Investigating the effect of induced stress on dual-task performance

Doing two tasks concurrently is an inevitable situation that occurs in daily life. Several factors such as pathological conditions, the aging process, and even stress may have a detrimental effect on both tasks’ performances. The aim of this study was to monitor perceived stress during dual-task to investigate how inducing stress affects dual-task performance. Eighteen healthy young participants, (24.76±3.56 years; 68.85 ±11.85 kg; 1.72±0.07 m) were recruited. Participants were asked to perform a single task (no secondary task) and DTs (wire maze with or without buzzer) randomly while standing on a firm surface. Perceived stress was obtained after each trial as a subjective measure. Ground reaction force (GRF) regularity in anterior-posterior and mediolateral directions, as well as wire maze error (ring to path contact), were calculated as dual-task performance. Subjects were able to perceive an increase in mental stress across conditions and, the increase in perceived stress led to fewer errors in the wire maze during the most stressful condition. Further, the addition of a secondary task increased the regularity of GRF in both directions, which might be due to more automatic GRF and less flexible postural control. The presence of DT and mental stress increased the regularity of GRF, while wire maze errors were reduced despite an increase in perceived stress. Induced stress during dual task appears to have caused a cost for standing, yet a benefit for wire maze performance, indicating task prioritization under stress

Dynamic stability association with cost of transport is different in patients with COPD compared to healthy controls

Patients with chronic obstructive pulmonary disease (COPD), suffer from deficits in their functional performance besides their lung disease. In this situation, increased muscle activity is needed to provide safe walking patterns, stability while walking. This increase in muscle activity leads to increased metabolic cost, i.e., using more oxygen to complete the task. The main objective of this study is to investigate the relationship between walking stability and metabolic cost in patients with COPD in comparison with age-matched controls. Seventeen patients with COPD and 23 healthy controls walked on a treadmill at three different speeds: preferred, fast (+20% preferred) and slow (-20% preferred) speeds. Metabolic cost was calculated by subtracting metabolic rate at standing from walking metabolic rate. Stability of walking was measured by margin of stability (MOS) in anterior-posterior (AP) and medio-lateral (ML) directions. We observed that mean MOS AP had an inverse relationship with COT in both groups for all speeds indicating people with lower margins of stability (higher chance of losing balance), have higher COT while walking. However, the relationship was stronger in healthy subjects and weaker in COPD. The weaker relationship in patients with COPD, could be due to the changes in lung function and muscular system due to the disease. Patients with COPD may decrease their speed to achieve a more stable walking pattern, which costs them more to move

The effect of walking speed and magnitude of perturbation on compensatory responses

Imposing a perturbation can induce an unstable condition during gait. Measuring the compensatory responses may be an accurate indicator of the ability to control stability. Responses to a perturbation can be quantified through the perturbed walking pattern deviations from an unperturbed condition. The aim of this study was to determine the effect of perturbation magnitude or speed of walking on compensatory responses to lateral perturbations during walking. Twenty healthy young participants recruited to this study and they were perturbed with the medium magnitude of perturbation, while walking on the treadmill at three different speeds (slow, preferred, and fast). They also walked on the treadmill at their preferred speed while perturbed with three different magnitudes of perturbation (small, medium, large). All perturbations were delivered toward the walker’s right side at the right heel contact. According to the results, there was a significant effect of speed of walking on the maximum deviation from unperturbed condition, indicating less deviation in faster speeds of walking. Moreover, increasing the magnitude of perturbation led to increased deviation from the unperturbed pattern. According to these results, walking with faster speed, and increasing the body momentum could be useful for maintaining stable in a perturbed condition

Efficacy of Chloral Hydrate-Hydroxyzine and Chloral Hydrate-Midazolam in Pediatric Magnetic Resonance Imaging Sedation

How to Cite This Article: Fallah R, Fadavi N, Behdad Sh, Fallah Tafti M. Efficacy of Chloral Hydrate-Hydroxyzine and Chloral Hydrate-Midazolam in Pediatric Magnetic Resonance Imaging Sedation. Iran J Child Neurol. 2014 Spring 8(2):11-17.ObjectiveMagnetic resonance imaging (MRI) is a useful diagnostic tool for the evaluation of congenital or acquired brain lesions. But, in all of less than 8-year-old children, pharmacological agents and procedural sedation should be used to inducemotionless conditions for imaging studies. The purpose of this study was to compare the efficacy and safety of combination of chloral hydrate-hydroxyzine (CH+H) and chloral hydrate-midazolam (CH+M) in pediatric MRI sedation.Materials & MethodsIn a parallel single-blinded randomized clinical trial, sixty 1-7-year-old children who underwent brain MRI, were randomly assigned to receive chloral hydrate in a minimum dosage of 40 mg/kg in combination with either 2 mg/kg ofhydroxyzine or 0.5 mg/kg of midazolam. The primary outcomes were efficacy of adequate sedation (Ramsay sedation score of five) and completion of MRI examination. The secondary outcome was clinical side-effects.ResultsTwenty-eight girls (46.7%) and 32 boys (53.3%) with the mean age of 2.72±1.58 years were studied. Adequate sedation and completion of MRI were achieved in 76.7% of CH+H group. Mild and transient clinical side-effects, such as vomiting of one child in each group and agitation in 2 (6.6 %) children of CH+M group, were also seen. The adverse events were more frequent in CH+M group.ConclusionCombinations of chloral hydrate-hydroxyzine and chloral hydrate-midazolam were effective in pediatric MRI sedation; however, chloral hydrate-hydroxyzine was safer. References1. Lehman RK, Schor NF. Neurologic Evaluation. In:Kliegman RM, Stanton BF, Schor NF, St. Geme JW,Behrman RE, editors. Nelson Textbook of Pediatrics.19th ed. Philadelphia: Saunders; 2011. p. 2013-7.2. Sahyoun C, Krauss B. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr 2012;24:225-32.3. Mason KP, Prescilla R, Fontaine PJ, Zurakowski D. Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol 2011;196(2):W194-8.4. Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anaesthesiol 2010;23(4):513-7.5. Freeman JM. The risks of sedation for electroencephalograms: data at last. Pediatrics 2001; 108(1):178.6. Cortellazzi P, Lamperti M, Minati L, Falcone C, Pantaleoni C, Caldiroli D. Sedation of neurologically impaired children undergoing MRI: a sequential approach. Paediatr Anaesth 2007;17(7):630-6.7. Haselkorn T, Whittemore AS, Udaltsova N, Friedman GD. Short-term chloral hydrate administration and cancer in humans. Drug Saf 2006; 29(1):67-77.8. Costa LR, Costa PS, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication. J Pediatr 2012;160(5):807-13.9. da Costa LR, da Costa PS, Lima AR. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Braz Dent J 2007;18(4):334-40.10. Klein EJ, Brown JC, Kobayashi A, Osincup D, Seidel K. A randomized clinical trial comparing oral, aerosolized intranasal, and aerosolized buccal midazolam. Ann Emerg Med 2011;58(4):323-9.11. Johnson E, Briskie D, Majewski R, Edwards S, Reynolds P. The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients. Pediatr Dent 2010;32(3):229-38.12. Wetzel RC. Anesthesia, Perioperative Care, and Sedation. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 359-60.13. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics 2006;118(6):2587-602.14. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J 1974;2(5920):656-9.15. Fallah R, Jalili Sh, Golestan M, Akhavan Karbasi S, Jarahzadeh MH. Efficacy of chloral hydrate and promethazine for sedation during electroencephalography in children; a randomised clinical trial. Iran J Pediatr 2013;23(1):27-31.16. Fallah R, Nakhaei MH, Behdad S, Moghaddam RN, Shamszadeh A. Oral chloral hydrate vs. intranasal midazolam for sedation during computerized tomography. Indian Pediatr 2013;50(2):233-5.17. Mason KP, Sanborn P, Zurakowski D, Karian VE, Connor L, Fontaine PJ, et al. Superiority of pentobarbital versus chloral hydrate for sedation in infants during imaging. Radiology 2004;230(2):537-42.18. Chowdhury J, Vargas KG. Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent 2005;27(3):191-7.19. Roach CL, Husain N, Zabinsky J, Welch E, Garg R.Moderate sedation for echocardiography of preschoolers. Pediatr Cardiol 2010;31(4):469-73.20. Avalos-Arenas V, Moyao-García D, Nava-Ocampo AA, Zayas-Carranza RE, Fragoso-Ríos R. Is chloral hydrate/ hydroxyzine a good option for paediatric dental outpatient sedation? Curr Med Res Opin 1998;14(4):219-26.21. Torres-Pérez J, Tapia-García I, Rosales-Berber MA, Hernández-Sierra JF, Pozos-Guillén Ade J. Comparison of three conscious sedation regimens for pediatric dental patients. J Clin Pediatr Dent 2007;31:183-6.22. Lee YJ, Kim do K, Kwak YH, Kim HB, Park JH, Jung JH. Analysis of the appropriate age and weight for pediatric patient sedation for magnetic resonance imaging. Am J Emerg Med 2012;30(7):1189-95.23. Kannikeswaran N, Sethuraman U, Sivaswamy L, Chen X, Mahajan PV. Children with and without developmental disabilities: sedation medication requirements and adverse events related to sedation. Pediatr Emerg Care 2012;28(10):1036-40.24. Fávero ML, Ponce FA, Pio MR, Tabith Junior A, Carvalho e Silva FL. Chloral hydrate to study auditory brainstem response. Braz J Otorhinolaryngol 2010;76(4):433-6. [Article in English, Portuguese]25. Heistein LC, Ramaciotti C, Scott WA, Coursey M, Sheeran PW, Lemler MS. Chloral hydrate sedation for pediatric echocardiography: physiologic responses, adverse events, and risk factors. Pediatrics 2006;117(3):e434-41

Combining Fuzzy MCDM with BSC Approach in Performance Evaluation of Iranian Private Banking Sector

The objective of this study is to construct an approach based on multiple criteria decision making (MCDM) and balanced scorecard (BSC) for evaluating performance for three nongovernmental Iranian's banks. Following the literature relating to banking performance and BSC concepts, experts and managers select 21 indexes for evaluation. Furthermore, fuzzy analytic hierarchy process (FAHP) calculated the relative weights of each chosen index in order to tolerate vagueness and ambiguity of information, and three MCDM analytical tools (TOPSIS, VIKOR, and ELECTRE) were adopted to rank the banking performance. The results indicate that a customer “” has the most significant BSC perspectives and the customer satisfaction “1” is the most major index in banking sector. This proposed fuzzy MCDM method combined with BSC approach is a comprehensive and up-to-date model that can be a useful and effective assessment tool

Chronic productive cough and extensive cysts in left lung

Bronchiectasis refers to dilated and thickened airways due to chronic inflammation and infections, with anatomic distortion of the bronchi. Here, we describe a 29-year-old man with a history of multiple hospitalizations for lung infection who presented to the pulmonary clinic with a complaint of worsening chronic productive cough in the previous year. This case presentation prompted a review of the etiologies of bronchiectasis in 291 recent cases admitted to Masih Daneshvari Hospital, Tehran

Results of Non-contrast Brain Computed Tomography Scans of 1-18 Year Old Epileptic Children

How to Cite this Article: Fallah R, Nafisi Moghadam R, Fallah Tafti M, Salmani Nodoushan M. Results of Noncontrast Brain Computed Tomography Scans of 1-18 Year Old Epileptic Children. Iran J Child Neurol 2012; 6(3): 33-38.ObjectiveThe advent of computed tomography (CT) scan revolutionized the diagnosticevaluation of neurologic patients. The aim of this study was to evaluate brain CTresults of epileptic children.Materials & MethodsIn a descriptive cross-sectional study, noncontrast brain CT scan of 150 consecutive1-18 year old epileptic children whom were referred to pediatric neurology clinic ofShahid Sadoughi University of Medical Sciences, from May 2008 to October 2010 inYazd-Iran, evaluated.ResultsSixty two girls and 88 boys with mean age of 6.6 ± 4.3 years were evaluated.In 38 (25.3 %) children, seizure onset age was under one year and 38 others hadabnormal mental / developmental status. Fifty three children (35.3 %) and 97 (64.7%)had partial and generalized seizures, respectively. Partial seizures were more prevalentin children with seizure onset in < 1 year [41.5% (22/53) vs. 16.5% (16/97)] Result of CT was normal in 74 % (n=111). Among the patients with abnormalresults, 18(46%) had brain atrophy, 10 (25.6%) structural CNS dysgenesia, six (15.4%)intracranial calcification, three (7.8%) hydrocephaly and two had (5.2%) brain tumor.Abnormal brain CT was more prevalent in patients with seizure onset in less than oneyear of age [60.5% (23 of 38) vs. 14.3% (16 of 112), p = 0.003], partial epilepsy [51% (27of 53) vs. 12% (12/97)], and abnormal developmental status [ 81.5% (31 of 38) vs.7% (8of 112]. Mean age of seizure onset in epileptic children with abnormal brain CT scanwas less (M ± SD:1/17 ± 0.6 years versus 4.02±1.9 years).ConclusionBrain CT scan might be considered in evaluation of epileptic children with partialseizures, seizure onset in less than one year of age or neurodevelopmental delay.ReferencesJagoda A, Gupta K. The emergency department evaluationof the adult patient who presents with a first-time seizure.Emerg Med Clin North Am 2011; 29(1):41-9.Camfield PR, Camfield CS. Pediatric epilepsy. In:Swaiman KF, Ashwal S, Ferriero D M. Pediatric Neurology: principles & practice. (4th ed). Philadelphia:Mosby Elsevier, 2006.P. 983.Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG; ILAE, Committee for Neuroimaging, Subcommittee for Pediatric. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009; 50(9):2147-53.Soto-Ares G, Jissendi Tchofo P, Szurhaj W, Trehan G,Leclerc X. Management of patients after a first seizure. J Neuroradiol 2004; 31(4):281-8. (in French)Hirtz D, Ashwal S, Berg A, et al. Practice parameter:evaluating a first nonfebrile seizure in children: report of the quality standards subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology 2000; 55:616– 623.Kuzniecky RI. Neuroimaging in pediatric epilepsy.Epilepsia 1996; 37, Suppl 1:S10-21.Adamsbaum C, Rolland Y, Husson B. Pediatric neuroimaging emergencies. J Neuroradiol 2004;31(4):272-80. (in French)Proposal for revised classification of epilepsies and epileptic syndromes. Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia 1989; 30:389–399.Hsieh DT, Chang T, Tsuchida TN, et al. New-onset afebrile seizures in infants: role of neuroimaging.Neurology 2010;12:74(2):150-6.Khodapanahandeh F, Hadizadeh H. Neuroimaging inchildren with first afebrile seizures: to order or not toorder? Arch Iran Med 2006;9(2):156-8.Berg AT, Testa FM, Levy SR, Shinnar S. Neuroimaging in children with newly diagnosed epilepsy: A community based study. Pediatrics 2000; 106(3):527-32.Maytal J, Krauss JM, Novak G, Nagelberg J, Patel M. Therole of brain computed tomography in evaluating children with new onset of seizures in the emergency department.Epilepsia 2000; 41(8):950-4.Kumar R, Navjivan S, Kohli N, Sharma B. Clinicalcorrelates of CT abnormality in generalized childhood epilepsy in India. J Trop Pediatr 1997;43(4):199-203.Aguilar-Rebolledo F, Sosa-Villalobos R, del Castillo- Troncoso C. Should computed axial tomography of theskull be done in all pediatric patients with epilepsy?. BolMed Hosp Infant Mex 1992;49(12):845-50. (in Spanish)Obajimi MO, Fatunde OJ, Ogunseyinde AO, OmigbodunOO, Atalabi OM, Joel RU. Computed tomography and childhood seizure disorder in Ibadan. West 2004;23(2):167-72.Wammanda RD, Anyiam JO, Hamidu AU, Chom ND,Eseigbe EE. Computerized tomography of children with seizure disorders. Niger J Clin Pract 2009;12(1):25-8.Korff C, Nordli DR Jr. Do generalized tonic-clonic seizures in infancy exist? Neurology 2005, 65:17501753.Vanderver A, Chang T, Kennedy C, et al. MR Imaging forthe diagnosis of cerebral dysplasia in new onset seizuresin children. Ann Neurol 2003,54:S114