Navid Bouzari

Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran.

BackgroundThe combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients. The main objective of this study is to determine the prevalence of prominent thalassemia complications.MethodsTwo hundred twenty patients entered the study. Physicians collected demographic and anthropometric data and the history of therapies as well as menstrual histories. Patients have been examined to determine their pubertal status. Serum levels of 25(OH) D, calcium, phosphate, iPTH were measured. Thyroid function was assessed by T3, T4 and TSH. Zinc and copper in serum were determined by flame atomic absorption spectrophotometry. Bone mineral density (BMD) measurements at lumbar and femoral regions have been done using dual x-ray absorptiometry. The dietary calcium, zinc and copper intakes were estimated by food-frequency questionnaires.ResultsShort stature was seen in 39.3% of our patients. Hypogonadism was seen in 22.9% of boys and 12.2% of girls. Hypoparathyroidism and primary hypothyroidism was present in 7.6% and 7.7% of the patients. About 13 % of patients had more than one endocrine complication with mean serum ferritin of 1678 ± 955 micrograms/lit. Prevalence of lumbar osteoporosis and osteopenia were 50.7% and 39.4%. Femoral osteoporosis and osteopenia were present in 10.8% and 36.9% of the patients. Lumbar BMD abnormalities were associated with duration of chelation therapy. Low serum zinc and copper was observed in 79.6% and 68% of the study population respectively. Serum zinc showed significant association with lumbar but not femoral BMD. In 37.2% of patients serum levels of 25(OH) D below 23 nmol/l were detected.ConclusionHigh prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.

Laser treatment of keloids and hypertrophic scars.

Background  Lasers have been used in the treatment of hypertrophic scars and keloids for more than 20 years. Different laser systems have been examined; among them pulsed dye lasers are currently considered the laser of choice in these settings.

A randomized, double-blind, placebo-controlled clinical trial of itraconazole in the treatment of cutaneous leishmaniasis

Background  Several modalities have been used for the treatment of cutaneous leishmaniasis (CL) with various results. In vitro and in vivo studies have shown inhibitory effects of azole drugs on Leishmania parasites.

What patients with vitiligo believe about their condition

Background  Vitiligo is a common disease with an unknown etiology. It is a chronic disease which causes severe disfigurement, and so may significantly affect a patients quality of life. This study was designed to evaluate the illness perception and quality of life in patients with vitiligo.

Comparison of direct smear, culture and histology for the diagnosis of onychomycosis.

A sensitive and efficient diagnostic strategy is needed to confirm the clinical suspicion of onychomycosis. The purpose of this study was to compare the sensitivity of three most commonly used diagnostic methods for onychomycosis. Nail specimens of 96 patients with clinically suspected onychomycosis were evaluated using potassium hydroxide smear, culture and histology. A positive result of any of these tests was considered confirmatory for fungal infection and the sensitivity of each test as well as various combinations of them was calculated. The diagnosis of onychomycosis was confirmed in 47 patients (48.9%). Histology was the most sensitive single test for the diagnosis of onychomycosis, although its sensitivity (80.8%) was not statistically different from smear (76.5%). Both histology and smear were significantly more sensitive than culture (53.2%). The most sensitive combination of tests, smear plus histology, was 97.8% sensitive with 98% negative predictive value. In conclusion, direct smear combined with histological examination is the most sensitive diagnostic approach for onychomycosis.

Serum zinc and its relation to bone mineral density in β-thalassemic adolescents

Trace elements have been considered to play critical roles in bone metabolism. This study aims at determining the serum zinc profile and its association with bone mineral density (BMD) abnormalities in thalassemic patients. In 131 transfusion-dependent β-thalassemic patients, aged 10–20 yr, serum levels of zinc were measured by flame atomic absorption spectrophotometry (F-AAS). BMD values at the lumbar (L1–L4) and femoral neck were determined by dual X-ray absorptiometry (DXA). Dietary zinc intake and daily consumption of calcium were evaluated by a food-frequency questionnaire. Low serum zinc was found in 84.8% (in 44.7% severely low). Below −2 BMD Z-scores were observed in 68.7% and 17.6% of the patients at the lumbar and femoral regions, respectively. Female patients with severe zinc deficiency had lower lumbar BMD Z-scores in comparison to the other females (−3.26 vs −2.54). Serum zinc in females with femoral BMD Z-scores <−2 was significantly lower by 16.4 µg/dL than other females. Our study suggests that serum levels of zinc can be lowered in the thalassemic patients and partly affect the BMD.

The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: A multicenter prospective interventional study

BackgroundHepatitis C virus (HCV) infection is a significant problem among patients undergoing maintenance hemodialysis (HD). We conducted a prospective multi-center study to evaluate the effect of dialysis machine separation on the spread of HCV infection.MethodsTwelve randomly selected dialysis centers in Tehran, Iran were randomly divided into two groups; those using dedicated machines (D) for HCV infected individuals and those using non-dedicated HD machines (ND). 593 HD cases including 51 HCV positive (RT-PCR) cases and 542 HCV negative patients were enrolled in this study. The prevalence of HCV infection in the D group was 10.1% (range: 4.6%– 13.2%) and it was 7.1% (range: 4.2%–16.8%) in the ND group. During the study conduction 5 new HCV positive cases and 169 new HCV negative cases were added. In the D group, PCR positive patients were dialyzed on dedicated machines. In the ND group all patients shared the same machines.ResultsIn the first follow-up period, the incidence of HCV infection was 1.6% and 4.7% in the D and ND group respectively (p = 0.05). In the second follow-up period, the incidence of HCV infection was 1.3% in the D group and 5.7% in the ND group (p < 0.05).ConclusionsIn this study the incidence of HCV in HD patients decreased by the use of dedicated HD machines for HCV infected patients. Additional studies may help to clarify the role of machine dedication in conjunction with application of universal precautions in reducing HCV transmission.

Malignant Skin Neoplasms

Skin cancers may be derived from any part of the skin, and the classification of all variants is extensive. Overall they are the most common cancers of the body, and include those that are highly mortal and those that are associated with an increased morbidity. In this review the most common skin cancers confronted by the clinician and their management are discussed. New associations are highlighted, as well as new information that can help the clinician to better understand the pathogenesis of many of these entities.

Sun protection in Iranian kidney transplant recipients: knowledge, attitude and practice.

Background  Kidney transplant recipients (KTR) are at increased risk of developing skin cancer. The purpose of this study was to evaluate the knowledge, attitude, and practices of KTRs regarding skin cancer after transplantation and to identify the role of education in motivating these patients to practice sun‐protective behaviours.

Hair removal using an 800-nm Diode laser: Comparison at different treatment intervals of 45, 60, and 90 days

Background  Some laser irradiation parameters such as wavelength, fluence, pulse duration, and spot size have been shown to influence the damage of any target inside the skin, however, the role of some patients’ factors such as hair growth cycle is still under debate.