Induced Abortion by Vaginal Use of Aluminum Phosphide in a 44-Year-Old Woman: A Case Report

Aluminum phosphide (AlP) is an efficient and toxic pesticide that is easily available in many Asian countries such as Iran. Many cases of unintentional or suicidal use of AlP have been reported in these countries, and these statistics are rising rapidly. We aim to present a case of abortion induced by vaginal use of AlP. We report a 44-year-old gravid woman who self-administered one-quarter of a 3-g AlP tablet intravaginally. Ultrasound at 6 hours post-admission showed no fetal movement or heart motion. Intravaginal administration of AlP can lead to fetal death and abortion. There is concern about the spread of vaginal use of these agents in pregnant women, as the number of illegal abortions is increasing

Comparison clinical and metabolic effects of metformin and pioglitazone in polycystic ovary syndrome

Introduction: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women. PCOS comprises a broad spectrum of anomalies, including hyperandrogenism, chronic anovulation, obesity, and infertility. Insulin resistance and its compensatory hyperinsulinemia play a key role in the pathogenicity of PCOS. This study compares the effects of 2 types of insulin sensitizer drugs, metformin and pioglitazone, on clinical, metabolic, and endocrine characteristics of women with PCOS. Methods: In this randomized clinical trial, 56 women with PCOS (ages 20–49 years) were treated orally with either metformin (500 mg 3 times daily) or pioglitazone (30 mg daily) for 3 months. Clinical (body weight, blood pressure [BP], and body mass index) and laboratory indices (fasting blood sugar [FBS], serum triglyceride [TG], cholesterol, low-density lipoprotein, high-density lipoprotein, insulin, testosterone, and dehydroepiandrosterone [DHEA]) were measured before and after therapy. Data were analyzed by Chi-square and McNemar's tests. Results: Significant decreases were seen after treatment with metformin in extent of hair loss (P = 0.008), wrist circle (P = 0.011), weight (P = 0.047), diastolic BP (P = 0.023), and DHEA (P = 0.035). A significant decrease in TG was seen with pioglitazone treatment (P = 0.047). In both groups, significant decreases in acne, menstrual disturbance, FBS, and serum insulin were seen. Conclusion: There is a significant amelioration of endocrine and metabolic indices with pioglitazone in PCOS patients. Although we were not able to recommend one treatment regime over the other, pioglitazone offers a useful, alternate treatment in women with PCOS who are not able to tolerate metformin

Late-onset Pompe Disease with Elevated Liver Transaminases: A Case Report

Pompe disease or type II glycogen storage disease is a rare autosomal hereditary disease. The prevalence of the disease is about 1 in 40,000 to 1 in 300,000 population. It usually occurs as a result of glycogen accretion following acid maltase deficiency. The current treatment is enzyme replacement therapy, which may slow down the disease progression. Sometimes, the clinical presentation can be atypical and lead to late recognition. This article reports a 32-year-old female with persistent fatigue and mild elevated liver transaminase levels. Biochemical analysis initially did not result in a diagnosis. Years later, increased Creatine kinase (CK) and lactate dehydrogenase (LDH) were observed. A muscle biopsy exhibited unusual glycogen accretion, followed by dried blood spot, indicative of Pompe disease. Notably, persistent raised levels of hepatic transaminases are not exclusive to liver pathology and clinicians should also consider extrahepatic causes

Ultrasonographic findings of rheumatoid arthritis patients who are in clinical remission

Background: The aim of this study was to recognize the findings of ultrasonography (US) in remitted rheumatic arthritis (RA) patients for detection subclinical arthritis. Materials and Methods: This descriptive study was conducted during 2016 in a rheumatology center. A total of 70 patients with remitted RA were included in the study. Sonography was performed on all 70 patients who did not show any clinical arthritis in clinical examination to find synovitis and effusion were evaluated with gray scale and hyperemia with power Doppler US. Results: Nearly 44.3% (n = 31) of our patients had positive sonography results including 20% synovitis, 21.4% hyperemia, and 18.6% (n = 13) effusion. A total of 1960 joints of 70 patients were evaluated, in which 3.2% (n = 63) of joints had positive sonography findings including 1.2% synovitis, 1.5% hyperemia, and 1.1 with effusion. Conclusion: US can diagnosis subclinical arthritis in patients with remitted RA who does not show any joint involvement in clinical examination

Prevalence of depression in rheumatoid arthritis patients and its relationship with disease activity: A cross-sectional study

Background. Depression is a common disorder in rheumatoid arthritis (RA) patients and can affect clinical outcomes. This study was conducted to determine the prevalence of depression and its relationship with disease activity in RA patients. Methods. In this cross-sectional study, 144 patients with RA were recruited from the Rheumatology Outpatients Clinic, Mostafa Khomeini Hospital Ilam, and were examined for disease activity and depression symptoms. Disease activity was assessed by DAS28 using laboratory tests and physical examination. The Beck self-report questionnaire was used for measuring depression disorder. Data were analyzed using the linear regression models in STATA 14 software. Results. The prevalence of depression in the sample was 61%. Multivariate analyses showed that patients with severe disease activity faced a significantly greater risk of depression compared to those with mild disease activity. Average levels increased by about 12.43 points in depression for patients with severe disease activity compared to those with mild disease activity. This association was statistically significant after adjusting for the model's other predictors (P<0.001). Furthermore, predicted models showed that the probability of depression increased with age and disease duration in patients with severe activity. Conclusion. Considering the relationship between depression and severe RA disease activity, the need to screen RA patients in terms of depression disorder and pay attention to comprehensive mental and physical care and cure for better clinical outcomes seems necessary. Practical Implications. Severe disease activity in RA may have been influenced by a psychological phenomenon such as depression; therefore, it was suggested that depression, as one of the diseases worsening the RA symptoms, should be screened and evaluated. It was also recommended that a comprehensive and multidisciplinary approach should be adopted by seeking assistance from psychiatric and psychological specialists in RA disease management

Two Unrelated Iranian Patients with Adenosine Deaminase 2 Deficiency: A Case Report and Review of Treatment

Background. Adenosine deaminase deficiency 2 (DADA2) is an autoinflammatory disorder, caused by the CECR1 gene mutation. The major clinical manifestations include recurrent vasculitis, neurological disorders such as stroke, hematologic abnormalities, and immunodeficiency. As reported in previous studies, DADA2 may be manifested by ischemic or hemorrhagic strokes. This disorder also includes various hematological manifestations (pure red cell aplasia, pancytopenia, hemolytic anemia, and pancytopenia with bone marrow involvement). Case Presentation. In this case report, we present the clinical and immunological findings of two unrelated patients with DADA2. The first patient was a 7-year-old female who experienced recurrent neurological symptoms such as vertigo, tinnitus, hearing loss, and right-sided hemiparesis. Her brain magnetic resonance imaging (MRI) revealed a left-sided stroke, and she responded well to antitumor necrosis factor alpha agents and plasmapheresis. The second patient was a 6-year-old female who had recurrent fever and bicytopenia, aphthous lesions, cervical lymphadenopathy, and elevated liver enzymes. We also discussed the strategies used to manage the clinical manifestations in these two DADA2 patients. Conclusion. In this case report, we discussed two cases with DADA2 deficiency and their respective manifestations. The first case showed neurological symptoms while the second case had hematological symptoms. Although there is no established treatment for DADA2 due to its rarity, steroids are commonly used to treat this disorder. Antitumor necrosis factor is also effective in controlling the symptoms, especially the neurological ones. In cases where there is no appropriate response to these treatments, hematopoietic stem cell transplantation can be beneficial