Report of 18 patients with Sheehan's syndrome [a case series]

Sheehan's syndrome has a broad spectrum of clinical and laboratory signs that range from nonspecific symptoms such as malaise, fatigue and anemia to severe hypophyseal insufficiency, which results in coma and death. We collected data from 18 patients diagnosed with Sheehan's syndrome during the past 10 years. Patients profiles, including history, physical examination, clinical presentation that lead to diagnosis, routine biochemical tests, lipid profiles, thyroid function tests, and basal hypophyseal hormone levels were reviewed. The time spent for making a definitive diagnosis of the disease ranged between 10 to 30 years with a mean of 15.55 +/- 5.04 years. Five patients [22%] had disturbances in their levels of consciousness at the time of presentation [four with hypoglycemia, one with severe hypothyroidism] Seven patients [39%] were evaluated for central hypothyroidism in outpatient service before definite diagnosis. All of the patients had a history of massive hemorrhage at delivery and lack of postpartum milk production. All of the patients have received replacement doses of Levothyroxine and Prednisolone. Considering the duration of disease, significant delays appear to occur in its diagnosis and treatment

[ efficacy and complications of metformin produced by Iranian Co in comparison with Canadian Co]

Different pharmaceutical types of metformin are available for glycemic control in type 2 diabetes mellitus. There is some doubt about the efficacy of metformin produced by domestic pharmaceutical companies. As a clinical trial, we compared the efficacy and complications of metformin produced by an Iranian company with metformin from a Canadian company in diabetic patients. Eighteen eligible women [age range: 32-62 years] with type 2 diabetes received metformin [500 mg twice a day] either from Iranian company or from Canadian company each for 6 weeks period in a randomized, double blind, crossover study. Fasting blood sugar [FBS], HbA1C, lipid profile [Chol, TG, HDL, and LDL], weight, and BMI were assessed before and after each treatment phase. The results were compared with each other by paired sample T-test and Independent sample T-test. Each of the two pharmaceutical types of metformin had the same therapeutic effects on FBS, HbA1C, lipid profile [except for HDL] and BMI. In addition, there was no significant difference between them in side effects [22.2% in each group]. According to the beneficial therapeutic effects of Iranian metformin, lower side effects and low cost, in comparison to its Canadian type, it seems that using Iranian metformin would be a suitable choice for control of glycemic patients. However, in this regard, further studies with greater samples are recommended

efficacy of combined levothyroxine plus liothyronine with levothyroxine alone in primary hypothyroidism: a randomized controlled trial

We conducted this controlled trial to investigate whether combined therapy with levothyroxine and liothyronine in primary hypothyroidism, would lead to improvements in general health, quality of life, psychological problems and metabolic changes. This study was a double blinded randomized control trial. Patients were invited to participate if they were between the ages of 18 and 60 years, and if they had been receiving treatment for primary hypothyroidism for at least 6 months, including a stable dose of levothyroxine for at least 3 months, and had normal serum thyroid hormone levels. Patients were randomized to receive combined levothyroxine plus liothyronine [patients in this group decreased their usual daily dose of levothyroxine by 50 microg and began taking 6.25 microg of liothyronine twice daily] or to continue their usual dose of levothyroxine. Treatment duration was 4 months. Weight, height, heart rate, blood pressure, total Cholesterol, LDL, HDL, Triglycerides, serum TSH, total T4, and total T3 levels were measured before and after of study. All patients completed the General Health Questionnaire -28 [GHQ-28] before and after the trial. Seventy-one participants were randomized into the 2 groups, and 60 completed the study. In the combined therapy group, serum T4 levels fell and serum T3 levels rose [P<.001], although both levels remained within normal limits. Serum TSH levels were similar in both groups at baseline and at 4 months. There were no differences between weight, heart rate, blood pressure and lipid profiles of two groups. For the GHQ-28, the overall score was similar but the anxiety/insomnia subscale was significantly higher [indicating worse psychological well-being] for combined treatment compared with T4 alone [P=0.037]. The only biochemical change was the expected rise in serum T3 levels and fall in serum T4 in the combined therapy group, because the blood samples were drawn only 1-2 hour after the morning dose of liothyronine. In conclusion, we found no evidence that combined T4/T3 replacement, resulted in improved well-being, general health, quality of life and lipid profile compared with T4 alone. T4 should remain the standard treatment for hypothyroidism

[Osteoporotic hip fracture incidence rate in Zanjan, Iran: March, 2003 to 2005]

Hip fracture, the most serious complication of osteoporosis, imposes a heavy financial burden for treatment on any health system, and accounts for more than 20% of orthopedic beds in many countries. The aim of this study was to determine the incidence rate of hip fracture in Zanjan, Iran over a period of two years, [March 21, 2003 to March 21, 2005]. In this study, we assessed all cases discharged with final diagnosis of hip fracture [Intertrochanteric, Subtrochanteric, Trochanteric and neck fracture] in Zanjan Shafiyeh hospital, which is the only volunteer center for hip fracture in Zanjan province. Of 490 cases of hip fractures, admitted in the last two years, 337 cases were attributable to osteoporosis; 57.9% of fractures were in males and 42.1% were in females. Most of the cases were urban residents. The highest incidence rate was observed in the group 70-79 year age group, mean age being 71.24 years, [71.34 -males and 71.09 yr- females]. Causes of 58.8% of fractures were simple falls or falls from stairs; 27% of fractures occurred in winter but there was no significant difference between seasons. The average time of hospitalization was 8.12 days. In the osteoporotic fracture group, hospital mortality rates were 4.45%. In most reports worldwide, hip fracture is more prevalent in women, whereas in our study, hip fracture in all age groups was more prevalent in men. Since 50% of fractures occurred before the age of 70, early interventions for prevention of osteoporosis, particularly in men are necessary. Prevalence of osteoporotic fracture in men needs further study

Comparison of excretory-secretory and somatic antigens of ornithobilharzia turkestanicum in agar gel diffusion test

Ornithobilharziosis as one of the parasitic infections may give rise to serious economic problems in animal husbandry. The Aim of the study was to prepare and compare the somatic and excretory-secretory [ES] antigens of O. turkestanicum in gel diffusion test. Excretory-secretory [ES] and somatic antigens of OrnithobiIharzia turkestanicum were prepared from collected worms from mesentric blood vessels of infected sheep. The laboratory bred rabbits were immunized with antigens and then antisera were prepared. The reaction of antigens and antisera was observed in gel diffusion test. ES antigens of this species showed positive reaction with antisera raised against ES and also somatic antigens. Somatic antigens also showed positive reaction with antisera raised against somatic and also ES antigens. The antigenicity of O. turkesbanicum ES and somatic antigens is the same in gel diffusion test

Interference in T3 radio immunoassay due to heterophil antibodies

Autoantibodies and heterophile antibodies may be interfere with immunoassay methods and yield false results, leading to incorrect diagnosis and consequently inappropriate diagnostic and therapeutic interventions, which eventually may not be only costly, but also endanger the patient's health. Interference of autoantibodienature are usually analyte specific [i.e Anti-T3 interfere only in T3 assay] and those due to heterophile antibodies are usually method specific [such as IRMA or two-site methods]. This is a case report of a patient presenting with nonspecific symptoms suspected of hyperthyroidism the TFT, and T3 evaluations were more than twice were normal range exclusively by RIA method. After ruling out interferences due to binding proteins disorders and autoantibodies by in house methods, use of blocking and removal technique show that this false result in T3 assay was caused by a heterophile antibody from Ig G class. In our review of literature this is the first case report of interference in exclusively T3 assay by RIA method due to the heterophile antibody

Clinical appearance, leishmanin test and elisa using monoclonal antibody in diagnosis of different forms of cutaneous leishmaniasis

Introduction: Cutaneous Leishmaniasis [CL] has 2 principal clinical forms in Iran: Anthroponotic and Zoonotic. These forms, previously called Dry and wet forms, are caused by Leishmania tropica and L. major respectively. Formerly, diagnosis of different forms was based on epidemiological status and clinical signs; but at present, definite diagnosis by advanced laboratory tests such as ELISA and Isoenzyme methods is possible. In order to investigate correlation between ELISA test, clinical appearance, and skin test, a study was undertaken in Emam Reza Hospital, Mashhad

Material and Methods: The study population was selected among the volunteers who had suspected skin lesions for C.L. Direct smear, culture and Leishmanin skin test was performed for 153 patients. ELISA using specific monoclonal antibodies [SMA] performed species determination

Results: The minimum and maximum ages of the patients were 19 months and 97 years old respectively. Most of the patients were Females [63.9%]. Among 72 patients whose cutaneous lesions were approved for Leishmaniasis, 91.6% had ulcers with dry appearance and 8.4% had appearance of wet form C.L. The etiologic agents isolated from the skin lesions of the latter patients were L.tropica [66.6%], L.major [28.8%] and unknown form [4.2%]. Among the patients who had skin lesions with wet appearance, the isolated agents were L.tropica [5.6%], L.major [1.4%] and unknown form [1.4%]. The sensitivity of Leishmanin Skin Test was higher in-patients infected by L. major

Conclusion: ELISA method using SMA is a sensitive and reliable test for differential diagnosis of Anthroponotic Cutaneous Leishmaniasis [ACL] and Zoonotic Cutaneous Leishmaniasis [ZCL]. Both ACL and ZCL are present in Mashhad. ACL is three times more prevalent than ZCL. Clinical appearance is not a valid factor for determination of species of Leishmania. The sensitivity of Leishmanin Skin Test is higher in wet form in relation to dry form. There may be other species of Leishmania causing cutaneous lesions in Mashhad