Objective: This case report highlights arachnoid cyst, a rare benign space-occupying lesions (SOL) formed by an arachnoid membrane containing cerebrospinal fluid (CSF) which in most cases, are identified by accident. Conversion disorder is characterized as a deficit or distortion in neurological functioning, or symptoms suggesting a general medical condition that is not referable to an organic lesion. Methods: We report a case of a 24 year old woman who came to a psychiatrist with history of suicide attempt. She had a history of failed marriage but no history of substance abuse. She had a history of dizziness, light-headedness, blurred vision, seizure and headache for a while. Seizure was identified to be pseudo seizures in further assessments. Results: Diagnosis of Conversion Disorder with Adjustment Disorder was revealed. In Barin Computerized Tomography (CT) scan there was an extra axial cystic lesion with the height, frontooccipital and lateral size of approximately 6.4 cm by 4 cm by 2.5 cm respectively in the left anterior middle fossa and Sylvian fissure. Based on patient's history, the arachnoid cyst and its symptoms may have a synergistic effect on patient's symptoms of conversion disorder. Conclusion: This case reflects the importance of ruling out medical problems in patients with psychiatric symptoms.

OBJECTIVEOne of the most common joint dislocations presented to the emergency department (ED) is anterior shoulder dislocation (ASD). Various techniques for the treatment of this abnormality have been suggested. In this study, we evaluated the efficacy and success rate of modified scapular manipulation (MSM) as a painless procedure compared to traction-countertraction (TCT) for reduction of ASD.

METHODSPatients with ASD who were presented to ED of Baqiyatallah Hospital, Tehran during 2011 were included. They were randomly divided into MSM group or TCT group and then pain at reduction, time of reduction, duration of hospitalization, and success rate were compared. In TCT group, reduction was performed using sedative and antipain medications.

RESULTSNinety seven patients (81.6% male) with a mean age of 34.15 years±13.48 years were studied. The reduction time between both groups showed a significant difference (470.88 seconds±227.59 seconds for TCT group, 79.35 seconds±82.49 seconds for MSM group, P<0.001). The success rate in MSM group in the first and second effort were 89% and 97% whereas 73% and 100% in the TCT group respectively (P<0.001).

CONCLUSIONIt seems that the manipulation technique can be more successful than the TCT method at the first effort whilst the second effort has the opposite results. Also MSM can be safer, cheaper and more acceptable for patients than TCT as a standard traditional method.

Adult ; Female ; Humans ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Scapula ; Shoulder Dislocation ; prevention & control ; therapy ; Traction ; methods

Background: Various techniques with different grafts and implants have been proposed to establish a smooth and symmetric nasal dorsum with adequate function. Broadly, two categories of materials have been used in this regard: alloplastic implant materials and autograft materials. The aim of these meta-analyses is to explore the incidence of complications after dorsum augmentation surgery using alloplastic materials. Materials and methods: After duplication removal 491 papers remained that title and abstract were assessed for eligibility. Regarding the study type, 27 observational studies were included, 21 retrospective and 6 prospective case series. A total of 3803 cases were enrolled in this systematic review and meta-analysis.ResultTwenty-seven articles reported on complications and outcomes of dorsal augmentation rhinoplasty with synthetic materials. In a random-effects model, the weighted mean percentage was 2.75% (95% CI 1.61 to 4.17%). the weighted mean percentage were 1.91% (95% CI 0.77 to 3.54%), 0.72% (95% CI 0.316 to 1.31%), and 0.78% (95% CI 0.43 to 1.24%) respectively. Conclusion The widely used alloplasts were expanded polytetrafluoroethylene (ePTFE), high-density polyethylene, and silicone. The total rates for complications, infection, deviation, irregularity, hematoma, extrusion, and overcorrection were 2.75%, 1.91%, 0.72%, 0.70%, 0.78%, and 0.49%, respectively. The revision rate, based on the random effects model, was 6.40% with 95%CI (3.84 to 9.57).

OBJECTIVE: We investigated the effects of antipsychotics on immune-challenged peripheral blood mononuclear cell (PBMC) cultures. METHODS: Blood samples were collected from twelve patients with first-episode schizophrenia. The PBMCs were separated and cultures were prepared and stimulated with lipopolysaccharide (LPS) or polyinosinic:polycytidylic acid (poly[I:C]), and then separately treated with a typical antipsychotic (haloperidol) or atypical antipsychotic (clozapine, quetiapine, or risperidone). Pro-inflammatory (interferon gamma [IFN-gamma]) and anti-inflammatory (interleukin [IL]-4 and IL-10) cytokine levels were measured in the LPS- or poly(I:C)-stimulated PBMC cultures treated with antipsychotics. RESULTS: Haloperidol and quetiapine significantly increased the IL-4 levels (p<0.05) in LPS-stimulated PBMC cultures, while clozapine and quetiapine significantly enhanced the IL-4 levels (p<0.05) in poly(I:C)-stimulated PBMC cultures. Only treatment with haloperidol resulted in a significant increase in IL-10 production (p<0.05) in LPS-stimulated PBMC cultures, whereas clozapine, quetiapine, and risperidone treatment significantly increased IL-10 production (p<0.05) in poly(I:C)-stimulated PBMC cultures. All of the antipsychotics reduced the IFN-gamma level significantly (p<0.05) in LPS- and poly(I:C)-stimulated PBMC cultures. CONCLUSION: Antipsychotic treatment altered immune function by raising the levels of anti-inflammatory cytokines (IL-4 and IL-10) and suppressing the levels of pro-inflammatory cytokines (IFN-gamma).
Antipsychotic Agents* ; Cell Culture Techniques* ; Clozapine ; Cytokines ; Haloperidol ; Humans ; Interleukin-10 ; Interleukin-4 ; Lipopolysaccharides ; Risperidone ; Schizophrenia* ; Quetiapine Fumarate

BACKGROUND: Anesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain. METHODS: In a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded. RESULTS: Groups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 +/- 12.7 in sufentanil group and 185.2 +/- 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001). CONCLUSIONS: Intrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.
Analgesia ; Analgesia, Epidural ; Analgesics ; Anesthesia ; Apgar Score ; Female ; Gestational Age ; Injections, Spinal ; Labor Pain* ; Midazolam* ; Pregnancy ; Sufentanil*

PURPOSE: Asthma and other allergic disorders have increased over the past decades in nearly all nations. Many studies have suggested the role of vitamin D deficiency in both T-helper1 and T-helper2 diseases; however, the association between vitamin D, allergy, and asthma remains uncertain. In this study, the associations of 25-hydroxy vitamin D3 levels with asthma and with the severity of asthma were evaluated. METHODS: This cross-sectional study was conducted on 50 asthmatic children and 50 healthy controls aged 6-18 years. Serum 25-hydroxy vitamin D3 levels were determined and compared between the two groups. The relationship between serum vitamin D levels and pulmonary function test outcomes and eosinophil counts were examined in asthmatic patients. RESULTS: Univariate analysis of the relationship between asthma and vitamin D showed that decreased vitamin D levels were associated with significantly increased odds of asthmatic state (P=0.002). In a multivariate analysis after adjustment for age, body mass index, and sex, the relationship between vitamin D and asthma increased. In asthmatic patients, 25-hydroxy vitamin D levels had direct and significant correlations with both predicted FEV1 (R2=0.318; P=0.024) and FEV1/FVC (R2=0.315; P=0.026). There were no associations between vitamin D level and eosinophil counts, duration of disease, and the number of hospitalization or unscheduled visits in the previous year (P>0.05). CONCLUSIONS: These results showed that serum 25-hydroxy vitamin D levels were inversely associated with asthma, and there was a direct and significant relationship between vitamin D levels and pulmonary function test outcomes in asthmatic children. An interventional study in asthmatic patients with low serum vitamin D concentration may establish a causal relationship between asthma and vitamin D.
Aged ; Asthma ; Body Mass Index ; Child ; Cholecalciferol ; Cross-Sectional Studies ; Eosinophils ; Hospitalization ; Humans ; Hypersensitivity ; Multivariate Analysis ; Respiratory Function Tests ; Vitamin D ; Vitamin D Deficiency ; Vitamins

One of the uncommon congenital variations is intrathoracic rib which a normal, a bifid, or an accessory rib lies within the thoracic cavity that is founded accidentally. Clinically, in most cases they are without symptoms; however, it may cause intrathoracic problems therefore it is important for radiologists and physicians to identify to prevent of excessive intervention and treatment during imaging diagnostic techniques of thoracic problems. In this report, we provide the case of a rare presentation of an intrathoracic rib in a 3-year-old boy arising from the inferior portion of a second rib based on findings from computed tomography. To our knowledge, this is only the second reported case of this type of intrathoracic rib that demonstrated with computed tomography.
Child, Preschool ; Humans ; Male ; Ribs* ; Thoracic Cavity

Sodium metabisulfite is used as a disinfectant, antioxidant, and preservative agent in the food, beverage, and drug industries. Neurons are highly sensitive to sulfite toxicity. Curcumin is the main part of turmeric and has neuroprotective effects on a variety of nervous system damages. The present study aimed to investigate the possible protective role of curcumin in learning and memory after exposure to sulfite in rats. The rats were divided into five groups receiving distilled water (solvent of the sulfite), olive oil (solvent of the curcumin), sodium metabisulfite (25 mg/kg/day), curcumin (100 mg/kg/day), and sulfite + curcumin. All the animals received daily gavages for 8 weeks. At the end of the 8th week, learning and memory were assessed in a partially-baited eight arm radial maze. The animals treated with sulfite showed fewer correct choices and more reference and working memory errors during the learning phase, at the end of the learning phase, and during the retention testing (p<0.001). The study results demonstrated that sulfite-exposure was associated with impaired learning and memory in rats. Adding curcumin to the rat nutrition plays a protective role in learning and memory after exposure to sulfite.
Animals ; Arm ; Beverages ; Curcuma ; Curcumin ; Drug Industry ; Learning ; Memory ; Memory, Short-Term ; Nervous System ; Neurons ; Neuroprotective Agents ; Olea ; Plant Oils ; Rats ; Retention (Psychology) ; Sodium ; Sulfites ; Water ; Olive Oil

PURPOSE: Limited studies have shown antifibrotic effects of pentoxifylline, captopril, simvastatin, and tamoxifen. No comparisons are available of the effects of these drugs on prevention of renal and bladder changes in partial urethral obstruction (PUO). MATERIALS AND METHODS: The rats were divided into six groups (n=7). The sham-operated rats (group I) only underwent laparotomy and did not receive any treatments. The PUO groups (group II-VI) received normal saline (PUO+NS), pentoxifylline (100 mg/kg/d; PUO+PEN), captopril (35 mg/kg/d; PUO+CAP), simvastatin (15 mg/kg/d; PUO+SIM), or tamoxifen (10 mg/kg/d; PUO+TAM) by gavage for 28 days. Then, the volume and/or length of the kidney components (tubules, vessels, and fibrous tissue) and the bladder components (epithelial and muscular layers, fibrous tissue, fibroblast and fibrocyte number) were quantitatively evaluated on the microscopic sections by use of stereological techniques. RESULTS: The volume of renal and bladder fibrosis was significantly ameliorated in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. Also, the volume and length of the renal tubules and vessels and bladder layers were more significantly protected in the PUO+PEN group, followed by the PUO+CAP, PUO+SIM, and PUO+TAM groups. CONCLUSIONS: Treatment of PUO with PEN was more effective in the prevention of renal and bladder fibrosis and in the preservation of renal and bladder structures.
Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Animals ; Captopril/*pharmacology ; Disease Models, Animal ; Estrogen Antagonists/pharmacology ; Free Radical Scavengers/pharmacology ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; Kidney/*drug effects/pathology ; Male ; Pentoxifylline/*pharmacology ; Rats ; Simvastatin/*pharmacology ; Tamoxifen/*pharmacology ; Urethral Obstruction/*drug therapy ; Urinary Bladder Neck Obstruction/*drug therapy

OBJECTIVERoad traffic accident (RTA) and its related injuries contribute to a significant portion of the burden of diseases in Iran. This paper explores the association between driver-related factors and RTA in the country.

METHODSThis cross-sectional study was conducted in Iran and all data regarding RTAs from March 20, 2010 to June 10, 2010 were obtained from the Traffic Police Department. We included 538 588 RTA records, which were classified to control for the main confounders: accident type, final cause of accident, time of accident and driver-related factors. Driver-related factors included sex, educational level, license type, type of injury, duration between accident and getting the driving license and driver's error type.

RESULTSA total of 538 588 drivers (91.83% male, sex ratio of almost 13:1) were involved in the RTAs. Among them 423 932 (78.71%) were uninjured; 224 818 (41.74%) had a diploma degree. Grade 2 driving license represented the highest proportion of all driving licenses (290 811, 54.00%). The greatest number of accidents took place at 12:00-13:59 (75 024, 13.93%). The proportion of drivers involved in RTAs decreased from 15.90% in the first year of getting a driving license to 3.13% after 10 years'of driving experience. Neglect of regulations was the commonest cause of traffic crashes (345 589, 64.17%). Non-observance of priority and inattention to the front were the most frequent final causes of death (138 175, 25.66% and 129 352, 24.02%, respectively). We found significant association between type of accident and sex, education, license type, time of accident, final cause of accident, driver's error as well as duration between accident and getting the driving license (all P less than 0.001).

CONCLUSIONOur results will improve the traffic law enforcement measures, which will change inappropriate behavior of drivers and protect the least experienced road users.

Accidents, Traffic ; statistics & numerical data ; Adult ; Automobile Driving ; statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Iran ; epidemiology ; Licensure ; Male ; Young Adult