Dysphagia as a Main Symptom of Myasthenia Gravis in a Middleaged Adult Male: A Case Report

Background: Myasthenia gravis (MG) is a rare neuromuscular disorder resulting from the destruction of acetylcholine receptors at the neuromuscular junction by IgG antibodies. Although dysphagia is a common symptom in generalized form of MG, it is rarely reported as a sole manifestation of the disease, specifically in younger patients. Herein, we report a middle-aged adult patient with dysphagia as the sole manifestation of MG.Case presentation: A 49-year-old male complaining of severe dysphagia underwent an extensive clinical and paraclinical examination. Oropharyngeal dysphagia was confirmed by an experienced speech-language pathologist using the water swallowing test. Unilateral right paresis of the soft palate and vocal fold was confirmed using laryngeal video stroboscopy. Chest computerized tomography (CT) scan, brain Magnetic resonance imaging (MRI), and routine blood, urine, and thyroid tests were normal. In electromyography, slow repetitive nerve stimulation (RNS) showed a decremental response in the right nasalis muscle. The diagnostic neostigmine test with 1.5 mg of intramuscular neostigmine led to significant recovery of laryngeal and pharyngeal motor dysfunction and dysphagia within 12 hours, so the MG diagnosis was confirmed. The patient was treated with plasmapheresis, pyridostigmine, and prednisolone, which followed an improving course and led to better swallowing of solid and liquid foods.Conclusion: MG should be considered as a diagnosis in middle-aged adults with complaints of dysphagia

Prevalence of Atopic Dermatitis Symptoms among Students in Kurdistan: a North-west Province of Iran

Background Atopic dermatitis (AD), often called eczema or atopic eczema is a very common skin disease; AD looks different in infants, children, and adults. The aim of this study was to determine the prevalence of the disease in Kurdistan province. Materials and Methods Cross-sectional study using written questionnaires ISAAC  where 4,000 students in two age groups 7-6 and 14 -13 years in the province were using multi-stage sampling was carried out so that the first two floors rural and urban communities in every city and in every school pupil samples were selected based on 8-digit code. Results The prevalence of itchy rashes in the past 6 months, itchy rashes in the past 12 months and rashes at flexural areas were 7.5%, 8.9%, and 10.3%, respectively; the prevalence was higher in 13-14 years old than 6-7 years old and was higher in boys than in girls(Odds Ratio (OR)=1.44, Confidence interval (CI)= 1.49-2,