Comparison of efficacy of folic acid and silymarin in the management of antiepileptic drug induced liver injury:a randomized clinical trial

BACKGROUND： Liver injury associated with antiepileptic drugs accounts for a large proportion of drug-induced liver injuries （DILI） in children. Although withdrawal of the causative agent is the only proved treatment for DILI, in some dinical situations it is not possible. Recent studies have reported promising results of using hepatoprotective drugs with antioxidant actions for the management of DILl. This study aimed to evaluate the efficacy of folic acid versus silymarin treatment in relation to decreasing liver enzymes in patients with DILI due to antiepileptic therapy. METHODS： This randomized, open-label, clinical trial evalu- ated 55 children with epilepsy who were on antiepileptic treat- ment and experienced DILL The children were randomized to receive either silymarin （5 mg/kg per day） or folic acid （1 mg per day） for one month and were followed up for three months. RESULTS： Liver enzymes significantly decreased in both groups. The decrease trend in alanine aminotransferase （ALT） and aspartate aminotransferase （AST） were stronger in the folic acid group compared to silymarin group （P=0.04 and P=0.007, respectively）. At the end of the study patients in the folic acid group had significantly lower ALT （P=0.04）, AST （P=0.02）, and gamma-glntamyl transferase （GGT） （P〈0.001） levels and also higher percentage of normal ALT （30.7% vs 3.4%, P=0.009） and AST （42.3% vs 0%, P〈0.001）, and GGT （23.1% vs 0%, P=0.008） values compared to the patients in the silymarin group. No rebound elevations in ALT, AST and GGT levels or adverse reactions were noted in neither of the study groups.CONCLUSION： Although both treatments were safe and effective in decreasing liver enzymes, folic acid seems to be superior to silymarin in the management of DILl.

The Incidence of Respiratory Distress Syndrome among Preterm Infants Admitted to Neonatal Intensive Care Unit: A Retrospective Study

Background: Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) is the most common cause of neonatal morbidity and mortality in preterm infants. We aimed to determine the frequency of RDS among 3 groups of preterm infants and the value of some related factors. Methods: A cross-sectional, descriptive analytical investigation was carried out in the NICU ward of Akbarabadi Hospital (Tehran-Iran) during spring 2011. Newborns’ data were collected and assessed by using their hospital medical records. Seventy-three preterm infants with gestational age < 34 weeks were hospitalized in the NICU. All participants were divided into 3 groups: extremely preterm (<28 weeks), very preterm (28 to <32 weeks) and moderate preterm (32 to 34 weeks). Frequency of RDS and some related factors were compared among 3 groups. Results: RDS was observed in 65.6% of all participants;however frequency of RDS was not different between three groups. An inversely correlation was found between gestational age and mortality rate (p = 0.05). In regard to Betamethasone administration prior to birth, this interval was significantly longer in alive neonates in comparison to infants who died (p < 0.05). Conclusion: RDS was frequent in preterm neonates with gestational age < 32 weeks. Time of Betamethasone administration prior to birth can significantly influence on neonatal mortality rate.

Breastfeeding Status and Effective Factors in 21 - 27 Months Iranian Infants

The aim of this study was to assess the Breastfeeding status among children aged 21 - 27 moths. A cross sectional study was carried out in South Health Center (Tehran-Iran) in 2010. Four hundred 21 - 27 month breastfed infants entered the study. This study compared some variables in 2 groups;weaning before and after 22 months. The level of significance was considered P < 0.05. Mean breastfeeding duration and median (either exclusive or combined) were 19.66 ± 6.40 and 22 months. Among all reasons were cited by mothers, some reasons like insufficient breast milk supply (77.9%), infant restless (77.1%), and Mother’s reluctance (75.6%) were the most common causes of exclusive breastfeeding cessation. A significant relation was seen between breastfeeding duration and gestational age or birth trauma (P Value = 0.031, P Value = 0.04). Breastfeeding training and First mother-infant skin to skin contact had significant roles on breastfeeding duration (P Value < 0.05, P Value = 0.001, respectively). It seems lots of public health efforts and policy are needed to improve breastfeeding rate in our country.

Congenital Microvillous Atrophy, Report of Two Consecutive Siblings with Complete Histologic, Immunohistochemical and Detailed Electron Microscopic Studies, First Report from Iran

Introduction: Microvillous inclusion disease (MVD) or microvillous atrophy disorder is a congenital disorder of the small intestinal epithelial cells that presents with persistent and severe diarrhea and it is characterized by enterocytes abnormalities [1] 08D0C9EA79F9BACE118C8200AA004BA90B02000000080000000E0000005F005200650066003300380035003800380033003700360030000000 . For these children, prognosis is generally poor due to metabolic acidosis with poor compensation. To our experiment, this disease is very rare in Iran and it is yet unreported, so we decided to report two consecutive siblings with the same disease from Iran. Report of Cases: Two siblings were born to healthy parents. Parents were cousins. Both siblings were hospitalized due to severe diarrhea starting shortly after breast feeding. The frequency of diarrhea in both cases was 10 to 17 times per day and their stools were loose and green. Histological studies of both siblings revealed duodenal mucosa with complete flattening of villi (total villous atrophy). Superficial lining cells showed atrophy. Crypts showed no hyperplasia, however it showed distortion and difference in size. By PAS staining and CD10 staining, a poorly developed brush border and typical inclusions were seen in apical boarder of enterocytes. Electron microscopy was performed for the second case and showed microvillous involution and inclusions in the apical part of the epithelial cells. Discussion: Microvillous congenital atrophy is a rare congenital disorder. Due to rareness of congenital microvillous atrophy (CMA), it is crucial to distinguish it from other diseases with persistent and severe diarrhea as soon as possible.

Introducing a Rapid and Safe Method for Myeloperoxidase Staining

Background: Myeloperoxidase staining is used to differentiate leukemias since several decades. Despite implementation of flow cytometric, cytogenetic and molecular techniques for identification of leukemic blasts, histochemical stains such as myeloperoxidase stain are persistently used for better classification of leukemias. The myeloperoxidase staining is a time consuming and hazardous procedure. The present report describes a sensitive, rapid and easy method for assessment of peroxidase activity. Materials and Methods: Bone marrow aspiration slides were stained with Dako product: Code number: K3467 containing DAB chromogen (3,3-diaminobenzidine in chromogen solution) and substrate buffer (Imidasole-HCL buffer, PH 7.5 containing hydrogen peroxide and an anti microbial agent) in a rapid procedure taking only ten minutes time. The staining needs no material preparation steps. Neutrophils in the slide are taken as positive control or another normal smear was costained to be used as control. All cases were followed up with flow cytometry and cytogenetic studies. Result: The reaction product of this stain is brown and granular. Promyelocytes and myelocytes are the most strongly staining cells with positive (primary) granules. Lymphoblasts are negative. The result of classification of leukemias with this technique was in concordance with flow cytometric immunophenotyping. Discussion: Many practical techniques have been described using benzidine as an indicator for myeloperoxidase staining. Benzidine is a carcinogenic material and its usage is severely restricted in laboratory. Formerly we prepared requisite materials for myeloperoxidase staining by hazardous ways (boiling), but we decided to apply ready to use 3,3-diaminobenzidine (DAB), which is used in final step of immunohistochemistry stains. Conclusion: Use of 3,3-diaminobenzidine (DAB) is highly recommended for myeloperoxidase staining, while the result is extraordinary and fully compatible with flow cytometry and the method is safe and rapid.

Implementing of Electronic Medical Record in Pelvic Floor Ward: A Pilot Study

The electronic medical record is an essential technology tool to improve the quality of care. In present study we reported on the design and feasibility of electronic medical records in Female Pelvic Floor Dysfunction Ward. Our main goal was documentation with the least possible missed data, evidence-based decision making, documented active patient follow up and increasing patient’s satisfaction. The Electronic Registry System of Female Pelvic Floor Dysfunction (Vali e Asr Hospital, Tehran, Iran) was designed in mid 2014 and tested till March 2015. The software description was designed based on previous paper questionnaire used in this ward. The electronic questionnaires were filled in upon hospitalization and thereafter including follow ups. The questionnaire included 10 demographic and 15 main questions. A digital analog scale (1 - 10) in each part quantified the effects of problem on patient’s quality of life and also the effects of interventions as well. Entered information in each step was available for those with defined access. Reporting design was dependent on the needed data. Our supervised data entry was a guarantee to the quality of information with the least errors. Access to all para clinical data made rapid and evidence-based decision making. Patient satisfaction was achieved because of unified approach. The most interesting part was access to evidence-based results and data to be used in research projects. This study showed that EMRs in Female Pelvic Floor Dysfunction Wards could provide valuable information, improve the quality of care and increase patient’s satisfaction.

Obstetrics Risk Management in 5 Iranian Hospitals (Tehran-2012)

Background: Risk management is improving quality of health care services and creating a safer system of care. We determined the main maternal and fetal risks in five Hospitals (Tehran-Iran) to offer some practical strategies to decline obstetric adverse events and provide better pregnancy outcome. Methods: A descriptive, cross-sectional study was carried out in 5 Iranian hospitals (2011-2012).?Twelve Obstetricians/perinatalogists and midwives from 5 hospitalswho were in charge of Maternity Units, were our assistants in these hospitals. We organized a secretariat including Obstetricians/perinatalogists and midwives. The principles of Obstetrics Risk Management were introduced to them in a 2 days’ workshop. Then the delegates from each hospital were asked to report the most common obstetrical complications of their hospitals. The main results were 24 complications. Then for sorting these risks we asked them to do scoring of the 24 complication with 1 - 10 grading in 4 aspects of probability of occurrence, possibility of prevention, priority of interventions and short term response to interventions. Post partum haemorrhage, labor management problems, and neonatal hypothermia got the highest scores in these regards, and then these 24 items were categorized in 2 groups of risk assessment and hospital management. Finally based on Risk Management Rules in Clinical Governance, the complications analysis was done with use of failure mode, effects analysis and practical strategies to decline obstetrical adverse events were suggested. Results: We understood all reported complications had common infrastructural problems: defects in Risk Assessment and Hospital Management Policies. We focused on basic infrastructural management in these 2 main subjects and in these two: our main problems were related to staff management and hospital management issues. Conclusion: Since managerial and staff dependent problems were our main problems, these two should be considered as our main priorities in risk management program.

Nailfold Capillaroscopy Findings in Diabetic Patients (A Pilot Cross-Sectional Study)

Background: Microcirculation is affected in diabetes mellitus and Microvascular abnormalities cause persistent diabetic complications. The aim of this study was nailfold capillaroscopic assessment to describe the pathological changes (morphological and structural) in capillary of a large series of patients with type 1 and 2 diabetes. Methods: A cross-sectional study was carried out in a Nailfold Capillaroscopy Center (Tehran-Iran) between 2011 and 2014. The study included 235 types 1, 2 diabetic patients. All patients underwent 10 nailfolds capillaroscopy examinations. Microvascular architecture, disturbances capillary distribution, capillary morphology, capillary density, efferent/afferent limb ratio, subpapillary venular plexus, and morphological abnormalities were evaluated. Conclusions were stated as normalor scleroderma pattern. Results of patients’ capillaroscopic images were recorded and analyzed quantitatively and qualitatively. P value < 0.05 was considered as statistical significance. Results: of all participants with mean age 59.91 ± 12.39, 183 cases (77.9%) were female and 52 (22.1%) were male. Tortuosity of capillaries was more often observed in our subjects (235 cases) followed by angiogenesis (171 cases). Normal and early scleroderma patterns were observed in 195 (83.0%) and 40 cases (17.0%). Based on P values, altered micro vascular architecture, capillary distribution and capillary morphology were more frequent in patients with scleroderma pattern in comparison to patients with normal pattern (P value < 0.05). Morphological abnormalities except from neo formation capillary and mega capillary were also significantly more common in patients with scleroderma pattern than patients in counterpart group (P value < 0.05). Conclusion: Nailfold capillaroscopy as a non-invasive, diagnostic and prognostic method may potentially affect on diabetes outcome and control.