Biofeedback treatment of narcotic addiction: A double-blind study

This is a report on the double-blind study on EMG biofeedback for 37 narcotic addicts in an outpatient methadone clinic. Patients were randomly assigned to either the experimental group (N = 24) receiving a contingent EMG biofeedback or a control group (N = 13) receiving non-contingent preaped “pseudo-biofeedback”. All patients were stabilized on a study dose of methadone and the mean daily amount did not differ between groups. All were experiencing a significant degree of anxiety at the time of evaluation. The evaluation consisted of the patient's self-report, which comprised the Beck Depression Inventory, anxiety checklist, withdrawal sickness rating, drug references, and the psychiatrist's rating of depression, namely the Hamilton Depression Scale, Hamilton Anxiety Scale, and BPRS. In addition, an evaluation of progress was obtained from the patient and his counselor which included the current job or school status and brief ratings of drug use, psychiatric symptoms, social adjustment, and illegal activity. All patients had at least one urine sample analyzed weekly for illicit drug use. Evaluation was done at the beginning, and at the end of the treatment and at a follow-up one month later.Termination status was assessed only for subjects who completed the course of 15 biofeedback sessions (N = 19). Patients attended five sessions per week for thirty minutes just prior to receiving the methadone. Fifteen sessions were scheduled over a three-week period. The results indicated that the two study groups did not differ and there was a significant improvement (p < 0.05) on several variables for the total patient sample. All the psychiatric ratings of anxiety, depression, psychopathology were significantly reduced. In addition, self-rated craving for narcotics and self-rated anxiety were lower and there were fewer drug avoidance responses on the sentence completion test. But there were no meaningful differences in the two groups in improvement as reflected in the psychometric instruments.     

Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study

Purpose

Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome.

Methods

Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children’s Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann–Whitney U test, and logistic regression analysis.

Results

Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160–213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737–0.994; P = 0.041) had independent association with metabolic syndrome.

Conclusions

Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.

     

Natural History of Chronic Hepatitis B Virus Infection in Ahvaz City,Iran

Objective: A long persistent of Chronic Hepatitis B (CHB) infection may develop liver cirrhosis or hepatocellularcarcinoma (HCC) and about one million people die due to HBV -related liver cancer and end-stage liver disease annuallyworldwide. The natural history of CHB phases comprises four phases: immune tolerant (HBeAg detectable and ALT(Alanine Transaminase) normal, HBeAg-positive immune active (HBeAg detectable, anti-HBe antibodies undetectableand ALT persistently elevated), HBeAg-negative immune active (HBeAg undetectable, anti-HBe antibodies presentand ALT persistently elevated), inactive carrier (HBeAg undetectable, anti-HBe antibodies present and ALT normal).The evaluation of chronic hepatitis B phases is a crucial to manage the burden of disease and limit the developmentof associated complications, such as cirrhosis and hepatocellular carcinoma (HCC). Thus this study conducted toevaluate the natural history of HBV infection in patients with chronic HBV infection in Ahvaz city, Iran. Methods: Inthis study, 71 non-treated CHB individuals were recruited including 44 (62%) males and 27(38%) females. The serawere tested for HBV markers, HBsAg, HBcIgG, HBeAg, and HBeAb. ALT assay and HBV viral load were carried outfor each CHB individual. Results: Based on the analysis of serological, ALT status and viral load, the results showed:immune tolerance 5(7%), eAg+ Immune Clearance 14(19.7%), eAg- Immune Clearance 29 (40.84%) and InactiveCarrier 23 (32.39%). The HBeAg seroconversion was observed in a male age 18 year. Conclusion: The results ofthe natural history of individuals with chronic hepatitis B phases CHB shows immune tolerance (7%), eAg+ ImmuneClearance (19.7%), eAg- Immune Clearance (40.84%) and Inactive Carrier (32.39%). To prevent the consequence ofCHB infection, an individual in immune tolerance phase should be tested periodically for ALT level, HBV markers,HBsAg, HBcIgG, HBeAg, HBeAb and HBV viral load. Then decision-making therapy can be applied for CHB patientsat early stage of immune clearance.     

Analysis of IL-10 and IL-6 Gene Polymorphisms and Their Serum Levels in Patients with Brucellosis: A Case Control Study

Background: It seems that polymorphism in the regulatory areas of cytokine genes affects the cytokine production capacity and may play a role in the development of infectious diseases. Interleukin-10 (IL-10) and Interleukin-6 (IL-6), which are cytokines of Th₂, cause the macrophage become inactive and patient conditions get worse.

Methods: In this case‐control study, 60 patients with brucellosis and 60 healthy participants were recruited. IL-10 genotyping at positions -1082 (G/A), -819 (C/T), and -592 (C/A) and IL-6 genotyping at position -174 (G/C) were analyzed by amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) and restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) methods. The levels of IL-10 and IL-6 were determined by a sandwich enzyme-linked immunosorbent assay in sera of study population.

Results: The AA and CC genotypes of the IL-10 gene at positions -1082 G/A and -819 C/T were significantly more frequent in patients in comparison to controls, respectively. The AG genotype of the IL-10 gene at positions -1082 G/A was significantly more frequent in control groups than the patients. Serum levels of IL-10 and IL-6 were significantly more frequent in the patients than in the control groups.

Conclusions: Our study showed that the AA and CC genotypes at positions -1082 and -819 are very important, respectively. These results suggest that IL-10 (-1082 G/A) GG genotype may be considered as a risk factor for brucellosis, while the AG genotype might be a protective factor against the disease.     

Interleukin-10 gene polymorphisms and susceptibility to brucellosis in Iranian patients

Background: Interleukin-10 (IL-10) is a Th2-type cytokine that inhibits macrophage activation. It is known that production of IL-10 is affected by its gene promoter polymorphisms. Objective: To investigate the relationship between IL-10 gene promoter polymorphisms and susceptibility to brucellosis. Methods: One hundred and ninety patients with brucellosis and 81 healthy animal husbandmen who owned infected animals and consumed their contaminated dairy products were included in this study. All individuals were genotyped for three bi-allelic IL-10 gene promoter polymorphisms at positions -1082(G/A), -819(T/C), and -592(A/C) using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results: The distribution of C alleles at positions -592 and -819 of IL-10 were significantly higher in patients than in the healthy animal husbandmen (p=0.034 and p=0.0086, respectively). IL-10 ATA single and double haplotypes were significantly higher in controls, compared to the patients (p= 0.0278 and p=0.013, respectively). Conclusion: According to the results higher frequency of C alleles at positions -592 and -819 of IL-10 in patients may be considered as genetic factors for susceptibility to brucellosis.     

Monitoring human cytomegalovirus infection in pediatric hematopoietic stem cell transplant recipients: using an affordable in‐house qPCR assay for management of HCMV infection under limited resources

Quantitative real‐time PCR (qPCR) assay is accepted as the method of choice for monitoring human cytomegalovirus (HCMV) infection in hematopoietic stem cell transplant recipients, but the high cost of commercial kits has hampered its use in many developing countries. In this study, an affordable in‐house qPCR was used to manage HCMV infection in pediatric patients and the diagnostic value of this method was compared with the conventional pp65 antigenemia assay. A total number of 1179 samples from 82 recipients were used in this study, and the effect of some potential risk factors on HCMV reactivation was evaluated. The qPCR was able to detect HCMV reactivation earlier and with higher sensitivity than antigenemia assay. Forty‐six episodes of reactivation were detected in 39 patients, of which all were detected by the qPCR assay, while only 21 episodes were diagnosed by antigenemia. The DNAemia level of 1284 IU/ml plasma was defined as the optimal cutoff value for starting pre‐emptive therapy. It was shown that the acute GVHD severity and the relationship of donor and recipient are the most significant risk factors for HCMV reactivation. The data suggest that the antigenemia method for monitoring HCMV reactivation could be substituted by the qPCR assay.