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Reviews in Clinical Medicine - Volume:5 Issue: 3, Summer 2018

Reviews in Clinical Medicine
Volume:5 Issue: 3, Summer 2018

  • تاریخ انتشار: 1397/07/19
  • تعداد عناوین: 6
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  • Behnoush Bakhshoudeh, Maryam Salehi, Ramin Sadeghi, Alireza Omranzadeh, , Toktam Sahranavard, Soheil Arekhi, Ali Jafarzadeh Esfehani, Naghmeh Zabolinejad * Pages 76-94
    Introduction
    Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are skin diseases that affect the quality of life. Although a systematic review on LPP and FFA treatment was published in 2013, further updates are needed. The aim of this study is to review systematically the studies published after the last systematic review.
    Methods
    We searched Scopus, PubMed, Embase, and ISI Web of Science. All the studies published during March 2012-June 2017 were included in this review. Two reviewers separately selected the studies and extracted the data. The results of studies were categorized as unimproved, stabilized, and improved based on the articles reports.
    Result
    Among the 38 studies, 20, 17, and one studies assessed LPP, FFA, and both treatments, respectively. The papers were case reports, case series, cohorts, and randomized controlled trials. Antimalarial agents and pioglitazone resulted in enhancement in 73 and 71% of the LPP patients, respectively. Improvement and stabilization were observed in almost one third of the topical steroid users and 6/12 of Tacrolimus/Pimecrolimus users in LPP. Improvement and stabilization in FFA was found in 68% of the individuals using antimalarial agents, 83% of intralesional steroid users, all cases of finasteride users, and 95% of the people utilizing dutasteride.
    Conclusion
    Contrary to the previous systematic review, we found antimalarial agents more effective than steroids in LPP. Finasteride/dutasteride may have favorable impacts on FFA. Intralesional steroids showed to be more effective than antimalarial agents in FFA. Still further studies are needed in order to define a treatment protocol. Low quality and heterogeneity of the articles were among the limitations for making a conclusion.
    Keywords: Frontal fibrosing alopecia, Lichen planopilaris, Treatment
  • Mohammad Hadi Sadeghian, Zahra Rezaei Dezaki *, Seyyede Fatemeh Shams, Sepideh Shakeri Pages 95-100
    Introduction
    Plasma cell myeloma is the distortion of differentiated B lymphocytes which is associated with uncontrolled proliferation of plasma cells in bone marrow. Some studies propound a role for HHV-8 virus in pathogenesis of plasma cell myeloma. Yet the findings are inconsistent. In this article we reviewed the literatures to determine the HHV-8 virus role in plasma cell myeloma pathogenesis.
    Methods
    In this systematic review, scientific databanks including PubMed, Scopus, Embase, ISI, and Google scholar were searched. The search was based on the subsequent keywords and medical terms in title; different combinations of keywords were used, they were compatible with MeSH terms.
    Result
    Four articles declared that there is no link between the HHV-8 and the pathogenesis of plasma cell myeloma; while five reported a connection between the virus and myeloma, arguing that virus infection will lead to disease progression.
    Conclusion
    There are differences between the results of the studies. It is required to do further researches about the association of HHV-8 and plasma cell myeloma.
    Keywords: Etiology, Human herpes virus 8, Multiple Myeloma
  • Ideh Ghafour, Forouzan Elyasi * Pages 101-104
    Thyroiditis is the most common inflammatory disorder that affects thyroid gland.The diagnosis is mainly based on clinical findings, in particular the degree of pain and tenderness of thyroid. Confirmatory laboratory test includes presence of thyroid specific autoantibodies. Treatment is based on the severity of symptoms (pain and redness) and aims to restore the normal function of thyroid. Drug-induced thyroiditis has been described previously in the literature. Venlafaxine is an antidepressant agent with an efficacy similar to that of selective serotonin reuptake inhibitors. The dose of this medicine can be adjusted up to 150 mg/day one year after initiation. However, usage of venlafaxine may be limited due to the dose-dependent side effects. Here we describe a patient diagnosed with generalized anxiety disorder and migraine headache who developed venlafaxine-induced thyroiditis following dose adjustment to the maximum of 150 mg/day. The diagnosis was made based on the clinical symptoms and confirmatory laboratory tests according to the Naranjo Adverse Drug Reaction Probability Scale. Thyroiditis symptoms subsided after reducing venlafaxine dose and initiating prednisolone therapy. It should be noted that thyroid function was fully restored to normal only after cessation of venlafaxine administration.
    Keywords: Anti-depressant, Drug side effect, Thyroiditis, Venlafaxine
  • Masoud Ghiasian , Sajjad Daneshyar *, mehrnaz olfat Pages 105-107
    Subclavian artery thrombosis is an uncommon cause of limb ischemia in females without a history of vasculopathy. This condition usually occurs secondary to atherosclerotic changes and hypercoagulable states, which are generally asymptomatic. However, it can manifest with such symptoms as coldness, pain, and pulselessness in the upper extremity. Herein, we presented a 40-year-old female admitted to our hospital with three days history of right-side hemiparesis and complaints of imbalance and vertigo. The patient had a history of 2-month consumption of high-dose oral contraceptive (OCP) agents for birth control purposes. Cervical magnetic resonance angiography showed a significant occlusion in the proximal part of the left subclavian artery, leading to the diagnosis of subclavian artery thrombosis secondary to the use of long-term high-dose OCP. Our diagnosis was confirmed with the Doppler color sonography. This case demonstrated the importance of a full assessment regardless of the patient’s chief complaints. This kind of assessment allows for a faster and more effective management, thereby reducing the associated costs. Therefore, any suggestive signs or symptoms of arterial thrombosis should be followed up even in low-risk patients. Accordingly, in case the achievement of confirmatory findings regarding the diagnosis of arterial thrombosis, the patient should be immediately subjected to proper medical and surgical interventions.
    Keywords: Arterial thrombosis, Ischemia, Oral contraceptive agent
  • Zahra Baghestani , Reza Boostani * Pages 108-110
    A 43-year-old male presented with diplopia and right sixth-nerve palsy. Brain magnetic resonance imaging (MRI) demonstrated a lesion in the right periventricular area. High-dose corticosteroid pulse therapy did not resolve the symptom. After one month, his diplopia progressed and he developed weakness of the left lower limb. Detailed examination revealed left sixth-nerve palsy, dropped foot, waddling gait, atrophy of the gluteal muscles and mild atrophy and weakness of the right upper limb. Neurological examination supported evidence of multiple cranial nerve palsies along with asymmetrical peripheral neuropathy. Electrodiagnostic studies were compatible with a mononeuritis multiplex. Rheumatologic evaluations were normal. Malignancy work-up were normal, except for some insignificant lymph nodes. Bone marrow aspiration and biopsy were normal. The second brain MRI detected multiple homogenous enhancing lesions in the right periventricular area.The result of stereotactic biopsy and immunohistochemistry staining demonstrated primary B-cell CNS lymphoma (PCNSL). Mononeuritis multiplex has not been reported as a paraneoplastic manifestation of PCNSL yet. In other words, it is not clear whether involvement of the peripheral nervous system in our patient is a paraneoplastic manifestation of PCNSL or a coincidence of PCNSL and hematologic lymphoma presenting with peripheral vasculitic neuropathy. It is recommendedthat future studies focus more on symptoms associated with PCNSL to recognize the exact relationship between PCNSL and peripheral neuropathy.
    Keywords: Electrodiagnostic study, Mononeuritis multiplex, Peripheral neuropathy
  • Zahra Amirian, Fatemeh Behmanesh, Elahe Heidari * Pages 111-114
    Recent studies have reported a relationship between vitamin D and atopic diseases such as asthma, allergic rhinitis, and atopic dermatitis, which is due to the recently discovered vitamin D receptors on many immune system cells. Among all atopic diseases, asthma has been studied the most in this regard. However, the role of vitamin D in other atopic diseases such as allergic rhinitis and atopic dermatitis is a matter of controversy. In this paper, we review the literature on the association between atopic diseases and vitamin D level with a focus on the childhood period. As of today, the role of vitamin D in atopic march is not clear and studies show controversial results. Therefore, further studies with adequate sample sizes and correction for perplexing factors are needed since this could be an innovative treatment in atopic children. It is also advisable to examine high-risk groups of children for vitamin D deficiency.
    According to the extracted data, vitamin D has a protecting effect against atopic diseases. At the same time, no evidence was found for such an association in some studies, thus, further studies are needed to clarify this issue.
    Keywords: Allergy, Atopy, Vitamin D