Clinical evaluation of Graves ophthalmopathy in north-east Islamic Republic of Iran

This study evaluated the prevalence and severity of ophthalmic manifestations in all Graves disease patients [n = 68] presenting to endocrine clinics at Mashad University of Medical Sciences between December 2002 and September 2005. The mean age of patients was 38.0 [SD 14.0] years, range 15 to 71 years. The most common complaints were foreign body sensation [54.0%] and puffy eyelids [48.4%]. The most common apparent abnormality was lid retraction in 64.2% of patients [bilateral in 95.3% of cases]. The patients had a mean modified Werner's NO SPECS classification score of 3.00 [SD 1.46]. The score was significantly higher in males than females [3.58 [SD 1.44] versus 2.63 [SD 1.35]] and was positively correlated with age

[Effect of hyperthyroidism on bone mineral density in premenopausal women]

Hyperthyroidism is a state of high bone turnover, but there is controversy about its effects on bone mineral density. It is more common in females [F: M ratio 10:1]. Since post-menopausal women are potentially at risk for osteoporosis because of aging and estrogen deficiency and because hyperthyroidism is more common in females, this study was done to determine the effects of hyperthyroidism on bone mineral density [BMD] in premenopausal thyrotoxic women. In this case- control study 50 women with untreated hyperthyroidism [age- range 20-50 yr] from outpatient endocrine clinics in the years 2004 - 2005 were selected. Patients who used drugs or had diseases that affect bone mineral density were excluded. After history taking and physical examination, thyroid function tests, PTH, phosphorus, calcium, alkalin phosphatase, fasting plasma glucose and creatinine were measured and then bone densitometry by LUNAR [DPX-IQ] device was performed. One hundred and ten age- and weight - matched healthy women from participants in Iranian Multicenter Osteoporosis Study [IMOS] were selected as controls. SPSS version 11.5 was used for data analysis and P value less than 0.05 cosidered as significant. Mean of age, height and weight was similar in patients and controls. Forty seven cases [94%] had Graves' disease and 3 cases [6%] had toxic solitary adenoma. Mean duration of disease before diagnosis was 6.02 +/- 4.38 months. There was no significant difference in mean of bone mineral density in vertebral column [p=0.83] and also in femural neck [p=0.74] between patients and controls. There was no correlation between bone mineral density in vertebral column and also in femural neck with serum levels of T4, T3, TSH and FT4I. There was no correlation between bone mineral density and duration of disease before diagnosis and also between bone mineral density and age. Hyperthyroidism is a known state of high bone turnover, but in hyperthyroid premenopausal women with disease of short duration and without other risk factors of low bone mass, bone densitometry could not be recommended as a required routine measurement

[Hyperthyroidism and systemic embolism in the absence of cardiac dysrhythmia]

Hyperthyroid patients are at increased risk of systemic embolism due to cardiac dysrhythmia, especially atrial fibrillation. Most of these embolic events occur in central nervous system. Systemic emboli in the absence of cardiac dysrhythmia and in arteries of extremities are very uncommon. In review of literature only one case is reported. It report a hyperthyroid patient with an embolism in left upper extremity in the absence of cardiac dysrhythmia

[Autoimmune hypothyroidism with dermopathy and ophthalmopathy [a case report]]

Pretibial myxedema is a rare dermatologic disease with unknown pathogenesis, which occurs very rarely, in non-thyrotoxic thyroid diseases. Review of literature, showed only two cases of hypothyroidism with ophthalmopathy and dermopathy. The case was a 48-year-old man presented with preorbital edema, mild proptosis, thyromegaly and pretibial skin lesions. There was no history of hyperthyroidism in the past. Laboratory tests showed primary hypothyroidism with high titers of Anti-TPO antibody and hyperchiosterolemia. CT scan of orbit showed no extraocular muscle involvement. Sodium levothyroxin was prescribed. Sometime later hyperchiosterolemia resolved and patient became euthyroid. Because of limited skin lesions, no dermatologic treatment was prescribed

[Thyroid autoantibodies in chronic urticaria]

Osteoporosis is the most common metabolic bone disease with significant morbidity and mortality. This study is a part of national study of osteoporosis in Iran. We studied the prevalence of osteoporosis and osteopenia in Mashhad and correlation of bone mineral density with age, height, weight and BMI. Also, we studied correlation between bone mineral densities in different skeletal regions. We also determine prevalence of low bone mass in Mashhadian women based on Mashhadian women reference population. 1003 persons from Mashhad citizens [631 women and 372 men], aged between 20-79 years were selected by random cluster sampling from 2000 through 2003. Those who had known diseases or used medications affecting bone mineral density were excluded based on history and physical examination. We used LUNAR [DPX-IQ] device for densitometry and WHO criteria for interpretation. SPSS [11.5] used for analysis of data and P value less than 0.05 considered as significant. Mean of age, height, weight and BMI was 42.02 +/- 12.77 years, 157.66 +/- 7.16 centimeter, and 69.11 +/- 12.24 kilogram and 27.83 +/- 4.8 kg/m[2], respectively. Mean of age in men and women was similar but mean of height, weight and BMI was higher in men and difference between men and women in height, weight and BMI was significant. There was a positive, significant correlation between bone mineral density in vertebral column and femoral neck regions and correlation coefficient [r] between them was 0.7. There was a positive significant correlation between bone mineral density and following parameters: height, weight and BMI. Correlation between BMD and age was negative and significant. In women prevalence of low bone mass with US/European reference population was higher than with Mashhadian reference population. These findings support the importance of regional reference population for better interpretation of BMD results. Finally, prevalence of osteopenia and osteoporosis in Mashhad was 46.8% and 12.6%, respectively. Osteoporosis is a health problem in Mashhad. So we encourage preventive measures such as modification of nutrition, adequate Calcium and Vitamin D intake and life style modification. We emphasize on using of regional reference population for interpretation of densitometry results. Because of correlation coefficient [r] of bone mineral density in different sites of skeleton is 0.7; we recommend that bone densitometry should be done both in vertebral column and femoral regions

[Demographic study on patients with Pemphigus Vulgaris and comparing results of various treatment protocols in such patients]

In conventional treatment of Pemphigus Vulgaris use of adjuvant and initial dose of Corticosteroid affect the healing of lesions in patients. The aim of this study is to evaluate the epidemiology and clinical features of Pemphigus Vulgaris patients and to compare the criteria of response to treatment in various initial doses of Prednisolon and also to study the effect of Immuran as an adjuvant. In this retrospective study on Pemphigus Vulgaris patients admitted in Qaem hospital in Mashhad during the past 10 years, 63 patients were included and epidemiologic parameters, clinical features, treatment agents and criteria of response to their treatment [time of stopping the development of new lesions , time of onset of healing, time of tapering dose of steroids] were studied. The average dose of Steroid and Immuran was 1.15 +/- 0.47 mg/kg/day and 2.2 +/- 0.9 mg/kg/day, respectively. The average time of stopping the development of new lesions was 10.49 +/- 8.7 days, starting healing lesions, 10.75 +/- 7.86 days and tapering the dose of steroid was 3.75 +/- 2.35 days. Use of Immuran in treatment of patients had a statistical relation [p=0.048] with the time of tapering dose of Steroids, although it had no such relation with the first and the second criteria of healing [p=0.312 and p=0.1] respectively. On the other hand, initial dose of Immuran in mg/kg/day had no statistical relation with three criteria [P values were 0.328, 0.136, 0.467 respectively], whereas initial dose of Preadnisolon showed statistical relation with the onset time of healing [p=0.000] but not with time of tapering or stopping new lesions. [P>0.05] No relation between the time of tapering of Steroid and the other two objective criteria of response [the time of stopping new lesions and the onset time of healing], may be due to individual decision for tapering the dose of Steroid. And probably use of Immuran as an adjuvant, has related only with onset of Steroid tapering [but not two other objective criteria]

[ comparison of the efficacy of fluconazol and griseofulvin in tinea cruris: a single blind clinical trial study]

Tinea cruris is a relatively common fungal infection. For many years Griseofulvin has been considered as the treatment of choice and now, new oral antifungal agents including Fluconazol are being used widely. The aim of this study was comparison of therapeutic effects of Griseofulvin and Fluconazol for treatment of tinea cruris. This is a single blind clinical trial study on 64 patients with tinea cruris in Dermatology Department of Ghaem Hospital between August 2004 and February 2005. All patients had clinical exam and a positive KOH test for fungal infection at first, and four and seven weeks later. Patients divided into two groups randomly: 32 patients were treated with 150mg Fluconazol once weekly and 32 were treated with Griseofulvin 500mg daily. Our data were gathered by questionnaires and were analyzed by SPSS statistecally software. On the fourth week 60% of Fluconazol group and of Griseofulvin group had clinical improvement [p=0.2], laboratory mycological studies showed that 80% of Flouconazole group and%84.4 of Griseofulvin group have had improvement [p=0.4]. Patients who had positive fungal test in the fourth week were cured clinically and paraclinically in the seventh week. There weren't any statistically significant differences between two groups. Fluconazol as like as Griseofulvin is an effective therapy for tinea cruris and it was also a simple, inexpensive and safe treatment

[Efficacy of 0.05% topical solution of tretinoin on healing of chronic ulcers and comparison of it with 1% topical cream of phenytoin]

Chronic ulcer with any kind of etiology is one of the therapeutic problems for patients and medical services. With respect to appropriate effects of retinoids on different stages of wound healing, we decided to evaluate efficacy of 0.05% topical solution of tretinoin on topical treatment of ulcers in comparison with 1% topical cream of phenytoin,that its effects on wound healing has been approved in several studies. In an interventional, clinical trial topical effect of these two drugs on healing of chronic ulcers of 30 patients with 37 ulcers was compared, with random allocation patients divided to two groups and finally 15 patients with 18 ulcers treated with l%topical cream of phenytoin and 15 patients with 19 ulcers treated with 0.05% topical solution of tretinoin. Then followed up for 6 weeks and evaluated for criteria of clinical recovery [size, depth, secretion and pain] in weekly visits. Analytic tests were done by using the chi-square test and P<0.05 was accepted as significant. 'At the end of, the treatment in phenytoin group 42.6 +/- 44.9% and in tretinoin group 44.7 +/- 43.4% of ulcers width were reduced. Also at this time ulcers' depth were diminished whereas in phenytoin group 55.6% and in tretinoin group 26.3% of those were in superficial dermis. Before treatment in phenytoin group 55.6% of ulcers were without pain though after it 100% of them had no pain. In tretinoin group ulcers without pain increased from 78.9% before to 84.2% after treatment. Percentage of ulcers with no secretion increased from 33.3% to 55.6% in phenytoin group and from 26.3% to 68.4% in tretinoin group With respect to results, tretinoin solution as phenytoin cream can be used as an appropriate topical treatment for chronic ulcer