Undesired effect of excessive betamethasone administration during pregnancy: a rare case

Background: Postpartum bilateral femoral neck fracture [BFNF] is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency

Case: This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations. The bone mineral density examination showed low bone density for the expected age

Conclusion: Clinicians, who deal with pregnant women, should consider the diagnosis of bilateral femoral insufficiency fracture in any pregnant women with pelvic pain. Awareness of risk factors of BFNF might help to reduce the rate of this complication

effect of quercetin on plasma oxidative status, C-reactive protein and blood pressure in women with rheumatoid arthritis

Considering the increased production of free radicals and inflammatory factors in rheumatoid arthritis [RA] and the effects of bioflavonoid quercetin on reducing oxidative stress, inflammation and blood pressure, the present study examined the effects of bioflavonoid quercetin on total antioxidant capacity [TAC] of plasma, lipid peroxidation and blood pressure in women with RA. The current study was a randomized double-blind clinical trial in which 51 women with RA aged 19-70 years, were participated. Patients were assigned into quercetin [500 mg/day] or placebo groups for 8 weeks. Dietary intake was recorded using 24-h dietary recall questionnaire and the physical activity was assessed through an international short questionnaire of physical activity at the beginning and end of the study. Plasma TAC and malondialdehyde [MDA] using colorimetric method, oxidized low density lipoprotein [ox-LDL] and high sensitivity C-reactive protein [hs-CRP] using enzyme-linked immunosorbent assay method and also blood pressure were measured at the beginning and end of intervention. After 8 weeks there were no significant differences in TAC of plasma, ox-LDL, MDA, hs-CRP, systolic and diastolic blood pressure between quercetin and placebo groups and in each group comparing before and after. In this study, quercetin had no effect on oxidative and inflammatory status of plasma and blood pressure in patients with RA. Further studies are needed to ensure the effect of quercetin on oxidative stress and inflammation in human

Hypovitaminosis D: are medical students at risk?

Vitamin D deficiency is a pandemic problem mostly diagnosed in elderly. Few studies are available exclusively done on the topic among young adults. Specific professions such as medical students may have higher risk for developing hypovitaminosis D. We aimed to assess the vitamin D status in medical students of Iran University of Medical Sciences; and to define a cut-off point for 25-hydroxyvitamin-D [25[OH]D] level based on secondary hyperparathyroidism. This was a cross-sectional study on 100 medical students conducted during October 2012. Serum 25[OH]D, intact parathyroid hormone [iPTH], and calcium were measured. Age, sex, body mass index, daily dietary fish and egg consumption, sun exposure, and sunscreen usage were recorded. The association between serum 25[OH]D and iPTH was assessed. Receiver operating characteristics curve analysis was performed. 25-hydroxyvitamin-D level was <30 ng/ml in 99% of all participants, and <20 ng/ml in 77%. Mean serum 25[OH] D level was 16.8 +/- 4.7 ng/ml. iPTH level in the group with 25[OH]D level of <10 ng/ml was significantly higher than in those with serum 25[OH]D level of 10 to <20 ng/ml and 20 to <30 ng/ml [109 +/- 47 pg/ml, 47 +/- 27 pg/ml and 46 +/- 19 pg/ml, respectively; P = 0.0001]. There was a significant linear inverse correlation between serum iPTH and 25[OH]D [r= -0.36, P = 0.0001]. 25[OH] D level of 15.4 ng/ml was determined as the optimal cut-off point in detecting possible secondary hyperparathyroidism. To improve the community vitamin D status, in addition to population-based food fortification programs, educational programs seem essential; not only for general population, but also for the more educated groups