Long-term detoxification of opioid use disorder with opium tincture assisted treatment.

Introduction: Retention in treatment, craving, and relapse rate are important indicators of the success rate in addiction maintenance therapy as they evaluate the effectiveness of the therapy and make necessary adjustments to the treatment plan. However, the rate of continuation in the treatment process and the rate of craving in patients with opioid use disorder undergoing maintenance treatment with opium tincture have not been studied. The present study aimed to investigate the rate of relapse, craving, and psychiatric disorders in patients with opioid use disorder undergoing treatment of gradual detoxification with opium tincture. Methods: Ninety patients with opioid use disorder who underwent treatment with the gradual detoxification method using opium tincture in the form of Congress 60 for 11 months were enrolled in the study. The level of craving based on the Desire for Drug Questionnaire (DDQ) and patients' self-report of drug use, the level of anxiety, depression, and sleep quality of patients were evaluated using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI), respectively. Also, suicidal thoughts were assessed by Beck Scale for Suicidal Ideation and quality of life by the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Results: The study found that the treatment resulted in a relapse rate of 16.7% for relapse. We also found that all sub-scales of the desire for drug questionnaire (DDQ), depression, and anxiety were significantly lower at the end of the study compared to its beginning. Additionally, quality of life and sleep significantly increased at the end of the study. All areas of craving, anxiety, and depression significantly decreased in all follow-up sessions that took place 1, 5, and 11 months after the start of treatment. Moreover, sleep disorders were improved considerably at the end of the treatment. Conclusion: The current study presented a low relapse rate of Iranian patients with opioid use disorder under structured treatment of gradual detoxification with opium tincture in a one-year follow-up period. Opium tincture under the Congress 60 protocol may help to control carving, decrease psychological disorders, improve quality of life, and consequently, lower relapse rate.

The assessment of health system responsiveness from the viewpoints of COVID-19 patients.

BACKGROUND: Pandemics such as Corona are currently major health concerns worldwide. Health system responsiveness to the medical and non-medical needs of patients during pandemics is essential. This study aimed to examine hospitals' responsiveness to Corona patients. METHODS: This descriptive and analytical research had a cross-sectional design. The study population included Corona patients discharged from 17 public hospitals of Mashhad University of Medical Sciences, Iran, in the spring of 2021. WHO questionnaire for health system responsiveness was used to collect data. 413 patients participated in the study who were selected by random classified sampling. To analyze the data, descriptive statistics, including frequency, and deviation, and to examine the relationship between variables, Kruskal-Wallis and Mann-Whitney tests were used. RESULTS: In this study, one-third participants were in the age range of 31 to 40 (32.6%). The ability of 277 (70.5%) participants to pay treatment costs was very low, and low. 380 (96.7%) of the respondents had basic health insurance and 101 (25.7%) had supplementary insurance. In general, respondents evaluated the responsiveness of hospitals as 75.6. The highest score was related to confidentiality, and the lowest to prompt attention. There was no significant relationship between the total response score with demographic information. CONCLUSION: The responsiveness of studied hospitals to Corona patients was adequate. However, there was dissatisfaction with the lack of timely treatment and medication. Moreover, the most important dimension of responsiveness was dignity. Healthcare providers need to pay attention to different aspects of responsiveness and improving the quality of and access to health services during pandemics and disasters.

Comparison of the Dynamic Postural Control During Lifting and Lowering an External Load in Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: This study aimed to compare dynamic postural control between individuals with and without chronic low back pain (LBP) through load lifting and lowering. METHODS: This cross-sectional study included 52 male patients with chronic LBP (age: 33.37 ± 9.23 years) and 20 healthy male individuals (age: 31.75 ± 7.43 years). The postural control parameters were measured using a force plate system. The participants were instructed to stand barefoot (hip-width apart) on the force plate and lift a box (10% of the weight of the participants) from the waist height to overhead and then lower it from overhead to waist height. The interaction between the groups and tasks was determined using a 2-way repeated-measures analysis of variance. RESULTS: There was no significant interaction between the groups and tasks. Regardless of the groups, postural control parameters including amplitude (P = .001) and velocity (P < .001) in anterior-posterior (AP) direction, phase plane in medial-lateral (ML) direction (P = .001), phase plane in AP-ML direction (P = .001), and the mean total velocity (P < .001) were lesser during the lowering compared with lifting. The results indicated that, regardless of the tasks, the postural control parameters including velocity (P = .004) and phase plane in AP direction (P = .004), velocity in ML direction (P < .001), phase plane (AP-ML) (P = .028), and mean total velocity (P = .001) in LBP were lesser compared with the normal group. CONCLUSION: Different tasks affected postural control differently in patients with LBP and healthy individuals. Moreover, postural control was more challenged during the load-lowering than the load-lifting task. This may have been a result of a stiffening strategy. It may be that the load-lowering task might be considered as a more influential factor for the postural control strategy. These results may provide a novel understanding of selecting the rehabilitation programs for postural control disorders in patients.

Clinical performance of rapid antigen tests in comparison to RT-PCR for SARS-COV-2 diagnosis in Omicron variant: A systematic review and meta-analysis.

The Omicron variant of concern has a high level of mutations in different genes that has raised awareness about the performance of immunological products such as vaccines and antigen detection kits. In this systematic review and meta-analysis, we investigated whether Omicron had a significant influence on rapid antigen test (RAT) performance in comparison to PCR. We registered this systematic review and meta-analysis in PROSPERO with the registration number CRD42022355510. We searched PubMed, Scopus, Embase, and Web of Science databases systematically to 1 August 2022. After article screening, we assessed the quality of the included studies based on the JBI checklist. Following data extraction, we performed a meta-analysis using R software. We included 18 qualified articles presenting sufficient data about RATs performance in comparison to RT-PCR in Omicron infections. The pooled specificity and sensitivity of RATs were 1.000 (0.997-1.000) and 0.671 (0.595-0.721), respectively. The FDA-approved kits showed a better performance than WHO-approved ones with a sensitivity of 0.728 (0.620-0.815). The use of RATs with nasal swabs showed a higher sensitivity compared with nasopharyngeal swabs. The sensitivity for samples with a CT-value >25 was 0.108 (0.048-0.227). Rapid antigen tests show impaired performance for COVID-19 diagnosis when the Omicron variant is circulating, particularly in samples with low viral loads.

The Effects of N-Acetyl-L-Leucine on the Improvement of Symptoms in a Patient with Multiple Sulfatase Deficiency.

Multiple Sulfatase Deficiency (MSD) is a rare autosomal recessive disease with specific clinical findings such as psychomotor retardation and neurological deterioration. No therapy is available for this genetic disorder. Previous studies have shown that N-acetyl-L-leucine (NALL) can improve the neurological inflammation in the cerebellum.In the current study, the effects of NALL on ataxia symptoms and quality of life were explored in a patient with MSD.This study was a crossover case study. The subject, a girl aged 12 years old, received NALL at a dose of 3 g/day (1 g in the morning, 1 g in the afternoon, and 1 g in the evening). A fasting blood sample was taken from the subject to evaluate side effects before the intervention and 4 weeks after taking supplement/placebo in every study stage. The ataxia moving symptoms were evaluated using the Scale for the Assessment and Rating of Ataxia (SARA) score in every study stage. Dietary intake was measured using 24-h dietary recall before and after the intervention. The diet compositions were assessed by Nutritionist IV software. Serum IL-6 level was measured using an ELISA kit.There was no significant change in complete blood count (CBC) and serum biochemical factors in the patient with MSD after receiving NALL (3 g/day) over 4 weeks. The SARA score was reduced by 25%. The gait whose maximum score accounts for approximately one-fifth of the maximum total SARA score (8/40) was decreased. The heel-to-shin slide, the only SARA item performed without visual control, was also improved after therapy. Furthermore, there was a downward trend in the 8MWT (8.71 to 7.93 s). Regarding quality of life assessments, the parent and child reported improved quality of life index, physical health, and emotional function after taking NALL. Moreover, total energy intake was increased with NALL treatment through the study period.Supplementation with NALL at a dose of 3 g/day over 4 weeks was well tolerated and improved ataxia symptoms, quality of life measure, and serum IL-6 levels in the patient with MSD. Further proof-of-concept trials are warranted to confirm the present findings.

Relationship between the prevalence and severity of non-alcoholic fatty liver disease and coronary artery disease: Findings from a cross-sectional study of a referral center in northeast Iran.

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is becoming increasingly prevalent worldwide, and cardiovascular diseases are the most common cause of death in NAFLD patients. The present study aimed to evaluate the possible relationship between the presence and severity of NAFLD and coronary artery disease (CAD). Methods: A cross-sectional study was conducted on 296 patients (122 men and 174 women, with mean age 54.10 ± 9.33 years) referred to the catheterization laboratory of Imam Reza Hospital affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran, for elective coronary angiography to investigate the presence and severity of CAD. Additionally, all patients underwent abdominal ultrasonography (USG) to detect NAFLD and its severity. Results: Among the 296 patients, 187 (63.2%) had CAD and 160 (50.1%) had NAFLD. NAFLD patients had significantly higher prevalence of obesity (odds ratio [OR] = 1.047, 95% confidence interval [CI] = 1.002-1.094), hypertension (OR = 1.909, 95% CI = 1.027-3.55), hyperlipidemia (OR = 3.474, 95% CI = 1.862-6.482), and CAD (OR = 2.009, 95% CI = 1.100-3.669). The percentage of patients with normal vessels was higher in the non-NAFLD group, followed by the group with mild and severe NAFLD (P < 0.001). However, single- and multi-vessel disease incidences among the non-NAFLD, mild, and severe NAFLD groups were 36.1, 43.1, and 63.7%, respectively. Interestingly, the percentage of patients with two-vessel stenosis was significantly higher in severe NAFLD patients than mild and non-NAFLD patients (P < 0.001). Conclusion: The prevalence and severity of NAFLD were independently associated with CAD. Mild NAFLD was primarily observed among patients with normal and non-obstructive coronary artery patients, while severe NAFLD was more frequent in extensive CAD patients with multi-vessel disease.

Comparative Study of Vascular Endothelial Growth Factor in Exudative and Transudative Pleural Effusion.

Background: Increased vascular permeability is one of the main mechanisms in the production of pleural effusion (PE) and vascular endothelial growth factor (VEGF) has a significant role in its pathogenesis. This study aimed to compare pleural levels of VEGF in transudative and exudative PEs besides the other pleural markers. Materials and Methods: In this prospective cross-sectional study, 80 patients with PE were divided into 4 groups as transudative (N=15), parapneumonic (N=15), tuberculosis (N=25), and malignant (N=25) PE. Biochemical tests measured the pleural protein, LDH, cholesterol, glucose, polymorphonuclear cell (PMN), and lymphocyte. ELISA measured the pleural VEGF level. Results: Out of 80 patients, 51 were male, and the total mean age was 55.34±18.53. There were significant differences in pleural VEGF between exudative and transudative effusion (P<0.001) and between malignant and benign effusion (P=0.014). The highest mean difference in pleural VEGF levels was seen in the comparison of transudative and malignant groups (Mean difference=-136.56; P<0.002). The VEGF level in 3 groups was not significantly different; transudative vs tuberculous, parapneumonic vs tuberculous, and parapneumonic vs malignant. Furthermore, VEGF higher than 73.09 pg/ml had a 64% sensitivity and 82% specificity for the diagnosis of malignancy. Among pleural markers (VEGF, protein, LDH, and glucose), VEGF had the highest area under curve (AUC=0.734). Moreover, pleural protein, LDH, and glucose levels significantly correlated with pleural VEGF; however, pleural cholesterol, PMN, and lymphocyte were not correlated. Conclusion: VEGF is assumed as an important factor in the pathogenesis of exudative PE, especially malignant effusion. It can distinguish between lymphocytic exudative PEs.

The predictive role of parathyroid hormone for non-alcoholic fatty liver disease based on invasive and non-invasive findings in candidates of bariatric surgery.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH) and hepatic fibrosis are the most detrimental hepatic abnormalities associated with increased body weight with devastating clinical outcomes. Therefore, there is a substantial necessity for efficient management strategies, including significant weight reduction. Bariatric surgery has been used as a therapeutic approach in a selected obese patient with NAFLD/NASH and other cardiometabolic comorbidities. PURPOSE: The study is focused on the predictive role of PTH with the indices of hepatic steatosis/NAFLD and NASH based on liver biopsy, elastography, and sonography in morbidly obese patients. METHODS: Ninety patients with BMI between 35 and 40 kg/m2 with more than two comorbidities who referred to Imam Reza outpatient clinic from December 2016 to September 2017 were recruited and underwent initial assessments, including demographic profiles, psychological assessment, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least two weeks before liver biopsy. The histological analysis of the liver was performed using biopsy samples which obtained from left hepatic lobe during bariatric surgery under direct surgeon observation using a 16-gauge Tru-cut needle. The study was approved by the ethical committee (IR.MUMS.fm.REC.1396.312). RESULTS: The level of PTH was significantly high in patients with positive histology for hepatic fibrosis, steatosis, and NASH/NAFLD compared to patients with negative histology (p = 0.005, p = 0.009, and p = 0.013, respectively). Also, patients with liver fibrosis confirmed by elastography had significantly higher serum PTH concentration than patients without fibrosis (p = 0.011). PTH was also positively correlated with hepatic fibrosis, NASH, and steatosis (p = 0.007, p = 0.012, p = 0.023, respectively). CONCLUSION: High levels of PTH was significantly associated with histological indices of (hepatic fibrosis, steatosis, NAFLD and NASH) and elasticity indices. Therefore, it is imperative to assess for high levels of PTH in the morbidly obese population pre-and post-bariatric surgery. However, for a more robust and comprehensive assessment, a randomized controlled trial is needed. The study was conducted in accordance with the practice guidance in the diagnosis and management of NAFLD from the American association for the study of liver disease (AASLD) 2018. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies.

PCR-Based Diagnosis of Leishmania Species in Chronic Granulomatous Dermatitis in Mashhad, Iran.

Background: Cutaneous leishmaniasis (CL) is a chronic granulomatous dermatitis (CGD). Approximately, 90% of CL patients are from seven countries including Iran. We explain polymerase chain reaction (PCR) diagnostic technique for chronic granulomatosis dermatoses including CL in Mashhad, Iran. Methods: This study enrolled 64 patients within 2009-2013 with chronic granulomatosis dermatitis referred to dermatology and pathology departments of Imam Reza Hospital, affiliated to Mashhad University of Medical Sciences (MUMS), Mashhad, Iran. We gathered demographic data from archived folders. Histological light microscopic evaluation and parasitological tests were done on selected specimens. We used PCR diagnostic test on specimens. Statistical analysis was done by SPSS version 15. Results: Generally, 7 out of 64 specimens had Leishmania DNA and other samples had no Leishmania DNA. The mean age of patients was 46 ± 18.77 years; disease duration was 7 ± 6.73 months ranging from 1-24 months. Most of the lesions were located on face and upper limb. Totally, 5 out of 7 samples were Leishmania major and 2 out of 7 samples were L. tropica. Tuberculoid granuloma was present in L. tropica samples and 3 of L. major samples. Other light microscopic changes were as follow: 42 suppurative granuloma, and epidermal changes including atrophy, pseudoepitheliomatous hyperplasia, and parakeratosis with dermal changes including, plasma cell, involvement of papillary and reticular dermis, and distribution of granuloma to hypodermis. Conclusion: Our results addressed PCR-based diagnosis of chronic cutaneous leishmaniasis, which is resulted from L. major and L. tropica.

Nutritional Intake and Chronicity Associated with the Old World Cutaneous Leishmaniasis: Role of Vitamin A.

BACKGROUND: Old world cutaneous leishmaniasis (CL) is known as a self-healing cutaneous parasitic infection. Host immunity has a fundamental role in the course of this infection. This study was designed to investigate the relationship between nutritional status and vitamin A intake with the clinical course of CL. METHODS: Overall, 250 patients with CL attending a dermatology clinic in Imam Reza Hospital Mashhad, Iran, were enrolled from Apr 2011 to Aug 2012. For data gathering, a semi-quantitative 302-item food frequency questionnaire was utilized. They received routine treatment protocols for leishmaniasis and 1 year of follow-up. RESULTS: As for the 149 patients who completed the study, a deficiency of macro and micronutrients, particularly vitamin A, was significantly related to a chronic clinical disease course. CONCLUSION: Imbalanced or insufficient nutritional intake including vitamin A deficiency, may influence the clinical course of CL.

Randomized Controlled Trial of Comparative Hypocaloric vs Full-Energy Enteral Feeding During the First Week of Hospitalization in Neurosurgical Patients at the Intensive Care Unit.

BACKGROUND: Nutrition support plays a pivotal role in improving the clinical outcomes of the patients admitted to the intensive care unit (ICU). However, there are controversies regarding the optimal amount of energy for the reduction of morbidity and mortality in neurosurgical patients at the ICU. METHODS: This randomized clinical trial was conducted on 560 patients who were admitted to trauma, stroke, and neurosurgery ICUs, and 68 patients were enrolled based on the inclusion criteria. In total, data of 58 patients were analyzed. In the full-energy group, enteral feeding started at 75% of their daily energy expenditure and gradually increased to 90%-100%. In the hypocaloric group, enteral feeding started with 30% of the daily energy expenditure and reached 75% within 7 days of the intervention. RESULTS: No significant differences were observed in the baseline characteristics of the patients in the hypocaloric and full-energy groups. The incidence of severe gastrointestinal intolerance was relatively high in the full-energy group (P < .001). Duration of mechanical ventilation and length of hospital stay were lower in the hypocaloric group compared with the full-energy group (P = .014 and P = .046, respectively). However, no significant differences were denoted in the length of ICU admission (P = .163), 28-day mortality (P = .640), and pneumonia (P = .162) between the study groups. CONCLUSIONS: In the neurocritical care unit, hypocaloric enteral feeding was associated with lower gastrointestinal intolerance, as well as reduced duration of ventilator dependence and length of hospital stay.

The effects of nanomicelle of curcumin on the matrix metalloproteinase (MMP-2, 9) activity and expression in patients with coronary artery disease (CAD): A randomized controlled clinical trial.

BACKGROUND: Coronary artery disease (CAD) is the most common type of cardiovascular disease. Increasing the expression and activity of matrix metalloproteinases (MMPs) facilitates vascular remodeling and cardiovascular complications. Curcumin (the active ingredient of turmeric) is a potent natural anti-inflammatory agent, with cardiovascular protective effects. The present study was a clinical trial for investigating the effects of curcumin on activity and gene expression of MMP-2 and MMP-9 in patients with CAD. METHODS: In this study, 70 patients with CAD (with 40%-50% stenosis) were randomly divided into two groups of curcumin (80 mg nanomicelle per day) and placebo. The intervention lasted 3 months. The activity levels of MMP-2 and MMP-9 in serum samples of patients were measured using gelatin zymography assay before and after the intervention. MMP-2 and MMP-9 gene expression in peripheral blood mononuclear cells (PBMCs) was also analyzed using real-time polymerase chain reaction (PCR). Statistical significance was set at P < 0.0500. RESULTS: After 3 months of medication, the expression of MMP-9 produced by PBMCs significantly decreased in the curcumin group (0.811 ± 0.25) in comparison with the placebo group (2.23 ± 0.94) (P < 0.0001). Furthermore, the zymographic analysis showed that the administration of curcumin significantly inhibited the activity levels of MMP-2 (12469.7 ± 5308.64 pixels) and MMP-9 (14007.2 ± 5371.67 pixels) in comparison with that in patients receiving placebo (MMP-2: 17613.8 ± 5250.68 pixels; MMP-9: 20010.1 ± 3259.37 pixels) (P < 0.0500). CONCLUSION: Our results show that curcumin can significantly reduce the expression and activity of MMP-2 and MMP-9. Because of the anti-inflammatory effects of curcumin, this compound can be considered as a new strategy for the prevention of cardiovascular events.

Cerebellar repetitive transcranial magnetic stimulation (rTMS) for essential tremor: A double-blind, sham-controlled, crossover, add-on clinical trial.

BACKGROUND: There is controversial evidence about the effect of cerebellar low-frequency stimulation in patients with essential tremor (ET). OBJECTIVES: In this study we assessed safety and effectiveness of 1 Hz (low-frequency) cerebellar repetitive transcranial magnetic stimulation (rTMS) on tremor severity in patients with essential tremor in a sham-controlled crossover trial. METHODS: A total of 23 patients assigned into two groups to receive either sham (n = 10) or rTMS (n = 13) treatment, with crossing over after a two-month washout period. Intervention consisted of 900 pulses of 1 Hz rTMS at 90% resting motor threshold or the same protocol of sham stimulation over each cerebellar hemisphere for 5 consecutive days. Tremor severity was assessed by Fahn-Tolosa-Marin (FTM) scale at baseline and at days 5, 12 and 30 after intervention. The FTM consists of 3 subscales including tremor severity rating, performance of motor tasks, and functional disability. Carry-over and treatment effects were analyzed using independent samples t-test. RESULTS: There was no significant improvement in the total FTM scores in rTMS compared to the sham stimulation on day 5 (p = 0.132), day 12 (p = 0.574), or day 30 (p = 0.382). Similarly, FTM subscales, including tremor severity rating, motor tasks, and functional disability did not improve significantly after rTMS treatment. Mild headache and local pain were the most frequent adverse events. CONCLUSION: Although cerebellar rTMS seems to have acceptable safety when used in ET patients, this study could not prove any efficacy for it in reduction of tremor in these patients. Larger studies are needed to evaluate efficacy of this therapeutic intervention and to provide evidence about the optimal stimulation parameters.

Casual effect of methotrexate+etanercept/infliximab on survival of patients with rheumatoid arthritis.

Background and objectives: Following the discovery of new drugs, physicians and pharmaceutical companies have become interested in examining patients' mortality and morbidity rates. In this respect, the effects of methotrexate (MTX)+etanercept/infliximab (ETA/INF) therapy on the survival of rheumatoid arthritis patients (RA) were evaluated in this study using marginal structural piecewise constant baseline hazard model. Patients and methods: According to the standard protocol, MTX is considered as the first-line treatment for RA patients. If there is no adequate response to MTX, biologic drugs will be added. To compare the survival rates of RA patients in MTX- and MTX+ETA/INF-treated groups, the piecewise constant baseline hazard model was fitted. Then, due to the existence of the time-dependent confounder (VAS) which was affected by previous treatment, the weight for each person-time was calculated via the inverse probability treatment weighting method. These weights were then used by marginal structural piecewise constant baseline hazard model. Finally, these models were compared. Results: The median (IQR) of the follow-up period in patients receiving MTX+ETN/INF and MTX was 11 (15.25) and 11 (31), respectively, and the 8-year survival rate was reported by 70% versus 68%, respectively. First, the piece-wise constant baseline hazard model was fitted. Fitting the given model showed that MTX+ETA/INF had a significant effect on patients' survival (HR=0.789, 95% CI [0.634, 0.983]). Second, marginal structural piecewise constant baseline hazard model was fitted. But, the results of this model revealed that MTX+ETA/INF did not have a significant impact on patients' survival (HR=0.968, 95% CI [0.860, 1.090]). Conclusion: Adjusting the pain score over time as a time-dependent confounder via marginal structural piecewise constant baseline hazard model, it has been demonstrated that MTX+ETA/INF does not have a significant effect on patients' survival rates. Therefore, a significant difference can be found between survival rates of these groups using longitudinal studies.

Additional effect of etanercept or infliximab on the liver function tests of patients with rheumatoid arthritis: a cohort study.

PURPOSE: One of the most important long-term side effects of therapy for rheumatoid arthritis (RA) is the elevation of liver function tests, with earlier studies reporting an elevation of more than 1× the upper limit of normal (>1 × ULN). The current study expands the literature by comparing the trends of transaminase changes caused by conventional and biologic disease-modifying antirheumatic drugs (DMARDs). PATIENTS AND METHODS: The drug categories examined were methotrexate (MTX) and all other nonbiologic DMARDs. Where RA patients exhibited inadequate response to conventional DMARDs (cDMARDs), we added biologic DMARDs (bDMARDs) to the treatment. We compared the trend of changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the patients receiving MTX with the trend observed in the patients whose treatment encompassed both bDMARDs and MTX. The comparison was conducted using random intercept models, which are a type of linear mixed effects model. RESULTS: This work involved 512 RA patients (MTX: 450, MTX + infliximab [INF]: 26, MTX + etanercept [ETA]: 36), whose ALT and/or AST levels were measured in 1,786 visits (MTX: 1,543, MTX + INF: 107, MTX + ETA: 136). ALT and/or AST elevations greater than 1 × ULN were observed in 344 (19.3%) visits (MTX: 295 [19.1%], MTX + INF/ETA: 49 [20.2%]). In this study, the trends of ALT and AST changes increased when receiving MTX, while the INF/ETA addition decreased these trends. The random intercept models indicated that changes in the mean ALT levels were significantly different over the time for MTX and MTX + INF/ETA groups (ß [SE] =-0.190 [0.093], P= 0.040) but changes in the mean AST levels were nonsignificantly different over the time for such groups (ß [SE] =-0.099 [0.064], P=0.120). CONCLUSION: Despite a higher incidence of elevated transaminases during the use of MTX + INF/ETA, the combination of INF/ETA with MTX reduced transaminase levels and returned ALT levels to normal concentrations.

Comparison of Effect of Oral Premedication with Ibuprofen or Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study.

The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Seventy-eight patients with irreversible pulpitis were randomly divided into 3 groups (26 per group) and given one of the following at 1 hr prior to performing local anesthesia: a placebo; 400 mg ibuprofen; or 4 mg dexamethasone. Each patient recorded their pain level on a visual analog scale before taking the medication or placebo, at 15 min after completion of IANB, and during treatment if pain occurred. The success of the anesthesia was defined as no or mild pain at any stage during the endodontic procedure. The success rate of the IANB was 38.5, 73.1, and 80.8% with the placebo, ibuprofen, and dexamethasone, respectively. Both ibuprofen and dexamethasone were significantly more effective than the placebo. No significant difference was observed, however, between the two experimental medications in terms of effectiveness. The results of the present study suggest that premedication with ibuprofen or dexamethasone increases the success rate of an IANB in patients with symptomatic irreversible pulpitis in the mandibular molars.

Cleft lip and palate and related factors: A 10 years study in university hospitalised patients at Mashhad--Iran.

BACKGROUND: Oral-facial clefts including cleft lip and palate are the most common congenital malformations of the head and neck. Environmental factors such as maternal hormonal disorders, use of psychiatric medications, vitamin and folic acid deficiency, hypoxia, cigarette smoking and maternal obesity and overweight can affect the incidence of these disorders. In Iran, one of the associated problems is a lack of accurate statistics regarding the present status of the patients, which can cause a disturbance in the health programmes of Ministry of Health and Medical Education. The aim of this study was to report the status of 398 cases of cleft lip and palate in Sheikh and Imam Reza Hospitals of Mashhad over a 10-year period. MATERIALS AND METHODS: This retrospective descriptive study was performed using data collection method and included the evaluation of the recorded files and completing the data forms. In this study, the file records of 398 patients referring to Mashhad Sheikh and Imam Reza (P.U.H) Hospitals were studied, from the beginning of 2002 to the end of 2011; the obtained data from the files were collected and classified. RESULTS: The highest frequency was related to cleft palate alone (40.7%); frequencies were lower regarding the cleft lip and palate and cleft lip alone (34.41% and 24.87%, respectively). Approximately, half of the patients were from rural areas of the city and had articulation disorders. Most of the patients were the first-born children of the family and their parents were consanguineously married; about one-third of the patients had a family history of the disease. CONCLUSION: According to the results of the present study, cleft lip is more frequent in males and cleft palate is more prevalent in females; the obtained results are consistent with the global statistics.

Investigation of the effects of curcumin on serum cytokines in obese individuals: a randomized controlled trial.

BACKGROUND: Obesity is a disorder often accompanied by a heightened state of systemic inflammation and immunoactivation. The present randomized crossover trial aimed to investigate the efficacy of curcumin, a bioactive polyphenol with established anti-inflammatory and immunomodulatory effects, on the serum levels of a panel of cytokines and mediators in obese individuals. METHODS: Thirty obese individuals were randomized to receive curcumin at a daily dose of 1 g or a matched placebo for 4 weeks. Following a 2-week wash-out period, each group was assigned to the alternate treatment regimen for another 4 weeks. Serum samples were collected at the start and end of each study period. Serum levels of IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFNγ, EGF, MCP-1, and TNF α were measured using a multiplex Biochip Array Technology based method. RESULTS: Mean serum IL-1ß (P = 0.042), IL-4 (P = 0.008), and VEGF (P = 0.01) were found to be significantly reduced by curcumin therapy. In contrast, no significant difference was observed in the concentrations of IL-2, IL-6, IL-8, IL-10, IFNγ, EGF, and MCP-1. CONCLUSIONS: The findings of the present trial suggested that curcumin may exert immunomodulatory effects via altering the circulating concentrations of IL-1ß, IL-4, and VEGF.

A sham-controlled trial of acupuncture as an adjunct in migraine prophylaxis.

BACKGROUND: Migraine is one of the most common types of headache, with significant socioeconomic effects. Prophylactic drugs are used to prevent migraine headaches but are unpromising. OBJECTIVE: To assess the effects of adding acupuncture to conventional migraine prophylaxis. METHODS: One hundred patients with migraine (41 male, 59 female), in whom prophylactic drugs had not produced a fall of at least 50% in the number of attacks, entered the study. The patients were randomised into two groups, sham and true acupuncture. The patients in both groups continued their prophylactic treatment and received 12 sessions of either true or sham acupuncture. Each session was 30 min and was repeated three times a week. The number of headaches in the two groups was compared at baseline, and at the end of four successive months. RESULTS: There was no significant difference in the frequency of attacks between the two groups before intervention. After 1 month, the frequency of attacks each month decreased from 5.1 (0.8) to 3.4 (1.2) in the true acupuncture group, and from 5.0 (0.8) to 4.4 (1.1) in the sham acupuncture group (a significant difference, p<0.001). The frequency continued to decrease in month 2 but increased in months 3 and 4; however, it was still significantly lower than baseline, and the difference remained significant after month 4. CONCLUSIONS: Acupuncture is applicable as an adjunct to prophylactic drugs in migraineurs in whom the number of attacks does not fall with prophylactic medication.

Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture.

BACKGROUND: Percutaneous vertebroplasty (PVP) is more commonly used for osteoporotic compression fractures (OCFs) and osteolytic vertebral body tumors. This study aimed to study the differences between OCFs and vertebral hemangiomas (VHs) treated with PVP. MATERIALS AND METHODS: Between September 2007 and January 2010, we prospectively treated 28 consecutive patients of OCFs (43 recently symptomatic OCFs) and 24 cases of VHs (26 VHs). We used visual analogue scale (VAS) pain and Oswestry Disability Index (ODI) to evaluate the patients. The followup period in group 1 and 2 were 25.1 months (range 12 - 31 months) and 21.3 months (range 14 - 28 months), respectively. Comparison of means was carried out with the Chi Square Tests, t-test, and N Par-Test for multiple comparisons, whenever appropriate. The level of statistical significance was set at P < 0.05. RESULTS: Following PVP the VAS score decreased to 4.57 and 4.17 in group 1 and 2, respectively. The ODI scores were 32.5% and 30%, respectively. This decrease in ODI scores lasted throughout the followup period. CONCLUSIONS: Although the preoperative scores were significantly different between group 1 and 2, there was no significant difference between two groups following the PVP.