Background: Traumatic diaphragmatic injury is known to present with the spectrum of symptoms, and... more Background: Traumatic diaphragmatic injury is known to present with the spectrum of symptoms, and most patients would have some symptoms due to abdominal organ herniation. Majority of injuries tend to present on the left hemidiaphragm but right-sided injuries also occur mostly with subtle, delayed presentation due to the buffering effect of the liver. Case presentation: A 65-year-old male presented to the emergency department with a complaint of nausea and vomiting and reported no bowel movement or passing of flatus for 5 days. Upon further questioning, he recalled that he fell from a tractor while working in his farm 2 months earlier and sustained blunt trauma to his abdomen. Both chest and abdominal X-rays revealed the niveau formation of the small intestine on the right side above the liver and right hemidiaphragm. Further evaluation with CT scan confirmed the presence of a few small intestinal loops behind the liver and also in the chest through a rupture in the right hemidiaphragm. Exploratory laparotomy was performed. Some small intestine loops had gone behind the liver and through 4 cm rupture in the posterior aspect of the diaphragm into the chest. Displaced intestinal loops were relocated and no sign of ischemia or necrosis was observed. The patient was symptom-free within 2 days and he was discharged after 4 days. Conclusion: Traumatic injuries of the diaphragm are rare, yet underestimated; therefore, they need a high index of suspicion for timely diagnosis and neglected diagnosis may present with a range of symptoms such as herniation months to years later.
Intracranial Hypertension as an initial Clinical manifestation of Systemic Lupus Erythematosus, 2019
Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affec... more Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affect multiple organ systems including central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension(IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of SLE. Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O) with normal CSF indices. She also had normocytic, normochromic anemia, mild Thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient’s manifestation of IH. Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause and subsequently appropriate diagnostic tests should be performed.
Background/aim
An anterior cruciate ligament (ACL) rupture is a common sports-related injury requ... more Background/aim An anterior cruciate ligament (ACL) rupture is a common sports-related injury requiring surgical intervention. With the advent of arthroscopically-assisted knee surgery, many graft fixation techniques for ACL have been developed. Femoral tunnel widening has been reported with a different incidence in various fixation techniques however its clinical significance is still not clear. We sought to compare femoral tunnel widening in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft using either Endobutton or Double Cross-Pin technique.
Methods In this prospective study, 40 patients with a diagnosis of unilateral, isolated ACL rupture were randomly assigned to either the Endobutton or Double Cross-Pin group. Patients were assessed for femoral tunnel widening using CT-scan and functional outcome was evaluated with international Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation score and Lysholm score. Femoral tunnel diameter was determined based on intraoperative drill diameter and tunnel diameters on CT-scan performed every 6 months up to 18 months after surgery. Repeated measure analysis was used to compare the femoral tunnel diameter between two groups.
Results All patients completed the study. The mean (±SD) age of Endobutton and Double Cross-Pin group was 29.75(±7.88), 31(±6.36), respectively. The mean change of femoral tunnel diameter for Endobutton group over 18 months was 3.05 and it was 2.34 for the Double Cross-Pin group. There was no statistically significant difference between two groups (p: 0.27). Also, the functional outcome was not significantly different between the two groups (p > 0.05).
Conclusion Femoral tunnel widening after hamstring graft was not significantly different between Endobutton and Double Cross-Pin fixation techniques.
Background: Femoral nonunion is an important complication, which can occur after intramedullary n... more Background: Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion.
Objectives: The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture.
Methods: Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded.
Results: All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed.
Conclusions: Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures
Background and aim Interferon beta is currently the first line treatment of relapsing-remitting m... more Background and aim Interferon beta is currently the first line treatment of relapsing-remitting multiple sclerosis (RRMS). Different formulations of interferon beta are available. Avonex and CinnoVex are two interferon beta-1a being prescribed by neurologists in Iran. The aim of this study was to compare the four and half year outcome of Avonex and CinnoVex in patients with RRMS. Methods A total 186 of patients with definite RRMS diagnosis were followed for four and half years. Patients were randomly assigned to receive either Avonex or CinnoVex. Patients were subsequently visited every 6 months, and MRI was also undertaken prior each visit. The efficacy end points were to compare mean scores of expanded disability status scale (EDSS) and the proportion of patients with MRI and clinical activity in follow-up visits between Avonex and CinnoVex. Safety end point was to compare the percentage of adverse events between two groups. Results One hundred and eighty-two patients completed the study. The population of study experienced a steady increase in EDSS during follow-up with a mean increase of 1.03. Repeated measures ANOVA revealed no statistically significant difference between Avonex and CinnoVex (p = 0.78). The most common adverse events were headache, myalgia, fatigue, fever, flu symptoms, injection site pain, and depression. Direct comparison of each adverse events revealed no meaningful difference between two groups except for only a few adverse events. There was no statistically significant difference in MRI activity and clinical activity between two groups. Conclusion Avonex and CinnoVex showed similar efficacy and safety outcome in patients with RRMS.
Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, an... more Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25–49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8–67 %. Thus, VNS is recommended for suitable patients in developing countries.
Background and Aim: Alzheimer disease (AD) is the most common cause of dementia. Currently , ther... more Background and Aim: Alzheimer disease (AD) is the most common cause of dementia. Currently , there is no disease-modifying therapy for AD. We aimed to evaluate the long-term efficacy and safety of MLC601 in the treatment of AD. Methods: In this open-label extension study, patients with mild to moderate AD according to DSM-IV criteria were recruited. Patients received MLC601 capsules 3 times a day for 4 years. Cognitive function was assessed every 6 months using Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores. Safety profiles, including adverse events (AEs), and treatment-related abnormality in laboratory tests were also reported. Results: Of a total of 122 patients, 105 completed the study. The mean age was 66.8 ± 6.3 years at the beginning of the study. Sixty-five (61.9%) were female. The mean (±SD) change in MMSE and ADAS-Cog scores at the end of the study was 2.1 (±3.8) and –5.1 (±8.7), respectively. Repeated measure analysis revealed a statistically significant change in both scores (p < 0.001). No patient left the study due to an AE. No abnormality was noted in lab tests. Gastrointestinal symptoms were the most commonly reported AEs. Conclusion: The efficacy of treating AD patients with MLC601 over 4 years has been demonstrated in the present study. Overall, it seems that the safety and efficacy of MLC601 is promising compared to currently prescribed treatments.
Purpose: Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a pati... more Purpose: Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a patient’s life, including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objectivemeasures but its impact on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsingremitting MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international quality of life (MusiQoL) questionnaires. Methods: Four hundred recruited RRMS patients were treated with human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen’s d effect size. The relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson correlation coefficients. Results: Three-hundred and eighty three completed the study. Two-hundred and thirty nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was −0.16 and SF-36 physical component and mental component showed overall effect sizes of −0.28 and −0.53, respectively. Mean (range) EDSS change was 1 (1–4). Three-hundred and seventy four were clinically stable with mean (range) EDSS change of 0.1 (−2–0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF- 36. Conclusion: We found that, HRQoL did not change significantly over the first year of therapy. Furthermore, decreases in HRQoL were inversely correlated with increases in EDSS score.
Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive
functi... more Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini- Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAScog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.
Background and aim
Vascular dementia (VaD) is the second most common cause of dementia and curren... more Background and aim Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD.
Methods In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results.
Results Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were −3.71 (±4.50) for MLC601 group and −9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p<0.001). Ten (24.39%) patients reported predominantly transient gastrointestinal adverse events in MLC601 group. No patient left the study due to adverse events. There were no clinically significant abnormalities on laboratory tests.
Conclusion Patients treated with MLC601 over the 2 years showed dramatically better cognitive outcome compared with those treated with placebo. MLC601 was devoid of any serious adverse events and was well-tolerated
Balo's concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by ... more Balo's concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by concentric lamella of alternating demyelinated and partially myeli-nated tissues. It is a rare and a relatively acute condition. Attacks may proceed rapidly over weeks or months, typically without remission, like Marburg's variant, resulting in death or severe disability. However, the majority of cases have a more benign, self-limiting course with spontaneous remission. Magnetic resonance imaging is a primary imaging modality in the diagnosis of BCS. Treatment with intense immunosuppression may be indicated in patients with more aggressive form. New reports reveal more evidence regarding the pathophysiology and treatment strategies.
Background: Traumatic diaphragmatic injury is known to present with the spectrum of symptoms, and... more Background: Traumatic diaphragmatic injury is known to present with the spectrum of symptoms, and most patients would have some symptoms due to abdominal organ herniation. Majority of injuries tend to present on the left hemidiaphragm but right-sided injuries also occur mostly with subtle, delayed presentation due to the buffering effect of the liver. Case presentation: A 65-year-old male presented to the emergency department with a complaint of nausea and vomiting and reported no bowel movement or passing of flatus for 5 days. Upon further questioning, he recalled that he fell from a tractor while working in his farm 2 months earlier and sustained blunt trauma to his abdomen. Both chest and abdominal X-rays revealed the niveau formation of the small intestine on the right side above the liver and right hemidiaphragm. Further evaluation with CT scan confirmed the presence of a few small intestinal loops behind the liver and also in the chest through a rupture in the right hemidiaphragm. Exploratory laparotomy was performed. Some small intestine loops had gone behind the liver and through 4 cm rupture in the posterior aspect of the diaphragm into the chest. Displaced intestinal loops were relocated and no sign of ischemia or necrosis was observed. The patient was symptom-free within 2 days and he was discharged after 4 days. Conclusion: Traumatic injuries of the diaphragm are rare, yet underestimated; therefore, they need a high index of suspicion for timely diagnosis and neglected diagnosis may present with a range of symptoms such as herniation months to years later.
Intracranial Hypertension as an initial Clinical manifestation of Systemic Lupus Erythematosus, 2019
Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affec... more Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affect multiple organ systems including central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension(IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of SLE. Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O) with normal CSF indices. She also had normocytic, normochromic anemia, mild Thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient’s manifestation of IH. Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause and subsequently appropriate diagnostic tests should be performed.
Background/aim
An anterior cruciate ligament (ACL) rupture is a common sports-related injury requ... more Background/aim An anterior cruciate ligament (ACL) rupture is a common sports-related injury requiring surgical intervention. With the advent of arthroscopically-assisted knee surgery, many graft fixation techniques for ACL have been developed. Femoral tunnel widening has been reported with a different incidence in various fixation techniques however its clinical significance is still not clear. We sought to compare femoral tunnel widening in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft using either Endobutton or Double Cross-Pin technique.
Methods In this prospective study, 40 patients with a diagnosis of unilateral, isolated ACL rupture were randomly assigned to either the Endobutton or Double Cross-Pin group. Patients were assessed for femoral tunnel widening using CT-scan and functional outcome was evaluated with international Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation score and Lysholm score. Femoral tunnel diameter was determined based on intraoperative drill diameter and tunnel diameters on CT-scan performed every 6 months up to 18 months after surgery. Repeated measure analysis was used to compare the femoral tunnel diameter between two groups.
Results All patients completed the study. The mean (±SD) age of Endobutton and Double Cross-Pin group was 29.75(±7.88), 31(±6.36), respectively. The mean change of femoral tunnel diameter for Endobutton group over 18 months was 3.05 and it was 2.34 for the Double Cross-Pin group. There was no statistically significant difference between two groups (p: 0.27). Also, the functional outcome was not significantly different between the two groups (p > 0.05).
Conclusion Femoral tunnel widening after hamstring graft was not significantly different between Endobutton and Double Cross-Pin fixation techniques.
Background: Femoral nonunion is an important complication, which can occur after intramedullary n... more Background: Femoral nonunion is an important complication, which can occur after intramedullary nailing and it requires surgical intervention. Plate augmentation over intramedullary nail is emerging as an acceptable option with satisfactory results for femoral nonunion.
Objectives: The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture.
Methods: Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded.
Results: All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed.
Conclusions: Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures
Background and aim Interferon beta is currently the first line treatment of relapsing-remitting m... more Background and aim Interferon beta is currently the first line treatment of relapsing-remitting multiple sclerosis (RRMS). Different formulations of interferon beta are available. Avonex and CinnoVex are two interferon beta-1a being prescribed by neurologists in Iran. The aim of this study was to compare the four and half year outcome of Avonex and CinnoVex in patients with RRMS. Methods A total 186 of patients with definite RRMS diagnosis were followed for four and half years. Patients were randomly assigned to receive either Avonex or CinnoVex. Patients were subsequently visited every 6 months, and MRI was also undertaken prior each visit. The efficacy end points were to compare mean scores of expanded disability status scale (EDSS) and the proportion of patients with MRI and clinical activity in follow-up visits between Avonex and CinnoVex. Safety end point was to compare the percentage of adverse events between two groups. Results One hundred and eighty-two patients completed the study. The population of study experienced a steady increase in EDSS during follow-up with a mean increase of 1.03. Repeated measures ANOVA revealed no statistically significant difference between Avonex and CinnoVex (p = 0.78). The most common adverse events were headache, myalgia, fatigue, fever, flu symptoms, injection site pain, and depression. Direct comparison of each adverse events revealed no meaningful difference between two groups except for only a few adverse events. There was no statistically significant difference in MRI activity and clinical activity between two groups. Conclusion Avonex and CinnoVex showed similar efficacy and safety outcome in patients with RRMS.
Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, an... more Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25–49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8–67 %. Thus, VNS is recommended for suitable patients in developing countries.
Background and Aim: Alzheimer disease (AD) is the most common cause of dementia. Currently , ther... more Background and Aim: Alzheimer disease (AD) is the most common cause of dementia. Currently , there is no disease-modifying therapy for AD. We aimed to evaluate the long-term efficacy and safety of MLC601 in the treatment of AD. Methods: In this open-label extension study, patients with mild to moderate AD according to DSM-IV criteria were recruited. Patients received MLC601 capsules 3 times a day for 4 years. Cognitive function was assessed every 6 months using Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores. Safety profiles, including adverse events (AEs), and treatment-related abnormality in laboratory tests were also reported. Results: Of a total of 122 patients, 105 completed the study. The mean age was 66.8 ± 6.3 years at the beginning of the study. Sixty-five (61.9%) were female. The mean (±SD) change in MMSE and ADAS-Cog scores at the end of the study was 2.1 (±3.8) and –5.1 (±8.7), respectively. Repeated measure analysis revealed a statistically significant change in both scores (p < 0.001). No patient left the study due to an AE. No abnormality was noted in lab tests. Gastrointestinal symptoms were the most commonly reported AEs. Conclusion: The efficacy of treating AD patients with MLC601 over 4 years has been demonstrated in the present study. Overall, it seems that the safety and efficacy of MLC601 is promising compared to currently prescribed treatments.
Purpose: Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a pati... more Purpose: Multiple sclerosis (MS) requires long-term therapy and can affect many aspects of a patient’s life, including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objectivemeasures but its impact on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsingremitting MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international quality of life (MusiQoL) questionnaires. Methods: Four hundred recruited RRMS patients were treated with human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen’s d effect size. The relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson correlation coefficients. Results: Three-hundred and eighty three completed the study. Two-hundred and thirty nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was −0.16 and SF-36 physical component and mental component showed overall effect sizes of −0.28 and −0.53, respectively. Mean (range) EDSS change was 1 (1–4). Three-hundred and seventy four were clinically stable with mean (range) EDSS change of 0.1 (−2–0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF- 36. Conclusion: We found that, HRQoL did not change significantly over the first year of therapy. Furthermore, decreases in HRQoL were inversely correlated with increases in EDSS score.
Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive
functi... more Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini- Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAScog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.
Background and aim
Vascular dementia (VaD) is the second most common cause of dementia and curren... more Background and aim Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD.
Methods In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results.
Results Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were −3.71 (±4.50) for MLC601 group and −9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p<0.001). Ten (24.39%) patients reported predominantly transient gastrointestinal adverse events in MLC601 group. No patient left the study due to adverse events. There were no clinically significant abnormalities on laboratory tests.
Conclusion Patients treated with MLC601 over the 2 years showed dramatically better cognitive outcome compared with those treated with placebo. MLC601 was devoid of any serious adverse events and was well-tolerated
Balo's concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by ... more Balo's concentric sclerosis (BCS) is considered a variant of multiple sclerosis characterized by concentric lamella of alternating demyelinated and partially myeli-nated tissues. It is a rare and a relatively acute condition. Attacks may proceed rapidly over weeks or months, typically without remission, like Marburg's variant, resulting in death or severe disability. However, the majority of cases have a more benign, self-limiting course with spontaneous remission. Magnetic resonance imaging is a primary imaging modality in the diagnosis of BCS. Treatment with intense immunosuppression may be indicated in patients with more aggressive form. New reports reveal more evidence regarding the pathophysiology and treatment strategies.
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Papers by mehdi abbasi
central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension(IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of
SLE.
Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O)
with normal CSF indices. She also had normocytic, normochromic anemia, mild Thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon
further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient’s manifestation of IH.
Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause
and subsequently appropriate diagnostic tests should be performed.
An anterior cruciate ligament (ACL) rupture is a common sports-related injury requiring surgical intervention. With the advent of arthroscopically-assisted knee surgery, many graft fixation techniques for ACL have been developed. Femoral tunnel widening has been reported with a different incidence in various fixation techniques however its clinical significance is still not clear. We sought to compare femoral tunnel widening in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft using either Endobutton or Double Cross-Pin technique.
Methods
In this prospective study, 40 patients with a diagnosis of unilateral, isolated ACL rupture were randomly assigned to either the Endobutton or Double Cross-Pin group. Patients were assessed for femoral tunnel widening using CT-scan and functional outcome was evaluated with international Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation score and Lysholm score. Femoral tunnel diameter was determined based on intraoperative drill diameter and tunnel diameters on CT-scan performed every 6 months up to 18 months after surgery. Repeated measure analysis was used to compare the femoral tunnel diameter between two groups.
Results
All patients completed the study. The mean (±SD) age of Endobutton and Double Cross-Pin group was 29.75(±7.88), 31(±6.36), respectively. The mean change of femoral tunnel diameter for Endobutton group over 18 months was 3.05 and it was 2.34 for the Double Cross-Pin group. There was no statistically significant difference between two groups (p: 0.27). Also, the functional outcome was not significantly different between the two groups (p > 0.05).
Conclusion
Femoral tunnel widening after hamstring graft was not significantly different between Endobutton and Double Cross-Pin fixation techniques.
Objectives: The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture.
Methods: Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded.
Results: All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed.
Conclusions: Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures
including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy
of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objectivemeasures but its impact
on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsingremitting
MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international
quality of life (MusiQoL) questionnaires. Methods: Four hundred recruited RRMS patients were treated with
human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires
at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at
baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen’s d effect size. The
relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson
correlation coefficients. Results: Three-hundred and eighty three completed the study. Two-hundred and thirty
nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was
−0.16 and SF-36 physical component and mental component showed overall effect sizes of −0.28 and −0.53,
respectively. Mean (range) EDSS change was 1 (1–4). Three-hundred and seventy four were clinically stable with
mean (range) EDSS change of 0.1 (−2–0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF-
36. Conclusion: We found that, HRQoL did not change significantly over the first year of therapy. Furthermore,
decreases in HRQoL were inversely correlated with increases in EDSS score.
function greater than that expected for a person’s age. The clinical significance of this
condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication
that has shown promising effects in Alzheimer disease. Accordingly, we conducted this
randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of
MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited.
The included participants were randomly assigned to groups to receive either MLC601
or placebo. An evaluation of global cognitive function was performed at baseline as well as
at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-
Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale
(ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between
the 2 groups during the study period. Safety assessment included adverse events (AEs) and
abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601
group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6
months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAScog;
in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the
ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically
significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients
(14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were
gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown
promising efficacy and acceptable AEs in MCI patients.
Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD.
Methods
In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results.
Results
Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were −3.71 (±4.50) for MLC601 group and −9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p<0.001). Ten (24.39%) patients reported predominantly transient gastrointestinal adverse events in MLC601 group. No patient left the study due to adverse events. There were no clinically significant abnormalities on laboratory tests.
Conclusion
Patients treated with MLC601 over the 2 years showed dramatically better cognitive outcome compared with those treated with placebo. MLC601 was devoid of any serious adverse events and was well-tolerated
central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension(IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of
SLE.
Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O)
with normal CSF indices. She also had normocytic, normochromic anemia, mild Thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon
further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient’s manifestation of IH.
Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause
and subsequently appropriate diagnostic tests should be performed.
An anterior cruciate ligament (ACL) rupture is a common sports-related injury requiring surgical intervention. With the advent of arthroscopically-assisted knee surgery, many graft fixation techniques for ACL have been developed. Femoral tunnel widening has been reported with a different incidence in various fixation techniques however its clinical significance is still not clear. We sought to compare femoral tunnel widening in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft using either Endobutton or Double Cross-Pin technique.
Methods
In this prospective study, 40 patients with a diagnosis of unilateral, isolated ACL rupture were randomly assigned to either the Endobutton or Double Cross-Pin group. Patients were assessed for femoral tunnel widening using CT-scan and functional outcome was evaluated with international Knee Documentation Committee (IKDC) 2000 Subjective Knee Evaluation score and Lysholm score. Femoral tunnel diameter was determined based on intraoperative drill diameter and tunnel diameters on CT-scan performed every 6 months up to 18 months after surgery. Repeated measure analysis was used to compare the femoral tunnel diameter between two groups.
Results
All patients completed the study. The mean (±SD) age of Endobutton and Double Cross-Pin group was 29.75(±7.88), 31(±6.36), respectively. The mean change of femoral tunnel diameter for Endobutton group over 18 months was 3.05 and it was 2.34 for the Double Cross-Pin group. There was no statistically significant difference between two groups (p: 0.27). Also, the functional outcome was not significantly different between the two groups (p > 0.05).
Conclusion
Femoral tunnel widening after hamstring graft was not significantly different between Endobutton and Double Cross-Pin fixation techniques.
Objectives: The aim of the present study was to determine whether plate augmentation over retained intramedullary nail is an effective treatment for nonunion of femoral shaft fracture.
Methods: Overall, 35 cases of femoral nonunion, initially treated with intramedullary nailing, were managed with plating augmentation. Patients with oligotrophic or atrophic nonunion also received iliac cancellous auto graft. The outcome was evaluated by the rate and duration of union and complications were recorded.
Results: All patients achieved bony union during an average time of 21 weeks (± 3.94) and no union occurred later than 35 weeks. In plain radiography, evidence of callus formation was seen at mean time of 10 weeks. There was no statistically significant difference in union time among different types of nonunion (P: 0.466) while a significant difference was noticed in the time for callus formation (P < 001). Also, no complications were observed.
Conclusions: Plating augmentation is an effective and safe treatment option for nonunion of femoral shaft fractures
including quality of life. MS patients score lower on health-related quality of life (HRQoL) measures. The efficacy
of subcutaneous interferon (IFN) β-1a has been extensively evaluated by using objectivemeasures but its impact
on HRQoL is currently unclear. In this observational study, we evaluated HRQoL of Iranian patients with relapsingremitting
MS (RRMS) treated with IFN β-1a by using short-form 36 (SF-36) and multiple sclerosis international
quality of life (MusiQoL) questionnaires. Methods: Four hundred recruited RRMS patients were treated with
human serum album free IFN β-1a for 1 year. Patients were required to fill in SF-36 and MusiQoL questionnaires
at the first visit and at each follow-up visit. Expanded disability status scale (EDSS) evaluation was performed at
baseline and at each visit. Comparisons in HRQoL between visits were calculated using Cohen’s d effect size. The
relationship between change in EDSS score and the score of each questionnaire was calculated using Pearson
correlation coefficients. Results: Three-hundred and eighty three completed the study. Two-hundred and thirty
nine were female. Mean (SD) age was 28.75 (±5.49). After 1 year, overall MusiQoL Index score effect size was
−0.16 and SF-36 physical component and mental component showed overall effect sizes of −0.28 and −0.53,
respectively. Mean (range) EDSS change was 1 (1–4). Three-hundred and seventy four were clinically stable with
mean (range) EDSS change of 0.1 (−2–0.5). Increase in EDSS was linked to a decrease in both MusiQoL and SF-
36. Conclusion: We found that, HRQoL did not change significantly over the first year of therapy. Furthermore,
decreases in HRQoL were inversely correlated with increases in EDSS score.
function greater than that expected for a person’s age. The clinical significance of this
condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication
that has shown promising effects in Alzheimer disease. Accordingly, we conducted this
randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of
MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited.
The included participants were randomly assigned to groups to receive either MLC601
or placebo. An evaluation of global cognitive function was performed at baseline as well as
at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-
Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale
(ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between
the 2 groups during the study period. Safety assessment included adverse events (AEs) and
abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601
group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6
months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAScog;
in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the
ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically
significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients
(14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were
gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown
promising efficacy and acceptable AEs in MCI patients.
Vascular dementia (VaD) is the second most common cause of dementia and currently there is scarcity of therapies for VaD. We aimed to investigate the efficacy and safety of MLC601 in the treatment of VaD.
Methods
In this multicenter, pilot, randomized, double-blind trial, 82 patients with VaD according to DSM-5 criteria received MLC601 or placebo capsules three times a day for 2 years. The primary efficacy end-point was evaluated by comparing Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score between the two groups over 2 years of study. Safety was also assessed by recording adverse events and abnormal laboratory results.
Results
Eighty-one patients completed the study and were included in the analysis. One patient was lost to follow-up in the placebo group. After 2 years, mean (±SD) changes in the MMSE score were −3.71 (±4.50) for MLC601 group and −9.33 (±4.80) for placebo group. ADAS-cog score showed (±SD) changes of 7.34 (±9.55) and 19.00 (±11.28) for MLC601 and placebo group, respectively. Repeated measures analyses showed that both MMSE and ADAS-cog scores were significantly better in the treatment group at 24 months (p<0.001). Ten (24.39%) patients reported predominantly transient gastrointestinal adverse events in MLC601 group. No patient left the study due to adverse events. There were no clinically significant abnormalities on laboratory tests.
Conclusion
Patients treated with MLC601 over the 2 years showed dramatically better cognitive outcome compared with those treated with placebo. MLC601 was devoid of any serious adverse events and was well-tolerated