Case report: a report of a rare case tumoral calcinosis syndrome in a patient afflicted with psoriatic arthritis.

In this report, we describe the case in which tumoral calcinosis occurs in a patient afflicted with psoriatic arthritis. INTRODUCTION: Tumoral calcinosis is a benign disease which occurs quite rarely. It is similar to a neoplasm and appears as the result of calcium deposition in the soft tissues around large joints. This disease can develop as a primary or secondary disease in patients. CASE REPORT: In this report, the authors describe the case in which tumoral calcinosis occurs in a female afflicted with psoriatic arthritis. We review the patient's clinical and para clinical findings. CONCLUSIONS: Our report is the first one in which an Iranian patient with psoriatic arthritis has been diagnosed to have tumoral calcinosis. Imaging and pathological examinations are the common diagnostic methods. The main treatment for that is tumor resection.

Neurological Manifestations in Familial Mediterranean Fever: a Genotype-Phenotype Correlation Study.

BACKGROUND AND AIMS: Familial Mediterranean Fever (FMF) is a periodic auto-inflammatory disease with an autosomal recessive hereditary pattern. The aim of this study is to explain the spectrum of possible neurological manifestations and its genotype-phenotype correlation in patients with familial Mediterranean fever. METHODS: In this case series study, data of 311 FMF patients at the FMF Registration Center in Iran (http://www.fmfiran.ir/) was studied. Patient's information was entered into a researcher designed questionnaire. Data were analyzed by SPSS software. RESULTS: The mean age of the 181 male and 130 female patients was 23.01 years, ranging from 3-78 years old. Twelve common MEFV gene analyses were performed in 311 patients, with mutated results in 187 (60.1%) patients. The most common neurological manifestations were headache in 47.26%; 64.1% of those were persistent and 35.9% had a recurrent nature. Other neurological manifestations were vertigo (83 patients, 26.7%), paresthesia (72 patients, 23.2%), tremor (53 patients, 17%), disorientation (40 patients, 12.9%), breath-holding (23 patients, 7.4%), migraine (19 patients, 6.1%), syncope (8 patients, 2.6%), epilepsy (7 patients, 2.3%), febrile seizure (4 patients, 1%), and ataxia (5 patients, 1.6%). There were no cases of stroke or metabolic disorders among these patients. CONCLUSION: The prevalence of epilepsy among FMF patients was significantly higher than the general population. FMF patients with negative results for MEFV gene mutations had significant frequency of headache, paresthesia, breath-holding, and ataxia.

Comparison of Bone Mineral Densitometry at 2 Sites Versus 3 Sites in Patients Suspicious for Osteoporosis.

OBJECTIVES: In this study, we aim to evaluate the bone mineral density (BMD) results of 2 standard sites with 3 sites including wrist in diagnosing osteoporosis. METHODS: We evaluated the BMD results of 1272 individuals referred for suspected osteoporosis between 2012 and 2015. Those individuals were included with BMD at lumbar spine, femur neck, and wrist. Bone mineral density was measured using a dual-energy X-ray absorptiometry (DXA) device. Bone mineral density and T score were measured for all 3 sites. RESULTS: There was significant correlation between wrist T score with hip T score (r = 0.606, P < .001) and lumbar T score (r = 0.527, P < .001). With BMD of 2 sites, patients had osteopenia in 46.3% and osteoporosis in 23.7%, while by adding wrist T-BMD, subjects had osteopenia in 46.6% and osteoporosis in 33%. Between BMD at 2 sites and 3 sites, there was concordance in 81.9%, minor discordance in 17.6%, and major discordance in 0.5%. CONCLUSIONS: We observed discordance between BMD measurements of 2 sites and 3 sites, with latter detecting more cases with osteoporosis. In fact, measurement of T scores of wrist along with lumbar and femur neck improves the diagnosis.

Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis.

INTRODUCTION: Knee osteoarthritis (OA) is a common form of arthritis in elders which can lead to reduced daily activity and quality of life. It is important to administer a proper treatment with high efficacy and low side effects. In this study, we evaluated the efficacy of duloxetine and gabapentin in patients with moderate to severe knee OA. METHOD: In this randomized clinical trial, 150 patients with moderate to severe knee OA were randomly allocated to receive duloxetine 30 mg (n = 50), gabapentin 300 mg (n = 50), or acetaminophen 1000 mg (n = 50) all twice a day for 12 weeks. Pain severity using visual analogue scale (VAS) and functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were measured before, 2 weeks, 1 month, and 3 months after intervention. RESULTS: WOMAC total and its subscale score were significantly lower in duloxetine compared to gabapentin in 2 weeks and 1 months after intervention, with no significant difference at the end of the third month. Both gabapentin and duloxetine groups had significantly more reduction in pain VAS and WOMAC and its subscales compared to acetaminophen group, with no significant difference between groups. CONCLUSIONS: Both gabapentin and duloxetine have similar and acceptable effects in pain reduction and improvement of functional status in patients with knee OA at the end of the third month's treatment. Duloxetine effects begin from the first weeks, while gabapentin effects begin gradually with the best at the end of the third month. KEY POINTS: • Medical treatment is used for releiving pain in knee osteoarthritis. • Gabapentin and duloxetine are both effective in reducing pain in knee osteoarthritis.

High Frequency of Macrolide-Resistant Streptococcus pneumoniae Colonization in Respiratory Tract of Healthy Children in Ardabil, Iran.

BACKGROUND: Streptococcus pneumoniae (S. pneumoniae) is one of the most common causes of human diseases in young children. Macrolides are commonly antibiotics used for empirical treatment of community-acquired respiratory infections. The purpose of this study was to determine antibiotic resistance pattern as well as the relationship between macrolide resistance and the major mechanisms of resistance in pneumococci isolated from healthy children. MATERIALS AND METHODS: In this cross-sectional study, 43 isolates of S. pneumoniae were collected from healthy children in Ardabil. Resistance pattern against tested antibiotics was determined using the disk diffusion method. The Minimum Inhibitory Concentration (MIC) of erythromycin was determined using the E-test strips. The mefA/E and ermB gene were detected in erythromycin-resistant isolates using the specific primers and Polymerase Chain Reaction (PCR) technique. RESULTS: According to antimicrobial susceptibility testing, 74.4 % of the isolates were resistant to erythromycin, 95.3 % to penicillin, 81.3 % to co-trimoxazole, 72 % to azithromycin, 41.8 % to tetracycline, 27.9 % to clindamycin, and 16.2 % to chloramphenicol. All isolates were susceptible to levofloxacin and vancomycin. In the case of rifampin, 95.3% of the isolates were sensitive and 4.6% semi-sensitive. The MIC of erythromycin for resistant isolates was between 1.5 and ≥ 256 µg/ml. PCR results revealed that 100% of erythromycin-resistant isolates contained mefA/E gene and 81.25 % contained both the ermB and mefA/E genes. CONCLUSION: The prevalence of antibiotic-resistant strains of S. pneumoniae, especially resistance to macrolides, was high among healthy children in Ardabil. According to the results of this study, we suggest using levofloxacin, rifampin and vancomycin antibiotics as an appropriate prophylactic regimen in pneumococcal infections.

Interstitial Keratitis, Vertigo, and Vasculitis: Typical Cogan's Syndrome.

Cogan's syndrome (CS) is a chronic inflammatory disorder of unknown etiology that most commonly affects young adults. Clinical hallmarks are bilateral interstitial keratitis and vestibuloauditory dysfunction. Association between CS and systemic vasculitis as well as aortitis also exists. The diagnosis of CS is based upon presence of characteristic inflammatory eye disease and vestibuloauditory dysfunction. We describe classic Cogan's syndrome in a 47-year-old female from Ardabil. The patient was admitted with headache, vertigo, nausea, vomiting, right leg claudication, musculoskeletal pains, bilateral hearing loss, and blindness for the past two months. Ophthalmologic examination revealed that visual acuity was 0.1 bilaterally. Conjunctival hyperemia, bilateral cataract, and interstitial keratitis were detected with a slit lamp examination. Pure tone audiogram (PTA) and auditory brain stem response (ABR) showed bilateral sensorineural hearing loss. The other differential diagnosis of CS was studied and ruled out. Pulse i.v. methylprednisolone and cyclophosphamide were given and were followed by oral prednisolone and cyclophosphamide. Clinical follow-up showed partial improvement.

The diagnostic value of ultrasound compared with nerve conduction velocity in carpal tunnel syndrome.

OBJECTIVE: Carpal tunnel syndrome (CTS) is the most common form of peripheral entrapment neuropathy. The use of sonography for investigation and diagnosis of musculoskeletal conditions has been rapidly increasing over the past few decades. The purpose of this study was to determine whether sonography can be an alternative method to nerve conduction study (NCS) in the diagnosis of CTS. METHODS: Individuals with electrodiagnostically proven CTS and healthy control subjects were enrolled prospectively. Median nerve cross-sectional area (CSA) and flattening ratio (FR) at three different levels, proximal to tunnel inlet, at tunnel inlet and tunnel outlet, and flexor retinaculum thickness, were measured. Then, comparisons between ultrasonography and NCS were made. RESULTS: We assessed 180 wrists, of which 120 were electrophysiologically confirmed as CTS diseased hands and 60 nondiseased hands in 90 patients (83 women and seven men). The mean median nerve CSA at the tunnel inlet was 13.31 ± 3.23 mm(2) in CTS diseased hands and 8.57 ± 0.82 mm(2) in nondiseased hands. Post hoc comparisons between the diseased and nondiseased hands demonstrated that the CSA at various levels of the median nerve were significantly greater in the CTS diseased hands than the nondiseased hands (P = 0.001). CSA at the tunnel inlet with a threshold of 9.15 mm(2) gave the best diagnostic accuracy with a sensitivity and specificity of 99.2% and 88.3%, respectively. The difference in cross-sectional area of the median nerve in mild, moderate and severe CTS was statistically significant. CONCLUSION: Ultrasonographic measurement of the CSA of the median nerve at the carpal tunnel inlet is useful in diagnosing and grading CTS.

Alkaptonuric ochronosis: a clinical study from Ardabil, Iran.

OBJECTIVE: Ochronosis is a term used to describe pigment deposition that occurs in the connective tissues of patients with alkaptonuria, an autosomal recessive disorder that results from a deficiency of homogentisic acid oxidase. Brown or blue-gray discoloration of the skin may be seen on the axillary and inguinal areas, face, palms or soles. In addition, blue-black discoloration can be apparent on skin overlying cartilage in which the pigment is deposited, such as the ears. The sclerae are also typically involved. The cheapest screening test to perform prior to expensive lab tests is the urine oxidation test: having it standing in light for a period of 24 h when suspicion has risen. METHODS: Retrospective analysis of patients with ochronotic arthropathy seen between September 2011 to September 2013 was carried out. RESULTS: Seven patients (four male, three female) with ochronotic arthropathy were seen, their mean age was 46.1 years. All patients had bluish-black pigmentations of the ear cartilage and sclera. Spondylosis was seen in all, whereas peripheral arthritis was present in five patients. Moderate aortic insufficiency and calcification of the aortic valve was detected in one male patient. Urine screening for homogentisic acid was positive in all seven patients. CONCLUSION: Alkaptonuria is a rare autosomal recessive disorder of the metabolism caused by deficiency of homogentisic acid oxidase. It is suggested that more widespread screening should be undertaken in order to assess the true incidence of the disorder.

Epidemiologic profile and clinical characteristics of ulcerative colitis in northwest of Iran: a 10-year review.

BACKGROUND AND AIM: There are few reports from Iran about the epidemiology and clinical features of inflammatory bowel disease (IBD). In this study, we aimed to determine the epidemiologic profile and clinical features of ulcerative colitis (UC) in Northwest of Iran. METHODS: This retrospective study covered the time period from 1998 to 2008 and included all patients of a private gasteroenterology clinic in the northwest of Iran, who had diagnosis of UC at the time of presentation or those whose diagnosis had been made later. In addition to description of epidemiology and clinical feature of disease, an attempt was made to identify factors associated with severity of disease. RESULTS: A total of 105 patients including 61 females (58.1%) were evaluated. Mean age of the patients was 33.5 +/- 13.1 years. The median time interval from initiation of symptoms to diagnosis was 9 months. The commonest presentation was proctosigmoiditis. (48.6%). Among extra-intestinal manifestations, sclerosing cholangitis had the highest frequency and was found in 2 (1.9%) patients. Among all evaluated variables, only family income (the higher the income the more severe the disease) and cigarette smoking (inverse association) were find to have significant association with severity of disease. CONCLUSION: A case profile of patients with ulcerative colitis from Northwest Iran suggests that the disease is seen most commonly in the third decade of life with a female preponderance. Family income and smoking influenced the course of ulcerative colitis in Iranian patients.