Azathioprine and hydroxychloroquine overdose in Sjögren's syndrome patient with hypocalcemia: a case report.

INTRODUCTION: Hydroxychloroquine and azathioprine have been routinely used to control and treat primary and secondary Sjögren's syndrome, which potentially triggered some overdoses by these drugs. Toxicity from hydroxychloroquine and azathioprine manifests in the form of cardiac conduction abnormalities, nausea, vomiting, and muscle weakness. Recognizing these unique drug overdoses and management of these toxicities is important. This case report aims to expand our current understanding of these drug overdoses and their management and also underscores the importance of anticipating and identifying fewer common complications, such as hypocalcemia. CASE REPORT: A 34-year-old Persian woman with a history of Sjögren's syndrome presented to the emergency department 3.5-4 hours after an intentional overdose of hydroxychloroquine and azathioprine and severe hypotension and loss of consciousness. Although the patient was regularly taking other medications, such as fluoxetine, naproxen, and prednisolone, she explicitly clarified that these were not the substances involved in her overdose. Early investigations showed hypokalemia (2.4 mEq/L), hypocalcemia (7.5 mg/dL), and hypoglycemia (65 mg/dL). She was also diagnosed with metabolic acidosis and respiratory alkalosis. The electrocardiogram showed changes in favor of hypokalemia; other lab tests were run on the patient. Supportive treatments were applied, including rapid intravenous fluid dextrose 5%, normal saline, potassium chloride 30 mEq, and calcium gluconate 100 mg. The patient was managed and monitored overnight in the emergency room and recovered without residual side effects. CONCLUSION: Hydroxychloroquine and azathioprine toxicity are considered rare, but it is likely to increase in frequency given the prevalence and increase in autoimmune diseases and the increasing usage of these drugs in treating such diseases. We found hypocalcemia as the presentation to this patient, which needs further investigation into the probable mechanism. Clinicians need to consider the unique effects of hydroxychloroquine and azathioprine poisoning and initiate appropriate emergency interventions to improve the outcomes in similar patients.

Cinnamon and cognitive function: a systematic review of preclinical and clinical studies.

Cinnamon is the inner bark of trees named Cinnamomum. Studies have shown that cinnamon and its bioactive compounds can influence brain function and affect behavioral characteristics. This study aimed to systematically review studies about the relationship between cinnamon and its key components in memory and learning. Two thousand six hundred five studies were collected from different databases (PubMed, Scopus, Google Scholar, and Web of Science) in September 2021 and went under investigation for eligibility. As a result, 40 studies met our criteria and were included in this systematic review. Among the included studies, 33 were In vivo studies, five were In vitro, and two clinical studies were also accomplished. The main outcome of most studies (n = 40) proved that cinnamon significantly improves cognitive function (memory and learning). In vivo studies showed that using cinnamon or its components, such as eugenol, cinnamaldehyde, and cinnamic acid, could positively alter cognitive function. In vitro studies also showed that adding cinnamon or cinnamaldehyde to a cell medium can reduce tau aggregation, Amyloid ß and increase cell viability. For clinical studies, one study showed positive effects, and another reported no changes in cognitive function. Most studies reported that cinnamon might be useful for preventing and reducing cognitive function impairment. It can be used as an adjuvant in the treatment of related diseases. However, more studies need to be done on this subject.