Sleep Disorder as a Triggering Factor for Relapse in Multiple Sclerosis.

BACKGROUND/AIMS: To determine the effect of sleep disturbances on predisposing multiple sclerosis (MS) patients for acute relapse. METHODS: This case-control study was conducted on 80 MS patients including 40 patients in the remission phase and 40 in the relapse phase. Patients were asked to fill in the Pittsburgh Sleep Quality Index to determine their sleep quality during the previous month. Individuals with scores of 5 or less were considered having normal sleep quality. RESULTS: Mean ± SD ages were 32.5 ± 7.7 and 30.2 ± 7.2 years among patients with and without acute relapses, respectively (p > 0.05). The mean disease duration and disease severity (according to Expanded Disability Status Scale [EDSS]) were comparable across the groups (p > 0.05). Among those with and without acute exacerbations, 87.5 and 50% had poor sleep quality, respectively (p = 0.0001), with OR of 1.75 (95% CI 1.25-2.43). The age, gender, EDSS, and disease duration did not associate with sleep quality in either groups (p > 0.05). CONCLUSIONS: This study showed that sleep disturbance might be a trigger for an acute MS exacerbation. Increasing the awareness of specialists and routine screening of sleep disorders in MS patients are warranted, as treatment of these disorders might decrease the likelihood of acute relapses.

Frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center.

Solid organ transplantation is an important lifesaving procedure mainly performed in patients with end-stage organ failure such as liver cirrhosis, congestive heart failure, and end-stage renal disease. While these complications are among the most preventable adverse effects of solid organ transplantation, these are generally neglected by physicians. Accordingly, this study was performed to evaluate the frequency of musculoskeletal complications among the patients receiving solid organ transplantation in a tertiary health-care center in a developing country. This cohort study was performed from 2000 to 2009, among fifty patients receiving organ transplantation (liver, heart, and lung) attending to a training hospital in Tehran, Iran. The main variables were musculoskeletal complaints and findings that were measured according to patients' self-report and clinical examination. The mean age of the patients was 40.2 ± 10.9 years ranging from 5 to 58 years. Twenty out of 50 patients (40%) had musculoskeletal complaints that the most common complaint was the arthralgia. Also, the mechanical arthritis was the most common clinical finding in clinical examination (24%). Low serum level of vitamin D (74.4%) and high serum alkaline phosphatase level (27.9%) were the most common biochemical abnormalities in understudy population. Finally, it may be concluded that nearly forty percent of patients receiving solid organ transplantation may develop musculoskeletal findings and/or complaints. These complications may be found and treated with regular examinations to reduce the burden of disease.

A review of the anti-diabetic potential of saffron.

Diabetes mellitus is one of the most prevalent metabolic disorders that affect people of all genders, ages, and races. Medicinal herbs have gained attention from researchers and have been widely investigated for their antidiabetic potential. Saffron (Crocus sativus L.) and its main constituents, that is, crocin and crocetin, are natural carotenoid compounds, widely known to possess a wide spectrum of properties and induce pleiotropic anti-inflammatory, anti-oxidative, and neuro-protective effects. An increasing number of experimental, animal and human studies have investigated the effects and mechanism of action of these compounds and their potential therapeutic use in the treatment of diabetes. This narrative review presents the key findings of published clinical studies that examined the effects of saffron and/or its constituents in the context of diabetes mellitus. Moreover, an overview of the proposed underlying mechanisms mediating these effects, the medicinal applications of saffron, and the new findings regarding its effect on diabetes and various cellular and molecular mechanisms of action will be debated.

Comparison of hydroxyzine and doxepin in treatment of pruritus due to sulfur mustard.

OBJECTIVE: To compare the safety and efficacy of doxepin and hydroxyzine in the treatment of chronic pruritus due to exposure to sulfur mustard. METHODS: In a randomized, double-blind safety and efficacy study, 50 patients with chronic pruritus were given either doxepin 10 mg/d or hydroxyzine 25 mg/d for 4 weeks. Pruritic score was calculated for each patient before treatment and 1 month after. RESULTS: After treatment, the mean pruritic scores +/- SD of the hydroxyzine and doxepin groups were 16.7+/-2.3 and 17.8+/-2.5, respectively. The severity of pruritus was decreased in 80% of patients in the hydroxyzine group and 75% in the doxepin group (P=.786). Eighteen patients in the hydroxyzine group and 14 patients in the doxepin group reported sedation. CONCLUSIONS: Both hydroxyzine and doxepin are effective and have equivalent results in controlling the symptoms of patients with chronic pruritus due to exposure to sulfur mustard.

Complications in neonates of mothers with gestational diabetes mellitus receiving insulin therapy versus dietary regimen.

BACKGROUND: Gestational diabetes mellitus (GDM) is a common obstetrical complication with both maternal and fetal side effects. OBJECTIVE: This study was performed to determine the complications in neonates of mothers with GDM receiving insulin vs. dietary regimen. MATERIALS AND METHODS: In this prospective cohort study, 140 neonates of mothers with GDM attending Javaheri Hospital of Azad University in Tehran in 2013 and 2014 were enrolled and the complications in those receiving insulin versus. dietary regimen were compared. RESULTS: The results demonstrated that 95.7% of those who received a dietary regimen and 85.7% among those who received insulin had a good outcome showing statistically significant differences (p=0.042). The mortality rate was not differed among the patients in two groups (p>0.05). CONCLUSION: According to the results of this study, it may be concluded that the frequency of complications in neonates of cases with GDM is getting less by receiving dietary regimen.

A comparison between gastroesophagheal ultrasonography vs. barium swallow in determining the pattern of gastroesophageal reflux in a pediatric population.

BACKGROUND: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology in infants and young children. Ultrasonography (US) has been considered to be a reliable diagnostic tool for GERD but the severity of GERD and the clinical implications based on imaging findings has not been evaluated. AIMS: To compare the diagnostic value of lower esophageal US with that of barium swallow in demonstrating the severity of GERD. MATERIALS AND METHODS: Fifty one pediatric patients, age between 1 month to 12 years, 34 male and 17 female with clinical suspicion of GERD were included. The patients were initially submitted to barium swallow (BS) and subsequently to transabdominal US. During BS, the number of gastroesophageal reflux episodes was documented in a 5-minute period. Transabdominal US documented the number and duration of reflux episodes during a 5-minute period, the angle of His, mucosal thickness, and intraabdominal esophageal length (IAEL). RESULTS: Duration and number of reflux episodes in US were significantly higher in patients that had severe gastroesophageal refluxes at BS. At US the cutoff point of 9.5 seconds (sensitivity 80%, specificity 60%) for reflux duration and more than 2 episodes in 5 minute ultrasound study (sensitivity 75%, specificity 58%) were defined to correlate with severe gastroesophageal reflux at BS.The angle of His, the esophageal wall mucosal thickness, and the IAEL did not correlate with the severity of GERD detected in BS. CONCLUSION: US can predict the severity of GERD. Therefore, except in the case of specific patients in whom mechanical causes are suspected to be responsible for GERD, BS can be replaced by US.

Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section.

BACKGROUND: One of the most important complications in cesarean surgery is postoperative pain, and different ways have been proposed to control it. OBJECTIVES: The purpose of this study was to determine the efficacy of Diclofenac and Paracetamol combination in comparison with Meperidine on postoperative pain after cesarean surgery. PATIENTS AND METHODS: One hundred and twenty women candidates for elective cesarean section under spinal anesthesia categorized as ASA class I were selected and randomly assigned to receive either Diclofenac suppository at the end of the operation and thereafter 1 gram infused bolus of Paracetamol (group A), or 20 mg bolus of Meperidine after transition to recovery room (group B) to control postoperative pain. RESULTS: Postoperative pain was present in recovery in 38.3% and 23.3% in groups B and A, respectively (P = 0.009). Postoperative pain was seen after six hours of operation in 38.7% and 16.7% in groups B and A, respectively (P = 0.010). Postoperative pain was present after 12 hours of operation in 38.3% and 15% in groups B and A, respectively (P = 0.002). The additive Meperidine use was the same between the two groups in recovery (P > 0.05). The additive Meperidine use was seen after six hours of operation in 26.7% and 6.7% in groups B and A, respectively (P = 0.013). The additive Meperidine use was seen after 12 hours of operation in 16.7% and none of the patients in groups B and A, respectively (P = 0.004). The frequency of drug adverse effects was the same between the two groups (P > 0.05). CONCLUSIONS: Totally, according to the obtained results it may be concluded that Paracetamol and Diclofenac combination would have a better efficacy in postoperative pain control and need reduction to additive analgesia compared to Meperidine.

Allergic and nonallergic asthma in children: are they distinct phenotypes?

The aim of current study is to describe clinical similarities and differences between atopic and non-atopic asthma in children. In a cross-sectional study, 95 asthmatic children (75 allergics and 20 nonallergics) were included in the study. Demographic, clinical, and familial history were compared between two groups. There was no significant differences between variables like sex, age of onset (p=0.75), severity (p=0.70), and family history among the two groups (p=0.42). Patients with allergic asthma were significantly older than those with non- allergic asthma (11.28 ± 3.19 and 9.75 ± 2.35 years, respectively, p=0.02). The controversy lingers over the presence of a completely distinct phenotype of non-atopic asthma in children. Our study suggested that phenotypes of allergic and non-allergic asthma in children were not entirely distinct.

Correlation of obesity and overweight with emotional-behavioral problems in primary school age girls in tabriz, iran.

OBJECTIVE: Obesity and overweight have shown an increasing trend in most developing countries. Childhood obesity would impose numerous health-related problems. This study was conducted to determine the correlation of obesity and overweight with emotional-behavioral problems in primary school age girls. METHODS: In a cross-sectional study, 300 primary school girls (aged 7-11 years) were selected using a multi-staged sampling method, including randomized cluster and stratified method. For all students body mass index was measured and then based on BMI for age and sex, from each grade (1-5), 20 students were selected for each group of normal weight, overweight and obese. The emotional-behavioral problems were evaluated using child behavior checklist that consists of 113 items for childhood behavioral problems. FINDINGS: Total behavioral problems were seen in 17%, 27%, and 2% in obese, overweight, and normal weight children, respectively. Internalizing problems (including Anxious/Depressed, Withdrawn, and Somatic Complaints) were seen in 11%, 15%, and 2% and externalizing problems (including Aggressive and Delinquent Behaviors) were observed in 8%, 17%, and 2% in obese, overweight, and normal weight children, respectively. The mean scores in all scales were higher in obese and overweight children in comparison with normal weight children and the emotional-behavioral problems had significant positive correlation with obesity and overweight (P<0.01). CONCLUSION: Despite the cultural differences between east and west, yet there are similarities in the most of the emotional-behavioral problems related to overweight and obesity. Also, it seems that the risk of behavioral-emotional problems in overweight girls is more than in obese girls. Overweight and Obesity prevention may be a primary preventive step for these problems in children.

Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access.

PURPOSE: To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy (PCNL) from subcostal access in patients with renal stone in the upper pole of the kidney. PATIENTS AND METHODS: Seventy patients with upper pole renal stones were enrolled in a randomized clinical trial from April 2003 to November 2008. The inclusion criteria were the existence of solely upper pole stones, stone size >1.5 cm, extracorporeal shockwave lithotripsy failure or stone in closed calix and diverticulum, and successful subcostal access for reaching the stone. The exclusion criteria were unsuccessful subcostal access, more than two percutaneous accesses, prominent collecting system perforation, intraoperative significant bleeding, ureteral obstruction, and renal anomaly. The totally tubeless procedure was performed on 35 patients (group A); another 35 patients (group B) underwent standard PCNL. The incidence of complications, hospital stay, transfusion rate, stone-free rate, and analgesics use as well as return to normal activity were compared during a 1-month study period. RESULTS: The mean stone burden was 2.81 (standard deviation [SD] = 0.59) in group A vs 2.87 (SD = 0.62) cm(2) in group B. Hospitalization averaged 1.49 (SD = 0.7) vs 2.89 (SD = 0.99) days (P < 0.001), and the average analgesics use was 8.2 (SD = 3.59) mg vs 14.3 (SD = 5.99) mg of morphine, respectively (P < 0.001). The patients returned to normal activity in 11 (SD = 4.2) days in group A vs 17.6 (SD = 4) days in group B (P < 0.001). Operative time, transfusion rate, complications, re-treatment, and the overall stone-free rate were not different significantly, and no major complication was seen in the study as well. CONCLUSION: Totally tubeless PCNL for the upper pole renal stone from subcostal access is accompanied by decreased hospital stay and analgesics use and a rapid return to normal activity. It can be considered as an accepted and cost-beneficial procedure for upper pole renal stones.

Electroretinogram in amblyopic and non-amblyopic children.

Amblyopia is a common visual impairment in developing countries and a major but neglected health issue. Definite diagnosis in children is difficult due to lower cooperation in this age range. Electroretinography (ERG) may be a useful objective method for diagnosis of amblyopia. In this study, we compare the ERG findings in amblyopic and non-amblyopic children. It is concluded that ERG is a sensitive and objective diagnostic test for amblyopia. It is recommended that ERG be used as a quick tool for diagnosis of amblyopia in children.

Cetirizine, doxepine, and hydroxyzine in the treatment of pruritus due to sulfur mustard: a randomized clinical trial.

A 4-week randomized, double-blind safety and efficacy study was conducted to compare the safety and efficacy of cetirizine, doxepine, and hydroxyzine 5 in the treatment of chronic pruritus due to sulfur mustard. Patients were treated in the Dermatology Clinic of Baqiyatallah Hospital. The study population consisted of 75 patients with chronic pruritus due to sulfur mustard exposure. Patients were given either cetirizine 10 mg, doxepine 10 mg, or hydroxyzine 25 mg/day, for 4 weeks. A calculated pruritic score for each patient was taken before and 1 month after treatment. Mean before-treatment pruritic scores were 38.2 +/- 4.8, 37.2 +/- 4.9, and 37.3 +/- 5.1 in the cetirizine, doxepine, and hydroxyzine groups, respectively. After treatment, the mean pruritic scores were 24.8 +/- 3.1, 17.8 +/- 2.5, and 16.7 +/- 2.3 in the cetirizine, doxepine, and hydroxyzine groups, respectively. In addition, 65%, 75%, and 80% of patients in the cetirizine, doxepine, and hydroxyzine groups were downgraded in the severity of pruritus (P 1/4 0.465). Sedation effects were reported in 6, 14, and 18 patients in the cetirizine, doxepine, and hydroxyzine groups, respectively. Hydroxyzine 25 mg/day has equal results compared to doxepine 10 mg once daily; but greater than cetirizine 10 mg once a day in controlling the symptoms of patients with chronic pruritus.

Laboratory evaluation of dimethyl phthalate against Anopheles stephensi and Culex pipiens.

Two repellents includes Iranian and Merck dimethyl phthalate (DMP) were evaluated against Anopheles stephensi and Culex pipiens, using American Society for Testing and Material (ASTM) standard ED 951-83 procedure, a free choice method based on the variable dose-fixed time. Also a modified of ASTM method we used for determination of effective dosages of the repellents. In ASTM method there were no significant differences between the two repellents (Iranian and Merck's DMP) as indicated by the ED50 and ED95 values (p > 0.05). But, there were significant differences in repellent sensitivity between An. stephensi and Cx. pipiens at the ED95 level. In modified ASTM method there were no significant differences between the two repellents against An. stephensi, as indicated by the ED50 values (p > 0.05). But, there are significant differences between the two repellents against Cx. pipence based on ED50 value. Results of this study showed that the Iranian synthesized DMP has necessary potential and specificity to compare with Merck manufactured product.

Electroretinogram in amblyopic and non-amblyopic children.

Amblyopia is a common visual impairment in developing countries and a major but neglected health issue. Definite diagnosis in children is difficult due to lower cooperation in this age range. Electroretinography (ERG) may be a useful objective method for diagnosis of amblyopia. In this study, we compare the ERG findings in amblyopic and non-amblyopic children. It is concluded that ERG is a sensitive and objective diagnostic test for amblyopia. It is recommended that ERG be used as a quick tool for diagnosis of amblyopia in children.