What is the real fate of vitamin D in multiple sclerosis?

Multiple sclerosis [MS] is a multifactorial disease [caused by both environmental and genetic features] that could results from a demyelination of the myelin sheath. Subsequently, it leads to many scars or lesions in different places within the central nervous system. The symptoms that occur depend on the site and rigorousness of the lesions and this is why people with MS experience different symptoms. Although, it is not clearly known that why people develop MS, research suggests that vitamin D plays a key role in preventing or repairing the damaged myelin. Previous studies have shown that vitamin D is a potent natural immune-regulator and has an anti-inflammatory action. Increased exposure to vitamin D may result in changed immunologic profiles or commotion that donates to MS risk. Vitamin D deficiency is caused by insufficient sunlight exposure or low dietary vitamin D[3] intake. Recent studies have also indicated that, there are several polymorphisms for vitamin D receptor [VDR] gene, but the effect of VDR gene polymorphisms on protein function of VDR and how exerts second signaling pathways in cells is still unknown. Therefore, this review focuses on vitamin D metabolism and genetic polymorphisms related to VDR and MS to better understand of discrepancies among patients

Preliminary study related the incidence of methylprednisolone pulse therapy in patients visited multiple sclerosis clinic located at the Isfahan Kashani hospital

To manage relapsing-remitting multiple sclerosis [MS] in the course of acute exacerbations, methylprednisolone [MP] [Medrol or Solu-Medrol], has the ability to lock the injured blood-brain barrier and decrease irritation in the central nervous system. The aim of this preliminary study was to investigate the frequency and time interval related to MP pulse therapy in patients with MS. This Study is conducted in the MS clinic of the Isfahan Kashani hospital, that was carried out on patients [n= 901] from June 2011 to December 2012. Patients who visited MS clinic just for once disinterested from analysis. According to the incidence of MP pulse therapy in females and males, two groups were made. Group 1 included patients with 2-3 times and Group 2 included patients with more than 4 times pulse therapy. Demographical data, pharmacological variables including number and time interval related to pulse therapy for each individual were recorded in dBase. The statistical analyses of d-Base were performed using SPSS. 901 patients in 1592 occasions were studied. The mean age of patients was 34.6 years old [ranged: 8-87 years old]. 586 patients included 465 females and 121 males visited MS clinic just for once. 245 females in 797 occasions and 70 males in 209 occasions received pulse therapy with a mean of 4 times [ranged: 2-11 times]. 51.1% and 48.9% of patients received MP pulse therapy for two and more than two up to 11 times respectively. In the 70% of the patients' time interval between pulse therapy was with a mean of 137 days [ranged: 28-480 days]. For pulse therapy, it seems that the female subjects refer to clinic are approximately 3.7 times higher than male subjects. To reduce the demand of patients to pulse therapy, disease management could be rationalized on the basis of illness expansion and its correlation to inter and intra individual variability. Finally, to understand the effectiveness of pharmacotherapy, in MS population [Isfahan/Iran], clinical neuropharmacology in relation to better understand of the individualized pharmacokinetics could be useful

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

Preliminary investigation of economics issues in hospitalized patients with stroke

The study of economics is important in Iranian stroke patients, because it is one of the costly diseases that could be linked to disability, mortality, and morbidity. The aim of this preliminary study was to investigate total treatment costs of hospitalized patients with stroke. A cross-sectional study of 24 patients conducted to Isfahan Neurosciences Research Centre was carried out between April 1, 2012 and September 31, 2012. Demographic [sex, age] and economic variables [Raise tariffs, accumulated surplus, the total amount, of patients', patients' paid, and home insurance contribution] were extracted from the patients' profiles. All information recorded and processed using Excel. The mean age of patients was 71 years [ranged; 40-93 years old]. Preliminary analysis of available costs issues could be described as: Raise tariffs [mean: 3500256 Rial, ranged: 504460-9775455 Rial], accumulated surplus [mean: 565578 Rial, ranged: 56700-2343664 Rial], the total amount [mean: 4045556 Rial, ranged: 715460-12219119 Rial], of patients' [mean: 756037 Rial, ranged: 0-8365447 Rial], patients' paid [mean: 1307762 Rial, ranged: 45300-9193000 Rial], and home insurance contribution [mean: 3070713 Rial, ranged 0-8887907 Rial]. The cost disparity within this study after stroke could be mainly connected to variations in duration of hospital stay. Inspecting agenda towards this direction could reduce the economic cost of stroke significantly. Therefore, further assessment correlated to attain strategies in order to reduce costs associated to patients' paid and home insurance contribution could be much more advantageous

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

Preliminary evaluations related to the ranges of hematological and biochemical variables in hospitalized patients with stroke

According to the international reports, brain stroke is the main reason of death and disability. In ischemic stroke, early and precise classification of patients who may profit from conflicting finest therapeutic interference is necessary if enhanced effects in terms of survival are to be talented. Due to uncomplicated, easy performance, and inexpensive method the aim of this preliminary study was to investigate changes related to biochemical and hematological variables in patients with stroke. A cross-sectional study located at the neurology ward of the Ayatolah Kashani and Alzahra Hospitals' [conducted to Isfahan Neurosciences Research Center] was carried out on fifty patients [females; n = 20 and males; n = 30] between April 1, 2012 and September 31, 2012. The data from subjects' records were taken for analyzing variables. The statistical analysis of d-base was performed using [SPSS] for windows. Analysis of available data showed that with a mean of 182.4 mg/dl, blood sugar [BS] ranged from 75 to 300 mg/dl [n = 15/50]. The changes in hemoglobin [Hgb] [mean 4.6 g/dl, n = 27/50], platelet [mean 210, 653/mm[3], n = 26/50] and lymphocyte [Lymph] [mean 37, n = 26/50] seems to be significant. The mean age of females was 76 years [ranged 46-93 years]. The mean age of males was 70 years [ranged 31-90 years]. Information related to previous drug history was available only in 24 patients. In 5 out of 22 cases ischemic heart disease [IHD] were positive. In 8 out of 29 cases, diabetes mellitus was positive. In 5 out of 28 cases, hypertension [HTN] was positive. In the four patients both IHD and HTN were positive. Any considerable alter in patients' biochemical and hematological figures [BS, Hgb, Plt and Lymph] may necessitate further attention related to inter- and intra-individual variability in clinical supervision and drug's assortment. Therefore, success in treatment could be achieved by the close management of clinical, biochemical, hematological, and pharmacological manifestation. To reduce disability, mortality, and morbidity in Iranian stroke population further clinical studies are needed to correlate drugs and laboratory markers to associated clinical events in order

Nephro and neurotoxicity of calcineurin inhibitors and mechanisms of rejections: a review on tacrolimus and cyclosporin in organ trans-plantation

In the meadow of medical sciences substituting a diseased organ with a healthy one from another individual, dead or alive, to allow a human to stay alive could be consider as the most string event. In this article we review the history of transplantation, mechanisms of rejection, nephro-neurotoxicity of tacrolimus and cyclosporin in organ transplantations. Directory of Open Access Journals [DOAJ], Google Scholar, Pubmed [NLM], LISTA [EBSCO] and Web of Science have been searched. The first reference to the concept of organ transplantation and replacement for therapeutic purposes appears to be to Hua-To [136 to 208 A.D], who replaced diseased organs with healthy ones in patients under analgesia induced with a mixture of Indian hemp. In 1936, the first human renal transplant performed by Voronoy in Russia. The first liver transplant in humans was performed on March 1, 1963 by Starzl in Denver, USA. Medawar was the first to assert that rejection was an immunological response, with the inflammatory reaction due to lymphocyte infiltration. Consequently, rational immunosuppressive therapies could inhibit deleterious T-cell responses in an antigen specific manner. Searching related to the history of organ transplantation from mythic to modern times suggests that, to prevent graft rejection, minimize nephro and neuro toxicity monitoring of immunosupressive concentrations could provide an invaluable and essential aid in adjusting dosage to ensure adequate immunosuppression