Search

Context: Dengue fever has been reported in 129 countries worldwide, including 100 countries in the Mediterranean region, South America, and Southeast Asia. It results in approximately 40,000 deaths each year, and there have been significant outbreaks of dengue fever in these areas in recent years. Approximately 50% of the global population is presently susceptible to acquiring the dengue virus, which is classified as an emerging and re-emerging ailment that is likely to impact several nations in the foreseeable future. Evidence Acquisition: Despite the significant harm inflicted upon human health and the economic conditions of countries in recent years, dengue continues to be classified as a neglected disease, without the requisite attention and concerted efforts by countries to effectively manage it. Any actions taken in this domain are inherently constrained. Consequently, due to the significance of dengue fever, this study aims to comprehensively examine this matter. Results: The disease used to be effectively managed in regions like the countries of the American continent and Singapore, but it has made a resurgence. Between 2008 and 2010, the number of cases in the regions of America, Southeast Asia, and the Western Pacific rose from 0.2 million to 2.2 million. These reports exclusively consist of officially documented sick cases. Multiple outbreaks have been documented in Asia, encompassing countries such as China, Pakistan, Taiwan, and Malaysia, as well as in South America, including Brazil and Mexico. Dengue fever cases have been documented in several Middle Eastern nations, including Yemen, Saudi Arabia, and southern Iran. Local transmission of the disease has begun in Europe, with France and Croatia reporting cases of local transmission. Annually, a minimum of 500,000 individuals experience serious illnesses requiring hospitalization. Approximately 2.5% of individuals who contract the condition die from it. Every year, numerous severe cases of dengue fever are documented, resulting in at least 20,000 deaths. Conclusion: Dengue fever is a complex systemic disease. Assessing the complete range of the disease burden of dengue fever will be crucial to properly comprehend the serious medical and economic repercussions it has on patients and the general public.

Federated Learning (FL) presents a decentralized approach to machine learning, allowing multiple clients to jointly train neural networks while maintaining the privacy of their local data. However, FL faces challenges due to data heterogeneity, leading to slow convergence and reduced performance. While sharing client information can mitigate data heterogeneity, it poses a dilemma between privacy preservation and model performance improvement. This study aims to tackle the challenge of data heterogeneity, particularly for Non-Identical and Independent Distributions (Non-IID) clients, by enhancing the global model. We propose a data-free knowledge distillation method (FedDiff) to fine-tune the global model on the server. FedDiff leverages a Diffusion model as a generator to explore the input space of local models and transfer knowledge from local models to the global one. Additionally, we customize the diffusion model’s data generative scheme to reduce training time. Extensive experiments demonstrate that FedDiff reduces communication rounds between clients and the server by up to 57% for CIFAR-10 classification and up to 71% for CIFAR-100 on average, compared to other state-of-the-art FL methods, while maintaining the same level of accuracy. This makes it particularly suitable for low-power devices with limitations on data transmission and reception, such as satellites and medical care devices.Furthermore, it preserves better average accuracy for all clients at the end of the training phase.

Background:Treatment of Medication Overuse Headache (MOH) is yet under debate and Celecoxib as a Cyclooxygenase 2 (COX2) -inhibitor has not been tried widely as a pain relief drug for this type of headaches in migrainous patients. Objectives: comparing the efficacy of celecoxib versus prednisolone for withdrawal period of MOH. Materials & Methods: A double-blind, randomized clinical trial was carried out, on 75 patients with MOH who visited the Isfahan Neurology Clinic in 2016. They were assigned into two groups of oral prednisolone and celecoxib prescribed for 15 days. Any changes in the duration (average hours of daily headache), frequency, and severity of headaches, and intake of rescue medication and their side effects were recorded after the 15-day intervention period. Data were analyzed by independent t, paired t, Mann-Whitney, Wilcoxon test, and chi-square tests in SPSS software version 20. Results: Average duration of headache in both groups significantly decreased after treatment (P

Background: We aimed to compare different clinical characteristics of epilepsy among two age groups of 20-60 and more than 60 years old. Methods: This retrospective, cross-sectional study was conducted during 2014-2015 in epilepsy clinics located in Isfahan city, Iran. The inclusion criteria were defined as definitive diagnosis of epilepsy, age of older than 20 years, and having medical record in Isfahan epilepsy clinics. Patients with incomplete medical records were excluded. Patients’ medical records were reviewed for seizure characteristics, demographic and paraclinical data; these findings were compared between the two age-groups. 200 patients were included in the study and 23 of them were excluded because of incomplete medical records. Findings: 120 cases (67.8%) were under 60 years old and 81 cases (45.8%) were men. The most frequent seizure type in younger and older age-group was generalized tonic-colonic (35.0%) and mixed seizures (29.8%), respectively. Abnormal brain magnetic resounance imaging (MRI) (66.7% versus 37% and P < 0.001), computed tomography (CT) scan (59.6% versus 30.9% and P < 0.001) and laboratory data (22.8% versus 8.5% and P = 0.009) were more frequent in older age-group. Family history of seizure was seen more in younger age-group (51.7% versus 29.8%, P = 0.006). Conclusion: We found that elderly patients presented more with complex partial and mixed seizures while the younger population presented more with generalized seizures. Abnormal findings in brain CT scan and MRI were seen more in older patients and younger patients were more likely to have family history of epilepsy.

Background: With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs. Materials and Methods: This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs. Results: Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely. Conclusion: Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.

Background: Obstructive sleep apnea and stroke are the most common diseases worldwide and especially in our country. Previous studies showed that both above diseases are common risk factors and in some of study co-morbidity to stroke and obstructive sleep apnea were reported. Thus, considering the high prevalence of stroke and obstructive sleep apnea, the aim of this study was to determine the symptoms and risk factors of obstructive sleep apnea among patients with acute stroke who were hospitalized in Alzahra hospital, Isfahan, Iran during 2014. Methods: In a case control study, 55 stroke patients and 55 healthy persons were studied for obstructive sleep apnea. Sleepiness symptoms and risk factors of obstructive sleep apnea was measured by special checklist and comparison between the two groups was done by SPSS software. Findings: The mean of obstructive sleep apnea in case and control groups was 9.6 ± 2.9 and 6.5 ± 4.9 respectively and a significant difference between the two groups was seen (P < 0.001). the mean of total number of risk factors of obstructive sleep apnea in the two groups was 9.5 ± 2.9 and 6.4 ± 4.8 respectively (P < 0.001). 29(52.7%) of case group and 11(20%) of control group had at least 10 numbers of obstructive sleep apnea symptoms and the difference between the two groups was significant (P < 0.001. Conclusion: Notice to high prevalence and importance of obstructive sleep apnea and stroke and common risk factors of the two disease and noting the lack of studies about co-morbidity of obstructive sleep apnea and stroke, more study about the relation between stoke and obstructive sleep apnea was needed, also patients with obstructive sleep apnea mast identify and treatment and prevention programs must be done for these patients.

Background: Acute disseminated encephalomyelitis (ADEM) is an uncommon monophasic disease often with good prognosis. It is a differential diagnosis of multiple sclerosis (MS). Accurate distinction between acute disseminated encephalomyelitis and multiple sclerosis is important for prognosis and treatment; as many patients with multiple sclerosis may benefit from early disease-modifying therapy to suppress ongoing and future relapses. Methods: In a retrograde study, all the patients presented to Alzahra hospital (Isfahan, Iran) with definite diagnosis of acute disseminated encephalomyelitis during a 10-year period were included. Demographic data, clinical signs and symptoms, and laboratory and imaging findings were collected and analyzed using t and chi-square tests via SPSS software. Findings: Forty-two patients with mean age of 20.05 ± 10.04 years and a female-predominance of 64.3% participated in the study. Thirty-three patients (78.6%) had a recent history of infectious disease. A seasonal pattern of distribution in spring (31%) and autumn (31%) was seen. The cerebrospinal fluid (CSF) analysis findings showed pleocytosis and increased protein in 26 (61.9%) and 25 (59.6%) cases, respectively. First magnetic resonance imaging (MRI) findings revealed that most of the lesions were in the periventricular (83%) and re-imaging in 25 cases showed completely or partially resolution of previous lesions with no new lesion in 18 (72%) and 7 (28%) patients, respectively. Conclusion: We found some controversies to previous studies in epidemiological and imaging studies which could be of a significant role in detecting and accurate diagnosis of acute disseminated encephalomyelitis which can significantly impact on physicians’ view of the disease.

Clinical presentation of demyelinating disorders is very heterogeneous, but initially isolated cranial nerve involvement, especially eighth nerve lesions, is extremely rare as the manifestation of clinically isolated syndrome (CIS) or multiple sclerosis (MS), so sudden sensory neural hearing loss (SNHL) is rarely a sole and presenting symptom of MS. A 31-year-old female presented with a history of left-sided ear fullness sensation and sudden hearing loss (without any history of trauma or infection); the pure-tone audiometry (PTA) showed unilateral SNHL pattern (high-frequency zone). The neurological and otolaryngologic examination was normal. Magnetic resonance imaging of the brain revealed several disseminated typical demyelinating plaques. The oligoclonal bands had been detected in the sample of cerebrospinal fluid. All of the routine laboratory data and serum autoantibodies were within normal ranges. Administration of high-dose corticosteroid improved her hearing. SNHL is a rare and atypical manifestation of CIS. Our case is assigned to be a high-risk CIS and may be developed to MS. It may be due to acute inflammatory demyelinating lesions of the cochlear nerve which could be a manifestation of CIS at first.

Background: Antiepileptic drugs (AEDs) may lead to an increase in the plasma concentration of homocysteine. There is limited information, especially from Iran, regarding the risk in patients who are treated with levetiracetam as a new type of AED. The aim of the present study was to investigate the effect of levetiracetam on plasma homocysteine, vitamin B12, and folate levels in adult patients with epilepsy. Methods: We conducted a case-control study and enrolled adult patients with epilepsy who had received monotherapy with levetiracetam for at least 6 months at some time prior to the study. homocysteine serum, vitamin B12, and folate were measured, and folate and vitamin B12 intake was determined by the food frequency questionnaire (FFQ). Results: Thirty-three patients on levetiracetam and 35 control subjects aged between 18 and 60 years were enrolled. No statistically significant differences in the means of the serum markers of vitamin B12, FA, and homocysteine levels were found between the two groups. In the first model,i.e., the crude model, no significant differences were observed in the serum concentrations of homocysteine, vitamin B12, and folate. In the second model, education was considered, and body mass index and folate intake was controlled with no significant difference being observed in the mean homocysteine serum level. Conclusions: Treatment with levetiracetam in patients with epilepsy has no effect on the serum levels concentrations of homocysteine, vitamin B12, and folate. This medication is suggested for patients who use AEDs on a long-term basis and at high dosages.

Background: Obstructive Sleep Apnea (OSA) is a type of sleep related breathing disorder due to upper airway obstruction with the high risk of 26% among adults. According to some researches, it seems there is a relation between OSA and epilepsy. Therefore, this study aimed to evaluate the risk of this disorder and daytime sleepiness in patients with complex partial seizure. Methods: This analytical descriptive study was done on 90 patients referred to Alzahra Neurology Clinic in Isfahan, Iran, in 2012. They were divided into two case and control groups (n = 45). The first consisted of Complex partial seizures (CPS) patients and the second was non-epileptic patients. Sleep Quality Questionnaire was completed for the participants, and demographic information, type and doses of used drugs, and seizure recurrence cases in the previous 3 months were gathered for each patient. Data were analyzed by SPSS software. Findings: The mean value of OSA in the case and control groups were 1.95 ± 1.41 and 1.84 ± 1.43, respectively, with no significant difference (P = 0.71). The mean score of EPWORTH questionnaire were 5.1 ± 4.4 and 5.3 ± 4.8 in the two groups; which were not significantly different. Conclusion: There was no evidence of OSA association with epilepsy. However, due to the importance of OSA it is recommended that further studies be carried out in this regard. Moreover, it is necessary for epileptic patients to gain definitive diagnosis. Then, the effects of OSA on improvement of seizure control, and their quality of life must be studied.

Background: Catamenial epilepsy is a kind of epilepsy, known in this name, when the periodicity of the exacerbation of the seizure is in association with menstural cycle. The present study examined the progesterone effectiveness as a complementary treatment in women with intractable catamenial epilepsy. Materials and Methods: The present study was conducted as a double-blind randomized controlled trial on 38 women with intractable catamenial epilepsy. Patients were assessed in two groups: The case group received in addition to AEDs, two (Mejestrol) 40 mg progesterone tablets in the second half of the cycle from 15 th to 25 th day. And the control group received in addition to AEDs, two placebo tablets daily. Age, BMI, epilepsy duration, types of the drugs used, progesterone level, and the number of the seizures in 3 months before and after the study were compared. Results: Based on the results of which there was no statistically significant difference in regard to age, BMI, epilepsy duration, types of the drugs used, progesterone level between the case and the control groups (P-value > 0.05). The number of the seizures after treatment has significantly decreased compared to before-treatment state. The degree of decreasing in the case group receiving the progesterone was higher than in the control group receiving the placebo. The difference, thus, is significant, based on statistical tests (P-value = 0.024). Conclusion: Based on the findings of this study using progesterone in women with intractable catamenial epilepsy has a significant effect on the degree of decreasing in the number of the seizures.