Quasi-experimental Effectiveness of Cognitive-Behavioral Therapy on Reliving Migraine Headaches in Migraine Sufferers

AbstractObjectives: This study aimed to investigate the effectiveness of cognitive-behavioral therapy on relieving migraine headaches in migraine sufferers.Materials & Methods: The research was a quasi-experimental study with pre-test and post-test method. The samples were outpatients of Public hospitals in Ilam since May - July 2010. They were selected based on inclusion and exclusion criteria, and divided into experimental group and control group. The data were analyzed using SPSS 16. and via multivariate covariance method..Results: The results showed that cognitive-behavioral therapy affected on reducing the duration of symptoms of migraine in sufferers (P<0.05).Conclusion:Cognitive behavioral therapy effects on reducing the time duration of symptoms of migraine headaches. This therapeutic method increases the level of individual, familial, social and occupational activities by reducing the time duration of symptoms and this method helps the individuals to resume their activities and regain their previous control instead of founding themselves incapable and helpless due to the pain they suffer from.

Evaluation of Association between duration of Hospitalization in-Patient with Deep Venous Thrombosis and the type of Treatment Considering the Effect of Comorbid Diseases

Introduction: Deep vein thrombosis (DVT) is a common disease with serious risks such as pulmonary embolism and there are different anticoagulant therapies for treatment of this condition. In this study, we investigated the association between the duration of hospitalization with different treatment methods and comorbidities. Materials and methods: In this retrospective cross-sectional study, the hospital records of 213 patients with a diagnosis of acute DVT in Shohada-e-Tajrish Hospital in 2019 and 2020 were reviewed. Patients were divided into five main groups and five subgroups based on the type of treatment. Then, the association between the duration of hospitalization and different treatment methods was studied. Results: Treatment with novel oral anticoagulants (NOACs) with an average length of 2.5 days of hospitalization significantly reduces the duration of hospitalization. Combination therapy with low molecular weight heparin (LMWH) and warfarin or LMWH alone, with an average of 8.38 and 8.20 days, is preferable to treatment with unfractionated heparin (UFH) and warfarin, with an average of 9.2 days. Warfarin treatment with an average duration of hospitalization of 8.43 days is in the third place. The use of other methods has increased the duration of hospitalization. History of comorbidities including history of hospitalization, hypertension, smoking, cancer and trauma are the five comorbidities that have the greatest effect on the length of hospitalization of patients, respectively. Conclusion: According to the present study, treatment with NOACs reduces the duration of hospitalization of patients more than the other treatment methods. The second best choice is LMWH injection therapy and continuation with warfarin or starting and continuing treatment with LMWH preferable to injecting treatment with UFH and continuing with warfarin. The type of underlying disease and comorbidities had a significant effect on the duration of hospitalization

Association between Anatomic Configuration of Thrombosis with Clinical Symptoms and Risk factors in Admitted Patients with Deep Vein Thrombosis

Introduction: Deep vein thrombosis (DVT) is prevalent and challenging for physicians. Previously, the clinical symptoms of DVT are different based on the location of the thrombosis. In this study, the anatomic location of thrombosis and its relation with clinical symptoms and DVT risk factors were investigated. Methods: In this retrospective study, the hospital documents of 204 patients with acute lower extremity DVTs in Shohada-e-Tajrish hospital were reviewed from April 2020 to February 2021. The diagnosis was confirmed using Doppler ultrasound. Based on the location of the thrombosis, the patients were divided into four groups: unilateral proximal group (UPG), bilateral proximal group (BPG), unilateral distal group (UDG), and ipsilateral proximal and distal group (IPDG). Finally, the frequency of risk factors and symptoms were compared between the groups. Results: In this retrospective study, 204 patients with the diagnosis of acute lower extremity DVTs at the time of hospitalization or during hospitalization were studied. The mean±SD age of the patients was 57.1±19.2 years (range: 12-98 years). Of these, 114 (55.9%) were men and 90 (44.1%) were women. There were 174 patients in UPG, 16 in BPG, 5 in UDG and 9 in IPDG. In total, 97.5% of the patients had proximal thrombosis while only 6.9% of them had distal thrombosis. The incidence of different limb circumferences was significantly higher in UPG and IPDG compared to BPG and UDG (P<0.05). There was no statistically significant difference between groups in terms of other symptoms and risk factors. Conclusion: Most of the DVTs were found in the proximal veins of the lower extremities. It seems that these DVTs are more likely to create edema compared to others and in unilateral cases may result in different circumferences of the lower limbs. But there was no significant association between other clinical signs of DVT including limb pain, edema, erythema, palpitations, and shortness of breath with thrombosis location. Also not significant association between DVT risk factors and the location of thrombosis were found

Steinernema feltiae- Xenorhabdus bovienii: more information on this bactohelminthic complex from Iran

Two families of entomopathogenic nematodes (EPNs), Steinernematidae and Heterorhabditidae, that are symbiotically associated with Xenorhabdus and Photorhabdus bacteria, are one of the effective biological control agents of insect pests. Native isolates can probably be more efficacious to control insect pests than exotic ones due to their adaptability to indigenous environmental conditions. In this study, Steinernema feltiae isolate FUM221, was recovered from soil samples collected from the Ardabil Province, Iran. Morphological and morphometric investigations of the first and second-generation adults, infective juveniles, and molecular characterizations were given based on ITS and 18S rDNA genes. Besides, molecular analysis based on the 16S rRNA region and phenetic data recognized Xenorhabdus bovienii as its symbiont bacterium. The scanning electron microscopy (SEM) images verified the identification of this isolate. The molecular characterization using two loci and phylogenetic analyses provided more evidence for the classification of this steinernematid and its difference of the same species from other countries. Moreover, molecular and phenetic characterizations of its symbiotic bacterium were provided with low variations compared to other isolates. Herein, the comprehensive taxonomic data of this steinernematid and its symbiont bacterium, is presented from Iran

Comparing the Effect of Vitamin E and N-Acetylcysteine on Prevention of Contrast-Induced Nephropathy in Diabetic Patients under Coronary Angiography

Introduction:  Considering the incidence of contrast  induced  nephropathy  (CIN) as well as  its  complications  and    costs,  prevention  and  reducing  the  risk  of  CIN  is  an  essential  issue.  The  present  study  aimed  to  evaluate  the  efficacy  of  vitamin  E  and  N-acetylcysteine  (NAC)  on the prevention  of  CIN  in  diabetic  patients  undergoing  coronary  angiography. Materials and Methods:  360  patients  with  diabetes  who  required  angiography,  including  patients  with  stable  angina  susceptible  to  acute  myocardial  infarction  and  patients  with  acute  coronary  syndrome  were  included  and  randomized  into  three  groups .  Group  1  received  serum  therapy  (Normal Saline)  plus  NAC  and  placebo  of  vitamin  E,  group  2  received  serum  therapy  plus  vitamin  E  and  placebo  of  NAC,  and  group  3  only  received  serum  therapy  with  two  placebos  of  NAC  and  vitamin  E.  The groups were compared considering CIN after angiography. Results:  A  total  of  93  patients  were  studied  in  group  1,  94  in  group  2,  and  113  in  group  3.  CIN  occurred  in  4  patients  (4.3%),  4  patients  (4.3%),  and  8  patients  (7.1%)  in  groups  1,  2,  and  3,  respectively  (P=0.58).  There was  a  significant  difference  in  mean  difference  of  creatinine  levels  before  and  after  study  in  groups  1  and  2  (both  P<0.001).  In  the  subgroup  of  patients  with  chronic  kidney  disease,  NAC  significantly  reduced  CIN  (P=0.03). Conclusion:  The results  suggested  efficacy  of  both  interventions,  considering  reduction  of  mean  Serum creatinine ( Scr) after  the  study,  while  lack  of  significant  difference  in  the  incidence  of  CIN  could  be  because  of  the  low  number  of  CIN  in  our  study.  The second  important  finding  of  this  study,  probably the  reduced  risk  of  CIN  in  diabetic  patients  with  chronic  kidney  disease  receiving  NAC,  recommends  the  use  of  NAC  for  prevention  of  CIN,  especially  in  this  subgroup  of  patients  undergoing  angiography

Effect of Vitamin D Administration on Glycemic Control in Patients with Type II Diabetes Mellitus and Vitamin D Deficiency

Introduction: The prevalence of diabetes mellitus (DM) and its morbidity and mortality are prominent all over the world. Observational data suggest that vitamin D deficiency is associated with insulin resistance. In this study, we aimed to assess this association. Methods:  This study was a clinical trial consisting of 42 patients with type 2 DM who had vitamin D deficiency. The patients underwent vitamin D replacement with vitamin D pearls (50,000 iu) weekly for 10 weeks. The level of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol (Chol), triglycerides (TG), hemoglobin A1c (HbA1C), 2 hour post prandial (2HPP), fasting blood sugar (FBS), body mass index (BMI), blood pressure (BP), and 25oHVitD3 were measured before and after the treatment in all patients. Data were analyzed with paired t test. Results:  100% of patients reached acceptable vitamin D level (above 30 mg/dl). No toxicity was reported. Changes in FBS, 2Hpp, HbA1C, Chol, SBP were significant and there was no significant change in LDL, HDL, and DBP. Conclusion:  Screening for vitamin D deficiency and its replacement may have a beneficial effect on type 2 DM management and its associated risk factors. More studies with larger sample size and use of placebo are recommended

Evaluating Post-discharge Thromboembolic Events in Patients With COVID-19

Background: COVID-19 is associated with a high rate of thromboembolic events in hospitalized patients, but it is unclear whether this risk remains high after discharge. This study aimed to evaluate the association of underlying factors with post-discharge thrombolytic events in COVID-19 patients and the association of thrombolytic events with subsequent mortality and ischemic heart disease.Methods: In this study, eligible patients with COVID-19 who were admitted to the respiratory ward of Loghman Hakim Hospital, Tehran, Iran, followed up for about 3 months after discharge to record any thromboembolic events. Patients who reported post-discharge thromboembolic events were confirmed based on their diagnostic tests. The Chi-square test was used to evaluate the association between thromboembolic events and qualitative parameters, and an independent t-test was used to evaluate their association with quantitative parameters. Logistic regression analysis was performed to assess the association between independent variables and the composite outcome.Results: Thromboembolic events were diagnosed in 35 patients (5.04%), including Myocardial Infarction (MI) in 17 patients (2.44%), venous thromboembolism in 10 patients (1.44%), and ischemic stroke in 8 patients (1.15%). None of the 26 patients who received thromboprophylaxis had thromboembolic events. During follow-up, 22 patients (3.17%) died, of whom, 10 patients (43.47%) had thromboembolic events. Thromboembolic events were not associated with sedentary life and oxygen (O2) dependency after discharge (P value of 0.40 and 0.098, respectively). Regression analyses showed that thromboembolic events were significantly associated with ischemic heart disease and mortality (P=0.007 and P<0.001, respectively).Conclusion: Our findings support a high rate of post-hospitalization thromboembolic events in COVID-19 patients; however, it needs more large-scale trials

Effect of Proton Pump Inhibitor Administration on Glycemic Parameters in Patients with Type 2 Diabetes Mellitus

Introduction: Proton pump inhibitors can influence glucose-insulin homeostasis by elevating plasma gastrin. Considering the few clinical trials and contradictory results of previous studies, we aimed to evaluate the effect of omeprazole, a proton pump inhibitor, on glucose-insulin homeostasis in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: In this before-after clinical trial, 40 patients with T2DM received omeprazole treatment for 12 weeks. Patients were asked to continue their diet, lifestyle, and physical activity throughout the study period. Glycosylated hemoglobin (HbA1c), fasting plasma sugar (FBS), insulin level, C-peptide and 2 hours post prandial blood sugar (2hppBS) were measured at baseline and after 12 weeks. Homeostatic model assessment of Insulin resistance (HOMA-IR) and homeostatic model assessment of β-cell dysfunction (HOMA-B) indices were also calculated at baseline and after 12 weeks of omeprazole administration. Results: After 12 weeks of omeprazole administration, there was a clear decrease in the mean HbA1C before (8.11±0.96) and after (7.13±0.68) the treatment (P<0.001). Similarly, a decrease in mean FBS and 2HPPBS before and after treatment was observed, which was statistically significant for FBS (P=0.01) but not for 2HPPBS (P=0.1). There was a clear increase in the level of Insulin (P=0.001) and C-peptide (P=0.003). The mean activity index of HOMA-B before and after receiving omeprazole was 54.41 27.06 and 79.24 45.32, respectively (P=0.007). Also, HOMA-IR index was 5 before, and 6 after receiving omeprazole (P=0.001). Conclusion: Administration of omeprazole, increases insulin levels and decreases the levels of HbA1c, FBS, thus improving glycemic status and can be combined with other drugs used to manage DM, especially in patients with gastrointestinal problems; but more studies are needed

The Effects of 3-Month Rosuvastatin Adjuvant Therapy on Post Thrombotic Syndrome following Deep Vein Thrombosis; a Randomized Clinical Trial

Introduction: Statins are known to have anticoagulation and anti-inflammatory effects. This study aimed to investigate the effect of Rosuvastatin in reduction of post thrombotic syndrome (PTS) following deep vein thrombosis (DVT). Methods: In this randomized clinical trial, patients who were diagnosed with DVT of lower extremity were randomly assigned to 4 treatment groups: group 1: Warfarin, group 2: Warfarin + Rosuvastatin, group 3: Rivaroxaban, and group 4: Rivaroxaban + Rosuvastatin. The treatments were followed for 3 months and prevalence of PTS (as primary outcome), as well as the changes in serum levels of D-dimer and C reactive protein (CRP), and the extent of thrombosis before and after the intervention (as secondary outcomes) were compared between groups. Results: 182 patients with the mean age of 55.22 ± 4.1 years finished the trial period (51.64% male). There was no significant difference between the groups regarding the baseline characteristics. Based on the Brandjes score, 31 (17.03%) patients had PTS at the end of the study. The occurrence of PTS was significantly lower in the groups taking statins (p<0.0001). Although the change in the mean difference of legs circumference before and after intervention, were significant in all groups (p < 0.05), the differences was more prominent in groups 2 and 4 (p < 0.0001). After 3 months of taking medication, decrease of CRP was more prominent in the statin groups (p = 0.001), and most cases with normal CRP were in statin groups. Among the patients with the serum D-dimer level above 10000 ng/mL, patients in the statin groups experienced significantly more reduction in D-dimer levels than the other groups (p<0.001). Conclusion: Rosuvastatin administration in combination with rivaroxaban or warfarin significantly reduces the level of inflammatory factors including CRP and D-dimer, compared to patients receiving anticoagulants alone. Rosuvastatin administration can significantly reduce the incidence of PTS and cause a difference in the size of the lower limbs within 3 months