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Background: COVID-19 is the cause of the recent pandemic. Viral infections could increase the risks of neurological impairments, including seizures. Here, we aimed to evaluate the prevalence, clinical, imaging, electroencephalography and laboratory characteristics of seizures in COVID-19., Methods: This retrospective cross-sectional study was performed on cases of COVID-19 infection and seizure. The prevalence of seizures in patients with COVID-19 was calculated using the incidence of seizures in all patients. The collected data were age, sex, history of previous illnesses, the severity of COVID-19 disease, patients' medications, hospitalization, and the presence of electrolyte disorders in patients' tests and other tests such as blood gas. Those patients with their first seizure episodes were also divided into two groups of cases with COVID-19 associated seizures (N=38) and non-COVID-19 associated seizures (N=37) and the mentioned data were compared between the two groups., Results: We assessed data of 60 patients with COVID-19-associated seizures (group 1), 40 patients with seizures not related to COVID-19 (group 2) and 60 patients with COVID-19 infection and no seizures (group 3). The prevalence of hypertension and diabetes mellitus were significantly higher in group 3 compared to group 1 (P=0.044 and P=0.009, respectively). Still, patients in group 1 had a higher prevalence of cerebrovascular accidents (CVA) compared to group 3 (P=0.008). The prevalence of abnormal EEG was significantly higher in cases with COVID-19 infection compared to the other group (P<0.001). Cases with their first seizure episode associated with COVID-19 had significantly higher creatinine levels (P=0.035), lower blood pH (P=0.023), lower blood HCO3 (P=0.001), higher ALT (P=0.004), higher blood urea nitrogen (BUN) (P=0.001), lower hemoglobin (Hb) (P=0.017), higher ESR (P=0.001), higher CRP (P<0.001) and higher mortality rates (P=0.004)., Conclusion: Patients with COVID-19 infection and seizure have higher mortality rates and disturbed laboratory data., Competing Interests: None., (AJND Copyright © 2022.)

Complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. Various mechanisms have been proposed to justify the cause of seizures in Covid-19 patients. To our knowledge, 13 cases of status epilepticus (SE) associated with COVID-19 have been reported so far. Here, we present a single-center case series, including the clinical, laboratory, and imaging characteristics, and the EEG and the outcome of SE in 5 Iranian patients with laboratory-confirmed SARS-CoV-2 virus. SE was para-infectious in four patients and post-infectious in one other patient. In Three patients, the causes of seizure were included severe hyponatremia, acute ischemic stroke, and meningoencephalitis. However, in two other patients, no specific reason for seizure was found, but there are possibilities for lesser-known mechanisms of Covid-19 that play roles in developing SE. Two of the patients recovered, and three patients, older and with higher comorbidities, failed to recover and died., Competing Interests: None., (AJND Copyright © 2022.)

Background: Some studies demonstrated the effect of the combination of modalities in Peyronie's disease (PD) therapy; however, there is no comprehensive study for evaluation of dexamethasone and phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil in the treatment of PD, so the study aimed to evaluate the efficacy of intraplaque injection of dexamethasone with oral tadalafil in the patients with PD., Materials and Methods: This double-blinded randomized, controlled trial was conducted on the patients with PD referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Then the patients were randomly divided into two groups as intervention and control groups. In the intervention group, tadalafil (5 mg PO) was administered once daily for 12 weeks and dexamethasone (8 mg) was injected once a week for 12 weeks. In the control group, the verapamil (5 mg: 2 cc) was injected once a week for 12 weeks. Before and after 12 weeks, an ultrasound was performed to assess the size, number and location of the plaque. The degree of penile curvature from the midline, dorsal and lateral curvature was also determined., Results: The means of penis curvature in the intervention and control groups before therapy were 34.09±7.05˚ and 31.09±7.06˚, respectively ( P =0.097) and also after therapy were 27.3±7.79˚ and 24.6±6.64˚, respectively (P=0.13). The means of plaque count in the intervention and control groups before treatment were 2.0±1.03 and 1.96±1.06, respectively (P=0.9) and after treatment were 1.22±0.71 and 1.40±0.79, respectively (P=0.34). The means of plaque size in the intervention and control groups were 12.31±4.9 cm and 12.45±4.12 cm, respectively (P=0.9) and after intervention 7.8±3.08 and 9.03±3.46 cm, respectively (P=0.15)., Conclusion: According to these findings, there was no significant difference between intervention and control groups regarding the degree of penis curvature, and the count and size of the plaque. Therefore, it seems that tadalafil therapy with dexamethasone did not improve PD compared to verapamil., Competing Interests: None., (AJCEU Copyright © 2022.)

Purpose: The aim of current study was to evaluate glomerular filtration rate (GFR) decline in patients with renal colic., Materials and Methods: This descriptive analytical study was conducted on patients with definitive diagnosis of renal colic in Alzahra hospital. Data including gender, age, and underlying disease were extracted from medical records. GFR and creatinine level were assessed before and 3 months after stone excretion. Hydronephrosis severity was assessed by ultrasound procedure., Results: In current study, 224 patients with renal colic and mean age 45.6±11.35 years old were selected. The mean GFR before and 3 months after urinary stone excretion were 45.89±18.84 and 61.13±22.10 ml/minute, respectively ( P <0.01). The mean creatinine at the beginning and 3 months after urinary stone excretion was 1.93±0.46 and 1.59±0.43 mg/dl, respectively ( P <0.01). The most frequency of patients with different hydronephrosis degrees was related to score 3 (n=92). There was significant difference between hydronephrosis severity in terms of GFR (P=0.000). No significant difference was seen between the mean GFR at the beginning of the study and at 3 months after urinary stone excretion in terms of diabetes and hypertension (P>0.05)., Conclusion: We observed significant difference between hydronephrosis severity in terms of GFR. This indicated that the increase of hydronephrosis degree was associated with worse renal function. Moreover, urinary stone excretion led to the increase of GFR and the decrease of creatinine level. In addition, the mean GFR was not influenced by diabetes and hypertension., Competing Interests: None., (AJCEU Copyright © 2022.)

Background: Various articles show the high prevalence of sleep disorders and especially excessive daytime sleepiness (EDS) in patients with refractory epilepsy and the importance of personal and social burden of this complication on individuals. Considering the insufficient evidence to draw efficacy and safety of modafinil and methylphenidate to treat EDS in the patient with intractable seizures, we decided to compare the effect of methylphenidate and modafinil with the control group. It is hoped that this study will pave the way for further studies., Methods: This study is a clinical trial (IRCT20171030037093N22) (URL: https://www.irct.ir/trial/42485). The study population was patients with refractory epilepsy referred to the neurology clinic of Al-Zahra Hospital, Isfahan, Iran, from 2019 to 2020. The patients were randomly divided into three groups. The first group was treated with methylphenidate, the second group was treated with modafinil, and the third group was not received any medication such as modafinil and methylphenidate. Methylphenidate dosage was 10-20 mg/day. The patients were treated with modafinil at a dose of 200-600 mg/day. EPWORTH sleepiness scale (ESS) and Total Sleep Time (TST) were calculated before and 8 weeks after the intervention for the patients., Results: 47 patients were included and divided into 3 groups, methylphenidate (10 males and 9 females), modafinil (7 males and 13 females), and control (4 males and 4 females). There was no significant difference among the groups based on ESS before and after intervention and TST after the intervention (P>0.05), but the mean of TST was significantly lower in the control group than in methylphenidate and modafinil groups before the intervention (P=0.003). The change of ESS and TST before compared to after intervention in the methylphenidate and modafinil group were significant (P<0.001), but the changes of ESS and TST in the control group were not significant (P>0.05). The frequency of complications (P=0.74) and outcomes (P=0.07) were similar in both groups., Conclusion: Modafinil and methylphenidate are two effective and safe drugs to increase the quality of sleep in the patients. Additionally, ESS and TST scores are better in the patients who used modafinil and methylphenidate., Competing Interests: None., (AJND Copyright © 2021.)

Background: Considering that patients with opioid dependence are at higher risk of inadequate sedation during operations, and the rescue analgesia in these patients are usually greater than the general population; the aim of this study was comparison of sedation quality of dexmedetomidine and morphine in patients with opioid use disorder undergoing cataract surgery., Methods: This clinical trial was conducted on 60 patients with opioid use disorder underwent cataract surgery that were referred to Feiz Hospital, Isfahan, Iran in 2018. Patients were randomly divided into two groups as the dexmedetomidine group started 1 μg/kg dexmedetomidine in 10 minutes before surgery and then continued with 0.5 μg/kg/h while the morphine group received 0.1 mg/kg of morphine before surgery. Sedation score, pain intensity, hemodynamic parameters, analgesic request and side effects were compared in the two groups., Results: There was no significant differences between groups based on Ramsay score before, during and after surgery (P > 0.05), the pain intensity in the morphine group was significantly lower during the recovery period than dexmedetomidine group, the duration of recovery and sedation in the morphine group was significantly more than the dexmedetomidine group, and nausea and vomiting and eye pain in the morphine group were significantly higher than dexmedetomidine (P < 0.05)., Conclusion: Morphine usage was more effective in pain relief than dexmedetomidine in patients with opioid use disorder undergoing cataract surgery, but the complications and recovery time were higher in morphine usage. Also the sedation was similar in both groups., Competing Interests: None., (AJCEI Copyright © 2021.)

Background: The Percutaneous laser disc decompression (PLDD) method was first described by Daniel Choy in Australia in 1987. Therefore, in this study, we examined the clinical signs and symptoms of patients with spinal canal stenosis due to disc protrusion after PLDD surgery., Methods: In this clinical trial study, 43 patients with spinal canal stenosis due to lumbar disks who referred to Kashani and Zahra Marzieh educational hospitals from 2006 to 2016 were entered the study. The patients were divided into two groups as discogenic canal stenosis (3 females and 9 males) and complex degenerative disorder (canal stenosis due to discogenic and ligamentos) (16 females and 15 males). Patients underwent PLDD surgery and the clinical manifestations such as back and radicular pain, claudication, and complications of the surgery (hematoma, reoperation, and neurological symptoms) in patients were evaluated until one year after the operation., Results: After one year of surgery, the mean of back and radicular pains significantly decreased in both groups (P<0.05). All patients with claudication in the discogenic group improved and 35.5% of patients with complex degenerative disorder were not claudication after one year of surgery. The outcomes of treatment in patients with discogenic canal stenosis were 91.7% excellent, and 8.3% fair and in the complex degenerative disorder group were 64.5% excellent, 19.4% good and 16.1% fair (P=0.16). None of the patients had new neurological symptoms, and 12.9% of the complex degenerative disorder group patients needed reoperation., Conclusion: The PLDD method is a better procedure for discogenic canal stenosis than complex degenerative disorder. Therefore, more studies are required in this field for long time., Competing Interests: None., (AJND Copyright © 2020.)

Background: Carbamazepine is a first line treatment for focal epilepsy. Tegretol and Tegatard are two trade name of Carbamazepine. Tegretol is produced by Novartis Pharmaceutical Company, Switzerland. Recently, Raha pharmaceutical Company in Iran has produced CBZ which trade named is Tegatard. Extended usage of Tegatard instead of Tegretol has economic benefits for Iranian families. In this clinical trial, we aimed to compare therapeutic efficacy and safety of Tegretol and Tegatard in patients suffering from focal seizures with or without secondary generalization., Methods: 200 patients with provoked or non-provoked focal seizure with or without secondary generalization were screened and 180 patients were fulfilled the criteria to enter this double blinded clinical trial study. Patients were divided into two groups, the first group (A) received Tegretol and the second group (B) Tegatard. Carbamazepine (CBZ) was prescribed with doses 10-20 mg/kg every 12 hours by neurologists. The patients were visited after 1, 3 and 6 months and the side effects and lab data in patients were investigated., Results: Patients were divided into two groups, 88 patients in group A (Tegretol) (50 males and 38 females) and 92 in group B (Tegatard) (51 males and 41 females). Mean age of patients was 35.39±11.17 years. There was no significant difference according to age and gender, Carbamazepine dosage, EEG recording, neuroimaging change and adverse effects of antiepileptic drug between two groups (P>0.05). Regarding the drug efficacy, in group A and B, 60 (68%) and 58 (63%) patients were seizure free after 6 month follow up; respectively. The differences between two groups were not statistically significant ( P value =0.46)., Conclusion: Tegatard is an effective drug with similar efficacy, similar side effects and cost-effectiveness compared with Tegretol and could be used widely when indicated., Competing Interests: None., (AJCEI Copyright © 2020.)

Introduction: Current methods for Urethral dilatation include filiforms and followers, metal sounds, balloon dilators, catheters of increasing size, introduction of a Council catheter over a guidewire, and coaxial dilators of increasing size. These methods however are effective but expensive and use of them is limited in many third world countries. In this retrospective study, we report the feasibility, complication and long-term follow-up of the newly Nelaton based urethral dilation method following by self calibration plan as a single referral center experience. Method: We reviewed the records of 333 men with urethral stricture longer than 1 cm over a 16-year period between March 2001 to December 2018. In this method the straight flexi-tip guide-wire is introduced through the urethra and advanced under cystoscopic vision. This wire then was used to guide the dilatation after withdrawal of the cystoscope. The tip of well-lubricated Nelaton urethral catheters incised and then advanced gently over the guide-wire serially from the smallest to the largest appropriate sizes. The patients were followed up regularly after the dilatation 1, 3, 6, 12 months and then annually postoperatively with taking history, PVR and uroflowmetry and all underwent retrograde urethrography at the 6 th and 12 th months of follow-up. Result: The mean age of patients was 39.19±16.9 years old (10 to 86 years). The mean period of the follow-up was 3.6±1.1 years (range, 3 to 4.3 years). Success rate after first attempted was 58.5% and after two attempted was 77.7% in two years follow up. After one year 51 (15.3%), two years 23 (6.9%) and after three years 11 (3.3%) cases required continued self dilatation once a month. Conclusion: Guide wire-assisted urethral dilatation is shown to be acceptable, cost-effective, simple, safe and feasible techniques for urethral dilation. Our technique may be the choice manner in selected patients with short memberanous urethral stricture, because of decrease the risk of incontinency., Competing Interests: None., (AJCEU Copyright © 2019.)