Comparison of two different induction doses of atracurium in myasthenia gravis in patients undergoing thymectomy

Myasthenia gravis is an autoimmune disorder resulting from a decreased number of active acetylcholine receptors at the neuromuscular junction. Thymectomy is one of its current treatments. Due to sensitivity of myasthenic patients to non-depolarizing muscle relaxants and also the interaction of this medication with anti-cholinestrase drugs, determining the dosage of non-depolarizing muscle relaxants for induction of anesthesia is one of the hurdles in thymectomy. Twenty myasthenic patients undergoing transsternal thymectomy were enrolled into the study. They were divided into two groups randomly, and received either 0.25 mg/kg or 0.50 mg/kg of atracurium to facilitate tracheal intubation. Neuromuscular blockade was measured using train of four [TOF] mode of neuromuscular stimulator 15 minutes after administration of atracurium and then each 5 minutes till entered the recovery phase. The time between injection of atracurium and the recovery phase was compared between the two groups. The two groups were similar with respect to age and gender. The time from the onset of myasthenia gravis to surgery, dosage and duration of pyridostegmine used preoperatively were not significantly different between the two groups. The time from administration of atracurium to recovery phase was not significant between the two groups [P=0.24]. There was no difference between two different doses of atracurium regarding entering the recovery phase, and as the effects of nondepolarizing muscle relaxants are unpredictable in myasthenic patients, we recommend the lower dose to prevent profound skeletal muscle weakness and postoperative complications

Randomized clinical trial of intravenous valproate [orifil] and dexamethasone in patients with migraine disorder

Background: Intravenous Valproate [IVVP] has been used in the treatment of migraine in some studies; however, it is far better known in the management of status epilepticus

Methods: Consecutive patients with migraine in our Headache Clinic were enrolled in this prospective, randomized clinical trial in 2011. The patients were randomized into two therapeutic groups, one receiving 900 mg IVVP [Orifil] and the other 16 mg IV Dexamethasone [IVDEX] diluted in 150 CC normal saline and infused for 10 minutes. Worst severity of pain before treatment and least severity at 3 hours after the infusion using a 0-10 point numeric rating scale were recorded. An interview with the patient was performed 72 hours after treatment to detect a possible relapse of headache

Results: Thirty-one migraine status patients, comprising 28 women and 3 men at a mean +/- SD age of 33.355 +/- 12.373 SD, were investigated. Differences in the therapeutic effects of IVVP [Orifil] and IVDEX on pain score were not significant between the two groups [t=0.933, df=29; P=0.358]. Relapse of headache occurred in 68.42% of the IVVP [Orifil] group and 66.67% of the IVDEX group. Distribution of relapse was not significantly different between the two therapeutic groups of patients [P=0.870]

Conclusion: IVVP [Orifil] was similar in efficacy to IVDEX as abortive therapy in patients with migraine status. IVVP [Orifil] appears to offer a safe and well-tolerated abortive treatment. Trial Registration Number: IRCT13891146234N2

Cerebral vein thrombosis in women using short course oral contraceptive consumption

Muslim women tend to postpone their menstrual period using short course oral contraceptives [OC] during Ramadan, Muslims fasting month. Recently, many cases of stroke, particularly cerebral vein thrombosis [CVT], have been reported in Ramadan. This work studies the incidence of CVT and its relation to Ramadan. This is a cohort study conducted from October 2006 to October 2009 and included 4 consecutive Ramadan's. All patients with definite diagnosis of CVT who were referred to the neurology department of Ghaem Hospital, Mashhad, Iran in this four-year period were included in the study. During the study period, 70 cases with CVT [11 males and 59 females] were recruited. Twenty five cases were admitted during Ramadan months which was significantly higher than all the other 32 months [p=1.9×10[-7]]. The higher frequency of females [6 times more] among CVT cases probed by investigating possible risk factors and short term OC consumption was revealed as the major risk factor [p=0.00071]. Higher incidence of CVT in females during Ramadan suggests the presence of specific risk factors in this group. Our study revealed that short-term use of OCs may be a major risk factor for CVT

Estimating the optimal dosage of sodium valproate in idiopathic generalized epilepsy with adaptive neuro-fuzzy inference system

Epilepsy is a clinical syndrome in which seizures have a tendency to recur. Sodium valproate is the most effective drug in the treatment of all types of generalized seizures. Finding the optimal dosage [the lowest effective dose] of sodium valproate is a real challenge to all neurologists. In this study, a new approach based on Adaptive Neuro-Fuzzy Inference System [ANFIS] was presented for estimating the optimal dosage of sodium valproate in IGE [Idiopathic Generalized Epilepsy] patients. 40 patients with Idiopathic Generalized Epilepsy, who were referred to the neurology department of Mashhad University of Medical Sciences between the years 2006-2011, were included in this study. The function Adaptive Neuro- Fuzzy Inference System [ANFIS] constructs a Fuzzy Inference System [FIS] whose membership function parameters are tuned [adjusted] using either a backpropagation algorithm alone, or in combination with the least squares type of method [hybrid algorithm]. In this study, we used hybrid method for adjusting the parameters. The R-square of the proposed system was%598 and the Pearson correlation coefficient was significant [P <0.05] and equal to 0.77, but theT-test was not significant [P >0.05]. Although the accuracy of the model was not high, it wasgood enough to be applied for treating the IGE patients with sodium valproate. This paper presented a new application of ANFIS for estimating the optimal dosage of sodium valproate in IGE patients. Fuzzy set theory plays an important role in dealing with uncertainty when making decisions in medical applications. Collectively, it seems that ANFIS has a high capacity to be applied in medical sciences, especially neurology