Galen Medical journal
Volume:4 Issue: 2, 2015

Demyelinating diseases of the central nervous system (CNS) are a group of autoimmune disorders affecting the myelin sheets of CNS neurons resulting in different neurological deficits and disability. Multiple sclerosis (MS), Devic’s disease, progressive multifocal leukoencephalopathy, acute disseminated encephalomyelitis (ADEM), and neuromyelitis optica (NMO) are among the most common types of demyelinating disorders. Currently MS is the leading cause of neurological disability in young population after trauma. The incidence and prevalence of MS is increasing worldwide primarily due to increase the incidence in female population. Globally, the median estimated incidence of MS is 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS is 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration is 20.2 years (range: 7.6-36.2). In Iran, the prevalence and incidence of MS is estimated to be 54.51 and 5.87 per 100,000. Diagnosis of demyelinating disorders is a controversial issue and several criteria has been introduced for the aforementioned subject. Diagnostic criteria for clinically definite MS require documentation of two or more episodes of symptoms and two or more signs that reflect pathology in anatomically noncontiguous white matter tracts of the CNS. The second may be documented by abnormal paraclinical tests such as MRI or evoked potentials (EPs).The standard treatment for patients with demyelinating disorders and especially MS is the medical management. Recent large placebo-controlled trials in relapsing-remitting multiple sclerosis have shown efficacy of new oral disease-modifying drugs, teriflunomide and dimethyl fumarate, with similar or better efficacy than the injectable disease-modifying drugs, IFN-β and glatiramer acetate. In addition, the new oral drugs seem to have a favorable safety profile. Further, the monoclonal antibody alemtuzumab, which in clinical trials has shown superiority to subcutaneous IFN-β 1a, has been approved in Europe. In acute exacerbation and flare up of the disease, methylprednisolone pulse is the only approved treatment.Although the standard of treatment of MS and other demyelinating disorders is medical, but neurosurgical procedures especially the functional neurosurgical interventions has found their way in management of patients with demyelinating disorders. These interventions are used to treat the complications of MS and demyelinating disorders such as tremor, trigeminal neuralgia, movement disorders and neuropathic pains. Most of these interventions are stereotactic in order to obtain precise targeting of a special deep brain nucleus. The first application of deep brain stimulation (DBS) in patients with MS was for treatment of tremor. Recently it has been demonstrated that DBS of ventral intermediate (VIM) nucleus of thalamus results in alleviation of severe, disabling tremor in patients with MS. Other experiments have also demonstrated decreased tremor and improved quality of life in MS patients responsive to DBS.Neuropathic pain and trigeminal neuralgia are among the other complications of demyelinating disorders which are associated with disability and decreased quality of life. Several investigations have shown that DBS of thalamic nuclei would be effective in treatment of neuropathic pain in patients with MS, although the results are controversial and need further investigations. The trigeminal neuralgia is often treated by microsurgical decompression of the trigeminal nerve. However this approach is not effective in patients with demyelinating disorders as they have different pathology. Case series have shown that Gamma Knife surgery (GKS) is an effective and safe treatment for trigeminal neuralgia in patients with MS. No clinical trial is available for comparing the results and outcome between GKS and microsurgical approach. However results of case series are favorable.There are still other field that could be approached surgically in patients with demyelinating disorders. Recent bodies of evidence have demonstrated a link between cervical cord plaques and discopathy in those with MS which needs further investigation. Tumefactive demyelinating lesions (TDL) are another issues observed in patients with MS which have unknown course and pathology. The link between demyelinating disorders and brain tumors is also another issues which deserves further investigation. To take a long story short, although the role of functional neurosurgical procedures in management of patients with demyelinating disorders especially MS is still limited, but there is optimistic horizons for growing role of neurosurgical procedures in management of different complications of demyelinating disorders refractory to medical therapy.

Research into the role of neuroimaging in primary headaches such as tension type headache (TTH) is ongoing. In the present study, we aim to evaluate the ability of neuroimaging to detect potential abnormalities in patients with new onset TTH and normal neurological exam. In a prospective study, 294 cases of new onset TTH with normal neurological exam, that had neuroimaging, were selected. Imaging was evaluated for significant abnormalities. The percentage of abnormal findings in imaging was calculated. 64(21.8%) patients had MRI. Of them, 21.8% of MRIs revealed abnormal findings. Meanwhile, from 238 CTs, only 0.4% showed abnormalities. Neuroimaging with current quality does not play an important role in management of patients with new onset TTH and normal neurological exam.

Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several medical and surgical procedures have been analyzed in prevention of post-ERCP pancreatitis as a major post-ERCP complication, so we conducted a study to assess the role of prophylactic pancreatic stents on prevention and severity of post-ERCP pancreatitis. This case control studied adult patients undergoing ERCP at the ERCP unit of a referral educational hospital. Data of the case (stent, N=90) and control (non-stent) (N=105) groups were retrieved from medical records. In our center, sphinctrerotomy was performed for 103 patients of non-stent group and successful pancreatic stent placement was done in 86 patients of stent group in a standard fashion. In stent group, a 5F, 4 centimeter pancreatic stent was emplaced over a guide wire under fluoroscopic guidance. All post–ERCP pancreatitis and major complications of all patients were retrieved too. Of 255 enrolled patients, 195 were at high risk of post-ERCP pancreatitis allocated in two groups of this study. Successful pancreatic stent placement was done in 86 patients (95.6%) of stent group. There was no major complication during procedures. The migration of pancreatic duct stent was diagnostic in 3 (3.5%) patients. The overall post ERCP pancreatitis was 4.0% and 16.6% in stent and non-stent groups, respectively. Based on our findings in this study, we strongly recommended pancreatic duct stent placement in high-risk patients; although the experience of endoscopist plays a crucial role.

Studies demonstrated controversial results on subclinical hypothyroidism (SCH) regarding lipid profile alteration with or without Levothyroxine treatment. The purpose of this study is to investigate the effects of Levothyroxine on serum lipids in SCH. One hundred patients with SCH referred to Taleghani hospital in Kermanshah were recruited and randomly assigned into the intervention or the control group. Patients in intervention group received Levothyroxine 50-75 micrograms for three months. Patients in control group received the same placebo with the same dose and duration. Lipid profile was measured before and after the trial and the changes were compared between groups. (IRCT code: 138903244179N1). Triglyceride, Total Cholesterol, LDL, HDL and Lipoprotein-A were measured before and after treatment. None of the factors showed significant difference either between or within groups, before and after the treatment (P<0.05). Treating with Levothyroxine does not have any clinically significant impact on lipid profile in SCH patients which indicates that we should not expect SCH patients to use Levothyroxine solely for lipid profile alternation, except those with other clinical indications for treatment.

It has been reported that ischemia-reperfusion is associated with augmentation of oxidative stress and its specific and sensitive markers. Oxidative stress may cause atrial fibrillation (AF) which is a common consequence after cardiac surgery. Dietary supplementation with antioxidants might lower the incidence of AF following coronary artery bypass graft (CABG) surgery. Fifty patients with coronary heart disease (CHD) referred to Namazi and Faghihi Hospitals in Shiraz, undergone elective CABG, were enrolled in this study. For evaluation of oxidative stress, whole blood was taken before and 24 hours after surgery and malondialdehyde (MDA) as an oxidative marker and glutathione (GSH) as an antioxidant marker were measured. Results showed a significant difference between the mean concentration of GSH before and after CABG surgery (P <0.05); however, the difference in plasma MDA levels before and after CABG was insignificant. CABG surgery results in oxidative stress and reduces GSH 24h after surgery and administration of antioxidants may attenuate post-operative oxidative stress.

Postmenopausal hot flash is a common disease amongst women with high prevalence of 75%. Hormone Replacement Therapy (HRT) is a well-known relief of symptoms which has disadvantages such as side effects and contraindication for certain types of hormone related diseases and breast or Estrogen related cancers. One of the alternatives is acupuncture which is an East Asian and more specifically Chinese method. In this study hormone therapy and acupuncture effectiveness have been compared in postmenopausal hot flash treatment. This study is aimed to initially diagnose vasomotor symptoms such as elevated body temperature, palpitation, headache and perspiration. Afterwards, assessment and finally comparing the efficacy of two methods for each symptom treatment have been carried out. In this clinical trial study, 20 climacteric female samples participated. Two study and control groups have been formed and each method efficacy has been evaluated on each of four major vasomotor symptoms. For all postmenopausal vasomotor symptoms, acupuncture and HRT had similar notably high relief of symptoms effectively; namely in hot flash 90% and 85%, in palpitation 65% and 70%, in perspiration 77.77% and 81.25%, and in headache 50% and 81.3%, respectively. Although in all fields except hot flashes, HRT had slightly better success. This survey pointed out that acupuncture is as effective as hormone therapy in relief of symptoms hot flash for postmenopausal women. Further researches are needed to assess the clear side effects of acupuncture method.

According to some provincial reports, prevalence of hepatitis A has had a decreasing trend during the past decade in Iran. We aimed to overview clinical manifestations and laboratory findings of Iranian pediatric patients diagnosed with hepatitis A infection. This retrospective study was performed on 162 consecutive pediatric cases of hepatitis A infection. Data were collected by reviewing hospital records on admission to hospital. The mean±SD age of participants was 9.90±4.08 years and 55.6% were boys. Regarding clinical manifestations, the most frequent symptom was jaundice. Fever was more prevalent in girls than in boys; whereas, abdominal tenderness was more prevalent in boys compared to girls. There was no difference in the prevalence of other clinical indices as well as in laboratory parameters between two sexes. Diarrhea was significantly more frequent in children younger than 2 years compared with other age subgroups. However, abdominal tenderness was more frequent in older patients compared to younger children. Regarding laboratory parameters, except for serum direct bilirubin that raised less in children younger than 2 years, the prevalence of other biochemical markers abnormality was comparable in different age groups. Hepatitis A infection is a common finding among Iranian children that equally occurs in boys and girls, while commonly appearing in children aged 7-18 years. The most frequent abnormal changes in laboratory parameters refer to change of liver enzymes, serum bilirubin, serum albumin and coagulated indices.

Family Physician plan is known as one of the most appropriate strategies to implement rural health insurance program in the form of referral system in Iran. This study aims to determine the satisfaction of family physicians and service consumers and its causes of dissatisfaction in the South of Iran. This cross-sectional study was performed in Kerman Health Network. Nineteen family physicians and 370 service consumers were selected using stratified random sampling. Data was gathered using two standardized questionnaires. Frequency tables, frequency percentage, mean graphs, Z and Freedman statistical tests were used to analyze the data. Mean scores of physicians’ satisfaction were 9.10 and 4.12 in staff performance and payment system, respectively. Service consumers were satisfaction of physician delivery care (7.25), and para-medical (3.61). Moreover, most physicians were interested in per capita (31/6%). Family physician and health service consumers are highly satisfied. Satisfaction is an important factor for ensuring service quality and any ignorance in this regard can reduce the quantity and quality of delivered care. Physicians are recommended to respect their consumers and consider their waiting time. Meanwhile, health system managers should promote physicians’ payment.

Development of biodegradable and biocompatible films based on protein polymer with strong antioxidant and antibacterial activities has gradually obtained extensive concern in the world. In this study, the improvement of gelatin film properties incorporated with Ferula assa-foetida essential oil (FAO) as a potential antioxidant/antibacterial wound dressing film was investigated. Gelatin films were prepared from gelatin solutions (10% w/v) containing different concentration of FAO. The effect of FAO addition on water solubility, water swelling, water vapor permeability, mechanical behavior, light barrier properties as well as antioxidant and antibacterial activities of the films were examined. Water solubility, water swelling and water vapor permeability for pure gelatin films were 29 ± 1.6%, 396 ± 8%, 0.23 ± 0.018 g.mm/m2.h, respectively. Incorporation of FAO into gelatin films caused a significant decrease in swelling and increase in solubility and water vapor permeability. Tensile strength, elastic modulus and elongation at break for pure gelatin films were 4.2 ± 0.4 MPa, 5.8 ± 4.2 MPa, 128 ± 8 %, respectively. Incorporation of FAO into gelatin films caused a significant decrease in tensile strength and elastic modulus and increase in elongation at break of the films. Gelatin film showed UV-visible light absorbance ranging from 280 to 480 nm with maximum absorbance at 420 nm. Gelatin/FAO films also exhibited excellent antioxidant ad antimicrobial activities. Our results suggested that gelatin/FAO films could be used as active films due to their excellent antioxidant and antimicrobial features for different biomedical applications including wound-dressing materials.

Human Immunodeficiency Virus (HIV) makes infected cases prone to opportunistic infections like Tuberculosis (TB) due to impaired immunity of the body, especially Multi Drug Resistant (MDR) ones which are a major concern. With HIV outbreak starting late in the 20th century, the international health community is observing a huge rise in the incidence of this complex disease. Herein, we estimated the incidence of TB among HIV-positive individuals and their responses to anti-tuberculosis medications in Shiraz, Southwest of Iran. 840 HIV-positive patients were included in this cross-sectional study. During the first examination CD4+ count and PPD test was obtained, patients were checked for other symptoms too. Patients, if diagnosed with TB, received proper medication. If therapy failed, second-line therapy was prescribed for them. Type of resistance was studied and recorded. Patients continued their routine anti-viral therapy during the study. Of 840 participants, 29 were diagnosed with Active TB (3.4%), 76% of them were diagnosed with PCR and culture and other with acid fast. Males were the majority of TB positives (82.8%). Most patients suffering from TB had CD4+ count lower than 200 (55.1%); 17.2% of the cases were MDR-TB. Low CD4+ count makes the patient vulnerable to TB. It is necessary to maintain patient’s immunity in order to treat and prevent tuberculosis; so, anti-viral therapies still play important roles in preventing TB in HIV-positive patients.

According to previous studies there are some different opinions on the pre-emptive effects of paracetamol in controlling post-operative pain, we aimed to compare the analgesic effects of pre-emptive paracetamol with post-operative paracetamol and morphine in patients undergoing septorhinoplasty. A hundred and six patients aged 15 to 50 were divided into 3 groups. One received 1 g paracetamol 30 minutes before the operation, another group received 1 g paracetamol after the surgery and the control group received 3 mg morphine sulfate in the recovery room after the surgery. The pain severity was recorded for each patient using a 10 slot table. Any signs of nausea and vomiting (N/V) or apnea were closely observed and recorded. Patients with pain score 5 or more received 2 mg morphine intravascularly. There was not any significant difference between the groups in total pain score and N/V (p>0.05). Post-operative morphine intake was significantly lower in pre-emptive group (P<0.05). None of the patients experienced apnea during the study. We concluded that pre-emptive paracetamol can lower the opium consumption in post-operative period but pre-emptive paracetamol cannot reduce the post-operative acute pain noticeably.

Subglottic stenosis is defined as inflammatory narrowing of the airway. It can be related to trauma, intubation, autoimmune disorders, vascular malformations, infection and congenital abnormalities. Pot-Wine Stain (PWS) is a small dermis venous malformation which is present at birth. PWS is found on face and neck, but can occur in throat and can cause subglottic stenosis. Case Report: Authors describe an 18-year-old girl with progressive dyspnea misdiagnosed with asthma having no response to medication. She has no histories of trauma, intubation, gastro-esophageal reflux disease (GERD) or allergy symptoms. Evaluations revealed subglottic stenosis in association with generalized PWS. To the best of our knowledge, this finding has not been reported in English medical literature.

With the advent of constitutional revolution in Iran and the increase in people’s knowledge, women’s status changed and ultimately improved. Publishing newspaper was one of the women’s attempts to keep their rights. Lady Somayyeh Kahhal was the first woman in this field, as well as ophthalmology in Iran. She published the first specialized newspaper for women in Iran under the title of Danesh (Knowledge). Lady Kahhal tried to disseminate information on women’s rights, moral issues and also health and hygiene in her weekly-published newspaper. In this paper, we will review the remaining biographical information about Kahhal and will introduce her newspaper, Danesh.