Pain in Patients with Multiple Sclerosis.

BACKGROUND: Multiple sclerosis is a chronic inflammatory disease which affects the central nervous system. Many patients with multiple sclerosis suffer from persistent pain during the disease course. In Iranian cases, pain has not been regarded as it should be. OBJECTIVE: The goal of this study was to determine the prevalence and types of pain in Iranian multiple sclerosis patients. MATERIAL AND METHODS: This cross sectional study was conducted in the multiple sclerosis clinic of Sina Hospital between October 2014 and August 2015. Eighty eight multiple sclerosis patients were enrolled. Participants were asked to fill a valid and reliable Persian version of the Brief Pain Inventory. Demographic data (sex, age), disease duration and disease course were extracted from patients' medical files. All patients were examined by an expert neurologist to obtain Kurtzke Expanded Disability Status Scale (EDSS). RESULTS: The mean age and mean duration of disease were 30.4±7.6 years and 5.9±4 years, respectively. Median EDSS was 1. All patients reported pain. The most common sites of pain were upper extremities (52.3%). Higher the EDSS score, higher pain interference with the evaluated items. By using the worst pain intensity as a dependent variable, and age, sex, EDSS, disease duration and type of disease as independent variables, regression analysis showed that the EDSS score was an independent predictor for the intensity of pain in this group of patients. CONCLUSION: Pain is a common symptom found in patients diagnosed with multiple sclerosis. Thus, an accurate and thorough assessment of pain should be integrated in the routine evaluation of patients diagnosed with multiple sclerosis.

Comparison of Oral Midazolam With Intravenous Midazolam for Sedation Children During Upper Gastrointestinal Endoscopy.

Upper endoscopy is a common procedure for the diagnosis and treatment of upper digestive tract diseases. The increasing number of pediatric gastrointestinal procedures has led to increasing attention on the safety and efficacy of medications used for sedation during the procedure. This randomized blinded interventional study was designed to compare the effect of oral midazolam with intravenous (IV) midazolam as a sedative medication in 119 children undergoing endoscopy. The mean time to sedation was 2.2±0.7 in IV midazolam group and 30.9±0 in oral midazolam group which was statistically significant difference between two groups. Separation from parents in oral midazolam group was as follow: 2 patients were high resistant (3.5%), 2 patients were resisted first and then relaxed (3.5%) and 55 patients were separated from their parents without any resistance (93%); whereas in IV midazolam group, 8 patients were high resistant (13.3%), 29 patients were relatively resistant (48.3%) and 23 patients were separated from their parents without any resistance (38.3%) that shows significant differences between the two groups. In terms of patient comfort during endoscopy, there was also a significant difference between the two groups. In oral midazolam, group parents were more consent, compared with the other group. The present study showed that oral midazolam is a safe and effective sedation during upper endoscopy in pediatrics. Oral midazolam reducing patients' anxiety during separation from parents leads the easy use of endoscopy and comfort of patients during endoscopy as compared with IV midazolam. Oral or IV midazolam were not able to put most patients in deep sedation level.

Comparison of Sexual Dysfunction in Women with Migraine and Multiple Sclerosis (MS).

Migraine and multiple sclerosis (MS) are two neurologic disorders that influence different aspects of women who are affected. Sexual function is one of the co-morbidities that are not considered well in such cases. The goal of this study to evaluate sexual function in women experiencing either migraine or MS. Eighty six married migraineus patients and 86 age- matched married MS cases were asked to fill out valid and reliable Beck depression inventory (BDI) and FSFI (Female Sexual Function Index ) questionnaires. BDI score was higher in women with migraine than MS cases and BDI scores in both groups were high in cases with sexual dysfunction. BDI score was significantly correlated with total FSFI and its subscales in both groups. Multiple linear regression analysis between the FSFI as a dependent variable and age, BDI and education level as independent variables showed that age and BDI are independent predictors of FSFI in both groups. Sexual dysfunction should be considered in women with either MS or migraine.

A Male Infant with Abetalipoproteinemia: A Case Report from Iran.

Abetalipoproteinemia (ABL) is a very rare autosomal recessive disorder caused by mutations in the microsomal triglyceride transfer protein gene (MTTP). ABL is characterized by lack of lipids and apolipoprotein B (apoB) in plasma, fat malabsorption and various clinical manifestations. We describe a 12-month-old infant boy, born from consanguineous parents and presented with diarrhea, steatorrhea, growth retardation, hypothyroidism, intraventricular brain cyst and kidney stones. The patient was diagnosed to have ABL and treated with dietary modification and oral fat-soluble vitamin replacement and followed until he reached 5 years of age.

Pelvic Floor Muscle Exercise for Paediatric Functional Constipation.

INTRODUCTION: Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. MATERIALS AND METHODS: In this study which was conducted in Children's Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. RESULTS: Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. CONCLUSION: Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC.

Comparison of sleep quality in women with migraine moreover, multiple sclerosis.

Multiple sclerosis (MS) and migraine are two common neurological disorders affecting women more than men. Sleep quality impairment has been reported in both diseases. The goal of this study was to compare sleep quality and depression between women with MS and migraine. Seventy women with migraine and 75 women with MS were enrolled in this study. Participants were asked to fill-out valid and reliable Persian versions of Pittsburg Sleep Questionnaire (PSQI) and Beck Depression Inventory (BDI). Mean age and duration of disease for MS group was 31.1 ± 7.6, 4.8 ± 5 and for second group 31.4 ± 5.6, 5.2 ± 4 years, respectively. Mean BDI score and number of patients with poor sleep (PSQI ≥5) were significantly higher in patients with migraine. There was significant positive correlation between PSQI and BDI scores in all participants (r=0.32, P<0.001), while correlation coefficient was 0.39, P=0.001 in patients with migraine and 0.35, P=0.002 in MS cases. Multiple linear regression analysis between the PSQI as a dependent variable and age, BDI and education level as independent variables showed that BDI is the independent predictors of PSQI in both groups. This study shows that patients with migraine suffer from poor sleep and depression more frequently than MS cases.

Depression, poor sleep, and sexual dysfunction in migraineurs women.

BACKGROUND: Migraine is a chronic disorder affecting women more than men. Sexual dysfunction is one the complaints of women with migraine, which is not regarded as it should be. The goal of this study was to determine sexual dysfunction in women with migraine, and possible effects of depression and sleep quality on their sexual function. METHODS: One hundred married migraineurs women were enrolled. All participants were asked to fill out valid and reliable Persian versions of Pittsburgh Sleep Questionnaire (PSQI), female sexual function index (FSFI) and beck depression inventory (BDI). RESULTS: Mean BDI, PSQI, and FSFI scores were 15.1 ± 9.1, 7.6 ± 4, and 21.6 ± 8.8 in all patients, respectively. Sexual dysfunction found in 68% and 79% were poor sleepers. Mean BDI and PSQI scores were significantly higher in women with sexual dysfunction (FSFI < 26.55). There was significant negative correlation between BDI score and FSFI (r = -0.1, P = 0.001) as well as significant positive correlation between BDI and PSQI (r = 0.42, P < 0.001). Multiple linear regression analysis showed that BDI and age were independent predictors of FSFI score. CONCLUSIONS: Physicians should consider sexual dysfunction in women with migraine along with depression and poor sleep in such cases.

Sexual function in women with multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory disease of central nervous system (CNS) and sexual dysfunction (SD) is one of the most common disabilities of MS women. The aim of this study was to determine sexual function of women with MS (multiple sclerosis). One hundred definite MS patients MS patients and fifty age-matched healthy controls were enrolled. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's  files and Kurtzke Expanded Disability Status Scale (EDSS) recorded for each patient by an expert neurologist. Participants were asked to answer the valid and reliable Persian version of Beck depression inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. The total FSFI score and subscale scores differed significantly between the MS patients and the controls. There was a significant negative correlation between EDSS and FSFI scores (rho=-0.44, P<0.001) and significant positive correlation between EDSS and BDI (rho=0.36, P<0.001) in patients. Mean BDI and all subscales of FSFI differed significantly between patients with total FSFI score higher and lower than 26.55. Sexual dysfunction should be considered in women with multiple sclerosis.

Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex.

To evaluate the relationship between disease duration, disability, disease pattern, age and sex with fatigue in MS patients. One hundred and seventy-three clinically definite MS patients and 87 age-matched healthy controls enrolled in this cross sectional study. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient's files and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for each patient by an expert neurologist. Participants were asked to answer the validated and reliable Persian version of beck depression inventory (BDI) and FSS (fatigue severity score) questionnaires. Mean FSS and BDI scores were significantly different between patients and controls (p < 0.001). Patients with longer disease duration, higher EDSS and progressive type of disease had significantly higher FSS and BDI scores. Although men had higher EDSS, FSS and BDI scores were similar in both sex groups. FSS was significantly correlated with age, disease duration, BDI and EDSS. The analysis of covariance revealed that there is no difference in the covariance-adjusted means for fatigue among two disease groups (relapsing remitting and secondary progressive) except for EDSS. MS patients with longer disease duration, higher EDSS and progressive type of disease suffer from fatigue more than cases with lower EDSS, duration of disease and relapsing type of the disease.

Validity and reliability of Persian version of Modified Fatigue Impact Scale (MFIS) questionnaire in Iranian patients with multiple sclerosis.

PURPOSE: To determine the validity and reliability of the Persian version of the Modified Fatigue Impact Scale (MFIS) questionnaire for Iranian patients with multiple sclerosis (MS). METHOD: One hundred and twenty patients with MS and 75 age-matched healthy controls were enrolled. Participants were asked to answer the valid and reliable Persian version of the Beck depression inventory (BDI), Fatigue Severity Scale (FSS) and translated MFIS questionnaires. Twenty cases filed the questionnaire two weeks later to assess reliability. The intra-class correlation coefficient (ICC), Cronbach's alpha and multiple regression analysis were used. RESULTS: The total MFIS score and subscale scores differed significantly between the patients with MS and the healthy controls. The ICCs and Cronbach's alpha values were also outstandingly high. There was a significant correlation between the FSS and MFIS scores in patients (r = 0.69, p < 0.001). Also, a significant correlation was investigated between the scores of the BDI and the MFIS (r = 0.68, p < 0.001). Multiple linear regression analysis between the MFIS as a dependent variable and Expanded Disability Status Scale (EDSS), BDI and disease duration as independent variables showed that the BDI and EDSS are dependent predictors of the MFIS. CONCLUSION: The results of this study indicate that the Persian version of MFIS can be regarded as a valid and reliable scale for assessing fatigue in Iranian patients with MS. IMPLICATIONS FOR REHABILITATION: Fatigue is one of the most common, disabling and troublesome complaints of individuals with MS. Different factors such as depression and physical disability are considered to play an important role in MS-related fatigue. Fatigue evaluation by means of a valid and reliable instrument is important in individuals with MS. Persian version of MFIS provides a valid and reliable instrument for fatigue evaluation.

Granulomatous hepatitis as a rare complication of Bacillus Calmette-Guérin vaccination.

Bacillus Calmette-Guérin (BCG) vaccine, which is a widely practiced vaccine in some regions, could lead to a variety of complications. Herein, a 2-month-old infant is presented who was referred because of hepatosplenomegaly and diarrhea. Liver biopsy indicated multiple small and large granulomas composed of epithelioid histiocytes; granulomas resided in portal or lobular areas. The diagnosis of granulomatous hepatitis was made, and treatment with isoniazid, rifampine, and ethambutol were started. Liver function tests were normalized and hepatosplenomegaly was reduced in an 8-month follow-up. The presence of epithelioid cell granuloma in the liver may indicate a diagnosis of disseminated BCG as a rare complication of vaccination. Prompt diagnosis and appropriate treatment could prevent further complications in the affected patients.