Multiple Sclerosis in Children: A Review of Clinical and Paraclinical Features in 26 Cases

ObjectiveMultiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system (CNS) that is increasingly being recognized as a disease affecting children. However, the clinical features of childhood MS at onset have been rarely reported from Asia.Materials & MethodsThis report presents a retrospective chart review of 26 patients with MS (20 females and 6 males), with an onset age of MS of less than 16 years, in the south of Iran between March 2001and November 2007; it documents researchers' experiencesResultsFemale/male ratio was 3:1. Mean age in females was higher than males (13 vs.12.16).The disease was highly variable in onset presentation; the most common initial symptoms were limb weakness, disequilibrium, and diplopia. Three patients had a positive family history of MS in their first degree relatives. VEP was abnormal in 9 of 19(47%). MRI demonstrated multiple plaques in the brain in 24(92%) cases. Relapse remitting MS was a dominant pattern noticed in 23(88%) cases.ConclusionMS, in childhood, is not as rare as commonly believed; although its diagnosis is essentially a clinical one, paraclinical investigations are of great value in the identification of demyelinating disorders in childhood. The disease, as it occurs in children, does not appear to differ clinically from the disease as observed in adults. If pediatricians should confront a child showing evidence of scatteredneurological deficits that remit, particularly weakness, disturbance of vision and co-ordination, they need to consider the possibility of MS. 

Human Umbilical Cord Blood Stem Cells Differentiate into Keratinocytes under In Vitro Conditions and Culturing Differentiated Cells on Bacterial Cellulose Film

Mesenchymal stem cells (MSC) are capable of self renewing and differentiating into other cell types. Human umbilical cord blood (HUCB) has been investigated as an alternative source to bone marrow. The aim of our examinations was to investigate MSC of HUCB could differentiate into keratinocytes under in vitro conditions. In this study, we examined the differentiation with chemical compounds, then to identify the stem cells are differentiated or not, PCR by using the expression of gene cytokeratin 18 was performed and to examine the proliferation characteristic of differentiated keratinocyte from HUCBMSCs, cultured them on cellulose film. Analysis of PCR confirmed the expression of cytokeratin 18 in keratinocytes; results of our study show that cellulose film isn’t a compatible substrate for differentiated keratinocytes. And growth factor, BMP4, with hydrocortisone and ascorbic acid with specific amounts is an appropriate induction factor for inducing of differentiation into keratinocytes

The Mid-Term Changes of Pulmonary Function Tests After Phrenic Nerve Transfer

Background: In the restoration of elbow flexion, the phrenic nerve has proven to be a good donor, but considering the role of the phrenic nerve in respiratory function, we cannot disregard the potential dangers of this method. Objectives: In the current study, we reviewed the results of pulmonary function tests (PFT) in four patients who underwent phrenic nerve transfer. Patients and Methods: We reviewed the results of serial spirometry tests, which were performed before and after phrenic nerve transfer surgery. Results: All patients regained Biceps power to M3 strength or above. None of our patients experienced pulmonary problems or respiratory complaints, but a significant reduction of spirometric parameters occurred after surgery. Conclusions: This study highlights the close link between the role of the phrenic nerve and pulmonary function, such that the use of this nerve as a transfer donor leads to spirometric impairments

Physico-chemical properties of water in shrimp hatcheries of Choebdeh (Abadan), south Iran

For assessing management efficiency in shrimp hatcheries of Choebdeh (Abadan), we surveyed the physico-chemical properties of water in two culture periods during the years 2001-2002. Different physical and chemical factors were measured in hatcheries under Thai and Philippine management methods. We measured factors such as salinity (17.9-35.3 ppt), BOD5 (6.12-8.72 ppm), DO (10.02-13.7 ppm), COD (4-98.9 ppm), NH3 (0-811A ppb), NO2 (10421 ppb), pH (8.04 -8.68), Turbidity (1-33 NTU), Ca (400.4-620.6 ppm), Mg (1104-1968 ppm), total hardness (6000-9400 ppm) and water temperature {25.4-32.4°C) while no amount of SH2 was found in the water samples. The results of this survey were compared with standard levels and safe ranges for aquaculture activities. Most factors were in standard range with only NH3 and NO2 showing a slight excess in some cases. An ANOVA test showed significant differences in levels of oxygen and COD of the tanks at different sampling times

In situ visualization of Ni-Nb bulk metallic glasses phase transition

We report the results of the Ni-based bulk metallic glass structural evolution and crystallization behavior in situ investigation. The X-ray diffraction (XRD), transmission electron microscopy (TEM), nano-beam diffraction (NBD), differential scanning calorimetry (DSC), radial distribution function (RDF) and scanning probe microscopy/spectroscopy (STM/STS) techniques were applied to analyze the structure and electronic properties of Ni63.5Nb36.5 glasses before and after crystallization. It was proved that partial surface crystallization of Ni63.5Nb36.5 can occur at the temperature lower than for the full sample crystallization. According to our STM measurements the primary crystallization is originally starting with the Ni3Nb phase formation. It was shown that surface crystallization drastically differs from the bulk crystallization due to the possible surface reconstruction. The mechanism of Ni63.5Nb36.5 glass alloy 2D-crystallization was suggested, which corresponds to the local metastable (3x3)-Ni(111) surface phase formation. The possibility of different surface nano-structures development by the annealing of the originally glassy alloy in ultra high vacuum at the temperature lower, than the crystallization temperature was shown. The increase of mean square surface roughness parameter Rq while moving from glassy to fully crystallized state can be caused by concurrent growth of Ni3Nb and Ni6Nb7 bulk phases. The simple empirical model for the estimation of Ni63.5Nb36.5 cluster size was suggested, and the obtained values (7.64 A, 8.08 A) are in good agreement with STM measurements data (8 A-10 A)

Complete improvement in a patient with multiple irreversible defects of the left ventricle on 99m technetium-sestamibi SPECT after percutaneous coronary intervention.

99mTc-sestamibi has been investigated as a potential viability marker; initial studies have shown good concordance between 201Tl and 99mTc-sestamibi activities in both viable and nonviable myocardium. However, assessment of myocardial viability by 99mTc-sestamibi remains controversial for tissue recovery after revascularization. Here, we present a patient with several regions of severely diminished and irreversible (defect persisting in both early and delay images of each set scanning) defects on initial scan which were dissolved completely on the follow up scan after an intervention. In a 75 year-old Asian woman with acute myocardial infarction who received thrombolytic therapy and subjected to percutaneous coronary angiography (PCI) on day 28 after acute myocardial infarction(MI), resting 99mTc-sestamibi SPECT was applied on day 4 (initial scan) and 138 (follow up scan) after acute MI at 30 and 180 min after injection of tracer (740 MBq); Two-dimensional echocardiography was carried out at the same time. On the initial image set, there was irreversible defects in the apex, anteroapical, inferoapical, anteroseptal, septal and also anterior walls, while the follow up image was normal in all regions.The angiography intervention showed just significant stenosis on left anterior descending (LAD) vessel (95). This may highlight the failure of 99mTc-sestamibi as a marker of myocardial viability and also mandate further validating of the procedure with follow up scan or other modalities for myocardial viability investigation

Comparing Blood Sugar Levels Measured by the Glucometer in Healthy and Crushed Fingers to Predict Gangrene in Tehran, Iran

Background: Crushed fingers are one of the most common reasons that patients visit the emergency centers for hand surgery, and based on the level of injury, it can cause many disabilities for patients. It is difficult to decide the treatment strategies (amputation, aggressive revascularization, immediate or delayed complex reconstruction and immediate conservative treatment) for crushed fingers. Objectives: The current study aimed to compare the blood sugar (BS) levels measured by the glucometer in healthy and crushed fingers to predict gangrene in patients referred to 15 Khordad Hospital in Tehran, Iran. Methods: This cohort study was conducted on 265 patients with crushed fingers referred to the emergency center of 15 Khordad hospital in Tehran, Iran, from March 2015 to March 2016. Blood glucose levels were measured by glucometer in the crushed fingers and in the finger of the opposite side at the same time and measurements were recorded. Data were analyzed using t-test and chi-square test with SPSS software version 22. Results: The results showed that 317 crushed fingers of 265 patients were ischemic based on the color, temperature, capillary refill time and pulse oximetry and accordingly the vascular reconstruction was not possible. Of 317 crushed fingers, 61 (19.24%) became gangrene (all with sugar levels lower than 37). The mean BS levels of the amputated and non-amputated fingers were 33.5 ± 1.52 and 111.04 ± 15.27 mg/dL, respectively. Therefore, there was a significant difference in the mean BS level between the patients with amputated and non-amputated fingers (P < 0.001). Conclusions: The lower levels of sugar in crushed fingers compared to healthy fingers can help to diagnose gangrene in crushed finger

Effect of selective heart rate slowing in heart failure with preserved ejection fraction

Background Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. Methods and Results We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [GraphicO2 peak] <80% predicted for age and sex). The result was compared with 22 similarly treated matched asymptomatic hypertensive volunteers. The primary end point was the change in GraphicO2 peak. Secondary outcomes included tissue Doppler–derived E/e′ at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; P<0.0001) and hypertensive (127 versus 145 bpm; P=0.003) cohorts. Ivabradine compared with placebo significantly worsened the change in GraphicO2 peak in the HFpEF cohort (-2.1 versus 0.9 mL·kg−1·min−1; P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Conclusion Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation