Association between dietary acid load and clinical features of migraine headaches among Iranian individuals

There is limited evidence regarding the possible role of dietary acid load (DAL) in the pathophysiology of migraine headaches. Therefore, we sought to examine DAL in relation to the clinical features of migraine including headache frequency, severity and duration, headache impact test-6 (HIT-6), and serum levels of nitric oxide (NO). In the present cross-sectional study, 262 patients (38 men and 224 women aged 20–50 years) were recruited through a simple random sampling method. Dietary intakes were obtained by using a validated 168-item semi-quantitative food frequency questionnaire (FFQ). DAL was then calculated by two different methods; potential renal acid load (PRAL) and net endogenous acid production (NEAP). In total, 262 patients with a mean (SE) age of 36.1 (0.53) and a BMI of 25.55 (0.21) were included in the current study. After controlling for potential confounders, a higher DAL was positively associated with headache frequency in those with the highest DAL score compared to the lowest (PRAL; β = 2.33; 95% CI 0.78, 3.88; NEAP; β = 1.74; 95% CI 0.13, 3.34). Increasing NEAP from 28.96 to 35.89 resulted in a 3.43 and 2.74 increment in HIT-6 scores in the crude (95% CI 1.35, 5.52) and fully-adjusted models (95% CI 0.40, 5.07), respectively. Moreover, a higher dietary PRAL was significantly associated with migraine-related disability, as shown by HIT-6, in subjects of the third tertile compared to those in the first tertile after controlling for confounders (β = 2.42; 95% CI 0.13, 4.70). In conclusion, our study highlighted the importance of the acid–base properties of a diet in the pathophysiology of migraine headaches. However, further well-designed studies are needed to confirm our findings

Unusual cardiovascular complications of brucellosis presenting in two men: two case reports and a review of the literature

Introduction: Brucellosis is a zoonosis with worldwide distribution, which is particularly endemic in many countries of the Mediterranean basin. Cardiovascular complications of this disease, such as endocarditis, myocarditis and pericarditis, are very rare, with even fewer cases of myocarditis or asymptomatic pericardial effusion in the absence of concomitant endocarditis being reported. Case presentation: We report two cases of brucellosis in two Caucasian men, aged 17 and 34 years old, with myocarditis and asymptomatic pericardial effusion, respectively. Of note, neither patient had concomitant endocarditis. The disease was confirmed serologically and by blood cultures. Both patients recovered completely after receiving appropriate antibiotic treatment without any sign of relapse during a follow-up of 12 months. Conclusion: These two cases emphasize that in endemic areas Brucella can be considered as a potentially causative agent of idiopathic pericardial effusion or myocarditis, even in the absence of concomitant endocarditis. This possibility could be taken into account particularly in cases where contraction of brucellosis is possible, such as occupational exposure or consumption of unpasteurized dairy products. © 2011 Gatselis et al; licensee BioMed Central Ltd

The status of hepatitis C virus infection among people who inject drugs in the Middle East and North Africa.

BACKGROUND AND AIMS: People who inject drugs (PWID) are a key population at high risk of hepatitis C virus (HCV) infection. The aim of this study was to delineate the epidemiology of HCV in PWID in the Middle East and North Africa (MENA). METHODS: Syntheses of data were conducted on the standardized and systematically assembled databases of the MENA HCV Epidemiology Synthesis Project, 1989-2018. Random-effects meta-analyses and meta-regressions were performed. Meta-regression variables included country, study site, year of data collection and year of publication [to assess trends in HCV antibody prevalence over time], sample size and sampling methodology. Numbers of chronically infected PWID across MENA were estimated. The Shannon Diversity Index was calculated to assess genotype diversity. RESULTS: Based on 118 HCV antibody prevalence measures, the pooled mean prevalence in PWID for all MENA was 49.3% [95% confidence interval (CI) = 44.4-54.1%]. The country-specific pooled mean ranged from 21.7% (95% CI = 4.9-38.6%) in Tunisia to 94.2% (95% CI = 90.8-96.7%) in Libya. An estimated 221 704 PWID were chronically infected, with the largest numbers found in Iran at 68 526 and in Pakistan at 46 554. There was no statistically significant evidence for a decline in HCV antibody prevalence over time. Genotype diversity was moderate (Shannon Diversity Index of 1.01 out of 1.95; 52.1%). The pooled mean percentage for each HCV genotype was highest in genotype 3 (42.7%) and in genotype 1 (35.9%). CONCLUSION: Half of people who inject drugs in the Middle East and North Africa appear to have ever been infected with hepatitis C virus, but there are large variations in antibody prevalence among countries. In addition to > 200 000 chronically infected current people who inject drugs, there is an unknown number of people who no longer inject drugs who may have acquired hepatitis C virus during past injecting drug use. Harm reduction services must be expanded, and innovative strategies need to be employed to ensure accessibility to hepatitis C virus testing and treatment

Tazocin (Piperacillin-tazobactam) Susceptibility Pattern in Nosocomial Infections

Abstract: Background & Aims: Utility of antibiotics, such as third and fourth generation of cephalosporins and carbapenems, and resistance to these antibiotics in hospital acquired infections are increased. There are scientific data that support the application of Tazocin (piperacillin-tazobactam) as an empirical treatment of moderate to severe bacterial infections. In our area there is not much information available on this topic. Therefore, we decided to determine the susceptibility pattern of bacterial species isolated in patients with infection to piperacillin-tazobactam at Alzahra Hospital (a tertiary care center), Isfahan, Iran. Methods: This cross-sectional study was conducted at Alzahra Hospital (referral and educational hospital) from 2009 to 2010. 90 clinical specimens of bacterial cultures isolated from blood, urine, and respiratory tract of patients with nosocomial infections in different parts of the hospital were included in this study. Standard methods for the detection of microbiological bacterial species were used, and the antibiogram pattern of bacterial samples was performed by using E-test method. Results: Among the 90 studied specimens in this study, 73 samples were gram-negative bacteria and the remainder was gram-positive. More than 78% of gram-negative bacteria and more than 88% of gram-positive bacteria, grown in cultures of patients with nosocomial infections at Alzahra Hospital, were sensitive to piperacillin-tazobactam. Conclusion: The information obtained from this research may be a guide for physicians that work in our region for the use of empiric therapy with piperacillin-tazobactam in cases of moderate to severe bacterial infections. Keywords: Antimicrobial resistance, Empiric therapy, Nosocomial infection, Piperacillin-tazobacta

A Study of the Relationship between Syncope Attacks and Diminished Carotid and Vertebral Artery Flow Using Doppler Ultrasonography of Cervical Vessels

Background:Syncope or drop attack is a common and potentially serious condition and prompt evaluation of the affected patients should be evaluated prompting for cardiac disease, seizure, structural lesions of the brain or peripheral nerves, as well as drug induced and metabolic disturbances. This study was conducted to evaluate carotid and vertebral arteries blood flow in patients with syncope in which other etiologies had been ruled out.
 Methods: This one-year retrospective case-control study involved 33 patients (case group) and 33 normal individuals (control group). Carotid and vertebral arteries blood flow was measured in all subjects (ml/min) and SPSS was used for data analysis.
 Results: Mean blood flow in vertebral arteries in the case group was significantly lower than in the control group (P<0.001), however mean carotid artery flow was not significantly different between them (P=0.58).
 Conclusion: Based on our results and findings of some other studies, we recommend duplex ultrasonography of vertebral and cervical arteries in patients suffering from drop attacks, after ruling out the prominent etiologies, such as seizure, heart disease, etc.
 Keywords: syncope, ultrasound, carotid artery, vertebral arter

Evaluation of Vasomotor Reactivity by Transcranial Doppler Sonography: Age and Sex Related Differences in Breath Holding Index in Iranian Population

Background: The assessment of cerebral vasoreactivity can provide information regarding the reserve capacity of cerebral circulation. Reduction of this property has been found in association with situations predisposing one toward cerebrovascular disease. In this study, we defined the vasoreactivity of brain vesseles according to age and sex of the patients.
 Methods: In this descriptive study, 289 healthy subjects (without hypertension, diabetes mellitus, obesity, smoking, CHF, CHD,) were admitted from January 2004 to June 2004. The population was divided to four groups, according to age and sex (women and men more and less than 30). After determination of each patient’s flow velocity of middle cerebral artery (MCA) by mean of a transcranial doppler instrument (TCD), before and after 30s apnea, breath holding index (BHI) was calculated. Data was analyzed, using SPSS software.
 Results: BHI was significantly higher in women than men (0.918±0.40 versus 0.637±0.22; P<0.001). BHI was significantly lower in older (age > 30 ) women (0.812±0.31) than in younger ( ≤ 30 years ) women (0.995±0.44; P<0.001) but there was no significant difference between older (age > 30 ) men (0.62±0.23 ) and younger ( ≤ 30 years ) men (0.65±0.20; P > 0.05).
 Conclusion: The average of BHI was lower in men than in women in total and in all age subgroups. BHI was relatively constant in all age subgroups in men but there was significant decline in BHI by increasing age in women. So despite of many physiologic changes related to aging, vasomotor reactivity remains relatively constant in men but decreases in women. Findings of our study suggest that changes of cerebrovascular vasomotor reactivity in healthy subjects may be related to aging, but they are probably mainly influenced by sex.
 Keywords: vasomotor reactivity, BHI, TC