Pachymeningitis in a Patient With Granulomatosis With Polyangiitis; A Case Report

Inrtoduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries. Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab. Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis

The Position of E-Health in Reshaping Doctor/Patient Communications

Accessibility to all levels of information technology has experienced rapid progress in recent years, particularly in the health sector. Rapid penetration into this technology has led to changes in lifestyles and changes in the working procedures of institutions. In 2014, the number of Internet users reached 3 billion, and this number is predicted to exceed 8 billion in 2018. Statistics estimate the number of Iranian users of the Internet to be about 45 million. In 2014, more than 80% of Internet users searched for health information. Today, the Internet plays a vital role in providing such health services as education, disease management, support, basic medical treatment decisions, and doctor-patient communication

Efficacy of Elaeagnus angustifolia extract in the treatment of knee osteoarthritis: a randomized controlled trial

Osteoarthritis (OA) is one of the most common musculoskeletal disorders all over the world. Available antiarthritic medications have only partial efficacy and their long-term use is associated with adverse events. Elaeagnus Angustifolia (EA) is a medicinal plant with analgesic and anti-inflammatory properties. The present study evaluated the impact of two doses of EA extract compared with ibuprofen on the severity of disease in patients with knee OA. This study was designed as a randomized, double blind, active-controlled and parallel group trial. Patients with OA were randomized to receive 300 mg/day (n=33) or 600 mg/day (n=32) of EA aqueous extract, or 800 mg/day ibuprofen (n=32) for 7 weeks. EA extract contained 0.21 % (w/w) kaempferol according to HPLC. Efficacy of treatment was assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) of pain, Lequesne’s Pain-Function Index (LPFI), and patient’s global assessment (PGA) index. The amount of kaempferol in the extract was determined by HPLC method to be 0.21 % w/w. There were significant reductions in WOMAC, VAS, LPFI and PGA scores by the end of trial with all three interventions. Comparison of the changes in WOMAC, VAS and LPFI scores among the treatment groups did not reveal any significant difference between EA and ibuprofen, and between low and high doses of EA. EA was safe and well tolerated during the course of trial and no adverse event was reported. The present results suggest beneficial effects of aqueous EA extract in reducing the symptoms of OA with an efficacy comparable to that of ibuprofen

Bilateral Facial Paralysis and Otitis Media as the First Presentations of Wegener’s Granulomatosis: A Case Report

Introduction: Cranial nerve palsy in Wegener’s granulomatosis is a curious incident, particularly if it occurs without kidney or lung involvement. In a review of medical articles, only 1 case of Wegener’s granulomatosis with bilateral facial nerve palsy was found. Case Presentation: The patient was a 16-year-old female who presented with pain and hearing loss in both ears and reduced muscle tone in the right side of her face. After myringotomy and ventilation tube embedding in both ears, she gradually developed infectious otorrhea in both ears. Despite antibiotic and antifungal therapy for 2 weeks after surgery, the patient developed paresis in the left facial nerve and gag reflex disorder. Both magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) tests were normal, but the C-anti-neutrophil cytoplasmic antibody (CANCA) test result was about forty times higher than normal, and a sinus biopsy also verified Wegener’s granulomatosis. The patient was then treated with pulse corticosteroid and cyclophosphamide therapy. Her gag reflex healed and the ear secretions stopped, but the facial nerve palsy continued. Conclusion: Although cranial nerve involvement in Wegener’s granulomatosis is an unusual incidence, it may occur in some cases. In the current case, otitis media and cranial nerve paresis without kidney or lung disorders were the only signs of disease onset; of course, computerized tomography (CT) scan revealed a right mandibular sinus disorder without any clinical signs. Another important point in this case is that other identified Wegener’s patients were in their fourth or fifth decade of life; thus, Wegener’s was the last choice for a diagnosis in the current case

Assessment of Factors Affecting the Establishment of Hospitals in Iran

Background: It is important to set up hospitals, since they play a key role in providing health care services based on the budget allocated to the health sector. Objective:  This study evaluated factors militating against the establishment of hospitals in Iran. It also emphasized the importance of health care services. Methods: This cross-sectional study was conducted in 2012 using a qualitative approach. The study sample consisted of 22 people, officials, administrators and health experts who were recruited by purposeful selection. In order to collect data, a semi-structured interview was conducted. Data was analyzed using an Atlas-Ti software. Results: Analysis of the interviews suggest that the issue of providing services in terms of ease of access and equity in the allocation of health services is also the focus of particular attention. The socio-economic status of regions were examined in terms of the need for poverty alleviation, equity in health and well-being of interest to industry participants. The survey interviews revealed that the issue of financing and human resources for provincial hospitals, were the key challenges raised by participants in the study. Conclusion: According to the findings of this study, feasibility studies and evidence-based management optimal decisions were adopted in order to build and operate hospitals in the provinces

Treatment of Osteopenic Menopause Women as a Public Health Problem with Nasal Calcitonin; an Original Study on Follow up Markers

Introduction: Various therapeutic options such as Calcitonin are suggested for patients with low bone density. However, the efficacy remains uncertain in all patients. C-telopeptide of type I collagen (CTx) is the authentic bone marker which is recently used to assess the bone turnover. This study aimed at revealing the therapeutic effects of Calcitonin on osteopenic women via serum CTx and assessment of other biochemical markers. Methods: we conducted a before-after clinical trial on menopause women with low bone mineral density (bone mineral density score less than 1.5 SD of peak bone mass) attending Baqiyatallah hospital clinic. They received 200 IU Calcitonin nasal spray, calcium (1000 mg) and vitamin D (400 IU). Then the serum CTx and other laboratory parameters were compared after a 6 months treatment. The data was analyzed using SPSS ver.16, paired T-test and regression model. Results: The study population included 115 menopause women with the mean age of 58.75 ± 8.15 years. The CTx amount decreased significantly compared with that of the baseline level (3.203 ± 2.24 vs. 2.497 ± 1.657 Pmol/lit, P 0.05). Conclusion: Nasal spray of Calcitonin could be effective on the progression of osteoporosis by decreasing bone tissue turnover and improving the bone density. Further controlled-studies with a larger sample size and a longer duration of follow up are recommended

Antiphospholipid antibodies and COVID-19 mortality and thrombotic events; A systematic review and meta-analysis

Introduction:Among various proposed pathologic mechanisms during the coronavirus disease 2019 (COVID-19) pandemic, overproduction of autoantibodies is not widely studied. Antiphospholipid antibodies (aPLs) are target proteins that have affinity toward charged phospholipids. APLs are thought to have pro-thrombotic potentials that increase during thromboembolism. The present systematic review and meta-analysis aimed to evaluate the relationship between serum aPLs level and COVID-19 mortality, severity, and thrombotic events.Methods: This systematic review and meta-analysis was conducted on all open access published articles in Medline, Scopus and Google Scholar. Studies evaluating individuals over the age of 18 years who were diagnosed with COVID-19 and had positive aPLs; and provided data on mortality or thrombotic events were included. Results: Of the initially identified 512 articles, 22 studies (overall 1462 patients) were finally included in the analysis. The prevalence of positive aPLs was 48.1%. Among the 372 patients with positive aPLs, 156 patients (41.9%) had severe COVID-19 that indicated a significant relationship between COVID-19 severity and aPLs positivity (p<0.05). The prevalence of thrombotic events in aPLs positive patients was 26.3% that indicated a significant relationship between aPLs positivity and the development of thrombotic events (p=0.03). APLs positivity was related to anytime mortality in COVID-19 patients (p=0.01).Conclusion: The present review demonstrated that aPLs are linked to COVID-19 severity and thrombotic events but not short-term mortality. Further studies with longer follow up periods are warranted

Specific Markers of Staphylococcus aureus and Escherichia coli VBNC in Patients with Rheumatoid Arthritis

Background and purpose: Recent studies suggest that the viable but nonculturable (VBNC) bacteria could cause inflammatory diseases. The aim of this study was to detect and investigate the expression of nuc and rfbE genes in blood samples of patients with rheumatoid arthritis (RA). Materials and methods: In this experimental study, 102 blood samples were collected from patients with RA and universal and specific primers were designed. Then, the genome was extracted and PCR reaction was performed to confirm the presence of universal and specific genes. Finally, RT-Real Time PCR reaction was carried out to evaluate the expression of marker genes associated with VBNC bacteria. Data were grouped and analyzed descriptively. Results: PCR showed nuc and rfbE genes in 54 (52.9%) and 12 samples, respectively, while according to RT-Real Time PCR these genes were expressed in 80% of the blood samples of patients with RA. Conclusion: In current study, the VBNC state of Escherichia coli and Staphylococcus aureus were present in the blood samples of patients with RA. Accordingly, and due to the pathogenicity of VBNC bacteria, different diagnostic methods and treatments should be considered for RA