Primary Hyperaldosteronism in a Normotensive Patient: A Case Report.

Introduction: Primary aldosteronism (PA) is a clinical syndrome characterized by hypertension, suppressed plasma renin activity (PRA), elevated plasma aldosterone concentration (PAC), and spontaneous hypokalemia. Case Presentation: We present a 37-year-old normotensive female with hypokalemia, high plasma aldosterone level, and suppressed renin. The patient was treated with eplerenone and potassium chloride supplement. Further investigation with a computed tomography (CT) scan revealed a mass in the left adrenal. Laparoscopic adrenalectomy led to the diagnosis of adrenal adenoma. Conclusions: Primary aldosteronism should be among the differential diagnoses in normotensive patients presenting with severe hypokalemia.

Longitudinal Associations Between TPO Gene Variants and Thyroid Peroxidase Antibody Seroconversion in a Population-Based Study: Tehran Thyroid Study.

Introduction: Autoimmune thyroid diseases (AITD) are usually accompanied by anti-thyroid antibodies which can serve as early predictive markers. This study was designed to investigate the relationship between thyroid peroxidase (TPO) gene variants and the presence of TPOAb and to evaluate the effect of environmental factors associated with seroconversion from TPOAb-negative to TPOAb-positive. Methods: Participants from phases 1 and 2 of the Tehran Thyroid Study in (n = 5327, ≥20 years) were evaluated in terms of TPOAb positivity, and its relationship with 53 single nucleotide polymorphisms (SNPs) from within the TPO gene (cross-sectional approach). TPOAb-negative participants (n = 4815) were followed up for seroconversion for 5.5 years. The relationship between the TPO gene variants and the TPOAb seroconversion was evaluated (longitudinal approach). Results: There were 521 TPOAb-positive participants in the cross-sectional phase and 266 new TPOAb-positive cases observed during the follow-up period. After quality control (Hardy-Weinberg equilibrium (p < 1 × 10-5) and minor allele frequency < 0.05), 49 SNPs were qualified for association analyses. From this set fourteen SNPs were identified that were associated with TPOAb positivity. rs6605278, located in the 3'UTR TPO gene, was the most highly significantly associated of the variant and remained associated after adjustment for age, gender, body mass index (BMI), smoking, number of parity, and oral contraceptive consumption in both cross-sectional and longitudinal analyses (p < 0.05). Conclusions: TPOAb-positivity can be partially explained by variants in the TPO gene. New TPOAb-associated SNPs were observed in Iranians as an ethnically diverse population.

Frosted branch angiitis caused by Varicella Zoster virus in an immunocompetent patient.

INTRODUCTION: Frosted branch angiitis(FBA) is a panuveitis with sheating of all retinal vesssels. CASE PRESENTATION: Herein we report an immunocompetent person who presented with fever, headache, atypical rash, and hazy vision. Ophthalmoscopy of both eyes revealed perivascular sheathing with frosted branch angiitis pattern in veins, patchy retinal hemorrhages. Aqueous PCR analysis turned positive for VZV. DISCUSSION: This case illustrates that VZV should be considered in the differential diagnosis of retinal perivasculitis. Since a rapid and accurate diagnosis is crucial for prompt administration of antiviral therapy, PCR-based analysis of aqueous humor is a valuable tool for detecting viruses.

Dissecting intramural hematoma of esophagus after thrombolytic therapy: a case report.

Esophageal hematoma is a relatively rare event. We report a case of severe chest pain associated with myocardial infarction and recurrent chest pain after administration of a thrombolytic agent. The chest pain was different from the presenting symptom and accompanied by 2 episodes of hematemesis. Esophageal hematoma was confirmed after endoscopy and computed tomography. Esophageal hematoma is a relatively rare event after thrombolytic therapy.

Atrial dissociation in a middle aged patient: a case report.

Atrial dissociation is characterized by different types of P waves captured in an electrocardiogram, usually seen in critically ill or post-cardiac transplantation patients. Our case demonstrates a 55-year-old man, presenting with chest pain (unstable angina) in the emergency department with transient double-P waves; representing the phenomenon. Our case did not have any of the suggested causes or any known cardiac problems; therefore, with ruling out other differential diagnosis, researches must be done to find another explanation, if repeated.

Prevalence of hepatitis d virus infection among hepatitis B virus infected patients in qom province, center of iran.

BACKGROUND: Hepatitis D virus (HDV) is a defective RNA virus that depends on the hepatitis B surface antigen (HBsAg) of hepatitis B virus for its replication, developing exclusively in patients with acute or chronic hepatitis B. There are little data regarding the routes of HDV transmission in Iran. The risk factors for HDV infection in Iran are blood transfusion, surgery, family history, Hejamat wet cupping (traditional phlebotomy), tattooing, war injury, dental interventions, and endoscopy. OBJECTIVES: We performed this study to determine the prevalence of hepatitis D in the general population of Qom province and the potential risk factors for acquiring HDV. PATIENTS AND METHODS: This cross-sectional study collected 3690 samples from 7 rural clusters and 116 urban clusters. HBs antigen was measured, and if the test was positive, anti-HDV was measured. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and administer the questionnaires. The data were analyzed using SPSS. RESULTS: Forty-eight subjects (1.3%) suffered from hepatitis B, and 1 HBsAg-positive case had HDV infection. The prevalence of hepatitis D infection in Qom Province was 0.03%. The prevalence of hepatitis D infection in HBsAg-positive cases was 2%. Our anti-HDV-positive case had a history of tattooing, surgery, and dental surgery. There was no significant relationship between tattooing, surgery history, or dental surgery and hepatitis D infection. CONCLUSIONS: The prevalence of hepatitis D in Qom is the the lowest in Iran, similar to a study in Babol (north of Iran).

Distribution and risk factors of hepatitis B virus infection in the general population of Central Iran.

BACKGROUND: Hepatitis B is the most common chronic viral infection in humans and the most common cause of death among viral hepatitis. As 70% to 80% of chronic hepatitis cases are caused by HBV in Iran, this virus alone is considered the most important cause of liver diseases and the major cause of mortality arising from viral hepatitis cases in Iran. OBJECTIVES: We planned this study to determine the prevalence of hepatitis B in the general population of Qom, central Iran. PATIENTS AND METHODS: The present study is a cross-sectional study. A total of 3690 samples were collected from 7 rural clusters and 116 urban clusters. Ten teams, each consisting of 2 trained members, were assigned to conduct the sampling and fill the questionnaires. The data were analyzed using SPSS. RESULTS: The prevalence rate of hepatitis B infection in Qom Province was 1.3%. The mean age of the patients with hepatitis B was 44.17 years. The prevalence of hepatitis B was 1.6% in men and 1.1% in women. Moreover, the prevalence of hepatitis B correlated positively with age, tattooing, and literacy level. CONCLUSIONS: The prevalence rate of hepatitis B in Qom is 1.3%. It is possible to prevent the disease by increasing public awareness. Further investigation on clinical presentations and a determination of the genotype of the virus are suggested.

Congenital hepatic fibrosis leading to cirrhosis and hepatocellular carcinoma: a case report.

INTRODUCTION: Congenital hepatic fibrosis is an uncommon cause of portal hypertension. Despite the presence of portal hypertension, hepatocellular and renal function are usually well preserved. Congenital hepatic fibrosis is included in the group of congenital diseases of fibropolycystic disorders. These include a broad spectrum of clinical diseases which are usually accompanied by hepatic involvement. CASE PRESENTATION: We report the case of a 27-year-old Iranian woman with congenital hepatic fibrosis leading to cirrhosis and subsequently hepatocellular carcinoma. CONCLUSION: Advanced cirrhosis was diagnosed and our patient was scheduled for liver transplantation. During preparation for transplant, a hepatic mass was discovered which was found to be hepatocellular carcinoma. Radiofrequency ablation was performed and our patient was referred for transplantation.