Assessment of miR-181b-5p, miR-23a-3p, BCL-2, and IL-6 in Peripheral Blood Mononuclear Cells of Autistic Patients; Likelihood of Reliable Biomarkers.

Autism is a neurodevelopmental disorder that is recognized by stereotypic and repetitive behaviors after 2 years of old. Dysregulation of the immune system, especially inflammation which is mostly regulated by IL-6, imposes a deficit in CNS development. Along with this crucial biomarker, researchers have proposed BCL-2, micro RNA-23a-3p (miR-23a-3p), miR-181b-5p as other probable biomarkers involved in inflammation and apoptosis. The aim of the study was to evaluate the alteration in the expression of these biomarkers in a group of autism spectrum disorder (ASD) children. Peripheral blood mononuclear cells (PBMCs) were obtained from 37 autistic patients. After RNA extraction with precipitation method, the Syber green qReal-time Polymerase Chain Reaction (PCR) was performed in order to evaluate the possible alteration in the expression of IL-6, BCL-2, miR-181b-5p, and miR-23a-3p. The results were compared with healthy controls. IL-6 was significantly upregulated in ASD patients (p=0.003). On the other hand, miR-23a was upregulated and BCL-2 downregulated in ASD patients but the changes were not significant. In initial evaluations, expression changes of miR-181b-5p were not statistically significant. However, when Patients were divided into two groups of upregulated and downregulated, re-evaluation showed that both up- (p=0.005) and down-regulation (p=0.004) (i.e. changes regardless of the direction) of miR-181b were significant in autistic children. IL-6 and miR-181b-5p can have proper diagnostic values and are reliable biomarkers with high sensitivity and specificity. On the other hand, PBMC can be utilized for such studies and also evaluation of patients' condition instead of brain tissue as it is less accessible.

Identification and Evaluation of Abused Children at Imam Hossein Hospital.

BACKGROUND: Child abuse is a phenomenon that confronts the child, family, and society with irretrievable physical and mental injuries, and its negative effects continue until adulthood. OBJECTIVES: The present study was conducted to identify and evaluate cases of abused children at a medical center. PATIENTS AND METHODS: This is a descriptive-analytic study. The subjects were all children and adolescents who were referred to Imam Hussein hospital within 6 months due to physical or psychiatric reasons and were diagnosed with child abuse and neglect by a child and adolescent psychiatrist. The number of these children was 73. Children and their parents were assessed by schedule for affective disorders and schizophrenia (SADS), Kiddie-SADS, and child abuse and demographic questionnaires. The statistical methods of mean and standard deviation were used to analyze the data. RESULTS: 56 cases (76%) were physically abused, 53 cases (72.6%) were emotionally abused, and 3 cases (12.3%) were neglected. The most common psychiatric disorder in abused children was ADHD (65.8%). The next most common were oppositional defiant disorder, obsessive compulsive disorder, general anxiety disorder, and enuresis. About 80% of the abused children had at least one psychiatric disorder. The most common psychiatric disorders in mothers were general anxiety disorder (34.8%) and depression (33.3%), and in fathers, it was substance abuse (19.7%). CONCLUSIONS: Child abuse is a common phenomenon that relates to psychiatric disorders in the abused child or abuser parents. It seems that on-time identification and appropriate interventions can prevent further negative consequences for the child, family, and society.

Clinical outcomes and cost effectiveness of two aftercare models provided by general physicians and nurses to patients with severe mental illness.

BACKGROUND: Implementing community-based psychiatric services is one of the priorities of the WHO/EMRO mental health programs. This study presents an aftercare service, as a community based-service, for patients with severe mental illness (SMIs). METHODS: In this randomized controlled clinical trial design, 176 patients, who attended selective hospitals with SMI, were allocated into three groups: clinical case managers provided by general practitioners, nurses and the control group (usual treatment). The clients and their caregivers received monthly home visits (education and treatment supervision). The effectiveness of the intervention was measured by indicators of psychopathology such as scores of YOUNG, caregivers' knowledge and satisfaction with the services. Health-related quality of life (SF-36) was considered as the primary outcome variable. Data were collected at baseline and at 12 months follow-up. Direct and indirect medical costs were obtained through a periodic completion of questionnaires and interviews by caregivers. Cost effectiveness ratio was estimated as cost per QALY gained in each group. SPSS 16.0 was used in this survey and statistical methods were chi-square, ANOVA, Scheffe as post-Hoc test and paired sample t-test with 95% confidence interval and 0.05 significance level. RESULTS: The results of our study revealed that the score of YOUNG, caregivers' knowledge and satisfaction with service were improved in both intervention groups after 12 months. Improvement in health-related quality of life was observed in the general practitioner and nurse group. The incremental cost effectiveness ratio was 5740807 IRR and 5048459 IRR per QALYs gained in the general practitioner and nurse groups, respectively. CONCLUSION: The model of aftercare services provided by trained nurses is the most cost- effective and feasible model for Iran's socio-economic conditions with low resource allocations.

The pigeonhole of occult hepatitis B.

Occult hepatitis B (OHB), or persistent hepatitis B virus (HBV) viremia in surface-antigen-HBsAg-negative patients, has been recognized as a medical concern during the last decade. The exact magnitude, pathogenesis and clinical relevance of OHB are unclear. This review organizes the published data on OHB and presents an overview of the current hypotheses on OHB's pathogenesis and clinical relevance.Many explanations have been offered for the pathogenesis of OHB, ranging from the inability of standard immunoassays to diagnose OHB to the involvement of the versatile virus-host factors. Also, special care should be taken regarding the diagnosis of OBH. It seems that both shared viral-host factors are involved in the pathogenesis of OBH. Further molecular studies on cohort patients group need to explore such association.

Chronic hospitalized and household maintained consumers; characteristics and differences among referees to the Iranian society supporting individuals with schizophrenia.

OBJECTIVE: Providing treatment and educational services for consumers and their caregivers is more effective if those services are implemented based on their characteristics and differences. To partly address this objective, the present study aimed to describe and compare characteristics and differences of chronic hospitalized and household maintained consumers and their caregivers who were regular users of educational and rehabilitation programs of the Iranian Society Supporting Individuals with Schizophrenia (ISSIS) in Tehran, Iran. METHODS: Two hundred and thirty one consumers were evaluated based on demographics, and clinical and symptom-related characteristics. Their caregivers (n = 231) were independently evaluated based on their knowledge on schizophrenia, family function, burden, and availability of social services and support for them. Data were analyzed by performing independent sample t-test and Mann-Whitney U. RESULTS: The study findings revealed hospitalized consumers were older, had longer length of illness, greater severity of positive and negative symptoms and lower efficacy in basic life skills in comparison with household maintained consumers. The caregivers of the hospitalized consumers had greater objective and subjective burdens and lower knowledge on schizophrenia in comparison with caregivers of household maintained consumers. While household maintained consumers had more access to medical insurance, their caregivers had more access to the supportive organizations, more availability of substitute caregiver and assistant caregiver compared with caregivers of hospitalized consumers. CONCLUSION: Our findings suggest the need to promote specific interventions and treatment programs for Iranian consumers and their caregivers based on their characteristics and differences due to schizophrenia. DECLARATION OF INTEREST: None.

Risk factors associated with psychiatric hospitalization among Iranian schizophrenic patients.

OBJECTIVE: Psychiatric hospitalization of patients imposes heavy burdens on caregivers, but little is known about this issue in Iran. The present cross-sectional study aimed to investigate the risk factors associated with psychiatric hospitalization of patients with schizophrenia who were the regular clients for the educational programs of The Iranian Society for Supporting Individuals with Schizophrenia (ISSIS) in Tehran, Iran. METHODS: 231 male and female study subjects and 231 of their caregivers participated in the study. The study subjects were independently assessed in demographics, clinical and symptom-related characteristics and basic life skills domains. Their caregivers were assessed in domains of knowledge on schizophrenia, burden, social support, family function, and the patterns of relationships with their patients and the role of health and supportive services. Data were analyzed by performing logistic regression model. RESULTS: Old age, low level of education, unemployment, greater severity of positive and negative symptoms, poor basic life skills among subjects, and objective family burden, inadequate knowledge on schizophrenia, low perceived social support and lack of medical insurance among caregivers were the most important factors associated with psychiatric hospitalization among the clients. CONCLUSIONS: Some factors originated in Iranian patients and their caregivers could cause patients' pathways to psychiatric hospitalization. Although the study results did not establish causation, based on the findings, psychoeducational interventions may reduce schizophrenia referral and lower the rate of need to inpatient services in Iran. DECLARATION OF INTEREST: None.

Clinical manifestations of the female athlete triad among some Iranian athletes.

PURPOSE: The study's purpose was to evaluate clinical manifestations of the female athlete triad among some elite Iranian athletes. METHODS: This cross-sectional study was conducted in three phases: 1) screening for menstrual irregularity (oligomenorrhea/amenorrhea) and/or stress fracture and weight-reducing drugs, 2) measurement of bone mineral density by dual-energy x-ray absorptiometry, and 3) a clinical interview to diagnose eating disorders. Phases 2 and 3 were conducted in athletes who reported menstrual irregularity and/or stress fracture and weight-reducing drugs. RESULTS: We evaluated a total of 786 athletes (94%) with a mean age of 21.1 ± 4.5 yr old. Seventy-two (9.2%) athletes reported menstrual irregularity, 11 (1.4%) of whom had polycystic ovary syndrome. Only three athletes (0.4%) had all three common clinical manifestations of the Triad (eating disorders, menstrual irregularity, and low bone mineral density). There was no association between these disorders and body mass index or type of sport. A total of 17 (2%) reported stress fracture, 14 of whom also reported a history of stress fracture without any menstrual irregularity. The athletes who competed in high-risk sports (endurance sports, weight class sports, and sports requiring a lean build) had significantly more stress fractures than those participating in other types (odds ratio = 3.35, 95% confidence interval = 1.22-9.15). CONCLUSIONS: Although the prevalences of clinical functional hypothalamic menstrual disorders and stress fracture were less than those reported in some other countries, athletes in the high-risk group had significantly more stress fractures than those in the low-risk group. Future studies should focus on screening, diagnosing, preventing, and treating all components of the newly defined Triad, especially in high-risk sports in Iran.

The prevalence of Attention Deficit Hyperactivity Disorder in Iran: A systematic review.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Children with ADHD may experience significant functional problems. Our objective was to examine the prevalence of ADHD and its subtypes in Iran. METHODS: Pubmed, ISI web of science, psychinfo, Iranpsych, Iranmedex, Irandoc were searched. Irandoc, Iranmedex and Iranpsych are Iranian databases of which the last one is especially for psychiatry and psychology literature. INCLUSION CRITERIA WERE: conducting studies by random sampling, using valid instruments to assess ADHD diagnosis or symptoms,and presenting a prevalence of ADHD or attention deficit and / or hyperactivity symptoms. RESULTS: After quality assessment, 16 studies were accepted. Their estimation of prevalence was different as different scales were used. Hyperactive type was more prevalent in boys, and inattentive type was more prevalent in girls. CONCLUSION: Being aware of the epidemiology of ADHD in Iran helps us to make improvements in planning the allocation of funds for mental health services. Using one instrument in studying the prevalence of ADHD in a population may lead to more precise estimations.

The Persian Bipolar Spectrum Diagnostic Scale and mood disorder questionnaire in screening the patients with bipolar disorder.

BACKGROUND: Considering the difficulties in diagnosing bipolar disorder in clinical practice and lack of needed screening instruments in Persian language, the present study aimed at assessing sensitivity, specificity, and predictive values for the Persian Bipolar Spectrum Diagnostic Scale. METHODS: The study was conducted in a university-affiliated hospital in Tehran, Iran, in a sample of 181 consecutive outpatients aged 18-65 years. The used instruments were the Structured Clinical Interview for DSM-IV axis I disorders, the Persian Bipolar Spectrum Diagnostic Scale, the Persian Mood Disorder Questionnaire, and the Scale to Assess Unawareness of Mental Disorder. RESULTS: Most patients were males (58%) and had bipolar I disorder (57%). Other bipolar disorders and major depressive disorder were diagnosed as 5.5% and 21%, respectively. Test-retest of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire demonstrated a good reliability for both. The sensitivity, specificity, and positive and negative predictive values of the Persian Bipolar Spectrum Diagnostic Scale at the score of 14, were 0.52, 0.79, 0.81, and 0.49, respectively. The sensitivity and specificity of the parallel application of the Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire were 0.76 and 0.67, respectively. CONCLUSION: The Persian Bipolar Spectrum Diagnostic Scale and Mood Disorder Questionnaire are useful in screening patients with bipolar disorder in clinical psychiatric settings. Parallel use of both tests seems more effective than either alone.