Overuse of psychotropic medications among children and adolescents with autism spectrum disorders: perspective from a developing country

Psychopharmacotherapy can be an effective part of the treatment for individuals with autism spectrum disorders (ASDs). However debate continues over the potential benefits and costs of these treatments; additionally little is known about the pattern of psychotropic medication use in developing countries. We aimed to survey the use of psychotropic medication, their subcategories and its associations among a representative local sample of 345 Iranian pupils with ASDs. All required information about demographics as well as clinical and medication history of children was collected through interviews with the families. Overall, 80% of participants were currently using at least one psychotropic medication while, and up to 97% of the sample had at least one psychotropic medication claim during the last year. Antipsychotics were the most frequent medications (57.4%) while antidepressants were used by only a small proportion of participants (8.7%). Further analysis revealed no significant association between any psychotropic medication use on one hand and clinical and demographic characteristics on the other hand. Time differences, cross cultural variations, and also cost and availability of treatment options in developing countries are discussed as possible explanations for different patterns and more than expected rate of psychotropic medication use in pupils with ASD.     

The Role of IL-6 for Predicting Neonatal Sepsis: A Systematic Review and Meta-Analysis

Objective

Neonatal sepsis (NS) is a common and life-threatening disorder in infants. Previous studies showed that interleukin-6 (IL-6) may be a valid non-invasive and rapid method for diagnosis of NS. We conducted this review to assess the validity of IL-6 for predicting NS.

Methods

This was a systematic review with meta-analysis. Embase, Medline and Web of Science databases were searched between January 1990 and December 2009. The search terms used were “cytokine”, “neonate”, “sepsis” and “interleukin-6". We used standard methods recommended for meta analyses of diagnostic test evaluations. The analysis was based on a summary ROC (SROC) curve. Meta-regression analysis was used to assess the effects of some confounding factors on the results of meta-analysis. Potential presence of publication bias was tested using funnel plots and the Egger test.

Findings

Meta-analysis was performed on 13 publications including 353 infants with sepsis and 691 control infants. The pooled sensitivity and specificity of IL-6 was 0.79 and 0.84, respectively. The maximum joint sensitivity and specificity (i.e., the Q value) in SROC curve was 0.82 and the area under curve (AUC) was 0.89 (95% CI: 0.84-0.94). Meta-regression analysis showed that the diagnostic accuracy of IL-6 was not affected by confounding variables. The evaluation of publication bias showed that the Egger test was not significant (P=0.07).

Conclusion

IL-6 seems to be a valid marker for predicting NS. It may be considered for early diagnosis of sepsis in neonatal care units.     

Investigation of Autism Comorbidities and Associations in a School‐Based Community Sample

PROBLEM: Individuals with autism spectrum disorders (ASDs) have at least as many comorbidities as individuals with typical development may show, but sometimes with different presentations. METHODS: The study used a school‐based health survey related to children diagnosed with ASD in Tehran to determine the possibility of comorbid conditions. Ninety‐one children and adolescents with ASD between the ages of 6 and 14 years were included in the study, all from five schools of different districts of the city, using stratified random sampling. All of the subjects had received a clinical diagnosis of ASD (autism, Asperger, and pervasive developmental disorder‐not otherwise specified) by a child neurologist or psychiatrist. All of the schools had registered the subjects and were restricted to those with high‐functioning forms of ASD, and none were identified with co‐occurring mental retardation. FINDINGS: Results indicated that 72.5% had at least one comorbid condition. There was a trend of higher severity in autism symptoms in subjects with comorbidity. Results showed that attention‐deficit/hyperactivity disorder and epileptic disorders were the leading comorbidity in respective categories. CONCLUSION: Autistic individuals should be monitored regarding their comorbid profiles, with an emphasis on female subjects and those with more severe symptoms. Clinically, the current study has implications for school healthcare providers, including nurses, in addition to researchers and practitioners working with children diagnosed with ASDs.     

Cross-Cultural Adaptation,Reliability, and Validity of The Autism Treatment Evaluation Checklist in Persian

Objective

The objectives of the current study were to translate and adapt Autism Treatment Evaluation Checklist (ATEC) into Persian language and to investigate its reliability and validity in an Iranian autistic sample.

Methods

A total sample of 134 children with autism spectrum disorders aged 6-15 years were assigned to the study. The process of cross-cultural adaptation was performed according to international methodological steps as following: translation, back-translation, revision by an expert committee and pretest. A sample of 20 primary caregivers of autistic children were pretested. The content validity of the ATEC was reviewed by the expert committee all through the stages. The construct quality of the questionnaire was evaluated by comparison of the adapted version of the instrument with similar tests assessed similar factors. Moreover, the reliability of the questionnaire was evaluated through stability and homogeneity assessments.

Findings

The results showed good content validity and internal consistency (Cronbach''s alpha: 0.86-0.93). In relation to construct validity, there was significant correlation between ATEC subscales and raw data obtained from Autism Diagnostic Interview-Revised (ADI-R) (r=0.38-0.79). The Intraclass Correlation Coefficient for the test–retest reliability was excellent for all the subscales and also for total scores (ICC: 0.79 - 0.93).

Conclusion

Cross-cultural adaptation of ATEC was successful. The psychometric properties were verified and indicated that the adapted questionnaire is valid and reliable to use in Iranian culture.     

Birth prevalence of oral clefting in northern Iran.

OBJECTIVE: To explore the prevalence of oral clefting in northern Iran. SETTING: In the Dezyani hospital 37,951 live births from 1998 through 2003 were screened for oral clefts. Clinical and demographic factors of diagnosed cases, including birth date, ethnicity, type of oral cleft, parental consanguinity, and coexisting anomalies, were recorded for analysis. RESULTS: The overall prevalence of oral clefting was 0.97 per 1000 live births. The prevalence of cleft lip with or without cleft palate and isolated cleft palate was 0.60 and 0.37 per 1000, respectively. The prevalence of oral clefting was 1.08 per 1000 male births and 0.86 per 1000 female births. With respect to parental ethnicity, the prevalence of oral clefting was 0.86, 0.88, and 1.47 per 1000 in Fars, Turkman, and Sistani, respectively. CONCLUSIONS: The prevalence of oral cleft among live births in the Dezyani hospital is similar to that reported in the previous studies for Iran and whites.     

Experimental wound healing using microamperage electrical stimulation in rabbits

We investigated the effects of microamperage electrical stimulation (MES) on the healing of skin incision in rabbits. Thirty male adult rabbits were randomly divided into sham-treated and experimental groups. Each group was divided into three subgroups, based on the duration of experiment (4, 7, and 15 days). A full-thickness incision was made on the skin of each rabbit. The experimental group received an MES of 200 microamperes current intensity for 2 h/day. Morphometrical and biomechanical evaluations were carried out. The mean number of fibroblasts at day 7 and the mean of tensile strength at day 15 were found to be significantly higher for the experimental group than for those in the sham-treated group (p < 0.01 and p < 0.05, respectively). Daily application of MES significantly accelerated the wound-healing process of full-thickness incision in the rabbits' skin.     

Prevalence and Pattern of Congenital Heart Disease among Neonates in Gorgan,Northern Iran (2007-2008)

Objective

Congenital heart disease (CHD) is the most common congenital anomaly in newborns. The aim of this longitudinal, hospital-based study was to evaluate the prevalence and pattern of CHD among Iranian newborns in Gorgan, Northern Iran.

Methods

11739 live births in Dezyani hospital in Gorgan were screened for CHD, 2007 through 2008. Clinical examination, echocardiography, color Doppler and cardio catheterization were used as diagnostic tools. Clinical and demographic factors, namely sex, type of CHD and associated anomalies of diagnosed cases were recorded in a pre-designed questionnaire for analysis.

Findings

The overall prevalence rate of CHD was 8.6 per 1000 live births. This was 9.96 per 1000 male births and 7.34 per 1000 female births. It was 4.5 and 13.19 per 1000 in 2007 and 2008, respectively. ASD was the commonest lesion (2.64 per 1000), followed by VSD+ASD (1.28 per 1000) and PDA (1.28 per 1000). The rate of ASD in male and female was 3.02 and 2.26 per 1000 respectively. Parents of 40 (39.6%) babies were related. 39 (38.6%) couples were first cousins.

Conclusion

This study showed that the prevalence of CHD among live births in Gorgan is lower than reported in the studies for Middle East and European countries.     

Chronic fatigue syndrome and cognitive deficit are associated with acute-phase neuropsychiatric manifestations of COVID-19: A 9-month follow-up study

Neurological Sciences - The preva lence of long-COVID symptoms is rising but it is not still possible to predict which patients will present them, and which types of symptoms they will present. We...