shahryar pourfarzam

The aim of this study was to evaluate the effect of citalopram on the prevention of migraine headaches as compared to placebo.

This double-blind randomized clinical trial was conducted on patients diagnosed with migraine headaches based on the guidelines of the International Headache Society. 226 patients who met inclusion criteria were randomly allocated to two control and intervention groups. The treatment group was treated with citalopram 30 mg daily for two months and the control group was given placebo the same amount as the treatment group. All the patients were assessed at the beginning of the trial and after 1 month and 2 months and the frequency, severity and duration of their headaches were documented using the Visual Analogue Scale (VAS) and Behavioral Rating Scale (BRS-6). Data were analyzed using SPSS v.16 software.   

Even though initially there was no statistically significant difference between the two groups regarding the severity, duration and frequency of episodes of migraine (P>0.05), the same parameters had drastic changes after the first and second months of treatment and the differences between the citalopram and placebo group regarding severity, duration and frequency of migraine episodes were statistically significant (P<0.05).

The outcome of this experiment showed that citalopram, a serotonin uptake inhibitor (SSRI), possibly through a serotonin-lowering mechanism, results in less exposure of the CNS to this agent, leading to less frequent, less severe and shorter migraine episodes. This medication appears to be useful as a preventive drug used to treat and maintain episodes of migraine headaches, especially in individuals suffering from both migraine headaches and clinical depression.

Little is known about pulmonary complications induced by Sulfur Mustard (SM), as a chemical warfare agent, especially considering its long term effects. The present study was carried out to investigate the association of α1-Antitrypsin (A1AT), Complement component C5a, and Secretory Immunoglobulin A (sIgA) with long-term pulmonary complications on SM-exposed individuals, 20 years after the exposure.

Sardasht-Iran Cohort Study (SICS) is a historical cohort study on 372 SM-exposed individuals and 128 age-matched unexposed participants. The clinical evaluations and Spirometry were performed on all the participants according to American Thoracic Society Criteria. Also, we assessed the salivary levels of A1AT, C5a, and sIgA using ELISA assay.

The results indicated significant associations between salivary levels of A1AT, C5a, and sIgA with chronic cough in the exposed victims. Also, there were associations between C5a and sIgA with dyspnea in SM-exposed victims with chronic cough compared with those in the exposed victims without chronic cough. The salivary levels of C5a significantly decreased in severe pulmonary involvement. Moreover, a significant relationship was observed between the salivary levels of C5a and pulmonary function testes.

According to the findings, the salivary level of C5a might reflect the severity of pulmonary involvements following SM exposure. A1AT, as a protective agent, has correlations with cough and dyspnea. Although no strong correlation was found between the salivary levels of these factors with persistence of pulmonary complications, they can be effective in the development and progression of pathological changes in the lungs of the SM-exposed victims.

Little is known about pulmonary complications induced by Sulfur Mustard (SM), as a chemical warfare agent, especially considering its long term effects. The present study was carried out to investigate the association of α1-Antitrypsin (A1AT), Complement component C5a, and Secretory Immunoglobulin A (sIgA) with long-term pulmonary complications on SM-exposed individuals, 20 years after the exposure.

Sardasht-Iran Cohort Study (SICS) is a historical cohort study on 372 SM-exposed individuals and 128 age-matched unexposed participants. The clinical evaluations and Spirometry were performed on all the participants according to American Thoracic Society Criteria. Also, we assessed the salivary levels of A1AT, C5a, and sIgA using ELISA assay.

The results indicated significant associations between salivary levels of A1AT, C5a, and sIgA with chronic cough in the exposed victims. Also, there were associations between C5a and sIgA with dyspnea in SM-exposed victims with chronic cough compared with those in the exposed victims without chronic cough. The salivary levels of C5a significantly decreased in severe pulmonary involvement. Moreover, a significant relationship was observed between the salivary levels of C5a and pulmonary function testes.

According to the findings, the salivary level of C5a might reflect the severity of pulmonary involvements following SM exposure. A1AT, as a protective agent, has correlations with cough and dyspnea. Although no strong correlation was found between the salivary levels of these factors with persistence of pulmonary complications, they can be effective in the development and progression of pathological changes in the lungs of the SM-exposed victims.

Pruritus is the most frequent chronic dermal complication of sulfur mustard (SM), which negatively influences the quality of life. Exact pathophysiology of SM-induced itching is unknown. The current study aimed at evaluating the possible association between SM-induced itching and the serum levels of matrix metalloproteinase (MMP)-9 and their endogenous inhibitors, and serum levels of soluble forms of selectins (sL-, sP-, and sE-selectins) as adhesion molecules involved in the development of different inflammatory reactions.
Serum levels of MMP-9, MMP-9/ tissue inhibitors of metalloproteinases (TIMPs), and selectins were measured by the enzyme-linked immunosorbent assay (ELISA), and compared between the groups (n=368) with and without itching, and matched control groups (n=126).
Serum levels of MMP-9 were significantly higher in the SM exposed group with itching, compared with that of the group without itching (medians: 894 and 624 pg/mL respectively; P-value =0.034). There was no relationship between the serum levels of MMP-9/TIMP-1, MMP-9/TIMP-2, MMP-9/TIMP-4, and itching in the patients exposed to SM. Median serum levels of sE- and sL-selectins in the exposed group with itching were higher than those of the exposed group without itching. These differences were statistically insignificant (P-values =0.084 and 0.095, respectively).
According to the results of the current study, the increased serum levels of MMP-9 and selectins 20 years after exposure may play role in the pathogenesis and persistence of SM-induced itching in the exposed individuals.

Matrix metalloproteinases (MMPs) are a family of proteinases and have the vigorous capacity to degrade all parts of the extracellular matrix. MMP enzymes strongly participate in physiological processes such as normal tissue remodeling and wound healing and in pathology of pulmonary diseases. They are released in response to environmental stimuli such as toxins and regulated by endogenous tissue inhibitors of metalloproteinases (TIMPs). Sulfur mustard (SM) is a chemical toxic which can cause severe permanent damages to lung tissues. The aim of this study was assessing the possible role of MMP-9 and TIMPs in SM-induced lung symptoms and signs in exposed patients 20 years after exposure.
Totally, 372 male volunteers with a history of SM exposure and 128 age- and sex-matched unexposed controls participated and were divided into three groups: normal, mild and moderate-severe. All participants underwent clinical evaluation and pulmonary function tests and serum concentrations of MMP-9 and its inhibitors were measured using the ELISA technique.
Serum level of MMP-9 was increased in the SM exposed group who had moderate-severe pulmonary complications compared with the SM exposed with normal lung (2.321 ± 2.836 vs. 1.546 ± 2.176, P = 0.001) while only the MMP-9/TIMP-4 complex was elevated in the SM exposed with normal lung individuals compared to its corresponding control group (85 ± 265 vs. 82 ± 222, P = 0.025). Although MMP-9 and its inhibitors did not show any correlation with spirometry findings, elevated circulating MMP-9 was detected in SM exposed patients with chronic chough and hemoptysis (P = 0.013 and P = 0.013 respectively).
High level of tissue disruption and remodeling mediators could influence lung structure in long-term after SM exposure. The correlation of clinical evaluation with these factors efficiently helps us to identify important effectors.

Macrophage Activating Syndrome (MAS) is a life-threatening disease seen in autoimmune diseases including lupus erythematosus, rheumatoid arthritis, Still's disease, polyarteritis nodosa. It is characterized by fever, pancytopenia, liver failure, coagulopathy, and neurologic symptoms and high serum ferritin. A 27 yr. old female patient was admitted in shahid Mostafa Khomeini Hospital (Tehran-Iran) in May 2011 because of lower extremities edema and ascites and fever from 1.5 month ago. In physical examinations she had generalized lymphadenopathy, splenomegaly and pleural effusion. In laboratory tests she had pancytopenia, positive ANA and Anti DNA (ds), hypocomplementemia, hypertriglyceridemia and high ferritin level. Gradually she had signs of RPGN and ARDS. The patient had no skin and musculoskeletal signs of SLE and no liver failure nor coagulopathy of MAS. Her lymph node biopsy was reported as Castleman syndrome. Unlike other studies, the patient showed MAS before treatment with cytotoxic for lupus nephritis.

Rhinogenic origin is an important source for headache, which may be treated by medical or endoscopic intervention. An aim of this study was to clarify whether the surgical or medical intervention is superior. In this randomized double blind clinical trial study, 44 patients (19 male and 25 female) with periorbital or frontal pain were enrolled. Patients were divided into 2 groups of surgical or medical intervention randomly. Medical group received 3 courses of 1.5 months 125 μg per puff, fluticason nasal spray (2 puffs Q 24 hours in each side), and oral Pseudoephedrin 30 mg Q 8 hours with 2 weeks intervals. Surgical group underwent turbinoplasty with functional endoscopic sinus surgery approach. Duration (per hour), frequency (per week) and severities of the headaches were measured by Visual Analog Scale (VAS) before treatment, and at 1.5, 3 and 6 months after institution of treatment by an examiner, who was unaware of the patients’ treatment plan. Before treatment, chronicity (P = 0.980), severity (P = 0.742), frequency (P = 0.730), and duration (P = 0.603) of the headaches were not significantly different. The severities of the headaches in surgical group were significantly lower at 1.5, 3 and 6 months (P < 0.001), also the frequencies and the durations of the headaches were significantly lower at 6 months after an institution of treatment compared to medical group (P = 0.027, P = 0.008, respectively). Turbinoplasty in chonca bullusa patients is an acceptable and a simple procedure for relieving pain in rhinogenic headaches, compared with medical treatment.

The most common complication of lumbar puncture (LP) occurring in over thirty percent of patients is headache. The position after lumbar puncture, needle type and size, and volume of the extracted cerebrospinal fluid (CSF) have been evaluated as contributory factors in occurrence of post lumbar puncture headache (PLPH), but the position before lumbar puncture has not been evaluated. The occurrence of post lumbar puncture headache was evaluated in 125 patients undergoing lumbar puncture, divided randomly into sitting and lateral decubitus groups in the following five days. Chi-square test was used for statistical analysis. Thirty eight patients (30.4%) reported headache after lumbar puncture in the two groups, and post lumbar puncture headache was significantly lower in the lateral decubitus position (p = 0.001). There was no significant difference between genders in the post lumbar puncture headache occurrence (p = 0.767). Lumbar puncture in sitting position could produce more post lumbar puncture headache in comparison with lateral decubitus position.