Archives of Iranian Medicine
Volume:2 Issue: 4, Oct 1999

Background- Tuberculosis continues to be a common disease in our region and one of its unusual presentation is fever of undetermined origin (FUO). Methods- During a 5-year prospective study on FUO in Shiraz University Hospitals, we investigated 68 cases of FUO, based on the criteria of Petersdorf and Beeson. Results- Infections comprised the majority of the cases (44%), followed by neoplasm (19%), collagen vascular disease (15%), miscellaneous (9%) and undiagnosed (13%). Tuberculosis (TB) turned out to be the most common cause of fever of undetermined origin in this study (16.2%) and it comprised 37% of patients in the infectious group. The majority of the patients had extrapulmonary tuberculosis (9 out of 11). Conclusion- As we expected tuberculosis is an important cause of FUO in our region where tuberculosis is still endemic. This is also true in other countries where the incidence of this disease has declined significantly in recent decades.

Background-Acute heavy exposure to sulfur mustard gas during Iran-Iraq war has resulted in various chronic pulmonary diseases among Iranian veterans, which tend to be irreversible to a large extent.Objective-This study was conducted to determine the rate of reversibility of airflow obstruction in patients with mustard-gas-induced chronic obstructive pulmonary disease (COPD).Methods-Baseline and post-bronchodilator spirometric studies were performed in 45 patients who had developed COPD following mustard gas exposure. Patients were selected randomly from the documented cases of mustard gas injury who were attending the Special Clinic for Chemical Gas Victims in Shiraz. The criteria for selection were the presence of COPD with a forced expiratory volume in first second (FEV1) of <75% of predicted, and the FEV1/FVC of <75%.Results-17 patients (37.7%) showed an increase in FEV1 of >15% of baseline.Conclusion-These patients, who can be categorized as chronic asthmatic bronchitis, constitute a significant proportion of chemical victims with COPD. Detection of this group of patients may lead to a more appropriate treatment using the asthma protocols.

High amounts of nitric oxide (NO), synthesized systemically and intra-articularly, play an important role in inflammatory joint disease, as shown in animal models of arthritis and in patients with rheumatoid arthritis. Due to the short half-life of NO, usually its end products nitrate (NO3–) or nitrite (NO2–) is measured as an index of NO production. As serum concentration of nitrite is too low, limited reports for its serum level in patients with rheumatoid arthritis are available.

The serum levels of these compounds were measured in 64 rheumatoid arthritis patients. The severity of disease was categorised according to patients C-reactive protein (CRP) levels. The results of serum nitrite and nitrate of patients were compared with corresponding values obtained in 40 healthy volunteers.

Patients with normal CRP had non-significant increase in the level of nitrite and nitrate. The patients with CRP levels above normal range (from 11 to more than 100 mg/l) had a significant increase in the serum level of nitrite (from P<0.05, to P<0.0001). The nitrate level was significantly higher only among those patients with CRP levels of more than 100 mg/l (P<0.05). Simple regression analysed for nitrite or nitrate and CRP showed significant correlation for nitrite (P<0.0001, and R=0.892), and nitrate (P<0.02, and R=0.273).

These results indicate that in rheumatoid arthritis there is a highly significant correlation between the values of nitrite and CRP, whereas a small but significant correlation exists between nitrate and CRP. Furthermore, it can be concluded that nitrite levels of serum are a better marker of rheumatoid arthritis than nitrate levels of serum. Finally, these data indicate that the measurement of nitrite could be a diagnostic, as well as prognostic, tool during the treatment of rheumatoid arthritis patients.

Background-Differentiation of exudates from transudates is the first step in the approach to a patient with pleural effusion. The predictive value of the relevant tests are a matter of debate.Objective-To determine the diagnostic value of serum-effusion albumin gradient to discriminate effusions into exudate and transudate.Methods-Eighty-nine effusion samples taken from patients with pleural effusion who were undergoing diagnostic or therapeutic thoracenthesis. Based on their clinical diagnosis, they were classified as either transdate or exudate. In a previous study, a cutoff value of 1.2 g/dl was taken for serum-pleural effusion albumin gradient to differentiate between exudate and transudate. A serum-pleural effusion albumin gradient of >1.2 g/dl was interpreted as transudate while a gradient =1.2 g/dl was interpreted as exudate. Results-Based on final clinical diagnosis, of 89 pleural effusions, 47 were transudates, and 42 were exudates. Based on serum-effusion albumin gradient with a cut off value of 1.2 g/dl, 4 patients with transudates, and three with exudates, were misclassified, which gives an overall accuracy of 91.5%. Conclusions-Determination of serum-effusion albumin gradient is of great value for distinguishing between transudative and exudative pleural effusions.

Background-Free radicals seem to be implicated in the genesis of a variety of pathological conditions, including inflammation and cancer. A belief has emerged among scientists that diet including vitamin A and C might influence the development of cancer in humans.Objective-To reassess the validity of such hypothesis, serum level of vitamin A, ß-carotene and vitamin C were measured in a group of patients suffering from different types of cancer.Methods-Two groups (each comprised of 30 cases) of diagnosed cancer patients were compared with healthy volunteers. Serum vitamin A, C and ß-carotene were measured.Results-The mean serum levels of vitamin A, ß-carotene and vitamin C in patients with cancer, were significantly (p<0.001) lower than those in healthy individuals.Conclusion-Our limited results confirm the notion that cancer patients have low levels of some vitamins which may be due to cancer, chemotherapy, or malnutrition and supplement of vitamins may have a benifical effect

Background- Urinary tract infection is one of the most common forms of nosocomial infection and urinary catheterization is the most frequent predisposing factor. These infections cause considerable morbidity and mortality and insert a great financial burden on the medical care system. This study was performed to determine the incidence of catheter-associated bacteriuria, to isolate the ethilogic organisms, and to assess their sensitivity to eleven most frequently prescribed antibiotics in Iran.Methods-Two urinary specimens were taken from the catheters of 146 patients admitted to the gynecology ward who carried an indwelled urinary catheter for >12 hours. The first specimen was taken at the time of catheterization and the second was taken after 72 hours.Results- Of 146 patients, 37 (25%) had a positive culture from which 40 different strains were isolated. Ninety percent of the strains belonged to Klebsiella pneumoniae, Enterobacter cloacae, and Proteus mirabilis. All of these strains were sensitive to amikacin and nalidixic acid. The sensitivity to gentamicin and tobramicin was 58%. All of the isolates were resistant to all other 7 antibiotics.Conclusion-The current antimicrobial regimen used in the hospital must be revised.

32-year-old female referred with gradually progressive dyspnea for 9 months duration. 2D echocardiography showed a right atrial tumor. With impression of atrial myxoma the patient underwent resection of tumor under cardiopulmonary by-pass, and cardiac arrest. A 5x3 cm polypoid mass was found adherent to interatrial septum which was then excised with a rim of septum. The defect was then repaired with a patch of pericardium. The patient had an uneventful post-operative course and was discharged in the 8th post-operative day.Histologically the tumor was consistent with cavernous hemangioma. Hemangiomas are uncommon primary tumors of the heart. The most common site of involvement is the right ventricle; it is however, rarely seen in the right atrium.

A 30 year old patient with chest pain and dyspnea revealing eosinophilia and total right lung collapse is presented. Surgical exploration of the chest revealed in X-ray an air-leaking nodule, which was due to Fasciola hepatica.Resection of the nodule lead to reexpansion of the lung.The patient was successfully treatment with triclobendazole.