A new diterpenoid from Salvia santolinifolia boiss

Phytochemical study of the Salvia santolinifolia root extract resulted in the isolation of one new quinone diterpenoid, aegyptinone E (1) as well as two known ones, aegyptinone A (2) and aegyptinone D (3). All the isolated compounds were reported for the first time from S. santolinifolia. Spectroscopic analyses including 1 D and 2 D NMR and HRESIMS were used to determine the chemical structures. Aegyptinone A (2) showed moderate antibacterial activity against Staphylococcus aureus, Staphylococcus epidermis, and Bacillus subtilis with MIC of 25 μg/mL.

Cultural vs. State Borders: Plant Foraging by Hawraman and Mukriyan Kurds in Western Iran

Plant foraging is a millennia-old activity still practiced by many people in the Middle East, particularly in the Fertile Crescent region, where several socioeconomic, ecological, and cultural factors shape this practice. This study seeks to understand the drivers of plant foraging in this complex region characterized by highly diverse linguistic, religious, and cultural groups. Our study aims to document the wild plants used by Kurds in Western Iran, identify similarities and differences among Hawraman and Mukriyan Kurdish groups in Iran, and compare our findings with a previous study on the Hawramani in Iraq. Forty-three semi-structured in-depth interviews were conducted in Kurdish villages of Western Iran. The results revealed the use of 44 wild food plant taxa, their preparation, and culinary uses. Among the reported taxa, 28 plant taxa were used by Mukriyani, and 33 by Hawramani. The study revealed a significant difference between the Hawraman and Mukriyan regions in Iran, whereas there is a high similarity between Hawramani Kurds in Iran and Iraq. We found that the invisible cultural border carries more weight than political divisions, and this calls for a paradigm shift in how we perceive and map the distribution of ethnobotanical knowledge.

Antimicrobial and cytotoxic naphthoquinones from microbial origin: An updated review

Naphthoquinones (NQs) are small molecules bearing two carbonyl groups. They have been the subject of much research due to their significant biological activities such as antiproliferative, antimicrobial, anti-inflammatory, antioxidant, and antimalarial effects. NQs are produced mainly by bacteria, fungi and higher plants. Among them, microorganisms are a treasure of NQs with diverse skeletons and pharmacological properties. The purpose of the present study is to provide a comprehensive update on the structural diversity and biological activities of 91 microbial naphthoquinones isolated from 2015 to 2022, with a special focus on antimicrobial and cytotoxic activities. During this period, potent cytotoxic NQs such as naphthablin B (46) and hygrocin C (30) against HeLa (IC50=0.23 µg/ml) and MDA-MB-431 (IC50=0.5 µg/ml) cell lines was reported, respectively. In addition, rubromycin CA1 (39), exhibited strong antibacterial activity against Staphylococcus aureus (MIC of 0.2 µg/ml). As importance bioactive compounds, NQs may open new horizon for treatment of cancer and drug resistant bacteria. As such, it is hoped that this review article may stimulates further research into the isolation of further NQs from microbial, and other sources as well as the screening of such compounds for biological activity and beneficial uses.

The Psychometric Properties of the Fear of Progression Questionnaire (FoP-Q) for Cancer Patients in Iran

PURPOSE

Fear of progression or recurrence is assumed as a rational response to the threat of cancers and types of cancer treatment. However, the elevated levels of fear in cancer patients can become dysfunctional. Therefore, a valid and reliable questionnaire is unquestionably required for this purpose. This study aimed to translate the Fear of Progression Questionnaire and evaluate its psychometric properties for patients with gastrointestinal cancers in Iran.

METHODS

In this study with a methodological research design, a total number of 430 patients affected with gastrointestinal cancers referring to Northern Iran completed the 43-item Fear of Progression Questionnaire. The psychometric properties of the questionnaire were evaluated, including the face validity and content validity. Then construct validity was assessed using exploratory and confirmatory factor analyses. Finally, the reliability was assessed using internal consistency (Cronbach's alpha) and stability (intraclass correlation coefficient).

RESULTS

Based on the result of the face and content validity, no items were revised and removed. The five extracted factors included were emotional response, employment, and loss of independence, economy/family, and coping. These factors explained 37% of the total variance of Fear of Progression Questionnaire. Reliability (by Cronbach's alpha) and stability (test retest was evaluated by intraclass correlation coefficient) were more than 0.7.

CONCLUSION

The study results revealed that the Persian version of the Fear of Progression Questionnaire had acceptable reliability and validity for cancer patients in Iran. Emotional responses explained the most variance of the concept of fear of progression among cancer patients.

Relationship between Toxoplasma gondii infection and psychiatric disorders in Iran: A systematic review with meta-analysis

BACKGROUND

Toxoplasma gondii, a ubiquitous parasitic protozoan, may be an important cause of neurological and psychiatric diseases. The present systematic review and meta-analysis, therefore, was conducted to investigate the scientific evidence regarding the potential association between T. gondii infection and psychiatric disorders in Iran.

METHODS

We systematically reviewed articles from world-wide databases, including PubMed, Scopus, Science Direct, Web of Science, Google Scholar, and Iranian national databases up to July 30th, 2021. The Newcastle Ottawa Scale (NOS) was used to assess the quality of included studies. The common odds ratio (OR) was estimated using inverse variance and a random-effects model. Heterogeneity was assessed using the χ2-based Cochrane test (Q) and the I2 index. Also, sensitivity analyses and publication bias were calculated. Moreover, subgroup analysis was performed based on the type of disorder and quality score of different eligible studies.

RESULTS

16 studies were included in this meta-analysis. Our meta-analyses found that the OR of the risk of anti- T. gondii IgG and IgM in psychiatric patients compared to the control group was 1.56 (95% CI; 1.23-1.99) and 1.76 (95% CI: 1.19-2.61), respectively. Subgroup analysis based on the type of disorder showed that the OR of the risk of anti- T. gondii IgG in Iranian schizophrenia patients and other psychiatric disorders compared to the control group were 1.50 (95% CI; 1.09-2.07) and 2.03 (95% CI: 1.14-3.60), respectively, which are statistically significant. Also, the OR of the risk of anti- T. gondii IgM in Iranian schizophrenia and depression patients compared to the control group was 1.54 (95% CI; 0.9-2.64) and 1.03 (95% CI: 0.2-5.24), respectively, which are not statistically significant. Additionally, subgroup analysis based on quality scores showed no significant influence on the results according to the moderate quality studies. However, this association was significant according to the high quality studies. The obtained results of Egger's test were 1.5 (95% CI; -0.62-3.73, P = 0.15) and 0.47 (95% CI; -0.82-1.76, P = 0.45), respectively, indicating publication bias. The significant results of the heterogeneity analysis confirmed a high level of heterogeneity in the IgG test (P = 0.000, I2 = 66.6%). However, no significant results from the test of heterogeneity were detected in the IgM test (P = 0.15, I2 = 27.5%). The results of the sensitivity analysis showed that the impact of each study on the meta-analysis was not significant on overall estimates.

CONCLUSIONS

Despite the limited number of studies, these outcomes supported a possible link between T. gondii infection and psychiatric disorders in Iran. However, more high-quality investigations are needed in the future.

Intelligent modeling of hydrogen sulfide solubility in various types of single and multicomponent solvents

This study aims to study the solubility of acid gas, i.e., hydrogen sulfide (H₂S) in different solvents. Three intelligent approaches, including Multilayer Perceptron (MLP), Gaussian Process Regression (GPR) and Radial Basis Function (RBF) were used to construct reliable models based on an extensive databank comprising 5148 measured samples from 54 published sources. The analyzed data cover 95 single and multicomponent solvents such as amines, ionic liquids, electrolytes, organics, etc., in broad pressure and temperature ranges. The proposed models require just three simple input variables, i.e., pressure, temperature and the equivalent molecular weight of solvent to determine the solubility. A competitive examination of the novel models implied that the GPR-based one gives the most appropriate estimations with excellent AARE, R² and RRMSE values of 4.73%, 99.75% and 4.83%, respectively for the tested data. The mentioned intelligent model also performed well in describing the physical behaviors of H₂S solubility at various operating conditions. Furthermore, analyzing the William's plot for the GPR-based model affirmed the high reliability of the analyzed databank, as the outlying data points comprise just 2.04% of entire data. In contrast to the literature models, the newly presented approaches proved to be applicable for different types of single and multicomponent H₂S absorbers with AAREs less than 7%. Eventually, a sensitivity analysis based on the GPR model reflected the fact that the solvent equivalent molecular weight is the most influential factor in controlling H₂S solubility.

Fluoxetine-induced Hypotension: A Case Report

Fluoxetine is a Selective Serotonin Reuptake Inhibitor (SSRI) that exerts its anti-depressive effect by blocking the presynaptic reuptake of the neurotransmitter serotonin, 5-hydroxytryptamine (5-HT). Although fluoxetine is usually considered safe for most patients, in the present case report, we describe a young patient with Mixed Anxiety and Depression Disorder (MADD) treated with fluoxetine 10 mg/day, who developed hypotension when the dosage was titrated up to 20 mg/day. After discontinuing the use of fluoxetine, the symptoms of hypotension improved. A temporal association and dose-dependent relationship between the hypotension and the use of fluoxetine was observed. To the best of our knowledge, this is the first case report that precisely associates regular doses of fluoxetine with the presence of hypotension. Because boosting central serotonergic function lowers blood pressure, it is suggested that a significant effect of fluoxetine on the vasomotor center may be responsible for the reduction of blood pressure. Thus, physicians should be aware of the possible risk of hypotension induced by fluoxetine and recommend patients discontinue the drug immediately if complications have occurred.

Food Security beyond Cereals: A Cross-Geographical Comparative Study on Acorn Bread Heritage in the Mediterranean and the Middle East

This article aims to contribute to the limited literature on traditional gastronomic knowledge concerning acorn-based bread by ethnographically documenting the ingredients, preparation techniques and consumption practices of baked goods made from acorn seeds and flour that are still used today or at least still present in living memory. A qualitative comparative case method was adopted, and ethnographic data were gathered from 67 people in six selected Mediterranean, Central Asian and Middle Eastern countries. The analysis highlighted distinct trajectories in the development of acorn-based bread, showing some differences in terms of ingredients, preparation techniques and baking methods in the two cultural and geographical macro-regions. By exploring the evolution of the alimentary role of acorn bread in the past century, our findings also support the hypothesis that the product, at least during the last two centuries, has mostly been used as a famine food. By acknowledging the cultural importance of acorn fruits and acorn-based products, this study suggests that the rediscovery of acorn-based products and associated traditional knowledge may foster the sustainable development of rural and marginal regions in the Mediterranean, Middle East and Central Asia. This could help to reinforce the resilience of local communities and thus increase food security. Furthermore, reassessing acorns as a foodstuff may aid in developing innovative products in line with emerging trends in the food sector, which is looking for new non-cereal-based bakery products and other novel culinary applications.

LC-MS-based metabolite profiling of aqueous extract of Pergularia tomentosa L. and its anti-hyperglycemic effect

Objectives

In this study, to find scientific evidence for the traditional use of Pergularia tomentosa as an anti-diabetic remedy, the effects of its aqueous extract on streptozotocin-induced diabetes mellitus in rats were evaluated.

Materials and Methods

Wistar rats were fasted overnight and diabetes mellitus was induced using streptozotocin (50 mg/kg body weight). The rats were randomly and equally divided into four groups (n=5): group I (normoglycaemic control), group II (diabetic rats), group III (diabetic rats treated with 200 mg/kg BW of an aqueous extract of P. tomentosa), group IV (normoglycemic rats treated with 200 mg/kg BW of an aqueous extract of P. tomentosa). Chemical profiling of the aqueous extract was carried out using liquid chromatography coupled with electrospray ionization and multiple-stage linear ion-trap and orbitrap high-resolution mass spectrometry (LC-ESI/LTQOrbitrap/MS/MS). In addition, the quantitative determination of the main cardenolides in the extract was carried out by an analytical approach based on LC coupled to tandem mass spectrometry with ESI source and hybrid triple quadrupole-linear ion trap mass analyzer (LC-ESI/QTrap/MS/MS).

Results

Aqueous extract of P. tomentosa showed a reasonable reduction in blood glucose level. Probably, the P. tomentosa effect on hyperglycemic and hyperlipidemic diabetic animals was associated with antioxidant properties, triglyceride levels, as well as liver enzymes. Meanwhile, LC-ESI/LTQOrbitrap/MS/MS analysis led to identification of double-linked cardenolides along with cardenolides and flavone glycosides as the main bioactive compounds.

Conclusion

The extract decreased the glucose level and induced a beneficial effect on the lipid profile, probably due to the presence of cardenolide glycosides.

Sleep profile status based on substance use, lipids and demographic variables in Tabari cohort study

BACKGROUND

This study aims to investigate the situation of sleep profile and its related factors in the Tabari Cohort Tabari (TCS) population.

METHODS

The information of 10255 of the Tabari cohort population in the enrolment phase was used in this study. The sleep profile data was collected and recorded by trained questioners. The sleep duration in day & night, the time interval between going bed and falling asleep, continuous use of sedatives, involuntary nap, limb hypermobility during sleep and shift working were determined for each person. Data analysis was performed by independent T test and Pearson correlation coefficient.

RESULTS

Mean, standard deviation, median, minimum and maximum of sleep duration in this population were 7.6, 1.6, 7.5, 0.5 and 17 h. Frequency of sleeping less than 6 h, 6-10 h and more than 10 h were 1168(11.4%), 8463(82.5%) and 624(6.1%) respectively. Prevalence of sleeping more than 10 h among men and women were 5% and 6.8% respectively (P < 0.001). Prevalence of sedative routine use among men and women were 4.7% and 9.6% respectively (P < 0.001). There were significant relationships between sleep duration and area residence, age group (P < 0.001), education level (P < 0.001), socioeconomic level (P < 0.001), triglyceride (P = 0.002), HDL-cholesterol (P = 0.013) and Cholesterol total (P = 0.021). There was a negative correlation between age and sleep duration (r = -0.062, P < 0.001).

CONCLUSION

The results showed the association of the quality and quantity of sleep with personal, social, environmental and biological factors such as gender, age, economic status, educational status, and lipid profile. Therefore without proper intervention, the incidence of outcomes associated with these risk factors can be predicted in TCS In later years.

Association between blood pressure and parameters related to sleep disorders in Tabari cohort population

Background

Insomnia and other sleep disorders can cause an increase in blood pressure, thereby resulting in premature death. Regarding this, the present study was conducted to investigate the relationship between hypertension and parameters related to sleep disorders in Tabari cohort population.

Methods

In this cross-sectional study, the data from the enrollment phase of the Tabari cohort study were adopted. Tabari cohort is a part of the PERSIAN (Prospective Epidemiological Research Studies in Iran) cohort study. Data analysis was performed using descriptive and inferential statistics.

Results

Out of 10,255 patients enrolled in the Tabari cohort, 2,281 patients (22.2%) had hypertension. According to the results of univariable logistic regression test, the odds ratio of high blood pressure in patients with insomnia and hypersomnia is 1.22 (95% confidence interval [CI], 1.06–1.40) and 1.22 (95% CI, 1.01–1.47) times higher than normal sleep. This odds ratio was not significant after adjusting the effect of sex, age, body mass index, waist circumference, area residence, high-density lipoprotein cholesterol, triglyceride, and total cholesterol variables with multivariable logistic regression. Frequency of routine hypnotic medication usage (14.6% vs. 5.7%, P < 0.001), involuntary napping (25.3% vs. 19%, P < 0.001), and leg restlessness during sleep (14.8% vs. 11.7%, P < 0.001) was higher in hypertensive individuals than in nonhypertensive cases.

Conclusions

This study showed that sleep disorders prevalence are higher in hypertensive patients than nonhypertensive patients. Also, routine use of hypnotics was significantly higher medication in patients with hypertension compared to that in the nonhypertensive patients.

Prevalence of Eating Disorders in Iran From Preschool to Old Age: A Systematic Review and Meta-analysis

Background: Eating disorders are among the deadliest psychiatric diseases that have become increasingly prevalent in different societies in recent years. Various biological, social, and psychological factors are involved in the emergence of different types of eating disorders. Several studies have been conducted by medical and non-medical researchers in Iran to estimate the prevalence of this disorder and its subcategories, which have been associated with different epidemiological methodologies and instruments and inconsistent results. Objectives: This study aims to statistically analyze all available findings to determine the total estimate of the prevalence of eating disorders in the general population of Iran and to investigate the reasons for the heterogenous results in previous studies. Methods: The articles were collected by searching the following databases: SID, Magiran, Irandoc, Iran Medex, PubMed, and Google Scholar. All studies evaluating the prevalence of eating disorders in any region of Iran from 1990 to the end of 2021 were included in the study. Meanwhile, articles that were irrelevant in terms of subject or methodology were excluded. Three researchers independently extracted the data from the articles based on a pre-prepared list that included the author’s name, study title, year of publication, journal name, city and study population, sample size, study instruments, and eating disorder prevalence. Results: The estimated point prevalence of any eating disorder in Iran was 22% (95% CI, 7%-38%). The estimated lifetime prevalence of eating disorder, anorexia nervosa, and bulimia nervosa was 1% (95% CI, 1%-2%), 1% (95% CI, 0%-1%), and 1% (95% CI, 0%-1%), respectively. Conclusions: The prevalence of eating disorders and its subcategories is much lower in Iran compared to high-income and developed countries. The available data are insufficient to determine the exact prevalence of this disorder in the general population, especially among Iranian men.

Profile of Cigarette and Drug Use Status in Population of Tabari Cohort Study

Background

The study of the smoking and drug use profile of the Tabari cohort enrolment phase, the outcomes of which will be evaluated in the coming years, has proper comprehensiveness. Therefore, the present study aimed to determine the cigarette and drug use status in the population of the Tabari cohort study (TCS).

Methods

In this study, the profile of cigarette and drug use in the TCS was evaluated. Data analysis was performed in SPSS version 24 using percentage, mean, and standard deviation, chi-square, and independent t test.

Findings

The frequency of daily smoking in the entire population was 9.1%, and the frequencies in men and women were 21.5% and 0.6%, respectively (P<0.001). The frequency of exposure to smoking in the home, at present or in the past, in the entire population was 30.5%, and in the populations living in urban and mountainous areas were 35.4% and 19.8%, respectively (P<0.001). The mean age at first use of cigarettes in the entire population was 20.50±7.61, whereas the mean age of regular smoking was 23.19±8.02. Furthermore, the frequency of experiencing drug abuse in the total population was 6.1%, and the frequencies in men and women were 14.1% and 0.7%, respectively.

Conclusion

According to the results of this study, cigarette smoking and drug use are significant in men, and overall exposure of the Tabari cohort population to tobacco and drugs in the home is high. If effective prevention is not on the agenda, a significant proportion of the future outcomes in this population may be attributable to these risk factors.

Ethnopharmacological study of medicinal plants in Sarvabad, Kurdistan province, Iran

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional medicine has a long history and plays an important role in the Kurdish community in Sarvabad county, Kurdistan province, Iran. Despite the great diversity of medicinal plants, cultural history, and variety of herbal medicine uses among Kurdish tribes, very few cohesive ethnopharmacological studies of this unique region are available in the scientific literature. Our study tried to gather medicinal plant species and document the associated indigenous knowledge of the ethnic groups in the Sarvabad district for the first time.

MATERIALS AND METHODS

Ethnobotanical data were collected from 92 local informants through semi-structured questionnaires, open interviews, and field surveys during a period of two years (2018-2020). The statistical analysis included use reports (UR) for each species, and informant consensus factor (FIC) to evaluate the data.

RESULTS

In the present study a total of 156 plant species belonging to 58 botanical families, were recorded for the treatment of 16 diseases categories. The most represented families were Lamiaceae, followed by Asteraceae, and Apiaceae. The most frequently cited plant species with the highest use report (UR) were Pistacia atlantica (161), Hymenocrater longiflorus (128), Melissa officinalis (124), Cyperus rotundus (114), Thymus transcaspicus (112), and Quercus brantii (109). Psychological (ICF = 0.96), musculoskeletal (ICF = 0.94), and digestive (ICF = 0.93), followed by respiratory problems (ICF = 0.92) showed the highest informant consensus factors among all ailment categories. Most herbal remedies were consumed as decoction. Leaves (28.5%) were the most widely used plant parts, followed by flowers (18.7%), aerial parts (14.5%), seeds (13.2%), and terrestrial parts (8.41%). Some interesting new medicinal uses for native and common species were reported. Species such as Cyperus rotundus, Hymenocrater longiflorus, Anthriscus nemorosa, Pistacia atlantica and Quercus brantii would be interesting targets for drug discovery and are suggested for further investigations.

CONCLUSION

The plant use reports, and quantitative data analyzed demonstrate that the relative importance of plant species and shared knowledge of herbal therapies among Kurdish communities of the Sarvabad county is still rich. A systematic study and evaluation of the biological activity of highly consumed plants, could identify the possible mechanism of action.

Sertraline-induced rectal bleeding and anal pain (a rare case presentation)

BACKGROUND

Selective serotonin reuptake inhibitors (SSRIs) have proven more problematic in terms of some side effects than the original clinical trials suggested. Sertraline may displace warfarin from plasma proteins and may increase the prothrombin time. The aim of this study was to report a rare case of the sertraline- induced severe anal pain and rectal bleeding without concurrent of taking any other drugs including non-steroidal anti-inflammatory drugs (NSAIDs).

CASE PRESENTATION

Here we report a case of a 31 -year old married man who referred to a psychiatrist with depressive disorder and started to take sertraline up to 400 mg daily, thereafter the patient reported severe anal pain and bleeding. Other etiologies of this side effect were evaluated with Naranjo evaluation scale and rolled out. The patient did not report any anal pain or bleeding after eight months of stopping sertraline.

CONCLUSION

Reported from sertraline, the psychiatrists must be more cautious when prescribing sertraline and monitor the patient properly for a long time to ensure these rare adverse effects and complications do not happen.

Zolpidem withdrawal seizure in an Iranian young woman: A case presentation

Background

Zolpidem is a non-benzodiazepine drug, approved by FDA for sleep induction. Zolpidem is thought to be a safer drug than benzodiazepines (BZD) because of no evidence of abuse or dependence potential, but several case reports of zolpidem abuse and dependence have been published along with a small number of cases demonstrating seizures after sudden zolpidem withdrawal.

Case presentation

A 32-year-old unmarried woman suffering from major depressive disorder had been taking zolpidem for insomnia for more than 1 year. She began to take zolpidem alone without mixing other kinds of hypnotics, and 50 mg of zolpidem used to be initially effective in treating her insomnia. In some days the dose increased up to 100 mg per day. In the end, she had to discontinue zolpidem abruptly because she could not afford it anymore. After 2 days, she suddenly showed facial spasm, mouth opening, tonic-clonic seizure, and loss of consciousness for about 1-2 minutes. Post-ictal confusion with clouded consciousness, psycho-motor retardation, persisted in 1 day. EEG in wakefulness revealed intermittent, generalized, diffused alpha wave and diffused sharp waves, and suggested seizure waves in the patient.

Conclusion

Our case suggested that the potential of zolpidem dependence and withdrawal seizure are also present in the Iranian population. The female-gender, high dosage and long-term use of zolpidem might be risk factors for the development of adverse effects.

Ethnobotany of the medicinal plants used by the ethnic communities of Kerman province, Southeast Iran

BACKGROUND

Traditional medicine is a major component in the primary healthcare system in the southeast of Iran, which has a rich floral diversity. However, there is no comprehensive report on the use of medicinal herbs in this specific region. This traditional usage of medicinal plants by local communities could serve as a source for pharmacological and phytochemical studies. The main objective of this study was to identify ethnopharmacological knowledge on medicinal plant species and their local healing applications by the folk communities of Kerman province in the southeast of Iran.

METHODS

In this cross-sectional study, data were collected from 217 herbal healers using semi-structured questionnaires, open interviews, and field surveys. Factors including use reports (UR) for each species, frequency of citation (FC), and informant consensus factor (ICF) were used to analyze the data. Plant species were identified by botanists through standard taxonomic methods.

RESULTS

A total of 402 medicinal plants were used in healing practices by the local communities of Kerman province. These species belong to 273 genera of 73 families, among which 367 species are dicotyledons, 27 are monocotyledons, 7 species are cryptogam, and one species is gymnosperm. An important implication from the current study is the identification of the traditional medicinal use of 292 plant species in this region for the first time. Asteraceae, Apiaceae, Lamiaceae, and Fabaceae were the dominant medicinally utilized plant families, respectively. Leaf, flower, fruit, and seed were the most common plant parts used. Generally, crude drugs were used in the form of decoction, followed by poultice and infusion forms. Moreover, oral route is considered as the most common administration route followed by topical route. Endocrine (diabetes), dermatological, gastrointestinal, and respiratory problems were ranked as the most frequent ailment categories for which medicinal plants in this region were applied, respectively. Our findings suggested dominant use of Asteraceae and Apiaceae plants for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae plants for dermatological problems.

CONCLUSION

Our findings suggested that Asteraceae and Apiaceae plants were used for the treatment of gastrointestinal disorders, Lamiaceae plants for respiratory and gastrointestinal ailments, and Apocynaceae and Euphorbiaceae plants for dermatological problems. Among the medicinal plants with high UR and new ethnobotanical uses, Rhazya stricta was used for wound healing, Calotropis procera, Clematis ispahanica and Euphorbia spp. for eczema, Cionura erecta for the treatment of cough, Launaea acanthodes for the treatment of gastrointestinal parasites, Berberis integrrima as an antidiabetic medicinal herb, Dracocephalum polychaetum and Rydingia persica for various types of chronic diseases, Citrus limon and Citrus aurantium for the treatment of ocular diseases and making the traditional kohl, Calendula officinalis for the treatment of pterygium and Prosopis farcta for preventing nasal bleeding. The identified medicinal plants can be further evaluated for their pharmacological activity and underlying mechanisms of action.

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents

PURPOSE

Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents.

METHODS

In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20.

RESULTS

Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p= 5.4, 95% CI = 5.1-5.7) and encopresis (p= 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95% CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95% CI = 9.1-12.2) were the most prevalent.

CONCLUSION

The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders.

Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: the national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP)

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6-18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). In this study, 54 children aged 6-9 years (0.58%, CI 0.47-0.77), 64 adolescents aged 10-14 years (0.57%, CI 0.47-0.77), and 117 adolescents aged 15-18 years (1.22%, CI 0.96-1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50-61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68-38.56), tobacco use (20.43%, CI 15.77-26.04), and depressive disorders (18.30%, CI 13.88-23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population.

Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents

OBJECTIVE

This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents.

METHOD

We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data.

RESULTS

Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders.

DISCUSSION

Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

Diplopia; an Adverse Effect of Citalopram

Citalopram, a selective serotonin reuptake inhibitor (SSRI), was approved by the Food and Drug Administration in 1998 as a safe and well-tolerated antidepressant; the use of it may result in rare and sometimes dangerous side effects. Diplopia is a rare adverse effect of citalopram that comes with double vision and disrupts daily living. Currently, only two cases of citalopram-related diplopia have been internationally reported. The current paper presents a third reported case of diplopia following citalopram use in a healthy subject. A 47-year-old man involved in an accident was subsequently affected by serious depression. Following 6 months of a 40-mg daily dose of citalopram, the patient complained of itchy irritated eyes and double vision symptomatic of diplopia. He was referred to an eye specialist, who confirmed no apparent problems following an examination of the eye. After a decrease in the dose of citalopram, the eye symptoms steadily decreased and eventually disappeared. The rapid disappearance of diplopia subsequent to the discontinuing use of citalopram suggests an association between the adverse reaction and the medicine. As a result, it is recommended that physicians inform patients of the possibility of induction of diplopia related to the use of citalopram and other SSRIs. In the future, the prescription of SSRIs at higher doses may be ordered with and on the recommendation of patients, who have been aware of the risks of the drug.

A Case report of hemodynamic instability, cardiac arrest, and acute severe dyspnea subsequent to inhalation of crystal methamphetamine

Misuse of stimulants similar to amphetamine is a universal problem. These stimulants cause many complications in their abusers. However, myocardial infarction is rarely reported as a complication of amphetamine abuse. Herein, we report a man aged 42 years presented at the Emergency Department with the chief complaint of acute dyspnea following ice inhalation without history of dyspnea. Within the first hour and a half of admission, the patient was treated by nasal oxygen and bronchodilator aminophylline. However, he did not respond to the initial treatment and lost his consciousness; showed ventricular fibrillation, cardiac arrest, and hemodynamic instability. So, cardiopulmonary resuscitation was immediately initiated for him. The patient was intubated, mechanically ventilated. Also, the synchronized electrical shock was delivered 5 times (200-360 J) along with amiodarone (300 mg intravenously [IV] stat, then 1 mg/min IV infusion for 6 hours and next 0.5 mg/min for 18 hours) to treat the ventricular fibrillation. The arrhythmia was subsequently controlled, and his normal sinus rhythm was resumed. Two hours later, condition of the patient improved, and he was extubated. After two days, when the patient got stable, the echocardiography was performed, which was completely normal.

P4611Colchicine before percutaneous coronary intervention in acute myocardial infarction

Aims

Myocardial perfusion could determine the outcome of patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the impact of colchicine on myocardial perfusion in this population.

Methods

In a double-blind, randomized trial, we assigned 196 patients with STEMI undergoing PCI to two groups: the colchicine group (N=95) and the control group (N=101). The primary endpoints were the thrombolysis in myocardial infarction (TIMI) score; TIMI myocardial perfusion grade (TMPG), and TIMI frame count (TFC). The major adverse cardiovascular events (MACEs) were recorded after one month of PPCI.

Results

The Final TIMI flow grade, TMPG and TFC were not significantly different between the 2 groups (p=0.75, p=0.533, p=0.161; respectively). MACE include Mortality, Non-fatal myocardial infarction, target lesion/vessel revascularization were similar between the 2 groups (p=0.058).

Study outcomes Characteristics Colchicine Group (n=95) Control Group (n=101) P value Discharge status   Deceased 2 (2.1%) 2 (2%) 1   Alive 93 (97.9%) 99 (98%) TIMI flow grade after PCI   0 2 (2.1%) 1 (1%) 0.747   1 2 (2.1%) 4 (4%)   2 17 (17.9%) 21 (20.8%)   3 74 (77.9%) 75 (74.3%) TIMI myocardial perfusion grade 2.39±0.89 2.31±0.95 0.533 ST segment resolution   Below 50 Percentage 23 (27.1%) 27 (32.1%) 0.71   Between 50 to 70 Percentage 8 (9.4%) 6 (7.1%)   Above 70 Percentage 54 (63.5%) 51 (60.7%)   MACE.1.Month 10 (9.9%) 3 (3.2%) 0.058   MACE.1.Month(Mortality) 4 (4.0%) 2 (2.1%) 0.451   MACE.1.Month(Non.Fatal.MI) 2 (2.0%) 0 (0%) 0.168   MACE.1.Month(TLR) 2 (2.0%) 1 (1.1%) 0.597   MACE.1.Month(TVR) 5 (5.0%) 1 (1.1%) 0.113

Conclusion

In STEMI patients treated by PPCI, the effect of colchicine before PPCI was not revealed on myocardial perfusion markers.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Antiproliferative Cardenolides from the Aerial Parts of Pergularia tomentosa

The LC-MS analysis of the MeOH extract of the aerial parts of Pergularia tomentosa led to the isolation of 23 compounds, of which the structures were elucidated unambiguously by NMR spectroscopic data analysis. Three new doubly linked cardenolides (4, 13, 14) along with several known cardenolides (1-3, 5, 7, 8, 15-23) and flavonol glycosides (6, 9-12) were identified. LC-HRESIMS analysis, in the negative-ionization mode, showed the absence of flavonoids in a methanol extract of the roots of P. tomentosa. On the basis of the antiproliferative activity reported for cardenolides, the isolated compounds were tested for their ability to decrease the cell viability of five different human cancer cell lines, PC3, HeLa, Calu-1, MCF-7, and U251MG, exhibiting IC₅₀ values ranging from 0.2 to 8.0 μM. Moreover, an S-phase entry assay was performed to investigate if the compounds could affect the cell cycle progression of PC3 prostate carcinoma cells. The results obtained demonstrated that the compounds 4, 7, and 14 at 1 μM considerably reduced the number of cells in the S-phase.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method : A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

First-episode psychosis as the initial presentation of multiple sclerosis: a case report

Background

Multiple sclerosis (MS) is an inflammatory disease that affects the central nervous system (CNS). MS with episode of psychosis is a rare entity, and to the best of our knowledge, no case has been reported from Iran till date.

Case presentation

We report a case of MS with first-episode psychosis in a 27-year-old single man with no history of psychiatric disorder or drug abuse. The patient developed neurological symptoms after 3 months and was finally diagnosed as a case of MS. His symptoms started with behavioral dysfunctions and progressively resulted in depression. Subsequently, treatment was performed with citalopram 20 mg daily, risperidone 2 mg three times a day, and biperiden 2 mg three times a day; however, no improvements in the symptoms were observed. T2-weighted magnetic resonance imaging has demonstrated periventricular and white matter multiple sclerotic plugs with lesions. Eventually, MS was diagnosed after the appearance of paresthesia, upper and lower limb muscle weakness, ataxia, and urinary incontinency as typical signs. Then, the medications were changed to methylprednisolone and interferon therapy, which resulted in improvements in the clinical conditions of the patient.

Conclusion

Based on the fact that organic disorders such as MS may sometimes appear with initial pure psychiatric symptoms without any neurological signs and symptoms, examinations for symptoms linked to CNS dysfunction, cognitive changes, atypical symptoms, detailed neurological examination, and limited response to conventional antipsychotic drugs are highly recommended to be carried out for patients with first-episode psychosis and even in the followup period.

Relationship of Hemodialysis Shift With Sleep Quality and Depression in Hemodialysis Patients

This descriptive correlational study was aimed at determining the relationship of hemodialysis shift with sleep quality and depression in 310 hemodialysis patients. Demographic and Clinical Questionnaires, the Pittsburgh sleep quality index, and Beck's Depression Inventory were used to ascertain the aforementioned relationship. Among the patients, 59.6% reported poor sleep quality and 44.8% reported experiencing depression. Results show that these conditions were significantly related to many factors. Although dialysis shift was not significantly related to sleep quality and depression, sleep quality was found significantly associated with age, female gender, illiteracy, unemployment, residence in rural areas, diabetes, addiction to sedatives, and phosphorus levels. A significant relationship was also found between depression and phosphorus levels. Logistic regression predicted age, gender, illiteracy, unemployment, residence in rural areas, and addiction to sedatives as factors for poor sleep quality. A body mass index (BMI) above 30, decreased urea, and increased phosphorus were predicted as factors for increased depression.

Comparison of the Effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and Sertraline on Depression and Anxiety in Patients after Coronary Artery Bypass Graft Surgery: Study Protocol for a Randomized Controlled Trial

Objective: The present study aimed at comparing the effects of Religious Cognitive Behavioral Therapy (RCBT), Cognitive Behavioral Therapy (CBT), and sertraline on depression, anxiety, biomarker levels, and quality of life in patients after coronary artery bypass graft (CABG) surgery. Method: This was a randomized controlled trial with parallel groups. A total of 160 patients after CABG surgery will be screened for anxiety and depression according to clinical interviews based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and Hospital Anxiety Depression Scale (HADS) scores (≥ 8). To assess religious attitude, Golriz and Baraheni's Religious Attitude questionnaire will be used. Participants will be randomly allocated to 4 groups of 40 including 3 intervention groups (RCBT, CBT, and sertraline) and 1 control group (usual care). RCBT and CBT programs will consist of 12 one-hour weekly sessions. The participants in the pharmacological intervention group will receive 25-200 mg/d of sertraline for 3 months. The Short Form-36 Health Survey (SF-36) will be administered to assess the patients' quality of life. Blood samples will be taken and biomarker levels will be determined using the enzyme-linked immunosorbent assay (ELISA). The primary outcome will be reduction in anxiety and depression scores after the interventions. The secondary outcomes will be increase in quality of life scores and normalized biomarker levels after the interventions. Discussion: If RCBT is found to be more effective than the other methods; it can be used to improve patients' health status after CABG surgery. Irct ID: IRCT201404122898N5.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Comparison of Religious Cognitive Behavioral Therapy, Cognitive Behavioral Therapy, and Citalopram on Depression and Anxiety among Women with Breast Cancer: A Study Protocol for a Randomized Controlled Trial

There has been evidence supporting the reduction of depression and anxiety by religious psychotherapy in cancer patients, however, there have been scarce randomized controlled trials. Therefore, there is a need for replication in a well-designed study to investigate the efficacy of these interventions among depressed women with breast cancer. A randomized controlled trial is designed to be conducted on 160 women with breast cancer. Participants will be screened for anxiety and depression diagnosed by clinical interview based on the DSM-IV criteria and the Hospital Anxiety Depression Scale. Golriz and Baraheni's Religious Attitude Questionnaire will be used to assess the religious attitude. Individuals meeting the prerequisites will be randomly allocated to four groups, each containing 40 participants, including three intervention groups (RCBT, CBT, and citalopram) and one control group (usual breast cancer treatment). An instrument by the EORTCQLQ-C30 and BR-23 will be used to measure the quality of life. Blood tests will be taken to assess biomarkers with the (ELISA) method. The results will determine whether RCBT is more effective than other treatments. If so, the outcomes of the study will have implications not only for the management of similar problems in cancer patients but also for the management of other chronic diseases.

Sleep Quality and Depression and Their Association with Other Factors in Hemodialysis Patients

BACKGROUND

Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients.

METHOD

This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model.

RESULTS

Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035).

CONCLUSION

Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders.

Negative Correlation between Serum S100B and Leptin Levels in Schizophrenic Patients During Treatment with Clozapine and Risperidone: Preliminary Evidence

Recently, extensive efforts have been made to understand the rate of energy expenditure and the weight gain associated with atypical antipsychotic treatment, including identification of markers of obesity risk. In recent years, leptin, an adipocyte hormone, has gained significant interest in psychiatric disorders. S100B has been considered as a surrogate marker for astrocyte-specific damage in neurologic disorders. Also, S100B has been detected in adipose with concentration as high as nervous tissue as a second release source. In this study we evaluated the relationship between S100B and leptin in schizophrenic patients under treatment with clozapine and risperidone.This study included 19 patients meeting the DSM-IV-TR criteria for schizophrenia, having body mass index (BMI) of 16- 25 kg/m(2) and suffering schizophrenia for more than 3 years and from this study. Twenty five healthy controls were group matched for age and gender whose BMI was 16-25 kg/m(2). Serum S100B and leptin levels and positive and negative symptom scale (PANSS) were assessed at admission and after six weeks. During the study, S100B showed a strong and negative correlation with leptin (r = -0.5, P = 0.01). Also, there were negative correlation between serum S100B level and PANSS negative subscale after 6 weeks of treatment (r = -0.048, P = 0.8). Positive correlation between leptin level and PANSS suggested a potential role for leptin which can mediate the link between antipsychotic induced weight gain and therapeutic response in schizophrenia.

Efficacy of Zinc Sulfate as an Add-on Therapy to Risperidone Versus Risperidone Alone in Patients With Schizophrenia: A Double-Blind Randomized Placebo-Controlled Trial

BACKGROUND

Zinc can modulate fast-excitatory transmission, facilitate the release of amino butyric acid and potentiate nicotinic acetylcholine receptors. There are also emerging evidences discussing the implication of these neurotransmitters in pathophysiology of schizophrenia.

OBJECTIVES

The purpose of this study was to evaluate the efficacy of Zn sulfate as an add-on therapy in the treatment of schizophrenia in a 6-week, double-blind and placebo-controlled trial.

PATIENTS AND METHODS

Eligible participants were 30 inpatients with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Patients were randomly allocated into two equal groups; one group of patients received risperidone 6 mg/day plus capsules of Zn sulfate (each containing 50 mg elemental Zn) three times a day and another group received risperidone 6 mg/day plus placebo. The Positive and Negative Syndrome Scale (PANSS) was applied to assess the psychotic symptoms and aggression risk at baseline, week 2, 4, and 6 of the study.

RESULTS

The results of this study showed that both protocols significantly decreased the scores on all subscales of the PANSS and supplemental aggression risk subscale as well as PANSS total score over the study. However, this improvement was significantly higher in Zn sulfate receiving group compared to the placebo group. No major clinical side-effects were detected.

CONCLUSIONS

It may be concluded that Zn is an effective adjuvant agent in the management of patients with schizophrenia.

Changes in serum levels of brain derived neurotrophic factor and nerve growth factor-beta in schizophrenic patients before and after treatment

Schizophrenia is one of the most debilitating diseases among psychiatric disorders. Recent studies suggest the existence of effective immunological changes in the pathophysiology of this disease. The purpose of the current study was to determine the changes in serum levels of Brain Derived Neurotrophic Factor (BDNF) and Nerve Growth Factor-beta (NGF) in schizophrenic patients before treatment and 40 days after treatment. In this case-control study, serum levels of BDNF and NGF were measured by ELISA in 26 patients with schizophrenia and 26 healthy controls. All patients were treated with clozapine or risperidone for 40 days. A positive and negative syndrome scale (PANSS) questionnaire has been used to recognize the severity of the disease and to assess the response to treatment. Neurotrophin concentrations were compared before and after the treatment and with control groups using paired t-test and ANOVA test. BDNF and NGF levels in the case group were more than levels after treatment, but these differences were significant only for NGF. Concentrations in both neurotrophins were higher than the control group. The statistically significant difference was observed between changes in the NGF levels in the case and the control group, while no significant difference was seen in changes of BDNF. The main conclusion to be drawn from this study was that the increase in BDNF and particularly NGF may have an important role in causing schizophrenia. And possibly drugs clozapine and risperidone help to treat the disease by reducing the concentration of Neurotrophins.

Contribution of depression and anxiety to impaired quality of life in survivors of myocardial infarction

OBJECTIVE

To quantify the adverse influence of depression and anxiety assessed at the time of myocardial infarction, on the quality of life 5 years after the infarction.

METHODS

The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were completed in a group of 196 patients admitted in the hospital following non-fatal myocardial infarction, and the SF-12 quality of life questionnaire was administered during the 5- year follow-up.

RESULTS

Regression analysis showed a strong association between baseline depression and QoL in both the physical and mental domains; the higher the depression scores, the poorer the QoL. However, anxiety present at the time of myocardial infarction did not predict later QoL.

CONCLUSIONS

Depression but not anxiety following MI predicts longer-term quality of life in myocardial infarction survivors.

Levels of anxiety and depression as predictors of mortality following myocardial infarction: A 5-year follow-up

BACKGROUND

Post-myocardial infarction (MI) depression is a highly prevalent disorder, affecting nearly 18% of all MI patients, and it is a major predictor of disability in the year post-MI. We sought to expand this analysis by: comparing case-level anxiety, depression, and comorbid anxiety and depression as predictors of long term mortality during a 5-year follow-up period after MI; and investigating the role of potential modifying and confounding factors.

METHODS

A total of 285 patients were screened on average 6 days after their MI and a 5-year survival rate was ascertained. The Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI) were completed by patients hospitalized for MI. In addition we tested the BDI × STAI interaction effect.

RESULTS

During the 5 years of follow-up, cardiac mortality was assessed in 274 of 285 eligible patients. Of the 274 patients whose survival data were available, 91 (33.2%) died. At entry, BDI score of 192 (67.4%) patients was ≥ 10 and 145 (50.9%) patients had STAI score ≥ 40. Anxiety was not associated with mortality, whereas depression significantly predicted death, but this association was attenuated to non-significance with full adjustment with disease severity and confounders.

CONCLUSIONS

Depression following MI does not predict longer-term survival with full adjustment.

Abuse potential of carbamazepine for euphorigenic effects

Euphoric effects following administration of CBZ alone have been never reported in any international journals and this is the first case report regarding to potential abuse of CBZ for euphoria. We hope this report will be a warning to physicians who will decide to prescribe CBZ, particularly in the patients who had a history of alcohol dependence as abuse potential of CBZ for euphoric effects has been frequently reported in the treatment of alcohol withdrawal.

Commitment to care: a qualitative study of intensive care nurses' perspectives of end-of-life care in an Islamic context

BACKGROUND

Currently, end-of-life care is a significant issue and a topic of debate in intensive care settings but understanding of nurses' perspectives about this within an Islamic context is surprisingly lacking.

AIM

The purpose of this study was to explore intensive care nurses' perspectives of the end-of-life care in South-east of Iran.

METHODS

A descriptive qualitative research approach was used to engage 12 intensive care nurses from three intensive care units of teaching hospitals affiliated to Kerman University of Medical Science in a semi-structured interview. Interview transcripts were analysed using an inductive coding approach.

RESULTS

Four major categories emerged from analysis of the interviews: commitment to care, awareness of dying patients, caring relationships, and dealing with barriers and ethical issues. The first category was emphasized and appeared dominant in all interviews.

LIMITATION

Because of specific socio-cultural and environmental factors, the findings of this study may not be applicable in other contexts, but enhance our knowledge about the topic in an Islamic context.

CONCLUSIONS

This study emphasizes the importance of looking at the end-of-life care for critical terminally ill patients within the context of spiritual milieu associated with commitment to a compassionate care until the last moment of their life. Intensive nurses, faced with various barriers and ethical issues, instead were focused on physical and spiritual care and believed that it should fulfil their role in the challenging process.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

These findings indicate that there is a need for policies that help increase the quality of life of dying patients. It is imperative that nursing managers and policy makers in Iran consider these findings to improve end-of-life care in intensive setting. More training programmes, further education and research on the topic, should be implemented.

Erectile dysfunction in methadone maintenance patients: a cross sectional study in northern iran

OBJECTIVE

Erectile dysfunction affects quality of life and is a common dysfunction in drug abusers. The aim of this study was to evaluate the frequency of erectile dysfunction in drug abusers on methadone maintenance therapy to reduce this drug side effect in the future studies.

METHODS

This cross-sectional study was conducted with two hundred addicted individuals on methadone maintenance therapy. Erectile dysfunction was surveyed using the International Index of Erectile Function (IIEF). Finally, all data were collected and analyzed by descriptive statistics such as measures of variability and central tendency and Chi-squared (χ(2)) test using SPSS Version18.0 software.

RESULTS

The amount of the total frequency of erectile dysfunction was pointed 30 or less among the two hundred patients and included the moderate and severe cases. In this study, the number of patients with erectile dysfunction was fifty three (26.5%).

CONCLUSION

The frequency of erectile dysfunction in our study was approximately 1.5 times of prevalence of the public (16.1%). In this study, all the factors related to sexual function such as erectile function, libido, orgasm, and sexual pleasure showed a decline among drug abusers.

Influence of IL-1RN intron 2 variable number of tandem repeats (VNTR) polymorphism on bipolar disorder

BACKGROUND/AIMS

Several lines of evidence point to the role of neurobiological mechanisms and genetic background in bipolar disorder (BD). The interleukin-1 receptor antagonist (IL-1Ra) is the principal regulator of IL-1α and IL-1β bioactivities. This study aimed to investigate the potential role of the variable number of tandem repeats (VNTR) polymorphisms of the IL-1Ra gene (IL1RN) in conferring susceptibility to BD.

METHODS

In total, 217 patients meeting DSM-IV-TR criteria for BD and 212 controls were recruited for the study. Genotyping of IL1RN was determined by polymerase chain reaction amplification of VNTR of 86 base pairs in intron 2 of IL1RN.

RESULTS

The genotype distribution of IL1RN polymorphism was significantly different between BD patients and controls. The IL1RN*1/2 genotype was more prevalent in BD patients than in controls (44.2 vs. 30.2%, p = 0.003). Multiple logistic regression analysis demonstrated that IL1RN*1/2 heterozygotes had a significantly higher risk for BD (OR 1.83 and 95% CI 1.22-2.74, p = 0.003). Further stratification of the BD patients into IL1RN*2 allele carrier and noncarrier subgroups revealed a strong association between IL1RN*2 carriage and prolongation of the disease (p = 0.02).

CONCLUSIONS

These findings suggest a positive association between VNTR polymorphism in IL1RN and BD. Additional studies, particularly with a prospective approach, are necessary to clarify the precise role of the VNTR polymorphism on the disease in different ethnic populations.

Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis

BACKGROUND

The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.

AIMS

To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.

METHOD

An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.

RESULTS

Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.

CONCLUSIONS

The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.

Citalopram versus psychological training for depression and anxiety symptoms in hemodialysis patients

INTRODUCTION

This study was designed to compare an antidepressant medication, citalopram, with psychological training in hemodialysis patients with symptoms of anxiety and depression.

MATERIALS AND METHODS

A total number of 44 hemodialysis patients scored 8 and more on the Hospital Anxiety and Depression Scale (HADS) were randomly allocated to two groups to receive citalopram, 20 mg/d, for 3 months or to attend 6 sessions of 1-hour psychological training. A nephrologist and a senior psychiatry resident were responsible for training of the patients, which contained explaining the anatomy of the kidneys, causes of kidney failure, treatment modalities, the mechanism involved in hemodialysis, the required care in hemodialysis patients, stages of adaptive reaction in human, and techniques of problem solving, stress management, and muscle relaxation. Both groups completed the HADS once before and once after the treatment. The final results of the two groups were compared.

RESULTS

Citalopram administration led to a significant decrease in the patients' depression score (P = .001), anxiety score (P = .048), and total HADS score (P = .002). Psychological training sessions also decreased significantly depression (P = .04), anxiety (P = .03), and total HADS scores (P = .045). There was no significant difference in the amount of decrease in the scores of depression (P = .65), anxiety (P = .19), and the total HADS (P = .66) between the two groups.

CONCLUSIONS

Psychological training and citalopram have similar effects on improving the symptoms of anxiety and depression in hemodialysis patients.

Effects of cigarette smoking on priapism induced by quetiapine: a case report

Priapism is defined as an unwanted, prolonged, and painful erection which is unrelated to sexual stimulation. Some case studies suggest that priapism is an adverse effect of antipsychotic medications. In our case study a 30 year-old Iranian male with schizophrenia was experiencing recurrent priapism associated with quetiapine use. There are three interesting facts about this case: Firstly, the patient suffered priapism after even low dose consumption of quetiapine. Secondly, this case had experienced priapism with risperidone, olanzapine, and even clozapine in the past, suggesting a possible pharmacodynamic interaction of antipsychotics and inner biological traits in this particular case. Thirdly, priapism induced by low dose quetiapine was resolved after cigarette smoking.

Toll like receptor-4 896A/G gene variation, a risk factor for migraine headaches

BACKGROUND

The pathogenesis of migraine involves immune-mediated mechanisms in the vascular endothelium. Toll like receptor 4 (TLR-4) is a signaling receptor of innate immunity which plays a role in various neuropathologies related to neuron inflammation.

OBJECTIVE

This case/control study is aimed to investigate whether TLR-4 896A/G variation is related to migraine headaches in an Iranian population.

METHODS

A total of 170 migraine patients (130 females, mean age 33.24 ± 11 years) and 170 age, sex, and ethnicity matched healthy controls (118 females, mean age of 31 ± 10 years) were recruited. Genotyping was carried out using the tetra primer amplification refractory mutation system (ARMS)-PCR.

RESULTS

The frequency of G allele was higher in migraine patients than the controls (15% vs. 4.7%; p<0.0001). Interestingly, the distribution of heterozygous 896A/G genotype statistically differed between migraineurs and controls (25.3% vs. 8.2%, p=0.00002, OR 3.87, 95% CI; 2.02-7.4). Multivariate logistic regression analysis indicated that G allele in affected female migraineurs is an independent factor associated with increased risk of migraine (OR 3.2, 95% CI 1.23-8.24, p=0.01).

CONCLUSION

Our results showed TLR-4 polymorphism as a genetic risk factor for migraine. However, further studies in different populations are required to elucidate the precise role of TLR-4 896A/G mutation in susceptibility to migraine.

Frequency and severity of obsessive-compulsive symptoms/disorders, violence and suicidal in schizophrenic patients

BACKGROUND

This study determined the prevalence and severity of obsessive-compulsive symptoms/disorder (OCS/OCD), aggression and suicidal in schizophrenic patients. Also we compared the prevalence and severity of aggression and suicidal in schizophrenic patients with and without OCS/OCD considering anxiety, depression and substance abuse as confounding factors.

METHODS

During 2007 and 2008, 100 schizophrenic patients were evaluated with Yale-Brown Obsessive Compulsive Scale, Positive and Negative Syndrome Scale, Beck Depression Inventory, Spilberger State/Trait Anxiety Inventory, Beck Scale for suicide Ideation, and Overt Aggression Scale.

RESULTS

OCS/OCD and suicidal attempts were seen in 33%, 10% and 12% of patients respectively. The most common form of aggression was against others (55%), and aggressive obsessions were seen in 10% of the patients. Comparing patients with and without OCS/OCD, there were no significant differences in the severity of schizophrenia, suicidal and overt aggression. The severity of overt aggression was related to the patients' age and education reversely. Also, there was a relationship between their suicidal thoughts and residence in the cities.

CONCLUSIONS

High rate of aggressive obsessions and lack of relationship between severity of aggression and presence of OCD indicated that these patients did not act on these thoughts. The risk of suicide was more serious in patients living in the cities, and risk of violence was more serious in younger and less educated patients.

Which is access suitable for a solitary upper pole renal stone? A possible novel criterion

AIM

The aim of the present study was to discover a new criterion for choosing subcostal or supracostal upper pole renal access before performing PCNL in upper pole renal stone cases.

METHODS

Between April 2006 and July 2009 we performed 35 subcostal upper poles PCNL in solitary upper pole stone cases. The inclusion criteria were stone size >1.5 cm or stone size <1.5 cm and resistant to extracorporeal shockwave lithotripsy. The exclusion criteria were renal anomalies, uretero-pelvic junction obstruction, multiple stone (associated pelvic or a lower pole stone) and any contraindication for surgery. We determined access length as the new criterion (the distance between the point of needle entrance and lower border of stone on the skin) and access success, in all patients. Then we analyzed the relationship between these two main variables and used roc curve to find a reliable cut point of access length.

RESULTS

The mean of access length was 9.72 cm (range: 6-14) and access was successful in 29 (82.8%) patients. Between measured variables, access length was the only variable that related to access success (P=0.04); furthermore, two reliable cut points (8 cm and 12 cm) for predicting access success. If access length was <8 cm or 8-12 cm or >12 cm, the access success was 100%, 83% and 50%, respectively.

CONCLUSION

Access length can be used as a criterion for choosing subcostal upper pole renal PCNL and predicting its success, in the case of solitary upper pole renal stones 12 cm can serve as a critical valve for a decision.