An Epidemiological Investigation on Patients with Non-traumatic Subarachnoid Hemorrhage from 2010 to 2020.

Objective: Subarachnoid hemorrhage (SAH) is still considered a life-threatening medical condition with a high mortality rate, particularly in developing countries. Thus, the present study aimed to investigate the angiographic findings of non-traumatic or spontaneous SAH. Methods: This retrospective cohort study included 642 health records of patients with non-traumatic SAH over a 10-year period, from 2010 to 2020. The required data, including demographic information, aneurysm type, size, location, disease severity classification, and secondary complications, were extracted. Results: The study included 642 patients, with 262 (40.8%) being male. The mean age of the participants was 54.72±13.51 years. The most prevalent type of aneurysm was saccular (89.1%), while serpentine (0.2%) and dissecting saccular (0.2%) aneurysms had the least prevalence. The most frequently involved arteries were the anterior communicating artery (ACoA; 38%), internal carotid artery (ICA; 27.6%), and middle cerebral artery (MCA; 13.4%). There was a significant correlation between sex and aneurysms occurring at ACoA and ICA (p< 0.0001), and ACoA - A1 (p=0.02). Patient age and sex were also significantly correlated with one another (p<0.0001). There was no statistically significant correlation between sex, aneurysm size, Glasgow coma scale (GCS), and modified Rankin scale (MRS). Conclusion: Based on our findings, the presence of aneurysms at ACoA, ACoA - A1, and ICA should be thoroughly ruled out in patients with severe headaches of sudden onset, particularly male patients of younger ages.

Relationship of Viral Load with the Laboratory Markers and Prognosis in COVID-19 Patients.

Background: Coronavirus disease 2019 (COVID-19) viral load determined from the cycle threshold (CT) values may be a marker of disease severity and predict disease progression. Our study aimed to investigate the relationship between SARS-CoV-19 cycle thresholds or viral load, laboratory markers, and patient prognosis. Methods: Patients who were admitted to Imam Reza Hospital at Mashhad University of Medical Sciences between March 2020 and March 2021 and had COVID-19 polymerase chain reaction (PCR)-confirmed at random were included in this cross-sectional study. Patients were randomly selected from those who tested positive on nasopharyngeal and oropharyngeal reverse transcription-PCR samples. The inclusion criteria were all patients older than 16 years with positive COVID-19 PCR results. Samples with Ct values of ≤36 were considered positive for SARS-CoV-2 RNA. Patients who did not have laboratory markers were excluded. We used SPSS Version 16 (Pearson correlation, analysis of variance, and logistic regression tests) to analyze the data. A P ≤ 0.05 was considered statistically significant. Results: In our study, serum lactate dehydrogenase and aspartate aminotransferase were found to be laboratory biomarkers inversely correlated with COVID-19 Ct values, indicating higher viral load (r = -0.14; P = 0.024 and r = -0.12; P = 0.053, respectively). Also, the platelet count is lower in patients with higher viral loads (r = 0.18; P < 0.001). However, we found no correlation between the viral load and some laboratory biomarkers such as ferritin, white blood cell and lymphocyte count, alanine transaminase, and c-reactive protein (P > 0.05). The patient's length of hospital stay was not correlated with their viral load (P > 0.05). Conclusion: The COVID-19 viral load has been linked to some laboratory indicators and may be used to predict patient death. These discoveries might help in the treatment of COVID-19 disease.

Investigating the Effects and Side Effects of Two Antipsychotic Drugs in the Treatment of Children and Adolescents with Tourette Syndrome: A Semi-experimental Research.

INTRODUCTION: Due to the high prevalence of Tourette's disorder among children and adolescents and its negative consequences, an appropriate and effective medical treatment with minimal complications is necessary. Therefore, this study was conducted to compare the effects of Aripiprazole and Risperidone on Tourette's disorders in children and adolescents. METHODS: The statistical population of this semi-experimental study was children and adolescents aged seven to eighteen years old. They were diagnosed with Tourette's disorder based on the DSM-V criteria by the clinical interview of a child and adolescent psychiatrist in the child Psychiatry clinic of Ibne- Sina's Psychiatric Hospital (Mashhad-Iran) in 2018. A total of forty participants were selected by the convenience sampling method, and they were randomly divided into two groups treated with medicines, Risperidone or Aripiprazole, for two months. Then, the demographic information questionnaire was completed. The Y-GTSS Scale was completed. The clinical Effect Rating Scale (CGI-Tics Scale) was completed. Calculation of body mass index and medical side effects complications were completed. The evaluation was carried out at the beginning and on the second, fourth, and eighth weeks, and the results were compared. The data were analyzed using SPSS software. 14, descriptive statistics, Chi-square, and variance analysis. RESULTS: The two groups were homogeneous in terms of demographic variables and body mass index. Despite the positive effect of both medicines, no significant difference was observed among the general scores of such disorders, the overall score of severity, Tourette's recovery, and BMI of these two groups at the intervals and the end of treatments. (p <0.05). Due to the low number of complications reported, statistical comparisons of the medical side effects were not made. CONCLUSION: According to the results, the two medicines, Aripiprazole and Risperidone, effectively improved the symptoms of Tourette's disorder and its overall severity. However, there were no significant statistical differences between them. Furthermore, in terms of the medical side effects, the statistical comparison between the two medicines was impossible due to the small number of complications.

Relationship of serum estradiol and progesterone with symptoms and sex difference in schizophrenia: A cross-sectional study in Iran.

Background: Schizophrenia is a devastating disease characterized by frequent relapses, cognitive decline, and emotional and functional disability, with unknown causes. The phenomenology and clinical course of schizophrenic disorders are different between the two genders, which is thought to be related mainly to the effects of steroid sex hormones on the nervous system. Regarding inconsistencies in the studies, we aimed to compare the levels of estradiol and progesterone between schizophrenia patients and healthy individuals. Methods: This cross-sectional study was conducted on 66 patients referred to the specialized clinical psychiatric ward of a teaching hospital in the north of Iran, for 5 months in 2021. Thirty-three schizophrenia patients confirmed by a psychiatrist based on DSM5 criteria were included in the case group, and 33 individuals without a psychiatric disease were included in the control group. We completed a demographic information checklist for each patient, along with the Simpson-Angus extrapyramidal side effect scale (SAS) for drug side effects and the positive and negative syndrome scale (PANSS) for the severity of the disease symptoms. Then, a 3-ml blood sample was taken from each participant to determine the serum levels of estradiol and progesterone. The data were analyzed by SPSS16 software. Results: Thirty-four (51.5%) and 32 (48.5%) participants in this study were male and female, respectively. The mean serum level of estradiol was 22.33 ± 13.65 pm/dl in schizophrenia patients and 29.36 ± 21.32 pm/dl in the control group, showing no significant difference between the two groups (P = 0.4). However, the mean serum level of progesterone was significantly lower in schizophrenia patients (0.37 ± 1.39 pm/dl) than in control subjects (3.15 ± 5.73 pm/dl) (P < 0.001). The PANSS and SAS scores were not significantly correlated with the level of sex hormones (P > 0.05). Serum estradiol and progesterone levels based on sex significantly differed between the two groups (except for female estradiol). Conclusion: Considering the hormonal differences between schizophrenia patients and control subjects, determining hormonal levels in these patients and using complementary hormonal therapies with estradiol or similar compounds can be beneficial as the starting point of schizophrenia treatment, where therapeutic responses can draw the future developmental framework.

Personality profile and therapeutic response to lithium carbonate and sodium valproate in mania with psychotic features.

Bipolar disorder is one of the major psychiatric disorders. Therefore, determining the factors that predict mood stabilizer response is important. This study aimed to investigate the relationship between personality profile and the response to lithium carbonate and sodium valproate in patients with psychotic mania. In this study, 50 patients with bipolar I disorder (manic episode with psychotic features) were randomly assigned to receive lithium carbonate (up to a serum level of 0.8-1.5 mEq/L) or sodium valproate (20 mg/kg). After stabilization of acute manic phase, Temperament and Character Inventory was completed by the patients themselves. Fifty subjects completed this study. The mean age ± SD of participants in the sodium valproate group and lithium carbonate group was 32.99 ± 9.94 and 30.73±7.94 years, respectively. The responders to sodium valproate had significantly higher scores in novelty seeking, harm avoidance (P = 0.003 and 0.004, respectively) and lower scores in persistence (P = 0.006) than the non-responders, but the responders to lithium carbonate did not have significantly different personality profiles. The results of the present study revealed that the personality profiles in the inpatients with psychotic mania are related to the responses to sodium valproate, but are irrelevant to the responses to lithium carbonate.

Effects of Celecoxib Adjunct to Selective Serotonin Reuptake Inhibitors on Obsessive-Compulsive Disorder.

INTRODUCTION: Inflammatory processes in the brain play an important role in the etiopathogenesis of Obsessive-Compulsive Disorder (OCD). Cyclooxygenase inhibitors, such as celecoxib reduce the production of proinflammatory cytokines. This double-blind study aimed to investigate the effects of adding celecoxib to Selective Serotonin Reuptake Inhibitors (SSRIs)on treating OCD. METHODS: Sixty patients who met the diagnosis criteria for OCD based on the Diagnostic and Statistical Manual of Mental Disorders -Fourth Edition- Text Revision (DSM-IV-TR) were recruited in the present study. Two psychiatrists independently confirmed the diagnosis by performing structured interviews. The study participants included 23 patients who received SSRIs and celecoxib (400 mg twice daily) and 22 patients in the control group that received SSRIs and placebo. Moreover, at baseline, in weeks 4, 8, and 12, the explored patients were assessed by a psychiatrist using the Yale-Brown Obsessive-Compulsive Scale (Y-BCOS). RESULTS: A significant difference was observed in the change of scores on the Y-BOCS in week 12, compared with the onset of the study between the study groups (t= -8.976, df=38, P=0.001). There was a significant difference between the study groups in obsession (F= 49.19, df= 1, P≤0.001), compulsion (F= 13.78, df= 1, P= 0.001), and OCD (F= 57.25, df= 1, P≤0.001), i.e., higher in the celecoxib group. CONCLUSION: This study showed that adjuvant treatment with celecoxib can further improve the symptoms of OCD in individuals receiving SSRIs.

Adjunct Triptorelin in the Treatment of Obsessive-Compulsive Disorder in Clients Receiving Selective Serotonin Reuptake Inhibitors (SSRIs).

Objective: Analog triptorelin is one of the effective agonists for the treatment of reproductive disorders, particularly prostate cancer. Due to results of previous studies, we hypothesized that obsessive-compulsive disorder (OCD can be effectively treated with the long-term administration of a gonadotropin-releasing hormone (GnRH) analog, namely triptorelin. The aim of this study was to evaluate the effectiveness of triptorelin injection in clients with OCD. Method : This randomized single-blind clinical trial was performed on 30 clients with OCD who had a Yale-Brown score of > 17 after 8 weeks of treatment. The participants were randomly assigned into two groups of triptorelin and placebo. The clients in the intervention group were treated with Selective serotonin reuptake inhibitors (SSRIs), including fluoxetine, in addition to triptorelin three times a month for at least 8 weeks. Clients in the control group received injection of distilled water as placebo three times in addition to the routine treatment. The outcome was evaluated by Yale-Brown OCD scale (Y-BOCS) at the baseline, as well as 4, 8, and, 20 weeks after the end of the treatment. Results: The mean scores of Y-BOCS in the intervention and control groups was 30.5 ±67.6 and 30.5 ±67.6, respectively, before intervention, indicating no significant difference between the two groups (P = 0.0.8). The comparison of Y-BOCS scores after the intervention showed a significant difference between the two groups in the scores 4 (P = 0.01), 8 (P < 0.005), and 20 (P < 0.005) weeks after the treatment. With regards to the side effects of the medicine, 6.7% (n = 1) of the clients in the control group developed headache and 66.7% (n = 10) had late period in intervention group. The results revealed a significant difference between the two groups in terms of side effects (P < 0.005). Conclusion: The results of this study showed triptorelin decreased the symptoms of OCD. The effectiveness of triptorelin in the treatment of symptoms in clients with OCD was confirmed in our study. However, due to the limited research addressing this domain, future studies are suggested to clarify this conclusion.

Intrathecal autologous bone marrow stem cell therapy in children with autism: A randomized controlled trial.

INTRODUCTION: This study aimed to determine the safety and efficacy of treatment with autologous bone marrow mesenchymal stem cell (BMMSCs) compared with the routine treatment in children with autism spectrum disorder (ASD). METHODS: In this ethically approved randomized controlled trial, 32 ASD children aged 5-15 years were randomly assigned to receive either autologous BMMSC plus rehabilitation therapy and risperidone (intervention group) or rehabilitation therapy and risperidone (control group). Autologous BMMSCs were intrathecally injected in the intervention group twice in 4 weeks. Patients were assessed using childhood autism rating scale (CARS), Gilliam autism rating scale-second edition (GARS-II), and clinical global impression (CGI) at the baseline, as well as 6 and 12 months after intervention. RESULTS: Overall, 32 patients in two groups of intervention (n = 14) and control (n = 18) completed the study, of which 27 (84.4%) were male. Mean age was 9.50 ± 2.14 years. The improvements in CARS total score, GARS-II autism index, and CGI global improvement showed no significant differences between the groups over 12 months. However, the main effect for time*group interaction was significant regarding the CGI-severity of illness, showing a significantly more pronounced improvement in the intervention group (F = 6.719; P = .002). DISCUSSION: Intrathecal injection of autologous BMMSCs seems to be safe and feasible, but has limited clinical efficacy in treatment of children with ASD.

Evaluation of the ability of emergency medicine residents in teaching and supervising emergency medicine interns.

BACKGROUND: Approximately 25% of the residents' time in each shift is allocated to educating lower-level assistants and interns. Assistants have played a major role in interns' education. AIM: To assess the teaching abilities of emergency medicine assistants in the training and monitoring of medical interns and undergraduate students. METHODS: This cross-sectional study was performed in 2015 at the emergency center of Imam Reza hospital in Mashhad University of Medical Sciences. We employed a researcher-made questionnaire to search the capability of emergency medicine residents to assess the teaching capabilities of emergency medicine residents to interns. This questionnaire was completed by 106 interns. The Validity of the questionnaire was confirmed by three specialist experts and reliability of the questionnaire was confirmed by Cronbach's alpha (0.94). This questionnaire consists of 24 questions in six areas. The analysis was performed by descriptive statistics using SPSS 16. RESULT: The study showed that the least favorable score was related to "residents get feedback on each shift" and the highest score was given to "a friendly relationship with the Interns and residents". CONCLUSION: Considering the key role of residents in the education and training of future healthcare specialists, training interventions and allocating sufficient time to the proper education of different members of healthcare teams and medical students could largely contribute to the development of clinical training systems.

Temperament-Character Profile and Psychopathologies in Patients with Alopecia Areata.

The aim of this study is to investigate psychopathologies and the temperament-character profile of Alopecia Areata patients and to compare them with healthy controls. Patients and controls who presented at a dermatology clinic were selected by convenience sampling to respond to Temperament and Character Inventory (TCI), SCL-90-R, and a checklist about the demographic data and their dermatologic and psychiatric history. Patients reported higher harm avoidance and reward dependence than controls (Cohen's d = .93 and = .94). A significant correlation between Harm Avoidance (r = -0.33, p = .02) and Reward Dependence (r = -0.28, p = 0.05) with sex was found (females scored higher). Lifetime history of AA relapse was significantly associated with higher psychiatric symptoms; the effect sizes were large for Obsessive-Compulsive (d = .81) and Paranoia Ideation (d = .89). The higher psychological symptoms in AA patients with the history of relapses in this study have a practical message for clinicians.

Assessment of unhealthy days among Iranian reproductive age women in 2012.

BACKGROUND: Unhealthy days are defined as the number of days during the past 30 days that a woman has not had a feeling of wellbeing. Wellbeing includes the woman's judgments about the level of satisfaction and quality in her life. Assessment of a woman's perception of unhealthy days can be used to help her determine the extent of the burdens associated with mental and physical feelings that things are not going well in her life, job and relationship. This study was conducted to measure unhealthy days and the general health status in Iranian women of reproductive age based on their own perceptions. METHODS: The participants of this study were women of reproductive age who were referred to health centers in Mashhad, Iran, in 2012. With the stratified random sampling method, 220 women were included in the study. The health-related quality of life-4 (HRQOL-4) questionnaire was used to assess the women's self-perceived unhealthy days. The data that were collected were analyzed by Kruskal-Wallis, chi-squared, Pearson correlation, and logistic linear regression tests with SPSS 11.5. RESULTS: The mean age of the participants was 32.6 years, and the median number of the self-perceived unhealthy days was 7.1 days (per month). In the domains of physical, mental, and disability unhealthy days, the data indicated 2 days, 2.1 days, and 0.1 day in a month, respectively. Also, nearly half of the participants reported that their general health status was poor to fair. The Kruskal-Wallis test showed that there was a significant difference between unhealthy days in the different age groups (p=0.01) as well as for the physical (p=0.02) and mental domains (p=0.4). The results of the regression analysis showed that the number of physical unhealthy days increased with age, number of children, and education. The number of mental unhealthy days increased with age, and the number of disability days increased as the age at which they were married decreased (p<0.05). A significant inverse relationship was observed between physical unhealthy days and education, with the number of physical unhealthy days decreasing as the years of education increased (r=-0.19, p=0.005). CONCLUSION: Women with less education who were older than 40, who married at an early age, and had more children reported more unhealthy days. These results emphasize the importance of preventive and educational health interventions in these vulnerable groups based on their physical and mental needs.