Search

Background: Myasthenic crisis is the most serious life-threatening event in generalized myasthenia gravis (MG) patients. The objective of this study was to assess the long-term impact of thymectomy on rate and severity of these attacks in Iranian patients. Methods: We reviewed the clinical records from 272 myasthenic patients diagnosed and treated in our neurology clinic during 1985 to 2002. Fifty-three patients were excluded because of unconfirmed diagnosis, ocular form of MG, contraindication to surgery, concomitant diseases and loss to follow-up. The Osserman classification was used to assess the initial severity of the disease. Frequency and severity of the attacks were compared between two groups with appropriate statistical tests according to the nature of variables. Multivariate logistic regression analysis was used to assess the predictors of myasthenic crisis in the group of patients without thymoma. Results: 110 patients were in thymectomy group and the other 109 patients were on medical therapy. These two groups had no significant differences with respect to age at onset, gender, Osserman score in baseline and follow up period. 62 patients (28.3% of all 219 patients) had reported 89 attacks of myasthenic crisis. 20 patients of 62 (32%) were in thymectomy group and 42 (68%) were in the other group. There was significant difference between the two groups in number of patients with crisis (P = 0.001; odds ratio = 2.8 with 95% CI of 1.5 to 5.2). In addition, these attacks were more severe in group of non-thymectomized patients as the duration of ICU admission was longer and they needed more ventilatory support during their attacks. Regression model showed thymectomy and lower age at onset as two predictors of decrement in myasthenic crisis rate in non-thymomatous MG patients. Conclusions: It is suggested that frequency and severity of myasthenic attacks as important endpoints in evaluation of MG patients. Thymectomy seems to have a preventive role on rate and severity of these attacks. [ABSTRACT FROM AUTHOR]

Background: Ophthalmology is unique in that its practitioners are exposed to a host of ergonomic (eg, indirect ophthalmoscopy), ergo-ophthalmologic (laser), infectious (adenovirus), and allergic (topical anesthetics) hazards. The purpose of this study is to provide a preliminary occupational health profile of Iranian ophthalmologists., Methods: A comprehensive list of occupation-related entities was incorporated into a questionnaire, which was distributed among 350 ophthalmologist participants of the Annual Iranian Congress of Ophthalmology (November 2000, Tehran) and was mailed twice to the 1050 nation's registered ophthalmologists. Independent Samples t and chi-square tests were used to assess the relationships., Results: One hundred sixty-two questionnaires were returned. The mean career time was 15.7 (range, 1-40) years. Twenty (12.3%) of the participants were women. The reported prevalences were as follows: history of infectious conjunctivitis, 49.4%; contact dermatitis, 43.2%; back pain, 80%; chronic headache, 54.9%; and laser or operating microscope-related visual disturbances, 15%. Psychological indispositions were reported by two thirds. Age and career time were inversely related to contact dermatitis, chronic headache, and stress-related problems (P < .05). Visual complaints were more prevalent in vitreoretina surgeons (P < .004). Psychosocial disorders were significantly more reported by women (P = .026; odds ratio = 4.4). Only 3% of participants reported to have none of the listed problems., Conclusion: Our preliminary survey disclosed a high prevalence of diverse complaints from back and neck pain, contact dermatitis, visual disturbances, and infectious conjunctivitis to stress-related and psychosocial disorders among the participants. Younger age, being a woman, and vitreoretina practice were the complaints correlates. Due to the low response rate, uncertainty over the representativeness and coverage of the sample, and lack of control groups, the findings have to be interpreted conservatively.