مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و ششم شماره 3 (پیاپی 121، امرداد و شهریور 1392)

Vitiligo may be associated with autoimmune thyroid diseases. Early sonographic findings in thyroid may be detectable even before occurence of clinical manifestations. So، we evaluated role of thyroid sonography in vitiligo patients without previously known thyroid disorders. This case-control study was performed in Ghaem Hospital in Mashhad between 2008 to 2010 years. A total of fifty patients with vitiligo and 35 healthy controls were enrolled. In all participants، dermatologic examination، thyroid autoimmunity and function tests and sonography، were performed. Chi-square، independent t-test، mannwhitney U and Spearman Rho tests، used for statistical analysis. P values less than 0. 05 considered significant. TSH level (p<0. 001) and Anti-TPO (p=0. 002) were significantly more in vitiligo patients than controls، but no significant difference was seen in Anti-Tg antibodies (p=0. 118) between two groups. No correlation was seen between Anti-TPO level and thyroid volume (p=0. 30). Thyroid heterogenicity in sonography was more common in vitiligo patients (p=0. 004). There was significant positive correlation between Anti-TPO and TSH levels (p<0. 01، r = 0. 5). TSH level was significantly higher in vitiligo patients with more than normal Anti-TPO in comparison with vitiligo patients with normal levels of Anti-TPO (p=0. 003). Autoimmune thyroiditis was the most common finding in vitiligo patients. Sonography could be used as an adjuvant for confirmation of asymptomatic autoimmune thyroiditis in patients with vitiligo.

Systemic sclerosis (SSc) is a connective tissue disease with unknown etiology which causes remarkable morbidity and mortality. Raynaud''s phenomenon (RP) is a complication of SSc leading to ischemia of extremities and digital gangrenes. Treatment of RP is a clinical problem and often remains inefficient. Ginkgo biloba is derived from the leaf of the Maidenhair tree. Its’ extract is leaded to improve tissue circulation; this study was designed to evaluate the efficacy of ginkgo biloba in the treatment of RP in systemic sclerosis. A total of Seventeen patients with SSc and RP were received either Ginkgo biloba pills (40 mg three times per day) or placebo for 3 months in a randomized، double blind، controlled trial. A two-week assessment period before treatment was done during which patients were asked to record the frequency، duration، and severity [using 10-point Raynaud’s Condition Score (RCS)] of attacks in a diary form before intervention. They continued to record the same data in their diary forms after intervention and were visited at the end of each month. The mean duration of attacks and the RCS were significantly decreased in Ginkgo group compared with the baseline (P<0. 05)، whilst no significant reduction was observed in the mean number of attacks (P=0. 147). In the placebo group no significant reduction was shown in the mean duration or number of attacks، and RCS. Ginkgo biloba reduces the duration and severity of Raynaud''s attacks of patients with systemic sclerosis.

Refractive errors are common eye problems which is a risk factor for impaired vision and glaucoma. The expert supposed that one possible reason for the increased incidence of glaucoma in patients with refractive errors is intraocular pressure. This study was conducted to determine the relationship between refractive errors and intraocular pressure. In this case - control study 115 patients with refractive error as the case group and 115 clients who were matched for age، sex and other characteristics، and did not have refractive error were selected through the sampling as the control group. The non-contact tonometer method، without the use of anesthetic in eye and with the help of air pressure was used the measure and record the intraocular pressure by an opopetrist specialist. Data were collected in spss15 software and analyzed by using Chi Square، t test and one way Variance at the level of 0. 05. The results showed that mean IOP of right eye in the case group was higher (15. 75 ± 2. 28) than control group (15. 03 ± 2. 16) (P = 0. 015). The mean intraocular pressure of left eye also in the case group were higher (15. 37±2. 38) than the control group (14. 69±1. 99) (P=0. 02). Results showed that in the right eye and the left eye in patients with refractive error the intraocular pressure was higher than those without refractive error. However، the mean IOP showed no significant differences based on the type of refractive error. The results of this study support the hypothesis that the refractive errors are risk factors of intraocular pressure.

Changes and imbalances in the homeostasis system is one of the main causes of heart attacks. Conflicting data existed about the effect of specific exercises on these factors. Therefore، the purpose of this study was to compare the effect of 4 weeks of resistance training and aerobic exercises on blood coagulation and fibrinolytics factors in inactive older men. A total of 30 elderly people (age 63/73 ± 2/66 years) were randomly divided into 3 groups: an aerobic (n=10)، resistance (n=10) and control (n =10) groups. Respectively، aerobic and resistance groups، participated in a program of aerobic and resistance exercise (3 days a week for 4 weeks). Body weight، bmi and coagulation factors levels such as، fibrinogen، pt، ptt and platelet count and also d-dimer fibrinolytic factors were measured. Overall 4 weeks of aerobic exercise training in older individuals significantly reduced fibrinogen، pt، ptt and platelets count levels، whereas increased d-dimer levels. Also 4 weeks of resistance training significantly reduced fibrinogen، pt، ptt and platelets count levels، but increased d-dimer fibrinolytic factor. It was also found that the effect of resistance training on blood coagulation factors such as pt، ptt، platelet count and d-dimer fibrinolytic factors was more than aerobic training، but the effect of aerobic training on coagulation factor fibrinogen was higher than resistance training. This study suggested that participation in aerobic and resistance activities can be very useful for prevention of threatening complications of hemostatic system and the aging process.

One of the most important ways of infectious transmission is the personnel’s contaminated hands. In orther to compare water and soap with alcohol in eradication of staff hands’ pathogens، this study was carried out on 100 personnesl in Imamreza hospital. In this study we took samples from 100 personnel''s palms in different wards of hospital while doing their nursing activites. Washing hands with water and soap or 70٪alcohol was performed by them for 20 seconds with the manager observation، then the sampling was repeated and transfored to bloody agar culture unit. Washing hands with soap or alcohol decreased the pathogens of the personnel hands. (p<0/001). Alcohol was more effective (76. 9%) than water and soap with (23. 1%) (p<0/002). The most common pathogens were: Staphylococcus epidermidis، Kllebsiella pneumoniae and E. coli. The most contaminated department was ICU ward (100%). Hand washing before and after contact with patients is an easy way to control hospital infections and if done with alcohol is more effective than with water and soap in eradicating staff hands’ microorganisms.

Secondary hyperparathyroidism is a common and curable complication in CRF patients. Although secondary hyperparathyroidism and zinc deficiency both are seen in CRF patients as complication but correlation between them is not well defined. In this study we have evaluated the correlation between serum zinc levels and serum PTH in hemodialysis patients.

This cross-sectional study was performed on one group consisting of hemodialysis patients (30 cases)، in Mashhad Imam Reza hospital. Patients who were under regular hemodialysis for at least 3 months after starting dialysis، with minimum age of 15، and were stable in the last 2 months entered the study. Levels of zinc، calcium، phosphorus، PTH، albumin and ALP were measured. Serum zinc was measured in fasting status by spectrophotometery.

Prevalence of zinc deficiency in hemodialysis patients was 65%. In hemodialysis patients no significant correlation was detected between serum zinc and PTH. There was also no significant correlation between serum zinc and calcium، phosphorus، ALP and albumin. However in hemodialysis patients there was a significant correlation between serum albumin and PTH.

In hemodialysis patients there was no significant correlation between serum zinc levels and serum PTH.

Hypertension has a high incidence and has several complications. Many studies have been done to reduce these complications. In recent years one of the important factors in hypertensive patients has been albuminuria. Essential hypertension produces clinical proteinuria and a significant reduction in renal function in many patients. The advent of more sensitive method to quantifies the urinary albumin extraction has revealed higher frequency of micro-albuminuria in patients with hypertension than in normotensive population. This wide variability in the incidence of micro-albuminuria in these studies may be related to the severity of hypertension، selection criteria، racial difference and، in some cases، to smaller number of patients studied. It can be different in men and women and also in separate periods of sexual hormone function in women. Three groups of hypertensive women including premenopausal، postmenopausal and hysterectomic referred to Ghaem hospital were selected. Sample size was 125 (for premenopausal 50، postmenopausal 50 and hysterectomic 25). Morning urine analysis of albumin was done by ELISA test. Mean age was 50. 1±10. 24 years old. Mean duration of hypertension was 6. 6±4. 78 years. Mean level of albuminuria was 20. 72±21. 89. There was no significant difference between three groups for albuminuria (p=0. 081)، but there was a statistical difference between premenopausal and hysterectomic patients (p<0. 001). It could be said that lack of sexual hormones may be influential for increasing of albuminuria.

Thalassemia is the most common genetic disorders in the world. There are more than 20. 000 beta thalassemia major patients in Iran. Most parts of the world، including Iran، apply a national program of thalassemia prevention. In our country، prenatal diagnosis and pregnancy termination has been an effective program in this area. But some studies do not consider this method appropriate. The aim of this study was to evaluate the attitude of thalassemia minor couples having a thalassemia major fetus.

This study was done on 65 thalassemia minor couples having a thalassemia major fetus from January 2008 till February 2009 and both couples answered the questionnaire in a quiet place without a questioner (a person asking question).

The ages of mothers and fathers were 17 to 35 years (24±4. 65 years) and 22 to 39 years (30. 36±5. 23) respectively. All couples except one attempted abortion and all of them were upset of having a thalassemia major fetus.

Although the legal abortion with the approval of religious leaders as long as 16 weeks of gestational age is performed in Iran، and in our study 98. 4% of cases had attempted abortion awared of thalassemia major person’s future، but all families were hurt with the happened insident. So، further investigations should be done for the couples’ complications. It is recommended to reduce the physical and psychological complications of couples using PGD method rather than CVS.

Bilateral basal ganglia abnormality، especially in globus pallidus، is a rare disorder of young childhood that can result in variety of problems such as speech disorders. Case report: A 7. 5 -year-old male child was referred by multiple problems such as disorders of gag reflex and swallowing، voice tremor، monoton speech and weakness of mastication muscles. The patient''s MRI scan revealed bilateral focal lesions in the globus pallidus with unclear reason. He had failed to respond to drug treatment، so he went on rehabilitation therapy when his problem progressed. Because of their association with cerebral cortex، especially with Broca''s area، the basal ganglia can influence the motor features of speech. Probably in the present patient، disturbances in the circuits between the basal ganglia and the language motor area of the cerebral cortex resulted in motor speech disorders. However، more investigations needed to be done.