Ahmadreza Dehpour, PharmD, PhD
Vol 55, No 8 (2017)
Behçet’s disease is a chronic, recurrent, inflammatory disorder characterized by orogenital ulcers and skin lesions; serious manifestations also include ocular, large vessel, gastrointestinal and neurological involvement. Genetic and unknown environmental factors modify the wide clinical spectrum of the disease. During the long clinical course of the disease, testicular and epididymal involvement has been reported, with scrotal pain and swelling being the most common symptoms. In this review, we discuss the various aspects of epididymo-orchitis in Behcet’s disease patients, and we evaluate the diagnostic approaches as well as the empirical therapeutic modalities of this entity.
Paraoxonase 1 is known as one of the most important ant oxidative enzymes associated with HDL-c, and because of its antioxidant and antiinflammatory activities. EPA has the antioxidant, anti inflammatory, antithrombogenic, and antiarteriosclerotic properties. Therefore, we investigated the effect of EPA supplementation on the serum levels and activity of PON1 in type 2 diabetic patients. This study was designed as a randomized, double-blind, and placebo-controlled clinical trial. Thirty-six patients with type 2 diabetes were given written; informed consent randomly was classified into 2 groups. They were supplemented with 2 g/day of the capsules of EPA or placebo for eight weeks. Blood sample was given for measurement of the serum levels of lipids, the activity of PON1, FBS and HbA1c. The patients supplemented with EPA showed a significant increase in the serum levels and activity of PON1 and the serum ratio of PON1/HDL-c. There were no significant differences between the two groups regarding any demographic, clinical or biochemical data, total energy intake, and macronutrient intake at the baseline during the intervention, except for a significant increase of protein intake and the levels of HbA1c in the placebo group, and a significant increase of HDL-c, as well as a slight reduction of total cholesterol, LDL-c, TG and FBS in the supplement group. EPA is atheroprotective via increase in the serum levels and activity of PON1, as well as change in the serum levels of lipids, FBS and HbA1c.
Multiple sclerosis (MS) is the most common cause of disability after trauma in young adults in Northern Hemisphere; it imposes a major burden on the affected young people. A significant association between MS and demyelinating peripheral neuropathy which might be due to common pathogenesis for the central and peripheral nerves demyelination has been reported in several studies. We aimed to assess if there is any peripheral nervous system involvement in a sample of Iranian MS population. Extensive nerve conduction studies (NCS) were conducted in 20 MS patients according to McDonald criteria, and 20 age and gender matched healthy appearing controls. The F-wave ratio was calculated through placing the minimum amount of F-wave proximal latency after 10 stimuli and median or tibial nerves compound motor action potential (CMAP) proximal latency in the corresponding formula. Data were compared between groups. Finally, we found the significantly lower median and tibial nerves conduction velocities (NCV) in MS patients than healthy controls (P=0.008 and 0.003 respectively, Independent Samples t-test). Also, tibial NCV had a significant statistical correlation with Kurtzke’s expanded disability scale score (EDSS) as patients with higher EDSS had lower tibial NCV (Pearson's correlation coefficient, r2=0.8). No statistical relationship was found between MS subtypes and NCS parameters. Although we found some electrodiagnostic abnormalities in Iranian MS patients in comparison to the healthy participants, these differences were small and inconclusive. More extensive well-designed electrodiagnostic studies for evaluation of peripheral nervous system involvement and its probable pattern in these patients seems to be needed.
Alzheimer's disease (AD) is a devastating neurodegenerative disorder in human beings associated with cognitive, behavioral and motor impairments. The main symptom of AD is dementia, which causes difficulties in carrying out daily practices. Brain waves are altered in people with AD. Relative indices of brain waves can be beneficial in the diagnosis of AD. In this case-control study, 50 patients with AD and 50 matched healthy individuals were enrolled in case and control groups respectively. With recording and analyzing of brain waves with the utilization of quantitative electroencephalogram (QEEG), index of theta/alpha ratio was assessed in both groups. The index of theta/alpha ratio was significantly higher in patients with AD in comparison to healthy individuals (P<0.05). Index of theta/alpha ratio obtained by QEEG provides a non-invasive diagnostic marker of AD, which may be helpful in identification of non-advanced disease in susceptible individuals.
Little attention has been paid to seasonality in suicide in Iran. Time pattern in suicide deaths and suicide attempts for some related factors such as gender, mental disorders has been found. In present study, we focus on suicide methods and the association with seasonality and other putative covariates such as gender. Through a cross-sectional study, overall identified suicide attempts and suicide deaths in the province of Ilam from 1 January 2010 and 31 December 2014 were enrolled. We used Edwards' test for test of seasonality in suicide methods. Seasonal effect (peak/trough seasons) and (deaths/attempts suicide) was explored by ratio statistics, the null hypothesis being that the attempted suicides in each method group are evenly distributed over a year. More suicide attempts by hanging 29.4% and self-immolation 41.4% were observed in spring and differ by season pattern in both genders. The overall distribution of suicides by violent and non-violent methods was (males x2=6.3, P=0.041, females x2=7.7, P=0.021) and (males x2=44.5, P=0.001, females x2=104.7, P=0.001), respectively. The peak and trough seasons was observed in taking medications and self-poisoning for spring and winter. Suicide with alcohol was no differ by season pattern (x2=1.0, P=0.460). Suicide in Ilam illustrates a significant seasonality for both violent and non-violent methods of suicide, in both genders, the two peaks were observed in spring and autumn for violent suicides, and spring and summer in non-violent suicides.
Given the limitations of traditional teaching methods in the learning process of adolescents, this study was designed to investigate the effects of osteoporosis prevention training through interactive multimedia method on the degree of knowledge and self-efficacy of female high school students. In this interventional study which was conducted in 2016 in Fars province, Iran, 120 high school students were selected through proportional stratified sampling from schools and different classes at first, second, third, and pre-university grades. The participants were randomly divided into two groups, each containing 60 students. Educational interventions for the test group included an interactive multimedia CD, and for the control group was an educational booklet. Before and one month after the intervention the students' level of knowledge and self-efficacy was measured. The spss 19 statistical software was used, and descriptive and analytical tests were performed to analyze the data. Results showed a significant difference in self-efficacy scores after the intervention (P=0.012) with the test group obtained a higher self-efficacy score than the control group. Also, a significant increase was observed in the knowledge score of both groups after the training (P<0.001), but the knowledge score between the two groups was not statistically significant (P=0.38) after the intervention. The use of new training methods like interactive multimedia CD for public education, particular adolescents about health and hygiene is recommended.
Applying simulation in medical education is becoming more and more popular. The use of simulation in medical training has led to effective learning and safer care for patients. Nowadays educators have confronted with the challenge of respecting patient safety or bedside teaching. There is widespread evidence, supported by robust research, systematic reviews and meta-analysis, on how much effective simulation is. Simulation supports the acquisition of procedural, technical and non-technical skills through repetitive practice with feedbacks. Our plan was to induct simulation in emergency medicine residency program in order to ameliorate our defects in clinical bedside training. Our residents believed that simulation could be effective in their real medical practice. They mentioned that facilitators’ expertise and good medical knowledge, was the strongest point of the program and lack of proper facilities was the weakest.
A 47-year-old woman presented with a history of resistant arterial hypertension, associated with disabling headache. She was subjected to an enormous number of tests in order to identify an underlying cause of secondary hypertension, such as pheochromocytoma or Cushing syndrome, but all the most common causes of secondary hypertension were investigated and gradually excluded. Factitious use of amphetamine or cocaine was excluded, and therapy compliance was verified by witnessed ingestion of drug therapy, in order to rule out Munchausen syndrome. The patient underwent a first transcatheter renal denervation (RDN) with poor effect on blood pressure (BP) at long term follow up. Because of extremely poor control of BP values, a second RDN was performed two years later, again with inadequate long term efficacy. Despite an uncontrollable pre-procedural BP, RDN had an excessive BP lowering effect in this patient, but only for few months. In conclusion, a definitive diagnosis was not performed in our patient, despite an extremely deepened examination of the most common cause of refractory hypertension.
Hydatid cyst is a rare parasitic infection that involved all organs. It caused by the larval stage of Echinococcus tapeworms. Hydatid cyst of the head and neck is a very rare condition, even in areas where Echinococcus infestation is endemic. Orbital hydatid cyst is extremely rare and accounts for less than 1% of all hydatid cysts. Herein a 24-year-old man with primary orbital hydatid cyst is introduced. He complained from proptosis and diplopia. MRI images revealed a lesion with low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, which displaced the optic nerve inferiorly and the globe inferolateral. The cyst was enucleated via frontotemporal craniotomy and superior orbitotomy approach. Histopathological examination of the fluid confirmed the diagnosis of hydatid cyst. Treatment of the orbital hydatid cyst is surgical excision followed by the systemic use of albendazole.
White sponge nevus is a rare benign autosomal dominant disorder with variable penetrance. It is characterized by asymptomatic white plaques affecting mainly the oral mucosa. Careful clinical and histopathological examination is indicated to exclude other more serious conditions presenting as oral white lesions. Herein, we present a new case of oral white sponge nevus in a 17-year-old Iranian male with no familial background.
Achondroplasia is an autosomal dominant disease which is characterized by limb shortening and narrow trunk, and macrocephaly. Women with achondroplasia suffer from infertility, menorrhagia, dysmenorrhoea, leiomyomata and early menopause. Our case was a 26-year-old woman with achondroplasia who had scoliosis and osteoporosis. She referred to our clinic at 9 weeks of gestation and had all screenings completely. She had a single female fetus with no abnormalities. She had an emergent due to rupture of membranes at 37 weeks and 3 days under general anesthesia. The neonate had no complications. The first minute Apgar score was 9 and 5th-minute Apgar score were 10. Umbilical artery Ph was 7.26 and birth weight was 3140. A woman with achondroplasia could have a normal pregnancy and give birth to a healthy term neonate under precise screening.