Efficacy of group cognitive rehabilitation therapy in multiple sclerosis.

OBJECTIVE: Cognitive impairment occurs in 40%-65% of patients with multiple sclerosis (MS). Several techniques for cognitive rehabilitation (CR) in these patients have been evaluated; however, the results have been controversial. In this study, we investigated the efficacy of group compensatory CR in patients with MS-related cognitive impairment. MATERIALS AND METHODS: Thirty-four female patients with diagnosed relapsing-remitting MS and evidence of impaired cognitive function were included and randomized to intervention (n = 17) and control (n = 17) groups. CR intervention consisted of eight 2-hour sessions of comprehensive group CR over a 4-week period that focused on improvement of memory, attention, and executive function. As placebo, the control group received the same number of non-therapeutic group sessions. Assessment of cognitive function was performed before intervention (pretest), at the end of intervention (post-test), and 3 months later (follow-up). RESULTS: The study population included 34 patients with a mean age of 35.5 years. Statistical comparison of memory assessments at 3-month follow-up showed significantly higher scores in the CR group than in the control group (93.33 vs 86.40 for Addenbrooke's Cognitive Examination test and 16.58 vs 12.00 for visual memory, 19.32 vs 14.05 for verbal memory, and 51.28 vs 44.41 for general scores on the Memory Functioning Questionnaire test, respectively). Wisconsin card sorting test score comparison showed significantly lower total time consumption in the CR group than in the control group (308.1 vs 340.8 seconds, respectively). Behavior rating inventory of executive function-adult scores in all four subtests were significantly higher in the CR group than in the control group (40.25 vs 55.4 for behavioral regulation index, 51.16 vs 68.6 for metacognition index, and 97.41 vs 124.00 for global executive composite, respectively). Attention was the only domain in which we did not observe any significant variation between groups in terms of post-test and follow-up scores. CONCLUSION: This study supports the efficacy of group CR in the improvement of cognitive function in patients with MS.

Differences in Morphologic and Hemodynamic Characteristics for "PHASES-Based" Intracranial Aneurysm Locations.

BACKGROUND AND PURPOSE: Several recent prospective studies have found that unruptured intracranial aneurysms at various anatomic locations have different propensities for future rupture. This study aims to uncover the lack of understanding regarding rupture-prone characteristics, such as morphology and hemodynamic factors, associated with different intracranial aneurysm location. MATERIALS AND METHODS: We investigated the characteristics of 311 unruptured aneurysms at our center. Based on the PHASES study, we separated and compared morphologic and hemodynamic characteristics among 3 aneurysm location groups: 1) internal carotid artery; 2) middle cerebral artery; and 3) anterior communicating, posterior communicating, and posterior circulation arteries. RESULTS: A mixed model statistical analysis showed that size ratio, low wall shear stress area, and pressure loss coefficient were different between the intracranial aneurysm location groups. In addition, a pair-wise comparison showed that ICA aneurysms had lower size ratios, lower wall shear stress areas, and lower pressure loss coefficients compared with MCA aneurysms and compared with the group of anterior communicating, posterior communicating, and posterior circulation aneurysms. There were no statistical differences between MCA aneurysms and the group of anterior communicating, posterior communicating, and posterior circulation aneurysms for morphologic or hemodynamic characteristics. CONCLUSIONS: ICA aneurysms may be subjected to less rupture-prone morphologic and hemodynamic characteristics compared with other locations, which could explain the decreased rupture propensity of intracranial aneurysms at this location.

Hypercalciuria in children with urinary tract symptoms.

We performed this prospective study to determine the urinary calcium to creatinine ratio (Ca/Cr) in children with different urinary symptoms. We studied 523 children in our nephrology clinic with an age range of 3 to 14 years (mean= 8) and male to female ratio of 0.61. All the children had at least one of the urinary tract symptoms (dysuria, frequency, urgency, abdominal and/or flank pain, diurnal incontinence or enuresis), microscopic hematuria, urinary tract infection or urolithiasis. Fasting urine was collected for measuring calcium and creatinine and the results were compared to the values for the normal Iranian children. Ca/Cr ratio of more than 0.2 (mg/mg) was considered as hypercalciuria. Of all the patients, 166 (31.3%) were hypercalciuric. Urine Ca/Cr ratio was significantly higher in all the subgroups with one or more of the urinary symptoms (P< 0.001). We conclude that urine Ca/Cr ratio is significantly increased in children with all types of urinary symptoms. We recommend measuring urinary calcium in all children with urinary tract symptoms, especially if unexplained.

Arthrographic distension of the shoulder joint in the management of frozen shoulder.

The study was an open randomized controlled trial to compare the outcome at 8 weeks with two different modalities in the treatment of 'Frozen shoulder'. Clinical cases with painful limitation of movement of shoulder were randomized to receive physical therapies alone versus physical therapies and shoulder arthrography with intra-articular steroid in a sequential randomization process. Cases suspected of having a concomitant illness and has potential to cause secondary frozen shoulder were excluded, such as, history of trauma to shoulder over the last 6 months, symptomatic clinical cervical degenerative diseases, and causes in and around the shoulder (infective and non-infective). Physical Therapies provided to all patients were therapeutic exercises, transcutaneous electrical nerve stimulation (TENS) and infra-red radiation (IRR). Outcome measures were improvement of pain on a Visual Analogue Scale (VAS) score and range of motion measured by Goniometer at 8 weeks. Patients were followed weekly for 8 weeks and outcome parameters were recorded on every evaluation. The baseline range of motion in the two groups was comparable. At 8 weeks a statistically significant difference in outcome were observed in the two groups. The chi-square means difference of improvement in range of motion for abduction was p <0.00 and for external rotation was p <0. 00. The pain reduction on VAS score was not significant in the two groups (p <0. 40). In the present small series, the distension arthrography with intra-articular (IA) steroid plus physical therapy was superior over physical therapy alone in the functional improvement of the frozen shoulder. Further studies with larger sample size are required to confirm the observations.

Insulin adsorbance to polyvinylchloride (PVC) surfaces of fluid container and infusion-set.

INTRODUCTION: In total parenteral nutrition (TPN) solution, adsorbance of insulin to polyvinylchloride (PVC) surfaces of fluid containers and infusion-sets, decrease the amount of insulin that reaches the patients. OBJECTIVE: To clarify the biding sites of insulin and to propose a solution to overcome this problem. METHODS AND MATERIALS: To each of four 1000ml. PVC bottles of 5 percent dextrose solution, 300 microunit of insulin per each milliliter of dextrose solution were added. Each bottle was then connected to an infusion-set and the system made to run at an infusion rate of 100ml. per hour. One milliliter samples were then collected from both the PVC bottles and infusion-sets-terminal, separately, immediately at the starting point (time zero) and 15, 30, 45 and 60 minutes thereafter. The concentrations of insulin were checked using insulin kits. RESULTS: At the starting point (time zero) the mean of insulin concentrations among four PVC bottles was 213.79 microunit per each milliliter of 5 percent dextrose solution. No significant fluctuation was noted in the concentration of insulin in the PVC bottles through 60th minute period. However the concentration of insulin at infusion-set- terminal decreased significantly at the end of the same hour (p. value = 0.004). CONCLUSION: Our results demonstrate that the adsorbance of insulin takes place at the surfaces of infusion sets. It follows therefore that increase in the primary dosage of insulin added to PVC infusion solutions and the selection of a suitable infusion set (polyethylene) seem to be beneficial for overcoming this problem.

Warfarin and aspirin versus aspirin alone in patients with acute myocardial infarction: a pilot study.

The benefits of anticoagulant therapy and antiplatelet agents in secondary prevention of myocardial infarction (MI) are well known. Administration of combined warfarin and aspirin (ASA) has not been well studied. The objective of this study was to compare the effect of coadministration of warfarin and ASA with administration of ASA alone on outcome of patients after MI. One hundred forty age- and sex-matched survivors of MI were randomized to receive either 100 mg/day ASA plus enough warfarin to reach a target: international normalized ratio of 2.5 (range: 2-3) (group A, n = 70), or only 100 mg/day ASA (group B, n = 70). The patients were examined for several variables including development of hemorrhage, reinfarction, and rehospitalization for 1 year post MI. Of the variables studied, minor hemorrhagic episodes were observed significantly (p = 0.002) more in group A than in group B patients. Rehospitalization and reinfarction rates, although occurring with lower frequencies in group A than in group B, did not reach the statistical significance level. In postmyocardial infarction patients, warfarin plus ASA did not provide a clinical benefit beyond that achievable with aspirin monotherapy, and for the observed markedly higher incidence of minor hemorrhage in combination therapy, antiplatelet therapy alone seems to be a more reasonable approach.

Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001.

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute (adult) respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier.

Anthrax: pathological aspects in autopsy cases in Shiraz, Islamic Republic of Iran, 1960-2001

Anthrax, like tuberculosis, shows a new epidemic spread in industrialized countries, revealing some ambiguous aspects to the disease and providing new challenges to medicine. Shiraz University of Medical Sciences has records of 7130 autopsies performed in the past 40 years, 33 of which are anthrax cases. We reviewed all the pathology slides of these cases and classified the organs involved in a search for unrecognized microscopic findings. The most common cause of death was sepsis, caused by organ involvement and direct cytotoxicity of Bacillus anthracis, in addition to its exotoxin production. Novel findings included hyaline membrane formation in respiratory system cases that is similar to acute [adult] respiratory distress syndrome and evidence of primary gastrointestinal involvement, showing the ability of the organism to pass the gastric barrier

Antihypertriglyceridemic effect of walnut oil.

Hyperlipidemia is an important modifiable risk factor of coronary heart diseases. So far, several studies, have indicated the beneficial effects of nuts on plasma lipid profile. Previously, in a pilot study the authors have shown that administration of 20 g/day of Persian walnut (Juglans regia L.) for 8 weeks could decrease plasma triglyceride (TG) concentration by 17% (p value < 0.05). Walnut also increased the plasma HDL-cholesterol level markedly (p value < 0.05). To make the measurements more reliable and to avoid the unwanted walnut side effects (eg, rash, pruritus), this randomized, double blind case-control study was conducted to evaluate the lipid-lowering effect of Persian walnut oil in the population of southern Iran. Sixty hyperlipidemic subjects were randomized into 2 groups; group A patients (n = 29) received walnut oil encapsulated in 500 mg capsules, 3 g/day, for 45 days. Group B patients (n = 31) received placebo and served as the control group. Lipid profiles of both groups were checked before; on days 15, 30, and 45 after the beginning; and 15 days after termination of the study. Plasma TG concentrations decreased by 19% to 33% of baseline in group A patients (p value < 0.05). No statistically significant change was observed in other measured parameters. It was concluded that walnut oil is a good antihypertriglyceridemic natural remedy and should be further explored in more detail.

Genital herpesvirus infection in a prepubertal girl.

An episode of acute vulvovaginitis which was found to be due to herpesvirus is described in an eight-year-old girl. The significance of such infections is discussed.