Access Recirculation in Permanent Catheters of Hemodialysis Patients.

Treatment for end stage renal disease patients is based on dialysis; however, the presence of access recirculation (AR) decreases dialysis efficiency and adequacy. This study was conducted to determine the recirculation rate in dialysis patients undergoing hemodialysis through using a permanent catheter. 60 patients including 23 males and 37 females were enrolled. Mean age of the participants was 57.66 (± 14.08) years. Mean AR in the subjects was 9.36%, and 16 (27%) of patients had mean AR above 10%. Moreover, there was a significant correlation between AR and catheter longevity (P < .001). It is suggested to limit the use of permanent catheters to specific cases and not to use them in place of arteriovenous fistulas.

Further Evidence of the Positive Influence of Repetitive Transcranial Magnetic Stimulation on Speech and Language in Patients with Aphasia after Stroke: Results from a Double-Blind Intervention with Sham Condition.

BACKGROUND: After a stroke, up to 20% of patients suffer from aphasia. The preferred treatment for stroke-related aphasia (SRA) is regular speech and language training (SLT). In the present study, we investigated to what extent adjuvant repetitive transcranial magnetic stimulation (rTMS) might enhance recovery. While there is growing evidence of the positive effect of adjuvant rTMS on aphasia, no study has yet been based on an Iranian sample. METHOD: A total of 12 patients (mean age: 55 years; right-handed; 7 women) underwent treatment for SRA 1 month after stroke. The standard treatment consisted of regular 45-min SLT sessions 5 times a week for 2 consecutive weeks. Additionally, patients were randomly assigned either to adjuvant rTMS (5 times a week for 30 min) or to a sham condition (5 times a week for 30 min). At baseline and after 2 weeks of intervention, the degree of aphasia was assessed with the Farsi version of the Western Aphasia Battery. rTMS was applied to the inferior posterior frontal gyrus of the right hemisphere. RESULTS: Speech and language improved over time, but more so in the rTMS than in the sham condition. Large effect sizes were observed for content, fluency, and the aphasia quotient; medium effect sizes were observed for command comprehension and repetition, while effect sizes were small for auditory comprehension and naming. CONCLUSIONS: Among patients with SRA, compared to a sham condition, adjuvant rTMS improved speech and language skills. The present results add to the accumulating evidence that rTMS as a neuromodulation technique has the capacity to enhance the effect of conventional SLT.

Adjuvant thiamine improved standard treatment in patients with major depressive disorder: results from a randomized, double-blind, and placebo-controlled clinical trial.

Given that antidepressants (ADs) work slowly, there is interest in means to accelerate their therapeutic effect and to reduce side effects. In this regard, thiamine (vitamin B1) is attracting growing interest. Thiamine is an essential nutrient, while thiamine deficiency leads to a broad variety of disorders including irritability and symptoms of depression. Here, we tested the hypothesis that adjuvant thiamine would reduce depression, compared to placebo. A total of 51 inpatients (mean age: 35.2 years; 53 % females) with MDD (Hamilton Depression Rating Scale score (HDRS) at baseline: >24) took part in the study. A standardized treatment with SSRI was introduced and kept at therapeutic levels throughout the study. Patients were randomly assigned either to the thiamine or the placebo condition. Experts rated (HDRS) symptoms of depression at baseline, and after 3, 6, and 12 weeks (end of the study). Between baseline and the end of the study, depression had reduced in both groups. Compared to placebo, adjuvant thiamine improved symptoms of depression after 6 week of treatment, and improvements remained fairly stable until the end of the study, though mean differences at week 12 were not statistically significant anymore. No adverse side effects were reported in either group. Results suggest that among younger patients with MDD adjuvant thiamine alleviated symptoms of depression faster compared to placebo. Importantly, improvements were observed within 6 weeks of initiation of treatment. Thus, thiamine might have the potential to counteract the time lag in the antidepressant effects of ADs.

Comparison of vitamin D3 serum levels in new diagnosed patients with multiple sclerosis versus their healthy relatives.

Multiple risk factors are introduced for Multiple Sclerosis (MS). Recent studies have suggested a possible correlation between vitamin D deficiency and an increase risk of MS. This study was therefore undertaken to compare vitamin D levels in new cases of MS and their relatives as healthy controls. Seventy five new diagnosed MS patients and 100 matched healthy controls among their relatives were enrolled in this study. Two groups were matched for gender, age, season in which serum level of vitamin D was checked and region and diet. Serum levels of 25-hydroxy vitamin D was measured, recorded and analyzed. Seventy five patients (57 female and 18 male) and 100 healthy subjects (75 female and 25 male) were enrolled in this study. The mean serum levels of 25-hydroxy vitamin D in case and control groups were 11.31 and 17.9 ng/ml, respectively (P=0.003). Compared to the healthy subject, serum levels of vitamin D were significantly lower in patients with MS. This difference was only significant in women. Observed difference of vitamin D levels of both groups were significant in summer. This study continues to support the role of vitamin D deficiency in MS.