Scorpion sting and allergic reaction to scorpion venom: A case-based review.

OBJECTIVE: To describe a young patient with scorpion sting (SS) with typical lesions of urticaria besides the local SS clinical picture. MATERIALS AND METHODS: A systematic screening of articles dating from 1966 to 2021 was conducted in the main databases. All articles included the association between SS and urticaria. A new case report is added to the published list. RESULTS: The literature search found 5 articles with 29 patients with SS and urticaria/allergic reactions. We performed our analysis by adding our present case, resulting in a total of 30 cases. Most were male, and their ages varied from 29 to 48 years. Regarding SS severity, most were mild or moderate. In two articles, patients had more than one sting. The allergic reaction varied from urticaria, pruritus, flushing, angioedema, wheezing, rhinorrhea, sneezing, consciousness alterations, and gastrointestinal and cardiovascular alterations. In 5/6 (83%) articles, the patients were alive at the study time. One subject died from anaphylactic shock. CONCLUSION: The present article systematically reviewed all published cases of SS and allergic reactions to scorpion venom. It is an infrequent association; most patients are male and in the productive age, and reaction may vary from mild to severe, including death.

Coenzyme Q10 supplementation in rheumatic diseases: A systematic review.

Coenzyme Q10 (CoQ10) is a potent antioxidant and anti-inflammatory substance used to treat some rheumatic diseases. Our objective was to review the use of CoQ10 in rheumatic diseases. PubMed/Medline, Embase, Scopus, and Web of Science databases were searched for articles on CoQ10 and rheumatic diseases between 1966 and April 2023. Twenty articles were found, including 483 patients. The investigated conditions were Fibromyalgia (FM) with 15 studies, Rheumatoid Arthritis (RA) with 3 studies, and Antiphospholipid Syndrome (APS) with 2 studies. After CoQ10 supplementation, RA patients observed improvements in disease activity index, inflammatory biomarkers (erythrocyte sedimentation rate), cytokine levels, and a decrease in malondialdehyde. In APS, CoQ10 improved endothelial function and decreased prothrombotic and proinflammatory mediators. Regarding FM, in most of the studies, the patients observed improvements in pain, fatigue, sleep, tender points count, mood disorders, and scores on the Fibromyalgia Impact Questionnaire (FIQ). The drug was well tolerated, with reports of minor side effects in two studies. CoQ10 supplementation seems to be efficacious as a complementary treatment for RA and FM. Upcoming studies with larger samples and including other rheumatic diseases are welcome.

Gluten-free diet can ameliorate the symptoms of non-celiac autoimmune diseases.

CONTEXT: A gluten-free diet (GFD) is the recommended treatment for gluten-dependent disease. In addition, gluten withdrawal is popular and occasionally is suggested as a treatment for other autoimmune diseases (ADs). OBJECTIVE: The current systematic review summarizes those entities and discusses the logic behind using a GFD in classical non-gluten-dependentADs. DATA SOURCES: A search for medical articles in PubMed/MEDLINE, Web of Sciences, LILACS, and Scielo published between 1960 and 2020 was conducted, using the key words for various ADs and GFDs. DATA EXXTRACTION: Eight-three articles were included in the systematic review (using PRISMA guidelines). DATA ANALYSIS: Reduction in symptoms of ADs after observance of a GFD was observed in 911 out of 1408 patients (64.7%) and in 66 out of the 83 selected studies (79.5%). The age of the patients ranged from 9 months to 69 years. The duration of the GFD varied from 1 month to 9 years. A GFD can suppress several harmful intraluminal intestinal events. Potential mechanisms and pathways for the action of GFD in the gut - remote organs' axis have been suggested. CONCLUSION: A GFD might represent a novel nutritional therapeutic strategy for classical non-gluten-dependent autoimmune conditions.

Successful treatment of ankylosing spondylitis with alternative and complementary medicine withdrawal of adalimumab treatment.

BACKGROUND AND PURPOSE: Current treatment strategies for ankylosing spondylitis (AS) include adalimumab and other biological drugs. However, treatment failures and side effects are commonly observed. This report documents the successful use of supplements and dietary changes to treat a patient with AS after cessation of adalimumab therapy. PATIENT PRESENTATION: A 38-year-old human leukocyte antigen B27 positive female patient with AS showed no improvement when treated with a non-steroidal anti-inflammatory drug. The patient then began adalimumab therapy with some success; however, after nine months, she developed a disseminated and refractory Molluscum contagiosum infection. Adalimumab was withdrawn, and the patient started taking supplements, while adopting an anti-inflammatory diet (dairy-free, gluten-free, and sugar-free). Normalization of inflammatory markers was achieved after two months, and magnetic resonance imaging of the sacroiliac revealed a notable physical improvement.

Safety and effectiveness of vitamin D mega-dose: A systematic review.

INTRODUCTION: Supplementation with high doses of vitamin D, known as mega-dose or "stoss therapy," refers to administering high doses of vitamin D by oral or intramuscular route in short periods of time. In this sense, conducting a review to organize this knowledge in a single article will generate a helpful instrument for researchers working in this area and for health professionals who use this therapeutic tool. OBJECTIVE: To carry out a literature review on safety and efficacy (normalization of serum vitamin D level, and changes in the clinical picture) of vitamin D mega-dose use. METHODOLOGY: This is a systematic review of the literature searching data through the electronic banks of PubMed, Scielo, and LILACS, using the following keywords: "vitamin D," "mega-dose," "stoss therapy," "cholecalciferol," in different combinations. CONSORT questionnaire was used to assess the quality of the included studies. RESULTS: Of the 59 articles screened for this review, 10 were included in the review, studying patients with rickets, osteoporosis, and critically ill patients. Two studies compared the exact dosage of vitamin D by different routes of administration, and three studies compared different doses by the same route. All others studied vitamin D mega-dose versus placebo. Adverse effects were observed through the presence of hypercalcemia/hypercalciuria. Serum vitamin D levels were normalized between 70 and 100% of patients, and adverse effects ranged between 1.9 and 18.5%. CONCLUSION: The study demonstrated that vitamin D mega-dose therapy is effective in normalizing serum vitamin levels, and the toxicity assessed through adverse effects was low, with no expressive clinical significance. Despite this, there is still a need for further studies in the area to confirm the results found.

High Prevalence of Metabolic Syndrome in Patients with Lumbar Spinal Stenosis: Association with Diabetes and Elevated Body Mass Index.

BACKGROUND: Lumbar spinal stenosis (LSS) is a narrowing of the lumbar canal causing lower back pain, gluteal pain, and neurogenic claudication. LSS has been associated with cardiovascular co-morbidities. Metabolic syndrome (MetS), a pro-inflammatory condition involving a cluster of risk factors for cardiovascular disease and diabetes, is increasingly prevalent worldwide. OBJECTIVES: To evaluate the prevalence of MetS in patients with LSS, compared to age- and sex-matched healthy controls, and to explore potential associations between MetS and LSS-related clinical parameters and cardiovascular risk factors. METHODS: We conducted a cross-sectional study including 64 patients diagnosed as symptomatic LSS (NASS criteria) and 32 controls. MetS was diagnosed using the 2009 Harmonizing criteria adjusted for South Americans. Multivariate logistic regression was used to identify independent risk factors for MetS. The level of statistical significance was set at 5. RESULTS: The prevalence of MetS was significantly higher in the LSS group than in the control group (76.6% vs. 31.3%; P < 0.001). LSS patients displayed greater waist circumference (P = 0.003), blood glucose levels (P = 0.009) and arterial pressure (P < 0.001) than controls. The variables with independent influence on MetS in the logistic regression model were: diabetes (P = 0.008), blood glucose (P = 0.004), and body mass index (P = 0.005). CONCLUSIONS: MetS was significantly more prevalent among LSS patients, and diabetes and elevated body mass index were found to be risk factors for MetS in these LSS patients.

Osteonecrosis in Primary Antiphospholipid Syndrome is Associated with Previous Glucocorticoid Use and Thrombocytopenia.

INTRODUCTION: The aim of this study was to investigate the frequency of avascular necrosis (AVN) and its associations with clinical and laboratory parameters in patients with primary antiphospholipid antibody syndrome (pAPS). METHODS: This was a cross-sectional study of 66 patients with pAPS who fulfilled the Sidney criteria for APS. Epidemiological and clinical data, and data on antiphospholipid antibodies were collected. Diagnosis of AVN was based on studies of magnetic resonance (MRI) images of affected bones. RESULTS: AVN was found in three of the 66 (4.5%) enrolled patients. Comparison of patients with pAPS with and without AVN showed that demographic data, comorbidities, and antiphospholipid antibodies profile were similar in both groups. Compared to patients without AVN, those with AVN had thrombocytopenia more frequently (66.7 vs. 7.9%) and used more glucocorticoids (100 vs. 35%). CONCLUSION: AVN is rare in patients with pAPS and may be associated with thrombocytopenia and previous glucocorticoid use.

Essential oil therapy in rheumatic diseases: A systematic review.

OBJECTIVES: This paper aims to review articles that have evaluated the role of essential oil therapy in patients with rheumatic diseases. METHODOLOGY: Systematic review. No study design or language limitation was applied. RESULTS: We have identified 13 articles, most of them were used in osteoarthritis (n = 4), rheumatoid arthritis (n = 3) and fibromyalgia (n = 3). Two studies included patients with RA and OA (n = 2). The number of people involved in the study varied from 9 to 162, where female sex was observed in 60-100%. The age of the patients ranged from 36 to 78.3 years old and disease duration 1-11.67 years. The lavender essential oil was the most used, and then Ginger oil, Rosemary oil, and Rosmarinus officinalis. Time of oil use varied from 2 to 12 weeks. Importantly, all studies but one (91.6%) have demonstrated the efficacy of aromatherapy. CONCLUSION: There are few reports on essential oils in rheumatic disease, mainly osteoarthritis, rheumatoid arthritis, and fibromyalgia. All but one study have showed the efficacy of this complementary therapy.

Musculoskeletal Manifestations Observed in Patients Diagnosed With Chikungunya Virus in 2 Municipalities of the Brazilian Amazon Region.

BACKGROUND: Chikungunya virus fever is an emerging disease that is rapidly spreading and becoming a global public health issue because of its clinical manifestations that cause physical limitations and high rates of chronification. No studies have characterized musculoskeletal manifestations in Brazilian patients with chikungunya. OBJECTIVE: To describe the musculoskeletal manifestations of patients with chikungunya infection in municipalities of the Brazilian Amazon region. METHODS: This study was an observational, descriptive, and analytical study conducted from March to May 2018. The gender, age, time of infection, clinical manifestations reported during the acute phase, and results of a physical examination of the musculoskeletal system were collected. RESULTS: The medical records of 63 patients with a laboratory confirmation of chikungunya virus fever were analyzed. Eighty-three percent of these patients were women, with a mean age of 50.6 ± 14.5 years and 3.3 ± 3.1 months of infection. The main clinical manifestations reported during the acute phase were arthralgia (100%), fever (91%), and exanthema (65%). The physical examination revealed that the main joints affected by arthralgia resulted in a polyarticular (57%, 5-10 joints) and symmetrical pattern (62%) that mainly affected the ankles (53%) and knees (51%). Regarding arthritis, the most frequently affected area was the wrist (42%), with an oligoarticular pattern (42%, 2-4 joints). CONCLUSIONS: In general, the clinical manifestations described in the Brazilian Amazon population are similar to those reported in publications from other countries; however, the main arthritis pattern identified is oligoarticular, with a predominance of the wrist. Moreover, the chronicity rate is 48%.

Cardiovascular comorbidities in antiphospholipid syndrome.

Antiphospholipid syndrome is an autoimmune disease characterized by venous and/or arterial thrombosis and/or recurrent fetal loss and the presence of antiphospholid antibodies. Among the causes of death of antiphospholipid syndrome there are the myocardial infarction and stroke. Comorbidities could worsen the evolution of these patients, and the knowledge about these situations could prevent or minimizethe risks associated with the disease. In this article, we review the literature about cardiovascular comorbidities, such as traditional risk factors for atherosclerosis, metabolic syndrome and vitamin D deficiency, and how these could influence the prognosis of antiphospholipid syndrome patients.

Coronary aneurysms in a child: an unusual presentation of pseudovasculitis.

Abnormalities of the coronary arteries in children are rare and Kawasaki disease is the most common cause of acquired coronary disease in a paediatric population. We report a case of a female child with coronary artery aneurysms and convulsions, who was diagnosed with Kawasaki disease. Due to systemic arterial hypertension and persistence of high inflammatory markers after treatment with high dose glucocorticoid and intravenous immunoglobulin, further investigation was performed and revealed a pheochromocytoma. Surgical removal led to normalization of blood pressure and laboratory parameters. Periodic echocardiography studies revealed progressive reduction of coronary aneurysms, with complete normalisation after 8 months. This is the first case described of coronary aneurysms presenting as a pseudovasculitis syndrome associated with pheochromocytoma.

The role of environmental factors in the pathogenesis of non-organ-specific autoimmune diseases.

The immune system must be able to discriminate between self and non-self. However, mechanisms of doing so sometimes fail, causing the activation and clonal expansion of autoreactive lymphocytes and the development of autoimmune conditions. Although some autoimmune diseases have heritable components, these components are not sufficient to develop an autoimmune condition. A variety of environmental factors have been described as possible triggers of autoimmune diseases, including drugs, infectious agents, smoking, vaccination and adjuvants. The aim of this chapter is to review the most common environmental factors associated with autoimmune diseases.