Treatment outcomes in mild traumatic brain injury: a systematic review of randomized controlled trials.

OBJECTIVES: Mild traumatic brain injury (mTBI) is a controversial and under-researched area, despite most traumatic brain injuries being classed as mild. Our objective was to review the evidence underpinning these approaches to treat mTBI including educational, psychological, rehabilitative and pharmacological approaches and discuss their efficacy. METHODS: A systematic review of literature was carried out using Web of science, Scopus, Medline, Pubmed, Cinahl, and PsychInfo databases. Randomized Controlled Trials (RCTs) looking at treatment outcome in mTBI for adults were included, published between 1980 and 2019. Methodological quality of the studies was reviewed using the Scottish Intercollegiate Guideline Network (SIGN) checklist for RCTs. RESULTS: Searches identified 3993 studies, of which 25 met inclusion criteria, and a total number of participants of 3213. Mean age was 35, and 59% male. Ten studies had <100 participants, 15 studies 100-395. Studies were grouped into education and early intervention, rehabilitation (8), psychological interventions (4), and pharmacotherapy (4). Inconsistency of definitions and outcome measures used precluded meta-analysis. CONCLUSIONS: Traditional education and reassurance can no longer be recommended as having the best evidence base for efficacy as compared to psychological and rehabilitative approaches, and guidelines should begin to reflect this.

Effect of memantine combination therapy on symptoms in patients with moderate-to-severe depressive disorder: randomized, double-blind, placebo-controlled study.

WHAT IS KNOWN AND OBJECTIVE: Current treatments for depressive disorders are far from optimum. This study was planned to evaluate possible antidepressant effects and safety of memantine, a selective N-methyl-d-aspartate receptor antagonist, in humans. METHODS: Sixty-six outpatients with the diagnosis of moderate-to-severe major depressive disorder, based on DSM-V diagnostic criteria, were recruited to participate in a parallel, randomized, controlled trial. Sixty-two participants completed 6 weeks of treatment with either memantine (20 mg/day) plus sertraline (200 mg/day) or placebo plus sertraline (200 mg/day). Patients were evaluated using the Hamilton Depression Rating Scale (HDRS) at baseline and at weeks 2, 4 and 6. Comparison of treatment efficacy in improving depressive symptoms between the two groups was the principal outcome measure. RESULTS AND DISCUSSION: A repeated-measures analysis demonstrated significant time × treatment interaction on HDRS score [F (2·09, 125·67) = 5·09, P = 0·007]. Significantly greater improvement was seen at all three follow-up sessions as well as significantly greater response rates at weeks 4 and 6 (P = 0·018 and P < 0·001, respectively) in the memantine group. Significantly more early improvers and more rapid response to treatment were observed in the memantine group (P = 0·001 and P < 0·001, respectively). A significant reduction was observed in HDRS score from baseline to the study endpoint in both memantine (P < 0·001, Cohen's d = 12·71) and placebo groups (P < 0·001, Cohen's d = 5·13). No serious adverse event occurred. No significantly greater remission rate was seen in the adjunctive memantine therapy. WHAT IS NEW AND CONCLUSION: A 6-week course of treatment with memantine as adjunct to sertraline showed a favourable safety and efficacy profile in patients with major depressive disorder. Nonetheless, larger controlled studies of longer duration are necessary to assess long-term safety, efficacy and optimal dosing.

Life parameters of Tetranychus urticae (Acari: Tetranychidae) on six common bean cultivars.

It is well recognized that the quality of host plants affects the development and survival of twospotted spider mite Tetranychus urticae Koch. The life table parameters of T. urticae, on six cultivars of common bean (Phaseolus vulgaris L.) (chiti Khomein, chiti Ks21189, red Akhtar, red Ks31169, white Pak, and white G11867) were studied at constant laboratory conditions (27 +/- 2 degrees C, 70 +/- 5% RH and 16:8 L:D). Total development times of immature males and females were significantly influenced by bean cultivar. T. urticae laid significantly more eggs per day on red Akhtar (16.16) than on the other cultivars. The mean generation time ranged from 23.37 to 34.82 d, and a significant varietal effect was seen. Percentage of egg hatchability oftwospotted spider mite ranged from 88.25 to 94.20%. The highest intrinsic rate of increase, was recorded on red Akhtar (0.269 +/- 0.031) and the lowest value was obtained on white Pak (0.129 +/- 0.048). In addition, net reproductive rate and finite rate of increase of the twospotted spider mite had the highest value on red Akhtar: 62.38 +/- 1.05 and 1.30 +/- 1.02, respectively. The lowest values of these parameters were recorded on white Pak as 26.11 +/- 1.40 and 1.13 +/- 1.10, respectively. Doubling time varied significantly on different cultivars and the lowest and highest values were obtained on red Akhtar and white Pak, respectively. Our findings revealed that white beans (Pak and G11867) were less suitable cultivars, suggesting that they are more resistant to the twospotted spider mite than the other cultivars.

Silicosis and tuberculosis: A systematic review and meta-analysis.

INTRODUCTION: Silicosis mostly happens in workers with high silica exposure and may accompany the development of various diseases like tuberculosis, cancer, or autoimmune diseases. The term silico-tuberculosis describes a condition in which an individual is affected by both silicosis and tuberculosis at the same time. This systematic review and meta-analysis study was conducted to evaluate the risk of tuberculosis in silicosis patients and individuals exposed to silica dust. METHODS: We performed a systematic search for relevant studies up to 6 September 2022 using PubMed/ Medline, and Embase with the following keywords in titles or abstracts: "silicosis" OR "silicoses" OR "pneumoconiosis" OR "pneumoconioses" AND "tuberculosis". Cohort and case-control studies containing relevant and original information about tuberculosis infection in silicosis patients were included for further analysis. Pooled estimates and 95% confidence intervals (CI) for the relative risk of tuberculosis in individuals with silicosis compared to those without; these were evaluated using the random effects model due to the estimated heterogeneity of the true effect sizes. RESULTS: Out of 5352 potentially relevant articles, 7 studies were eligible for systematic review, of which 4 cohort studies were included for meta-analysis. The total population of all studies was 5884, and 90.63% were male. The mean age of participants was 47.7 years. Our meta-analysis revealed a pooled risk ratio of 1.35 (95%CI 1.18-1.53, I 2: 94.30%) which means an increased risk of silicosis patients and silica-exposed individuals to tuberculosis infection. CONCLUSION: Silicosis and silica dust exposure increase the risk of tuberculosis. Therefore, we suggest that individuals with long-time silica exposure, like mine workers, be routinely considered for both silicosis and tuberculosis screening programs.

Molecular imaging of glioblastoma multiforme using anti-insulin-like growth factor-binding protein-7 single-domain antibodies.

BACKGROUND: Insulin-like growth factor-binding protein 7 (IGFBP7) is an abundant, selective and accessible biomarker of glioblastoma multiforme (GBM) tumour vessels. In this study, an anti-IGFBP7 single-domain antibody (sdAb) was developed to target GBM vessels for molecular imaging applications. METHODS: Human GBM was modelled in mice by intracranial implantation of U87MG.EGFRvIII cells. An anti-IGFBP7 sdAb, isolated from an immune llama library by panning, was assessed in vitro for its binding affinity using surface plasmon resonance and by ex vivo immunobinding on mouse and human GBM tissue. Tumour targeting by Cy5.5-labelled anti-IGFBP7 sdAb as well as by anti-IGFBP7 sdAb conjugated to PEGylated Fe3O4 nanoparticles (NPs)-Cy5.5 were assessed in U87MG.EGFRvIII tumour-bearing mice in vivo using optical imaging and in brain sections using fluorescent microscopy. RESULTS: Surface plasmon resonance analyses revealed a medium affinity (K(D)=40-50 nM) binding of the anti-IGFBP7 sdAb to the purified antigen. The anti-IGFBP7 sdAb also selectively bound to both mouse and human GBM vessels, but not normal brain vessels in tissue sections. In vivo, intravenously injected anti-IGFBP7 sdAb-Cy5.5 bound to GBM vessels creating high imaging signal in the intracranial tumour. Similarly, the anti-IGFBP7 sdAb-functionalised PEGylated Fe3O4 NP-Cy5.5 demonstrated enhanced tumour signal compared with non-targeted NPs. Fluorescent microscopy confirmed the presence of anti-IGFBP7 sdAb and anti-IGFBP7 sdAb-PEGylated Fe3O4 NPs selectively in GBM vessels. CONCLUSIONS: Anti-IGFBP7 sdAbs are novel GBM vessel-targeting moieties suitable for molecular imaging.

Psycho-cutaneous disorders: an epidemiologic study.

BACKGROUND AND AIMS: Psycho-dermatology addresses the interaction between mind and the skin. Effective management of at least one third of the patients attending the skin department depends, to some extent, upon the recognition of emotional and psychologic factors. The aim of this study was to provide epidemiologic data about common psycho-dermatoses and their prevalence in dermatologic patients in Iran. MATERIALS AND METHODS: Patients suspicious to have psychocutaneous problem with primary dermatologic chief complaint were included. After detailed dermatologic evaluation, all patients were visited by an expert psychologist to determine prevalence of DSM-IV disorders in each psychocutaneous category including delusion of parasitosis, trichotillomania, dermatitis artefacta and neurotic excoriation. RESULTS: A total of 178 patients including 78 (43.8%) males and 100 (56.2%) females entered the study. The commonest psychocutaneous disorder was neurotic excoriation followed by trichotillomania, delusion of parasitosis and dermatitis artefacta. Mood disorder was the commonest DSM-IV disorder in our patients, then anxiety disorder and drug-induced symptoms. CONCLUSION: According to our results, it seems that all psychocutaneous disorders but delusion of parasitosis are commoner in females. Mood and anxiety disorders were common in patients with dermatitis artefacta, as patients with neurotic excoriation. In trichotillomania, obsessive compulsive disorder was the commonest disorder. Drug abuse is a major background of delusional parasitosis.

Efficacy of oral naltrexone on pruritus in atopic eczema: a double-blind, placebo-controlled study.

AIM: The intent of our study was to determine the efficacy of oral naltrexone, an opioid antagonist, in the treatment of pruritus in patients with chronic eczema. METHODS: This double-blind, placebo-controlled study recruited 38 patients with eczema complaining from pruritus. Pruritus scores were evaluated. Patients were given placebo (n = 20) or naltrexone 50 mg (n = 18) for 2 weeks period. During the study, pruritus scores based on visual analogue scale system (VAS) were assessed three times: at the start of study, after 1 week, and after 2 weeks. RESULTS: In both groups, decreased VAS scores were observed, but naltrexone showed to be significantly more effective than placebo in decreasing VAS score after 1 week (P < 0.005) and 2 weeks (P < 0.001). CONCLUSION: Naltrexone is more effective than placebo in the treatment of pruritus in patient with eczema. Naltrexone might be considered as an adjunct treatment in the treatment of pruritus. However, further studies in this aspect are highly fostered.

Resting-State Functional Connectivity in Popular Targets for Deep Brain Stimulation in the Treatment of Major Depression: An Application of a Graph Theory.

We examined the functional connectivity of subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), and ventral caudate (VCa), the main target areas for the treatment of major depression disorder (MDD), using deep brain stimulation (DBS). MDD is one of the most common diseases in the world, and approximately 30% of MDD patients do not respond to common therapies, including psychotherapy and antidepressant medications. Alternatively, DBS has been recently used to treat MDD. Resting state fMRI was obtained from seventeen healthy subjects and seven MDD patients. The functional connectivity network of the brain was constructed for all subjects and measured by the `degree' value for each SCG, NAc, and VCa regions using the graph theory analysis. The results show that the degree values of VCa and the left SCG are higher in the MDD group than the healthy group. Furthermore, the patterns of the degree values were different for the right and left hemispheres in MDD patients. Our findings suggest that degree values and their patterns have a potential to be used as diagnosis tools to detect the brain areas with abnormal functional connectivity.

Effects on readiness to change of an educational intervention on depressive disorders for general physicians in primary care based on a modified Prochaska model--a randomized controlled study.

BACKGROUND: The Prochaska model of readiness to change has been proposed to be used in educational interventions to improve medical care. OBJECTIVE: To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME). METHODS: This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the RESULTS: The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively. CONCLUSIONS: Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.

The Impact of Mindfulness-Based Stress Reduction on Emotional Wellbeing and Glycemic Control of Patients with Type 2 Diabetes Mellitus.

OBJECTIVE: The aim of the study was to determine the effect of mindfulness-based stress reduction (MBSR) intervention on emotion regulation and glycemic control of patients with type 2 diabetes. MATERIALS AND METHODS: Sixty patients with type 2 diabetes were recruited for this randomized controlled trial from an outpatient clinic at Imam Hospital in Iran. The intervention group participated in 8 sessions of MBSR, and the control group continued the treatment as usual. Fasting blood sugar and HbA1c were measured as two indices of glycemic control. Overall mental health, depression, and anxiety were measured using the General Health Questionnaire (GHQ-28), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS), respectively. All the assessments were performed at baseline and after 8 weeks and 3 months as follow-up. RESULTS: In comparison with the control group, the MBSR intervention group showed a significant reduction on all outcome measures including FBS, HbA1C, HARS, and HDRS scores (p < 0/05). CONCLUSION: MBSR had a remarkable improvement on emotional wellbeing and glycemic control of patients with type 2 diabetes.

Molecular identification of Sarcocystis species in raw hamburgers using PCR-RFLP method in Kashan, central Iran.

The prevalence of bovine Sarcocystosis is high in the most regions of the world. It can be a human health problem due to consumption of raw or under cooked hamburgers or other bovine meat products. This study was carried out to investigate the prevalence and species identification of Sarcocystis among of hamburgers, using PCR-RFLP methods in Kashan, central Iran. Overall 200 raw industrial hamburgers samples with at least 60% meat were randomly collected from nine different brands in Kashan, central Iran. The genomic DNA was extracted and a PCR-RFLP method was used to amplify an approximately 900 bp fragment at the 18S rRNA(SSU) gene, restriction enzyme BclI was used for species identification. The results showed that 58 (29%) of 200 tested hamburger samples were infected to Sarcocystis spp. The prevalence rate was 31.25 and 26.9% in the hamburgers with 90 and 60-75% meat, respectively. According to PCR-RFLP analysis, 43 (74.1%) of the 58 isolates were Sarcocystis cruzi, 12 (20.7%) showed co-infection to S. cruzi and Sarcocystis hirsuta, 2 (3.5%) was mixed infected to S. cruzi and Sarcocystis hominis, 1 (1.7%) showed the pattern of mix infection to three species. This study revealed one-third of industrial hamburger were infected to S. cruzi or mixed infection of S. cruzi with other bovine sarcocytosis. To prevent cattle infection, the possible ingestion of the disposal sporocyst stage from dogs must be eliminated. Although in this study, the prevalence of S. hominis was low and cannot be considered as a major zoonosis, it should be recommended avoiding eating under cooked hamburger and other bovine meat products to prevent human infection.

The effect of cognitive behavioural psycho-education on premenstrual syndrome and related symptoms.

Premenstrual syndrome (PMS) is a distressing group of symptoms related to menstrual cycle during reproductive age. Its substantial burden on daily function and quality of life, particularly on mental aspects, was to the impetus for this study with the aim of determining the effectiveness of a psycho-educational package on premenstrual syndrome and related symptoms. In a randomized clinical trial, 123 (17-19-year-old) adolescent girls with PMS were randomized to psycho-educational intervention (including 62 subjects) and control (including 61) groups. The participants completed a demographic questionnaire, premenstrual syndrome symptom daily record scale and the Symptom Checklist-90-Revised (SCL-90-R). A paired and two independent samples t-test and chi-squared test were used for analysing data using SPSS statistical package. At the end of the study there was statistically significant decrease in severity of total PMS in intervention compared with control group (P < 0.001). Also, a significant difference in somatization, anxiety and hostility was observed between two groups (P < 0.05). However, depression marginally decreased (P < 0.1) in intervention group, and interpersonal sensitivity was not statistically different between intervention and control groups. Intervention alleviated the severity of PMS and related somatization, anxiety and hostility, yet it could not change the severity of depression and interpersonal sensitivity.

Detection of drug resistance gene in cutaneous leishmaniasis by PCR in some endemic areas of iran.

BACKGROUND: Cutaneous leishmaniasis is still a health problem in many rural and urban regions of Iran and drug resistance has emerged as a major impediment in the treatment of leishmaniasis. This study aims to determine the drug resistance gene in cutaneous leishmaniasis by PCR in some endemic areas of Iran. METHODS: Ninety seven samples were collected from ulcers of leishmaniasis patients from some endemic areas of Iran. The Giemsa stained samples were examined microscopically and cultured in NNN and RPMI 1640 mediums for parasite detection. After DNA extraction, PCR was done by a pair of specific primers. For detection of mutation in DNA, first PCR products were electrophoresed on CSGE gel. The suspected samples were compared by sequencing and RFLP results were demonstrated. Comparison of DNA derived from a wild type cell and mutant cell was undertaken by CSGE and sequencing methods. RESULTS: Among 90 isolates (92.8%) examined for detection of mutation in gene with CSGE and RFLP, 10 (11.1%) revealed a disorder in sequencing selection for unresponsive to drug. CONCLUSION: Drug resistance in cutaneous leishmaniasis to sodium stiboglocanat is probably due to a mutation in a genome. A field study is needed to determine the distribution of drug resistance and other gene mutations involved in unresponsiveness to drugs in leishmaniasis endemic areas of Iran.

Study on ITS1 Gene of Iranian Trichomonas vaginalis by Molecular Methods.

BACKGROUND: Trichomoniasis is a worldwide protozoan parasitic disease and metronidazole is a choice drug for its treatment. Because of disease importance in public health and its controversial ideas about the prevalence of drug resistance, this study was carried out. METHODS: Fifty-two suspected vaginal samples were collected from 2006 to 2007 in Gynecology Maryam Hospital, Tehran, Iran. All isolates were examined by microscopic, culture and PCR techniques. The PCR products were analyzed by RFLP and CSGE methods and two suspected samples were sequenced. RESULTS: Trichomonas vaginalis was identified from all 52 samples. Of 52 isolates, 45 samples were successfully cultured and amplified by PCR except one. Seven were positive only by PCR. Finally, ITS1 fragment was successfully amplified in 51 of 52. CSGE analysis and PCR products digestion by MspI followed by sequencing showed nucleotide mutation at position 209 (C209T) of the ITS1 fragment in two (3.9%) of them. CONCLUSION: The results showed mutation in ITS1 fragment of T. vaginalis in two (3.9%) of Iranian isolates which may be related to metronidazole resistance.