Journal of Research in Medical Sciences
Volume:17 Issue: 9, Sep 2012

Epilepsy is a common, chronic neurological disorder that affects more than 40 million people worldwide. Epilepsy is characterized by interictal and ictal functional disturbances. The presence of interictal epileptiform discharges (IEDs) can help to confirm a clinical diagnosis of epilepsy, and their location and characteristics can help to identify the epileptogenic zone or suggest a particular epilepsy syndrome. The aim of this study is to determine the factors that affect IEDs. Poisson marginal model was done on 60 epileptic patients who were referred to Shefa Neurological Research Center, Tehran, for Video-Electroencephalogram (V-EEG) monitoring from 2007 to 2011. The frequency of IEDs was assessed by visual analysis of interictal EEG samples for 2 h. The results show that among age, epilepsy duration, gender, seizure frequency and two common anti-epileptic drugs (Valproic acid and Carbamazepine), only age and epilepsy duration had statistical significant effect on IED frequency. Investigating the factors affecting IED is not only of theoretical importance, but may also have clinical relevance as understanding the evolution of interictal epileptogenesis may lead to the development of therapeutic interventions. Generalized estimating equation is a valid statistical technique for studying factors that affect on IED. This research demonstrates epilepsy duration has positive and age has negative effect on IED which means that IED increases with epilepsy duration and decreases with increasing age. So for monitoring IED, we should consider both age and epilepsy duration of each patient.

The aim of our study was to determine the content of fat and fatty acid composition of breast milk and the association with the mother’s diet. This cross-sectional study was conducted among pregnant mothers who came to health care centers for last prenatal care in Isfahan, Iran. Eight to 72 hours after delivery, 2 to 5 ml of colostrum was collected by hand into tubes. They were kept in an ice box and sent within half an hour to the collaborating health centre for freezing at -20°C until analysis, which was performed at the laboratory of NNFTRI in Tehran. The milk samples were homogenized by Vortex (Heidolph Vortex Shaker REAX 1. 220 V. 30 W Germany) at 2400 rpm for 30 sec. The data of 86 out of 91 samples were complete. The mean maternal age and gestational age was 28.37 ± 5.55 years old and 38.7 ± 1.2 weeks, respectively. The content of fat was 2.17 ± 1.22 g/100 ml breast milk. Arachidonic acid (AA, 20:4n-6) and docosohexaanoic acid DHA (22:6n-3) made 0.8 ± 0.4% and 0.3 ± 0.2% of total fatty acids. Although the AA/DHA ratio in our study is suitable, but the content of DHA is nearly low. Dietary habits of women in reproductive age group should be improved, with special emphasis on the fatty acid content of breast milk. This may have long-term impact on health promotion and disease prevention.

The efficacy of mitoxantrone induction therapy in rapidly worsening multiple sclerosis (MS) is well established. Plasma exchange is also applied as an adjuvant in exacerbations of relapsing MS. The aim of this study was to compare the efficacy of combination therapy with mitoxantrone and plasma exchange versus mitoxantrone alone in patients with aggressive MS. Forty patients with aggressive relapsing remitting MS were randomly put into two groups. The first group underwent monthly plasma exchange for three successive months, followed by 12 mg/m2 mitoxantrone at the end of each course and two more doses of 6 mg/m2 mitoxantrone in 3-month intervals. The second group received the same doses of mitoxantrone only without plasma exchange. At the end of 8 months treatment course, clinical reassessment and neuroimaging was performed and treatment was continued with interferon-b. At the end of induction therapy, Expanded Disability Status Scale score was significantly improved in both groups (P < 0.001). Number of demyelinating and gadolinium-enhancing plaques in brain magnetic resonance imaging (MRI) was prominently reduced in group 2 (P £ 0.05), but the changes were not statistically significant in group 1, except for juxtacortical plaques. Administration of mitoxantrone as an induction therapy in patients of aggressive relapsing remitting MS results in significant improvement of their clinical state and MRI activity. However, combination of plasma exchange with mitoxantrone gives no more benefits than mitoxantrone alone and sometimes worsens the situation possibly by reduction of mitoxantrone efficacy as a result of plasma exchange.

Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm2) in 3 sessions at weekly intervals) or sham therapy (n = 20 in each group). Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients’ pain scores, performed at baseline and 12 weeks after completion of the therapy. The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001), but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03). Both groups showed significant pain improvement over the course of the study (P  < 0.001), though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049). ESWT contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

The prevalence of irritable bowel syndrome (IBS) in the community is 10%–20% and have symptom based diagnostic criteria. Many symptoms of celiac disease (CD) with 1% prevalence in some communities can mimic IBS. Sensitive and specific serologic tests of CD can detect asymptomatic cases. The purpose of this study was to compare the level of anti-tissue-transglutaminase (tTG) IgA in IBS patients and controls group. This case–control study was performed at a University hospital in which 107 patients with IBS who met the Rome II criteria for their diagnosis were compared with 126 healthy age and sex-matched controls. Both groups were investigated for CD by analysis of their serum tTG IgA antibody with human recombinant antigen. Titers were positive containing over 10 u/ml and borderline if they were between 4 and 10 u/ml. 86 percent of IBS patients were female. The mean antibody level was 0.837 u/ml in IBS group and 0.933 u/ml in control group without any significant difference. DISCUSSION AND Results of this study may intensify disagreement on the situation of CD in IBS patients.

Computed Tomography (CT) scan without contrast is the modality of choice for diagnosis of stroke. However, routine brain CT scan, with linear processing has some limitations in early diagnosis of ischemic stroke. The aim of this study was to evaluate and compare the sensitivity and specificity of processed CT images with conventional ones in early diagnosis of cerebrovascular attack (CVA). This was a self-controlled study conducted in a university referal hospital from 2010 to 2011. Seventy CT scans underwent a process using Laplacian Pyramid transform. Thirty five of participants were diagnosed with CVA while others had only headache and no ischemic stroke diagnosis based on the first and follow-up CT scans. A neuroradiologist made diagnosis with and without the help of processed CT scans. The McNemar and Wilcoxon analysis were used to compare the sensitivity, specificity, positive and negative predictive values of two methods. The sensitivity (% 65.7 vs. %31.4, P-value = 0.001), positive predictive value (% 85.2 vs. % 61, P-value = 0.03) and negative predictive value (% 73.9% vs. %49, P-value = 0.01) of the processed method were significantly higher than the routine one, while no difference was seen in specificity (% 88.6 vs. %77.1, P-value = 0.15). Moreover, the accuracy of the processed method was significantly better than the linear one (P-value < 0.001). It was concluded that nonlinear modified Laplacian Pyramid method can composed CT scans which can be more helpful in early detection of ischemic stroke.

CA 15.3 is elevated in most patients with distant metastatic breast cancer who had prognostic information. The present study was performed to estimate predictive ability of CA 15.3 in assessment of symptomatic metastasis in patients with breast cancer. During five years, 159 primary breast cancer patients were evaluated. A total of 2226 determination of serum CA 15.3 (14 per patient) were performed. We performed contemporary clinical examinations with CA 15.3 measurements at the time of diagnosis, end of chemotherapy, every three months in the first two years and every six months in the second two years of follow-up period. Imaging studies were performed if clinical or laboratory examinations (abnormal serum levels of CA 15.3) suspected symptomatic metastasis. Metastasis in participants was confirmed by imaging study in symptomatic patients. There was no significant increase in CA 15.3 tumor markers during chemotherapy (P = 0.08). There was a significant relationship between CA 15.3 positive results and metastasis situation (P = 0.00). Mean of maximum CA 15.3 level in metastatic patients (52.72 ± 27.09) was significantly higher than non-metastatic patients (27.58 ± 13.46; P = 0.00). CA 15.3 abnormality (OR, 1.07; 95% CI: 1.04-1.11; P value, 0.01) and abnormal lymph nodes remained as predictor of metastasis (OR: 1.16; 95% CI: 1.05-1.28; P value < 0.0001). CA 15.3 is one of the predicting factors for symptomatic metastasis.

There is an association between viral infection and development of diabetes mellitus. This study aimed to investigate the role of rubella virus, cytomegalovirus and coxsackievirus in patients with type 1 (T1D)and type 2 (T2D) diabetes mellitus in respect to the glycemic control and immune response presented by serum γ-interferon leveland antiviral antibodies. A total number of 160 (70 male and 90 female) T1D and 75 T2D (25 male and 50 female) patients allocated randomly from Martyr Layla Qasm center for diabetes mellitus in Erbil, Iraq, were enrolled in the study. Serum IgG antibody (I.U./mL) against rubella virus, cytomegalovirus coxsackievirus as well as serum interferon-γ were determined. Type-1 diabetic patients with positive anti-coxsakievirus antibody presented with significantly shorter duration of illness(4.822±2.442 year) and poorer glycemic control (HbA1c %: 9.8951.272) This observation was not noticed with other viral infection as well as in T2D. Significant alterations in serum interferon-γ (8.051±13.371 pg/ml) were observed in T1D and related to coxasackievirus infection (13patients had a level higher than10.975 pg/ml; the upper limit of 95% C.I of control, and 34 had a level less than 4.457 pg/ml; the lower limit of95% C.I of control). Subjects with type 1 diabetes and Coxsackie infections seem to have a different immunological and clinical profile. This needs further study.

Definitions of chronic kidney disease (CKD) in many catheterization laboratories have relied on the serum creatinine (Scr) rather than glomerular filtration rate (GFR). Regarding that CKD is the primary predisposing factor for contrast induced nephropathy (CIN), we compared the sensitivity of calculated GFR by 24-h Urine creatinine with Cockcroft-Gault (CG) equation and Scr level to define at risk patients for CIN who were undergone coronary angiography (CAG). Two hundred fifty four subjects who were candidate for CAG and had normal creatinine level were enrolled. Before CAG, GFR was calculated from a 24-h urine collection, CG equation and a single Scr sample regarding to previously described protocol. Contrast volume used for each case <100 ml. CIN was defined as a 0.5 mg/dL or 25% elevation in the Scr. CIN occurred in 10.6%. Baseline GFR, the volume of contrast agent, and diabetes were the independent risk factors for CIN. GFR was less than 60 ml/min/1.73 m2 in 28% and 23.2% of patients regarding to 24-h urine creatinine and CG equation, respectively. In CIN prediction, 24-h urine creatinine estimated GFR had 85.2%, 59.3% and CG equation GFR had 78.9%, 81.1% sensitivity and specificity, respectively. Although, GFR estimated by CG equation has less sensitivity than GFR calculated from 24-h creatinine in CIN probability, but it is better than Scr alone and because of cost-effectiveness and convenience using of this method, we suggest at least using CG equation for GFR calculation before CIN, especially in diabetic and/or older than 60 years cases.

To investigate the reasons for postvitrectomy diabetic vitreous hemorrhage (PDVH), and to analyze the time of PDVH onset, the treatment of PDVH, the visual outcome of the treatment, and factors that affect visual acuity after treatment. Overall, 292 eyes from 236 patients with proliferative diabetic retinopathy (PDR) underwent vitrectomy from 2006 to 2010. Fifty eyes out of 43 patients had severe postoperative vitreous hemorrhage. The average follow-up duration was 6.8 ± 3.8 months (range, 2 – 12 months). Recurrent vitreous hemorrhage (VH) after primary vitrectomy occurred in 40 eyes (80%) with an average time of VH onset of 62.5 ± 32.8 days (range, 3 – 170 days). VH occurred after silicone oil removal occurred in 10 eyes (20%), with an average time of VH onset of 27.4 ± 20.3 days (range, 1 – 60 days). The reasons for PDVH included chronic errhysis from retinal neovessels (47.1% of the eyes), residual fibrous vascular membrane (12.8% of the eyes), fibrovascular ingrowth at sclerotomy sites (4.3% of the eyes), iris neovessels and neovascular glaucoma (4.3% of the eyes), retinal vein occlusion (2.8% of the eyes), retinal tears (8.1% of the eyes), retinotomy (1.4% of the eyes), epichoroidal bleeding (1.4% of the eyes), polycythemia rubra vera (1.4% of the eyes), hypoperfusional retinopathy (4.3% of the eyes), and unknown reasons (12.8% of the eyes). Visual acuity increased in 43 eyes (86%) after surgical or nonsurgical treatment. The improvement in visual acuity after treatment was not affected by age, sex, duration of diabetes, time of PDVH onset, frequency of surgery, or treatment methods. Postvitrectomy diabetic vitreous hemorrhage commonly occurs two months after vitrectomy. Residual epiretinal neovascularization is the most common cause of PDVH. Active surgical or nonsurgical treatment for severe vitreous hemorrhage can obviously improve the patient's visual prognosis.

Pharmacovigilance assesses the safety profile of drugs. its main aim is the increase of spontaneous reporting of adverse drug reactions (ADRs).The Italian drug agency (AIFA; Agenzia Italianadel Farmaco) is financing several projects to the aim of increasing reporting, and in Calabria a pharmacovigilance information centre has been created. We analysed the AIFA database relatively to Calabria in the year 2011 and we have analyzed ADRs using descriptive statistics. We have also collected a questionnaire-based interview in order to describe the background knowledge in the field. Regarding the number of AIFA reported ADRs from Calabria,a 38% increase (138 vs. 100) in comparison to 2010 was evidenced. hospital doctors represent the main source of signaling (%). Ketoprofene and the combination amoxicillin/clavulanic acid represent the most frequently reported drugs causing ADRs (%).our questionnaires indicated that despite the health professionals have met at least once an ADR only a small percentage of them was reported to the authorities (%).there is a very good knowledge of the ADR concept and reporting system (90% of interviewed distinguish an ADR and knows how to report it), and there is a strong interest in participating to training courses in the field (95% are interested). Despite Calabria has had a positive increase in the number of reported ADRs, the total number is very low and the pharmacovigilance culture is far from being achieved in this region.

Approximately 1% of all pregnancies are in woman with epilepsy. Although، the majority of children born to women with epilepsy are normal، they are at increased risk for malformations. Notably، the teratogenicity of antiepileptic drugs is a well-defined subject. The incidence of major malformations in offspring of mothers with epilepsy who were treated with AEDs is higher than women with untreated epilepsy and in the general population. These malformations include spina bifida، cleft palate، limb reduction defects، cardiac abnormalities، hypospadias، and gastrointestinal atresia. The exact mechanism by which the AEDs mediate abnormalities in the fetus is uncertain. However، there are several hypotheses to explain them. Some of the most important include folate-related actions، ischemia، reactive intermediates (e. g.، free radicals)، and genetic susceptibility. Thus، understanding the mechanisms of AED-related abnormalities is of vital importance for the care of epileptic women and their offspring.

Sex-related differences in the severity of multiple sclerosis (MS) could be influenced by the sex hormones. This cohort (historical) study evaluated the sex hormone levels during menstrual cycle and their correlation with disease severity in MS. Patients with MS had significantly lower testosterone, dehydroepiandrosterone sulfate, and prolactin levels than controls in the follicular and luteal phase but lower estradiol levels only in the follicular phase. A positive correlation coefficient between follicle stimulating hormone and disease severity, and a reverse correlation with estradiol were found. The hormone-related modulation of disease severity supports the suggestion that sex hormones play a role in MS disease.

Mucoepidermoid carcinoma of the pancreas is rare. Here، a 63-year-old woman with left upper abdominal pain and abdominal distension is presented. Her mucoepidermoid carcinoma was located at the left upper abdomen، arising from the pancreatic body and tail without invasion of pancreatic capsule. On pathologic examination، the tumor consisted of three types of cells، the majority being poorly differentiated adenocarcinoma cells with mucin products in their cytoplasm، and some moderately differentiated adenocarcinoma with a tendency to form ducts. In addition، there were epidermoid cells and intermediate undifferentiated cells. She survived for 12 months after surgery.

Gossypibomas or retained surgical foreign bodies، although uncommon causes of abdominal lumps، still remain a major cause of concern for surgeons worldwide. Their early identification and treatment are mandatory to prevent morbidity as well as mortality. The major diagnostic dilemma still remains in the vagueness of presentation of this callous entity. We present a similar situation in which a 30-year-old lady، previously operated for a uterine myoma، reported to us with an intra-abdominal lump which on exploration turned out to be a surgical sponge.

Diabetic muscle infarction (DMI) is an unusual complication of diabetes mellitus. It is usually seen in long-standing diabetes mellitus. This article presents a case of DMI in the left forearm of a 58-year-old woman. She had a swollen forearm. The level of creatine kinase was 5930 U / L. Her condition was initially suspected for either cellulitis or venous thrombosis. A magnetic resonance imaging (MRI) study of the forearm showed diffuse edema and abnormal signals of the left forearm. The diagnosis of DMI was made. She was treated conservatively and her symptoms resolved within a short period of time. DMI should be considered as a differential diagnosis of any painful and swollen limb in diabetic patients.