Acute Ischemic Stroke with Devastating Consequences Can Occur Due to Posterior Sternoclavicular Joint Dislocation.

Posterior sternoclavicular joint dislocation is a rare injury requiring prompt diagnosis as it has been associated with the compression of the subclavian and brachiocephalic arteries. We report the case of a 27-year-old male presenting with altered mental status and left hemiparesis found to have life-altering neurologic damage caused by severe orthopedic injury after a fall while intoxicated. Imaging revealed a posteriorly displaced right medial clavicle with surrounding hematoma compressing the brachiocephalic artery causing local thrombus formation and distal embolization, ultimately resulting in malignant cerebral infarction. His hospital course was complicated by cerebral edema requiring decompressive craniectomy, hemorrhagic transformations, brachiocephalic pseudoaneurysm, and the development of remote embolic ischemic infarctions.

Mepolizumab-Induced Posterior Reversible Encephalopathy Syndrome (PRES), a new patient report.

BACKGROUND: Posterior Reversible Encephalopathy Syndrome (PRES) is a neurotoxic state characterized by seizures, headache, vision change, paresis, and altered mental status. PRES has an important place in medicine due to the wide variety of causative diseases, infections, and medications that precipitate its mysterious onset. Although exposure to medications, particularly immunosuppressants, cancer chemotherapy, and biologic drugs, is a common occurrence in patients who develop PRES, Mepolizumab has never before been associated. CASE PRESENTATION: This report of a 67-year-old male patient outlines the first reported case of Mepolizumab-induced PRES in the literature. CONCLUSIONS: Treatment of severe asthma, asthma-exacerbations, and diseases such as eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss) with Mepolizumab is rapidly gaining popularity ever since the drug's recent FDA-approval. This report aims to raise awareness of this potentially life-threatening and previously unreported side effect of Mepolizumab since early identification of the causative agent is the key to preventing the severe neurologic disability and possible death that may occur from the delayed treatment of PRES.

Symptomatic Vascular Compression of Brainstem May Be Managed Conservatively.

Medulla compression from vertebral artery abnormality is a very rare occurrence with few cases present in the literature. It has been documented to present with a very wide spectrum of clinical symptomatology ranging from asymptomatic to full hemiplegia. There is currently no treatment algorithm in place to guide clinicians encountering such patients but treatments have historically involved major posterior compartment surgical interventions. This case outlined a patient evaluated for dizziness without any other neurological symptoms or signs, found to have abnormal dilatation, elongation, and tortuosity of the vertebral artery with resultant compression of the medulla oblongata. The patient was managed conservatively after discussion of surgical options. This report outlined an important consideration for management of medullar compression by vertebral artery based on symptom severity with the possibility of postponing surgical or endovascular interventions and opting for conservative management with an anti-platelet regimen, particularly in the short term.

Declining trends in HIV and other sexually transmitted infections among female sex workers in Iran could be attributable to reduced drug injection: a cross-sectional study.

OBJECTIVE: The HIV trend among female sex workers (FSWs) is understudied. We assessed the prevalence and trend of HIV and five other STIs among FSWs in Iran. METHODS: We recruited FSWs (1337 in 2015, 1005 in 2010) from 21 sites in 13 cities in two cross-sectional biobehavioural surveys. Eligible FSWs were women aged ≥18 years who reported selling sex to more than one male client in the past 12 months. Consenting FSWs were interviewed using a behavioural questionnaire and tested for HIV and five other STIs. We considered study sites as clusters in the analysis and two-sided Fisher's exact test to compare the HIV prevalence between the two survey rounds. RESULTS: HIV prevalence was 2.1% in 2015 (vs 4.0% in 2010, p=0.007). Lifetime drug injection was reported by 6.1% of participants in 2015 (vs 14.6% in 2010, p=0.003). In 2015, among FSWs with history of lifetime drug injection, HIV prevalence was 8.6% (vs 9.8% in 2010, p=0.425). The prevalence of other STIs in 2015 was 0.4% (95% CI 0.2 to 1.0) for syphilis, 1.3% (95% CI 0.8 to 2.1) for gonorrhoea, 6.0% (95% CI 4.8 to 7.4) for chlamydia, 11.9% (95% CI 8.5 to 16.5) for trichomoniasis and 41.8% (95% CI 39.2 to 44.5) for human papillomavirus. CONCLUSIONS: HIV prevalence among FSWs in Iran decreased, but remains considerably high. The decrease in HIV prevalence compared with 2010 might be explained by a decrease in drug injection. Other STIs are also high in this population. Harm reduction programmes need to be continued and scaled up among this underserved population in Iran.

Epidemiology of suicide in 10-19 years old in southern Iran, 2011-2016: A population-based study on 6720 cases.

OBJECTIVE: Globally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10-19. Hence, this study investigates the adolescent suicide, aged 10-19, in southern Iran. METHODS: In this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016. RESULTS: Overall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts. CONCLUSIONS: Suicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.