The Long-term Effect of Neurofeedback Therapy as Adjuvant Therapy on the Management of Tinnitus: A Prospective Clinical Trial

Background: Recently, various studies have been performed to examine the effect of neurofeedback on treating tinnitus. However, these studies reported different results. In this process, the nervous activity of the patient is evaluated. For example, the aspects associated with brain processes are extracted through temporal processing signs, and then auditory or visual feedback is given to the person. Objectives: The present study investigates the effect of neurofeedback sessions on treating tinnitus. Materials & Methods: In this clinical trial study, 30 patients with tinnitus who met the inclusion criteria were included. They referred to the otorhinolaryngology clinic of Azahra and Kashani hospitals in Isfahan City, Iran. The patients underwent 20 sessions of neurofeedback and were examined at time intervals before the intervention and then 1, 3, and 5 months after the intervention. To evaluate the patients, we used tinnitus handicap inventory and visual analog scale. To examine the changes in VAS and THI data at different times, repeated measure ANOVA test was utilized. The significance level was considered less than 0.05. The analysis was performed in SPSS V. 24. Results: Five months after the intervention, tinnitus handicap inventory (P<0.001) and visual analog scale (P<0.001) scores of the patients significantly improved. Also, no complication resulting from the use of neurofeedback was observed in the patients. Conclusion: Usage of neurofeedback sessions as adjuvant therapy could be an effective treatment in patients who suffer from tinnitus.

Effect of transcranial direct current stimulation on short-term and long-term treatment of chronic tinnitus

OBJECTIVE

This study was conducted to investigate the effectiveness of anodal and cathodal methods in reducing the intensity of tinnitus and to compare them with the control.

METHODOLOGY

This randomized double-blind clinical trial with case and control groups was conducted in Al-Zahra Hospital in Isfahan between 2015 and 2016. In this trial, 51 patients with tinnitus, for at least one year, were selected among those outpatients visiting the throat, nose and ear clinic within this period. Inclusion criteria were patients on electrical stimulation prohibition, with Ménière's disease, otosclerosis, chronic headache, and pulsatile tinnitus. Patients were randomly divided in three equal-sized groups: anodal stimulation group, cathodal stimulation group, and control group. The subjects received 20-min current stimulation (2 mA). Five subjects were selected from those with a significant difference between the stimulated states (anodal or cathodal) and/or control. They received weekly transcranial electrical stimulation for two months, and their long-term recovery from tinnitus was investigated. Data analysis was done with SPSS20.

RESULTS

Findings showed no significant between-groups difference in mean scores of tinnitus before the intervention (p = .68); whereas, this difference was significant immediately after the intervention (p = .02) and 1 h after it (p = .03). The mean score of tinnitus in the anodal stimulation group was significantly lower than the control; whereas, no significant difference was observed between the anodal and cathodal stimulation groups, and between the cathodal and control groups (p < .05). Findings also showed that the mean scores of tinnitus in two cathodal stimulation groups (p = .24) and control group (p = .62) were not significantly different at three different points of time; whereas, this score was significantly different in the anodal group at these time points (p = .01).

CONCLUSION

In conclusion, anodal stimulation was more effective than the cathodal and control stimulation in reducing the intensity of tinnitus in the short term.

Quality of Life, Anxiety and Depression in Patients with Differentiated Thyroid Cancer under Short Term Hypothyroidism Induced by Levothyroxine Withdrawal

BACKGROUND

We studied quality of life (QOL), anxiety, and depression in patients with differentiated thyroid cancer (DTC) either during treatment with levothyroxine or during withdrawal from levothyroxine when whole-body scanning (WBS) needed to be performed.

METHODS

DTC patients projected to undergo WBS were included in the study. They were studied at two time-points - the day before levothyroxine withdrawal, and one month after levothyroxine withdrawal. They were asked to fill WHOQOL-Bref, BDI-II, and HADS questionnaires at both time-points, and blood samples were taken to measure TSH, Tg, and TgAb levels.

RESULTS

Twenty-nine subjects (11 males) with a mean age of 42.6 ± 14.1 years entered the study. From the first to second time-point, the mean TSH level increased from 0.73 to 106.9 U/ml and the mean Tg level increased from 20.4 to 63.6 ng/ml. QOL scores decreased in four dimensions (physical health: 67.8 to 25.7; psychological: 58.9 to 38.9; social relationship: 67.5 to 56; and environment: 57.2 to 48.8). Patients also felt more depressed (48.3% to 93.2%) and anxious (65.5% to 89.6%). All changes were statistically significant (p < 0.005).

CONCLUSION

We found decreased QOL after short-term hypothyroidism, especially in physical health and psychological dimensions. We also found that patients became significantly depressed and anxious after levothyroxine withdrawal. Our findings suggest that alternative therapies, such as those employing rhTSH, should be considered for these patients. Psycho-oncological support might also be useful in helping them overcome their symptoms during short-term hypothyroidism; however, considering the reversibility of their symptoms, supportive care might be more effective.Key words: quality of life - anxiety - depression - thyroid cancer - hypothyroidism - levothyroxine - whole body scanning.

The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran

BACKGROUND

Dental anxiety and fear are major complications for both patient and dental care provider. The purpose of this study was to assess the prevalence of dental anxiety and fear in patients who referred to Isfahan Dental School and their relation to their age, gender, educational level, past traumatic experiences and frequency of dental visits.

MATERIALS AND METHODS

In this cross-sectional study, 473 patients were provided with a questionnaire including three sections. First section contained questions concerning their age, gender, educational level, frequency of dental visits, reasons for irregular attendance and existence of past traumatic experiences. Second section comprised a Farsi version of Modified Dental Anxiety Scale (MDAS); and third included a Farsi version of dental fear survey (DFS). Data were analyzed by t-test, ANOVA, Pearson and Spearman correlation tests.

RESULTS

The prevalence of dental anxiety among the study population was 58.8%. No correlation was found between age and MDAS (r = -0.08, P = 0.07) and DFS (r = -0.03, P = 0.53). Women demonstrated higher anxiety (P < 0.001) and fear (P = 0.003). Education had no significant effect on dental anxiety (r = -0.046, P = 0.32) and dental fear (r = -0.017, P = 0.79). Previous traumatic experiences were found to result in elevated anxiety and fear (P < 0.001). There was an inverse relationship between frequency of dental attendance and anxiety (r = -0.128, P = 0.008).

CONCLUSIONS

Within the limitations of this study, anxiety associated with dental treatment was widespread in the study population. Dental fear and anxiety were not affected by age or education level. Dental fear and anxiety were higher in women. In addition, people who visited the dentist more regularly and individuals without previous traumatic dental experiences were less anxious.

The effects of chloroform, ethyl acetate and methanolic extracts of Brassica rapa L. on cell-mediated immune response in mice

Turnips with a long history of usage, are helpful in preventing breast and prostate cancer, inflammation and body`s immune system dysfunction. In this study, we investigated the effects of chloroform, ethyl acetate and methanolic extracts of Brassica rapa L. on cell-mediated immune response in mice. Chloroform, ethyl acetate and methanolic extracts of B. rapa glands were prepared by maceration method. To study the effects of B. rapa on acquired immunity, groups of Balb/c mice (n=8) were used. Sheep red blood cell (SRBC) was injected (s.c., 1×10(8)cells/ml, 0.02 ml) and 5 days later, different extracts (10, 100 and 500 mg/kg), betamethasone (4 mg/kg) and Levamisol (4 mg/kg) as a positive control and normal saline as a negative control were given i.p. After 1 h SRBC was injected to footpad (s.c., 1×10(8)cells/ml, 0.02 ml) and footpad swelling was measured up to 72 h. To investigate the effects of B. rapa on innate immunity the same procedure was used, but animals only received one injection of SRBC 1 h after i.p. injection of test compounds. Our findings showed that SRBC induced an increase in paw swelling with maximum response at 6-8 and 2-4 h for innate and acquired immunity, respectively. Betamethasone inhibited and levamisol increased paw thickness in both models. In both innate and acquired immunity models, chloroform, ethyl acetate and methanolic extracts of B. rapa glands significantly and dose-dependently reduced paw thickness. Ethyl acetate extract showed better effect. As glucosinolates are better extracted by ethyl acetate, it may be concluded that they are contributed in the more pronounced effects of ethyl acetate extract.

Effects of iodized salt consumption on goiter prevalence in Isfahan: the possible role of goitrogens

OBJECTIVE

To evaluate the success of the Iranian Iodine Deficiency Disorders Committee in achieving World Health Organization (WHO) goals for reducing the prevalence of goiter in children by adding iodine to table salt beginning in 1989.

METHODS

In 1997, 8,000 male and female 6- to 18-year-old students were selected by cluster sampling in schools of Isfahan. Their thyroids were examined by four endocrinologists, and goiter was staged on the basis of the WHO classification. As an index of iodine consumption, urinary iodine concentrations were measured in 3,000 students.

RESULTS

Goiter was observed in 62% of the students. Of the overall study group, 94% had sufficient iodine consumption (urinary iodine concentration of 10.0 microg/dL or more). Of those students who had sufficient iodine intake, 63.2% had goiter. Of the 6% of students with iodine deficiency, 5% had mild, 0.9% had moderate, and only 0.1% had severe iodine deficiency. Goiter was absent in half of the students with severe iodine deficiency. The prevalence of goiter in 6- to 10-year-old children was 65%.

CONCLUSION

Despite sufficient iodine intake, the prevalence of goiter is still high in Isfahan City. Apparently, either this high prevalence has no relationship to iodine deficiency and possibly other unknown goitrogens are involved in the pathogenesis of goiter in Isfahan or the period of iodine intake has been too brief to affect thyroid sizes. Inasmuch as goiter prevalence is also high in the 6- to 10-year-old children, who have had iodized salt available for most of their lives, the second option is less probable. Another possibility is an increased rate of autoimmune thyroid diseases (because of iodine repletion) that resemble goiter during their early stages.