Evaluation of Association between Flu-Like Syndrome Induced by Beta Interferon Drug and Required Drug Response in Patients with Multiple Sclerosis

Background: Beta interferon is one of the important drugs for multiple sclerosis. Its common side effects are flu-like symptoms caused by drug injection. The purpose of this study was to evaluate the possibility of predicting the response rate of this drug based on the flu-like drug reaction.Materials and Methods: This case-control study performed in Loghman Hakim hospital in Tehran in 2017 and 110 patients with multiple sclerosis under beta interferon treatment studied. Patients were divided into two groups with and without flu-like drug reaction. A neurology resident according to the patient’s history and patient records filled in the questionnaires. The results of the two groups were compared by SPSS 16 software.Results: A total of 110 patients including 31 patients with flu-like drug reaction and 79 non-complicated patients were evaluated. These patients included 32 males and 78 females with an average age of 35.55 years. The mean duration of beta interferon use was 4.33 years in the case group and 4.34 years in the control group. Finally, a significant correlation between the flu-like drug reaction and the optimal response in the first year treatment was found (p=0.026). In addition, cause of drug discontinuation had significant correlation with presence of flu like drug reaction (p=0.028). There was no significant correlation between the disease annual attacks rate and flu like drug reaction.Conclusion: Flu-like drug reaction is a common complication of interferon beta drugs, which has a therapeutic difference in patients with and without this drug reaction

The Cost analysis of cervical cancer screening services provided by Damavand health center in 2013

Background: Today, the health sector in many countries is facing with severe resource constraints; hence it is absolutely necessary that cost-benefit and cost-effectiveness assessment have a major role in design of health services. The purpose of this study was to evaluate the cost-benefit and effectiveness of cervical cancer screening service (Pap smear test) done by the health centers in Damavand County in 2013.  Methods: This is a descriptive study with cross-sectional method. All data was extracted from existing documents in Damavand health network.Cost of service screening for doing Pap smear test (manpower costs of performing the service, the cost of transferring samples, water, electricity, telephone and gas) was estimated in all health centers then results, were compared with the incomes of this service.  Results: Screening program coverage was 22.3%, 6.9% and 6.05% in 2011, 2012 and 2013 respectively. All costs and incomes of units performing Pap smear screening test were calculated. Entire costs and incomes of this service during 2013 were respectively 303,009,000 and 11,640,000 RLS equal $12,227 and$496.73. Therefore, the cost-benefit ratio of this screening test was approximately 0.040.  Conclusion: The costs of units performing cervical cancer screening test in Damavand Health Center were much more than this benefit and because of a none-positive Pap smear test in spite of high cost, performing this test in Damavand health centers was not cost effective

Lifestyle assessment in two age groups of ischemic stroke: A cross-sectional study in Iran

  Background: Healthy lifestyle factors are associated with a lower risk of stroke. The current study aimed to describe lifestyle-related risk factors in ischemic stroke.   Methods: In this cross-sectional study patients with ischemic stroke in two age groups assessed for lifestyle. Demographic characteristics (age, sex, BMI, marital status, educational level, job type as low or full stress, living area), lifestyle habits, and past medical history in two age groups collected in the structured form by researchers. Chi-square (Fisher's exact) test for assessment of the statistical difference between categorical variables applied. Also, a multivariate logistic regression model was used to predict possible life-threatening lifestyles which can lead to stroke under the age of 50 (odds ratio, 95% confidence interval). All statistical tests were two-tailed and were performed with the use of PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc. P values <0.05 were regarded as significant.   Results: Totally, 11.2% of ischemic stroke cases were 50≥ years old. In the  multivariable logistic regression model higher BMI (P=0.02, OR =1.5, 95%CI=1.2 – 4.3), smoking (P<0.001, OR=1.8, 95%CI=1.08 – 2.56), alcohol drinking (P<0.001, OR=1.6, 95%CI=1.01 – 3.87), hookahs consumption (P<0.001, OR=1.2, 95%CI= 1.1 – 3.5) were predicting factors for ischemic stroke incidence in age ≤50 and only appropriate diet (low fat, sugar, salt, high fruits and  vegetables) (P=0.01, OR= 0.7, 95% CI= 0.04-0.87) was  preventive factors against stroke in age ≤50 years in compare with over 50.   Conclusion: Based on this survey many lifestyle factors effects the incidence of ischemic stroke in any age group. Therefore, periodic monitoring and effective in educating healthy people should be planned

Pituitary macroadenoma resulting from primary hypothyroidism: A16-year-old girl

Background: Primary hypothyroidism is a common medical condition. It can lead to pituitary adenoma which is usually asymptomatic, but it can also lead to symptomatic macroadenomas which are hard to diagnose due to different clinical presentations. Case presentation: A 16-year-old girl presented for endocrinology consultation prior to neurosurgical operation. She had galactorrhea which was accompanied by vertigo & low grade blurred vision without a headache and was diagnosed with pituitary macroadenoma and was planned for a surgery. She had TSH level of more than 100 mU/L, free thyroxine of 1.9 pmol/L. Her thyroid peroxidase (TPO) antibody level was 13.3 IU/mL, insulin growth factor-1 392 µ/l and serum prolactin level 42 ng/ml. During physical exam and with the laboratory findings, we suspected for a primary hypothyroidism as the leading cause of pituitary macroadenoma. As the result, we cancel the surgery and start levothyroxine therapy 100µg daily for her. In the follow-up it revealed that our diagnosis was correct and she went into remission with pituitary gland shrinking and decreasing TSH and prolactin levels. Conclusion: It is important to understand the different presentation of primary hypothyroidism to decrease the unnecessary risk of maltreatment in patients

Quality of Life in Acromegaly Disease Among Iranian Population:One Longitudinal Before-After Study

Background: The current study aimed to determine the quality of life (QoL) scores before and after treatment in patients with acromegaly.Methods: In this longitudinal before-after study, the acromegaly quality of life (AcroQoL) questionnaire was used to assess the QoL. Demographics, clinical manifestations and co-morbidity data, pituitary axis involvement, biochemical and hormonal component tests, and health-related quality of life (HRQoL) before and after treatment (endoscopic transsphenoidal surgery, medication, radiotherapy) were evaluated in patients over 18 years of age. To compare the mean of continuous data, the independent t and Mann–Whitney tests were used. To compare the mean QOL score before and after the study, the paired-t and Wilcoxon tests were performed. The significance level was set at p<0.05.Results: Among 80 patients with acromegaly who underwent trans-sphenoid surgery with or without radiotherapy or medication therapy with somatostatin analogs, 52 (65%) entered the remission phase within 6 months. Associations were found between the remission phase and female gender (p=0.004) and lower growth hormone (GH) (p=0.04) but not between remission and lower insulin-like growth factor-I (IGF1) after surgery (p=0.02) or gonadal axis disorder after treatment (p<0.001) statistically. Moreover, a significant association was found between not being in the remission phase and gonadal axis disorder before treatment (p=0.04). The QoL score in all dimensions of the AcroQoL questionnaire increased 6 months after treatment (p<0.001). Total AcroQoL score was higher after treatment in the remission group (p=0.03). The psychological scale had a significantly higher score both on the total scale (p<0.001) and on the two subscales of appearance (p<0.001) and personal relationship (p=0.003).Conclusion: Because of the importance of QoL in acromegaly patients, further studies in this field are recommended

Blood Lead Levels in Opium-Poisoned Children: One Cross-Sectional Study in Iran

Background: Lead poisoning is now more common due to accidental or intentional exposure to opiumimpregnated with lead. We aimed to determine the relationship between the blood lead levels (BLLs) andbasic characteristics in opium-poisoned children.Methods: In this cross-sectional study, 32 children younger than 13 years old who had been admitted toLoghman Hakim Poison Center, Tehran, Iran, due to opium poisoning, were evaluated for BLLs. Patients’demographics, symptoms, signs, and lab tests were evaluated as well as the BLLs.Findings: The median and range of age in children with opium poisoning were 14 and 141 months withminimum and maximum age of 3 and 144 months, respectively, and 62.5% were boys. Their mean BLL was9.78 ± 3.44 μg/dl and in 70% of opium-poisoned children, BLL was ≥ 5 μg/dl. There was a significantdifference between mean BLLs in girls and boys (17.07 ± 6.57 μg/dl in girls and 6.61 ± 3.22 μg/dl in boys,P = 0.02). We found a significant correlation between BLL and hemoglobin (Hb) level. In very low Hb level( 14 g/dl,BLL decreased again (P = 0.01).Conclusion: Although none of the children needed chelation therapy, strategies should be developed toprevent children from being exposed to opium and other materials impregnated with lead regarding itseffects on all organs of children

The prophylactic effect of hydroxychloroquine on the severity of COVID-19 infection in an asymptomatic population: A randomized clinical trial

Background: Laboratory and observational data suggest that hydroxychloroquine (HCQ) has biological activity against SARS-CoV-2, potentially permitting its use for disease prevention. This study aimed to evaluate the hydroxychloroquine effect as prophylaxis for SARS-CoV-2 infection. Methods: In this double-blind randomized controlled trial,  1000  healthy people without any signs and symptoms of COVID-19 were randomly assigned in a 1:1 ratio to receive either 800 mg hydroxychloroquine or placebo (four 200 mg tablets in two divided doses on day 1 of the first week, followed by 200 mg (in a single dose) weekly for the next 6 weeks). Results: Among 871 participants who remained and followed within 10 weeks 97(11.1%) became SARS-CoV-2 positive. there were statistically significant differences between infected or non-infected in the hydroxychloroquine (36 of 97 [37.1%]) and placebo (61 of 97 [62.9 %]) groups with a risk ratio of 2.1 (95% confidence interval (CI) 1.01 - 3.21; p = 0.005). The incidence of severe forms of COVID-19 ( hospitalized in the coronavirus ward or the ICU) was 2 of 97 (0.02 %) in participants who received a placebo compared to hydroxychloroquine. The proportion of non-infected people who received hydroxychloroquine prophylaxis was nearly twice higher than that of placebo users (1.87, 95% CI: 1.19 - 2.84, p = 0.05). There were no significant differences between the two groups regarding side effects (1.1% vs. 0.9%), and no severe adverse reactions were observed. Conclusion: Pre-exposure therapy with hydroxychloroquine appears to prevent moderate and severe illness caused by COVID-19 in asymptomatic persons

Effect the pre-exposure prophylactic of hydroxychloroquine on severe COVID-19 disease: a randomized controlled trial

Background. In vitro studies have shown some effects for Hydroxychloroquine (HCQ) against SARS-CoV-2 virus. Despite effective vaccination program, relatively large proportion of population remains unvaccinated. So, there still remains a need for other prophylactic measures. The present study aims to evaluate whether HCQ can prevent severe COVID-19 outcomes among health-care workers. Materials and methods. In this randomized, double blind placebo-controlled clinical trial 334 healthcare workers aged 18–65 years old were included of whom 278 individuals completed the study. Participants were randomly assigned to the HCQ group (800 mg at day one, followed by 400 mg weekly for the next 7 weeks); or the placebo group. Participants were followed three weeks after the last dose of drug or placebo (10 weeks from the first dose of drug or placebo). The primary outcome was hospitalization or death from COVID-19. Results. Of 148 people who received HCQ, none were hospitalized or died from COIVD-19, while of 130 people who received the placebo, 2 (1.5%) were hospitalized for COIVD-19 (p-value: 0.26). And, 22 (14.9%) people in the HCQ group and 15 (11.6%) people in the placebo group contracted COVID-19 (p-value: 0.99). Adverse reactions were reported by 5 (3.4%) of participants in the HCQ group and 5 (3.9%) of participants in the placebo group (p-value: 0.99). Conclusion. We found that HCQ has no significant prevention effect on the incidence of mild COVID-19. However, the low rate of hospitalization (the primary outcome) in this trial like most of the other clinical trials with HCQ would have required increasing the sample size considerably to be able to comment on the effectiveness of HCQ in prevention of severe forms including death rate. This justifies systematic reviews to include similar studies to further investigate the issue

Investigation of the Clinical and Diffusion-Weighted Brain MRI Findings in the Patients with Repeated Transient Stereotypical Neurological Deficit

Background and aim: Determine clinical and brain MRI findings in patients with repeated stereotypical TIA. Materials and Methods: Thirty-six patients with symptoms of repeated stereotypical TIA were performed MRI &amp; MRA. Result: Twenty patients had infarct that 14 cases had lacunar infarct and 6 cases had large infarct.Of these 20 patients, 12 cases had subcortical infarct and 8 cases had cortical infarct. Also, among 36 patients, 18 cases had artery stenosis. There is a significant relationship between artery stenosis and the presence of infarct.In addition, there was no significant relationship between infarct size and the size of the stenosed arteries. Conclusion: Most patients with repeated stereotypical TIA have infarct in DWI and they have a thrombotic cause and antiplatelet drug can be used instead of anticoagulants. &nbsp

Depression disorders rate and related factors in suicide attempters with drug or toxins

Background: Suicide is a complicated phenomenon which is influenced by the interaction of psychological and environmental factors. The aim of this study was to investigate rate of depression disorders in suicide attempters with drug or toxins in the Baharloo hospital, Tehran, Iran, duration 1394.Materials and Methods: In this cross-sectional descriptive study, Beck Depression standardized questionnaire and demographic/socioeconomic information form was given to 248 suicide cases with drug or toxins to fill completely. For analyzing the data, Chi- Square and Multiple logistic regression tests were executed by spss19.Results: In this study, from 248 cases hospitalized due to suicide attempt with drugs or toxins, 87.2% diagnosed with depressive disorders. In chi2 analysis there was significant association between depression disorders and these variables “married status (p=0.001), housewife (p=0.002), family monthly income below 10000000 Rials[1] (p=0.005), substance use (p=0.001), psychiatric disorders history (p=0.001)”. In full model multiple logistic regression analysis (total variables entered in model) we found significant association between depressive disorders and "   gender, woman (p=0.03, OR=6.2, 95%CI= 1.33-3.44), aged 25-15 years (p=0.002, OR=22.7, 95%CI= 3.16-154.9), married status (p=0.007, OR=10.2, 95%CI= 1.87-55.5), worker or self-employment (p=0.02, OR=15.66, 95%CI= 1.41-172.25), (p=0.02, OR=14.97, 95%CI= 1.32-162.5)  and family monthly income below ten million Rails (p&lt;0.001, OR=11.30, 95%CI= 3.16-40.8) ".  Also, family monthly income below 10000000 Rials (p&lt;0.001, OR=5.34, 95%CI= 2.05-13.91), married status and divorced or widow/widower (p&lt;0.001, OR=3.93, 95%CI= 11.5-33.74), (p=0.01, OR=3.27, 95%CI= 16.57-83.71), age 15-25 and 26-35 (p=0.02, OR=9.15, 95%CI= 2.32-36.08),(p=0.01, OR=5.34, 95%CI= 1.36-21.03) are predictor factors for depression disorders leading to suicide attempt.Conclusion: Future planning should focus on premature diagnosis of psychiatric disorders particular depression disorders because of first cause of suicide. This aim will be achieved through continuous consulting and following vulnerable cases.Keywords: Depressive disorders, suicide, drug or toxins