Journal of Case Reports in Practice

2

Authors: Vakilan Farveh, Mirfeizi Zahra, Gholobi Arash, Chamanian Soheila, Moghiman Toktam

Scleroderma (SSC) is a systemic inflammatory disease characterized by vascular dysfunction and excessive fibrosis which may involve many organs particularly the heart, lungs and kidney. In scleroderma cardiac disease and pulmonary arterial hypertension (PAH) are common findings where as coronary diseases have been reported with a similar frequency or as rare in several studies. Atypical presentation, wide range of differential diagnosis and co morbidities can result in certain difficulties in diagnosing coronary disease in these patients. Hereby, we report two cases with scleroderma and PAH and a mild increased filling pressure in which significant coronary disease was discovered incidentally. Therefore, it seems crucial to perform further studies on the preferred time for evaluating CAD in such patients.

2

Authors: Bidaki Reza, Haghighi Fateme sadat

Hypoglycemia is a serious and vital clinical concern in patients with diabetes mellitus. While the effect of hypoglycemia on the quality of life and diabetes management in persons with diabetes mellitus is well recognized, much less is investigated about its outcomes on families. We focus here on the reaction of caregiver of a diabetic patient. The patient is a 36 year-old married woman. She referred because of severe insomnia. Her husband was a diabetic patient from 2 years ago. she has fear of hypoglycemia as persistence stress about her husband, therefore unconsciously, she try to avoid hypoglycemia of her husband by asleep and hyper aerosol. A structured education program can increase knowledge of hypoglycemia and the self-management skill of patients to decrease the occurrence of hypoglycemia and its psychological outcomes in patients and their family members.

3

Authors: Almasi Simin, Ebrahimi Nafiseh, Zamani Kazem

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects young women. Old age lupus occurs after the age 50 years and the disease occurs in 10-20% of patients over 50 years. This case was a 78-year-old woman who admitted to our hospital with polyarthritis, dyspnea, chest pain, typic malar rash, thrombocytopenia, lymphopenia:, positive antinuclear antibody (ANA):,and high titer anti-dsDNA from 3 weeks before admission. However older patients are more likely to have an insidious presentation and anti-ds DNA was very high and the other hand malar rash, polyarthritis and thrombocytopenia was reported very rare in old age in literatures bur our patients had acute presentation and her disease pattern similar pattern of disease in young patients.

6

Authors: Limaiem Faten, Arfa Nafaa, Bouraoui Saadia, Lahmar Ahlem, Mzabi Sabeh

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, arising from the interstitial cells of Cajal. They have variable malignant potential, ranging from small lesions with a benign behaviour to fatal sarcomas. In this paper, the authors report three cases of GISTs involving respectively the stomach, the duodenum and the jejunum. Our series included two women and one man aged between 42 and 74 years. The presenting symptoms included abdominal pain (n=2), gastrointestinal bleeding (n=1), abdominal mass (n=1), weight loss (n=1) and anemia (n=1). The three patients underwent surgical treatment. Histological examination of the surgical specimen coupled with immunohistochemical study confirmed the diagnosis of GIST in all cases. Detailed immunohistochemical studies are useful in successfully identifying any case of GIST, which is crucial to clinical treatment. New insights into the origin and progression of GISTs are setting the stage for further therapeutic innovations, with the goal not just to control disease growth, but to eliminate all tumour cells at the time of initial therapy.