Nicolau Syndrome.

A 23 year-old man was admitted to the hospital with chief complaints of pain, edema and spasm of the left lower limb, as well as mottling of dorsal and plantar aspects of the foot.  One week before the current admission, he was treated with oral co-amoxiclave and intramuscular penicillin 6.3.3. Immediately after the third injection, he experienced burning and yellowish discoloration at the site of the injection wich then progressed to his leg and foot. Pain, significant edema, spasm and mottling occurred within 30 minutes of the injection. The patient was referred to the hospital after 36 hours from the beginning of the symptoms. Color Doppler sonography revealed no impairment in the lower extremity flow and the common femoral artery, superficial femoral, popliteal, dorsalis pedis and posterior tibialis arteries were normal. Superficial probe sonography detected mild effusion in the left ankle without collection.

Effect of Omega-3 Fatty Acids on Depressive Symptoms in HIV-Positive Individuals: A Randomized, Placebo-Controlled Clinical Trial.

BACKGROUND: The antidepressant effect of omega-3 fatty acids has been described in the non-HIV population. The effect of omega-3 fatty acid supplementation on the mood status of HIV-positive patients has not been evaluated yet. OBJECTIVE: In this study, the effect of omega-3 fatty acids on depressive symptoms was evaluated in HIV-positive individuals. METHOD: A total of 100 HIV-positive patients with Beck Depression Score ≥16, were assigned to receive either omega-3 fatty acids or placebo twice daily for 8 weeks. Depressive symptoms of each participant were evaluated at baseline (month 0) and at the end of months 1 and 2 of the study. Beck Depression Inventory Second Edition, depression subscale of the Hospital Anxiety and Depression Scale, and Patient Health Questionnaire were used for assessment of depressive symptoms. RESULTS: Reduction in mean ± SD of all depression scores during the study period was statistically significant within the omega-3 group and when compared with the placebo group (for both comparisons, P < 0.001). Also, the mean differences of all depression scores were decreased significantly during the intervals: months 0, 1, and 2 (P < 0.001 for all comparisons). Among the participants, 7 (7%) and 4 (4%) patients in the omega-3 and the placebo group, respectively, experienced mild gastrointestinal problems, but the incidence of adverse drug reactions related to the interventions was not statistically different between the groups (P = 0.09). CONCLUSION: Omega-3 fatty acids improved depressive symptoms in HIV-positive individuals without any significant adverse reaction.

Pattern and associated factors of anti-hepatitis C virus treatment-induced adverse reactions.

OBJECTIVES: To assess the pattern and possible risk factors of conventional and/or pegylated interferon alpha (IFN-α) plus ribavirin therapy for causing adverse reactions in patients with chronic hepatitis C virus. Patients attending a referral center in Iran were assessed. METHODS: During an 18 month period all adult individuals diagnosed with chronic hepatitis C virus who planned to receive anti-hepatitis C virus treatment were prospectively screened regarding all related subjective and objective adverse drug reactions. RESULTS: The number of adverse drug reactions were significantly associated with the number of concomitant medications (p < 0.001), female gender (p = 0.027), increased age (p = 0.001), pegylated IFN-α (p = 0.015) and hepatitis C virus genotype 1 (p = 0.002). History of a prior anti-hepatitis C virus treatment course (OR = 3.081, 95% CI = 1.174 - 6.085; p = 0.022) and the number of co-administered medications (OR = 1.165, 95% CI = 1.034 - 1.314; p = 0.012) were identified as the only statistically significant risk factors for developing anti-hepatitis C virus medication-related psychiatric and dermatologic adverse reactions, respectively. CONCLUSION: These data could be exploited by health-care professionals and policy makers as a guide for developing optimal educational and preventive strategies in the setting of anti-hepatitis C virus medication safety.

Adherence to chronic hepatitis C treatment regimen: first report from a referral center in iran.

BACKGROUND: Various aspects of adherence to HCV treatment such as frequency, risk factors as well as causes of non-adherence, and its real role in clinical and virological outcome of the infected patients have remained largely unknown. OBJECTIVES: The current study aimed to evaluate patients' adherence to anti-HCV medications in Iran. MATERIALS AND METHODS: From October 2010 to March 2011, socio-demographic characteristics, features of HCV infection, clinical properties, and habitual history of 190 patients were collected. Adherence of each patient to anti-HCV medications was determined at months 1, 3, and 6 of treatment by self-reporting and pill or empty ampoule counting. Adherence to anti-HCV treatment regimen was determined based on the 80/80/80 rule. RESULTS: Adherence rate to interferon, ribavirin, or a combination of them over the first 6 months of therapy in Iranian HCV patients measured by both methods of self-reporting and pill counting were 35.4-65.8%, 46.3-56.8%, and 28.4-51.1%, respectively. Delay in receiving new prescription, financial issues, and adverse drug reactions were the most common causes of non-adherence in the patients. Adherence to ribavirin was identified as an independent predictor of achieving the end of treatment response, or sustained virological response. CONCLUSIONS: The rate of adherence to interferon and ribavirin varied significantly according to the method of calculation. Over the treatment course, adherence to interferon alpha and ribavirin, each or their combination, diminished significantly.