Epidemiology of Neuromyelitis Optica in the World: A Systematic Review and Meta-Analysis

Background. Neuromyelitis optica (Devic’s disease) is a severe autoimmune inflammatory disorder of the central nervous system. Epidemiological aspects of NMO have not been systemically reviewed. In this study we systematically reviewed and assessed the quality of studies reporting the incidence and/or prevalence of NMO across the world. Methods. A comprehensive literature search using MEDLINE, EMBASE, and Web of Science for the terms “Neuromyelitis optica,” “devic disease,” “incidence,” “prevalence,” and “epidemiology” was conducted on January 31, 2015. Study quality was assessed using an assessment tool based on recognized guidelines and designed specifically for this study. Results. A total of 216 studies were initially identified, with only 9 meeting the inclusion criteria. High level of heterogeneity amongst studies precluded a firm conclusion. Incidence data were found in four studies and ranged from 0.053 per 100,000 per year in Cuba to 0.4 in Southern Denmark. Prevalence was reported in all studies and ranged from 0.51 per 100,000 in Cuba to 4.4 in Southern Denmark. Conclusion. This review reveals the gaps that still exist in the epidemiological knowledge of NMO in the world. Published studies have different qualities and methodology precluding a robust conclusion. Future researches focusing on epidemiological features of NMO in different nations and different ethnic groups are needed

Evaluation and assessment of Iranian- Islamic housing indicators in old and new neighborhoods of Urmia city

Introduction     Perhaps housing can also Introduced as the main factor and objective of shaping skeleton and structure of the city, because firstly whatever of cities explicitly at citizenry possession, are homes and housing; secondary, home is a space for birth and growth and maturation of man at individual or among the family situation; Third, home is a place of activity establishment and growth of  family which that is the smallest social unit; Fourth, housing is the main and the most basic factor of identity of man and society and the basis of unification or vice versa Scattering of them (Naghi­zadeh, 2013).     Affordable Housing, is a housing that its features based on the cultural values and their regeneration and promotion in the society and toward the obliteration of self- alienation and return to itself; and cultural activities and the introduction of national identity and searching the special methods in format of qualitative policies and executive policies in it is necessary (Naghi­zadeh, 2012). Codification of housing basics by using the foundations of Iranian- Islamic architecture of the past decades and Islam monotheism worldview principles and also requirement of  pay attention to improving the quality of housing and transformation in methods of construction of buildings is inevitable (Naghizadeh & Asadzadeh Birjandi, 2013). Consideration to muslim housing in Islam is knot with insight to divine verses and this matter sacredness of the human living place. Sacredness that explain the unique features of good home and at muslim human dignity; that pay attention to each of them provide human heavenly and earthly bliss (Hoseini & Samimi, 2015).     City housing and residential context are as the main manifestation of appearance of Islamic values (because of filling major section of the city area) can be in the both of old and organic urban fabrics, that based on their period native and cultural conditions, and evolved over time and remained up to now and investigated and evaluated in new fabric of cities, which forms based on urbanism methods and new patterns. This research, look for two main objectives, firstly, analysis and assessment of the housing current status of old and new neighborhoods in Urmia city based on Islamic housing indicators, secondary, analysis and assessment of  Iranian- Islamic indicators status of old and new neighborhoods of Urmia city, so that this way able to achieve the strengths and weaknesses of observe of  Iranian-Islamic indicators with the matching of results.Data and Method            Islamic housing indicators classify in two categories of quantitative and qualitative. Quantitative indicators include: housing area, housing facades, housing quality, housing resistance and safety, housing orientation to the qibla, existence of green spaces in the neighborhood and qualitative indicators include: the use of natural light, comfort in housing, housing relation with nature, non- overlooking into housing, accessibility to housing. In the first stage, quantitative indicators were extracted through the library studies and in the next step housing quality indicators was evaluated through questionnaires. For this work, 330 number of questionnaires through Cochran formula was obtained that among residents of the studied neighborhoods were collected. Also, for weighting the Islamic housing indicators, 30 numbers of expert questionnaires were set, which 15 numbers of questionnaires were polled by experts of seminary courses and 15 numbers of questionnaires were polled by academic experts related to housing. AHP model also has been used for weighting the intended indicators by expert questionnaire. To analysis and assessment of the studied neighborhoods situation with the Islamic housing indicators and also for assessment of Islamic- Iranian housing indicators in the studied neighborhoods, TOPSIS method was used. After initial analysis and assessment of condition by using the output of TOPSIS, was proceed to the pathology and identify weaknesses of indicators, which finally was leaded to present solutions in order to reduce the problems related to having Iranian- Islamic indicators in the studiedneighborhoods.Results and Discussion            According to TOPSIS method results, Behdari neighborhood as one of the new neighborhoods of the Urmia city, with consideration of Iranian- Islamic indicators toward the Mahdi- al- qadam neighborhood, which that is one of the old neighborhoods of the Urmia city, is more favorable. With the return to the indicators, respectively determine that, resistance and safety, housing area, comfort in housing and overlooking have the greatest impact in undesirable position of Mahdi- al- qadam. In other words, having weakness of mentioned indicators in the Mahdi- al- qadam neighborhood has caused that this neighborhood toward the Behdari neighborhood placed in a lower position. Therefore, in planning for the Mahdi- al- qadam neighborhood its necessary that solutions be explained to improvement of indicator status. Also, according to the results presented in table number 3 that shows the ranking of indicators in neighborhoods, resistance and safety indicator has been ranked first. Comparison between situation of the Mahdi- al- qadam neighborhood and resistance and safety indicator shows having major weakness of mentioned indicator in Mahdi- al- qadam neighborhood.ConclusionConducted analyzes in this research showed that among the chosen indicators, overlooking indicator as the factor that covering visibility and Create privacy lies in itself, also it is important from the point of view of the Seminaries and academic experts, but unfortunately this indicator is among the weakest indicators in Mahdi- al- qadam and Behdari neighborhoods and needs more attention. In both neighborhoods, interesting point is located the resistance and safety indicator in the highest position among the other indicators, that shows favorable situation of this indicator among the other indicators. Also, the results of comparing two neighborhoods represents this point that Behdari neighborhood, with consideration of all Iranian- Islamic indicators, is in a more favorable situation toward the Mahdi- al- qadam neighborhood

Gabapentin induces edema, hyperesthesia and scaling in a depressed patient; a diagnostic challenge

Gabapentin is a common drug used as analgesic and anticonvulsant and also is prescribed for insomnia, depression, obsessive - compulsive disorder and panic attack. We report a case of a 48-year-old man who is prescribed gabapentin because of insomnia, headache, and depressed mood. In the first period of using the drug no complication has been seen. However in the next period, side-effects such as hyperesthesia, scaling and severe localized edema has been observed. After several laboratory tests and imaging, no reason was found for his edema. And after discontinuing gabapentin the pain and edema was quite relieved. We found out the brand of the drug has been switched in the second stage. The point which makes our study special is the incidence of side-effects such as severe edema, scaling and hyperesthesia for the first time because of using gabapentin and changing the drug combination

Mismanagement of a hypochondriacal patient

Hypochondriasis is a persistent preoccupation that despite appropriate medical evaluations and assurance of patient′s physical health, the patient insists on having a serious disease. The case which is discussed in this article is a 39-years-old woman that hospitalized for half of her life and no one can perceive her disorder according to her assertions. The mentioned case is a "difficult patient"with fear of oxygen shortage and being choked (Pnigophobia) which leads to continuous tendency to wear oxygen device even during sleep. There is no benefit in exaggerating her condition for herself so there is no fictitious disorder considered. During the therapy she has been assured that she does not have a serious disease and she has learnt to decrease oxygen intake and breath with his mouth. The point that makes this study different from the others is that most of hypochondriacal patients have a fear of getting HIV, cancers, hepatitis and MS but our patient has phobia of pulmonary embolism

Comparison of Common Monogenic Defects in a Large Predominantly Antibody Deficiency Cohort

Background: Predominantly antibody deficiencies (PADs) are the most common primary immunodeficiencies, characterized by hypogammaglobulinemia and inability to generate effective antibody responses. Objective: We intended to report most common monogenic PADs and to investigate how patients with PAD who were primarily diagnosed as suffering from agammaglobulinemia, hyper-IgM (HIgM) syndrome, and common variable immunodeficiency (CVID) have different clinical and immunological findings. Methods: Stepwise next-generation sequencing and Sanger sequencing were performed for confirmation of the mutations in the patients clinically diagnosed as suffering from agammaglobulinemia, HIgM syndrome, and CVID. Results: Among 550 registered patients, the predominant genetic defects associated with agammaglobulinemia (48 Bruton's tyrosine kinase [BTK] and 6 μ heavy chain deficiencies), HIgM syndrome (21 CD40 ligand and 7 activation-induced cytidine deaminase deficiencies), and CVID (17 lipopolysaccharides-responsive beige-like anchor deficiency and 12 atypical Immunodeficiency, Centromeric instability, and Facial dysmorphism syndromes) were identified. Clinical disease severity was significantly higher in patients with μ heavy chain and CD40 ligand mutations compared with patients with BTK (P = .003) and activation-induced cytidine deaminase (P = .009) mutations. Paralysis following live polio vaccination was considerably higher in patients with μ heavy chain deficiency compared with BTK deficiency (P < .001). We found a genotype-phenotype correlation among patients with BTK mutations regarding clinical manifestation of meningitis and chronic diarrhea. Surprisingly, we noticed that first presentations in most patients with Immunodeficiency, Centromeric instability, and Facial dysmorphism were respiratory complications (P = .008), whereas first presentations in patients with lipopolysaccharides-responsive beige-like anchor deficiency were nonrespiratory complications (P = .008). Conclusions: This study highlights similarities and differences in the clinical and genetic spectrum of the most common PAD-associated gene defects. This comprehensive comparison will facilitate clinical decision making, and improve prognosis and targeted treatment

Comparison of Common Monogenic Defects in a Large Predominantly Antibody Deficiency Cohort

Predominantly antibody deficiencies (PADs) are the most common primary immunodeficiencies, characterized by hypogammaglobulinemia and inability to generate effective antibody responses