Paget's disease of bone in the patient presented with a bowed leg

Key Clinical Message In dealing with bowed limbs along with increased alkaline phosphatase (ALP), even if the typical changes to the face are not very noticeable at first glance, Paget's disease of the bone (PDB) should be suspected, and the necessary investigations should be carried out to confirm the diagnosis. Abstract Paget's disease of the bone (PDB) is the second most prevalent metabolic bone disorder worldwide with disorganized bone remodeling. Here, a patient is presented with pain and bending of the right leg, whose skull and forehead changes are not noticeable at first glance, but with clinical suspicion and additional diagnostic evaluations, PDB diagnosis is confirmed for the patient

Femoral head avascular necrosis of in a young cushingoid opium addicted patient in the context of new combined opioid substance with corticosteroids

Key Clinical Message AVN should be considered in addicted to oral opium patient without history of glucocorticoid consumption who present with pelvic pain, due to recent reports of the illegal and secret addition of glucocorticoid in new combination substance with opium

A Comparison of learning In Traditional and Evidence Based Journal Clubs

Introduction: Journal clubs are known as the teaching methods in most of the medical training centers. In journal club (JC) participants discuss about articles in recent medical papers and finally, written scientific results are accepted or rejected. The aim of this study was to compare the traditional and evidence based medicine (EBM) type of JCs. Methods: The present study was conducted in Imam Reza Hospital, Tabriz University of medical sciences from January to March 2010. Forty participants were enrolled in our study: 16 stagers, 11 interns and 13 internal medicine residents. We held 3 journal clubs with 14 participants in the first session and 13 participants in the other sessions. Journal club was held at the end of each week. The first paper was presented by one of the attending physicians of rheumatology ward. The second paper was presented by another attendant of rheumatology ward who was a member of EBM group of Tabriz University of Medical Sciences. Then the results were compared. Results: The comparison of the sums of participants’ scores didn’t show any meaningful difference between traditional and EBM journal club in topic, purpose, and methods & material part of papers, but in the results section of the papers, the difference was remarkable. Conclusions: Our study showed that in the EBM journal clubs, participants learnt more about the results part of the papers.but in the results section of the papers

Safety of liver function monitoring every 3 months in patients treated with low dose methotrexate

Introduction: The objective of this study was to evaluate the safety of liver transaminases monitoring every 12 weeks in patients with inflammatory connective tissue disorders who aretreated with methotrexate (MTX). Methods: In a retrospective study, the data from the rheumatic patients receiving MTX wereanalyzed. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at baseline and every 12 weeks. The patients were classified according to their ALTand AST levels as no change, 1-2 times increase, 2-3 times increase, and more than 3 timesincrease in their ALT or AST levels. Based on the physician’s decision on the dose of MTX,the patients were classified into no change in MTX dose, decrease in MTX dose, anddiscontinuation of MTX. Based on the physician’s final decision about the continuation ofMTX, the patients were classified into one of the following groups: continuation of MTXwithout MTX dose reduction; MTX dose reduction; MTX discontinuation due to livercomplication; and MTX discontinuation due to other reasons. Results: A total of 809 patients who were on MTX were included in the study. The meanfollow-up duration and the mean duration of treatment with MTX were 31.22 and 19.76 months, respectively. The mean accumulation dose of MTX was 865.85 mg. Due to theincrease in the level of transaminases in 26 (3.2%) of the patients the dose of MTX wasreduced, and in 9 (1.1%) cases it was temporarily discontinued. During the follow-up of thepatients with elevated transaminases levels, they returned to normal limits in 90 (99.5%) of thepatients; however, in 4 of the cases (0.5%) they remained elevated and MTX wasdiscontinued. The probability of the patients remaining on MTX for 5 years withoutdiscontinuation for liver complications was 98.5%. Conclusion: Liver transaminases monitoring every 12 weeks for MTX treated patients is safe