Dysphagia in neuromyelitis optica spectrum disorder and multiple sclerosis: A comparison of frequency, severity, and effects on quality of life.

OVERVIEW: Dysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals. METHODS: Seventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire. RESULTS: The frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0-3.5]) and MS patients (2, IQR [0-4]) had a significantly higher median total DYMUS score than control (0, IQR [0-1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status. CONCLUSION: The presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.

Health risk assessment of exposure to triclosan in pregnant women using Monte Carlo simulation techniques: based on biomonitoring data.

This study aimed to assess the triclosan (TCS) health risk in an Iranian pregnant women sample by Monte Carlo simulation (MCS). The urinary TCS of 99 women after the 28th week of pregnancy was detected by gas chromatography/mass spectrometry detector (GC/MS), and the MCS model implemented a health risk assessment. The corresponding hazard quotient (HQ) and the sensitivity analysis were calculated. TCS was measured in 100% of the urine samples with a median concentration of 2.89 µg/L. The median of HQ was obtained at 1.93 × 10-4. The TCS exposure risk in the studied population was lower than the allowable limit. A comparison between HQ values in the two weight subgroups of pregnant women showed that the risk level is almost equal, and there was minimal health risk in pregnant women from exposure to TCS.

Trends in incidence rates of childhood type 1 diabetes mellitus: A retrospective study in Isfahan province, Iran.

AIMS/INTRODUCTION: We aimed to determine the incidence trend of childhood type 1 diabetes mellitus in Isfahan province over a period of 12 years. MATERIALS AND METHODS: In this retrospective study, children aged <20 years at the time of type 1 diabetes mellitus diagnosis, from March 2007 to March 2019, were included. The crude and adjusted incidence rate of type 1 diabetes mellitus is calculated as the number of cases per 100,000 person-years by the period. The cumulative, age- and sex-specific incidence rates were also calculated. Age-specific incidence rates were calculated for age and sex groups. RESULTS: A total of 1,954 (983 boys and 971 girls) cases of type 1 diabetes mellitus were identified. The mean age at diagnosis in all studied populations was 9.89 (standard deviation 4.76). There were no significant differences between the proportion of boys and girls in different years (P = 0.12) and different age groups (P = 0.19). The average annual percent change of incidence rate for the total population, for girls and boys, was 6.9%, 6.7% and 6.3% respectively. The type 1 diabetes mellitus incidence rate had a significant trend to be increased from 2007 to 2019 (P < 0.001, t = 3.6). CONCLUSION: Our findings showed that currently our region is considered a region with a high incidence rate of type 1 diabetes mellitus. Although we have had fluctuations in the incidence rate over the 12 years, the overall trend is increasing.

Effect of Maternal Triclosan Exposure on Neonatal Thyroid-Stimulating Hormone Levels: A Cross-Sectional Study.

Objective: This study is aimed at assessing the relationship between maternal urinary triclosan (uTCS) exposure and the thyroid-stimulating hormone (TSH) level of infant cord blood. Methods: This cross-sectional study was carried out in 2019-2020 in Isfahan, Iran, and 99 pregnant women participated in the study. Urine samples were collected after the 28th week of pregnancy, and the concentration of TCS was measured using GC/MS. The cord blood levels of TSH (CBL-TSH) were measured. The association between uTCS and CBL-TSH was examined based on the general linear model. Results: TCS was detected (≥0.01 ng/mL) in 100% of the urine samples, with the interquartile range (25%-75%) of uTCS levels 0.6-6.23 µg/g Cr. uTCS was not associated with CBL-TSH after adjustment for covariates. A significant relationship was observed between CBL-TSH of neonates born to mothers who had given birth only once compared to mothers who had given birth twice or more times. Conclusions: Maternal exposure to TCS did not affect the infant CBL-TSH. However, the high concentrations of TCS in maternal urinary samples indicate the necessity of more precise regulations to decrease the use of this chemical in the industry and increase public awareness about using TCS-free compounds.

Effect of levetiracetam drug on antioxidant and liver enzymes in epileptic patients: case-control study.

BACKGROUND: There is a limited amount of data regarding levetiracetam (LEV), an antiepileptic drug. OBJECTIVE: This study was conducted to assess the effect of LEV on antioxidant status and liver enzymes. METHODS: In this case-control study, 33 epileptic patients under treatment with LEV for at least 6 months were compared with 35 healthy subjects. We measured serum total antioxidant capacity (TAC), salivary superoxide dismutase (SOD), alanine aminoteransferase (ALT), and aspartate aminoteransferase (AST) levels in both groups. Dietary intakes were collected using a Food Frequency Questionnaire (FFQ). RESULT: The level of TAC in the healthy subjects was significantly higher than it was in the patients (P=0.02), but the mean of ALT (P=0.02) and AST (P=0.03) was significantly higher in the patients in comparison with the controls. Mean salivary SOD showed no difference between the two groups. In the patients, the duration of drug use was inversely correlated with serum TAC (p=0.04) and had a direct correlation with ALT (p=0.01) and AST (p=0.03.). CONCLUSION: The results of our study indicated that LEV increased liver enzymes Also, treatment with this drug did not improve oxidative stress, but this could be due to the different in the dietary antioxidant intake. Routine screening of the liver and antioxidant enzymes in patients with chronic use of LEV is recommended.

Efficacy of synbiotic supplementation in improving rheumatoid arthritis.

BACKGROUND AND PURPOSE: Today, improving rheumatoid arthritis (RA) as a chronic inflammatory disease is attributed to the proper status of the gut microbiota. Although some supplements containing beneficial live microorganisms (probiotics) can reduce inflammation by altering the bacterial composition of the gut, there is limited information on the effect of synbiotic (probiotics mixed with prebiotics) supplements on RA. Therefore, this study aimed to evaluate the anti-inflammatory effects of a synbiotic supplement as an adjuvant therapy in rheumatic patients. Moreover, for the first time, it was attempted to investigate whether addition of a synbiotic (1000 mg/day) to the combination of methotrexate and prednisolone increases the effectiveness of these antirheumatic drugs. EXPERIMENTAL APPROACH: Eligible patients (186 subjects) were randomly divided into two groups. Both groups received their standard routine antirheumatic drugs, methotrexate and prednisolone. Moreover, the first group received a daily oral synbiotic supplement (1000 mg) for 3 months while the second group received a placebo. Various parameters indicating RA status were evaluated at baseline (time 0) and 3 months after the treatment. FINDINGS / RESULTS: The results showed the changes in the level of RA indicators, including tender joint count with a range of 0 to 28 joints, swollen joint count with a range of 0 to 28 joints, visual analog scale, erythrocyte sedimentation rate, CRP, and disease activity score based on 28 joints, after 3 months. CONCLUSION AND IMPLICATIONS: Overall, no significant differences in the measured parameters were observed between synbiotic and placebo groups probably due to the short duration of the treatment period, and it is suggested to extend the treatment period to six months.

The effects of garlic (Allium sativum) supplementation on inflammatory biomarkers, fatigue, and clinical symptoms in patients with active rheumatoid arthritis: A randomized, double-blind, placebo-controlled trial.

Based on the antiinflammatory properties of garlic, current study was conducted to evaluate the garlic supplement effects on serum levels of some inflammatory biomarkers, clinical symptoms, and fatigue in women with active rheumatoid arthritis. In this randomized, double-blind, placebo-controlled trial study, 70 women with RA were randomly divided into two groups: The intervention group was supplemented with 1,000 mg of garlic, and the control group received placebo for 8 weeks. At baseline and at the end of the study, clinical symptoms, fatigue, serum level of C-reactive protein (CRP), tumor necrosis factor-a (TNF-a), and erythrocyte sedimentation rate (ESR) were determined. After intervention, serum levels of CRP (p = .018) and TNF-a (p < .001) decreased significantly in the garlic group as compared with the placebo group. Also, pain intensity, tender joint count, disease activity score (DAS-28), and fatigue were significantly decreased in the intervention group compared with the control group (p < .001; for all). Swollen joint count was significantly decreased in the garlic group (p < .001), but not in the placebo group (p = .123). No significant changes were observed for ESR. Garlic supplementation by improving inflammatory mediators and clinical symptoms can be considered as a potential adjunct treatment in patients with RA. However, further studies with larger duration are needed.

Effect of Vitamin D and Magnesium Supplementation on Behavior Problems in Children with Attention-Deficit Hyperactivity Disorder.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by the three main symptom domains including inattention, hyperactivity, and impulsivity. Recent findings suggested that nutrients might play an important role in the pathology of ADHD. The present study aimed to examine the effects of Vitamin D and magnesium supplementation on behavior problems in children with ADHD. METHODS: This double-blind, randomized controlled clinical trial study was conducted on 66 children with ADHD in Clinic of Noor and Ali Asghar Hospital in Isfahan, Iran, in 2016. Children were randomly allocated to receive both Vitamin D (50,000 IU/week) and magnesium (6 mg/kg/day) supplements (n = 33) or placebos (n = 33) for 8 weeks. Conners' Parent Rating Scale was used to evaluate children's behavior at baseline and at the end of the study. RESULTS: After 8 weeks of Vitamin D consumption as well as magnesium, the serum levels of 25-hydroxy-Vitamin D3 and magnesium increased significantly in the intervention group compared with placebo group. Supplementation with Vitamin D and magnesium caused a significant decrease in conduct problems, social problems, and anxiety/shy scores; but it had no significant effect on psychosomatic problems score. CONCLUSIONS: Vitamin D and magnesium supplementation in children with ADHD was effective on conduct problems, social problems, and anxiety/shy scores compared with placebo intake, but it did not affect psychosomatic problem scores, significantly.

Effects of curcumin on cardiovascular risk factors in obese and overweight adolescent girls: a randomized clinical trial.

BACKGROUND: Obese adolescents are at higher risk of development of cardiovascular risk factors and obesity in later life. Dietary intake of antioxidants, particularly curcumin, as an active ingredient of turmeric extract, may have noticeable effects on obesity and its important complications such as cardiovascular risk factors. Therefore, the aim of this study was to assess the effects of curcumin supplementation on cardiovascular risk factors among overweight and obese female adolescents. DESIGN AND SETTING: Randomized placebo-controlled clinical trial; Pediatric Cardiovascular Research Center, Isfahan, Iran. METHODS: 60 adolescent girls (aged 13-18 years) were randomly assigned to receive either placebo or intervention. The adolescents were asked to consume one 500 mg tablet per day, containing either standardized 95% turmeric extract or placebo, and to undergo a weight maintenance or a mild weight loss diet for 10 weeks. Anthropometric and biochemical indices were assessed at the baseline and the end of the intervention. RESULTS: Curcumin supplementation had beneficial effects on body mass index (P = 0.019), waist circumference (P = 0.008), hip circumference (P = 0.030), high-density lipoprotein levels (P = 0.042) and triglyceride/high-density lipoprotein ratio (P = 0.021). However, in univariate analysis of covariance, no significant differences were found between the intervention and placebo groups after 10 weeks of supplementation (P > 0.05). CONCLUSIONS: Prescription of curcumin supplementation along with use of a slight weight loss diet might have beneficial effects on some cardiovascular risk factors among overweight and obese female adolescents. Larger clinical trials with higher curcumin doses and longer duration are needed to confirm the results from the current study. CLINICAL TRIAL REGISTRATION: IRCT20171107037302N1.

Effects of curcumin on cardiovascular risk factors in obese and overweight adolescent girls: a randomized clinical trial

ABSTRACT BACKGROUND: Obese adolescents are at higher risk of development of cardiovascular risk factors and obesity in later life. Dietary intake of antioxidants, particularly curcumin, as an active ingredient of turmeric extract, may have noticeable effects on obesity and its important complications such as cardiovascular risk factors. Therefore, the aim of this study was to assess the effects of curcumin supplementation on cardiovascular risk factors among overweight and obese female adolescents. DESIGN AND SETTING: Randomized placebo-controlled clinical trial; Pediatric Cardiovascular Research Center, Isfahan, Iran. METHODS: 60 adolescent girls (aged 13-18 years) were randomly assigned to receive either placebo or intervention. The adolescents were asked to consume one 500 mg tablet per day, containing either standardized 95% turmeric extract or placebo, and to undergo a weight maintenance or a mild weight loss diet for 10 weeks. Anthropometric and biochemical indices were assessed at the baseline and the end of the intervention. RESULTS: Curcumin supplementation had beneficial effects on body mass index (P = 0.019), waist circumference (P = 0.008), hip circumference (P = 0.030), high-density lipoprotein levels (P = 0.042) and triglyceride/high-density lipoprotein ratio (P = 0.021). However, in univariate analysis of covariance, no significant differences were found between the intervention and placebo groups after 10 weeks of supplementation (P > 0.05). CONCLUSIONS: Prescription of curcumin supplementation along with use of a slight weight loss diet might have beneficial effects on some cardiovascular risk factors among overweight and obese female adolescents. Larger clinical trials with higher curcumin doses and longer duration are needed to confirm the results from the current study. CLINICAL TRIAL REGISTRATION: IRCT20171107037302N1

Factors in relation with fatigue and illness perception in patients with myocardial infarction and the changes in fatigue due to intervention on illness perception: Research design, methodology, and preliminary results.

BACKGROUND: In physical diseases including cardiovascular diseases (CVDs), illness perception (IP) plays an important role in illness outcomes. Fatigue is a major bothersome symptom after myocardial infarction (MI). This manuscript presents the research design, methodology, and primary findings of a study on factors in relation with fatigue and IP in patients with MI, and changes in fatigue after intervention on IP. METHODS: 241 patients with MI who experienced a first-time acute MI (AMI) participated in this study in 2016-2017. During hospitalization, the demographic and clinical information of participants were collected. After four months, the information regarding fatigue, IP, coping with stress, type D personality, perceived social support (PSS), and locus of control of the participants was collected at their houses. About one year later, based on the results of phase one of the study, a psychoeducation course was conducted for 35 of the patients as intervention group while 36 patients were supervised as control group. Two months later, the role of IP in fatigue changes of the participants was assessed. RESULTS: 155 (65%) of the patients had positive family history of coronary heart disease (CHD). 103 (43%) were cigarette smokers, 100 (43.5%) had high blood cholesterol, and 72 (30%) had sedentary life style before MI. CONCLUSION: The overview of the factors related to fatigue and IP of the patients with MI could help the care teams to provide better care in the recovery period of the illness.

Effects of curcumin supplementation on markers of inflammation and oxidative stress among healthy overweight and obese girl adolescents: A randomized placebo-controlled clinical trial.

INTRODUCTION: It is well known that there is a strong linkage between obesity, systemic low-grade inflammation, and oxidative stress in the pediatric population. Possible strategies that might control obesity and its relevant problems in this crucial group are of utmost importance. Therefore, the aim of this study was to evaluate the effects of curcumin supplements on inflammation, oxidative stress, and chemerin levels in adolescent girls. METHODS: Totally, 60 overweight and obese adolescent girls were randomly assigned to either placebo or intervention group in a randomized placebo-controlled parallel trial design. Adolescents consumed one 500-mg curcumin or placebo per day along with a slight weight loss diet for 10 weeks. High-sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), total antioxidant capacity (TAC), malondialdehyde (MDA), chemerin levels, and anthropometric measurements were assessed at the beginning and end of the trial. RESULTS: Curcumin supplementation had a significant effect on IL-6 levels and oxidative stress markers including TAC and MDA in crude model. After controlling the effects of confounders, curcumin supplementation had a substantial effect on inflammation (hs-CRP and IL-6) and oxidative stress (TAC) marker of adolescents. DISCUSSION: Ten weeks of curcumin supplementation had beneficial effects on inflammation and oxidative stress markers among postpubescent overweight and obese girl adolescents.

The MTHFR C677T polymorphism influences the efficacy of folic acid supplementation on the nerve conduction studies in patients with diabetic polyneuropathy; A randomized, double blind, placebo-controlled study.

BACKGROUND: Among patients with diabetic polyneuropathy, the status of folic acid, homocysteine, and nerve conduction studies (NCS) variations has been associated with methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms. The objective of the present study is to assess B9 vitamin supplementation associated with MTHRF C677T polymorphism can be effective on NCS variations in patients. MATERIALS AND METHODS: This study is a randomized, double-blind, placebo-controlled study. Patients were randomly allocated to either intervention (1 mg of folic acid, n = 40) or placebo (n = 40) groups based on parallel group design. Blood samples were taken to determine the serum levels of folic acid and homocysteine. The NCS data were collected for the assessment of diabetic neuropathy. Genotyping was performed for C677T polymorphism of the MTHFR gene. RESULTS: Four months after intervention, patients significantly observed change of serum folic acid and homocysteine levels based on C677T genotypes in the MTHFR gene. The amplitude of sensory peroneal nerve between intervention and placebo groups with CC genotype was significantly different (2.8 ± 1.6 vs. 1.9 ± 1.1). However, peak latency and amplitude of sensory sural nerve between CC (3.8 ± 1.8 vs. 4.0 ± 1.5 for peak latency and 3.5 ± 1.0 vs. 2.5 ± 1.0 for amplitude; and CT + TT genotypes (3.7 ± 1.7 vs. 3.9 ± 1.3 for peak latency and 3.2 ± 1.0 vs. 2.3 ± 1.1 for amplitude) were significant. Furthermore, significant difference for variables of motor tibial nerve and motor peroneal nerve amplitude was observed in different groups of MTHFR C677T genotypes (5.4 ± 2.9 vs. 4.6 ± 3.2 for onset-latency of tibial nerve between CC genotype; 4.8 ± 2.8 vs. 4.6 ± 3.2 for onset-latency of tibial nerve between CT + TT genotype; 0.6 ± 0.2 vs. 0.3 ± 0.1 for amplitude of tibial nerve between CC genotype; 0.5 ± 0.3 vs. 0.3 ± 0.2 for amplitude of tibial nerve between CT + TT genotype; 26.0 ± 13.3 vs. 23.2 ± 13.4 for velocity of tibial nerve between CC genotype; 26.0 ± 13.7 vs. 23.1 ± 9.6 for velocity of tibial nerve between CT + TT genotype; 1.6 ± 1.0 vs. 0.9 ± 0.7 for amplitude of peroneal nerve between CC genotype; 1.4 ± 0.7 vs. 0.9 ± 0.5 for amplitude of peroneal nerve between CT + TT genotype). CONCLUSION: The study determined that MTHFR C677T polymorphism effects the efficacy of folic acid supplementation on serum folic acid, homocysteine levels and some NCS parameters in diabetic polyneuropathy patients.

Vitamin B12 and Folate Status in Patients with Epilepsy Under Levetiracetam Monotherapy.

BACKGROUND: Antiepileptic drugs (AEDs) may lead to an increase in the plasma concentration of homocysteine. There is limited information, especially from Iran, regarding the risk in patients who are treated with levetiracetam as a new type of AED. The aim of the present study was to investigate the effect of levetiracetam on plasma homocysteine, vitamin B12, and folate levels in adult patients with epilepsy. METHODS: We conducted a case-control study and enrolled adult patients with epilepsy who had received monotherapy with levetiracetam for at least 6 months at some time prior to the study. homocysteine serum, vitamin B12, and folate were measured, and folate and vitamin B12 intake was determined by the food frequency questionnaire (FFQ). RESULTS: Thirty-three patients on levetiracetam and 35 control subjects aged between 18 and 60 years were enrolled. No statistically significant differences in the means of the serum markers of vitamin B12, FA, and homocysteine levels were found between the two groups. In the first model, i.e., the crude model, no significant differences were observed in the serum concentrations of homocysteine, vitamin B12, and folate. In the second model, education was considered, and body mass index and folate intake was controlled with no significant difference being observed in the mean homocysteine serum level. CONCLUSIONS: Treatment with levetiracetam in patients with epilepsy has no effect on the serum levels concentrations of homocysteine, vitamin B12, and folate. This medication is suggested for patients who use AEDs on a long-term basis and at high dosages.

Effect of folic acid supplementation on nerve conduction velocity in diabetic polyneuropathy patients.

OBJECTIVES: In diabetic polyneuropathy (DPN) patients, the effect of folic acid and homocysteine has been related to components of nerve conduction velocity (NCV). The objective of this study was to determine the effect of folic acid supplementation on NCV in DPN patients. METHODS: Patients were randomized to receive either 1 mg of folic acid (n = 40) or placebo (n = 40) for 16 weeks. Blood samples were collected to assess serum folic acid and homocysteine concentrations, and NCV was performed for assessment of diabetic neuropathy. RESULTS: At 16 weeks, in the supplemented group, serum levels of folic acid (p < 0.001) increased, homocysteine concentrations decreased (p < 0.001), with no change in serum vitamin B12 levels. There was a significant increase in sensory sural amplitude (p < 0.001), and components of motor nerves, including amplitude (p = 0.001) and velocity (p < 0.001), but decreased onset latency of peroneal (p = 0.019) and tibial (p = 0.011) motor nerves. CONCLUSION: Our data suggest that supplementation with 1 mg of folic acid for 16 weeks may be useful for enhancing NCV in DPN patients.

Association Between BMI and Inflammation Among Diabetic Polyneuropathy Patients.

BACKGROUND: Inflammation is defined as body tissues response to harmful stimuli. Obesity-related inflammation leads to increased risk chronic diseases including diabetic polyneuropathy (DPN). The present study was performed to determine association between body mass index (BMI) and inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in DPN patients. METHODS: In this cross-sectional study, 200 DPN patients with a mean (SD) of age 58.76 (9.53) years were selected. All patients completed the questionnaire including demographic data and chronic disease history. In addition, anthropometric measures and clinical laboratory tests were taken. Multivariate linear regression was used to detect the association between BMI, CRP, and ESR levels. RESULTS: BMI was associated with increase in ESR and CRP levels (ß-ESR = 4.67, P < 0.001 and ß-CRP = 0.71, P < 0.001). Also, this association remained after adjustment for other different variables. CONCLUSIONS: These findings indicate that higher BMI is related to increase inflammatory markers including CRP and ESR in DPN patients. Therapies for DPN and reducing inflammation should target the weight loss among obese patients.

Efficacy of Group Cognitive-behavioral Therapy in Maintenance Treatment and Relapse Prevention for Bipolar Adolescents.

BACKGROUND: Despite conducting wide-ranging of pharmacotherapy for bipolar adolescents, many of them are showing a deficit in functioning with high relapse rate. The aim of the current study was to develop a manual and investigate the efficacy of group cognitive-behavioral therapy (G-CBT) for female bipolar adolescents. MATERIALS AND METHODS: During the first qualitative phase of a mixed-methods study, a manual of G-CBT was developed. Then, 32 female bipolar adolescents aged 12-19 years old, receiving usual maintenance medications (UMM), were selected. Participants were randomized to the control (UMM) and intervention group (5, 2 h weekly sessions based on G-CBT manual with UMM). The parents in intervention group participated in three parallel sessions. All participants filled the following questionnaires before 1, 3, and 6 months after the initiation of the study: Young Mania Rating Scale, Children Depression Inventory and Global Assessment of Functioning. The results were analyzed using SPSS 21 software. The concurrent qualitative phase was analyzed through thematic analysis. RESULTS: The results showed no significant differences in all questionnaires' scores through intervention and follow-up sessions (P > 0.05). However, using cutoff point of CDI, G-CBT was effective for intervention group (relapse rate: 25% vs. 44.4%). Two themes were extracted from the second qualitative phase: emotion recognition and emotion regulation, especially in anger control. CONCLUSIONS: The results showed that the addition of G-CBT to UMM leads to decrease in the depressive scores but has no effect on manic symptoms and relapse rate.

Carotenoids as Potential Antioxidant Agents in Stroke Prevention: A Systematic Review.

Stroke and other cerebrovascular diseases are among the most common causes of death worldwide. Prevention of modifiable risk factors is a cost-effective approach to decrease the risk of stroke. Oxidative stress is regarded as the major flexible operative agent in ischemic brain damage. This review presents recent scientific advances in understanding the role of carotenoids as antioxidants in lowering stroke risk based on observational studies. We searched Medline using the following terms: (Carotenoids [MeSH] OR Carotenes [tiab] OR Carotene [tiab] OR "lycopene [Supplementary Concept]" [MeSH] OR lycopene [tiab] OR beta-Carotene [tiab]) AND (stroke [MeSH] OR stroke [tiab] OR "Cerebrovascular Accident" [tiab] OR "Cerebrovascular Apoplexy" [tiab] OR "Brain Vascular Accident" [tiab] OR "Cerebrovascular Stroke" [tiab]) AND ("oxidative stress" [MeSH] OR "oxidative stress"[tiab]). This search considered papers that had been published between 2000 and 2017. Recent studies indicated that high dietary intake of six main carotenoids (i.e., lycopene, <- and®-carotene, lutein, zeaxanthin, and astaxanthin) was associated with reduced risk of stroke and other cardiovascular outcomes. However, the main mechanism of the action of these nutrients was not identified, and multiple mechanisms except antioxidant activity were suggested to be involved in the observed beneficial effects. The dietary intake of six major carotenoids should be promoted as this may have a substantial positive effect on stroke prevention and stroke mortality reduction.

Seasonal and Monthly variation in stroke and its subtypes-10 Year Hospital-Based Study.

BACKGROUND AND OBJECTIVES: There is no evidence of long-term studies of seasonal variations in stroke in Iran. Hence, the aim of this study was to determine the seasonal and monthly variation of 28-day mortality in Isfahan, Iran. METHODS: From 2003 to 2013, In a Hospital-based retrospective study, 24186 cases with first-ever stroke were analyzed in Isfahan. Multinomial logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for seasonal and monthly 28-day mortality for stroke in general and three subtypes of stroke including intracranial hemorrhage (ICH), ischemic (IS) and subarachnoid hemorrhage (SAH). RESULTS: In this study, unadjusted and adjusted odds ratios of seasonal 28-day mortality of stroke was highest in the winter and lowest in the summer. Although, differences were not statistically significant. For total and IS stroke, the unadjusted 28-day mortality ratio (UMR) was significant in February (1.19, 95% CI 1.00 -1.42, P= 0.04) as compared to March. Whereas after adjusted, for total stroke, 28-day mortality was significantly lowest in May (0.746, 95% CI 0.575-0.97, p=0.029), June (0.777, 95% CI 0.60-0.99, p=0.49) and July (0.771, 95% CI 0.59-0.99 p=0.049) as compared to March. The AMR between months were not significant in SAH and IS. CONCLUSION: Our findings demonstrate clear obvious monthly variation of 28-day mortality of stroke and its subtypes in Isfahan but no seasonal variations were observed.

The Effect of Active Treatment and Visit Compared to Conventional Treatment, on Preventing Recurrent Suicidal Attempts: A Randomized Controlled Clinical Trial.

BACKGROUND: Suicide is a major problem, and its prevention is a global priority. In many cases, suicide attempter attempts to do it again after the rescue. In current study we aimed to compare active visit and treatment of patients in a periodic manner with treatment as usual, in the prevention of recurrent suicidal attempts. MATERIALS AND METHODS: This study was a randomized controlled clinical trial which was conducted in Isfahan Noor Hospital's Emergency Center on 60 patients in 2013-2014. The samples were selected using simple random sampling and they were assigned into two groups: The conventional treatment group (treatment as usual) (30 patients), and visit and active treatment (30 patients). In the intervention group, there were ten follow-ups by a face-to-face visit over 12 months, and six follow-ups by phone call in control group. Through the completion of the initial and follow-up questionnaire evaluation was performed. The data were analyzed using Cochran test, and repeated measure (ANOVA). RESULTS: During the 12-month follow-up visit and active treatment, significant difference in reducing suicidal thoughts (P = 0.003) was observed and an increase in the life expectancy (P = 0.001), interest and motivation in life (P = 0.001) was found in the intervention group, and also nonsignificant reduction was found in the rate of suicidal attempts. CONCLUSION: Visit and active treatment is useful in suicide attempters and it can helps in preventing recurrent suicide attempt as a preventive program by increasing hope and reducing suicidal thoughts.