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Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.

Purpose Vitamin D deficiency has been reported as a key factor in the development of infectious diseases such as respiratory tract infections and inflammatory processes like acute respiratory distress syndrome. However, the impact of vitamin D on the severity and outcome of COVID-19 is still not fully known. Herein, we aimed to evaluate the prognostic role of serum vitamin D concentration on the extent of lung involvement and final outcome in patients with COVID-19. Methods Seventy-three subjects with confirmed diagnosis of COVID-19 were investigated in this study. The patients had been admitted to our academic hospital from February 28, 2020 to April 19, 2020. Demographic and clinical data, serum 25(OH)D levels, and findings of initial chest computed tomography were recorded. Linear and binary logistic regression, cox regression and ROC curve tests were used for statistical analysis. Results The mean age of patients was 55.18 ± 14.98 years old; 46.4% were male. Mean serum 25(OH)D concentration was significantly lower in the deceased (13.83 ± 12.53 ng/ mL compared with discharged patients (38.41 ± 18.51 ng/mL) (P

Coronavirus disease 2019 (COVID-19) is a novel and highly contagious disease caused by Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Older adults and patients with comorbidities and immunosuppressive conditions may experience severe signs and symptoms that can lead to death. This case series assesses the clinical course, imaging features, and outcomes for 12 patients with COVID-19 and a history of kidney transplantation. Patients were evaluated for symptoms, laboratory data, imaging findings, and outcomes from February 2020 to April 2020. Fever, cough, and dyspnea were the most common clinical symptoms, noted in 75% (nine/12), 75% (nine/12), and 41.7% (five/12) of the patients, respectively. Most of the patients had a normal white blood cell count, while 33.3% (four/12) had leukopenia and 8.3% (one/12) had leukocytosis. A combination of consolidation and ground glass opacity was the most predominant (75%) pattern of lung involvement on computed tomography (CT). Eight patients died of severe COVID-19 pneumonia and acute respiratory distress syndrome and four were discharged. All recovered cases had a unilateral peripheral pattern of involvement limited to only one zone on initial chest CT. It seems that CT imaging has an important role in predicting COVID-19 outcomes for solid organ transplant recipients. Future studies with long-term follow up and more cases are needed to elucidate COVID-19 diagnosis, outcome, and management strategies for these patients.

Introduction: Stroke is one of the most devastating neurologic conditions in the world. Despite all the efforts that have been made for effective treatment, the prevalence of this medical condition is still high. One of the new methods in the treatment of patients is the use of low power laser and pulsed magnetic fields. The previous studies investigated the effectiveness of these methods individually. However, the present study aimed to investigate their effectiveness in combination. Methods: We divided the patients into control (n=26) and experimental (n=26) groups. The primary variables included the Mini-Mental State Examination (MMSE) and the National Institute of Health Stroke Scale (NIHSS). The experimental group received extremely low-frequency electromagnetic field (EMF-ELF) treatment with 1 mT power and laser in rejection with a wavelength of 840 nm for 5 days and 45 min/d. Results: The variable measured during this study, in addition to comparing the results of the intervention between the control and experimental groups, showed a significant difference in all indicators before and after the intervention. The mean and standard deviations of the modified Rankin scale (mRS), functional status (Barthel’s index), and cognitive status (MMSE) (PConclusion: Laser and magnetic field combination can be effective in the treatment of stroke. Further studies are recommended to ensure a better comparison.

Background Coronavirus infection is a novel respiratory disease affecting people across the world. Although the majority of patients present with fever, dyspnea, cough, or myalgia, various signs and symptoms have been reported for this disease. Recently, neurological symptoms have been noticed in patients with COVID-19 with unknown etiology. However, the occurrence of strokes in young and middle aged patients with COVID-19 is not fully explained. Methods In this series, six patients younger than 55 years of age with diagnosis of stroke and a confirmed diagnosis of COVID-19 were evaluated for symptoms, lab data, imaging findings, and outcomes from March 2020 to the end of April 2020 from all stroke cases in a tertiary academic hospital. Patients older than 55 and all others who had evidence of cardiac abnormalities (arrhythmia/valvular) were excluded. Results Fever, myalgia, cough, and dyspnea were the most common clinical symptoms noted in 66.66% (4/6), 66.66% (4/6), 50% (3/6), and 50% (3/6) of the patients, respectively. The mean ± standard deviation (SD) of National Institutes of Health Stroke Scale (NIHSS) for the patient was 10.16 ± 7.13 (ranged 5–24). The most involved area was middle cerebral artery (MCA) (five in MCA versus one in basal ganglia) and the majority of our patients had a low lung involvement score (mean ± SD: 13.16 ± 6.49 out of 24). Finally, one patient was deceased and rest discharged. Conclusion Stroke may be unrelated to age and the extent of lung involvement. However, different factors may play roles in co-occurrence of stroke and COVID-19 and its outcome. Future studies with long-term follow-up and more cases are needed to assess prognostic factors.

The corpus callosum (CC) is the major interhemispheric commissure and its abnormalities include agenesis, hypoplasia, and hyperplasia. The CC anomalies are typically related to other central nervous system (CNS) or extra-CNS malformations. The antenatal diagnosis of complete CC agenesis is easy after mid-trimester by ultrasound (US) even in the axial plane. The non-visualization of cavum septum pellucidum and colpocephaly are critical signs in the axial view. More subtle findings (i.e., hypoplasia and partial agenesis) might also be recognized antenatally. In this review, the focus was given on the prenatal diagnosis of CC abnormalities in US and magnetic resonance imaging.

The COVID-19 vaccination programs have sparked several concerns and ongoing debates over safety issues. Here, we presented three cases of patients with serious adverse events, encephalopathy; Vaccine induced thrombotic thrombocytopenia, and Leukocytoclastic Vasculitis, after receiving the ChAdOx1 nCoV-19 vaccine.

Cervical spine fractures are common fractures due to spine trauma. Odontoid fracture is responsible for 20% of cervical spine fractures. Vertebral artery injuries (VAIs) had widely focused in this setting due to its occurrence with upper cervical fractures. In our case of study, a 42-year-old female presented in the hospital’s emergency department with a history of cervical spine injury without neurological deficits. In further investigations, cervical spine X-ray, magnetic resonance imaging (MRI), and angiography were done to evaluate the possible injuries to the bone, spinal cord, and vascular structures surrounding the spine that eventuated in the accidental diagnosis of bilateral vertebral artery occlusion. This case of the study demonstrated the importance of diagnostic investigations that can evaluate in an emergency department and bilateral vertebral artery occlusion without neurological symptoms due to collateral arteries establishment.

Background: Neonatal seizure is a rare neurologic condition. The current study aimed at determining the etiology of neonatal seizure. Methods: The current study evaluated the data of 100 neonates who were hospitalized at neonatal intensive care unit (NICU) during 2015-2017. A pediatric neurologist made the final diagnosis of seizure. Patients’ medical records were used to review neonatal seizure variables. SPSS (version 16) was used to perform the statistical analyses. Results: The current study enrolled 100 newborns (41% female) admitted to the NICU following the first episode of seizure and the body temperature of 36.8-39.2°C (mean: 37.2°C). Of 100 participants, 94 (94%) had acute symptomatic seizure and 6 (6%) were compatible with neonatal epilepsy syndrome criteria. According to the results, the commonest etiologies were the neonatal encephalopathy and hypoxic-ischemic encephalopathy constituting 82% of participants. Conclusion: The consequences of acute symptomatic seizures in neonates are determined mainly by the etiology of the seizures. Seizure burden and use of anti-seizure drugs may also have some impact, but this has yet to be fully defined.

Background: The purpose of the current study is to estimate the incidence of epilepsy after neonatal seizure (NS) by reviewing of the latest studies on the relationship between NSs and epilepsy in newborns and also discuss risk factors may contribute to this relationship. Methods: A literature review was performed using the search terms "neonatal seizure AND epilepsy," "newborns AND epilepsy," "postneonatal epilepsy." After exclusion of several studies, which did not meet inclusion criteria, the epilepsy incidence rate was measured by dividing the number of all cases of epilepsy who had a history of NS in selected studies considered with the number of all newborns enrolled to the studies minus the number of cases who lost the follow-ups. Results: By reviewing the literature, 13 studies were found, which completely meet the inclusion criteria and published between 2009 and 2019, of which three were population-based while the remaining studies performed hospital-based. Overall, the population evaluated in these series has been estimated to be 2438 newborns of which 454 died, and 300 missed the follow-ups. The incidence rate for afterward epilepsy in all 1684 subjects with NS was 20%, literally 343 of the NS subjects. Conclusion: The presented review enrolled the most recent studies encompassing enough and extended the time as well as adequate sample size. Epilepsy is considered a common outcome of NS, particularly in those with other neurodevelopmental comorbidities, even if there were always several limits associated with various study designs and condition.

Purpose Due to a suggestive three-way relationship between brain structural disorders, microvascular lesions, and cognitive impairments, we aimed to examine the association of the volume and number of white matter hyperintensity lesions and lacunar infarcts with cognitive impairment among patients with cardiovascular risk factors in a sample of the Iranian population. Materials and methods This study was conducted on a total number of 156 normal subjects aged 30–74 years with cardiovascular risk factors. We used the Framingham general cardiovascular risk factors prediction model to calculate the likelihood of each risk factor. The total number of lacunar infarcts and the volume of white matter hyperintensity lesion were calculated in brain magnetic resonance imaging. Cognition status was assessed using the Montreal Cognitive Assessment questionnaire. Results An adverse association was revealed between Montreal Cognitive Assessment score and different cardiovascular risk profiles including the Framingham body mass index score ( p Conclusion Periventricular lesions are associated with impaired memory, language, and visuoconstruction while subcortical lesions are associated with impairment in naming, attention, language, and abstraction functions in normal subjects with cardiovascular risk factors but without cardiovascular or cerebrovascular disorders.

Hydatid cyst is one of the predominantly cystic liver lesions and is also a zoonotic disease that is highly endemic in the Mediterranean region. This condition has extensive differential diagnoses, such as hepatic mesenchymal hamartoma, a rare benign hepatic tumor, which commonly occurs in infants and children, and is extremely rare in adults. Its imaging findings vary from a cystic tumor to a solid mass occupying one or both lobes of the liver. We report an unusual case of a purely cystic mesenchymal hamartoma of the liver in a 60-year-old female patient. The patient had been treated with albendazole for several years; however, the final histopathology revealed mesenchymal hamartoma.

Background: Many problems in the diagnosis of patients with suspected appendicitis have led to the design of clinical scoring systems. In children, diagnostics tools for appendicitis are more critical. Younger patients, diagnostic challenges become more. Practical scoring systems are useful without any particular material and necessitate novel ability. Objectives: However, in spite of the reported outstanding consequences, these scoring systems are not employed regularly. Methods: In this cross-sectional study performed from October 2016 to October 2017, ten provinces out of the 31 provinces in Iran were randomly selected. A total of 631 patients referring to the hospitals with the suspicion of acute appendicitis were assessed. Related variables such as age, sex, right lower quadrant (RLQ) pain, migration of pain to RLQ, nausea, and presence of vomiting, anorexia, tenderness in RLQ and guarding, presence of rebound tenderness, and degree of fever were taken from recorded files by pediatricians. Alvarado scoring system was used for included cases to assess the accuracy of this test for diagnosis of appendicitis in our centers. Results: The mean age of eligible patients was 9.3 ± 3.21 years ranged from 3 years to 18 years, and 380 (60.5%) were male. Using the Alvarado score system in this study, considering the cut-off point value of 7 to decide for operation, the positive predictive value (PPV) showed 32.6%, and negative predictive value (NPV) was 76.73%, with a sensitivity of 44.05% and, specificity of 66.95%. There were statistically no significant correlations among the scoring of the Alvarado and diagnosis of AA (P < 0.05). Regarding receiver operator characteristic curves (ROC), the area under curve (AUC) was 0.58 (0.54 to 0.63) for Alvarado. The AUC was very low, so there was no value for the diagnosis of appendicitis. According to the findings of the present study, the cut-off point of 4.5 is suggested for the diagnosis of acute appendicitis in children with a sensitivity of 73% and specificity of 58%. Conclusions: Although the Alvarado scores supply obviously practical diagnostic information in the management of pediatric population with supposed appendicitis, this method delivers no adequate PPV for clinical practice as a safe way for determining necessary operation.

Background COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles. Methods All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID) DERR1-10.2196/23316

BACKGROUND COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. OBJECTIVE We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles. METHODS All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. RESULTS Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. CONCLUSIONS The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23316

Lumbar epidural analgesia is using widely as an alternative method for anesthesia. Although it has its benefits such as the low risk of complications in contrast with general anesthesia, also it has some adverse effects, for instance: headache, loss of consciousness, pneumocephalus, dizziness, and seizure. Pneumocephalus is a rare complication of lumbar epidural block. In this case of study, a patient represents stenosis in the site of anastomosis of colon and duodenum candidate for a repair surgery with the lumbar epidural block. Epidural catheter insertion was done in the sitting position; local anesthesia was administered at the 4th and 5th lumbar vertebral interspace. A 17-gauge Husted needle was inserted using the loss-of resistance (LOR) by air technique. Immediately the patient complained of headaches and then deteriorated to a tonic-clonic movement accompanied by post-seizure sleep, which ended up in termination of the procedure. The first-day CT-scan revealed multiple pneumocephalus. Supporting treatment was administered for 10 days; another CT-scan taken from the patient demonstrated improvement and the patient was discharged without any neurological deficit. Regional analgesia should be administered if possible under the superintendence of an expert, however, complications of an epidural catheter, such as accidental dural puncture, can postpone the recovery of the patient.

Background Researchers have recently focused on assessing the accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting pelvic lymph node metastases in gynecological malignancies. Purpose To evaluate the diagnostic value of DW-MRI in discriminating between metastatic and non-metastatic pelvic lymph nodes in endometrial cancer patients. Material and Methods This retrospective database study was conducted with 33 women aged 30–84 years with pathologically proven endometrial cancer that had been assessed by DW-MRI before their first treatment initiation at our referral hospital from March 2016 to April 2019. The diffusion technique (b = 50, 400, and 1000 mm2/s) was used in the imaging, and continuous apparent diffusion coefficient (ADC) metrics (ADCmin, ADCmax, ADCmean, ADCSD, and rADC) were compared between the metastatic and non-metastatic lymph nodes. Results In total, 48 lymph nodes from 33 patients were assessed. All metastatic lymph nodes were restricted, while among the non-metastatic lymph nodes, only 19.3% were restricted. Considering pathological reports of metastatic and non-metastatic lymph nodes as the gold standard, DWI-related restricted and non-restricted features had a sensitivity of 80.6%, a specificity of 100%, and an accuracy of 87.5% to discriminate between a metastatic and non-metastatic pattern. ADC metrics of ADCmin, ADCmax, ADCmean, ADCSD, and rADC showed high values enabling differentiation between metastatic and non-metastatic lymph nodes. The best cut-off values were 0.7 × 10−3, 1.2 × 10−3, 1.01 × 10−3, 123, and 0.78, respectively. Conclusion DW-MRI is a useful quantitative tool for differentiating between metastatic and benign lymph nodes in endometrial cancer patients.

Introduction: The first unprovoked seizure (FUS) in children is a convulsive seizure with an unknown cause, which may be due to an underlying neurological disease or a manifestation of epilepsy. Objective: The aim of this study was to evaluate the findings of brain magnetic resonance imaging (MRI) in pediatric patients with FUS, presenting to the emergency department (ED). Methods: In this cross-sectional study, all children with FUS (age: >1month and0.05). Conclusion: It may be useful to perform brain MRI for children with FUS presenting to ED, especially those who are suspected of developmental disorders.

The Radiologic Society of North America (RSNA) divides patients into four sections: negative, atypical, indeterminate, and typical coronavirus disease 2019 (COVID-19) pneumonia based on their computed tomography (CT) scan findings. Herein, we evaluate the frequency of the chest CT-scan appearances of COVID-19 according to each RSNA categorical group.A total of 90 patients with real-time reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 were enrolled in this study and differences in age, sex, cardiac characteristics, and imaging features of lung parenchyma were evaluated in different categories of RSNA classification.According to the RSNA classification 87.8, 5.56, 4.44, and 2.22% of the patients were assigned as typical, indeterminate, atypical, and negative, respectively. The proportion of "atypical" patients was higher in the patients who had mediastinal lymphadenopathy and pleural effusion. Moreover, ground-glass opacity (GGO) and consolidation were more pronounced in the lower lobes and left lung compared to the upper lobes and right lung, respectively. While small nodules were mostly seen in the atypical group, small GGO was associated with the typical group, especially when it is present in the right lung and indeterminate group.Regardless of its location, non-round GGO is the most prevalent finding in the typical group of the RSNA classification systems. Mediastinal lymphadenopathy, pleural effusion, and small nodules are mostly observed in the atypical group and small GGO in the right lung is mostly seen in the typical group.

Pyrite is considered as a disturbing sulfide mineral in the beneficiation of sulfide minerals and coal and in order to prevent floating of pyrite in the flotation, different inorganic, organic and biological depressants could be used. The most important organic pyrite depressants are starch, dextrin, guargum, carboxymethyl cellulose (CMC), ethylene diamine tetra acetic acid (EDTA), Diethylenetriamine (DETA). In this paper, flotation experiments were carried out by modified Halimond tube. At first, flotation experiments were performed to obtain optimal pyrite flotation condition (suitable collector and frother for maximum recovery). In optimal condition (collector: KAX + KIPX , 16 ppm; collector condition time: 4 min; frother: Poly Propylene Glycol (A65), 20 ppm; frother condition time: 30 s), pyrite recovery increased to 95.63%. Flotation kinetics experiments were performed and various kinetic models were evaluated on pyrite flotation. The results showed that flotation kinetics of pyrite is second-order. After obtaining optimal condition for flotation and kinetic studies, the effects of type and dosage of different organic depressants including starch, dextrin, guargum, carboxymethyl cellulose, EDTA and DETA at three concentrations (50, 100, 150 ppm) at neutral pH were comprehensively investigated. The results of the experiments showed that DETA can significantly reduce the recovery of pyrite at 150 ppm by 44%.

Background: Most nurses, especially operating room personnel, seems to be more likely to be affected by mood disorders than other social strata. The present study attempted to systematically review the prevalence of depression and its main determinants among operating room personnel in Iran. Methods: The method of this systematic review is documenting in a published protocol in the International Prospective Register of Systematic Reviews (PROSPERO) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. After this massive search, titles and abstracts of retrieved documents have screened and all irrelevant articles excluded. Two reviewers screened the documents and selected all relevant studies and assessed included articles separately. Results: Totally, 12 citations found in the initial literature search where four citations excluded, as they did not meet the inclusion criteria. The final number of studies available for analysis was 12 including a total of 373 operating room personnel (86 men and 287 women, mean the age of 27.71 years ranged from 20 to 36 years). The pooled prevalence of depression among operating room personnel was estimated to be 45.3%. In this regard, 27.0% of personnel suffered from severe depression. A significant heterogeneity found in the overall analysis of the overall prevalence of depression and its severe pattern. Conclusion: A notable number of operating room personnel in Iran suffer from depression even in its severe condition emphasizing the importance of the managerial approach to minimize its adverse effects on their performance as well as to improve their quality of life

Background: Previous studies have shown cycloserine to be neuroprotective in some neurodegenerative disorders. Objectives: To investigate the effect of cycloserine on motor function in Parkinson’s disease in a rat model. Materials and Methods: Fifty-six healthy male wistar rats were used in this study and were divided into seven groups according to receiving saline, low dose (i.e. 100 mg/kg) and high dose (i.e. 200 mg/kg) of cycloserine for a short period (i.e. 8 days) (groups A-C, respectively) or long period (i.e. 16 days) (groups D-F, respectively) in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-rat model of Parkinson. Also, a healthy group not receiving MPTP or any other drug was considered as the control group (group G). Apomorphine-induced rotational test (AIRT), elevated body swing test (EBST) and rotarod performance test (RPT) were done to examine behavioral performances. Results: Long-period treatment with cycloserine reduced MPTP-induced behavioral disturbances, i.e. net number of rotations in AIRT, net biased swing in EBST and reduced rotarod performance time in RPT, more than short period treatment. Although high dose of cycloserine was more effective than its low dose in reducing motor disturbance in initial trials of each test, long period treatment with low dose of cycloserine was similar to long period treatment with a high dose of it in reducing MPTP-induced Parkinsonism in EBST and RPT in latent trials. Conclusion: Long-period treatment with low-dose cycloserine seems to be the best option to obtain a sufficient neuroprotective effect for lowering motor disturbance in Parkinson’s disease.

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.

Background and Purpose: Cognitive impairment (CI) is one of the most notable disabilities of Parkinson’s disease that is associated with lower quality of life. Early detection of CI is therefore very important for these patients. The purpose of this study was to examine the relationship between cognitive function and the metabolic data from magnetic resonance spectroscopy (MRS) of the patient suffering with Parkinson’s disease. Methods: Totally, 45 patients with Parkinson’s disease were used in this study. Subjects were divided into three groups based on scales for outcome from Parkinson cognition (SCOPACOG) test. Patients were classified as non-cognitive impairment (NCI; n=15), mild cognitive impairment (MCI; n=15) and dementia (PDD; n=15). All subjects underwent MRI and 1 H-MRS techniques and metabolic changes such as NAA/Cr and NAA/Cho ratios, which were measured in the left hippocampal area of the brain. Results: The mean and standard deviation of the NAA/Cr ratio in the three cognitive groups (NCI, MCI, PDD) were (2.51±0.037), (2.50±0.033) and (2.47±0.025), respectively. ANOVA test showed a significant difference in the three groups. Furthermore, the Scheffé test showed a significant difference between patients in the MCI and PDD groups (p=0.01). There was no significant difference between the non-cognitive impairment and mild cognitive impairment groups (p=0.54). No significant difference was found in NAA/Cho ratio (p=091). Conclusion: A decreasing NAA/Cr ratio has influence on cognitive function and the development of severe cognitive dysfunction in Parkinson suffering patients. Furthermore, 1 H-MRS determinant can be useful to evaluate cognition in Parkinson patients.

Background: Parkinson disease (PD) introduced as the second most prevalent neurodegenerative disease following Alzheimer disease. A patient’s nutritional status may be compromising in PD. This study aimed to describe the outpatient nutritional status in patients with PD at a third-level hospital in Iran. Methods: The validated Persian version of the Mini-Nutritional Assessment (MNA) questionnaire was used to evaluate the nutritional status of 158 Iranian PD patients (age, 35-85 years). The exclusion criteria were as follows: chronic comorbidities affecting the nutritional status (e.g., diabetes and hypertension); adherence to special diets; and cognitive disorders. Based on the MNA questionnaire, a total score below 17 represented malnutrition, while scores 17-24 indicated a risk of malnutrition. Results: Based on the findings, 26% of the participants had low weight, 67% of whom were over 65 years. According to the MNA questionnaire, 14.3% of the participants showed malnutrition and 26.2% were at risk of malnutrition. Conclusion: Based on our findings, PD can contribute to reduced nutritional status. More than onefourth of the PD population was at risk of malnutrition, which highlights the need for more attention towards nutritional assessment. Nutritional assessment is essential for the development of nutritional interventions and early detection of PD patients who are at risk of malnutrition.

The current knowledge on how to use stem cells therapeutically for improving motor function in patients with cerebral palsy is growing. The present review aimed at assessing clinical trials related to beneficial effects of stem cells in patients with cerebral palsy. Electronic searches including “stem cell” and “cerebral palsy” as keywords were conducted using PubMed, Ovid, Web of Science, Scopus, Cochrane library, and CINAHL till February 2016. Two assessors reviewed the methodological quality and eligibility of the retrieved articles, independently. Among 77 studies initially reviewed based on the keywords, only 6 clinical trials were identified that met the inclusion criteria. Pooled response rate of stem cell therapy to treat cerebral palsy was estimated by assessing the percentage of improvement with a gross motor function classification system score. The resulting pooled estimate indicated a 30.7% (95% CI: 25.80% to 35.69%) increase in the score, 1 to 6 months after cell transplantation. In this regard, the test for heterogeneity was statistically significant (I2 = 87.9%, χ2 = 41.22, P < 0.0001). Stem cell therapy has the potential to improve motor function in patients with cerebral palsy. However, promising results from limited studies warrant further research.

Background and purpose: Progressive degeneration of dopaminergic neurons in the midbrain is the main mechanism of Parkinson’s disease (PD). Although potassium channels affect neural activity and death in this area, little research has investigated the effect of potassium channel blockers, such as 4-aminopyridine in the pretreatment of PD. Methods: Fifty-six healthy male Wistar rats were selected for this study. They were divided into seven groups according to receiving saline or 4-aminopyridine, receiving a low or high dose of 4-aminopyridine and receiving 4-aminopyridine for short or long periods. Apomorphine-induced rotational test, elevated body swing test and rotarod test were done to examine behavioral performances. Results: 4-aminopyridine could not completely block behavioral disturbances induced by MPTP, however, it decreased them in all behavioral tests. Long administration of 4-aminopyridine was more effective than short administration in lowering behavioral disturbances. Although high dose of 4-aminopyridine was more effective than low dose in initial trials of each behavioral test, there was no difference between them in the last trial. Conclusion: Long administration of low dose of 4-aminopyridine is the best way to lessen behavioral disturbances induce by MPTP and also avoiding side effects of high dose of 4-aminopyridine.

Background and purpose: Cognitive impairment (CI) is one of the causes of disabilities in multiple sclerosis patients (MS). Therefore, early detection and evaluation of cognitive performance is very important in patients with MS. The aim of the present study is to compare Montreal Cognitive Assessment (MoCA) test and Mini Mental Status Exam (MMSE) in Relapsing Remitting (RR) MS patients. Methods: Fifty RRMS patients who met inclusion and exclusion criteria were recruited in this study. MMSE and MoCA were administrated to all subjects. Also demographic data, disease duration and EDSS were recorded. The results of both tests were compared. Results: The mean score of MoCA and MMSE was 22.86±3.85 and 27.64±2, with a significant difference (p

Background and Purpose: The increased risk for cognitive defects in individuals affected by metabolic syndrome especially in those patients with cardiovascular disorders is now claimed. We aimed to assess the relationship between cognitive performance and the various components of metabolic syndrome. Methods: One hundred and eighteen consecutive individuals aged 30 to 86 years were included into this cross-sectional survey. The metabolic syndrome and its definitive components were defined according to the definition described in the Framingham Heart Study by NCEP ATP III criteria. The Montreal Cognitive Assessment (MOCA) questionnaire was employed to cognitive screening. Results: Those patients with metabolic syndrome had significantly lower mean MOCA score compare to the group without metabolic syndrome (19.11 ± 5.49 versus 21.28 ± 4.56, p = 0.021). Among all cognition sub domains, the mean attention score was significantly lower in the group with metabolic syndrome than in another group. In a multivariate linear regression model adjusting sex and age variables showed that the presence of metabolic syndrome could effectively predict cognitive impairment (beta = -2.202, SE = -0.214, p = 0.013). Conclusion: The presence of metabolic syndrome can be mainly related to damaging cognition especially impairing the power of attention.

Background and Purpose: Because of well-established role of obesity in brain lesions, progressing cognitive deficits in obese patients has been recently suggested. In current study and for the first time, we aimed to assess cognition status in Iranian obese people and to compare it with non-obese individuals. Methods: One hundred and eighteen consecutive patients with the different cardiovascular and metabolic primary complaints were assigned to obese group (n=25, 21.2%) and non-obese group (n=93, 78.8%). Cognitive status was assessed at initial visit using the Montreal Cognitive Assessment (MoCA) questionnaire. Results: Mean of total cognitive score in obese patients was 20.04±4.57 and in non-obese ones was 20.19±5.32 with no difference (p=0.886). In total, 8.0% of obese patients and 20.4% of non-obese patients had normal cognitive function (p=0.149). No significant difference was also found in different subdomains of cognitive ability between obese and non-obese groups. None of the cognitive domains had significant association with BMI as the considered indicator for defining obesity. Based on multivariate linear regression modeling, obesity could not predict cognitive deficit (beta=0.034, SE:1.10 p=0.973). Conclusion: Our survey could not demonstrate an association between obesity and cognitive impairment in a sample of Iranian patients.

Imerslund-Grasbeck syndrome (IGS) is a rare syndrome characterized by clinical symptoms and signs of Vitamin B 12 deficiency and proteinuria. Our patient was a 5-year-old boy with pallor, lack of appetite, and low weight gain. Laboratory studies showed severe macrocytic anemia, normal reticulocyte count, negative direct coombs test, normal osmotic fragility, and autohemolysis test. He has had intermittent proteinuria since 3 years ago despite normal creatinine level and absence of hematuria or hypertension. Finally, based on low level of serum B 12 vitamin and normal folate level accompanied by asymptomatic proteinuria, the diagnosis of IGS was made. Furthermore, his sister has had laboratory abnormalities without any symptoms. IGS responded to B 12 replacement therapy dramatically but intermittent proteinuria persisted even after appropriate therapy.

Body stuffing is defined as ingestion of unpackaged or packaged illicit drugs in a quick process. The drugs have usually been wrapped loosely in cellophane, plastic bags, paper, or aluminum foil. Methamphetamine toxicity is a dangerous state that occurs during methamphetamine leakage from the ingested packages in the gastrointestinal tract. This is usually occurring with cocaine and heroin, but methamphetamine body stuffing may less commonly happen, as well. Accordingly, management of methamphetamine body-stuffers is an important subject that has remained a controversy in clinical and legal aspects. We have reported two body-stuffer cases who underwent exploratory laparotomy. Although surgery was done, it was not useful to exit packs and even led to severe methamphetamine toxicity. These cases show that surgical treatment may be ineffective and even harmful in body-stuffers. On the other hand, this report suggests that pre and post-operation abdominal CT-scan is necessary for evaluating surgical treatment in patients who are still symptomatic.

Cerebral stroke is a rare disease in children. Moyamoya (MM) is one of the infrequent cerebrovascular diseases with unknown etiology. We report an 8 year-old-boy with chief complain of sudden onset bilateral parietal lobe headache. He mentioned that his headache was first started about three weeks ago and was associated with visual disturbance. His mother declared that the boy developed gait problems few days later and only could walk with assistance. He was diagnosed with MM disease. After, medical treatment his symptoms were mildly improved and because of his family disagreement cerebral revascularization surgery was not performed.

Background: Herpes virus group can persist in the latent form in the body, Pneumocystis jerovecii, on the other hand, is a fungus which is ubiquitous in the respiratory tract of mammals, with 90% of adult human beings possessing antibodies to this organism. Concomitant presence of different microorganisms, may result in one microorganism altering the activity of another. Objectives: To determine the frequency of 5 latent Herpes viruses and Pneumocystis jirovecii and to ascertain the rate of concomitant presence of these microorganisms in saliva of healthy children. Patients and Methods: This cross-sectional study was performed on 150 immune-competent children 1 to 15 years old visited in the outpatient clinics at a university-affiliated children’s hospital from 22nd May to 21st August 2011. Samples of saliva obtained from the children were subjected to DNA extraction by polymerase chain reaction. Results: At least one microorganism was isolated from saliva of 148 children, (98.6%). In 13 cases only 1 microbe was detected, (8.6%), 2 pathogens were isolated from 24 children, (16%), 3 from 20 cases, (13.3%), 4 from 54 individuals (36%), and 5 from 37 subjects (54.4). HSV was the most frequent organism detected in 80.7%, and P. jirovecii the least frequent, (32.7%). Other viruses were HHV6, 66.7%, CMV 66.0%, HHV7 64.7%, and EBV 37.3% in order. No significant difference was found in the frequency of microorganisms in the two sexes or in different age groups, except for CMV which was significantly less frequent in age group of 6-10 years (P value = 0.001). Regression analysis revealed an association between HHV6 and HHV7 (OR = 1599.4; P value < 0.001); a correlation was also found between EBV and CMV (OR = 3.1; P value = 0.012). In contrast, a negative correlation was found between P. jirovecii and three viruses of the Herpes virus group including EBV (OR = 0.27; P value = 0.006), HSV1 (OR = 0.36; P value = 0.028), and CMV (OR = 0.48; P value = 0.075). Conclusions: Shedding of latent Herpes viruses and concomitant presence of multiple inactive micro-organisms is common in saliva of immune-competent children.

Background Tranexamic acid (TXA), a synthetic antifibrinolytic drug, is effective as a treatment for serious hemorrhage, including bleeding arising from major trauma and post-operative interventions. Significant acute gastrointestinal bleeding may have a poor outcome despite routine medical and endoscopic treatments. The aim of this study was to assess whether early intravenous and/or intravenous plus topical administration of TXA reduces the need for urgent endoscopy for acute gastrointestinal bleeding. Method This double-blind randomized clinical trial included 410 patients with proven acute gastrointestinal bleeding. All patients received conventional therapy. The subjects were randomized to three groups: (A) 138 patients received intravenous TXA (1 g q6h); (B) 133 patients received topical TXA (1 g single dose by nasogastric tube) plus systemic TXA; and (C) 139 patients received a placebo (sodium chloride 0.9%) for 24 hours. Subgroup statistical analyses were conducted for urgent endoscopy, mortality, re-bleeding, blood transfusion, endoscopic and/or surgical intervention rates, and health status. Results The time to endoscopy was significantly shorter in group C (15.58 ± 7.994, p Conclusions Our results showed that the antifibrinolytic properties of TXA can aid in changing an urgent endoscopy to an elective procedure, with better outcomes for both physicians and patients.

Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a patient's life, including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objective measures but its impact on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsing-remitting MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international quality of life (MusiQoL) questionnaires.Four hundred recruited RRMS patients were treated with human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen's d effect size. The relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson correlation coefficients.Three-hundred and eighty three completed the study. Two-hundred and thirty nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was -0.16 and SF-36 physical component and mental component showed overall effect sizes of -0.28 and -0.53, respectively. Mean (range) EDSS change was 1 (1-4). Three-hundred and seventy four were clinically stable with mean (range) EDSS change of 0.1 (-2-0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF-36.We found that, HRQoL did not change significantly over the first year of therapy. Furthermore, decreases in HRQoL were inversely correlated with increases in EDSS score.

Amyloidosis is an extracellular deposition of abnormal serum proteins. Systemic amyloidosis could involve different organs such as the spleen, liver, and kidneys. Renal artery microaneurysm is very rare in renal amyloidosis. We report a 44-year-old woman who was referred to our general hospital for evaluation of rising serum creatinine level, anemia, and pathological fracture. Two hours following renal biopsy, she developed severe pain in the left flank during voiding and ultrasonography revealed a large perinephric hematoma. She underwent angiography that incidentally showed pseudoaneurysm with diffused renal artery microaneurysm. The feeding artery to the pseudoaneurysm was completely ligated by an interventional radiologist. The subsequent histopathological report of the kidney revealed amyloidosis.

Background: Magnetic resonance imaging (MRI) plays a critical role in diagnosis of multiple sclerosis (MS) and detecting brain changes during the course of the disease, but many aspects of MR Imaging such as its relationship with MS disabilities has remained unrecognized yet. One of the MS disabilities is cognitive impairment (CI), with an incidence of about 45% to 60%. Objectives: The purpose of this study was to examine the relationship between cognitive function and the volume of the brain lesions by assessing some of the sub-items of cognition. Patients and Methods: We assessed cognition using the Montreal Cognitive Assessment (MoCA) Test and brain changes in 46 MS patients in whom brain changes were detected with 1.5 tesla MR Imaging. Brain lesions were classified in three regions consisting of juxtacortical, periventricular and infratentorial. Lesion volumes were estimated using MIPAV software. We used SPSS 20 for data analysis. Also, we classified patients according to age, gender, and education. Results: There were no significant correlation between total lesion volumes and MoCA score. But significant correlations between total lesion volumes with visuospatial/executive function were found in persons with higher education. Conclusions: White matter lesion volumes have influence on some of the cognition sub-items in MS patients. Furthermore, MRI determinants can be useful for clinicians to evaluate cognition in MS patients.

Kennedy disease is a rare X-linked neurodegenerative disorder that affects patients in 30-50 years of age. It is caused by CAG-repeat in androgen receptor gen. There is no known effective treatment for Kennedy disease. We report a 60-year-old man who had fasciculations and proximal and distal muscle weakness. Physical examination showed involvement of the bulbar musculature accompanied by tongue atrophy and perioral muscle weakness. Furthermore, he had bilateral gynecomastia. Laboratory and imaging findings were normal, except electromyography that showed chronic proximal and distal denervation. Finally, the patient diagnosed with Kennedy disease according to clinical presentation and EMG abnormality that confirmed with genetic study.