Reviews in Clinical Medicine
Volume:7 Issue: 3, Summer 2020

The aim of present study was evaluation and comparison of the white blood cell, erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in febrile children with or without convulsion.

Three hundred sixty eight febrile children aged 6-60 months with or without convulsion were studied. Demographic, white blood cell (WBC), ESR and CRP were compared and analyzed.

There was 368 children (184 patients with febrile convulsion as case group and 184 febrile patients without convulsion as control group), with the average age of 26.6±14.4 months and 17.71±15.4 months respectively (p=0.001). In case group 59.78% and in control group 43.48% were male (p=0.002). There was no significant difference between groups regarding WBC, ESR and CRP. There was significant relationship between leukocytosis and convulsion in patients with longer than 15 minutes convulsion (p=0.03). There was not any significant relationship between febrile convulsion patients according to type, duration and frequency of convulsion in ESR and CRP.

Leukocytosis and elevated ESR and CRP in patients with febrile convulsion can represent underlying etiology of the fever and it may not be due to convulsion itself. But in longer than 15 minutes convulsion, it can lead to leukocytosis itself.

The effectiveness of the educational system along with the research development in each country is considered as one of the criteria of development measurement.
This study is a descriptive - cross-sectional study during 2018-2019. The statistical population includes all medical students who have passed the physiopathology degree in the second semester and data collection is done by field method. The instrument of consists of two parts. The first part contains demographic information of the participants and the second part presents standard questionnaire of educational experience include  Course Experience Questionnaire (CEQ) and Neumann's Quality of Learning Experience. The data were analyzed using mean and standard deviation, Pearson correlation coefficient, independent T-test and ANOVA were used.
In this research, 45.7% were male) n=49), 54.20% female (n=58), 14% married (n=15), 86% single (n=92), 8.41% Have a work (n=9), 91.58% dont have a work (n=98), and finally 55.1% were interested in their field. There was a significant positive correlation between the scores of appropriate teaching (P-value <0.001), clear goals (P-value <0.001), appropriate evaluation (P-value <0.001), independence (P-value<0.001), and general skill (P-value<0.001), with experiences of courses. The strongest correlation with the quality of educational experiences was the appropriate evaluation (0.65).
The results of this study indicate that in order to achieve the most important goal of medical education, more efforts are needed to improve educational quality.

This study aimed to determine the influence of age and gender on pupil size under different illuminance conditions in emmetropic and myopic healthy eyes using Keratograph 4 topography.
This study investigated 221 eyes of 221 subjects. After complete ocular examination, the undilated pupil diameters were measured using a pupilometer and Keratograph 4 software (OCULUS, Wetzlar, Germany) with a sequence of 9.8 seconds of the scotopic stimulus (0.1 lux) and 0.2 seconds of the photopic stimulus (150 lux) repeated 5 times automatically. At the end of the procedure, the software provided maximum and minimum values (scotopic and photopic) of the pupil diameter. The age, gender, and refraction related changes of the pupil size were evaluated in different illuminance conditions.
Out of 221 participants in this study, 122 (85 female) and 99 (66 female) cases were myopes (MSE: -2.18±1.69 D, age: 26.03±6.98 years) and emmetropes (MSE: -0.11±0.27 D, age: 28.05±10.17 years), respectively. Considering refractive groups, pupil size was larger in myopes, compared to the emmetropes in both illuminance conditions (P<0.001). Moreover, the pupil size was found to be independent of gender in both photopic and scotopic conditions (P=0.71 and P=0.55, respectively). Additionally, a significant decrease was observed in pupil size with increasing age (P<0.001).
This study showed that pupil size is influenced by age, illumination levels, and refractive status. These findings are important in both the optical industry and clinical decision-making process regarding treatment management.

Recurrent aphthous ulcers are the most common pathologic conditions of the oral cavity, which despite having clear clinical features, the etiology is unknown. This study aimed to determine the relationship between one of the histocompatibility antigens (HLA DRB1) and its sub-groups with the incidence of recurrent aphthous ulcers in an Iranian population (North East of Iran). In this case-control study, a total of 72 patients with recurrent aphthous ulcers and 70 healthy subjects in Northeast Iranian population were included. Genotyping was done by polymerase chain reaction-specific sequence primers (PCR- SSP) for each sample, according to standard kit protocol (BAG- Germany). In 72 patients with recurrent aphthous ulcers that were included in this study, 26 were male and 46 were female; of the 70 control patients, this difference not significant statistically (P>0.05). The frequency of HLA -DRB1 *16 was 0.7% in the healthy subjects, however frequency of HLA -DRB1 *16 in patients with recurrent aphthous stomatitis (RAS) was 42.36%, and this difference was statistically significant (P=0.03). But, this difference was not observed in other subgroups. The frequency of DRB1 * 16 in the patients with RAS were higher than the group. Therefore, DRB1 * 16 can be suggested as a Predisposing factor for aphthous ulcers patients.

Alzheimer's disease is a type of dementia and there were 50 million individuals have dementia in 2018 worldwide and the cost of dementia care to Medicare and Medicaid is so high (about US$1 trillion) in that year. Recently, several articles show that tuberculosis may be increased the development rate of Alzheimer's disease in these patients. So knowing the probable relationship between these two could be helpful. Also, there is evidence demonstrating that the Bacillus Calmette–Guérin (BCG) vaccine and rifampicin as a conventional vaccine and medicine against Mycobacterium tuberculosis infections could be used as a promising agent for the prevention and reduce the development of Alzheimer’s disease and other neurodegenerative diseases. According to our knowledge, the present review is the first and only review that assessed the possible relationship between tuberculosis and Alzheimer's disease as well as the possible therapeutic role of rifampicin and BCG vaccine in treatment and prevention of Alzheimer's disease, respectively.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has brought unpredictable challenges to the whole world by causing Coronavirus disease2019(COVID-19). Although respiratory tract manifestations are the most commonly reported symptoms in COVID-19, early studies reported a low incidence of typical gastrointestinal (GI) symptoms, such as diarrhea, nausea, vomiting, and even liver dysfunctions. However, The prevalence and prognosis of Gastrointestinal system involvement, including gastrointestinal symptoms and liver injury, remains mostly unknown in patients with COVID-19. We aimed to review the effects of COVID-19 on the GI system. Anorexia was the most frequent digestive symptom in adults (39.9%‐50.2%), and diarrhea was the most frequent symptom in both adults and children.Moreover, vomiting was more common in children. Approximately nine percent of adult patients showed vomiting. Almost 36% of children encounter vomiting; nausea is considered for 15% of children. Gastrointestinal bleeding was presented in more than ten percent of children, while abdominal pain was more frequent in severely ill patients.

Tuberculosis (TB) infection is caused by an intracellular bacterium, Mycobacterium tuberculosis (Mtb). The disease is among the most important infectious diseases, which has dedicated most cases of morbidity and mortality to itself worldwide. The global report of World Health Organization (WHO) in 2019 shows that from 10.7 million infected people in 2018, 1.6 million died. Although the BCG vaccine has been used for about a hundred years, it is only effective in children, but is not able to produce a protective and reliable immunity against adult pulmonary TB. Hence, using an alternative vaccine with high more efficacy than BCG seems to be urgent. The IL-33/ST2 axis forms of IL-33 and ST2, and both of them are the members of IL-1 family. IL-33 is secreted as an alarm in response to cell damages and cellular stress, and ST2 causes stimulation of MyD88/NF-κB signaling pathway, which is needed for the proper response of infected cells to Mtb and other intracellular pathogens. In Th2 cells, NF-κB enters into the nucleus, and acts as a transcription factor. Finally, cytokines such as IL-4, IL-5, and IL-10 are produced which are effective in the prevention of tissue damage. Based on various information, it is recommended that IL-33 can be as a novel therapeutic candidate in post-exposure cases of TB disease.

N-acetylcysteine (NAC), a precursor of L-cysteine with antioxidant, anti-inflammatory and neurotropic effects, is a promising agent in alleviating symptoms associated with schizophrenia.  However, the role of NAC on parameters of Positive and Negative Syndrome Scale (PANSS) remain uncertain. This systematic review and meta-analysis explored the effect of NAC on parameters of PANSS in patients with chronic schizophrenia.
We searchedPubmed/MEDLINE™, PsycNET™, PsycLIT™, Scopus™ and Google Scholar™  for studies on the effect of NAC on PANSS in patients with schizophrenia from inception to March 2019. We adopted medical and non-medical subjects headings (MeSH, non-MeSH) and several keywords, including  “NAC”, “N-acetylcysteine”, “N-acetyl cysteine”, “Acetylcysteine”, “N-Acetyl-L-cysteine”,  “schizophrenia”, “psychotic disorder”, “psychosis”, “schizoaffective” and “dementia praecox”.
We identified seven trials with274 patients meeting the inclusion criteria, with follow up between 8-52 weeks, and NAC supplementation between 1200-3600 mg/day. Significant improvements in PANSS were identified following NAC for total (SMD=-0.61, 95% CI = -0.91, -0.31 ; P<0.001), general (SMD = -0.58; 95% CI = -0.90, -0.26; P=0.0004); and negative (SMD = -0.56; 95% CI = -0.92, -0.21; P = 0.001) scores, respectively. No significant heterogeneity was found among studies. Significant reductions were observed following sub-group analysis in trials ≤ 24 weeks duration, with appreciable effect size for total (SMD= -0.83), general (SMD= -0.67) and negative (SMD=-1.09) scores.
Supplementation of NAC was effective in alleviating PANSS symptoms associated with schizophrenia in trials ≤ 24 weeks duration. The use of NAC as an adjunct seems promising and further investigation is warranted to determine its precise role.