Mohammadreza Peyman

An International collaborative pathologic study of surgical lung biopsies from mustard gas-exposed patients

BACKGROUND Recent studies have shown strong evidence that bronchiolitis obliterans is the major long-term sequelae of exposure to sulfur mustard (SM). This study is the first to examine the histopathologic spectrum of changes in a large number of surgical lung biopsies from patients exposed to SM. METHOD Fifteen patients with chronic respiratory disease from mustard gas exposure were divided into severe (6 cases) and mild exposure (9 cases). All had surgical (open or thoracoscopic) lung biopsy, pulmonary function tests (PFTs) and chest high-resolution computed tomography scan (HRCT). RESULT The mean age of the cases was 43.8+/-9.6 (range 33-65). All patients had dyspnea and cough as the two main complaints. Only one patient was a smoker. Thirteen patients had normal PFTs, while one had obstruction and one had mild restriction. Six (66.6%) patients in the mild exposure and 3 (50%) in the severe exposure group showed evidence of more than 25% air trapping on chest HRCT. Among the mild group, 3 had features of constrictive bronchiolitis and another had features suggestive of this (bronchiolectasis and mucus stasis). The next most common finding was a mild-to-moderate chronic cellular bronchiolitis (3 patients). Two among the 6 in the severe group showed constrictive bronchiolitis and one showed features suggestive of constrictive bronchiolitis. CONCLUSION We conclude that about half of patients had diagnostic constrictive bronchiolitis, or bronchiolectasis and mucus stasis consistent with more proximal luminal compromise. The fact that there were no differences between the low- and high-dose groups suggests that effects of SM are not solely dependent on the severity of exposure. The results also indicate that the diagnosis of chronic lung disease due to SM may be difficult. Surgical lung biopsy may be helpful in difficult cases, as constrictive (obliterative) bronchiolitis can be present in symptomatic patients with normal PFTs and chest HRCT.

CUTANEOUS AND OCULAR LATE COMPLICATIONS OF SULFUR MUSTARD IN IRANIAN VETERANS

Although sulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century, it has reemerged in the past decade as a major threat around the world. This agent injured over 100,000 Iranians and one-third is suffering from late effects until today. Mustard affects many organs such as the skin, eyes, and lungs, as well as the gastrointestinal, endocrine, and hematopoietic system. In this study we focused on review of the late Cutaneous and ocular complications caused by exposure to SM. All studies regarding long-term ocular and cutaneous effects, which have been done on Iranian population, were collected from domestic and international sources. Pruritus is the most common complain and a malignant change is the most important lesion, which has to be considered. Also this agent is causes of chronic and delayed destructive lesions in the ocular surface and cornea, leading to progressive visual deterioration and ocular irritation.

Retinal nerve fiber layer structure abnormalities in schizophrenia and its relationship to disease state: evidence from optical coherence tomography.

PURPOSE We determined structural retinal nerve fiber layer (RNFL) changes in schizophrenia patients and established if the structural changes were related to the duration of the illness using spectral-domain optical coherence tomography (SD-OCT). METHODS We recruited a total of 30 schizophrenic patients and 30 age-matched controls in the study. The schizophrenic patients were subdivided further to acute (n = 5), chronic (n = 13), and long-term chronic (n = 12) subgroups depending on their duration of illness. Using SD-OCT, the peripapillary RNFL thickness, macula thickness, and macula volume measurements of schizophrenic patients and the control subjects were measured and compared at each location. RESULTS Schizophrenic patients showed a statistically significant reduction in overall peripapillary RNFL thickness (cases, 94.70 ± 9.88 μm; controls, 103.53 ± 6.53 μm; P < 0.001), macula thickness (cases, 269.26 ± 12.59 μm; controls, 284.83 ± 9.76 μm; P < 0.001), and macula volume (cases, 9.61 ± 0.45 mm(3); controls, 10.17 ± 0.35 μm; P < 0.001). Chronic and long-term chronic schizophrenic patients were found to have significant peripapillary RNFL thinning, macula thinning, and reduction of macula volume when compared to controls (P < 0.001). There also was a statistically significant reverse correlation (P < 0.05) of peripapillary RNFL thickness (r = -0.36), macula thickness (r = -0.38), and macula volume reduction (r = -0.36) with the duration of schizophrenic illness. CONCLUSIONS These results indicate that RNFL and macula thickness, as well as macula volume measurements are reduced in schizophrenic patients. The degree of thinning and reduction was more significant in the chronic phase of the disease and correlated with the duration of illness. These findings demonstrate that SD-OCT can be a useful tool for the diagnosis and monitoring the progression of this disease.

Does hinge position affect dry eye after laser in situ keratomileusis

Purpose: To evaluate the effect of corneal flap hinge position on dry eye after laser in situ keratomileusis (LASIK). Methods: In a prospective double-masked randomized controlled clinical trial, 212 consecutive eyes of 106 myopic patients underwent LASIK; in each patient, one eye was randomly assigned to the superior hinge and the other eye to the nasal hinge procedure. The patients were examined pre-operatively and 1 week, 1 month, 3 months and 6 months after surgery for visual acuity, fluorescein tear film breakup time and Schirmer’s baseline tear secretion test; a subjective evaluation of dry eye symptoms was accomplished by the Ocular Surface Disease Index (OSDI®) questionnaire at the 1-month, 3-month and 6-month postoperative visits. Results: Tear film breakup time was not significantly different with the nasal or superior hinge flap technique at the preoperative, 1-week, 1-month, 3-month and 6-month visits (p > 0.05 for all comparisons between two groups). No significant difference between the two groups was found for the amount of Schirmer’s baseline tear secretion test at pre- and postoperative visits (p > 0.05 for all comparisons between two groups). Subjective evaluation of symptoms also showed no significant difference at the 1-month, 3-month and 6-month postoperative visits. Conclusions: The nasal and superior hinge flap methods do not affect signs and symptoms of dry eye after LASIK. We recommend that selecting the hinge position should be done according to the surgeon’s preference and ease.

Bronchial anthracosis: a potent clue for diagnosis of pulmonary tuberculosis.

OBJECTIVES Occupational exposure to carbon, silica, and quartz particles are predisposing factors for bronchial anthracosis. In some cases anthracosis may be associated with mycobacterium tuberculosis. This study aims to investigate the clinical, radiographic, and bacteriologic findings in bronchial anthracosis patients and its association with tuberculosis. METHODS This is a prospective study conducted between 1998 and 2001. A total of 919 patients underwent diagnostic bronchoscopy for pulmonary diseases. Of these, 71 patients showed evidence of bronchial anthracosis, 32 (45.8%) males and 39 (54.2%) females, age range, 30-92 years. The distinctive clinical features, nature of bronchoscopic lesions, and radiologic findings were analyzed prospectively and summarized. Bacteriologic studies and results of laboratory examinations were also assessed. RESULTS Forty-one (57.8%) patients had positive smears or cultures for mycobacterium tuberculosis. Of 71 patients with bronchoscopic evidence of pulmonary diseases, 30 had previous occupational exposure, and 41 stated no previous exposure. Cavitary lesions on chest radiography, positive purified protein derivative tests and high ESR were more prevalent in tuberculous patients than the others. CONCLUSION Bronchial anthracosis was caused by active or previous tuberculous infection. Detailed examinations for the presence of active tuberculosis should be performed in patients with such bronchoscopic findings in order to prevent the spread of tuberculosis and to avoid unnecessary invasive procedures.

Risk factors for clinically significant macular edema in a multi-ethnics population with type 2 diabetes

AIM To determine the risk factors of clinically significant macular edema (CSME) in patients with non-proliferative diabetic retinopathy (NPDR) in a multi-ethnics Malaysian population. METHODS We performed a case control study in which 150 patients with bilateral NPDR and CSME in either eye were compared to 150 patients with bilateral NPDR and no CSME in both eyes. CSME and NPDR were graded according to Early Treatment of Diabetic Retinopathy Study criteria. Students t-test, odds ratio and multiple logistic regression analysis were performed to analyze the duration of diabetes, body mass index (BMI), blood pressure(BP), total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), fasting blood glucose (FBG), HbA1c, full blood count, serum creatinine and proteinuria between the two groups. RESULTS Both groups were matched in terms of age, gender and ethnicity. Duration of diabetes, total serum cholesterol, serum LDL, FBG, HbA1c and serum creatinine were significantly higher in the CSME group (P<0.05). The hemoglobin, packed cell volume were significantly lower in the CSME group (p<0.05). There was no significant difference for serum HDL, TG, BMI, systolic and diastolic BP. Multiple logistic regression analysis showed that total serum cholesterol and HbA1c had significantly high odds of developing CSME. CONCLUSION HbA1c and total cholesterol are the two most important risk factors associated with CSME in patients with NPDR.

Intravitreal bevacizumab for radiation-induced cystoid macular oedema in patients with nasopharyngeal carcinoma: a clinical series.

Aims: To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma. Methods: Five patients were recruited. The length of time from the last external beam radiation therapy to presentation ranged from 12 months to 15 years. Intravitreal bevacizumab (1.25 mg/0.05 ml) was given and repeated monthly injections were administered until best corrected visual acuity (BCVA) improved to 6/9 or until 3 further injections did not show further improvement in BCVA. BCVA was measured and fundus photography, optical coherence tomography (OCT) and fluorescein angiography were performed at baseline. BCVA and OCT were recorded at each monthly visit. The duration of follow-up ranged from 6 months to 2 years. Results: Five patients (7 eyes) were recruited. At the final visit, 3 eyes (71.4%) showed reduction in the central subfield thickness (CST; mean reduction of 17.6%, range 9-149 µm) with improvement in BCVA, whilst 2 eyes worsened in terms of CST and final BCVA. Another 2 eyes remained altered in BCVA despite slight improvement in CST. Conclusion: The use of intravitreal bevacizumab in this group of patients showed variable response in terms of CST and BCVA outcome but remains a viable option to treat this challenging condition.

Assessment of Polymerase Chain Reaction in the Detection of Pseudomonas aeruginosa in Contact Lens-Induced Severe Infectious Keratitis

Purpose: The aim of this study is to evaluate the role of real-time polymerase chain reaction (PCR) and conventional bacterial culture methods in the detection of Pseudomonas aeruginosa in contact lens-induced severe, partially treated corneal ulcers referred to a tertiary center. Methods: The study duration was 6 months. All patients with contact lens-related corneal ulcer, requiring admission during the study period were recruited. Samples from corneal scrapings were simultaneously sent at the time of admission for PCR and culture testing. An in-house real-time PCR was developed to detect the P. aeruginosa lasA gene. The results of PCR and culture were compared using McNemars &khgr;2 test. Results: Ten patients were recruited. The mean age was 33 years (20–45 years). All the patients had contact lens-related keratitis (>4 mm) of which eight (80%) were found positive for P. aeruginosa by PCR or culture. There was no significant difference between PCR and culture in detecting P. aeruginosa (P<0.05). Conclusions: PCR is, at least, as good as conventional cultures in detecting P. aeruginosa. It is a rapid assay as compared with culture, and early detection enables prompt treatment thus reducing the destructive effect of the organism on the cornea.

Neonatal herpes simplex virus type-1 central nervous system disease with acute retinal necrosis.

We report a case of neonatal herpes simplex virus (HSV)-1 central nervous system disease with bilateral acute retinal necrosis (ARN). An infant was presented at 17 days of age with focal seizures. Cerebrospinal fluid polymerase chain reaction was positive for HSV-1 and brain magnetic resonance imaging showed cerebritis. While receiving intravenous acyclovir therapy, the infant developed ARN with vitreous fluid polymerase chain reaction positive for HSV-1 necessitating intravitreal foscarnet therapy. This is the first reported neonatal ARN secondary to HSV-1 and the first ARN case presenting without external ocular or cutaneous signs. Our report highlights that infants with neonatal HSV central nervous system disease should undergo a thorough ophthalmological evaluation to facilitate prompt diagnosis and immediate treatment of this rapidly progressive sight-threatening disease.

Association between Ocular Pseudoexfoliation and Sensorineural Hearing Loss

Background. Our study aimed to investigate an association between ocular pseudoexfoliation (PXF) and sensorineural hearing loss (SNHL) and to compare them with age and sex matched controls without pseudoexfoliation. Method. This was a case-control study of 123 patients which included 68 cases with PXF (at least one eye) and 55 controls without pseudoexfoliation. Pure-tone audiometry (PTA) was done for these patients at sound frequencies taken as important for speech comprehension, that is, 250 Hertz (Hz), 500 Hz, 1000 Hz, and 2000 Hz. Results. There were 41 patients with pseudoexfoliation syndrome (PXE) and 27 with pseudoexfoliative glaucoma (PXEG). The majority of patients with hearing loss (60%; n = 51) were PXF patients and the remaining 40% (n = 34) were controls. Below average hearing thresholds were significantly higher in the pseudoexfoliation group compared to the control group (P = 0.01; odds ratio (OR), 3.00; 95% confidence interval (CI), 1.25–7.19). However, there was no significant difference in the mean hearing threshold levels between the three groups (PXE, PXEG, and controls) in either ear (ANOVA, right ear: P = 0.46 and left ear P = 0.36). Conclusion. Our study found an association between PXF and SNHL, confirming that PXF can involve organs in the body other than the eye.