Ahmadreza Dehpour, PharmD, PhD
Vol 57, No 11 (2019)
Cognitive impairment, an important side effect of electroconvulsive therapy (ECT), may be related to the release of prostaglandins in the brain. Cyclooxygenase-2 (COX-2), constitutively expressed in the CNS, has a functional role in glutamate-mediated learning and memory. The goal of this pilot, double-blind, placebo-controlled trial was to evaluate the effects of the selective COX-2 inhibitor celecoxib on the adverse cognitive effects of ECT. Twenty patients diagnosed with the major depressive disorder for which ECT was indicated as a treatment for their current episode randomly received either celecoxib (200 mg orally twice a day, a total dose of 400 mg/day) or placebo. All patients underwent the same protocol for anesthesia and ECT procedures. The patients received celecoxib or the placebo for the whole period of ECT treatment, starting the day before ECT and continuing until the sixth (last) session of ECT. The Wechsler Mental Scale-III (WMS-III), the Mini-Mental Scale Examination (MMSE), and Stroop Color test were used to assess cognition before the first session and after the first, third and sixth sessions of ECT. Hamilton rating scale for depression was also used for the assessment of depression before and after the trial. Our data showed that celecoxib group did not have significant improvement in cognition based on WMS-III or MMSE scores. There was an improvement in the Stroop Color test but not statistically significant. Our results demonstrated that although celecoxib was well tolerated in patients undergoing ECT, it did not improve related cognitive impairment. Clinical trial registration number: IRCT201201247202N2. CNS, central nervous system; COX-2, Cyclooxygenase-2; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision; ECT, electroconvulsive therapy; ECS, electroconvulsive shocks; HAM-D, Hamilton rating scale for depression; LTP, long term potentiation; MDD, major depressive disorder; MMSE, Mini-Mental State Examination; NSAIDs, nonsteroidal anti-inflammatory drugs; WMS-III, Wechsler Memory Scale-III.
There is strong evidence on the interaction of several genetic variations and environmental conditions in the etiology of asthma. Association of a disintegrin and metalloproteinase 33 (ADAM33) with asthma risk is not clear and shows diversity between nations and ethnicities. Several single nucleotide polymorphisms (SNP) of the ADAM33 gene are introduced and studied according to the disease onset and characteristics. The aim of our study is to determine the association of ADAM33 rs2280091 polymorphism and pediatric asthma in the Iranian population. A total of 63 asthma patients (aged 6-18) and 86 healthy controls were enrolled in our study. Asthma type, classification, and severity were defined. SNPs of the ADAM33 gene at rs2280091 (T1) were analyzed. Pulmonary function tests, total blood eosinophil count, and IgE count were also assessed. T1 genotype and allele frequencies were not associated with asthma risk in Iranian pediatric asthma. Atopic asthma subgroup and patients with normal eosinophil count showed association with ADAM33 rs2280091. Moreover, asthma patients with AG genotype showed lower pulmonary functions.
Acute gastroenteritis is one of the most important causes of death in children in developing countries which cause by different enteropathogens, including bacteria, viruses, and parasites. Among these, most of the acute gastroenteritis in children are caused by viral infections mainly by rotavirus and norovirus. This study aimed to study the epidemiological and clinical status of acute gastroenteritis resulting from rotavirus and norovirus in children between June 2015 and June 2016 in Iran. A total of 211 stool specimens were collected from Ali Asghar Children's Hospital and Bahrami Children's Hospital in Tehran, from June 2015 to June 2016. The samples were screened by commercial enzyme immunoassay (EIA) Ridascreen kit and real time RT-PCR to detect rotavirus and norovirus genogroups I and II, respectively. The information on demographic and clinical manifestations was collected, and data analyzed using IBM SPSS statistics version 22. Overall, the detection rate of rotavirus was 25.6 %, and for norovirus infection, it was 17.5%. All norovirus positive specimens belonged to genogroup II. Higher rates of rotavirus infections were observed in children from 7 to 24 months, and higher rates of norovirus infections were detected in children from 1 to 12 months. Clinical symptoms were not different between rotavirus and norovirus case-patients. The present study not only highlights the importance of rotavirus and norovirus infections in Iran but also verifies the relevance of norovirus as the cause of severe gastroenteritis in children.
The main cause of chronic liver disease in Iran is Non-alcoholic fatty liver disease (NAFLD). A common pathological feature of chronic liver disease is fibrosis, so particular vigilance against patients with liver fibrosis is necessary to lead healthcare resource planning. The aims of the current study were to determine the prevalence and predictors of significant fibrosis and advanced ones among individuals with NAFLD. In the current cross-sectional study conducted during 2013-2016, the presence of fibrosis among NAFLD patients was assessed using the NAFLD fibrosis score (NFS) and AST to Platelet Ratio Index (APRI) systems. Multivariate logistic regression models were used to predict significant fibrosis or advanced fibrosis among NAFLD patients. Analysis of the results of over 999 patients (569 females and 430 males) with the mean age of 43.28±14.034 years in Iran during 2015-2016 showed that the overall prevalence of NAFLD among Iranian adults was 19.6%. NAFLD prevalence was not significantly higher in males compared to females (51.5% vs. 48.5%, P=0.66). On multivariate logistic regression analyses, females were less likely to have NAFLD compared to males (OR 0.32, 95% CI 0.24-0.42, P<0.001). The overall prevalence of liver fibrosis among NAFLD patients was 38.8%.20.4% and 6.12% of NAFLD patients had evidence of significant and advanced fibrosis, respectively. Our most recent dataset analysis emphasized the major burden of NAFLD among people of Iranian origin. A high prevalence of individuals with NAFLD and advanced fibrosis was observed.
We aimed to compare the sonographic measurement of median nerve cross-section area (CSA) in patients with Amyotrophic Lateral Sclerosis (ALS) and healthy individuals. The effect of duration of the disease on correlations between paraclinical findings and ALS functional rating scale (ALSFRS) were secondarily aimed to be evaluated. The cross-sectional study was approved by the Ethical Committee of Iran University of Medical Sciences and conducted between January 2017 and December 2018. We evaluated the median nerve surface area by means of sonography in 35 ALS patients and 35 healthy controls. Compound muscle action potential (CMAP) amplitudes during nerve conduction study and ALSFRS were recorded by the same trained specialist. Data were analyzed using SPSS software version 18. We did not find a significant difference between CSA in ALS patients and the normal population (P>0.05). Comparing to normal individuals, the mean CMAP decreased significantly in ALS patients (6.6±3.07 mV versus 10.25±2.2 mV, P<0.001). ALSFRS correlated with both CSA of the median nerve at the wrist (P:<0.001, r:0.78) and the CMAP (P:<0.001, r:0.74) that were confirmed by regression models designed to consider the effect of disease duration on these correlations. CSA was not different between ALS patients and the normal population, but CMAP decreased in ALS patients. ALSFRS correlated with both CSA and CMAP of the median nerve.
Exercise and physical activity have well known physical and mental benefits, especially during students' life. This study was conducted to evaluate physical activity among students of Tehran University of Medical Sciences (TUMS). We have randomly recruited students of TUMS in the 2017-2018 academic year to report their routine physical activity through filling out the Persian version of the Global Physical Activity Questionnaire as well as demographic characteristics among 12 different schools. Accordingly, we classified the physical activity of participants into three groups (high, moderate, and low). From a total of 425 students, data from 417 were analyzed. The age range of students was from 18 to 48, with a mean (SD) of 25.8 (5.43) years. 53.5% and 46.5% of participants were male and female, respectively. Students were classified into 3 categories of high (41%), medium (38%), and low (21%) physical activity. In the present study, 87.3% and 12.7% of students were active and inactive, respectively. There was a significant difference in the overall activity level between genders and work-related activity between students of clinical and non-clinical settings. No significant differences were found between physical activity level and other demographic data. Our results showed that the majority of students had a physical activity of more than 600 MET-min/week. No significant relationship was found between physical activity and age, school, GPA, and BMI. Compared to the national activity report, students of TUMS were at the proper level of physical activity. However, further research is needed to confirm these results.
Asthma is the most common chronic illness in children and is a major reason for pediatric
emergency department visits. Beta-2 agonists are considered the most effective drugs for immediate relief in
the symptoms. This study aimed to compare the effectiveness of salbutamol delivered via jet nebulizer with a
metered-dose inhaler (MDI) plus a spacer for asthma exacerbation in the pediatric emergency departments. The
study was a randomized control, parallel-group design in children with age ranging from 6 months to 14 years,
presenting in the emergency department with an acute asthma attack. A total of 116 patients were recruited for
the study. Sixty-two patients were enrolled in the MDI/spacer group, and 54 patients were in the nebulizer
group. Patients were assessed at baseline (0 min) and 15, 30, 45 and 60 min after commencement of the
nebulizer and MDI/spacer. The response of each group to treatment was compared. The parents were counseled for their child enrolment in the study, which was approved by the Human Ethics Committee of Shahid Beheshti
University of Medical Sciences. Ethic code was IR.SBMU.SM.REC.1394.19. The patients in both treatment
groups demonstrated statistically noticeable improvement in clinical scores at all study assessment periods.
Results revealed that salbutamol via MDI/spacer was as effective as salbutamol nebulization during the
treatment of asthma exacerbations. Salbutamol MDI/spacer is equally efficacious when compared to
nebulization. Therefore, because Salbutamol MDI/spacer is more user-friendly and affordable, it is preferable
to be used in emergency departments
To compare the cosmetic outcome and acute cutaneous, cardiac, and pulmonary toxicity profile of accelerated hypofractionated and conventional whole breast radiotherapy (WBRT).This was a blocked randomized, clinical trial on women with early-stage node-negative invasive breast cancer after breast conservation surgery (BCS) with clear margins randomly assigned to receive WBRT either at a conventional dose of 50.0 grays (Gy) in 25 fractions (the conventional group) or at a dose of 42.5 Gy in 16 fractions (the hypofractionated group). Boost irradiation was permitted in both groups. Data were analyzed by SPSS V21.0 using Mann–Whitney U, independent-samples t- and Chi-Square/Fisher's exact tests at the level of P≤0.05.The median follows up was 16 months. Forty-one patients in the conventional WBRT arm and 45 patients in the hypofractionated WBRT group were enrolled. No significant difference was observed in terms of left and right ventricle systolic dysfunction and diastolic dysfunction. Pulmonary function tests after 6 and 12 months follow up, were comparable in both groups (P=0.2). Skin toxicity during and after treatment was acceptable in both groups. Breast size change in the conventional and the hypofractionated WBRT groups was 14.3% and 7.1%, respectively (P=0.6). Excellent or good cosmetic outcome was similar in both groups.The results of our study support the use of accelerated hypofractionated WBRT in women with invasive breast cancer less than five cm and node-negative after breast-conserving surgery, which provides a more convenient shorter course of radiotherapy with a comparable cosmetic outcome and cutaneous, cardiac, and pulmonary toxicity profile.
The hyper-immunoglobulin M (HIGM) syndrome comprises a group of rare inherited immunodeficiency disorders characterized by normal or elevated levels of serum IgM with low or absent levels of serum IgG, IgA, and IgE. Patients with this syndrome usually present with a history of recurrent infections or opportunistic infections. Here, we report two male cousins from homozygote twin mothers. The first cousin presented with no signs or symptoms other than neutropenia, which was accidentally found in a routine blood test. Immunological workup in this patient showed undetectable IgG and IgA levels and normal IgM levels. The second cousin had a history of recurrent infections, and at the time of admission, he was diagnosed with Pneumocystis jirovecii infection. The immunologic workup of this patient showed undetectable IgG, decreased IgA, and increased IgM level. Due to their interesting family relationship, genetic analysis was performed, which detected a novel mutation in exon 2 (c.266 del G) of the CD40 ligand gene (CD40LG).
Idiopathic occlusion of nearly all cerebral venous sinuses in association with the widespread formation of dural arteriovenous fistulas (AVF) is an extremely rare condition. The cause-and-effect relationship between thrombosis and AVF is not known, but a disturbance in venous flow and distant stagnation has been mentioned as probable pathomechanisms. We introduce a patient that was misdiagnosed as Parkinson's disease and treated accordingly for weeks. Then, rapidly-progressive dementia and shortly after that, an intracerebral hemorrhage occurred, and the diagnosis was established after Magnetic Resonance Imaging and Angiography. There were a whole venous sinus system thrombosis and the formation of numerous dural arteriovenous fistulas. The mechanism and diagnostic nuances are described in this paper, and the treatment options and prognosis are discussed.