Safety and efficacy of levetiracetam and carbamazepine monotherapy in the management of pediatric focal epilepsy: a randomized clinical trial.

Due to the limited number of studies in children with focal epilepsy and the importance of choosing the most suitable drug to control seizures in children, the administration of the most effective medication with the most negligible adverse events is vital. This study aimed to evaluate the effectiveness and adverse events of carbamazepine vs. levetiracetam monotherapy in children with focal seizures. A monocentric, randomized, controlled, double-blind, parallel-group clinical trial was designed. This study was approved by the Iranian Registry of Clinical Trials (registration number: IRCT20170216032603N2) on June 19, 2020, and conducted at the neurology department of Imam Ali Hospital, Karaj, Iran, from February 2020 to March 2021. This study assessed 120 patients with recently diagnosed focal seizures aged 2 to 14. Patients were randomly divided into two groups, who received carbamazepine (CBZ) 15 to 20 mg/kg and levetiracetam (LEV) 20 to 40 mg/kg daily, respectively. Patients were evaluated for improvement and complications at weeks 4, 12, and 24. Out of 120 patients included in the study, six patients were excluded due to various complications of CBZ. The mean number of seizures at the end of the fourth, twelfth, and twenty-fourth weeks were 1.09 ± 0.75, 0.62 ± 0.27, and 0.39 ± 0.12 in the carbamazepine group and 1.11 ± 0.63, 0.52 ± 0.21, and 0.37 ± 0.11 in the LEV group, respectively (P > 0.05). Similarly, the number of seizure-free patients was 34, 44, and 48 in the CBZ group compared to 41, 50, and 54 in the LEV group, respectively (P > 0.05). On the other hand, the frequency of somnolence, dermatologic complications, and agitation was considerably higher in the CBZ group (P < 0.05). Although both medicines were equally effective in seizure control, CBZ was associated with considerably more adverse events and less patient compliance. Physicians should be aware of this difference to prevent unwanted consequences.

DNA Methylation in Cancer: Epigenetic View of Dietary and Lifestyle Factors.

Background: Alterations in DNA methylation play an important role in cancer development and progression. Dietary nutrients and lifestyle behaviors can influence DNA methylation patterns and thereby modulate cancer risk. Introduction: To comprehensively review available evidence on how dietary and lifestyle factors impact DNA methylation and contribute to carcinogenesis through epigenetic mechanisms. Materials and methods: A literature search was conducted using PubMed to identify relevant studies published between 2005 and 2022 that examined relationships between dietary/lifestyle factors and DNA methylation in cancer. Studies investigating the effects of dietary components (eg, micronutrients, phytochemicals), physical activity, smoking, and obesity on global and gene-specific DNA methylation changes in animal and human cancer models were included. Data on specific dietary/lifestyle exposures, cancer types, DNA methylation targets and underlying mechanisms were extracted. Results: Multiple dietary and lifestyle factors were found to influence DNA methylation patterns through effects on DNA methyltransferase activity, methyl donor availability, and generation of oxidative stress. Altered methylation of specific genes regulating cell proliferation, apoptosis, and inflammation were linked to cancer development and progression. Conclusion: Dietary and lifestyle interventions aimed at modulating DNA methylation have potential for both cancer prevention and treatment through epigenetic mechanisms. Further research is needed to identify actionable targets for nutrition and lifestyle-based epigenetic therapies.

Salivary levels of disease-related biomarkers in the early stages of Parkinson's and Alzheimer's disease: A cross-sectional study.

Introduction: Finding a non-invasive and repeatable tool has been recommended to make an accurate diagnosis of Alzheimer's disease (AD) and Parkinson's disease (PD). Methods: 70 volunteers participated in three groups: 24 with mild dementia of AD, 24 in the first and second stages of PD, and 22 healthy controls. After valuing the scores of cognitive tests, the salivary levels of phosphorylated tau (p-tau), total alpha-synuclein (α-syn), and beta-amyloid 1-42 (Aß) proteins have been evaluated. Finally, the cutoff points, receiver operating characteristic (ROC), sensitivity, and specificity have been calculated to find accurate and detectable biomarkers. Results: Findings showed that the salivary level of Aß was higher in both PD (p < 0.01) and AD (p < 0.001) patients than in controls. Moreover, the level of α-syn in both PD and AD patients was similarly lower than in controls (p < 0.05). However, the level of p-tau was only higher in the AD group than in the control (p < 0.01). Salivary Aß 1-42 level at a 60.3 pg/ml cutoff point revealed an excellent performance for diagnosing AD (AUC: 0.81). Conclusion: Evaluation of p-tau, α-syn, and Aß 1-42 levels in the saliva of AD and PD patients could help the early diagnosis. The p-tau level might be valuable for differentiation between AD and PD. Therefore, these hopeful investigations could be done to reduce the usage of invasive diagnostic methods, which alone is a success in alleviating the suffering of AD and PD patients. Moreover, introducing accurate salivary biomarkers according to the pathophysiology of AD and PD should be encouraged.

Cerebral venous sinus thrombosis following intracerebral hemorrhage after COVID-19 AstraZeneca vaccination: A case report.

The patient was a 55-year-old female patient who presented with sudden onset of left hemiplegia, facial hemiparesis, and hypoesthesia. She has received her first dose of the AstraZeneca COVID-19 vaccine. This case indicates that vaccination may raise the hypercoagulable state even in a condition of post-ICH and anticoagulant prophylaxis.

IgG4-related disease associated with the primary manifestation of recurrent cerebral venous thrombosis: A rare case report.

Nervous system involvement in IgG4-related systemic disease (IgG4-RD) is rarely reported and manifests as hypertrophic pachymeningitis and hypophysitis. In this report, a 33-year-old woman with neurological manifestations was diagnosed with IgG4-RD by biopsy. The patient showed improvement in symptoms after treatment.

Heart Failure Status among Acute Ischemic Stroke Patients: A Hospital-Based Study.

Background: Since heart failure (HF) and ischemic stroke have common risk factors, their concurrent occurrence is likely. Strokes in HF patients could be life-threatening and lead to severe disabilities, longer hospitalization time, and mortality. The present study aims to investigate the prevalence of HF and its severity based on ejection fraction (EF) in patients with acute ischemic stroke. Methods: The present cross-sectional study included acute ischemic stroke patients admitted to Shahid Rajaei hospital in Karaj in 2020-2021. The diagnosis of HF was based on transthoracic echocardiography within 48 hours of symptom onset, and HF was classified into two groups: 41-49% as mildly reduced EF (HFmrEF) and ≤40% as reduced EF (HFrEF). Patients who did not complete cardiac studies were excluded. Results: 257 acute ischemic stroke patients (62.6% male) were included. Among stroke patients, the prevalence of HF, including HFrEF and HFmrEF, was 30.0% (95% CI: 21.4-38.6). HFmrEF and HFrEF was diagnosed in 32 (12.5%) and 45 (17.5%) patients, respectively. HF was significantly associated with older age, hypertension, past myocardial infarction (MI), and arrhythmia. A history of previous MI significantly increased the odds of heart failure (OR: 3.25, 95% CI: 1.82-5.81). Conclusion: There is a high prevalence of HF among acute ischemic stroke patients. Older patients with a history of hypertension and previous MI are at higher risk. Since patients with HF have a higher mortality and morbidity rate after experiencing an ischemic stroke, close cooperation between the neurology and cardiology specialists for providing advanced care for survivors is required.

Acute polyneuropathy as the main manifestation of primary Sjogren's syndrome: A case report.

Sjogren's syndrome is an inflammatory disease affecting many systems. We report a Sjogren case with the presenting feature of an acute motor-predominant polyneuropathy resembling Guillain-Barre syndrome. Upon further investigation, it was found that the patient had sicca symptoms for months. Scrupulous history should be taken to prevent a missed diagnosis.

Multiple Complex Complications After Redo Bariatric Surgery (Infrequent Complication: Fistula Between the Splenic Artery and the Remnant of the Stomach): A Case Report.

With the epidemic prevalence of obesity in today's society, bariatric surgery has become very popular in treating severe obesity. Although the complications of this surgery have decreased with the advancement of medicine and post-treatment care, there are still complications that can lead to death if neglected. In this case report, we present a 44-year-old patient who underwent redo bariatric surgery. She was discharged from the hospital in good general condition but returned a few days later with a major complaint of abdominal pain and sudden bleeding from the upper gastrointestinal tract. After performing CT and endoscopy and considering the results, the patient underwent laparotomy, which showed a fistula between the splenic artery and the remnant of the stomach. After surgery and after the recovery period, the patient was discharged from the hospital. In this case report, we describe for the first time an uncommon and unique complication following redo bariatric surgery. We suggest that a fistula between the splenic artery and the remnant of the stomach should be considered in patients with abdominal pain and upper gastrointestinal bleeding who underwent redo bariatric surgery.

Giant cell arteritis with rare manifestations of stroke and internal carotid artery dissection: A case study.

Giant cell arthritis is a systemic vasculitis. A 51-year-old man was presented with sudden onset of right-side blurred vision, frozen movements, and ptosis in the right eye and left side paresis. The diagnosis of GCA with first manifestations of stroke and carotid dissection may be neglected as an underlying cause.

Intentional Ingestion of a Metallic Wire Causing Perforation and Retroperitoneal Abscess: A Case Report.

Foreign body ingestion is a frequent condition, with the majority of foreign bodies (FBs) tending to spontaneously proceed along the gastrointestinal tract without any major complications. A wide range of procedures are available to remove FBs; however, a real challenge exists in managing sharp, rigid, and long foreign objects, which are related to higher rates of complications. A 34-year-old man who intentionally swallowed a metallic wire of 20 cm length, presented to our ED with abdominal pain 2 weeks after the ingestion. The FB had migrated to the stomach and duodenum. Complications included perforation of the duodenum and ascending colon and a retroperitoneal abscess. FB removal was done via laparotomy, followed by the repair of perforations and damaged tissues. This case highlights the complications of a FB presence in the gastrointestinal tract for 14 days and emphasizes the importance of urgent and appropriate management of such conditions.