Intractable Seizure Disorders: Efficacy of The Classic Ketogenic Diet

 ObjectiveThe ketogenic diet is a high-fat, low carbohydrate, adequate protein diet,developed in the 1920s for the management of intractable seizure disorders in children. To evaluate efficacy and tolerability of the classic  ketogenic diet, we analyzed records of the children started on the diet from 1999 to 2006 at the Mofid children's hospital.Materials & Methods The subjects were 87 children, mean age 55 months. Before initiation of the diet, 55% of the patients had seizures, at least 1-4 times per day, 36% - 5 or more per day and 9% - 2 to 4 times per week. Mean number of Anti Epileptic Drugs (AEDs) tried for them was 8 and 67% were receiving three or more drugs.Results The ketogenic diet showed drastic improvement, with at least 50% reduction in seizure frequency in 87% of our patients, 39% of whom showed complete seizure control in the third month. After one year, in 80% of the patients who returned, improvement  continued, with 26% of them being seizure free; besides, 23% had one AED decreased, 36% had two or three AEDs decreased, and 25% (one child) had all AEDs discontinued. Of the 30 improved cases, 20%, at the end of the first year, had improved behavior as  well, and 23% of them had become more alert. The median diet duration of the improved group was 15 months.Conclusion The improvement in our patients, low  side effects, and the duration of diet by families reveal that the ketogenic diet can still be a very useful alternative therapy in certain epileptic children.

A survey on some risk factors and evaluation of their impacts on streptococcosis in rainbow trout farms in east of Mazandaran province (Haraz River)

One of the most important bacterial fish diseases which has caused some outbreaks in rainbow trout farms in Iran is streptococcusis .The farmers were suffering from huge economic losses due to the disease outbreaks in different rainbow trout farms in Iran. The aim of our study was to determine rate of streptococcusis incidence in different stage of growth in farmed rainbow trout in Haraze River, Mazandaran province. Fish and water samples were randomly collected and measured of randomly in10 selected farms, monthly throughout a year. After clinical observations, Isolation and recognition of strep strains were made using biochemical tests. Some Environmental factors include Nitrate, Nitrite, Temperature, pH, Ammonia and DO measured during sampling periods. According to our results 4.6% of juvenile samples showed clinical singe of streptococcusis while only0.7% of them had strep. Contamination .These rates in adult samples were 8.9 and 1 percent respectively. Major isolated bacterial strain was Streptococcus uberis. Incidence of streptococcusis in rainbow trout 20% affected by fluctuation of Nitrite, temperature and DO. Management of these factors can decrease rate of disease outbreaks

Safety and effectiveness of high-dose vitamin C in patients with COVID-19: a randomized open-label clinical trial

Background: Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease. Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen. Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO2) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO2 levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups. Conclusions: We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020 © 2021, The Author(s)

Type B Hepatitis in Iran

Hepatitis B surface antigen CHBsAg) was found in 1% of controls, 2.1% of professional blood donors, 2.0% of leprosy patients and 76.1% of acute hepatitis in Tehran and Mashhad, Iran. All HBsAg positive samples also possessed antibody to the hepatitis B core antigen and all were subtype ayw. Type B hepatitis and the HBsAg state aloe frequent in Iran, but most must be accounted for by u nonparenter- al" or "rnapparent'' parenteral exposure

Extraction and Identification of Secondary Metabolites Produced by Trichoderma atroviridae (6022) and Evaluating of their Antifungal Effects

Introduction: Fungi release wide spectrum of secondary metabolites that belong to several chemical groups with different biochemical origins. These materials produce as intermediate and end products of diverse metabolic pathways. The profile of the secondary metabolites for a known species or strain will vary depending on the substrate, the duration of incubation, the type of nutrients, temperature and other environmental parameters. Trichoderma spp. are well-known producers of secondary metabolites with different biological activities. The secondary metabolites with antibiotic activity can be classified into two main types. Low molecular weight and volatile metabolites which are involved in complex Trichoderma plant-pathogen interactions. They belong to various structure classes such as alcohols, ketones, alkanes, furans, simple aromatic compounds, isocyanate compounds, volatile terpenes, some polyketides, butenolides, and pyrones. All of them are relatively nonpolar compounds with a significant vapor pressure. These volatile organic compounds (VOCs) in the soil environment could be traveled over distance and affect the physiology of the pathogens. They also enhance growth and systemic resistance in plants. These VOCs have been evaluated for T. atroviride, T. harzianum, T. viride, T. longibrachiatum, T. pseudokoningii and T. aureoviride. High molecular weight metabolites (like peptaibols) are polar metabolites which act directly by contact between Trichoderma species and competitor organisms. Due to potent separation and highly sensitive detection, gas chromatography-mass spectrometry (GC-MS) is the main method for detection of the fungal VOCs. Mass spectrometric detection offers the possibility to identify individual volatiles from complex mixtures. Structure characterization and confirmation of identity are usually achieved by comparison of mass spectra with library spectra and the determination of chromatographic retention indices. Due to the capacity of Trichoderma species in crop protection and promoting vegetative growth, they are marketed as biopesticides, biofungicides and biofertilizers. The identification of molecules with such biological activities can support the development of new biopesticides and biofertilizers based on Trichoderma metabolites. The aim of this study was to investigate antifungal effects and chemical composition of secondary metabolites produced by Trichoderma atroviridae(6022) against Macrophomina phaseolina and Sclerotinia sclerotiorum. Materials and Methods: Antifungal effects of isolate 6022 against M. phaseolina and S. sclerotiorum were evaluated under invitro condition by dual culture technique, volatile (Dennis & Webster 1971) and non-volatile (Vinal 2006) metabolites. Volatile metabolites tests were done in 4 cases: Co-culture, 24, 48 and 72 hour cultures. For considering non-volatile metabolites of this isolate, different concentrations of culture filtrate and mycelial mass have been prepared in (autoclaved) potato dextrose agar (PDA), individually. Secondary metabolites were extracted via 4 processes by using of organic solvents (Siddiquee 2012), Headspace technique (Stoppacher 2010) and soxhlet water bath distillation methods for mycelial mass (Dubey 2011) and identified by using the GC-MS device with nonpolar column (DB-5). Results and Discussion: In dual culture test, isolate 6022 inhibited the mycelial growth of the pathogen, then over ran and sporulated on the mycelia. The related results for the volatile test in 24, 48, 72h and Co-cultures, indicated that the antagonist inhibited the mycelial growth of the pathogen and production of sclerotia in culture media (PDA). Results of the non-volatile test (in different concentrations) showed significant inhibitory effects on mycelial growth and production of sclerotia. After extraction and GC separation, the constituents of mixtures can be detected via mass spectrometry (MS) by comparison of mass spectra with library spectra searching. According to mass spectra library, 61 compounds such as some alkanes, alkenes, phenolic, alcoholic, terpenoid and aromatic compounds have been detected by 4 processes that among them, alkanes had the highest frequency. Many important compounds with the antifungal effect such as iso-amyl-alcohol, 2-ethyl-1-hexanol, 1-pentanol, stearic acid, palmitic acid, bis (2-ethylhexyl) phthalate, di-n-octyl phthalate have been identified. So, inhibitory effects of isolate 6022 are related to these compounds. Conclusions: Secondary metabolites of the biocontrol fungus Trichoderma have been involved in different biological processes such as biocontrol or communication between fungi and their living environment. These fungi have antibiotic activity against plant pathogenic fungi, so the requirement for monitoring Trichoderma VOCs profiles has been offered. The results showed that isolate 6022 has the potential for controlling above mentioned pathogens so it can be the suitable alternative for chemical toxins. This method is simple for extraction of the secondary metabolites, under laboratory conditions and studied in Iran for the first time

Techno-functional properties of the selected antifungal predominant LAB isolated from fermented acorn (Quercus persica)

Improving the quality and shelf life of wheat bread using controlled novel sourdoughs is a promising biotechnology process. In the present study, after molecular identification of the selected antifungal predominant lactic acid bacteria (LAB) isolated from fermented acorn, the isolate was used as starter culture to produce controlled fermented acorn (CFA). Then the characteristics of wheat bread containing non-fermented acorn, controlled and spontaneously fermented acorn were evaluated in terms of textural properties, antioxidant capacity, in situ antifungal activity and overall acceptability in comparison with the control. Sequencing results of the PCR products led to the identification of Pediococcus acidilactici as the selected antifungal LAB isolate. The effect of controlled fermentation on production of bioactive ingredients from acorn was also verified using GC/MS analysis. Crumb texture profile analysis revealed the significant effect (P < 0.05) of acorn substitution on crumb hardness, porosity and loaf specific volume. DPPH radical scavenging activity was remarkably increased after addition of CFA. Surface growth of A. flavus on wheat bread containing CFA was also significantly lower than the other samples. Sensory acceptance of the supplemented bread didn�t show significant difference with control. Accordingly, wheat bread enrichment with CFA, not only improve its quality and shelf life but also increase its safety and techno-functionality characteristics. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage

&quot;n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Postpartum hemorrhage is a major cause of maternal mortality and morbidity. It has been identified that active management of third stage of labor is an effective way in preventing postpartum hemorrhage. This randomized controlled trial was conducted to compare sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage in nulliparous women.&quot;n&quot;nMethods: In this randomized controlled trial conducted in Arash hospital from 2006 to 2009, Five hundred forty two nulliparous pregnant women were enrolled. They were randomized to receive either 400 microgram sublingual misoprostol or 20 IU oxytocin intravenously, immediately after the birth of newborn. &quot;n&quot;nResults: Post partum Hemorrhage was significantly lower in women who received sublingual misoprostol (p&amp;lt;0.0001). Patients who received misoprostol had shorter length of third stage of labor (6.45 minute in misoprostol Vs 6.9 minute in oxytocin group, p=0.003). Comparison of hemoglobin levels in two groups before and after delivery showed that there is a significant lesser hemoglobin drop in misoprostol group p=0.046. Side effects were more common in misoprostol group (p&amp;lt;0.0001). However, they were not serious; shivering (35.66%) in misoprostol group and headache (9.63%) in oxytocin group were the most common adverse effects.&quot;n&quot;nConclusions: Sublingual misoprostol is more effective than intravenous oxytocin in preventing postpartum hemorrhage and is recommended for prevention of postpartum hemorrhage

Using Augmented Reality Technology to Optimize Transfacet Lumbar Interbody Fusion: A Case Report

The transfacet minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a novel approach available for the management of lumbar spondylolisthesis. It avoids the need to manipulate either of the exiting or traversing nerve roots, both protected by the bony boundaries of the approach. With the advancement in operative technologies such as navigation, mapping, segmentation, and augmented reality (AR), surgeons are prompted to utilize these technologies to enhance their surgical outcomes. A 36-year-old male patient was complaining of chronic progressive lower back pain. He was found to have grade 2 L4/5 spondylolisthesis. We studied the feasibility of a trans-Kambin or a transfacet MIS-TLIF, and decided to proceed with the latter given the wider corridor it provides. Preoperative trajectory planning and level segmentation in addition to intraoperative navigation and image merging were all utilized to provide an AR model to guide us through the surgery. The use of AR can build on the safety and learning of novel surgical approaches to spine pathologies. However, larger high-quality studies are needed to further objectively analyze its impact on surgical outcomes and to expand on its application