Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial

How to cite this article:Abbaskhanian A, Ehteshami S, Sajjadi S, Rezai MS. Effects of Piracetam on Pediatric Breath Holding Spells: A Randomized Double Blind Controlled Trial. Iran J Child Neurol Autumn 2012; 6(4): 9-15. Abstarct:Objective Breath holding spells (BHS) are common paroxysmal non-epileptic eventsin the pediatric population which are very stressfull despite their harmlessnature. There has been no specific treatment found for the spells yet. The aimof this study was to evaluate the efficacy of piracetam (2-oxo-l-pyrrolidine)on these children.Materials & MethodsIn this randomized double blind clinical trial study, 150 children with severe BHS referred to our pediatric outpatient service were enrolled from August2011 to July 2012. The patients were randomized into two equal groups.One received 40mg/kg/day piracetam and the other group received placebo,twice daily. Patients were followed monthly for three months. The numberof attacks/month before and after treatment were documented.ResultsOf the enrolled patients, 86 were boys. The mean age of the patients was17 months (range, 6 to 24 months). In the piracetam group, 1 month after treatment an 81% response to treatment was found. In the placebo group,none of the patients had complete remission and 7% of the cases had partialremission. Overall, control of breath-holding spells was observed in 91%of the patients in the group taking piracetam as compared with 16% in the group taking placebo at the end of the study. There wasd nosignificant difference detected between the groups regarding the prevalenceof drug side effects.ConclusionA significant difference was detected between piracetam and placebo in prevention and controlling BHS. Piracetam (40mg/kg/day) had a good effecton our patients. ReferencesDi Mario FJ Jr. Prospective study of children with cyanotic and pallid breath-holding spells. Pediatrics. 2001 Feb;107(2):265-9.Kotagal P, Costa M, Wyllie E, Wolgamuth B. Paroxysmal non epileptic events in children and adolescents. Pediatrics. 2002 Oct:110(4):e46.Kolkiran A, Tutar E, Atalay S, Deda G, Cin S. Autonomic nervous system functions in children with breath-holding spells and effects of iron deficiency. Acta Pediatric. 2005 Sep;94(9):1227-31.Hüdaoglu O, Dirik E, Yiş U, et al. Parental attitude of mothers, iron deficiency anemia, and breath-holding spells. Pediatr Neurol. 2006:Jul;35(1):18-20.Ahmad Bhat M, Ali W, Mohidin K, Sultana M. Prospective study of severe breath holding spells and role of iron. J Pediatr Neurol. 2007;5(1):27-32.Lombroso CT, Lerman P. Breath holding spells (cyanotic and pallid infantile syncope). Pediatrics. 1967 Apr;39(4):563-81.Gouliaev AH, Senning A. Piracetam and other structurally related nootropics. Brain Res Rev. 1994 May;19(20:180-222.Azam M, Bhatti N, Shahab N. Piracetam in severe breath holding spells. Int J Pschyiatry Med. 2008;38(2):195-201.Garg RK. Piracetam  for the treatment of breath holding spells. Indian Pediatrics.1998 Oct;35(10):1034-5.Donma MM. Clinical efficacy of piracetam in treatment of breath holding spells. Pediatr Neurol. 1998 Jan;18(1):41-5.Murata R, Matsuoka O, Hattori H, Kawawaki H, Nakajima S, Nakamura M et al. Efficacy of Kan-baku-taiso-to (TJ-72) on breath-holding spells in children. Am J Chin Med. 1988;16(3-4):155-8.Kelly AM, Porter CJ, Mc Goon MD, Espinosa RE, Osborn MJ, Hayes DL. Breath-holding spells associated with significant bradycardia: successful treatment with permanent pacemaker implantation. Pediatrics. 2001 Sep;108(3):698-702.McWilliam RC, Stephenson JB. Atropine treatment of reflex anoxic seizures. Arch Dis Child. 1984 May;59(5):473-5.Ashrafi MR, Mohammadi M, Shervin Badve R.        Efficacy of piracetam in treatment of breath-holding spells Iran J Pediatr. 2002;12(4):33-6.Daoud AS, Batieha A, al-Sheyyab M, Abuekteish F, Hijazi S. Effectiveness of iron therapy on breath-holding spells. J Pediatr. 1997 Apr;130(4):547-50.Ziaullah Nawaz S, Shah S, Talaat A. Iron deficiency anemia as a cause of breath holding spells. J Postgrad Med Instit. 2005;19(2):171-4.Di lanni M, Wilsher CR, Blank MS, Conners CK, Chase CH, Funkenstein HH et al. The effects of piracetam in children with dyslexia. J Clin Psychopharmacol. 1985 Oct;5(5):272-8.Wilsher CR, Bennett D, Chase CH, Conners CK, Dilanni M, Feagans L et al. Piracetam and dyslexia: effects on reading tests. J Clin Psychopharmacol. 1987 Aug;7(4):230-7.DiMario FJ Jr, Sarfarazi M. Family pedigree analysis of children with severe breath-holding spells. J Pediatr. 1997 Apr;130(4):647-51.Winnicka K, Tomasiak M, Bielawska A. Piracetam-an old drug with novel properties. Acta Pol Pharm. 2005 Sep-Oct:62(5):405-9.Winblad, B. Piracetam: a review of pharmacological properties and clinical uses. CNS drug rev. 2005 Summer:11(2):169-82

Factors Associated with The Incidence of Coronary Heart Disease in The Mashad: A Cohort Study

Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years\u27 follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population

Validity and reliability of the Persian version of the Brief Aging Perceptions Questionnaire in Iranian older adults

Leila Sadegh Moghadam,1,2 Mahshid Foroughan,1,3 Farahnaz Mohammadi Shahboulaghi,1,4 Fazlollah Ahmadi,5 Moosa Sajjadi,6 Akram Farhadi3 1Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 2Nursing Department, Gonabad University of Medical Sciences, Gonabad, Iran; 3Department of Ageing, University of Social Welfare and Rehabilitation, Tehran, Iran; 4Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; 5Nursing Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran; 6Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran Background: Perceptions of aging refer to individuals’ understanding of aging within their sociocultural context. Proper measurement of this concept in various societies requires accurate tools. Objective: The present study was conducted with the aim to translate and validate the Brief Aging Perceptions Questionnaire (B-APQ) and assess its psychometric features in Iranian older adults. Method: In this study, the Persian version of B-APQ was validated for 400 older adults. This questionnaire was translated into Persian according to the Wild et al’s model. The Persian version was validated using content, face, and construct (using confirmatory factor analysis) validities, and then its internal consistency and test–retest reliability were measured. Data were analyzed using the statistical software programs SPSS 18 and EQS-6.1. Results: The confirmatory factor analysis confirmed construct validity and five subscales of B-APQ. Test–retest reliability with 3-week interval produced r=0.94. Cronbach’s alpha was found to be 0.75 for the whole questionnaire, and from 0.53 to 0.77 for the five factors. Conclusion: The Persian version of B-APQ showed favorable validity and reliability, and thus it can be used for measuring different dimensions of perceptions of aging in Iranian older adults. Keywords: Brief Aging Perception Questionnaire, psychometric study, older adults, validit

يافته هاي الكتروكارديوگرافي مرتبط با ايسكمي ميوكارد در بيماران با علايم غير قلبي مراجعه كننده به اورژانس نمازي در سال 1397

Introduction: Silent myocardial ischemia is defined as the presence of objective evidence of cardiac ischemia in the absence of chest discomfort or one of the symptoms equivalent to angina. The aim of this study was to evaluate the electrocardiography (ECG) findings related to cardiac ischemia in non-cardiac patients with suspected silent myocardial ischemia referring to the emergency department. Methods: This retrospective cross-sectional study (March 2018-March 2019) was conducted on adult patients with non-cardiac complaints referring to the Emergency Department of Shiraz Namazi Hospital, southern Iran, with triage levels 1 and 2, who were suspected to have silent myocardial ischemia, and underwent ECG and two troponin tests after admission. Patients with trauma, triage levels 3-5, those with typical chest pain, and patients with diagnosis of ST-Elevation Myocardial Infarction (STEMI) were excluded from the survey. Demographic data, the results of two troponin tests, and cardiac ischemia-related findings on ECG, including ST depression and T inversion, were evaluated. Then, the data were statistically analyzed using SPSS version 16 and descriptive and analytical statistical tests. Results: Overall, 180 patients were enrolled. The mean (± standard deviation) of patients’ age was 69.3±15.01 years. 92 patients (51.1%) were male. ST depression and T inversion were found in ECG of 90 (50.0%) and 88 (48.9%) patients, respectively. ST depression and/or T inversion was observed in 168 (93.3%) patients. There was no statistically significant relationship between mean age, gender, and cause of referral with ST depression or T inversion. Two positive troponin test results were observed in 23 (12.8%) and both tests were negative in 59.4% of patients. There was no statistically significant relationship between having at least one positive troponin test and having ST depression or T inversion findings (P-value=0.56 and P-value=0.90, respectively). Conclusion: ST depression and T inversion were present in ECG of half of the patients. Two positive troponin and both negative tests were observed in 23 (12.8%) and 59.4% of patients, respectively. This finding indicates that the matching of ECG findings and multistage troponin test is great important in the final diagnosis of cardiac ischemia, however, ECG changes in patients with non-cardiac complaints do not necessarily is indicated the myocardial infarction.مقدمه: ایسکمی میوکاردی خاموش بعنوان وجود شواهد عینی از ایسکمی قلبی در غیاب ناراحتی قفسه سینه یا یکی از علائم معادل آنژين تعریف میشود. هدف مطالعه حاضر، بررسی یافته های الکتروکاردیوگرافی (ECG) مرتبط با ایسکمی قلبی در بیماران غیرقلبی مشکوک به ایسکمی میوکاردی خاموش مراجعه کننده به اورژانس بود. روش کار: مطالعه حاضر به صورت یک مطالعه مقطعی گذشته نگر (فروردین تا اسفند 1397) بر روی بیماران بزرگسال با شکایت غیرقلبی مراجعه کننده به اورژانس نمازی شیراز، در جنوب ایران با سطح ۱ و ۲ تریاژ و شک به ایسکمی میوکاردی خاموش انجام گرفت که برای ایشان ECG و دو نوبت تست تروپونین پس از ورود به اورژانس، انجام شده باشد.  بیماران ترومایی، سطح تریاژ 3-5، بیماران با درد قفسه سینه تیپیک، و بیماران با تشخیصST-Elevation Myocardial Infarction (STEMI) از مطالعه خارج شدند.داده های دموگرافیک، نتیجه دو نوبت آزمایش تروپونین و یافته های مرتبط با ایسکمی قلبی در ECG شامل ST depression و T inversion بررسی شد. تجزیه و تحلیل اطلاعات با استفاده از نرم افزار spss نسخه 16 و آزمون های آماری توصیفی و استنباطی انجام شد. یافته ها: در مجموع، 180 بیمار وارد مطالعه شدند. میانگین سن بیماران 01/15± 3/69 سال بود. 92 بیمار (1/51%) مرد بودند.ST depression  و T inversion بترتیب در ECG 90 (50%) و 88 (9/48%) بیمار یافت شد. وجود یکی از یافته های ST depression یا T inversion در 168 (3/93%) بیمار مشاهده گردید. بین میانگین سنی، جنسیت و علت مراجعه با داشتن ST depression یا T inversion ارتباط معنادار آماری دیده نشد. آزمایش مثبت تروپونین در هر دو مرحله در 23 (8/12%) و آزمایش هر دو مرحله منفی در 4/59% بیماران مشاهده گردید. بین داشتن حداقل یک نوبت تروپونین مثبت و داشتن یافته های ST depression و T inversion ارتباط معنادار آماری وجود نداشت (بترتیب P-value برابر با 56/0 و 9/0). نتیجه گیری: ST depression و T inversion در ECG نیمی از بیماران وجود داشت. آزمایش تروپونین دو نوبت مثبت و دو نوبت منفی به ترتیب در 8/12% و 4/59% بیماران مشاهده شد. این یافته بیانگر آن است که تطبیق یافته های ECG و آزمایش تروپونین چند مرحله ای در تشخیص نهایی ایسکمی قلبی از اهمیت بالایی برخوردار می باشد، اما تغيیرات ECG در بيماران با شكايت غيرقلبي حتما نشانگر انفاركتوس قلبي نيست

Abnormal tend of ferrite hardening in a medium-Si ferrite-martensite dual phase steel

Abstract In this paper, the effects of carbon, Si, Cr and Mn partitioning on ferrite hardening were studied in detail using a medium Si low alloy grade of 35CHGSA steel under ferrite-martensite/ferrite-pearlite dual-phase (DP) condition. The experimental results illustrated that an abnormal trend of ferrite hardening had occurred with the progress of ferrite formation. At first, the ferrite microhardness decreased with increasing volume fraction of ferrite, thereby reaching the minimum value for a moderate ferrite formation, and then it surprisingly increased with subsequent increase in ferrite volume fraction. Beside a considerable influence of martensitic phase transformation induced residual compressive stresses within ferrite, these results were further rationalized in respect of the extent of carbon, Si, Cr and Mn partitioning between ferrite and prior austenite (martensite) microphases leading to the solid solution hardening effects of these elements on ferrite