Background:  Systemic lupus erythematosus (SLE) is an autoimmune disease with variable clinical manifestations mostly affecting the skin, joints, hematopoietic system, kidney, and the central nervous system. The micro-RNAs (miR) are small, non-coding, endogenous RNAs, with key roles in many biological processes. The aim of this study was to investigate the cellular expression of miR-21 and miR-155 in SLE patients and healthy controls. Methods: SLE patients (n=35) and matched healthy controls (n=35) were enrolled in this study. SLE activity was assessed with Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. The peripheral blood mononuclear cells (PBMC) were isolated and the RNA was extracted following cDNA synthesis. The expression of miR-21 and miR-155 was evaluated by the real-time PCR technique. Results: The results showed that the expression level of miR-21 was significantly reduced in patients (0.64 times and p-value=0.02) and significantly correlated with disease duration. However, no significant differences were observed between the patients and control subjects for miR-155 (p-value =0.42). Moreover, the expression of miR-21 was indirectly correlated with the disease duration (R= -0.24, p-value = 0.05), but miR-155 did not reveal any significant association with clinicopathological features of the patients. Conclusion: The result of this study suggests a significant down-regulation of miR-21 in PBMC of SLE patient, mostly in individuals with a longer disease history.

We report case of a 42 years old female who came with a constellation of behavioral symptoms, delirium, body stiffness, and fever for one week. Past medical history was significant for a prolonged critical care admission at an outside facility for seizures two years ago. Her examination was consistent with the diagnosis of encephalitis. Initially, she was managed as viral encephalitis based on cerebrospinal fluid analysis with a predominant lymphocytic picture. Computed tomography (CT) scan brain was normal. An electroencephalogram (EEG) revealed moderate to severe diffuse encephalopathy. During her stay at our hospital, she developed orofacial rhythmic dyskinetic movements coupled with autonomic dysfunction. Due to her predominant symptoms of encephalitis coupled with psychiatric, autonomic and dyskinetic features, she was investigated for an underlying autoimmune etiology. She was tested positive for N-methyl-D-aspartate receptor (NMDA-R) antibodies. She received four sessions of plasmapheresis and was referred to another facility where she died. NMDA-R encephalitis poses a significant diagnostic challenge to the clinicians. These cases are potentially treatable if diagnosed earlier and started on recommended treatment with plasmapheresis, intravenous immunoglobulins, pulsed steroids, and immunosuppressants. Autoimmune encephalitis is an expanding entity which is evolving with advancements in neuroimmunology.

Tuberculosis (TB) is a global epidemic in the tropical countries. The head and neck region is less commonly affected by TB and the nasopharyngeal TB has been rarely reported in literature. Here, we report a case of a male with a mass and obliteration of the fossa of Rosenmuller that mimicked recurrent nasopharyngeal carcinoma. Histopathological examination revealed tuberculosis of nasopharynx. The patient was treated with anti-tuberculous drugs and improved. Nasopharyngeal TB with a proper treatment and follow up shows good prognosis.

Sarcomas are malignant mesenchymal neoplasms that comprise less than 1% of all malignancies diagnosed annually in all body sites; a number far surpassed by epithelial-derived carcinomas. Of the soft tissue sarcomas, liposarcoma, derived from adipose tissue, accounts for approximately 17% to 30% of all soft tissue sarcomas and is considered one of the most common soft tissue sarcomas in adults. Head and neck liposarcoma are markedly less common than those in other body sites, comprising only 2% to 9% of sarcomas. We herein report the case of a 62-year-old male with a two year history of a right supraclavicular mass, which turned out to be liposarcoma and its further management. A missed step in the algorithm of head and neck swelling management that is fine needle aspiration cytology (FNAC) precipitated a less than ideal management in this case.

Background: To estimate the risk of malignancy of a thyroid nodule, several factors should be taken into account including age, gender, nodule size and history of radiation. Recently, preoperative serum thyroid stimulating hormone levels (TSH) is considered as an independent predictor for thyroid malignancies in patients with diffuse or nodular goiter; higher TSH levels are associated with an increased incidence of thyroid cancer in patients with nodular thyroid disease. We performed a diagnostic accuracy study on serum TSH in patients with malignant and benign thyroid nodules who were referred to the clinics of 5-Aazar and Shahid Sayad Shirazi Hospitals during the years 2014 and 2015. Methods: Patients with solitary thyroid nodules who were referred to Endocrinology clinics of 5-Aazar and Shahid Sayad Shirazi Hospitals during 2014 and 2015 were enrolled. Patients undergoing medical treatment were excluded. Serum TSH and T4 levels were initially measured in this study, and after performing fine-needle aspiration biopsy of thyroid nodules (FNA), pathology results were compared with TSH serum levels. Demographic information of participants was recorded. Chi-square test and independent T-test were used for data analysis. The P value ≤ 0.05 was considered statistically significant. Results: Of 80 patients, 24 (30%) were females with mean ± SD age of 42±13 years.  The mean ± SD serum TSH level in patients with malignant (N=20) and benign (N=60) nodules were 4.7±2.4 μU/mL and 2.5±2.3 μU/mL, respectively. All patients had subclinical thyroid dysfunction. In sensitivity analysis of ELISA, TSH level cut-point in the diagnosis of thyroid malignancies was 3.45 μU/mL with sensitivity and specificity of 80% and 78%, respectively. Sixteen (80%) of 20 patients in the malignant group had TSH levels above 3.45 μU/mL. In the benign group, 47 (78.3%) had TSH levels below 3.45 μU/mL. Conclusion: We found a significant difference in mean TSH serum level between patients with benign and malignant thyroid nodules; malignancy risk was higher in thyroid nodules from patients with high serum TSH level. The cut point for TSH in the diagnosis of thyroid malignancies is 3.45% with sensitivity of 80% and specificity of 78.3%.

Neonatal cerebral sinovenous thrombosis (CSVT) compromises nearly 50% of all pediatric-related CSVT. Although guidelines support anticoagulation in pediatric CSVT, the role of anticoagulation in infant’s CSVT remains controversial. This case report presents a case of 7-month old infant with CSVT necessitating anticoagulant therapy and describes the course of CSVT diagnosis.

We report a case of a 24-year-old male, laborer by profession, who consulted neurology outpatient with chronic symptoms of gross muscle contractions, generalized weakness, and limitation in his routine activities since the age of eight. The examination was remarkable for pseudo hypertrophy in the calves muscles, pes cavus, and gross spontaneous muscle fasciculation with symmetrical involvement of the distal and proximal muscle groups in lower and upper extremities. His creatinine phosphate kinase (CPK) levels in blood were high. Nerve conduction study (NCS) and electromyography (EMG) confirmed diagnosis of Issacs’ disease showing neuromyotonic discharges associated with denervation and polyphasic units with fibrillation, positive sharp waves, and continuous repetitive discharges. He was started on carbamazepine, to which he responded well, and his symptoms improved.