Seyed Farshad Allameh
Vol 3 No 2 (2018): Spring
Hypocalcaemia is a dangerous electrolyte imbalance with 18% prevalence in hospital admitted patients. 1 Regulation of calcium level is by 3 main calcium-regulating hormones. These hormones are parathyroid hormone (PTH), vitamin D, and calcitonin; and they act by effecting on the bowel, kidneys, and skeleton. Causes of hypocalcaemia includes vitamin D deficiency, hypoparathyroidism, renal diseases, hypomagnesaemia, hungry bone disease after parathyroidectomy, drugs like calcium chelators, massive blood transfusion, critical illness, parathyroid hormone resistance, vitamin D resistance. Pseudohypoparathyroidism (PHP) refers to a group of metabolic disorders in which resistance to parathyroid hormone leads to hypocalcaemia, hyperphosphatemia, and elevation of serum PTH level in the setting of normal renal function. Herein we report an interesting case of hypocalcaemia who came to the emergency department with suspicion to intracranial hemorrhage and lead to the diagnosis of pseudohypoparathyroidism.
Heterogeneous findings have been reported regarding the effects of anti-depressive drugs over platelet counts. Among antidepressant drugs, Selective Serotonin Reuptake Inhibitors (SSRIs) has been shown to reduce platelet aggregation. We report a patient with reduction in her platelets counts as well as bruising occurrence following three days of receiving sertraline. In patients with a history of bleeding, ITP or familial ITP, their psychiatric treatment and prescribing SSRI should be done with caution.
Wilson’s disease is a rare hereditary disorder passed down in the autosomal recessive way. This disorder involves the speech parts of the brain leading to dysarthria, which impairs all of the five speech systems, i.e. the respiratory, phonation, articulation, resonance, and prosody. The patient studied in this research was a 28-year-old woman with Wilson’s disease, who visited Rofaydeh Rehabilitation Hospital in Tehran City with complaints about severe speech disorders. Based on the clinical and paraclinical examinations the patient was diagnosed with a decrease in the maximum phonation time (MPT) of 2 to 3 seconds, reduced intelligibility and articulation impairment. The patient underwent medicinal, behavioral, and rehabilitation (include speech therapy) treatments. Following a continuous two-year follow-up rehabilitation, a considerable improvement in the speech was observed as an increase in intelligibility (up to 5% of the words), the consistency between respiration and speech and an increase in verbal and nonverbal communications.
Vestibular Schwannoma (VS) is a brain tumor arising from the internal auditory canal, growing towards the cerebellopontine angle. Diagnosis and management of these tumors during pregnancy may present a therapeutic challenge. Herein, we report a case, of a huge VS presented in pregnancy by nonspecific symptoms. Thus, despite increased intracranial pressure and its possibly dangerous sequela, the patient delivered full-term vaginally. Finally, three months after delivery, VS underwent retrosigmoid microsurgical removal. The postoperative period was uneventful, with total hearing loss in her left ear and, transient paralysis of the left seventh cranial nerve. Gynecologists and Obstetricians should consider brain tumors in the differential diagnosis of CNS symptoms in the prenatal period, if there are no pregnancyrelated etiologies to explain.
Due to low prevalence of late onset Obsessive-Compulsive Disorder (OCD), it is more likely to have an organic etiology. In this article we present a 59-year-old man, referred for recently developed obsessive compulsive symptoms, with no prior history of OCD in the past. The symptoms were included ego-dystonic recurrent obsessional doubts, leaded him to compulsive checking several times a day and caused a remarkable distress and functional impairment. His neurological exam revealed no deficit. The most prominent finding in MRI was two large areas of focal gliosis and porencephaly located at head of right caudate. The size was 12 mm which is compatible with lacunar infarct. Frontal subcortical areas of signal change were noted. The symptoms were almost recovered only after 2 months treatment with sertraline 100 mg/daily and bupropione 150 mg/daily. It seems that there is a remarkable relationship between basal ganglia and frontal lesions, particularly infarction, with late-onset OCD.
A 30-year-old woman with a 20-year history of type 1 diabetes referred to our clinic with the complaints of facial acne, hirsutism, and irregular menstrual cycles (hirsutism was identified in physical examination). On biochemical analysis, high serum levels of antiTPO and DHEA-S were detected. Based on ultrasonographic findings indicative of thyroiditis and positive anti-TPO test, the diagnosis of Hashimoto's thyroiditis was made. A diagnosis of Polycystic Ovary Syndrome (PCOS) was confirmed later according to the Rotterdam criteria (revised 2003). The patient received metformin and insulin for 3 months and her menstrual cycles became regular.
Tracheal bronchus is a rare congenital bronchial anomaly with a prevalence of 0.1-5.0%. The anomaly is generally asymptomatic in adults and detected incidentally bronchoscopy or radiologic examinations. Herein we report a case of tracheal bronchus in an adult male presenting with recurrent haemoptysis and cough.
Too Many Calcifications
Seyed Farshad Allameh
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