Effect of add-on melatonin on seizure outcomes and quality of sleep in epilepsy with idiopathic generalized tonic-clonic seizures alone in adult patients: Cross-sectional, randomized, double-blind, placebo-controlled clinical trial.

BACKGROUND: Effective treatment of epilepsy is a major challenge in the field of neurology. Studies have suggested that melatonin can work in epilepsy with a good safety profile. OBJECTIVES: This study was performed to determine the effectiveness of melatonin in seizure outcomes, as well as the quality of sleep in patients with generalized epilepsy. METHODS: In this cross-over clinical trial study, 60 patients with epilepsy with idiopathic generalized tonic-clonic seizures alone (EGTCS) and under valproic acid treatment received either melatonin or placebo with a washout period of 2 weeks intermittently. Outcome variables included a reduction in the severity and frequency of epilepsy besides improvement in electroencephalogram (EEG) abnormalities and sleep quality. RESULTS: By adding melatonin, a decrease in the mean severity score of epilepsy (according to the Chalfont questionnaire) was 32.33 ± 9.24, while it was 5.58 ± 14.28 in treatment with placebo (p = .002). Evaluation of the number of attacks and EEG results did not disclose any therapeutic efficacy in treatment with melatonin versus placebo. The quality of sleep improved in 40% (first round) and 53.4% (second round) of subjects who received melatonin (p < .001). CONCLUSIONS: Considering that the addition of melatonin to routine anti-seizure treatment was effective in reducing the severity of epilepsy and improving sleep quality, it seems that melatonin can be useful as an adjunct therapy for EGTCS in well-defined circumstances.

COVID-19 Presenting as Acute Necrotizing Pancreatitis.

The ongoing pandemic of the novel coronavirus disease 2019 (COVID-19) originated in Wuhan, China, in December 2019. Various manifestations of coronavirus (SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) have been reported since the pandemic began. Some articles have reported acute pancreatitis in several patients due to COVID-19 infection. In this case report, we introduce a patient in whom SARS-CoV-2 caused necrotizing pancreatitis. Acute abdomen is one of the manifestations of COVID-19. Various causes such as acute pancreatitis and necrotizing pancreatitis can be in the list of differential diagnoses.

A Rare Case Report of Acute Necrotizing Encephalopathy of Childhood.

OBJECTIVE: Acute necrotizing encephalopathy of childhood (ANEC) is a fast growing disease, accompanied by progressive encephalopathy. The aim of this study was to report a rare case of ANEC in a four-year-old boy with bilateral thalamic necrosis and non-fatal outcomes. CASE REPORT: The patient was a four-year-old Iranian boy, without any history of health problems or hospitalization, except for jaundice and phototherapy in the neonatal period. He had no neurological signs or symptoms during admission, and he was admitted only with chief complaints of acute onset of fever, coryza, and icterus. In the neurological consultation, brain MRI was requested to analyze the possibility of brain damage. The results indicated the involvement of cerebellum, thalamus, and basal ganglia, which led to the diagnosis of ANEC. CONCLUSION: Based on our findings, although ANEC is a rare disease, it should not be underestimated.

Helicobacter Pylori Infection in Sjögren's Syndrome: Co-incidence or Causality?

BACKGROUND AND AIM: Lymphoid cell infiltration and destruction of exocrine glands, specifically lacrimal and salivary glands are characteristics of Sjogren's syndrome (SS). An etiological role has been proposed for Helicobacter pylori (H. pylori), interacting in the clinical course and complications of SS (including gastric cancer and lymphoma). The aim of this study was to identify the probable correlation between H. pylori infection and Sjogren's syndrome (SS). METHODS: In this case-control study, ELISA method was used to determine serum level of IgA and IgM anti H. pylori antibody in 43 subjects with SS according to the international criteria and 95 healthy subjects as control. SPSS-17 was used to analyze data with t-test. P value <0.05 were considered significant. RESULTS: Serum level of IgM (34.9% vs. 10.5%, p-value= 0.001) and IgA (67.4% vs. 46.3% p value= 0.021) anti H. pylori antibody were significantly higher in SS patients compared to the control group. There was a positive correlation between age and H. pylori infection (r=0.2, Pvalue= 0.05). CONCLUSION: Patients with SS had a higher prevalence of H. pylori infection compared to the normal population. Eradication of H. pylori is recommended particularly in older patients with SS.

Ventricular endomyocardial fibrosis in a pregnant female with Behçet's disease.

A 32-year-old pregnant woman, diagnosed with Behçet's disease 6 months earlier, presented with recent mild hemoptysis and exertional dyspnea. Transthoracic echocardiography showed an enlarged dysfunctional right ventricle. A large hypoechoic triangular-shaped mass was seen attached to the inner right ventricular wall, filling the cavity. No change in the size of the mass was noted after anticoagulant administration, and right heart failure progressed. Surgery was performed to remove the mass and repair the tricuspid valve. This was a very rare presentation of Behçet's disease in pregnancy, which resulted in delivery of a completely healthy baby despite corticosteroid pulse therapy and cyclophosphamide.