comparative assessment the efficacy of intravenous infusion of sodium valproate and phenytoin in the treatment of status epilepticus

Status epilepticus [SE] is a type of persistent lasting seizure with high mortality and morbidity. Numerous medications are suggested for the treatment of SE, two of which are sodium valproate and phenytoin. The purpose of this study is to conduct a comparison between the efficiencies of intravenous sodium valproate and phenytoin in the treatment of this type of epilepsy. This is a clinical trial study conducted on SE-suffering patients admitted to the emergency departments of Al-Zahra and Ayatollah Kashani Medical Centers of Isfahan in 2009 and 2010. The patients were randomly assigned into two groups and taken under treatment, separately by intravenous infusion sodium valproate and phenytoin. No significant difference was observed between the two groups [at P = 0.06]. In terms of incidence of the clinical complications, the incidence of clinical complications in the two groups was significantly different [at P = 0.03]. Based on the findings the efficiency of sodium valproate is larger than that of the phenytoin, and thus, the treatment by sodium valproate is preferred over the treatment by phenytoin

Quality of sleep in patients with Parkinson's disease

Parkinson's disease [PD] is a progressive neurodegenerative disorder causing motor and non-motor symptoms. The latter are common and include autonomic dysfunction, cognitive impairment, and sleep difficulties. Many of the non-motor aspects of PD such as sleep disturbance are more common and significantly affect the day-to-day activities of patients and their quality of life. The most important aim of this study was to evaluate the sleep quality in patients with PD. This case-control study was performed on patients with PD referred to the Neurology Clinic of our teaching hospital in 2011. Thirty-four patients with PD and 34 healthy people as control group were enrolled in this study. Sleep quality of patients and control was evaluated by Parkinson's disease sleep scale [PDSS] questionnaire. PDSS is a reliable and valid tool to measure sleep disorders in PD. The mean total PDSS score in patient group was 55.29 [SD = 26.92] indicating moderate to severe sleep disturbances whereas, the mean total score in control group was 20.34 [SD = 10.65]. Difference between the two groups' mean scores was significant [P < 0.05]. Our study demonstrated that patients with PD experienced poorer nocturnal sleep quality than the control group

Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy

The challenge of antiepileptic drugs [AEDs] management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription. A cross sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female [n = 17] and male subjects [n = 19] with a mean age of 27 years [range; 7-74 years] were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS [version 18] for windows. The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase [AP], lymphocyte [Lymph], white blood cell [WBC] counts and hemoglobin [Hgb]. There was a significant increase in [AP] [mean; 534.6 u/l; [P = 0.02] in three patients and [Lymph] [55%; [43-84]%; [P = 0.04] in seven patients. WBC was lower than 4400 mm[3] [P = 0.02] in six patients. Hgb was significantly lower in 70.6% of women [11.8; [10-14.2] g/dl; [P = 0.04] and 68.4% of men population [12.3; [9.7-13.8] g/dl; [P = 0.01]. Mean age of epilepsy onset was 15.6 years [range: Birth-74 years]. Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy [2 up to six AEDs simultaneously] was 19.4% plus 80.6% respectively. In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure

Preliminarily analysis of carbamazepine [CBZ] C[0] in patients visited Isfahan epileptic clinics

Carbamazepine [CBZ] is mostly considered as the first line of effective treatment against simple or complex partial seizure and primary-secondary generalization. To prevent side-effects related to higher amount of CBZ minimum concentration [C[0]] in body fluid or seizure attacks associated to lower amount of CBZ-C[0], the suggested minimum therapeutic concentrations range from 4 to 12 ng/ml [according to previous publications]. The aim of this preliminarily study was to investigate the scope of discrepancy associated to the C[0] of CBZ in patients visited Isfahan Epileptic Clinic. A cross-sectional study of 22 patients located in neurology ward of Isfahan Neurosciences Research Centre [INRC] was carried out between April 1, 2012 and December 31, 2012. Female [n = 9] and male subjects [n = 13] with a mean age of 27.4 years [range; 16-38 years] were studied. Pharmacological [CBZ-C[0]] and demographical variables were recorded and processed in excel. The results of CBZ-C[0] showed wide inter-individual variability. The mean value of CBZ-C[0] was 7.2 ng/ml. In 10 out of 22 patients, CBZ-C[0] were lower than the suggested therapeutic window [4-12 ng/ml]. CBZ-C[0] in nine patients was non-detectable and in one patient was 0.5 ng/ml [45% <4 ng/ml]. In 55% of the patients, CBZ-C[0] ranged from 4.8 to 12 ng/ml. A schedule therapeutic drug monitoring based on measurement of CBZ-C[0] for individual patient could be a practical marker to achieve therapeutic objectives. Further study related to correlating of CBZC[0] to clinical events in Iranian Epileptic population seems to be valuable

Isolated third nerve palsy from mild closed head trauma

Head injury is a common occurrence in motor vehicle accidents. There are numerous causes for cranial nerve injury that include head trauma or other lesions. Few studies regarding cranial nerve injury following mild head trauma [GCS: 14 - 15] exist in the literature. [1]The oculomotor nerve is a somatic and visceral motor nerve. When it is completely injured the result is ptosis, pupils that are non-reactive to light and a lack of eye movement. We report the case of a completely isolated oculomotor nerve palsy associated with minor head injury

[Clinical correlation between findings of renal scintigraphy and clinical/laboratory findings in children with febrile UTI]

Urinary tract infection [UTI] is one of the most common bacterial infections in children. Non-specific symptomatology in infants and young children makes the clinical differentiation between lower UTI and acute pyelonephritis [APN] difficult. The aim of this study was to assess the correlation between APN findings of renal cortical scintigraphy and selected clinical/laboratory findings of febrile UTI in infants and children admitted at our center. A prospective study was conducted in 83 infants and young children aged I month -8 years hospitalized with febrile UTI in nephrology ward of Abuzar children's hospital. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography [US], voiding cystoureterography [VCUG], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], hemoglobin [Hb], white blood cell count [WBC] and urine analyses were performed. Mean age was 24.3 months with 82% [68] girls. DMSA scintigraphy showed APN findings in 45/83[54.2%] patients, with a mean age of 30.2 months, including 9 males [20%] and 36 [80%] females. There were statistically significant correlations between the APN findings of DMSA scintigraphy and the fever duration, body temperature, lucocytosis, anemia, proteinurea, CRP levels and ESR [p<0.05]. Vesicoureteral reflux was found in 20.5% of patients with no statistically significant correlations to the APN findings of DMSA scintigraphy. Although initial DMSA renal scintigraphy is useful for determination and localization of kidney involvement during febrile UTI, some clinical and paraclinical findings can predict the scintigraphycal findings of kidney involvement that need further evaluations for portable complications in the future

Vitamin B[12] deficiency and multiple sclerosis; is there any association?

Vitamin B[12] [Cobalamin] deficiency can result in some clinical and paraclinical characteristics similar to what is seen in multiple sclerosis [MS] patients. This study aimed to evaluate the controversial association between B[12] deficiency and MS. We measured serum vitamin B[12] in 60 patients with MS and 38 healthy controls. Clinical disability was evaluated according to the Extended Disability Status Scale [EDSS]. Serum B[12] concentration was measured with Radioimmunoassay Dual Isotope method. The cutoff value for low serum vitamin B[12] concentration was 75 pg/mL. Patients were in remission at the time of blood draw. There were 13 [21.6%] MS patients and 10 [26.3%] controls with low serum B[12] concentration with no significant difference between the groups; P>0.05. The mean serum vitamin B[12] concentration in MS patients [108.9 +/- 45.3 pg/mL] was not significantly different compared with controls [98.9 +/- 44.4 pg/mL]; P=0.284. Likewise, there was no correlation between the concentration of serum vitamin B[12] and disease' age of onset, duration, subtypes, or disability status. In contrast to some previous reports, our findings did not support any association between B[12] deficiency and MS

Pizotifen in migraine prevention: A comparison with sodium valproate

Background & Objective: Pizotifen is an alternative option for prophylactic treatment of migraine headache. This study aims to compare the effi cacy and safety of pizotifen with sodium valproate; one of the most-widely used drugs in migraine prevention. Methods: This was a single blind, randomized, parallel-group study. After a 4-week baseline evaluation, patients with episodic migraine were randomly assigned to get either sodium valproate or pizotifen for a period of 12 weeks. Patients were asked to fi ll a headache diary through the study. Headache characteristics and the possible side effects were evaluated throughout and at the end of trial. Results: Forty two patients aged 20 to 49 were recruited to the study. With both drugs, the frequency, intensity and duration of headaches were signifi cantly reduced (p < 0.05). Except for headache duration, pizotifen was signifi cantly superior to sodium valproate in the headache parameters assessed. Total reported side effects were initially higher in patients who received pizotifen (37 vs. 22; P= 0.038); however, persistent side effects were lower for pizotifen (6 vs. 10; P= 0.22). Conclusions: The results of this study suggest that pizotifen is a safe and effective drug in migraine prevention.

Synthesis, labeling and quality control of a new neuropeptide Y analogue for diagnosis of breast tumors

Over expression of selected peptide receptors in human tumors has been shown to represent clinically relevant targets for cancer diagnosis and therapy. The aim of this work was to investigate Neuropeptide Y [NPY] as a new radiopharmaceutical for diagnosis of breast cancer. A neuropeptide Y analogues with Y[1] receptor preference and agonistic properties was synthesized by solid phase method. After conjugation with diethylenetriaminepentaacetic acid [DTPA] labeling with [111]In was performed. For labeled peptide, yield of labeling, stability in human serum, receptor binding in cell surface with internalization in SK-N-MC cells, and biodistribution in normal rat were determined. Peptide was synthesized and labeled with more than 95% purity. Radiolabeled peptide was stable in human serum and specifically binds and internalized in the cells with Y1 receptor [4h = 22%]. A rapid clearance from blood pool and urinary with hepatobiliary excretion were observed. Our results showed that this peptide can be considered as a candidate for diagnosis of breast tumors

New peptide based freeze-dried kit [99m] Tc-HYNIC]-UBI 29-41 as a human specific infection imaging agent

Ubiquicidin 29-41 [UBI] is a fragment of the cationic antimicrobial peptide that is present in various species including humans. The purpose of this study was to investigate radiochemical and biological characteristics of [6-hydrazinopyridine-3-carboxylic acid [HYNIC]]-UBI 29-41 designed for the labeling with 99mTc using tricine as coligand. Synthesis was preformed on a solid phase using a standard Fmoc strategy and HYNIC precursor coupled at the N-terminus. Purified peptide conjugate was labeled with 99mTc at 100°C for 10 min. Radiochemical analysis involved ITLC and high-performance liquid chromatography methods. Peptide conjugate stability and affinity to human serum was challenged for 24 hours and its in vitro binding to bacteria was assessed. Biodistribution and accumulation of radiopeptide in staphylococcus aureus infected mice were studied using scintigraphy and ex vivo counting. Radiolabeling was performed at high specific activities, and radiochemical purity was >95%. The stability of radiolabeled peptide in human serum was excellent. In vitro studies showed 70% of radioactivity was bound to bacteria. After injection into mice with a bacterial infection, removing from the circulation occurred mainly by renal clearance and site of infection was rapidly detected within 30 min. Target to nontarget muscle ratio was 2.099 +/- 0.05% at 30 min post injection. [99mTc-HYNIC]-UBI 29-41 showed favorable radiochemical and biological characteristics which permitted detection of the infection with optimal visualization within 30 min

Radioiodine D amino acids labeling of rituximab, a new method for enhancing the radiopharmaceutical targeting and biostability

Radioimmunotherapy [RIT] is a very promising new therapy for the treatment of recurrent B-Cell non-Hodgkin's lymphoma [NHL]. Iodine-131 is the most frequently used nuclide in clinical RIT, but its usefulness has been limited by dehalogenation of monoclonal antibodies labeled via conventional methods. To circumvent this problem, we have synthesized a tri-peptide consisting of non-metabolizable D amino acids attached to N-Hydroxysuccinimide [NHS]. Tri-peptide was synthesized by standard Fmoc solid phase synthesis on tritylchloride resin. Labeling of tri-peptide was performed using the chloramine-T method and the conventional extraction. Radioiodination of tri-peptide was followed by conjugation to anti-CD20 antibody. In vitro stability of labeled antibody in serum and phosphate buffered saline [PBS] was measured for 48hr by [thin layer chromatography] TLC. Raji cell line was used to test cell binding of the labeled anti-CD20. The chemical purity of synthesized peptide as assessed by analytical [high performance liquid chromatography] HPLC was 95%. Labeling of tri-peptide resulted in a radiochemical yield of 50-71% with radiochemical purity of > 95%. At Rituximab concentration of 10mg/ml, coupling efficiencies of 65-80% was obtained with radiochemical purity of 95% and Specific activity [SA] of 185MBq/mg [5mCi/mg]. This study showed that labeling monoclonal antibodies with radioiodine by non-metabolizable D amino acids will improve bio-stability of the product

Comparison of mental health in patients with chronic idiopathic generalized seizure with control group

Seizure is a prevalent neurological disorder. The number of patients diagnosed with this condition is increasing every year. Psychiatric disorders with seizure are highly prevalent, thus diagnosis and effective treatment seizure is great of importance in terms of its impact on the patients' of quality life. It has been demonstrated that attempted and committed suicide occur in seizure patients more than general population. This study assesses the psychological profiles and mental health state of patients with chronic seizure disorders using the Symptom Checklist-90-R [Scl-90 R]. This descriptive-analytical study was carried out on 40 patients with chronic idiopathic seizure disorder and 40 control participants from seizure clinics of Isfahan University of Medical Sciences in 2004. Scl-90-R was used to evaluate the subjects' psychological symptoms. Eighty-two percent of the subjects were male and 18% were female [mean age: 28.1 years]. The average scores of the case and the control groups were 1.65 versus 0.83 in somatization, 1.79 versus 1.39 in obsessive-compulsive symptoms, 1.61 versus 1.24 in interpersonal sensitivity, 2.01 versus 1.56 in depression and 1.82 versus 1.24 in anxiety respectively. The difference between two groups were significant is all domains [P<0.05]. The total score for psychopathology was 16.43 in the case group versus 12.21 in the control group, which also shows a significant difference between the cases and controls. This study demonstrated the undesirable mental health state of patients with chronic seizure disorder compared to controls, particularly in depression, anxiety, obsession-compulsion, somatization and interpersonal sensitivity domains

In vitro activities of amphotericin-B in combination with rifampin against aspergillus species

The main goal of study was finding the synergism effect of amphotricin B [AMB] and rifampin [RIF] on 3 species of Aspergillus. Activities of amphotericin B in combination with rifampin were tested in buffered yeast-nitrogen base using checkerboard method. Plates were inoculated with 20 micro l spores suspensions of each organism and incubated at 30°C for 24h. For this method, the MICs were defined as the lowest antimicrobial concentration inhibiting visible fungal growth on the plates. Minimal fungicidal concentration was defined as the first tube showing no growth on the plate. The MIC of amphotericin B for 100% of isolates of A. fumigatus and A. flavus were inhibited by 4mg/lit amphotericin B. 100% of isolates of A. niger were inhibited by 8mg/lit amphotericin B. When amphotericin B was combined with rifampin, amphotericin B MICs decreased to 2, 1 and 4mg/lit in A. fumigatus, A. flavus rephrase and A. niger respectively. The results indicate that combination of amphotreicin B and rifampin was synergistic on A. fumigatus, A. flavus and A. niger

new monoclonal antibody radiopharmaceutical for radioimmunoscintigraphy of breast cancer: direct labeling of antibody and its quality control

Radioimmunoscintigraphy [RIS] has found widespread clinical application in tumor diagnosis. The antibody [Ab] PR81 is a new murine anti-MUCl monoclonal antibody [MAb] against human breast carcinoma. In this study a very simple, rapid and efficient method for labeling of this MAb with [99m] Tc, particularly suitable for development of a [kit] is described. The reduction of Ab was performed with 2-mercaptoethanol [2-ME] at a molar ratio of 2000:1 [2-ME:MAb] and the reduced Ab was labeled with [99m] Tc via methylene diphosphonate [MDP] as a transchelator. The labeling efficiency which was determined by instant thin layer chromatography [ITLC] was 94.2% +/- 2.3. Radiocolloides measured by cellulose nitrate electrophoresis were 2.5% +/- 1.7. In vitro stability of the labeled product in human serum which was measured by gel filtration chromatography [FPLC] was 70% +/- 5.7 over 24 hr. The integrity of labeled MAb was checked by means of SDS-PAGE and no significant fragmentation was observed. The results of the cell-binding studies showed that both labeled and unlabeled PR81 were able to compete for binding to MCF 7 cells. Biodistribution studies were performed in normal BALB/c mice at 4 and 24 hrs post-injection and no important accumulation was observed in vital organs. These results show that the new radiopharmaceutical may be considered as a promising candidate for imaging of breast cancer

[Synthesis, formulation and quality control of 99mTc-HYNIC-hlgG for imaging focal sites of infection and inflammation in human subjects]

Imaging of infection and inflammation is an important issue in nuclear medicine as it may have relevant implication for the management of patients with infections or inflammatory diseases. In this regard the synthesis of human polyclonal immunoglobuline G [IgG] radiolabeled with technetium-99m [99mTc] by a novel method, via a nicotinamide hydrazine derivative, was performed. The biological behavior, stability and its high specific activity make this radiopharmaceutical a suitable reagent for radiolabeling of proteins and peptides. In this article the method for synthesis of a sterile and apyrogen 99mTc-HYNIC-hIgG kit is presented. The preparation of the kit consists two steps, in the first step 740 MBq pertechnetate was added in Kit No.1, which contains SnCl2 and tricine. After 5 minutes the aliquot in Kit No.1 was added to Kit No.2, which contains HYNIC-hIgG. 99mTc-HYNIC-hIgG complex is stable in cysteine and serum with a labeling efficiency more than 90% after one hour

Evaluation of tumor targeting with radiolabeled F [AB'] 2 fragment of a humanized monoclonal antibody

Humanized monoclonal antibody U36 and its F[ab']2 fragment, radio labeled with 125I, were tested for tumor localization in nude mice bearing a squamous cell carcinoma xenograft line derived from a head and neck carcinoma. Monoclonal antibody IgG or F[ab']2 fragment were injected in parallel and at days 1, 2 and 3, mice were dissected for determination of isotope biodistribution. IgG as well as F[ab']2 showed highly specific localization in tumor tissue. The mean tumor uptake [n=3] is expressed as the percentage of the injected dose per gram of tumor tissue [%ID/g].%ID/g of IgG was 11.7% at day 1 and decreased to 10.9% at day 3 whereas%ID/g of F[ab']2 was 2.9% at day 1 and decreased on following days. Tumor to blood ratios [T/B] at day 1 were 0.86 for IgG and 1.32 for F[ab']2 and reached a maximum at day 3 with values of 4.41 and 1.84 respectively. These findings suggest that the superior tumor to non-tumor ratios in the day of 1 render the F[ab']2 fragment more qualified for specific targeting radioisotopes to tumor xenografts in this exprimental setting

Synthesis, formulation and quality control of mebrofenin [BRIDA] as a 99mTc-Kit for chole scintigraphy

This article will review the essential chemical structure of IDA derivatives and their biokinetic characteristics as the hepatobiliary agents. The article also presents the procedures of Synthesis, formulation and Quality control of mebrofenin [BRIDA] as a 99mTc-Radiopharmaceutical kit which is produced in Radioisotope Division of N.R.C. 99mTc-BRIDA has extremely low renal excretion and hence greater hepatic specificity. In addition, the BRIDA is much more resistant to Markedly elevated levels of bilirubin rather than the other IDA'S analoges