Tehran University Medical Journal

Background: Graves' disease is the most common cause (85% of all cases) of thyrotoxicosis in women in childbearing age. Many of the symptoms are similar to hyper-metabolic status during pregnancy. The cause of the disease is autoantibodies that stimulate the thyroid-stimulating hormone (TSH) receptor. Hyperthyroidism is uncommon in pregnancy and its prevalence is 0.1-%0.4. In this paper we introduce a patient who was admitted with a primary diagnosis of pulmonary embolism and treatment with final diagnosis of thyroid storm and was discharged with good condition.
Case presentation: In the first pregnancy of a 29-year-old woman with gestation age of 31 weeks was referred to obstetric emergency unit Ghaem Hospital, Mashhad, Iran in March 2015. She had Grave’s disease in her past medical history which was treated with methimazole before pregnancy and propylthiouracil (PTU) during pregnancy. In admission, she presented with tachycardia and tachypnea and hypertension and lower extremity edema. During pregnancy, she used propantheline instead of propylthiouracil due to pharmacy mistake. She admitted in Intensive care unit. After rule out of pulmonary embolism, ultrasonography showed a fetus with 30 weeks of gestational age with an approximate weight of 1680 grams. The amniotic fluid was reduced. She was treated with thyroid storm diagnosis due to a medication error. In serial obstetric visits fetal heart rate was not detected. Due to the fetal death, the pregnancy was terminated. Hyperthyroid therapy continued with PTU after delivery. She was discharged with a good general condition.
Conclusion: Despite the rarity of thyroid storm during pregnancy, in the event of unstable hemodynamic condition and cardiac dysfunction in pregnant women, rule out of thyroid disorders should be considered. Clinician should be paid attention to past drug history and underline disease of patient.

Background: Scleroderma is a chronic systemic disorder that affects the connective tissues. It is characterized by several immune manifestations, inflammation, vascular damage, and fibrosis. Some of the viral infections with complex mechanisms are involved in the development and progression of many autoimmune diseases, such as scleroderma. The present study aimed to investigate the serological prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) infections in Iranian patients with scleroderma.
Methods: In this descriptive study 65 patients with scleroderma and 65 healthy individuals who had no autoimmune diseases and matched for age and sex, from May 2017 to April 2018 at Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran, were included. The serum of study participants were evaluated for cytomegalovirus specific immunoglobulin G (CMV-IgG), Epstein-Barr virus viral capsid antigen immunoglobulin G (EBV-VCA-IgG), hepatitis B surface antigen (HBsAg), hepatitis C virus antibody (HCVAb), and human immunodeficiency virus antibody (HIVAb) using commercially available the enzyme-linked immunosorbent assay (ELISA) kit.
Results: CMV-IgG was diagnosed in serum of all patients with scleroderma, while 49 (98%) healthy subjects had positive results for this test. In addition, EBV-VCA-IgG was diagnosed in 58 (89.2%) sclerodermic patients and 40 (80%) healthy subjects. The prevalence of CMV-IgG and EBV-VCA-IgG was not significantly different between patients and healthy subjects and had no significant relationship with age and sex. However, the titer of antibodies against CMV and EBV infections in the scleroderma group was higher than that in the control group (P<0.0001, and P<0.0001), respectively. The presence of HBsAg and HIVAb was not confirmed in any of the patients with scleroderma, but HCVAb was detected only in one patient. All of the individuals in control group were serologically negative for HBsAg, HCVAb, and HIVAb.
Conclusion: Serological prevalence of HBV, HCV, HIV, EBV, and CMV infections in patients with scleroderma is similar to the healthy group.

Background: Systemic lupus erythematosus is a systemic autoimmune disease that affects almost all organs of the body, and viral infections are involved in its development and progression. The present study aimed to evaluate the serological status of some viral infections in patients with systemic lupus erythematosus and a healthy population.
Methods: This descriptive study conducted from May 2017 to April 2018 at Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran on 70 patients with systemic lupus erythematosus and 70 healthy individuals who had no autoimmune diseases and were matched with the patient group for age and sex. All patients had active records and were routinely visited in rheumatology clinic of Hafez hospital, affiliated with Shiraz University of Medical Sciences. The evidence of active disease was assessed by the physicians of this practice according to the American College of Rheumatology criteria. Peripheral blood samples were collected in tubes containing EDTA and centrifuged at 3000 rpm for 5 min. The plasma of study participants was evaluated for HBsAg, HCVAb, HIVAb, EBV-VCA-IgG, and CMV-IgG using a commercially available ELISA kit.

Conclusion: Considering the higher frequency of EBV-VCA-IgG and the higher titer of antibodies against CMV and EBV in patient groups compared to healthy individuals group, it seems that periodical assessment of viral load in patients with systemic lupus erythematosus will be beneficial to prescribe medication by physicians if it is needed.

Results: 10 people participated in the final analysis. The mean age of patients was 33.20 years (26-46 years). Three patients had a history of perianal abscess surgery, two patients had a history of fistula surgery and 1 patient had a history of Fisher surgery. The mean closing time of the cavity was 14.2 days (10-22 days). Two patients (20%) had a fever and two patients (20%) had a surgical site infection. Bleeding and recurrence were not observed in any of the patients. The mean preoperative Wexner score was 0.80±0.76 Which decreased to 0.68±0.50 postoperatively (P=0.045). Conclusion: Finally, the findings of the study showed that the use of PRF to repair a complex fistula is a method that can be easily repeated with minimal side effects and can heal wounds caused by fistulas with supralevator collection. This treatment can play an important role in the treatment of complex fistulas that have moderate or extensive involvement with the sphincter, or the occurrence of fistulas with sphincter dysfunction.