Adjunctive silymarin supplementation and its effects on disease severity, oxidative stress, and inflammation in patients with Alzheimer's disease.

BACKGROUND: Brain tissue in Alzheimer's patients is exposed to oxidative stress. Silymarin is an adjunct drug that has anti-inflammatory and antioxidant properties. OBJECTIVE: This study aimed to evaluate the effect of silymarin on biomarkers of oxidative stress, inflammation, and disease severity in Alzheimer's patients. METHODS: This randomized, single-blind clinical trial study was performed on 33 patients with Alzheimer's disease (AD) whose disease was confirmed by DSM-5 criteria and by brain imaging. Patients in the case group received three 250 mg silymarin capsules daily (each containing 150 mg silymarin), as an adjunctive medication in addition to the routine medication regimen. In the placebo group (control), patients received the same amount of placebo. All patients underwent Mini Mental State Exam (MMSE) and a panel of blood tests including malondialdehyde, neopterin, catalase, paraoxonase-1, total oxidative status, and total antioxidant capacity to reevaluate the changes pre/postintervention at the end of the trimester. RESULTS: The catalase and MDA serum levels after the adjunctive silymarin treatment decreased significantly (Catalasebefore silymarin = 9.29 ± 7.02 vs Catalaseafter silymarin = 5.32 ± 2.97, p = 0.007 and MDAbefore silymarin = 4.29 ± 1.90 vs MDAafter silymarin = 1.66 ± 0.84, p < 0.001) while MMSE increased notably (MMSEbefore silymarin = 10.39 ± 6.42 vs MMSEafter silymarin = 13.37 ± 6.81, p < 0.001). CONCLUSION: Silymarin can be effective as an adjunct drug and a powerful antioxidant in reducing oxidative stress and improving the course of AD.

The axis of long non-coding RNA MALAT1/miR-1-3p/CXCR4 is dysregulated in patients with diabetic neuropathy.

Background: Diabetic neuropathy (DN) is a prevalent complication of diabetes mellitus characterized by pain and inflammation. Long non-coding RNAs (lncRNAs) have been associated with DN. This study aimed to investigate transcript levels of Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), microRNA (miR)-1-3p, and C-X-C motif chemokine receptor 4 (CXCR4) in the DN patients and type 2 diabetes mellitus (T2DM) cases without neuropathy. Methods: Here, 20 cases with DN and 20 T2DM subjects without neuropathy (as the control group) were included. Total RNA was extracted from peripheral blood mononuclear cells (PBMCs) of all participants. The expression levels of targets were evaluated by Real-time-PCR. Results: Results showed that MALAT1 (Fold change = 2.47, P = 0.03) and CXCR4 (Fold change = 1.65, P = 0.023) were significantly upregulated, while miR-1-3p was downregulated (Fold change = 0.9, P = 0.028) in whole blood samples from DN patients compared to the control group. A significant correlation was found between transcript levels of MALAT1 and CXCR4 (rho = 0.84; P < 0.0001). Conclusions: This study suggests a possible involvement of the MALAT1/miR-1-3p/CXCR4 axis in the pathogenesis of DN.

Efficacy of electroconvulsive therapy in Parkinson's disease: A clinical trial.

Motor and psychiatric symptoms in patients with Parkinson's disease (PD) constitute some of the most problematic issues for both the patients and their caregivers. This study evaluated the short- and long-term efficacy of electroconvulsive therapy (ECT) in PD patients whose psychiatric symptoms had been exacerbated due to drug therapy. Fifteen PD patients were treated using an electroshock device at a range of 25-100 Joules over a period of 6 weeks, during 12 sessions. Motor and psychiatric symptoms of all patients were evaluated before conducting ECT as baseline, after 12 sessions of ECT at the 6th week, and one month after completion of the treatment at the 10th week. The results showed that the variables mentation, behavior, mood, performance of daily activities, and severity of motor and psychiatric symptoms, were significantly improved at the end of the 6th and 10th weeks when compared with the baseline. Moreover, the results revealed that the mean values were significantly different only for motor symptoms at the end of the study (10th week) compared with the second time point. The current trial may indicate that ECT could potentially serve as a viable treatment for PD patients with refractory psychiatric symptoms. However, due to waning efficacy of ECT, it is recommended that PD patients undergo a conventional treatment in conjunction with periodic ECT sessions to ensure an optimal medical outcome.

Prevalence of Multiple sclerosis and its clinical and demographic characteristics in Kurdish populations in western Iran (2020).

BACKGROUND: Multiple Sclerosis (MS) is a costly burdensome nervous system disorder leading several disabilities in young and middle-aged people. Knowing MS clinical, epidemiologic and demographic characteristics may help to estimate and predict the required health services and medication facilities for the affected people. This study was aimed to determine the prevalence of MS and its demographic characteristic in about 2 million Kurdish populations in western Iran in 2020. METHODS: This cross-sectional study was conducted in 2020 on MS patients with Kurdish Ethnicity living in Kermanshah /western Iran which is a Mountainous area in. MS patients were registered and recruited to this study from several centers. The settings have been approved by the nationwide MS registry of Iran (NMSRI). Using two questioners, a questionnaire included sex, age, the age in which the MS symptoms onset, the age of diagnosis, family history of MS, and type of MS, and second one was the Expanded Disability Status Scale (EDSS) checklist. The demographic information of Kermanshah province was adopted from the Statistical Center of Iran. In addition to descriptive statistics, U-Mann-Whitney and Chi-square tests were also used. RESULTS: A total of 1557 MS patients with a mean age (±SD) of 38.66 ± 9.9 years were recruited in this study. Of them, 1216 (78.1%) were female. The majority of patients, 300 patients (19.3%), were in the age range 35-39 years, and the highest prevalence (184.82 per 100,000 populations) was observed in the age range 40-44 years. The prevalence of MS in Kermanshah province is estimated 79.50 per 100,000 people, 125.71 per 100,000 in female and 34.41 per 100,000 in male. This prevalence was higher in female (female to male was 3.65 to 1). The EDSS score was significantly higher in male than in female (3.06 ± 2.2 in male versus 2.42 ± 1.8 in female) (p = 0.001). The type of MS was significantly different between male and female, so that SPMS and PPMS were more common in male (31(10.3%), 22(7.3%)) than female (81(7.5%), 39(3.6%)) (p = 0.012). A positive family history of MS was found in 12.6% of patients. CONCLUSION: Given the information about prevalence of MS in Kermanshah (in 2012), the prevalence of MS in Kermanshah has increased during last decade. MS disabilities were more extensive in male rather than female.

Clinical effectiveness and safety of fingolimod in relapsing remitting multiple sclerosis in Western Iran.

OBJECTIVE: To investigate the clinical effectiveness and safety of fingolimod in the western Iranian population. METHODS: This study was performed as a prospective observational study between March 2014 and October 2015. Sixty patients with relapsing remitting multiple sclerosis (RRMS) who were referred to the MS clinic of Imam Reza Hospital, which is affiliated with Kermanshah University of Medical Sciences, Iran, were treated with 0.5 mg oral fingolimod capsules once daily for 12 months. The outcomes were clinical and included the annualized relapse rate, expanded disability status scale (EDSS) change, proportion of relapse-free patient, and side effects. RESULTS: An 85% reduction in the annualized relapse rate compared with the baseline (from 1.8+/-1.35 to 0.27+/-0.58, p=0.001) was observed, and 76.66% of patients were free from relapse after the 12-month intervention. In addition, a significant reduction of EDSS was measured from 3.32 at baseline to 2.97 (p=0.001). The overall adverse events in our study were similar to those in previous studies. CONCLUSION: The present study confirms the effectiveness of fingolimod as a second-line therapy in western Iranian RRMS patients. Fingolimod side effects were generally mild and tolerable.

Evaluation of pulsing magnetic field effects on paresthesia in multiple sclerosis patients, a randomized, double-blind, parallel-group clinical trial.

OBJECTIVES: Evidence is mounting that magnet therapy could alleviate the symptoms of multiple sclerosis (MS). This study was performed to test the effects of the pulsing magnetic fields on the paresthesia in MS patients. PATIENTS AND METHODS: This study has been conducted as a randomized, double-blind, parallel-group clinical trial during the April 2012 to October 2013. The subjects were selected among patients referred to MS clinic of Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Iran. Sixty three patients with MS were included in the study and randomly were divided into two groups, 35 patients were exposed to a magnetic pulsing field of 4mT intensity and 15-Hz frequency sinusoidal wave for 20min per session 2 times per week over a period of 2 months involving 16 sessions and 28 patients was exposed to a magnetically inactive field (placebo) for 20min per session 2 times per week over a period of 2 months involving 16 sessions. The severity of paresthesia was measured by the numerical rating scale (NRS) at 30, 60days. The study primary end point was NRS change between baseline and 60days. The secondary outcome was NRS change between baseline and 30days. RESULTS: Patients exposing to magnetic field showed significant paresthesia improvement compared with the group of patients exposing to placebo. CONCLUSION: According to our results pulsed magnetic therapy could alleviate paresthesia in MS patients .But trials with more patients and longer duration are mandatory to describe long-term effects.

The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis.

OBJECTIVE: To compare the efficacy and safety of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) in the treatment of patients with cerebral venous sinus thrombosis (CVST), and to provide an appropriate treatment option in these patients. METHODS: This is a randomized double blind clinical trial conducted between December 2013 and December 2014. The subjects were selected among patients referred to Neurology Department, Imam Reza Hospital; affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran. Fifty-two cases of CVST were included in this study and randomly divided into 2 groups. Twenty-six cases received LMWH and the other 26 cases received UFH. The primary outcomes include hospital mortality rate and neurologic deficits as assessed by the National Institutes of Health Stroke Scale (NIHSS). The secondary end point was disability as measured by the Modified Rankin Scale (MRS). RESULTS: We observed the rate of mortality and neurological deficits and disability based on NIHSS, and the MRS did not differ between the 2 groups. CONCLUSION: The efficacy of LMWH and UFH in reduction of neurologic deficit and functional disability in patients with CVST are similar.

Gabapentin versus levodopa-c for the treatment of restless legs syndrome in hemodialysis patients: a randomized clinical trial.

To compare the efficacy of gabapentin and levodopa-c (Levodopa/Carbidopa) in reducing restless leg syndrome (RLS) symptoms and sleep problems in hemodialysis patients with RLS in a four-week randomized clinical trial. The diagnosis of RLS was made using the criteria of the International Restless Legs Study Group. Each subject completed three questionnaires: IRLS questionnaire, Pittsburgh Sleep Quality Index and Epworth sleepiness scale. After four weeks of washout period for previous treatments for RLS, subjects were randomly assigned to four weeks of gabapentin (200 mg) or levodopa-c (110 mg). After four weeks of therapy, the questionnaires administered at the outset of the study were re-administered. Both drugs were found effective for the management of RLS. But, the effect of gabapentin was more significant. Gabapentin significantly improved the IRLS total score (change from baseline to post-treatment ≈-17) compared with levodopa-c (change from baseline to post-treatment ≈-13) (P: 0.016). Regarding sleep parameters, levodopa improved sleep quality, sleep latency and sleep duration (P <0.0001). Gabapentin was also effective with respect to sleep parameters (P <0.0001). Our study shows that gabapentin is a safe effective therapy for RLS among hemodialysis patients. This medication may be considered as an alternative or additive treatment to current therapeutic remedies for hemodialysis patients with RLS.

Evaluation of the efficacy and safety of pregabalin, venlafaxine, and carbamazepine in patients with painful diabetic peripheral neuropathy. A randomized, double-blind trial.

OBJECTIVE: To evaluate the efficacy and safety of carbamazepine, pregabalin, and venlafaxine in patients with painful diabetic neuropathy (PDN). METHODS: Our study was performed as a randomized, double-blind, parallel-group clinical trial between December 2012 and December 2013 at Kermanshah University of Medical Sciences, Kermanshah, Iran. Two hundred and fifty-seven patients with clinically definite PDN were randomized to receive, carbamazepine, venlafaxine, or pregabalin. The primary outcome was subjective pain as assessed by the visual analogue scale (VAS). Secondary outcomes consisted of sleep, mood, and work interference assessments, and a percentage of patients achieving at least 50% reduction in pain intensity. RESULTS: Means of VAS scores for carbamazepine, pregabalin, and venlafaxine treatment groups at the baseline (74.5, 82.3, and 74.5) and endpoint (39.6, 33.4, and 46.6) revealed significant reduction, although pregabalin was more efficacious than carbamazepine, and venlafaxine. Improvements in means scores of sleep, mood, and work interferences were identified in all treatment groups. CONCLUSION: This study showed the efficacy of venlafaxine, pregabalin, and carbamazepine in pain reduction in patients with diabetic neuropathy, although pregabalin was shown to be superior to carbamazepine, and venlafaxine in relieving pain, no significant superiority was shown between carbamazepine, and venlafaxine.

P wave duration and dispersion and QT interval in multiple sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is one of the most frequent disorders of central nervous system, resulting in autonomic disturbances. Some electrocardiographic changes have been reported in these patients that can lead to arrhythmia. In this study we compared P wave duration and dispersion and QT interval of MS patients to healthy control subjects. MATERIAL AND METHODS: Eighty four multiple sclerosis patients and 84 healthy, age and sex-matched volunteers were included. A 12-lead electrocardiogram was undertaken in order to measure minimal and maximal P wave duration, P wave dispersion (PWD) and QT interval. RESULTS: In patient group, mean P wave duration, maximum P wave duration and PWD were significantly longer than control group. QT interval was longer in patient group but the difference was not significant. CONCLUSION: In this study, P wave duration and P wave dispersion was found to be higher in MS patients than healthy control subjects.

Evaluation of the intravenous magnesium sulfate effect in clinical improvement of patients with acute ischemic stroke.

BACKGROUND: Evidence is mounting that magnesium may play a critical role in the development of strokes and the healing process during and after a stroke. Magnesium is an N-methyl-D-aspartate (NMDA) glutamate receptor antagonist that has been shown to be neuroprotective in many preclinical models of ischemic and excitotoxic brain injury. This study was performed to evaluate the intravenous magnesium sulfate effect in clinical improvement of patients with acute ischemic stroke. METHODS: One hundred and seven patients with acute ischemic stroke signs and symptoms lasting less than 12 hours were included in the study and were divided into two groups, 55 patients received 4 g of MgSO(4) over 15 minutes and then 16 g over the next 24 hours, and 52 patients were received matching placebo. The study primary end point was stroke related neurologic deficit evaluation by the national institute of stroke scale (NIHSS). RESULTS: Patients receiving MgSO(4) showed significant recovery compared with the group of patients receiving placebo. CONCLUSION: This study suggests that magnesium sulfate can be used as a safe and useful neuroprotective agent in acute ischemic stroke and lacunar stroke patients may represent a relevant and practical target population for agents with biological activity in white matter.

Evaluating the rate of recurrence of epilepsy after therapy discontinuation in 2-year seizure-free epileptic patients.

INTRODUCTION: The potential complications of antiepileptic drugs render them risky and associated with numerous morbidities for long-term therapy. Therefore, it is essential to balance therapy discontinuation against risks of epilepsy recurrence. However, the risk factors predicting recurrence are yet to be identified. The present study was conducted in order to determine the rate of recurrence after gradual therapy discontinuation as well as its influential factors in epileptic patients under medical therapy who were seizure-free for a period of 2 years. METHOD AND MATERIALS: This is a descriptive cross-sectional study on epileptic patients who referred to the specialized neurology clinic of Kermanshah University of Medical Sciences from 1994 to 2010. The data were extracted from patients' medical records and analyzed. FINDINGS: A total of 391 patients were evaluated. In our study, 51.2% of patients experienced recurrence of seizure at the end of the 2-year follow-up. Recurrence occurred most frequently during medication tapering (51%). While the largest number of patients were aged under 12 years (178 patients; 45%), the rate of recurrence was greatest for patients aged 20-40 years (43 patients; 66.2%). DISCUSSION AND CONCLUSION: As our findings suggest, type of epilepsy, multidrug therapy, abnormal electroencephalography before discontinuation, and abnormal brain computed tomography scan are factors that influence the risk of recurrence after therapy discontinuation. It is essential for the physician to take these factors into account and weigh the risk of recurrence against the benefits of therapy discontinuation.