Journal of Case Reports in Practice
Volume:4 Issue: 3, Jul 2016

Osteoporosis is a debilitating disease which is a huge burden in this high-technology sedentary world. As Bone Mineral Content (BMC) which symbolizes bone health starts to diminish; the relative risk of osteopenia/ osteoporosis will rise. Therefore osteopenic/ osteoporosis management and treatment is a big rheumatology challenge. National Institute for Health and Care Excellence (NICE) focuses on three important factors includes age, Bone Mineral Density (BMD), and fracture risk factor before starting the treatment of osteoporosis. Recently American Association of Clinical Endocrinologists recommended that younger women who have gone through menopause have to get BMD tested which seems very rational. There is significant heterogeneity in the management and treatment of osteoporosis in our daily practice with different Guidelines like NOGG or NOF. Early screening for recognition and on time managing should be our goal and we would be ensured that individuals who are at risk of osteopenia/ osteoporosis would be treated if necessary prior to its disaster complication “fracture”.

In emergency room settings it is a mistake to pounce on the injured region of a patient while disregarding the ongoing medical problems. Furthermore, in patients referred from other centers with a certain diagnosis, it is quite easy to overlook other pathologies. Here we report a 42-year-old female patient who admitted to emergency department after a fall and inaccurately was considered to have traumatic acute elbow dislocation since her connective tissue disease was overlooked leading sequential mistakes in the management. The patient and the disease should be taken as a whole and one should never overlook performing a systematical examination for each and every patient.

Systemic sclerosis (SSc) is a systemic autoimmune disease of unknown etiology. One of the recurrent reversible manifestations of vascular involvement which is caused by excessive vasospasm of digital arteries in SSc is Raynaud’s phenomenon (RP). More than 95% of SSc patients suffer from this complication and approximately 30% of these patients will have digital ulcer (DU) yearly. DU augments dysfunction in fingertips by impairment of hand function and ischemic complications. In this case series, we want to report 6 patients with RP and DU who fulfilled the criteria of SSc16 in Mashhad, Iran. 40 mg/night of atorvostatin for 3 months was added to their standard treatment regimen. Body mass index (BMI) was calculated by body weight/ height2 formula.Statins such as atorvastatin are useful for reducing RP and DU in SSc patients. This study proved that a dose of 40 mg atorvastatin can improve the quality of the patients’ life, RP and ulcer formation.

Obsessive-compulsive disorder (OCD) is a debilitating chronic disease with an estimated prevalence rate of 2 to 3 percent in the general population. The first patient was a 34-year-old female with a diagnosis of OCD according to DSM-V from about seven years ago with the Yale-Brown score 31. She referred to our center with simultaneous infertility and PCO since 11 years. The second patient was a 32-year-old female with a diagnosis of OCD according to DSM-V with Yale-Brown score 34 since 5 years ago. In two patients, paroxetine may lead to successful pregnancy in addition to reducing the OCD symptoms. According to this initial report and the randomness of pregnancy in patient treated with paroxetine, there may be a hope to develop new protocols for the treatment of infertility using paroxetine.

Spontaneous abortion or miscarriage is very common nowadays. Our patient is a 38 year old woman with history of four spontaneous abortions and inability to carry the baby after 12th week of pregnancy with positive CMV IgG results. The treatment includes 11 acupuncture treatments and Cordyceps synensis in capsule, 1g two times a day starting from 01.08.2014. The patient takes the Cordyceps during the pregnancy too, and in March, 2016 she gave a birth to a healthy baby girl. Acupuncture treatment and Cordyceps sinensis as part of the Traditional Chinese Medicine, are effective treatments and give positive results in the treatment of spontaneous abortion, as well as protecting the fetus in pregnancy.

We present a case of pulmonary artery aneurysm in a young male patient with Behcet’s disease which completely resolved after treatment with infliximab. Fourteen months after diagnosis of Behcet’s disease he developed chest pain and massive hemoptysis. His symptoms resolved within a few days after treatment with infliximab and repeated computed tomography angiography which performed after 6 months showed complete resolution of aneurysm.