The Effects of Succimer and Penicillamine on Acute Lead Poisoning Patients

Background: Lead poisoning was on the rise in recent years. There exists a lack of easy access to some of the main chelator drugs in developing countries. Thus, this study aimed to explore the comparative effects of Succimer and D-Penicillamine on acute lead poisoning patients from 2013 to 2018. Methods: This descriptive study was conducted in the Clinical Toxicology Department of Khorshid Hospital in Isfahan City, Iran. Adult patients with acute lead poisoning were included in the study. Patients in the 3 treatment groups of D-Penicillamine, D-Penicillamine with succimer, and succimer were compared concerning demographic characteristics as well as clinical and laboratory findings at admission time and two weeks later.Results: In total, 163 patients were evaluated in this research. There was no significant difference between the treatment groups respecting improvement in clinical symptoms. The mean blood lead levels during hospitalization and two weeks after the treatment did not significantly differ between the three groups; however, there was a significant reduction in all study groups after two weeks of treatment (P<0.05). The mean white blood cell count was significantly lower only in the D-Penicillamine group two weeks after hospitalization (P<0.05). In the D-Penicillamine group, the mean platelet, hematocrit, and hemoglobin levels were significantly lower two weeks after hospitalization, although within the healthy range.Conclusion: D-Penicillamine may be an acceptable chelator drug for treating patients with acute lead poisoning, especially in communities without access to drugs, like succimer

Ampicillin-Sulbactam for the Treatment of Aspiration Pneumonia in Patients with Opioid Overdose: A Randomized Controlled Clinical Trial

Background: Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.Methods: In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.Results: Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550). Conclusion: The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin

Vitamin D receptor gene variants in Parkinson’s disease patients

Background: Vitamin D plays an important role in neurodegenerative disorders as a crucial neuro-immunomodulator. Accumulating data provide evidences that vitamin D receptor (VDR) gene is a candidate gene for susceptibility to Parkinson’s disease (PD).Aim: To find out whether the risk of the development of sporadic PD might be influenced by VDR gene polymorphisms in an Iranian population or not.Subjects and methods: A genetic study was conducted to investigate the relationship between VDR gene polymorphisms and the severity of PD. Fifty-nine PD patients and 53 matchedhealthy controls were genotyped using polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) analysis. For this purpose, four single nucleotide polymorphisms (SNPs) in VDR gene including FokI T > C (rs 10735810), BsmI A > G (rs 1544410), ApaI A >C (rs 7975232), and TaqI C> T (rs 731236) have been evaluated.Results: Our genotyping studies revealed that holding ApaI a allele and FokI f allele could significantly increase the risk of developing Parkinson’s disease 1.85 and 2.46 times, respectively (p= 0.023 and 0.008). Moreover, Aa heterozygous of ApaI also shows a significantly elevated risk of developing PD when compared to AA homozygous (OR = 7.44, p= 0.005). For BsmI and TaqI polymorphisms, no significant difference in genotype or allele distribution was found between PD patients and the controls. Moreover, in this study, no significant association was found between different genotypes and Hoehn & Yahr staging and Unified Parkinson Disease Rating Stage (UPDRS) rating scale.Conclusion: This study demonstrates a possible association between the VDR FokI and ApaI polymorphism and PD, indicating that VDR polymorphisms may change genetic susceptibility to sporadic PD in the Iranian population

Electrocardiogram Changes in Patients With Acute Ethanol Poisoning

Background: Alcohol consumption leads to a significant number of deaths, mostly in men, worldwide. Considering the effect of ethanol toxicity on the heart, we studied various Electrocardiographic (ECG) changes in patients with acute ethanol poisoning. Methods: A cross-sectional study was performed on patients admitted to Khorshid Hospital (affiliated to Isfahan University of Medical Sciences) due to ethanol poisoning. All 15- to 50-year-old patients with acute ethanol intoxication were included in the study (N=250). The patients’ information, including the demographic characteristics, clinical manifestations, and ECG changes were recorded and analyzed. Different variables were compared between the patients with or without ECG changes.Results: Most of the research patients (n=208) were men (83.82%). The Mean±SD age of the study patients was 26.8±8.87 years. About 54.8% of the patients presented abnormal ECG. The changes in ECG were not significantly different based on the demographic characteristic and clinical manifestations. The time interval between ethanol consumption and admission was significantly higher in patients with abnormal ECG, compared to those with normal ECG (Mean±SD: 7.09±10.67 vs. 4.77± 4.54 hours, respectively) (P=0.03).Conclusion: ECG changes are common in patients with ethanol poisoning. The time interval between ethanol consumption to hospital admission may be an important factor in the occurrence of ECG changes

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery

Study Design Randomized clinical trial. Purpose In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding. Overview of Literature Bleeding is the most significant complication in patients undergoing spinal surgery. Methods We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively. Results T-tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed (p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group (p =0.056). Diabetic females had the highest bleeding amount between the groups (p =0.03). Bleeding was higher in patients with higher BMI (p =0.02) and was related to operative time (p =0.001) in both the groups. Conclusions Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose

Evaluation of Seizure Frequency Distribution in Epileptic Patients with Normal and Abnormal Electroencephalogram in Al-Zahra Hospital of Isfahan

Background: Epilepsy is a chronic neurological disorder characterized by seizure recurrence in patients. Electroencephalogram (EEG) has a diagnostic and prognostic role in the management of patients. Studies have shown a significant relation between seizure recurrence and abnormal EEG in newly diagnosed epileptic patients, and people with first episode of unprovoked seizure. The aim of this study is to evaluate seizure frequency in chronic epileptic patients on drug therapy based on normal or abnormal EEG. Materials and Methods: This prospective cohort study examined seizure recurrence in 59 epileptic patients (50.8% generalized, 49.2% focal) with normal and abnormal EEG. Data were recorded in patient medical file, and patients were followed by telephone call or visiting by neurologist. Results: In this study, 59 patients with a mean age of 29.58 ± 10.37 years were assessed that 42.4% of them were males and 57.6% were females. Seizure frequency in patient with specific abnormal EEG was significantly more than other patients (specific abnormal: 78.9%, nonspecific abnormal: 45.5%, and normal: 31%, P = 0.005). Seizure recurrence in patients on polytherapy was significantly higher than others (polytherapy: 76.9% and monotherapy: 27.3%, P < 0.001). In patient with abnormal imaging seizure, frequency was more than other patients which was nearly significant (P = 0.054). Conclusion: Abnormal EEG and number of anticonvulsant drugs have a role in seizure recurrence in epileptic patients

The evaluation of Serum testostrone level in reproductive age women with multiple sclerosis and its relation with disease severity

Background: Multiple Sclerosis (MS) is the most common demyelinating disease. An autoimmune basis has been confirmed for pathogenesis of MS, and studies have shown that sex hormones such as testosterone may play a role in the disease mechanism. The purpose of this study was to survey these changes in MS patients. Materials and Methods: 31 MS patients were included in this cross-sectional study and matched with 60 healthy coses as control group. The serum testosterone level of both groups were randomly determined in follicular and luteal phases. Then the testosterone hormone levels and their correlation with the disease were studied. Results: In this study, testestrone level in patients was 0.461 ± 0.3 ng/ml in the follicular phase compared to controls with mean level of 0.82 ± 0.4 ng/ml(pv=0.011) .Mean testestrone level in female patients was 0. 58 ± 0.7 ng /ml in the luteal phase compared to controls with mean level of 0.88± 0.3 ng/ml (pv = 0.03). Patients with MS had significantly lower testosterone, in the follicular and luteal phase, but no relation with the disease was observed. Conclusion: Testestrone has a positive relation with MS. Further studies to determine the cause of relation and effect of endocrine system on MS pathogenesis and treatment are suggested

Frontotemporal dementia parkinsonism: Clinical findings in a large Iranian family

Frontotemporal dementia (FTD) is a group of neurodegenerative disorders characterized by atrophy of the frontal and temporal lobes. Clinical features suggestive of FTD include pre-senile onset before the age of 65, behavioral changes, social and interpersonal disinhibition, fluent and nonfluent aphasia, and loss of insight. FTD and parkinsonism linked to chromosome 17 (FTDP-17) was defined during the International Consensus Conference in Ann Arbor, Michigan in 1996. FTDP-17 is an autosomally dominant inherited condition. Most genotypic alterations do not correlate with clinical phenotypes. However, mutations affecting exon 10 splicing are associated with parkinsonism. In the present study, a male case with FTDP who presented with insidious onset of speech difficulty at a young age that was associated with signs of parkinsonism and a positive family history of FTD with MAPT gene mutation at exon 13 has been reported

The Role of Stem Cell Therapy in Multiple Sclerosis: an Overview of the Current Status of the Clinical Studies

The complexity of multiple sclerosis (MS) and the incompetence of a large number of promise treatments in MS urge us to plan new and more effective therapeutic approaches that aim to suppress ongoing autoimmune responses and induction of local endogenous regeneration. Emerging data propose that hematopoietic, mesenchymal and neural stem cells have the potential to restore self-tolerance, to provide in situ immunomodulation and neuroprotection as well as to promote regeneration. Thus in this article we will first provide an overview of the cell sources for, proposed mechanisms that contribute to the beneficial effects of stem cell transplantation and the ideal route and/or timing of stem cell-based therapies for each main stem cell group. Finally, we provide an overview of the current status of stem cell researches in clinical trial stages in MS by comparable and healthy therapeutic effects of different stem cells therapy in MS patients.   Keywords: Cell therapy and transplantation,  Hematopoietic stem cells, Mesenchymal stem cells, Neural stem/precursor cells, Stem cells

Time-Dependent Effect of Oral Morphine Consumption on the Development of Cytotrophoblast and Syncytiotrophoblast Cells of the Placental Layers during the Three Different Periods of Pregnancy in Wistar Rats

Previous studies have shown that morphine abuse during pregnancy cancause a delay in the development of the placenta and embryo and also bring about birth defects. The present study investigates the effect of the duration of maternal morphine consumption during pregnancy, as well as the impacts of morphine abuse on the development of placental layers during the three different periods of pregnancy in Wistar rats. Materials and Methodology. Female Wistar rats have been used in the present study. Experimental groups received morphine (0.05 mg/mL of drinking water) after one night of coupling with male rats for mating. On 9th, 10th, and 14th days of pregnancy, pregnant animals were killed, and placentas were removed and fixed. The cells of the placentas layers were calculated by light microscope and MOTIC and SPSS software. Results. The maternal surface thickness of the placenta was significantly increased, whereasthe fetal surface thickness of placenta was significantly decreased with morphine consumption with a time-dependent manner in experimental groups, compared to control groups. Moreover, the number of trophoblast cells increased in both maternal and fetal surfaces of placenta with respect to the duration of morphine consumption which was overt in the experimental groups compared to the control groups. Conclusion. In general, the time-dependent effects of oral morphine consumption can inhibit the development and natural functioning of cytotrophoblast and syncytiotrophoblast cells of the placental layers