Compartment syndrome: an unusual course for a rare disease

We report a case of compartment syndrome of the left upper limb following hemorrhage due to Crimean-Congo hemorrhagic fever in a 45-year-old man. As far as we know, there is not such a report in the literature. We discuss clinical manifestations, electrophysiologic findings, differential diagnosis, and management of the patient. A high degree of awareness for an early diagnosis may participate to improve the poor prognosis.     

Klippel-Feil anomaly associated with thoracic hemivertebrae/butterfly vertebrae and patella hypoplasia

A case with multiple congenital anomalies of the spine and bilateral patella hypoplasia is reported. To our knowledge, no report of concomitant Klippel-Feil syndrome, thoracic hemi vertebrae/butterfly vertebrae bilateral patella hypoplasia, reducible atlantoaxial instability, and occipitoatlantal fusion simultaneously has been reported in the literature.     

Cerebral arteriovenous malformations: influence of angioarchitecture on bleeding risk

Summary ¶Background. To evaluate the angioarchitecture of cerebral arteriovenous malformations (cAVMs) with special regard to its influence on the risk of intracranial haemorrhage. Methods. Clinical and neuroradiological data of 171 patients with cAVMs, who were treated at our department, were analysed retrospectively. The angioarchitectonic data were obtained from angiographic series, cranial CT scans and MR images. A ² test was conducted to correlate the parameters and determine the P values. Findings. The following parameters correlate to an increased risk of haemorrhage: diameter of the nidus 2cm (P<0.001), number of arterial feeders 2 (P<0.001), diameter of the main feeder 1mm (P<0.0001), number of veins draining the nidus 2 (P<0.001), exclusive deep drainage (P<0.05), and low or middle flow-velocity (P<0.01). Specific angioarchitectonic features such as venous stenoses, varicose dilatation of the draining vein, arterial aneurysms of the feeding artery, arteriovenous fistula within the nidus, contralateral drainage and sinushypo/-aplasia did not alter the bleeding rate. Interpretation. Various angiographic features were correlated with the occurrance of intracranial haemorrhage in patients with cerebral AVMs. In addition to the well-known factors influencing the bleeding risk of cAVMs like size, pattern of venous drainage and location within the brain our data demonstrate the importance to look at the diameter of the main feeder and the number of draining veins showing a better correlation.     

Mercury in Wetland Birds of Iran and Iraq: Contrasting Resident Moorhen, <Emphasis Type="Italic">Gallinula chloropus,</Emphasis> and Migratory Common Teal, <Emphasis Type="Italic">Anas crecca,</Emphasis> Life Strategies

We document mercury distribution in tissues of two waterfowls; moorhen (Gallinula chloropus; n = 6), and Common Teal (Anas crecca; n = 6) from Shadegan wetlands in Southwestern Iran. Mean value of mercury in moorhen liver was (0.36 Hg μg g⁻¹ dry weight), Common Teal had (4.34 Hg μg g⁻¹ dry weight) mercury. In all tissues, Common Teals had significantly higher mercury concentrations than moorhens (U test, p ≤ 0.05). Mercury was 12, 9, 8, and 6 times higher in liver, muscle, kidney, and feather of Common Teals. These birds have comparable diets but Common Teals are migratory and moorhens are residents of Shadegan wetlands.     

Double crush syndrome: an analysis of age, gender and body mass index

OBJECTIVES: The aim of this study is to evaluate the role of age, gender, body mass index (BMI), wrist ratio and median sensory nerve conduction velocity as independent risk factors for double crush syndrome (DCS) and to analyze the strength of association of these factors. PATIENTS AND METHODS: We have undertaken a case-control study in 142 patients (125 females) with carpal tunnel syndrome (CTS) and 109 controls. Based on clinical and electrophysiologic criteria 106 pure CTS patients and 36 DCS patients as well as 62 female and 47 male control subjects were selected from patients and their relatives referred to our tertiary referral hospital. Totally nerve conduction studies and electromyographic examination were done in 201 hands. Height, weight, BMI, wrist width, depth, circumference and ratio were measured in all patients and control group. Mean values of different risk factors for DCS group and controls were measured. A logistic regression analysis was conducted to evaluate odds ratio of different risk factors. RESULTS: The mean values for age was greater in DCS patients than CTS group. Male gender and increasing age had odds ratio of 4.19 (CI 95%: 1.35-12.96) and 1.13 (CI 95%: 1.07-1.19), respectively. CONCLUSION: Our study confirms that male gender and increased age are independent risk factors for DCS. We suggest that in elderly men presenting with CTS, electrophysiologic screening for cervical radiculopathy should be considered because the treatment of DCS differs from pure CTS.     

Tuberculous radiculomyelitis: review and presentation of five patients.

BACKGROUND: The southeast region of Iran is an endemic area for tuberculosis. Tuberculous radiculomyelitis (TBRM) was considered a rare form of parenchymal neurotuberculosis. OBJECTIVE: To analyze the clinical, laboratory and electrophysiological data of patients with TBRM. We report five patients and review the literature. METHOD: We searched Medline since 1966 and reviewed all cases of TBRM, excluding those with Pott's disease. We then evaluated the clinical and electrophysiological data of our patients. RESULTS: Five patients (two men), with a mean age of 25 years, were assessed. The mean duration of symptoms before diagnosis was 4.5 weeks. Three patients had clinical manifestation of tuberculous meningitis (TBM). Diagnosis was based on sputum smear and culture, cerebrospinal fluid (CSF) culture and polymerase chain reaction (PCR) gene amplification of Mycobacterium tuberculosis. Paraparesis or paraplegia, sphincter incontinence and Babinski sign were the main clinical features. CSF analysis was compatible with chronic meningitis. Electromyography showed radiculopathy in all patients and peripheral nerve disease secondary to axonal damage in only three, while myelography showed adhesive arachnoiditis in three. CONCLUSION: Despite the rarity of TBRM, clinical features were well described. To prevent neurological sequelae, early diagnosis and treatment is mandatory. Electrophysiological study may predict the prognosis.     

Childhood Sex-Typed Behavior and Gender Change in Individuals with 46,XY and 46,XX Disorders of Sex Development: An Iranian Multicenter Study

Disorders of sex development (DSD) are congenital conditions in which the typical genetic and hormonal profiles are affected and thereby the usual process of sexual differentiation. Most of these studies, however, have been conducted in Western countries. In the present study, preschool sex-typed activities of Iranian individuals with DSD and their age-matched non-affected male and female relatives were assessed using the Pre-School Activities Inventory (PSAI) modified for retrospective self-report. A total of 192 individuals participated in our study, including 33 46,XX individuals with congenital adrenal hyperplasia (CAH; M age?=?10.36, SD?=?5.52), 15 46,XY individuals with complete androgen insensitivity syndrome (CAIS; M age?=?19.8, SD?=?7.14), and 16 46,XY individuals with 5-alpha reductase deficiency type-2 (5α-RD-2; M age?=?17.31, SD?=?7.28), as well as one age-matched non-affected male and female relative for each patient. With regard to PSAI scores, male-identifying participants with 5α-RD-2 and male controls reported similar levels of male-typical childhood play. Female-identifying participants with 5α-RD-2 and CAH showed comparable scores: significantly less masculine and more feminine than male controls, but significantly more masculine and less feminine than females with CAIS and female controls. These findings support the role of androgens in the development of sex-typical childhood play behavior, with those being exposed to higher levels of fetal functional androgens expressing more masculine behavior at preschool ages.     

A review of pioglitazone HCL and glimepiride in the treatment of type 2 diabetes

Type 2 diabetes (T2D) is a progressive disorder with a consistent and steady increase in glycosylated hemoglobin (HbA1c) over time associated with enhanced risk of micro- and macrovascular complications and a substantial reduction in life expectancy. There are three major pathophysiologic abnormalities associated with T2D: impaired insulin secretion, excessive hepatic glucose output, and insulin resistance in skeletal muscle, liver, and adipose tissue. These defects have been treated in clinical praxis by use of oral insulin secretagogues (sulfonylureas/ glinides) or insulin, biguanides, and thiazolidinediones (TZDs) respectively. Pioglitazone HCL is an insulin sensitizer in the TZD family and glimepiride is an insulin secretagogue in the SU family. This article reviews mechanisms of action and clinical data behind the use of these two commonly used oral hypoglycemic agents with documented efficacy and good safety profile of once-daily administration, alone or in combination with insulin or metformin, in the management of T2D in terms of glycemic and non-glycemic effects, tolerability and side effects, and impact on vascular health.