Successful maintenance treatment of a patient with resistant hyperthyroidism with traditional Persian medicine recommendations: A case report and literature review.

INTRODUCTION: Hyperthyroidism is a common endocrinology condition that could affect several aspects of the patient's life. CASE PRESENTATION: We present a 27-year-old woman who was sent to the traditional Persian medicine (TPM) clinic with a diagnosis of uncontrolled chronic hyperthyroidism (lower levels of thyroid stimulating hormone (TSH) and higher levels of T3 and T4) and its complications, such as developing exophthalmos, palpitations, anxiety, sleep problems, hair loss, and dry skin. The patient was under treatment with prednisolone and methimazole for up to one year, but no acceptable improvement was achieved. The patient received a package of TPM recommendations, which included lifestyle modification, Melissa officinalis herbal tea, and Persian barley water. The patient was followed for one year. After two months of follow-up of the patient, the level of TSH increased, and the level of T3 and T4 decreased. In addition, the patient's symptoms, including exophthalmos, palpitation, anxiety, sleep disturbance, and dryness of the skin, were improved considerably. After three months of consumption of the TPM-based regime and prescription, the serum levels of TSH, T3, and T4, of the patient were in normal ranges. In a one-year follow-up of the patient, the patient's condition was stable and her thyroid function tests were normal. We hereby present the following case to be in line with the CAse REports (CARE) checklist. CONCLUSION: It appears that TPM lifestyle recommendations, Melissa officinalis herbal tea, and Persian barley water were effective in treating the patient with uncontrolled hyperthyroidism. We recommend further studies and clinical trial designs in this regard.

Prevalence and risk factors of latent tuberculosis infection in hemodialysis patients in southwest Iran.

INTRODUCTION: Tuberculosis (TB) is a significant global health concern, particularly in developing countries. Diagnosing latent tuberculosis infection (LTBI) in hemodialysis patients is crucial because of the risk of developing active tuberculosis in this population due to attenuated immune response. Herein, we assessed the prevalence of LTBI in hemodialysis patients. METHODS: In this cross-sectional study, we included all patients referred to hemodialysis centers in Kohgiluyeh and Boyer-Ahmad Province, southwest Iran, in 2018 through census sampling. Tuberculin skin test (TST) was utilized to screen the patients for LTBI. All steps were done by trained physicians. RESULTS: In total, 183 patients (mean age: 59.3, SD= 16.0) were included in the study of which 76 (41.5%) were females, and 107 (58.5%) were males. Neither the patients nor their family members had a history of tuberculosis. Assuming an above 5-millimeter enduration as a positive TST result, 22 patients (12%) had LTBI. None of the demographic or clinical features differed between TST -negative and -positive groups. CONCLUSION: Hemodialysis patients are prone to LTBI due to several immunological and environmental factors. Screening for LTBI may be beneficial to prevent active tuberculosis in this population.

A case of ankylosing spondylitis presenting with fever of unknown origin diagnosed as aortitis: A case report.

Key Clinical Message: Clinicians should be aware of rare manifestations of AS, while considering a low threshold for screening vascular involvement in an axial SpA/nrxSpA/AS presenting with unexplained fevers and significant constitutional symptoms and elevated markers. Abstract: Ankylosing spondylitis (AS) is a chronic inflammatory disease from the spondyloarthritis complex, which usually affects young men and primarily involves sacroiliac joints and the spine. It can also present with non-joint involvement, such as cardiovascular manifestations. Aortitis is a rare yet critical cardiovascular complication associated with AS, which can lead to life-threatening outcomes when undiagnosed. Here we report a 34-year-old man with intermittent fevers and significant weight loss, myalgia, and arthralgia for 1 year before being referred to our hospital due to undefinable causes despite multiple diagnostic efforts. The patient presented with elevated inflammatory markers and involvement of sacroiliac joints in favor of the AS. A positron emission tomography scan was also done to rule out underlying malignancy, which led to the detection of inflammation in ascending aorta, compatible with aortitis. The patient was treated with nonsteroidal anti-inflammatory drugs, prednisolone, and infliximab, and his signs and symptoms significantly improved. Our case reports a rare but substantial complication of AS, in a young patient without a history of prolonged disease presenting with unspecific manifestations. The implantation of a thorough examination of AS patients, including cardiac examinations, could contribute to faster and more efficient diagnosis and treatment.

Therapeutic Efficacy of Great Plantain (Plantago major L.) in the Treatment of Second-Degree Burn Wounds: A Case-Control Study.

Background: Great plantain (Plantago major L. or P.major) is a medicinal plant that is available all around the world. The whole plant has several bioactive compounds including terpenoids, flavonoids, phenolic compounds, alkaloids, fatty acids, iridoid glycosides, polysaccharides, and vitamins. Scientific studies have recognized several medical benefits like wound healing, anti-inflammatory, antimicrobial, antiulcerative, and antioxidative agents. The wound-healing capacity of this plant has been investigated under in vivo and ex vivo conditions. In the current study, we aim to compare the therapeutic effect of the P.major extract with 1% sulfadiazine on the healing of second-degree burn wounds. Method: Second-degree burn victims were included in our study. The investigation and control group, respectively, received P. major ointment 10% and silver sulfadiazine ointment 1%. The bacterial culture from the wound site was taken on days 3, 7, 10, 13, and last day of hospitalization. Patients' subjective complaints were obtained through the visual analog scale (VAS). All patients were treated and evaluated in the hospital. Result: Among the 15 patients, 11 were male, and the mean age was 33.3 years. The average complete healing duration was 11.73 vs. 13 days in the P. major and control group, respectively (P=0.166). On the third day, infection control was similar between the two groups, and on the seventh day, all bacterial cultures were negative. Although there was a significant reduction in pain scores during the recovery time, no significant differences in pain reduction were noted between the two groups (P=0.849). Conclusion: We showed that P.major ointment is a safe and suitable herbal compound in the treatment of second-degree burn wounds that not only has wound-healing properties but also is an analgesic and antimicrobial compound.