Shiraz Emedical Journal
Volume:5 Issue: 1, Jan 2004

To obtain preliminary information on gambling, problem gambling, and help-seeking behaviors this study was performed. for this purpose, Iranian-Canadian community members and helping professionals in the Toronto area were interviewed through focus groups and personal interviews. The study resulted that gambling is considered to be common and perceived as a social pastime among members of the Iranian community in Toronto. It was concluded that problem gambling is stigmatized, thus its significance is underestimated in the community. Lack of resources and language barriers are among factors influencing this community''s help-seeking perception and practice towards problem gambling.

Hepatitis C Virus (HCV) infection is one of the common causes of chronic hepatitis in hemophiliac patients. We report the result of an open referral center, trial of interferon treatment of patients screened for hepatitis C virus infection. TEHRAN HEPATITIS CENTER (THC) conducted the trial. Twenty-four hemophiliac patients with hepatitis C were enrolled into the study. PCR was checked for all patients, liver function tests, routine chemistry tests, complete blood count, urine analysis, thyroid test (at 3-month intervals), and clinical examinations were performed at monthly intervals during the 12-month of therapy. We administered 3 million units (MU) of α Interferon through subcutaneous injections three times a week for 12 month.We had 22 male and 2 female. The mean age was 22.92 + 13. We had 66.7% enzyme response and 47.6% complete response, patients had 63.2% negative PCR at the end of study. The most frequent complication two weeks after treatment was fatigue (54.2%), and at the end of treatment was myalgia (33.3%). It is concluded that interferon α can be used in hemophiliacs with hepatitis C infection with acceptable results.

The association between Human Immunodeficiency Virus (HIV) and Pulmonary Tuberculosis (PTB) present a grave public health and socio-economic threat in developing countries because HIV activates dormant tuberculosis and may cause death. The incidence of HIV related pulmonary tuberculosis was investigated among 405 patients (208 males and 198 females) with mean age of 29 years in Edo State, Nigeria, using microscopical and serological methods. Out of 405 patients examined, 68(16.8%) consisting of 24 males (11.6%) and 44 females (22.2%) had HIV infection. Infection in females was statistically higher than in male (P<0.05). A total of 88 (21.7%) patients had PTB disease with PTB in males as 54 (26.1%) being statically higher than that of females at 34 (17.2%) (P<0.05). Thirty-nine patients which represent 9.6% of the number examined had HIV-PTB co-infection. Although infection in females at 23 (11.6%) was higher than in males 16 (7.7%), the difference was not statistically significant (P>0.05). Patients within the age groups of 21-30, 31-40 and 41-50 years had statistically significant high value of HIV infection (P<0.05), while patients of 20 years and below had statistically significant high PTB disease (P<0.05). HIV was statistically high among the trader (P<0.05) while PTB was statistically higher among drivers and students (P<0.05). There was statistically significant difference in the co-existence of HIV-PTB among drivers and traders (P<0.05). It seems lifestyle has a major role in the pattern of these two potentially lethal diseases.

One of the factors involved in accelerated atherosclerosis in hemodialysis patients is dyslipidemia. In this study we evaluated some factors that can be involved in intensification of dyslipidemia in hemodialysis patients. This study was done on 36 Hemodialysis patients. For patients we measured lipoprotein (a), triglyceride, cholesterol, High-density lipoprotein, low-density lipoprotein and iPTH, Ca, P, and Magnesium of the serum. In statistical analysis there was not any correlation between the serum lipids mentioned above and iPTH. There was also no correlation between serum calcium, Ca X P product with serum lipids (p>0.05) levels. In our study there was a positive correlation between serum magnesium and lipoprotein (a) and also a positive correlation between serum magnesium and triglyceride level (P<0.05). Magnesium does not appear to increase lipoprotein synthesis. It may be involved in the regulation of some enzymes responsible for lipoprotein synthesis. The correlation of serum magnesium and triglyceride that was found could be due to changes in hepatic triglyceride metabolism, as lipoprotein (a) is a factor involved in accelerated atherosclerosis. Its association with serum magnesium could be important in hemodialysis patients.

Legionella pneumophillia (LP) is one of the major causes of community acquired pneumonia (CAP) world wide. There is no clear data on its incidence in Iran. All adult patients who were referred to emergency rooms of two tertiary centers in Shiraz, south of Iran with clinical impression of pneumonia, during a one year period, were prospectively studied using a micro Elisa test for LP, which was checked in both acute and convalescent sera. Forty nine patients completed the study. Considering the four-fold rise in titer as diagnostic criteria for acute infection with LP, 12.24% had this infection. There were no difference between patients with and without this infection regarding clinical, laboratory and radiological findings. It was concluded that LP infection is not rare in the south of Iran and it should be covered when starting antibiotics for treatment of patients with CAP empirically.

Cerebrovascular accident (CVA) is the third most common cause of death and has two main types: Ischemic (subdivided to thrombotic and embolic) and hemorrhagic (including intracranial hemorrhage and subarachnoid hemorrhage). Administration of thrombolytic, anticoagulant and antiplatelet agents are the main treatments of ischemic stroke; while surgical procedures, brain structure decompression, and closure of aneurysm are essential in the management of hemorrhagic ones.

Lung disease is a frequent manifestation in patients with systemic sclerosis, and has replaced renal disease as the leading cause of mortality. The two major types of pulmonary diseases in systemic sclerosis are interstitial lung disease (ILD), occurring in approximately 80% of patients, and pulmonary hypertension (PH), occurring in up to 50% of patients. Prognostic factors for poor outcomes include male sex, the presence of lung involvement early in disease, low Dlco, severe Raynaud’s phenomenon, and cigarette smoking. ILD may occur in either limited or diffuse cutaneous scleroderma. Retrospective autopsy studies show that clinical determinants of pulmonary disease may be relatively insensitive. Diagnosis of ILD is made using history, physical examonation, chest X ray, HRCT, BAL and pulmonary function test. DLco is the best index of the extent of the ILD when compared with HRCT as the “gold standard”. Based on the concept that persistent alveolitis is associated with a significant reduction of lung volumes and DLco, several anti-inflammatory drugs have been used in the treatment of established scleroderma lung fibrosis. Although corticosteroids have no apparent effect in the treatment of pulmonary fibrosis, when used at an early stage of the disease, they improve pulmonary function, alveolitis and reduce mortality; however, high-dose glucocorticoids probably should be avoided in scleroderma due to the associated risk of scleroderma renal crisis. Colchicine, D-Penicillamine and chlorambucil are also used but the best results have been observed with cyclophosphamide.

Today, with increasing number of patient who receive chemotherapy or bone marrow transplants, complex of fever and neutropenia are more frequently seen. In addition to infectious causes, other etiologies such as pyrogenic medications, allergic reactions, administration of blood products and malignancy process (per se) should also be noted. Approach to these patients should be consisted of a complete history taking, physical examination and using paraclinical data such as laboratory and radiologic studies. Empirical antibiotic therapy is used to protect against the early morbidity and mortality of untreated bacterial infections. This article reviews the different causes of the fever in neutropenic patients, how to approach to the problem and how to treat it.