Background

The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established.

Main observation

We introduce a 58-year-old man with an abrupt, de novo and erythrodermic eruption in 2002 that was previously exposed to sulfur mustard during the Iran – Iraq war in 1987. Six weeks after the onset of diffuse eruption, he developed papules on the glans penis and generalized dermatophytosis. A biopsy of his eruption was consistent with cutaneous T-cell lymphoma/Sézary syndrome. A complete blood count demonstrated leukocytosis, eosinophilia and atypical lymphocytosis. Subsequently, Sézary syndrome was confirmed and T-cell count with increased CD4/CD8 in flow cytometry. The biopsy of his penile papules was consistent with Kaposi's sarcoma.

Conclusion

These findings suggest a causative relationship between sulfur mustard gas exposure, cutaneous T cell lymphoma and immune compromised state with opportunistic infections.

BACKGROUND

Bleeding time test is used to assess the function of platelets in human body. The aim of this project was thus to estimate the sample size required to determine the normal range of bleeding time (BT) in Borujerd (a city in Iran). A pilot study was designed to determine the range of normal BT in a small group of normal people. The total sample size for the next study was then calculated according to the results.

METHODS

In order to determine the sample size, a total of 33 volunteers participated in this study. The normal range of BT was determined by Ivy method. Written informed consents were obtained from all participants and their clinical history was recorded. The sampling was performed once for each participant. However, the results were interpreted by two observers. The study protocol was approved by the Ethics Committee of the research center at Lorestan University of Medical Sciences (Iran).

RESULTS

In this study, 33 normal participants (20 women and 13 men) were divided into four age groups of 35-44, 45-54, 55-64 and over 64 years old. Maximum and minimum BTs in men were 209 (in the age group of 35-44 years) and 150 seconds (in the age group of over 64 years), respectively. On the other hand, the corresponding values in women were 194 (in 55-64 year-old subjects) and 145 seconds (in women over 64 years of age). Considering the aforementioned results, the total sample size for the next study was determined to be 580 normal subjects by two-sample t-test power analysis at a power of 0.91816.

CONCLUSION

There was a significant difference between the normal range of BT in participants of Borujerd and previously recorded range in other studies. Moreover, normal BT in men decreased by aging. This study did not show any special order in increasing or decreasing BT in women.

Background

First and second-degree heart blocks are partly common rhythm disorders in thalassemic patients but complete heart block is a very rare complication of iron overload cardiomyopathy.

Case Presentation

This 15-year-old boy, a known case of major β-thalassemia was admitted to our emergency unit with dyspnea and cough because of decompensated heart failure. The electrocardiogram showed complete heart block with junctional escape rhythm. Interestingly, his previous electrocardiogram taken 2 months earlier, had some PVC and second degree, Mobitz type 1 (Wenckebach) heart block. After improvement of dyspnea and control of blood pressure in normal range, the patient was referred to ER. A dual-chamber permanent pacemaker was implanted and his symptoms improved, but he died 24 days after discharge from hospital.

Conclusion

We present a rare case of complete heart block after a second-degree (Mobitz 1) heart block that was due to severe iron overload cardiomyopathy.

BACKGROUND

Fibrinolytic therapy is the standard therapeutic method for patients with acute myocardial infarction (AMI). This study endeavored to assess the delay in arrival to the emergency department and door to needle time for thrombolytic therapy.

METHODS

This study was conducted on 80 patients with AMI whom referred to our clinic from January 2009 to January 2010. We measured time of arrival, needle time and door to needle time for all patients. Moreover, the relations of these times to some variables such as age, gender and the referred shift of emergency department personnel were calculated.

RESULTS

A total of 80 patients, 62 (77.5%) male and 18 (22.5%) female were evaluated for thrombolytic therapy. The arrival time of overnight shifts was 14.59 ± 1.23 minutes shorter than other shifts. The median door to needle time was 46.56 minutes and the mean time of the onset of chest pain to arrival at the emergency department was 19.44 minutes. Seventy-two patients (90%) received fibrinolytic therapy within the first 30 minutes of arrival. The needle time was significantly longer in the night shift (P < 0.05) (between 8 to 14 minutes), while the time of receiving Streptokinase therapy in the other shifts was not meaningfully different. Finally there was a statistically significant difference between the referred shifts and needle time (P < 0.05).

CONCLUSION

Despite our good results for door to needle time, to improve and attain the gold standard’s limits in administering fibrinolytic therapy, improvement of policies like training the personnel to shorten this time is recommend.

BACKGROUND

Hypertension (HTN) is one of the most important problems in all parts of the world. Although the disease is usually asymptomatic, its diagnosis and treatment are easy. The aim of this study was to compare the effect of Nifedipine (Adalat®), Captopril and sublingual Nitroglycerin on reducing blood pressure (BP).

METHODS

This study was a parallel group randomized controlled trial. From the patients referred to our heart clinic, 120 patients with severe HTN were enrolled in the study. The patients were randomly allocated into 3 groups A, B, and C. The patients were advised to use 5 drops of Adalat in group A, Captopril 25 mg sublingually in group B, and 1 sublingual Nitroglycerin pearl in group C. The BP was measured every 20 minutes during one hour.

RESULTS

Systolic BP was reduced significantly by Adalat and Captopril compared with sublingual Nitroglycerin in the 20th, 40th and 60th minutes (P = 0.001), but there was no significant difference between Adalat and captopril in reducing systolic BP. In addition, the result of reducing diastolic BP was not significantly different among the three groups.

CONCLUSION

We saw the same effect on reducing BP by Captopril, Adalat, and sublingual Nitroglycerin. Among these three drugs, the side effects of Captopril were the least frequent. Adalat caused headache and flushing. Thus, it seems Captopril can be used instead of Adalat in medical centers.

Aim

To determine the prevalence and causes of visual impairment and blindness in the Sistan‐va‐Baluchestan Province of Iran.

Methods

A population‐based cross‐sectional study with a multistage cluster sampling technique was used to identify the study subjects. Visual acuity (VA) was defined for all participants aged ⩾10 years. Participants with a VA of <20/60 were examined by an ophthalmologist to determine the causes of low vision or blindness.

Results

5446 (84.0%) of the invited people were examined. The prevalence of visual impairment (VA <20/60) was 6.81% (95% CI 5.91% to 7.71%) and of bilateral blindness (VA <3/60) was 0.79% (95% CI 0.50% to 1.08%). Visual impairment increased with age and illiteracy. Bilateral blindness doubled in women aged >40 years. The causes of visual impairment and blindness were cataract (37.7%), corneal opacity (15.0%), amblyopia (15.0%), glaucoma (5.7%) and hyperopia (5.0%). 39.5% of the visual impairment cases were potentially curable.

Conclusion

The estimated magnitude of visual impairment and blindness was much higher than our expectations. Further investigation of the pattern of vision loss in women and children, particularly as a result of trachoma and amblyopia, is warranted. Implementation of measures to treat curable cases of the study population can improve the situation in the region dramatically.