RESUMO
Background: Critically ill COVID-19 patients have an elevated risk of experiencing hypercoagulable conditions. Currently, many COVID-19 patients have been administered anticoagulation or antiplatelet therapies to lower the risk of systematic thrombosis. Iliopsoas hematoma is a potentially fatal and rare complication of bleeding disorders or anticoagulation therapy which sometimes grows to become clinically significant. The main purpose of this case review is to emphasize the importance of diagnosing iliopsoas hematomas and the possibility of antiplatelet contribution to its development. Case Presentation: We are reporting a rare presentation of non-traumatic iliopsoas hematoma in a non-anticoagulated patient. The patient is a 59-year-old male, with known type-2 diabetes, on oral hypoglycemic medications, 3-weeks post-COVID-19. He had started aspirin 81 mg orally, once daily, to prevent thrombotic events associated with COVID 19 infection, with no anticoagulant use and no other medications. He came in through the ED, presenting with two weeks history of progressive right lower limb weakness in which an iliopsoas hematoma diagnosis was confirmed based on radiological investigation. Conclusion: The possibility of iliopsoas hematoma should be considered in non-anticoagulated patients with no inherited or acquired coagulation disorders presenting with limb weakness. The link between antiplatelet use in a COVID-19 patient and the development of soft tissue bleeding (e.g., iliopsoas hematoma) must be studied further.
RESUMO
Background Isotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression. Objective To evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020. Methods Using the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study. Results Of the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)]. Conclusion This study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.
