Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran.

BACKGROUND: In March 2020, the WHO declared the novel coronavirus (COVID-19) outbreak a global pandemic. Although the number of infected cases is increasing, information about its clinical characteristics in the Middle East, especially in Iran, a country which is considered to be one of the most important focal points of the disease in the world, is lacking. To date, there is no available literature on the clinical data on COVID-19 patients in Iran. METHODS: In this multicenter retrospective study, 113 hospitalized confirmed cases of COVID-19 admitted to university affiliated hospitals in Shiraz, Iran from February 20 to March 20 were entered in the study. RESULTS: The mean age was 53.75 years and 71 (62.8%) were males. The most common symptoms at onset were fatigue (75: 66.4%), cough (73: 64.6%), and fever (67: 59.3%). Laboratory data revealed significant correlation between lymphocyte count (P value = 0.003), partial thromboplastin time (P value = 0.000), international normalized ratio (P value = 0.000) with the severity of the disease. The most common abnormality in chest CT scans was ground-glass opacity (77: 93.9%), followed by consolidation (48: 58.5%). Our results revealed an overall 8% (9 out of 113 cases) mortality rate among patients, in which the majority was among patients admitted to the ICU (5: 55.6%). CONCLUSION: Evaluating the clinical data of COVID-19 patients and finding the source of infection and studying the behavior of the disease is crucial for understanding the pandemic.

One decade distinct features, morbidity and mortality of scleroderma: a cross-sectional study.

OBJECTIVES: Conducting an epidemiologic study on scleroderma patients referred to hospitals and tertiary centres of rheumatologic diseases in Shiraz, located in south of Iran. METHODS: A cross-sectional study was done on patients' records registered in scleroderma outpatient clinics as well as hospitals associated with Shiraz University of Medical Sciences. Gathering data in pre-formed data sheets, descriptive analysis plus qualitative comparisons by chi-square test were done using SPSS 15. RESULTS: In 533 medical records, female to male ratio was 7.3:1. The disease is mostly seen in 3rd and 4th decades of life. More patients had negative family histories (56.1%). 37.5% of the patients had diffuse form of the disease, 36.8% had limited one, and 17.3% had overlap syndrome, mostly, by lupus erythematosus (33%). Most common first presentation was Raynaud phenomenon (40.7%). Two most prevalent clinical manifestations were skin thickening (97.2%) and gastrointestinal involvement (68.9%). Clinical presentations were compared between three most common types of the disease plus various stages of life. Among recorded capillaroscopies, active form was the most prevalent one (38.3%). In documented serologic markers, the most common positive one was anti-nuclear antibody (ANA) (75.6%). Two most common etiologies of hospitalisation were digital ulcer (30.9%) and pulmonary fibrosis (5.7%). The most common cause of death (17) was pulmonary fibrosis (35.2%). CONCLUSION: This study is the first epidemiologic survey on Iranian scleroderma patients with significantly large sample size compared to previous studies worldwide. It can thus provide some guidance for further multi-provincial, multinational and interracial studies on scleroderma.

Protective Effects of Co-Enzyme Q10 on Thioacetamide-Induced Acute Liver Damage and Its Correlation With Behavioral, Biochemical, and Pathological Factors.

BACKGROUND: Acute liver damage may be followed by biochemical, behavioral, and pathological alterations, which can result in serious complications and even death. OBJECTIVES: In this experimental study we determined whether coenzyme Q10 (CoQ10), a common supplementary medicine known to have protective, antioxidative, and anti-inflammatory effects in cells, has any protective effect against thioacetamide (TAA)-induced liver damage and its related neurobehavioral alterations in rats. MATERIALS AND METHODS: In this experimental study forty-eight Wistar rats were divided randomly into four groups (n = 12): C1 was the control group; C2 received a single-dose of TAA (350mg/kg; intraperitoneally) without any other treatment; E1 received TAA + 5 mg/kg CoQ10 (intraperitoneally); and E2 received TAA + 10 mg/kg CoQ10. After sacrificing the rats, liver enzymes and plasma-ammonia (NH4) were measured and histopathological analyses of the livers were carried out. Elevated-plus-maze, open-field, and forced-swimming tests were also performed to investigate behavioral correlations. RESULTS: The serum levels of alanine-aminotransferase (ALT), aspartate-aminotransferase (AST), and NH4 show significant increases (P < 0.05). The groups treated with CoQ10 were shown to have significantly lower clinical grade of encephalopathy (P = 0.001), higher locomotor activity (P = 0.000), and lower levels of depression (P = 0.000). Furthermore, it was also shown that CoQ10 treatment may lead to significant decreases in scores of centrilobular necrosis, apoptosis, inflammatory cell infiltration, vacuolization, and liver necrosis (P < 0.05). CONCLUSIONS: Overall, CoQ10 was determined to have positive effects on liver injury and its related behavioral and biochemical changes.

Treatment of refractory generalized convulsive status epilepticus with enteral topiramate in resource limited settings.

PURPOSE: To explore the feasibility, safety and efficacy of enterally administered topiramate (TPM) as an adjunctive treatment for adult patients with refractory generalized convulsive status epilepticus (RGCSE). METHODS: This prospective open-label non-randomized clinical trial was performed at Namazee hospital, Shiraz University of Medical Sciences, Shiraz, Iran from January 2013 through February 2014. Patients 18 years of age and older with RGCSE were enrolled. Topiramate was used, in case of failure of at least two standard anti-epileptic drugs in patients in whom the standard third or fourth line therapies were not available. Topiramate tablets were crushed and administered through the nasogastric tube; 400mg stat and then 200mg Bid. Status epilepticus response to TPM was categorized as successful (termination of SE within 24h following TPM introduction, without modification of concomitant AEDs), possible (SE termination associated with the introduction of TPM, concomitantly with other medications) or unsuccessful. RESULTS: Twenty patients were studied. Topiramate was successful in terminating SE in five (25%) patients; possibly successful in 11 (55%); and not successful in four (20%). No clinically significant adverse effects related to TPM administration were observed. Eleven (55%) patients returned to their baseline clinical condition at the time of discharge from the hospital, but two (10%) patients did not. CONCLUSION: Treatment with enterally administered topiramate could potentially be efficacious in some patients and appeared to be tolerated well in patients with RGCSE. Low cost and feasibility makes TPM a potentially useful agent in treating patients with RGCSE, especially in resource limited settings.

Ictal injury in psychogenic non-epileptic seizures.

PURPOSE: Whilst ictal injuries in psychogenic non-epileptic seizures (PNES) have been reported previously, very few studies have described the spectrum of ictal injuries in these patients. In the current study, we tried to determine the spectrum of reported ictal injuries associated with PNES and to investigate the possible associated risk factors. METHODS: All patients with PNES were recruited prospectively in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, between 2008 and 2013. The diagnosis was made by clinical assessment and ictal video-EEG recordings. We asked all patients and their caregivers about history of any minor (e.g., tongue biting, bruises, and lacerations) or major (e.g., burns and fractures) physical injuries associated with their seizures, since their disease started. Clinical variables, factors potentially predisposing to PNES and video-EEG recordings of all patients were analyzed. RESULTS: Two hundred and eleven patients were studied. Sixty-five patients (30.8%) reported injuries with one or more of their attacks. The most common type of reported injury was tongue biting. Lacerations, bruises, limb fractures, dental injury, and burn were also reported. CONCLUSION: PNES commonly produce physical injuries. Despite the shibboleth that injuries rarely occur during PNES, mild injuries commonly happen and even severe injuries such as fractures and burns are not uncommonly reported in these patients. Patients with more dramatic seizure manifestations (e.g., urinary incontinence) were more likely to report ictal injuries.

Prolonged psychogenic nonepileptic seizures or pseudostatus.

PURPOSE: The purpose of this study was to determine if patients with episodes of prolonged psychogenic nonepileptic seizures or pseudostatus are different from those with psychogenic nonepileptic seizures (PNESs) without prolonged attacks regarding their demographic and clinical characteristics and factors potentially predisposing to PNESs. METHODS: In this prospective study, all patients with a clinical diagnosis of PNESs (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 through 2013. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics of patients with PNES-status with those with PNES-only. RESULTS: Two hundred and eleven patients were studied. Forty-nine patients (23.2%) reported episodes of PNES-status, and 162 patients (76.8%) did not report PNES-status. There were no significant differences between these two groups of patients regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs. CONCLUSION: Psychogenic nonepileptic seizure status (PNES-status) is relatively common among patients with PNESs. It seems that patients with PNES-status are not different from those with PNES-only, at least regarding the demographic and clinical characteristics and factors potentially predisposing to PNESs.

Psychogenic non-epileptic seizures in Iran.

PURPOSE: We investigated the demographic and clinical characteristics of psychogenic non-epileptic seizures (PNES) in patients in Iran. METHODS: In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2013. The epileptologist interviewed all the patients. We investigated the demographic and clinical characteristics of PNES. RESULTS: Two hundred and forty-nine patients were diagnosed as having PNES. Two hundred and eleven patients had video-EEG recordings available and included in the study. One hundred and forty-one (66.8%) were female and 70 (33.2%) were male. There were no significant differences between our patients and previous reports regarding the clinical and semiological characteristics of PNES. CONCLUSION: Psychogenic non-epileptic seizures are relatively common at epilepsy clinics. It appears that an Islamic lifestyle (in Iran) has little influence on the clinical characteristics and manifestations of PNES, as we observed similar results as in most previous studies from other cultures.

Gender differences in manifestations of psychogenic non-epileptic seizures in Iran.

PURPOSE: Psychogenic non-epileptic seizures (PNES) are more prevalent among women. We investigated the potential differences in demographic and clinical characteristics of PNES between women and men. METHODS: In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2012. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics and seizure semiology of PNES between women and men. RESULTS: Two hundred and twenty-two patients were diagnosed as having PNES. One hundred and eighty-eight patients had video-EEG recordings available and included in the study. One hundred and twenty-nine (69%) were female and 59 (31%) were male. There were no significant differences between women and men with PNES with regard to demographic, clinical and semiological characteristics. CONCLUSION: We did not observe any significant demographic differences between women and men with PNES. Likewise, seizure characteristics and semiology were very similar in both genders. It appears that an Islamic lifestyle (in Iran) has little influence on the sex ratio and clinical manifestations of PNES compared with the Western studies.