First Report on Sergentomyia sintoni and Sergentomyia clydei (Diptera: Psychodidae): Their Natural Promastigote Infection and Some Aspects of Biology in Sistan-Baluchistan Province,Southeastern Iran

ObjectiveTo This paper has explained initial survey on two vectors of lizard leishmania promastigote in south-east of Iran.MethodsTotally 333 S. sintoni and 475 S. clydei were collected from rodent burrows by sticky traps in three villages of Chabahar County. Sand flies were dissected in a drop of normal saline.ResultsNatural leptomonad infection rate involved %2.1 S. sintoni and %5 S. clydei. The finding about seasonal variation was showed the highest infection rate in two vectors in the first week of August. The highest population of gravid and semi-gravid of main vectors of Lizard leishmaniasis, S. sintoni and S. clydei, were observed in the last week of September and the lowest were in the last week of July. The examination of accessory glands showed that the maximum population of parous was observed in the last week of September and the last week of July it was at least. This is the first report of leptomonad (promastigote) infection in S. sintoni and S. clydei in Sistan-Baluchistan Province, southeastern Iran.ConclusionsA further study with more focus on biology of Sergentomyia genus is suggested.     

Hydrophilic polymer vasculopathy with coinciding pseudoxanthoma elasticum‐like changes in an amputated toe

For the past decades, hydrophilic polymer gel coating have been widely used on endovascular devices to decrease friction and to aid with binding and delivering of medications in drug‐eluting stents. In the recent years, hydrophilic polymer emboli disease has been recognized as an iatrogenic adverse effect which has led to considerable morbidity and mortality of patients. This under‐recognized embolic phenomenon now has reproducible pathognomonic histologic findings. Small‐ to medium‐sized blood vessels are occluded with basophilic, amorphous, non‐refractile, non‐polarizable and whirled aggregates of foreign body material. Depending on the affected organ, the patients have variable symptomatology, from livedo racemosa, gangrene of extremities to cardiac arrhythmias, hemiparesis, stroke and death. Here, we present a unique case of hydrophilic polymer vasculopathy 6 years post‐endovascular procedure with coinciding pseudoxanthoma elasticum‐like changes. As the literature has seen increased reporting of individual cases and case series documenting the patients’ diverse symptomatology; hydrophilic polymer vasculopathy should be entertained sooner in the patient's differential diagnosis.     

Effects of voice therapy as objectively evaluated by digitized laryngeal stroboscopic imaging

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.     

Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS,a randomized double-blinded clinical trial

Objective

Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART.

An open trial of citalopram in children and adolescents with depression

OBJECTIVE: The aim of this study was to collect pilot data on the magnitude of effect and tolerability of citalopram in early-onset major depressive disorder (MDD). METHOD: This study was performed in two academic child and adolescent psychiatric clinics (2000 through 2002). Thirty children and adolescents, 8-17 years of age (mean age, 13.57 +/- 2.5), of both sexes (53.3% girls; 46.7% boys) and diagnosed with MDD by means of clinical psychiatric evaluation, Diagnostic Interview for Children and Adolescents (DICA) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria, were studied in an open-label clinical trial with 10-40 mg/day of citalopram for 6 weeks. The outcome measures were the Hamilton Depression Rating Scale (HDRS), the Children Global Assessment Scale (CGAS), and the New York State Psychiatric Institute side-effect form. RESULTS: Moderate (50%-70% change in HDRS and CGAS) to large (> 70% change in HDRS and CGAS) effect were seen in 91.7% of children (22/24). There were significant changes on HDRS (X = 22.78; t = -14.12; p < 0.000) and CGAS (X = 26.02; t = 9.68; p < 0.000) between baseline and the 6th week. Mild side effects were reported in 2 patients (8.3%). Adverse effects that contributed to discontinuation were nausea and vomiting in 3.3% (n = 1) of patients and unexpectedly switching to mania in 16.7% (n = 5) of patients. CONCLUSION: Citalopram may be an efficatious treatment in early-onset MDD. However, the high switch rate to mania warrants further investigations, as well as cautions, in using it.     

Integrating clinical practice guidelines into daily practice: impact of an interactive workshop on drafting of a written action plan for asthma patients

INTRODUCTION: Written action plans (WAPs) are instructions that enable asthmatics to manage their condition appropriately and are recommended by current asthma clinical practice guidelines (CPGs). However, general practitioners (GPs) rarely draft WAPs for their patients. An interactive, case-based workshop for asthma, combined with an objective structured clinical examination (OSCE), was developed to increase GPs' knowledge and use of WAPs in Québec. METHODS: The study compared 24 GPs receiving an OSCE preworkshop and 12 months post-workshop (group 1) with 16 GPs receiving an OSCE preworkshop and at 6 and 12 months post-workshop (group 2). Participants received no feedback on their OSCE performance. During the workshop, which presented a preformatted tool to aid drafting of the WAPs, all 40 GPs worked individually and in small groups to answer questions on a hypothetical clinical case and then discussed the responses with a facilitator and an asthma specialist. RESULTS: Only group 2 GPs showed a significant improvement in knowledge of WAPs 12 months post-workshop (p = .01). The likelihood of prescribing WAPs to patients increased in group 2 to a degree approaching statistical significance (p = .070), and there was a borderline nonsignificant trend for prescribing practice to improve more among group 2 GPs than among group 1 GPs (p = .052). There was also a nonsignificant trend for 6-month OSCE to increase attendance at the 12-month OSCE. DISCUSSION: An interactive workshop employing a preformatted WAP tool and a reinforcing OSCE at 6 months yielded improved knowledge of WAPs at 1 year. Although originally developed as a form of evaluation, the OSCE appears to have formative value even when correction is not provided and may increase the effectiveness of continuing medical education interventions to enhance CPG implementation.     

The stress of birth enhances in vitro spontaneous and IL-8-induced neutrophil chemotaxis in the human newborn

The birth process induces fetal stress. Stress has profound effects on the immune system, also by acting on the trafficking of leukocytes, a process in which adhesion and chemotaxis are primordial and critical events for the development of effective antimicrobial defenses. The newborn is rapidly challenged by a microflora at the epithelia linings and therefore depending on early, innate immunity onset. The objective of the study was to investigate the immune response in cord blood from newborns in relation to different degrees of fetal stress, with focus on neutrophil chemotaxis. We analyzed in vitro transmigration ability of neutrophils and their CD11b expression, measured total white blood count (WBC) and the major leukocyte populations, interleukin (IL)-8, interferon (IFN)-gamma, and soluble E-Selectin, as well as relevant immuno-modulating hormones in infants born at term after Cesarean section prior to the start of labor (n = 55), normal vaginal delivery (n = 87), and assisted delivery (n = 26). Arterial pH and lactate were used as stress markers. We found that spontaneous and IL-8-induced transmigration ability of neutrophils from newborns after normal delivery was significantly higher compared with that of neutrophils from Cesarean section or from adults. With a progressive increase in fetal stress, there were significant elevations in total WBC, in particular neutrophils and monocytes, as well as an enhanced IL-8 and soluble E-Selectin level. Assisted delivery, associated with the highest degree of fetal stress in addition had an enhanced lymphocyte and monocytes count as well as an increased IFN-gamma level. There were significant direct correlations between neutrophils and monocytes, respectively, with cortisol, beta-endorphin, and prolactin. Interferon-gamma was directly related to dopamine, as well as to the lymphocyte and monocyte count. The setting of the HPA-axis at birth is a promoter of an alarm response and a surge of neuroendocrine immuno-modulating factors that enhances antimicrobial defenses of the newborn. We speculate that IL-8 induced by normal labor may be a priming factor for an increased neutrophil chemotaxis through the pre-activated endothelium of the fetus. Assisted delivery may trigger excessive recruitment of additional inflammatory cells and IFN-gamma release.     

The involvement of KATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain in rats

This study investigated the role of K_ATP channels in morphine‐induced antinociception and hepatic oxidative stress in acute and inflammatory pain. The K_ATP channel modulators (K_ATP channel opener, diazoxide 100 mg/kg, p.o, and K_ATP channel blocker, glibenclamide, 3 mg/kg i.p.) were administered with morphine (80 mg/kg, i.p.). Antinociception was assessed by the tail‐flick and formalin tests in rats and measured by the area under the curve values and the maximum percent effect for 3 h. The indices of hepatic oxidative stress: glutathione, glutathione peroxidase, and malondialdehyde were then determined in the liver homogenates obtained from the treated animals. In both tests, glibenclamide antagonized morphine‐induced antinociception, whereas diazoxide augmented it in the tail‐flick test only. In the formalin test, glibenclamide alone has a significant hyperalgesic effect, whereas diazoxide decreased the number of flinches. Coadministration of glibenclamide with morphine antagonized the hepatotoxic effect of morphine in both animal models. In the tail‐flick test, glibenclamide administered alone significantly increased malondialdehyde's level. Coadministration of diazoxide with morphine increased glutathione level in the formalin test. Diazoxide administered alone exacerbated the hepatic oxidative stress in both animal models. These findings suggest a role of K_ATP channel modulators on morphine‐induced antinociception and hepatic oxidative stress. The administration of glibenclamide may prevent morphine‐induced hepatotoxicity. The effectiveness of diazoxide in the management of pain is limited due to its deleterious effect on the liver. However, the interaction of the K_ATP channel modulators with morphine depends on the differential sensitivity to the pain stimulus.