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Hossein Pakdaman,1 Ali Amini Harandi,1 Koroush Gharagozli,1 Mehdi Abbasi,1 Majid Ghaffarpour,2 Farzad Ashrafi,1 Hosein Delavar Kasmaei,1 Asghar Amini Harandi3 1Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; 3Department of Biochemistry, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran Background and aim: Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD. Methods: In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results. Results: Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were –3.71 (±4.50) for MLC601 group and –9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p

Abstract Many COVID-19 survivors experience lingering post-COVID-19 symptoms, notably chronic fatigue persisting for months after the acute phase. Despite its prevalence, limited research has explored effective treatments for post-COVID-19 fatigue. This randomized controlled clinical trial assessed the impact of Amantadine on patients with post-COVID-19 fatigue. The intervention group received Amantadine for two weeks, while the control group received no treatment. Fatigue levels were assessed using the Visual Analog Fatigue Scale (VAFS) and Fatigue Severity Scale (FSS) questionnaires before and after the trial. At the study's onset, VAFS mean scores were 7.90 ± 0.60 in the intervention group and 7.34 ± 0.58 in the control group (P-value = 0.087). After two weeks, intervention group scores dropped to 3.37 ± 0.44, significantly lower than the control group's 5.97 ± 0.29 (P-value

Abstract Background Meningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis. Methods We extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study. Results Headache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens. Conclusions The most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.

Background Tumors are the second-most common cause of death after cardiovascular diseases. Brain tumors are really different regarding location, symptoms and signs. The aim of this study was to determine the prevalence of different primary brain tumors in Iran. Methods This cross-sectional study analyzed the medical records of patients with primary brain tumor referred to university hospitals between January 2016 and January 2017. By examining the hospitalization records, clinical symptoms, pathological and imaging findings, data was collected on age, sex, hand dominance, type of tumor, and the involved hemisphere. A chi-square test of independence was used to analyze the relationship between hand dominance and tumor grade. P-values less than 0.05 were considered statistically significant. Results In total, 1113 patients with brain tumor with mean age of 41.89 ± 18.06 years, including 708 males (63.6%), were studied in Tehran, Iran. The most common brain tumors were glioblastoma with a frequency of 330 (29.6%) and astrocytoma 183 (16.4%). The rarest tumor types are ependymoblastoma with a frequency of 14 (1.3%). Overall, 551 (49.5%) patients had left hemisphere and 459 (41.2%) had right hemisphere involvement. There was no significant relationship between hand dominance and tumor grade (p>0.05). Conclusion Brain tumors are more common in the fourth and fifth decades of life, and glioblastoma and astrocytoma tumors are the most common brain tumors. The sex distribution of these patients in the present study shows a higher prevalence in men. There was a significant relationship between the hand dominance in patients and contralateral hemisphere involvement.

In this paper, we calculate CNJ(p)(Lr(Ω,Σ,μ) and ... NJ(p)(Lr(Ω,Σ,μ) is a measure space and r > 1. [ABSTRACT FROM AUTHOR]

Abstract Volvulus appears with unusual symptoms in pregnancy and postpartum, and if the clinicians do not consider it, the patient becomes complicated quickly. It seems that volvulus may cause obstetrics complications such as preterm delivery.

Let C be a nonempty closed bounded (not necessary convex) subset of a Banach space X and let T : C → C be an (αβ)-nonexpansive mapping with α > 0, β > 0 and α + β < 1. In this paper, we show that T has a unique fixed point. Moreover, T is a Picard operator if and only if T is asymptotically regular. [ABSTRACT FROM AUTHOR]

In this paper, we obtain a generalization of a fixed point theorem given by Popescu [O. Popescu, Comput. Math. Appl., vol. 62, no. 10, pp. 3912-3919, 2011]. An example is also given to support our main result. [ABSTRACT FROM AUTHOR]

Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affect multiple organ systems including central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension (IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of SLE. Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O) with normal CSF indices. She also had normocytic, normochromic anemia, mild thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient's manifestation of IH. Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause and subsequently appropriate diagnostic tests should be performed. Keywords: SLE, IIH, Papilledema

Diverse studies suggest that interleukin-6 (IL6), as a member of cytokines family, has a major role in inflammatory processes of airways and lungs. In this study, an attempt was made to determine the serum level of IL6 in sulfur mustard (SM) injured patients and its comparison with controls. The measured IL6 mean level in patients with chemical injuries (0.76±0.3 ng/ml) was significantly higher than the control group’s mean level (0.34±0.12 ng/ml). Furthermore, patients with moderate to severe symptoms had a serum level of (0.95±0.92 ng/ml) which was significantly higher than mild (0.47±0.54) and control (0.34±0.12) groups. The outcome of this research program demonstrates that an increase in serum level of IL6 can have a role in pulmonary complications of SM, similar to other well defined pulmonary diseases. However, further studies are required to clarify the role and mechanism of IL6 in such patients.

Background: MLC601 is a possible modulator of amyloid precursor protein processing, and in a clinical trial study MLC601 showed some effectiveness in cognitive function in Alzheimer's disease (AD) patients. We aimed to evaluate the effectiveness and safety of MLC601 in the treatment of mild to moderate AD as compared to 3 approved cholinesterase inhibitors (ChEIs) including donepezil, rivastigmine and galantamine. Methods: In a multicenter, nonblinded, randomized controlled trial, 264 volunteers with AD were randomly divided into 4 groups of 66; groups 1, 2, 3 and 4 received donepezil, rivastigmine, MLC601 and galantamine, respectively. Subjects underwent a clinical diagnostic interview and a cognitive/functional battery including the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Patients were visited every 4 months, and the score of cognition was recorded by the neurologists. Results: There were no significant differences in age, sex, marital status and baseline score of cognition among the 4 groups. In total, 39 patients (14.7%) left the study. Trend of cognition changes based on the modifications over the time for MMSE and ADAS-cog scores did not differ significantly among groups (p = 0.92 for MMSE and p = 0.87 for ADAS-Cog). Conclusion: MLC601 showed a promising safety profile and also efficacy compared to 3 FDA-approved ChEIs.

Background: Growing bodies of evidence suggest that angiogenesis plays a crucial role in the development and progression of multiple sclerosis (MS). Vascular endothelial growth factor (VEGF) is one of the key factors involved in angiogenesis. Because of this importance, we investigated the serum levels of VEGF in MS patients according to their clinical phase and subtype of MS in this study. Material and Methods: This case-control study was done on 47 definite MS patients with the first clinical attack and 47 randomly selected individuals without any underlying inflammatory and autoimmune disease as the control group. The total serum VEGF level was measured from the subject's peripheral blood sample by ELISA during the first and second attacks of MS and 6 months after the first attack in the remission phase as well as the control group. In addition, the correlation between these variables and the influence of gender, age, and duration of the remission phase on such associations was evaluated by using the independent t test and Pearson's correlation coefficient. Results: There was an increase in the serum level of VEGF in all phases of MS compared with non-MS individuals (p value <0.0001) and a significant correlation between the serum level of VEGF and the interval between first and second attacks (r = −720, p < 0.0001). A higher serum level of VEGF in the first attack leads to higher VEGF levels in the second and sixth mount of remission phases. Conclusion: Rise in the serum VEGF level may be involved in MS's relapsing phases and a shorter remission phase. Therefore, it could be used as a prognostic and predictive biomarker for MS disease. [ABSTRACT FROM AUTHOR]

Background: The association of gastro-esophageal reflux (GER) with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR) in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40%) and the controls (6.7%) prior to anti-acid therapy (P < 0.0001). After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05) but did not change in the controls (P = 0.15). Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

Kidney transplant recipients are susceptible to various infections due to the use of immunosuppressive drugs. The present study was performed as studies on the prevalence of intes-tinal fungal and parasitic infections in kidney transplant recipients are limited. A total of 150 kidney transplant recipients and 225 matched immunocompetent outpatients, who were referred to the laboratory of Noor Hospital, Isfahan, were studied. After recording demographic characte-ristics, direct test and specific laboratory cultures were carried out on the stool specimens. Patients were instructed on sanitary rules and, during each medical visit, they were reminded of the same. The overall prevalence of intestinal parasitic and fungal infections was 33.3% and 58.7%, respec-tively, in transplant recipients and 20% and 51%, respectively, in the control group; the difference was not statistically significant. The most prevalent intestinal parasite was Entameba coli, which was seen in 9.3% of the study patients and 6.7% of the controls. The most prevalent fungus was Candida sp., which was seen in 22% of the study patients and 24.4% of the control group. Co-existing infection with two or more fungi was seen in 14.8% and 3.4% in the case and control groups, respectively; P

Carnitine deficiency is a commonly observed problem in maintenance hemodialysis (MHD) patients, which results in altered metabolism of fatty acids and subsequently development of dyslipidemia. To evaluate the effect of oral L-carnitine (LC) supplementation on lipid profile of adult MHD patients, we studied 30 of them (19 males, 11 females) who received LC supplementation of 250 mg tablets three times a day for eight weeks. They were compared with 30 matched patients as a control group. Serum lipid profiles were compared before and after the intervention between the two groups. There was a significant decrease of the values of the lipid profile in the intervention group before and after carnitine supplementation including the mean values of total cholesterol (190 ± 36.8 vs. 177 ± 31.2 mg/dL), triglyceride (210 ± 64.7 vs. 190 ± 54.1 mg/dL) and LDL-cholesterol (117 ± 30.1 vs. 106 ± 26.3 mg/dL), while the values did not change siginificantly from base line in the control group. However, the difference for HDL-cholesterol in intervention group was not statistically significant. None of the patients dropped out of the study due to drug side effects. Oral LC supplementation (750 mg/day) is able to improve lipid profile in patients on MHD. Further long-term studies with adequate sample size are needed to define the population of patients who would benefit more from carnitine therapy and the optimal dose and the most efficient route for administration of the drug.

Objectives: To determine the levels of vascular endothelial growth factor isoform consisting of 165 amino acids (VEGF165) in Bronchoalveolar Lavage Fluid from Mustard Exposed Patients.Methods: Bronchoscopy with Bronchoalveolar Lavage was performed on sulphur mustard exposed patients. A total of 39 patients with documented exposure to Sulfur Mustard during the Iran-Iraq war participated in this study, of which 38 patients were males and one patient was female.Results: The mean±SD age of patients was 41 ± 6.6 years. The mean time after exposure to sulfur mustard was 19 ±1.7 years. Eighteen patients had concomitant war injuries but they were not related to the respiratory system. While Twenty-two patients had a history of submassive persistent hemoptysis. There was no case with massive hemoptysis. Most of the patients had small airway obstruction (FEV1/FVC�0= 78.14 ± 9.76 and FEV1�0=82.79±18.23). Twenty-three patients had significant air trapping in the chest. High Resolution Computed Tomography was compatible with BOS. VEGF165 concentrations in BALF were 36.87 ± 34.68 pg/ml. When corrected to total protein of Bronchoalveolar Lavage Fluid (BALF) it was 0.76 ± 0.70 pg/mg. BALF of VEGF did not correlate with hemoptysis or air trapping in chest HRCT. Thus, there was also no correlation between level of VEGF165 in BALF and any of PFT indexes (FVC, FEV1, MMEF or PEF).Conclusions: Although VEGF is one of the cytokines which has an important role in chronic pulmonary disorders, it seems that it has no essential role in the severity of Mustard Lung Disease.

Sulfur mustard is one of the major potent chemical warfareagents. It was widely used against not only military personnelbut also civilian people of Iran during the last years (1984–1988) of the Iraq–Iran war. A number of studies were performedregarding the acute and long-term consequences ofsulfur mustard on respiratory system. Currently, many aspectsof leading respiratory disorder that was prescribed as “mustardlung” have been revealed. However, there is growing concernabout pathophysiological mechanisms behind the mustardlung. Herein available published materials about mustard lungare summarized, and it has been tried to highlight practicalpoints relevant to the diagnosis and treatment of the disease.Iran J Med Sci 2010; 35(4): 273-280.

In this paper, which is deeply inspired from Aussel and Hadjisavvas [On quasimonotone variational inequalities. J Optim Theory Appl. 2004;121:445–450] and Daniilidis and Hadjisavvas [Characterization of nonsmooth semistrictly quasiconvex and strictly quasiconvex functions. J Optim Theory Appl. 1999;102(3):525–536], we study the existence of solutions of the Stampacchia variational inequality for a quasimonotone set-valued vector field on a Hadamard manifold. Moreover, the existence results are obtained under weak assumptions like quasimonotonicity and upper-sign continuity. An application of our results is also given. [ABSTRACT FROM AUTHOR]