• Editorial
  • Educational impact of case reports

    EDITORIAL

    Report on a clinical case that is experienced during the daily practice of medicine is of prime importance provided that its content add additional information to the knowledge in the field and help clinicians to be aware of the reported condition. Many case reports are published on a daily basis with...
  • Opinions and Ideas
  • A different look at pulsed glucocorticoid protocols Is high dose oral prednisolone really necessary just after initiation of pulse therapy?
    Pulse glucocorticoid therapy is pivotal in severe and life threatening forms of rheumatic and immune-mediated conditions. High dose oral prednisolone has numerous adverse effects and should be balanced with the advantages. Minimal effective dose of most drugs warrants minimal systemic and...

    Main Text

    Glucocorticoids (GCs) or corticosteroids that are biologically similar to adrenal cortical hormones have created revolution in remission of widespread diseases especially in rheumatic and immunologic disorders. Timing of administration and therapeutic dose of this class of medicine varies widely depending on the type of disorder and stage of disease from...
  • Understanding osteoporosis aims to boost our bone health
    Osteoporosis is a debilitating disease which is a huge burden in this high-technology sedentary world. As Bone Mineral Content (BMC) which symbolizes bone health starts to diminish; the relative risk of osteopenia/ osteoporosis will rise. Therefore osteopenic/ osteoporosis management and treatment...

  • Letter to editor
  • Insomnia due to fear of hypoglycemia; a psychological reaction
    Hypoglycemia is a serious and vital clinical concern in patients with diabetes mellitus. While the effect of hypoglycemia on the quality of life and diabetes management in persons with diabetes mellitus is well recognized, much less is investigated about its outcomes...

    Letter to editor

    Hypoglycemia is a serious and vital clinical concern in patients with diabetes mellitus. The American Diabetes Association (ADA) has categorized hypoglycemia as symptomatic, asymptomatic, and severe.1 Severe hypoglycemia is defined as a condition that needs another person"s help to provide carbohydrates, glucagon, or take other remedial actions. If severe...
  • Complete resolution of pulmonary artery aneurysm in a patient with Behcet’s disease with infliximab
    We present a case of pulmonary artery aneurysm in a young male patient with Behcet"s disease which completely resolved after treatment with infliximab. Fourteen months after diagnosis of Behcet"s disease he developed chest pain and massive hemoptysis. His symptoms resolved within...

  • Case Report
  • Spontaneous regression of chronic lymphocytic leukemia
    Immune therapy and graft-versus-tumor effect seen after allogeneic hematopoietic stem cell transplantation provide proof-of-principle of the ability of human immune system to control cancer. Spontaneous regression of cancer is another dramatic evidence of the existence of powerful immune surveillance in human...

    INTRODUCTION

    Host immunity plays a critical role in both -creating a microenvironment hostile for tumorigenicity in conjunction with tumor suppressor system as well as in propagating tumor genesis.1 One potential window to our understanding the relationship between immunity and cancers is the phenomena of spontaneous remission which has been described in a...
  • Syncope as a presentation of Fahr"s disease
    Fahr"s Disease is characterized by neurologic, psychiatric, and cognitive disorders of unknown etiology, and is also characterized by symmetric calcifications in the basal ganglia and cerebellar dentate nucleus.The most common symptom of the disease is considered to be movement disorders, both...

    INTRODUCTION

    Fahr’s disease (FD), also called bilateral striatopallidodentate calcinosis (BSPDC), was first defined by German neurologist Karl Theodor Fahr in 1930. It is characterized by neurologic, psychiatric, and cognitive disorders of unknown etiology, and is also characterized by symmetric calcifications in the basal ganglia and cerebellar dentate nucleus, in individuals aged 5-65...
  • Coronary disease in scleroderma; report of two cases
    Scleroderma (SSC) is a systemic inflammatory disease characterized by vascular dysfunction and excessive fibrosis which may involve many organs particularly the heart, lungs and kidney. In scleroderma cardiac disease and pulmonary arterial hypertension (PAH) are common findings where as coronary diseases...

    INTRODUCTION

    Scleroderma (SSC) is a systemic inflammatory disease characterized by vascular dysfunction and excessive fibrosis which may involve many organs particularly the heart, lungs and kidney.1 In such cases interstitial lung fibrosis and pulmonary vascular disease can lead to pulmonary arterial hypertension. Myocardial fibrosis, valvular disease, microcirculation and conduction abnormalities have also...
  • Marcus Gunn jaw winking syndrome; a case with only severe retraction
    Marcus Gunn jaw winking syndrome (MGJWS) first described in 1883 by Marcus Gunn is a synkinesis of masticatory muscles (usually) and levator palpebrae superioris resulting in a synchronic eyelid and pterygoid muscles contraction. It is a rare, congenital, unilateral and non-progressive...

    INTRODUCTION

    Marcus Gunn jaw winking syndrome (MGJWS) first described in 1883 by Marcus Gunn as a unilateral ptosis and eyelid contraction associated with pterygoid muscles contraction.1 Although it is a rare congenital disorder but constitutes up to 13% of congenital ptosis.2 There are two major MGJWS, external and internal. In external type...
  • Not all myeloid sarcomas have a liquid friend! Myelosarcoma of the sacrum accompanied by severe myelofibrosis
    Myeloid sarcoma is a rare disease with poor prognosis. It is characterized by tumor masses composed of myeloblastic cells and usually occurs in association with acute myeloid leukemia. A 71 year old female with past medical history of essential thrombocytosis for...

  • Association of ankylosing spondylitis and Takayasu’s arteritis: a case report
    Ankylosing spondylarthritis and Takayasu’s arteritis are two inflammatory diseases with a not yet elucidated pathogenic mechanism. Only a few cases with this association (15 cases) have been published in the literature. We report here a new case of a 20-year-old, HLA-B27...

    INTRODUCTION

    Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown cause associated with human leukocyte antigen (HLA)-B27. In general population AS occurs in 1-2% of HLA-B27 positive adults.1 The male to female preponderance is 2:1.2 This disease presents with idiopathic, progressive, inflammatory arthritis of the spinal, extra axial and sacroiliac joints.1...
  • Persistent pancytopenia and a hypocellular bone marrow after induction chemotherapy in a young adult with acute myelogenous leukemia; What is missing here?
    Congenital bone marrow failure syndromes (CBMFS) are generally diagnosed in infancy and early childhood, but may go unrecognized until adulthood. These syndromes are increasingly being diagnosed into adulthood, possibly due to the availability of genetic testing. We describe a young gentleman...

    INTRODUCTION

    Congenital bone marrow failure syndromes are a group of genetic disorders with decreased production of one or more cell lineage and are characterized by a predisposition for malignancy, particularly hemato-logic malignancies.1 Shwachman Diamond syndrome most often presents in infancy with bone marrow failure and exocrine pancreatic dysfunction. The management of these...
  • Enterococcal-associated respiratory tract infection in dermatomyositis
    This is to report a rare case of enterococcal pneumonia and pleural effusion in a 32-year-old woman with severe and active dermatomyositis. She developed fever, respiratory failure, and pleuritic chest pain for 12 days before admission to our hospital. Chest X-ray...

    INTRODUCTION

    Polymyositis (PM) and dermatomyositis (DM) are systemic inflammatory disorders affecting skeletal muscles and other organs.2-4 PM and DM are consid-ered to be associated with high morbidity and mortal-ity rates, primarily related to life-threatening muscle weakness, cardiac and lung impairment, as well as infectious manifestations.1–5 In clinical series of pa-tients with PM/DM,...
  • Dyskeratosis congenita; a case with a favorable outcome
    Dyskeratosis congenita (DKC) is a rare bone marrow failure syndrome which is recognized with a clinical triad of hyperpigmentation, nail dystrophy and oral leukoplakia. Two major conditions are known to be responsible for the high mortality rate of DKC which are...

  • Spontaneous acute compartment syndrome of the forearm in a patient on oral anticoagulant therapy
    Acute compartment syndrome (ACS) in the upper extremity may present with many different signs and symptoms such as swelling, severe pain or paresthesia. These patients require an emergent fasciotomy to decompress the compartment. It is commonly caused by major traumas however...

    INTRODUCTION

    Acute compartment syndrome (ACS) of the upper ex-tremity is a rare diagnosis. ACS can be defined as the increase in compartment pressure which exceeds tis-sue perfusion pressure leading to ischemia and necro-sis.1 Often times the cause is due to traumatic events such as suprachondylar humerus fractures, vascula-ture injury or circumferential full...
  • Pachydermoperiostosis and literature review
    To report two cases of pachydermoperiostosis and to improve the clinic methods of diagnosing and treating this disease. Two pachydermoperiostosis patients in Huashan hospital were reported; the laboratory tests, imaging, and pathology tests had been taken; the related literatures were analyzed....

    INTRODUCTION

    Pachydermoperiostosis (PDP), also known as To-uraine - Solente - Gole – syndrome, first reported in 1868 by Friedeich, clearly was confirmed as an in-dependent disease in1935 by Touraine, Solente and Gole. It can be divided into primary and secondary subcategories. The secondary one is often second-ary to cardiopulmonary disease, such as...
  • Autoimmune hepatitis associated with an abnormally low ceruloplasmin level
    A 44-year-old female with a remote history of autoimmune hepatitis (AIH) in remission presented with fatigue and scleral icterus, and developed fulminant liver failure within 24 hours of admission. The initiation of therapy was delayed due to the incidental finding of...

    INTRODUCTION

    Autoimmune hepatitis (AIH) is thought of as a cause of chronic liver disease accounting for approximately 20% of cases of chronic hepatitis, with an estimated annual incidence among whites of Northern Europe-an descent of 1.9 cases per 100,000.1,2 Acute severe presentations are uncommon and remain the greatest challenge with the least...
  • Medicolegal causation analysis of a lumbar spine fracture following a low speed rear impact traffic crash
    Epidemiologic study indicates that low-speed traffic crashes are associated with a relatively low risk of significant injury. This fact is often used to defend legal actions in cases in which it is alleged that a significant injury has resulted from a...

    INTRODUCTION

    The assessment of injury causation following a low speed traffic crash is often a contentious issue, for several reasons. The most prominent reason is related to the fact that the majority of low speed collisions consist of aligned rear impact crashes [1], and that the occupant most likely to be injured...
  • Post-traumatic pulmonary pseudocsyt
    Traumatic pulmonary pseudocysts are rare cavitary lesions of the lungs that develop after chest trauma. The lesions often occur in young adults and males. Other cavitary lesions of the lungs must be taken into consideration when distinguishing the diagnosis, and it...

    INTRODUCTION

    Injuries to the lung parenchyma after blunt trauma to the chest often result in lung contusion or hematoma. The cavitary lesions of the lungs and pseudocysts rarely occur in association with lung trauma. These lesions mostly occur in young adults and childre.1 Traumatic pulmonary pseudocysts (TPP) generally do not require specific...
  • A case of propylthiouracil ANCA associated vasculitis with extensive skin necrosis and bizarre gastrointestinal ulcers
    ANCA-associated vasculitis is a rare complication of anti-thyroid treatment. It can involve several organs and can be life-threatening. Skin is commonly involved. In this study, we present a case who was under treatment with propylthiouracil (PTU) for two years and developed...

    INTRODUCTION

    Propylthiouracil (PTU) is a thiourea anti-thyroid agent which inhibits the synthesis of thyroid hormones, it is frequently used in the managing of hyperthyroidism, and is usually prescribed for a long periods of time. Several adverse effects related to PTU have been described including agranulocytosis, aplastic anaemia,1 hepatitis,2 and interstitial pneumonitis.3 Autoimmune...