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Background: Diagnosis of neuropsychiatric systemic lupus erythematosus (NPSLE) is challenging due to nonspecific biomarkers. High serum levels of neurofilament protein light subunit (NFL), high mobility group box 1 (HMGB1), Matrix metalloproteinase-9 (MMP-9) and have been reported in several autoimmune diseases. The aim of this study was to examine whether their plasma levels could serve as a diagnostic or prognostic biomarker for NPSLE. Methods: There were 90 SLE patients enrolled in this cross-sectional study (87.8% women and 12.2% men with a mean age of 41.67±11.05 years). We assessed the mental status of patients, also we measured the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Systemic Lupus International Collaborating Clinics/ACR (SLICC/ ACR) Damage Index or SDI scores. Serum levels of NFL, HMGB1, MMP9, and ds-DNA were investigated to find a role in the pathophysiology of NPSLE. Results: Among the 90 patients with SLE, 63 (70%) met the criteria of NPSLE syndrome. Our results have shown a notable difference concerning SEDIAC-2k score, SDI score, PANS, MoCA, and Beck anxiety depression, between the two groups (p < 0.05). Although serum level of all measured serum biomarkers (NFL, MMP-9, HMGB1, dsDNA) were higher in patients with NPSLE, the difference was not statistically significant. Interestingly, our results showed that the serum level of NFL was correlated with the serum level of HMGB-1 and MMP-9. (r: 0.411, P=0.003). Conclusion: Serum level of NFL, HMGB-1 and MMP-9 may be used to detect abnormal mental status in patients with SLE.

Abstract Bladder injury is the most common urological trauma following the gynecological procedure. Normal vaginal delivery candidates with unresponsive and prolonged ascites and bladder‐emptying complaints should be examined for bladder rupture. We also suggest measurement of ascitic fluid creatinine levels in these patients.

The patient was a 24-year-old man with persistent vegetative state following severe traumatic brain injury due to a car accident, who was referred to the emergency department with a generalized tonic-clonic seizure due to severe hypoglycemia. The patient was treated with phenytoin, levetiracetam, bromocriptine and enoxaparine. The patient was transferred to the Intensive Care Unit (ICU) for accurate monitoring. The patient in the ICU was treated with 100 cc/h of Dextrose 10% plus Intravenous antibiotic to treat urinary tract infection induced sepsis. The previous prescribed medications were also prescribed. Despite proper feeding through PEG tube and receiving 100 cc/h of Dextrose 10%, the patient’s blood glucose was dropped frequently below 50 mg/dl and hypertonic glucose infusion was several times required for treatment of hypoglycemia. Administration of bromocriptine as antidiabetic agent was eliminated after consultation with a neurologist surgeon. After bromocriptine discontinuation, hypoglycemia was resolved. In this non-diabetic patient, severe hypoglycemia occurred after administration of bromocriptine, which was an unusual complication in the non-diabetic patient treated with bromocriptine.