Toxic reactions to local anesthetics may occur due to over dose, accidental intravenous injections or rapid systemic uptake of the drugs. But there have been few reports on toxicity due to displacement of epidural catheters after an initial correct insertion and performance of a test dose. Here we present a case of local anesthetics toxicity due to possible displacement of the epidural catheter during APR (Ant-post Colporrhaphy) surgery. The patient’s level of consciousness decreased at the end of surgery. She demonstrated CNS and cardiovascular toxicity due to local anesthetics. Consequently the patient was intubated and transferred to ICU, where she received mechanical ventilation along with other supportive treatments such as inotropic and antiepileptic drugs. We concluded that supportive therapy is the treatment of choice for such cases.

Severe allergic reactions during specific immunotherapy may occur in the treatment of hymenoptera sting allergy. The objective of the present study was to examine the characteristics of allergic reactions during specific immunotherapy in patients with allergy towards hymenoptera venom in the Iranian population. A prospective study was performed using the clinical reports of 27 patients with anaphylaxis to bee venom (Apis melifera, Geupes vespula and Geupes Polites). Ten patients treated with Cluster protocol during 2002 and 2006.After diagnosis of hymenoptera sting allergy according to history and intradermal tests, the patient were treated with Cluster protocol immunotherapy. The protocol lasted 6 weeks with an increase in the concentration of venom from 0.01 mg/ml to 100 mg /ml. None of the patient received premedication. All patients with hymenoptera venom allergy received 120 injections. Anaphylactic reactions were classified according to the Mueller-classification. he frequencies of systemic reactions during Cluster protocol were 8.33% and 5% for yellow jacket and honey bee venom respectively. No patient experienced severe systemic reaction. Cluster protocol for hymenoptera immunotherapy is a reliable method for the treatment of anaphylactic reactions to bee venom. It is safe with low cost and do not need hospitalization.

A very rare and interesting manifestation of, a bone tumor (toxic osteoblastoma) is presented in which the tumor has unusual systemic and local symptoms. These manifestations are thought to result from an exaggerated immunologic response to. the tumor. After tumor excision all the reactions disappeared.

Background and aim: Psoriasis is one of the most common inflammatory skin disorders with a genetic background. Several treatment modalities have been used, including systemic and bath PUVA. The aim of this study was to evaluate the efficacy of systemic and bath PUVA in the treatment of psoriasis in Razi Hospital.Materials and methods: This retrospective database study was done in Razi Hospital and the records of 390 psoriatic patients referred to phototherapy unit in 1999-2003 were studied. One hundred and forty nine patients were treated with systemic and 238 patients with bath PUVA.Results: The most common form of psoriasis was the plaque type and the majority of patients were male. Complete remission of disease was achieved in 20.1% of systemic PUVA and 17.2% of bath PUVA patients, usually after 20-29 sessions of phototherapy. The mean cumulative UVA dose for complete remission was 233.46 and 108.79 J/cm2 in systemic and bath PUVA groups, respectively. Relapse occurred in 33.3% and 17.07% of patients achieving complete remission in systemic and bath PUVA groups, respectively. Erythema was the most common side effect in both groups.Conclusion: Both systemic and bath PUVA are efficacious in the treatment of psoriasis. The total UVA dose needed for complete clearance was higher in systemic PUVA and relapse occurred more frequently in this group.

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Background: Concerning the importance and the high frequency of renal involvement in patients with systemic lupus erythematosus (SLE), and the ability to measure the value of hematuria on predicting the incidence of lupus nephritis, this study aimed to determine the frequency of lupus nephritis in SLE patients with hematuria. Methods: This cross-sectional study investigated 500 patients with SLE in Isfahan City, Iran, between the years 2001 and 2015. Medical history, as well as demographic and clinical data of patients including the levels of C3, C4, and anti-dsDNA antibody, presence of lupus nephritis, proteinuria, cellular cast, pyuria, urinary tract infection, urinary tract stones, congenital renal defects, and history of any kidney disease were obtained from the patients' files at the end of the study period, and analyzed using SPSS software. Findings: The frequency of hematuria in patients with lupus nephritis was 36. 1%, and there was no significant relationship between the presence of hematuria and the existence of lupus nephritis in patients with SLE [odds ratio (OR) = 0. 727, confidence interval of 95% = 0. 376-1. 648, P = 0. 520]. The individuals with lupus nephritis had a lower age distribution compared to the cases without it (P = 0. 005). Most of the cases in the lupus nephritis group had low C3 and C4, but most patients in non-lupus nephritis group had normal levels of C3 and C4 (P < 0. 05). Conclusion: The relative frequency of lupus nephritis in SLE patients with hematuria was approximately 36%. Therefore, the presence of hematuria in patients with SLE may account for incidence of lupus nephritis one-third of the cases.

Background: Systemic lupus erythematosus (SLE) is a common autoimmune disease, and if not diagnosed and treated in a timely manner, can lead to irreversible complications such as lupus nephritis. Thus, the early detection of the disease is very important. On the other hand, some studies have shown that there is a relationship between the serum levels of anti-Mullerian hormone (AMH) and the activity of lupus disease. The aim of this study was to determine the relationship between antibody titer with severity and activity level of SLE. Methods: In a cross-sectional study, 70 women in age range of 18-35 years old with SLE who referred to rheumatology clinic of Alzahra hospital, Isfahan, Iran, were selected. Lupus activity was determined using SLE Disease Activity Index-2000 (SLEDAI-2k) score, and serum level of AMH was measured; and the relationship between SLE activity and serum level of AMH was evaluated. Findings: Mean serum level of AMH was 1. 49 ± 1. 58 ng/ml, ranging from 0. 20 to 7. 36; and thus, 11 patients (15. 7%) had low levels of the hormone. Moreover, there was a statistically significant inverse correlation between disease activity scores and serum levels of AMH, as much as 0. 46 (P < 0. 001). Conclusion: The results of our study showed a relation between lupus activity and serum AMH. Especially, among the patients under treatment with corticosteroids and cyclophosphamide pulse therapy, there were lower levels of AMH; and this might lead to ovarian reserve loss and fertility problems in women of childbearing age.

Objective According to the basic role of drugs side effects in selection of an appropriate drug, patient compliance and the quality of life in epileptic patients, and forasmuch as new dugs with unknown side effect have been introduced, necessity of this research is explained. This study was conducted to evaluate the incidence and clinical characteristics of anti-epileptic drug (AED) related adverse reactions in children.Material&Methods In this descriptive study, children less than 14 years old with AED side effects referred to the Children’s Medical Center and Mofid Childeren’s Hospital (Tehran, Iran) were evaluated during 2010-2012. The informations were: sex, age, and incriminating drug, type of drug side effect, incubation period, history of drug usage, and patient and family allergy history. Exclusive criterions were age more than 14 years old and reactions due to reasons other than AEDs.Results A total of 70 patients with AED reaction were enrolled in this study. They included 26 (37%) females and 44 (63%) males. The maximum rate of incidence was seen at age less than 5 years old. All the patients had cutaneous eruptions that the most common cutaneous drug eruption was maculopapular rash. The most common culprit was phenobarbital (70%) and the least common was lamotrigine (1.4%).Conclusion In this study, we found higher rates of drug rash in patients treated with aromatic AEDs and lower rates with non-aromatic AEDs. Various endogenous and environmental factors may influence the propensity to develop these reactions.