COMPARING THE EFFECT OF SECOND-GENERATION ANTIPSYCHOTICS VERSUS SELECTIVE SEROTONIN REUPTAKE INHIBITORS IN REFRACTORY OBSESSIVE-COMPULSIVE DISORDER: A SYSTEMATIC REVIEW OF THE PAST, PRESENT, AND FUTURE CLINICAL TRIALS

Objective: In this concise and systematic review, the trend of using major medication modalities prescribed for refractory obsessive-compulsive disorder (OCD), including serotonin-specific reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs) are discussed.Methods: We systematically searched PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) systematically using Mesh terms. OCDis extremely disabling and associated with considerable depression and other serious psychiatric illnesses.Results: Through databases, we found 78 randomized clinical trials (RCTs), which included selective SSRI compared with routine drug therapy or placebo. Out of these 78 studies, 62 studies were conducted on adult patients with OCD, comprising 7920 cases. While only 16 RCTs were performed on children and adolescents with OCD, including 1313 people. We found 24 clinical trial studies related to SGAs, of which were conducted on adult patients with OCD, including 992 cases.Conclusion: As our data showed among the SSRIs, fluvoxamine has been particularly well studied and used in RCTs in both children and adolescents with OCD. According to the summary of our review, it will be better when therapists use SGAs in the early treatment programs of refractory OCD. Thus, considering our reviewed, it seems that the first choice of early treatment programs of refractory OCD is fluvoxamine in combination with quetiapine or aripiprazole.Keywords: Obsessive-compulsive disorder, Refractory, Second-generation antipsychotic drugs, Selective serotonin reuptake inhibitors.Â

Estimating Case Fatality and Case Recovery Rates of COVID-19: is this the right thing to do?

Introduction: Case fatality rates (CFRs) and case recovery rates (CRRs) are frequently used to define health consequences related to specific disease epidemics, including the COVID-19 pandemic. This study aimed to compare various methods and models for calculating CFR and CRR related to COVID-19 based on the global and national data available as of April 2020.Methods: This analytical epidemiologic study was conducted based on detailed data from 210 countries and territories worldwide in April 2020. We used three different formulas to measure CFR and CRR, considering all possible scenarios.Results: We included information for 72 countries with more than 1,000 cases of COVID-19. Overall, using first, second, and third estimation models, the CFR were 6.22%, 21.20%, and 8.67%, respectively; similarly, the CRR was estimated as 23.21%, 78.86%, 32.23%, respectively. We have shown that CFRs vary so much spatially and depend on the estimation method and timing of case reports, likely resulting in overestimation.Conclusion: Even with the more precise method of CFRs estimation, the value is overestimated. Case fatality and recovery rates should not be the only measures used to evaluate disease severity, and the better assessment measures need to be developed as indicators of countries’ performance during COVID-19 pandemic

SARS-Cov2-Induced Cytokine Storm and Schizophrenia, Could There be a Connection?

Today, a new coronavirus (2019-nCoV, later named SARS-CoV-2) has become known as a pandemic with over 3,949,200 cases and 271,782 deaths. It has been considered that most of the deaths in infected patients stem from comorbidity conditions. Therefore, understanding at-risk populations are currently under the focus of investigations. This object has highly driven attention to put patients with a higher potential of death related to SARS-CoV2 infection at priority. For instance, this can happen in Schizophrenia owing to ambiguous immunology attributes, including elevated levels of pro-inflammatory cytokines and stress-related immune disability. Given that, the hyper-inflammatory responses are the significant cause of the pathophysiology of the SARS-CoV2-related mortality. Moreover, SARS-CoV2 can prompt the risk of developing Schizophrenia in the future. This review punctuates that prenatal/perinatal infection could be associated with increased Schizophrenia risk; on the flip side, the potential risk of ongoing medication can worsen mentally disabled patients, and healthy people are at risk

Multiple unite sustained released floating of sodium diclofenac: Formulation and evaluation using factorial design

The aim of this study was prepare and evaluate floating granules of sodium diclofenac with lipid excipient for prolonged gastric residence and reduced dose regimen. Floating granules prepared by extruder-spheronization technique. Compritol and gelucire as lipid excipient, HPMC as retardant and tween 80 as emulsifier were used. The effect of drug/lipid, drug/HPMC, drug amount, percentage of tween and type of lipid on floating ability, morphology and dissolution parameters were evaluated by factorial design. Results showed floating ability of granules was influenced by proportion of drug/lipid, drug/HPMC and percentage of tween. Floating property of Compritol was more than gelucire and provided good floating particles. Compritol granules provided suitable sustained release pattern in the manner that increase in D/L reduced D8 and MDT and increase in %T increased MDT. Higuchi model was the best fitted for dissolution data of granules prepared by Compritol and gelucire. In conclusion, Compritol provided more suitable floating ability and sustained release property.Keywords: Sodium diclofenac; Floating granules; Gastric residence time; Extruder-spheronizatio

A Validation Study for POSSUM and EuroSCORE as a Predictor of Mortality After Selective Cardiac Surgery

Aim: to assess physiological and operative severity score for the enumeration of mortality (POSSUM) scoring system and compare it with European system for cardiac operative risk evaluation (EuroSCORE) scores in patients who underwent cardiac surgery from two hospitals in the southwestern region of Iran. Methods: in this retrospective study, total of all 1420 patients who were admitted for elective cardiac surgery at our centers, from 2007 to 2012, were scored using the POSSUM and EuroSCORE systems. Results: the overall mortality rate was 0.87%. Among the risk factors, history of diabetes, smoking, respiratory disease, and myocardial infarction, were significantly affect the mortality rate. Therefore, of these risk factors, only the hemoglobin was significantly correlated with the morbidity rate. The predictive accuracy of mortality equations was 74.5%. The lower predictive accuracy of mortality equations was 67.8% was observed using EuroSCORE. Conclusion: although results are statistically significant, but the analysis have never intended to affect the decision to operate, and this decision must be based on clinical expertise, because of the need to standardize data collection and stratify the risks involved in operations, scoring systems such as POSSUM should be used prospectively. However, if analyzed correctly, POSSUM is a good predictor of mortality in patients undergoing cardiac surgery.Key words: cardiac surgery, physiological and operative severity score for the enumeration of mortality (POSSUM), European system for cardiac operative risk evaluation (EuroSCORE)

Which came first, the risk of migraine or the risk of asthma? A systematic review

Objectives We conducted this review to systematically assess the association and risk of the migraine in the patient with asthma and vice versa. Methods We systematically searched publishes articles indexed in PubMed, Scopus, Cochrane library, PsycINFO, CINAHL, ISI Web of Science, Science Direct from inception, and Embase databases until June 2017. The quality assessment of the involved studies was done using the Newcastle-Ottawa Scale (NOS). Results Eight studies with 389,573 participants were reviewed and selected for data extraction. Among the selected studies, 5 were reported the association between migraine with asthma risk, and the rest three studies reported the risk of asthma in patient with migraine compared to non-moraine individuals. Odds ratio (OR) of migraine for patient with asthma as compared with non-asthmatic individuals was 1.62 (95% CI 1.43–1.82). Data pooling using a random-effect model showed that migraine was associated with a significant increased risk of asthma (relative risk (RR): 1.56; 95% CI: 1.51–1.60; p < .00001). Besides, sub-group and sensitivity analyses supported the positive association between asthma and migraine, and risk of asthma in migraine patients. Conclusion Now it is unknown if control of the asthma will impact the severity of migraines or vice versa, but it is necessary to perform more research to further explain the mechanisms through which asthma increases the frequency of migraine or vice versa. If two conditions linked, once an individual undergo better control of asthma symptoms, might the excruciating migraine ease, too