Outcome of graves' disease after anti-thyroid drug treatment in south west of Iran

This study was conducted to observe the optimal results of long term treatment with antithyroid drugs in patients with graves' disease. Total of 268 patients with graves' disease who were referred to endocrinology clinic during 2005 - 2008 and treated with anti-thyroid drugs for a long term were studied. Data about the age, gender, estimated weight of thyroid before and after the treatment, level of thyroid hormones, disease relapse, hypothyroidism and the drug side-effects were collected and analyzed. Eighty two [31%] patients were males, 186 [69%] females, mean age of 35 +/- 27 years and follow-up course of 31 +/- 16 months], were studied. After the discontinuation of long term treatment, 53% were affected with relapse of hyperthyroidism. The mean duration of hyperthyroidism relapse after the treatment was 8.3 +/- 7.3 months. The relapse rate was significantly higher in the treated patients in both ends of age spectrum [P < 0.001]. In males and patients with large thyroid and lower TSH level at the end of treatment, the rate of relapse was higher [P=0.016, P < 0.033, P=0.001 respectively]. The incidence of hypothyroidism after treatment was about 6%. More decrease of thyroid size during the treatment course, higher level of serum TSH after discontinuation of the treatment, and lower thyroid hormone levels before the treatment were some of the effective factors in hypothyroidism incidence [P=0.005, P < 0.001, P < 0.05 respectively]. Of the 268 graves' patients treated with antithyroid drugs, 104 patients [39%] remained euthyroid in the follow-up course. Using long-term treatment with antithyroid drugs is still the first step in treating patients with graves' specially in middle-aged women with smaller goiters

Survey of nosocomial infections and causative bacteria: a hospital-based study

To determine the frequency of Nosocomial Infections [NI] presenting during the in-patient stay and their causative bacteria in Golestan teaching hospital, Iran. In a prospective cross-sectional study, all patients admitted in Golestan teaching hospital of Ahvaz from Sep 2009 to March 2010 were included in the study. NNIS questionnaire was used for data collection and essential cultures were done. From 9407 hospitalized patients, 296 cases [3.1%] proved to have NI. They consisted of 118 women [39.9%] and 178 men [60.1%] [Mean age 46.1 +/- 24.1]. The rate of NI in Intensive Care Units [ICU wards] was 12% and in other wards was 1% [P=0.003]. The mortality rate among patients with NI was 23.3%. The most common types of infection were: UTI [43.6%], pneumonia [35.1%], surgical wound infection [14.5%] and blood infection [6.8%]. The most common infection in ICU was pneumonia [45%] and in other wards was UTI [P=0.001]. The most common causative bacteria were enterobacter [59.8%] followed by Escherichia coli [34.5%] and pseudomonas aeroginosa [25.3%]. Nosocomial Infections [NI] rate in our study was low compared to many centers and significantly higher in ICU than other wards. Gram negative bacteria were the most common cause of Nosocomial Infections [NI]

Effect of various drug treatments on bone density in hypogonadal men

To evaluate bone mass in hypogonadal men who received testosterone, alendronate, calcium and vitamin D for one year. In this clinical trial 44 hypogonadal men were evaluated. For diagnosing of hypogonadism, serum LH, FSH, and testosterone levels of the patients were assessed using RIA method. Bone mineral density [BMD] was measured using dual energy x-ray absorptiometery [DXA] in lumbar spine [L2-L4] and femoral neck before treatment. All patients received 250 mg IM testosterone enanthate every 15-20 days. Patients with T score < -1.5 received 70 mg oral Alendronate weekly, testosterone, 1gr elemental calcium and 400 U vitamin D daily. Patients with -1.5 < T score < -1 received calcium and vitamin D supplementation and testosterone. After one year of treatment Bone mineral density was measured again. Results were compared with pretreatment BMD and the healthy age and sex matched control group. Serum testosterone level was measured again during the treatment. Forty four patients aged 18-57 years were included in this study. 25 of them completed the course of study after one year. The mean serum testosterone level was 0.5 +/- 0.5 ng/ml before the treatment. After one year, it increased to 5.5 +/- 3 ng/ml [PV=0.01]. The mean bone mineral density in lumbar spine was 0.97 +/- 0.22 g/cm[2] which differed significantly from the control group at baseline [1.017 +/- 0.12g/cm[2]] [PV=0.006]. After one year, the mean BMD increased to 1.09 +/- 0.22g/cm[2] [PV= 0.02], which showed no statistical significant difference with the control group [PV=0.13]. The mean baseline BMD in femoral neck was 0.88 +/- 0.12 g/cm[2], which showed no significant difference with the control group [0.92 +/- 0.10 g/cm[2]] [PV=0.45], the mean T score before treatment showed significant difference with the control group [PV=0.00]. Bone mineral density in femoral neck increased to 0.97 +/- 0.13 g/cm[2] after one year [PV=0.01]. The mean annual change of BMD in lumbar spine and femoral neck was 12 +/- 8.4% and 10 +/- 7.2% respectively during one year treatment. Annual change of BMD showed no significant difference in all types of hypogonadism after one year [PV=0.34]. There was no significant correlation between age and BMD level before treatment, BMD increment was higher in younger patients after treatment [PV=0.04]. The results show that one year administrating testosterone, alendronate, calcium and vitamin D in hypogonadal men can increase BMD significantly in lumbar spine and femoral neck

Meige's syndrome

The Meige's syndrome is characterized by the presence of bilateral, symmetrical, dystonic cramp of face muscles or muscles of middle line of body, the respiratory muscles and muscles of throat. The etiology of Meige's syndrome is uncertain. A disorder of basal ganglia function along with perhaps neurotransmitter imbalance [dopamine and acetylcholine] is likely to be the mechanism involved in the causation of this disorder. It is a rare condition and only a limited number of cases have been reported in literature. However, many patients may remain undiscovered or misdiagnosed. Our aim is to introduce a case of 68 years old man who was referred to neurology department with chief complaint of oromandibular dystonia and dysphasia. He was treated successfully with Botulinum toxin