AQUEDUCT-WORKER'S LUNG
Twenty patients who had worked in aqueducts presented with widespread bronchopulmonary disorders that seemed to be related to their occupation. Aqueduct-workers dig underground canals to direct water from foothills towards farms and residential areas to be used for both irrigation and community requirements. Due to the dry conditions that prevail in Iran, landslides are frequent and these workers are required to clear canals of debris. Staying deep underground, the workers inhale large amounts of earth and rock dusts in underventilated tubes. In addition, kerosine or carbide is used to provide light; hence heavy smoke and soot are inhaled too. Together, these unfavorable conditions cause anthracotic chronic bronchitis and pneumoconiotic parenchymal changes with a tendency toward progressive massive fibrosis. Airway lesions are characterized by edema, inflammation, tortuosity, narrowing and outstanding areas of anthracosis of the main bronchi and the larger subdivisions. Clinically the patients seems to be well considering chest X-ray findings that include nodular and conglomerates towards a complicated pneumoconiosis. Moreover, there were steaky densities mostly in paracardiac regions. Pulmonary function tests revealed mainly an obstructive pattern. The course of the disorders is chronic with acute episodes of superimposed infection but the underlying condition remains unchanged with a tendency to proceed to respiratory disability. Diagnosis is all important because these worker may have changed their occupation owing to their restricted lung function therefore that they may fail to mention their original job. Unless the physician is already familiar with these problems or asks directly about previous occupations, the management may be confounded by irrelevant diagnoses and possibly by unnecessary invasive procedures.
Authors: Amoli K.
Source: J Med Council I.R. Irn 1998; 4:133-8.
HEPATITIS E EPIDEMIC IN IRAN
Hepatitis E is an infectious disease caused by a calcivirus and is transmitted by fecal-oral route. Sewage leakage into water supplies is a main cause of epidemics, in fact in all established epidemic states an infected water reservoir is well documented. During an epidemic of viral hepatitis in the region of Lordegan, Southeast of Iran in 1992, 154 patients presented with clinical jaundice. All the patients underwent clinical and laboratory examinations. The sera of 114 patients displayed no HBSAg or anti-HAV, anti-HCV, IgM anti-HBC or IgG anti-HBC. The patients were thus diagnosed as having hepatitis E infection. This epidemic, the second reported in Iran, began in July 1992, prevailed during the autumn of 1992 and was almost eradicated by March 1993. Besides jaundice, the most common clinical findings were dark colored urine (96%), right upper quadrant pain (94%), nausea and vomiting (87%), weakness (83%) and anorexia (82%). Arthritis appeared in 9% of the patients, of whom the knee joint and the elbow joint were involved in all, and half of the patients, respectively. Serum bilirubin was under 12 mg/dl in 77% of the patients (range 2-25 mg/dl) and direct and indirect bilirubin levels roughly equalled each other. SGOT and SGPT levels as high as respective 56 times and 47 times normal range were reported. Ten pregnant women were among the afflicted individuals of whom 2 died of infection during the epidemic. Contamination of local underground water supplies by sewage was documented confirming the strong suspicion that the outbreak of hepatitis was due to unsanitary sewage disposal with secondary contamination of drinking water.
Authors: Ariyegan M, Amini S.
source: J Med Council I.R. Irn 1998; 15:139-43.
THE EFFECT OF ANTIOXIDANT (VITAMIN E) ADMINISTRATION ON RED BLOOD CELL FRAGILITY IN ß-THALASSEMIA MAJOR
Cell fragility due to a hemoglobin chain defect is the major cause of anemia in ß-thalassemia major. The protective properties of vitamin E against oxidation prohibits RBC membrane lysis; and a low serum level of vitamin E indeed has been observed in ß-thalassemic patients. Despite this finding, there is, as yet, no agreement regarding vitamin E therapy. In this study, 20 major ß-thalassemic patients with an average age of 8.81 were chosen on a random basis and underwent treatment with a daily dose of 500 IU vitamin E. With the exclusion of one, the treatment was continued in the 19 remaining patients for a period of 7 months and osmotic fragility test (OFT) as well as bilirubin and hemoglobin measurements were carried out monthly. Throughout the study, no major side effects appeared and indeed many families insisted on further treatment. At the end of this treatment period, red blood cell osmotic frigidity returned to normal (p=0.001), but no appreciable changes were observed in the levels of hemoglobin or bilirubin. The results of this study show that vitamin E after 7 months of continuous consumption can reduce osmotic fragility. This effect is partially explainable by the vitamin's effect on membrane repair and maintenance and also its antioxidant properties. Applying longer periods of treatment in a larger group of patients may further elucidate the issue.
Authors: Jamshidi HR, Ghaneie M, Tabibian N
Source: Irn J Blood Transfus 1997-98; 4(3-4):134-8.
HISTOPATHOLOGICAL CLASSIFICATION AND CLINICAL PROFILE OF HODGKIN'S LYMPHOMA PATIENTS AT THE CHILDREN MEDICAL CENTER OF TEHRAN
Hodgkin's lymphoma is distributed world-wide and afflicts all age groups. Prevalence rate, age of onset and histopathologic profiles are somewhat different in developed versus developing countries. Although the disease seems to be less prevalent in underdeveloped regions, there is a shift of peak incidence in childhood. In western societies the "nodular sclerosis" subgroup is the most common form especially in females. In order to determine the different attributes of the disease in Iran, all patients referred to the Children's Medical Center of Tehran during 1975 to 1990 and diagnosed as Hodgkin's lymphoma were evaluated retrospectively. Seventy patients met the inclusion criteria and pertinent medical records and histology slides were re-examined. A total of 250 microscopic slides of lymph nodes, spleen and liver were classified according to the Rye Classification System. Clinical data including stage of the disease, sex and age of onset were extracted and analyzed. The results showed that 66% of the patients were less than 10 years of age (with a mean of 7.6 years) and 51 patients (73%) were male. B symptoms were present in 56% of the cases and 61.4% of the patients were in stage III and IV of Ann Arbor Staging System. The most common clinical findings were superficial lymphadenopathy affecting the neck and axillary regions in 97% and 53% of the patients, respectively. "Mixed Cellularity" was the prevailing histologic subgroup and was diagnosed in 54% of the cases. It is concluded that in comparison with developed countries, in which "nodular sclerosis" is the most common histopathologic subgroup, Hodgkin's lymphoma commonly presents with mixed cellular features in Iran. Also the male to female predominance is more pronounced and the age of onset is probably earlier.
Authors: Tahan-Nejhad Z, Rakhshan M, Izadyar M.
Source: Sci J Ahwaz Univ Med Sci 1998; March:26-32.
PENICILLIN RESISTANT PNEUMOCOCCI IN IRAN
The pneumococcus (Streptococcus pneumonia) is one of the virulent pathogens causing various diseases such as pneumonia, meningitis, sinusitis, otitis etc. Since the time of its discovery, penicillin has been the standard treatment for pneumococcal infections. Unfortunately during the past two decades a small but increasing resistance to penicillin has been recorded.
In this study, we investigated the antimicrobial resistance in pneumococcal strains separated from different body fluids and excretions of patients in Labafinedjad Hospital in Tehran, during 1991-1995. Blood, CSF, sputum, pleural effusion, ascitic fluid and pus from patients admitted to the infectious disease wards were collected. The presence of S. pneumonia in the specimens was established through detecting the inhibition of gram-positive, catalase-negative diplococci by optochin.
Antibiograms were prepared using the Joan Stocks method and MIC for penicillin was calculated. A total of 233 pneumococcal specimens were cultured.
The results showed that 17.5% of the pneumococci were resistant to penicillin and MIC estimation revealed that 85% of the resistant strains were so even at 2m g/ml concentrations.
Although resistant-strains in Iran are not so prevalent as in Europe (where only 1/3 of the pneumococci are sensitive to penicillin), resistance to penicillin is growing and continuous surveillance is prompted.
Authors: Afshar SA, Saghari H.
Source: Irn J Infect Tropic Dis 1998; 7:14-8.
BLOOD COAGULATION DERANGEMENTS IN SNAKE-BITTEN PATIENTS IN THE BUSHEHR PROVINCE, SOUTHERN IRAN
About 3500 species of snakes are recognized throughout the world, of which less than 10% are venomous. Unfortunately, snake bite leads to 30,000-40,000 worldwide mortalities annually.
As far as we know, 10 species of venomous terrestrial snakes are present in Iran, and the Bushehr province (Southern Iran) is the natural habitat of one; a viper known as Echis carinatus. Envenomation by this viper (like most of the Viperidae species) leads to fatal coagulation disorders hemolysis and even spontaneous hemorrhage.
In this study, we investigated all the snake-bitten patients referred to the Fatemeh Zahra Hospital in Bushehr during May to September 1998, in association with those referred to the 17th Shahrivar Hospital in Borazjan (Bushehr province) for the month of July 1998.
A total of 91 patients (79 in Bushehr and 12 in Borazjan) were assessed. The mean age of the patients was 21 (ranged 30 months to 75 years) and most were male (58 vs. 33).
Seventy one (78%) patients were bitten on the lower extremity and 19 (21%) had bites on the upper extremity. One patient suffered snake-bite on the trunk. In all instances, the bites were caused by Echis carinatus. Eighteen patients attempted to incise and suck the site orally before admission to the hospital.
Sixty-nine (79%) patients showed some kind of coagulation derangement i.e. prolonged PT (defined as 3 seconds more than normal) on prolonged PTT (defined as more than 1.5 fold increase versus control). One patient displayed thrombocytopenia (less than 100,000 per cubic mm). Hemoglobinuria and hematuria were present in 21 (32.8%) and 18 (28%) of the cases, respectively. Spontaneous bleeding occurred in one-fifth of the patients.
All patients received antivenin and fortunately no mortality occurred. Except in 3 patients, the coagulation defect was restored to normal in 72 hours. Incision and suction of the site had no significant ameliorating effect. The results are comparable to those attained in the region. The benefits of antivenin administration are further discussed and underlined.
Authors: Mostaghni AA, Alipour MB.
Source: Tebbe Jonoub 1998; 1(1):79-88.
ALTERATIONS OF SERUM TRACE ELEMENTS IN BETA THALASSEMIA MAJOR PATIENTS UNDER DEFEROXAMINE TREATMENT
Thalassemia major patients require routine blood administration to overcome anemia. This management leads to the accumulation of iron in parenchymal cells. In order to avoid this adverse effect, chelating agents such as deferoxamine (Desferal) are injected at regular intervals.
Although deferoxamine has been regarded as a safe drug with minimal side effects, it is becoming clear that it chelates some important trace elements in the body and may derange their homeostasis.
In this study, we compared the serum levels of zinc, copper, and magnesium in a group of ß-thalassemia patients treated with deferoxamine with a group of normal controls.
Sixty thalassemia patients were randomly selected and serum Zn, Cu, Mg and ferritin were carefully measured. These measurements were also carried out in 40 closely matched volunteers.
The results showed that serum Zn (82.61?24.96 m g/dL vs. 123.9?21.29 m g/dl (p<0.03) and Mg (1.85?14 mg/dl vs. 2.03?0.19 mg/dl p<0.05) were significantly lower in thalassemia patients, while serum Cu (116.35?25.04 m g/dl vs 97.20?17.9 m g/dl p<0.05) was higher. There was a significant correlation between Zn levels and duration and dosage of deferoxamine treatment but no correlation was detected between serum Zn and ferritin.
It is concluded that deferoxamine probably chelates Zn and Mg and decreases their serum levels. Besides, the previously held notion that deferoxamine reduces Zn only after it has successfully reduced iron and ferritin levels is not supported.
The higher Cu concentration in thalassemia major patients is probably due to parenchymal hepatic damage which is a common side effect in blood transfused patients.
The measurement of serum ceruloplasmin and 24 hour copper excretion is recommended in further studies.
Authors: Moghadam A, Izadiar M, Samie Sh.
Source: Blood (The Iranian Journal of Blood Transfusion), 1998; 4(3-4):180-6.
THE COMPARISON OF THE EFFECTIVENESS OF TRIPLE (BISMUTH PLUS 2 ANTIMICROBIALS) THERAPY VS. OMEPRAZOLE PLUS ANTIMICROBIAL IN PEPTIC ULCER HEALING
Some studies recommend the argumentation of H. pylori eradication regimes with antisecretory drugs. In this study, we compared the effectiveness of a regimen comprised of omeprazole and amoxicillin with the classic triple drug regimen of bismuth plus 2 antimicrobials.
One hundred and one patients from the out-patient department of Shariati Hospital, Tehran with proven duodenal ulcer and positive urease-test were selected. These patients were randomized into two groups: one group received the classic triple therapy (bismuth subnitrate 375 mg tds for 4 weeks + tetracycline 500 g tds + metronidazole 250 mg tds both for 2 weeks) and the other group received amoxicillin 1000 mg twice daily plus omeprazole 20 mg twice daily both for 2 weeks. All the patients underwent a control endoscopy 2 and 6 weeks after the beginning of treatment. Eradication was assumed, if urease test and culture were negative in all specimens taken from antral and corpus mucosae.
The results showed that 93 patients completed the study after 6 weeks (45 patients in the treatment group with triple therapy and 48 patients with amoxicillin + omeprazole). The disappearance of ulcer pain was faster in the group under the regimen including omeprazole than in the group with triple therapy (2.4 ? 2.7 days vs 4.5 ? 3.5 days, p<0.01). The two weeks healing rate was significantly higher in the patients treated with high dose omeprazole than in the group with bismuth + tetracycline + metronidazole therapy (77% vs 33.3%, p<0.01), however, 12 out of 37 patients with healed ulcers in the omeprazole dual therapy had ulcer relapse at 6 weeks. Only in one of these 12 patients H. pylori was eradicated. Fifteen of the 45 patients with triple therapy had healed ulcers at 2 weeks; among these 14 remained healed at 6 weeks (H. pylori was eradicated in 8 patients). The 6 weeks healing rate with dual therapy was the same as with classic triple therapy (64.6% vs 77.6%); the eradication rate was lower in the former than in the latter (30.4% vs 51.1% respectively, p=0.056).
It is concluded that high doses of acid suppressing drugs in eradication regimens results in rapid ulcer healing and pain disappearance, but is associated with early ulcer relapse due to lack of eradication. Its addition to regimens with bismuth and antibiotics is not necessary to achieve ulcer healing.
Authors: Kashifard M, Malekzadeh R, Siavashi F, Michaeli J, Massarat S.
Source: Gowaresh (Digestion) 1998; 2(11-12):22-5.
LONG TERM COMPLICATIONS OF MUSTARD GAS POISONING ON THE HYPOPHYSEAL-GONADAL AXIS FUNCTIONING
A large number of Iranian soldiers suffered mustard gas poisoning during the latter years of the Iran-Iraq war. Previous research indicates that mustard gas has deleterious effects on the hypophyseal-gonadal axis function. A significant decrease in testosterone concentration has been shown to occur 5 weeks after exposure.
In this study we investigated the status of hypophyseal-gonadal axis 3 years after exposure to mustard gas.
One hundred and sixty eight mustard gas victims in association with 200 closely matched normal individuals were selected. All the patients had suffered mustard gas poisoning three years before this study, in the final year of war (1988). Individuals suffering from systemic disease or under treatment with specific agents were not included. Blood specimens were collected and serum FSH, LH and testosterone were measured by radioimmunoassay.
Our data showed that there were no significant differences between the patient group and normal individuals considering height (170 cm vs 173 cm), weight (65 kg vs 70 kg) or age (29 years vs 23 years). Serum testosterone was significantly lower in the patient group(27.41 ng/dl ?19.6 vs 43.3 ng/dl ? 24.39 p<0.03).
In fact, 61.5% of the patients had testosterone levels below the normal range. There was no significant difference between LH and FSH levels in the patients and normal controls.
It is concluded that mustard gas not only affects the hypophyseal-gonadal axis in the short term, but also long lasting negative effects are common.
Authors: Amini MR, Hosseinpour M.
Source: Res Med (Pajouhesh dar Pezeshki) 1998; 21(4):27-31.