Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: the first report from Iran

BACKGROUND: Few data exist about the clinical epidemiology of acute myocardial infarction and its complications and mortality in Iran. To fill this knowledge gap, we studied clinical characteristics and the outcome for a group of Iranian patients with acute myocardial infarction, who were, for the first time in our country, followed after discharge from hospital for 1 year. METHODS: All patients (139 individuals) with confirmed acute myocardial infarction who were treated at the coronary care unit of Dr Shariati Hospital and followed up over a 1-year period (June 2002 to June 2003) were prospectively studied. Numerous relevant variables including epidemiologic data, treatments received, in-hospital course and complications were recorded. The survivors were followed at 1, 6 and 12 months after discharge. RESULTS: In all, there were 101 men and 38 women aged 58.6+/-11.8 years. Only 35.9% of patients received thrombolytic therapy, and primary percutaneous coronary intervention was performed in 6.4% of cases. In-hospital death occurred in 21 of 139 (15.1%), with an equal distribution between the two sexes. One-month, 6-month and 12-month cumulative mortality rates were 17.3, 20.1 and 21.6%, respectively. CONCLUSION: Although our patients were younger than myocardial infarction patients in developed countries, they had a higher rate of in-hospital mortality than those of the international statistics. This may be due, in part, to the lower rate of administration of primary reperfusion strategies in our center, namely primary percutaneous coronary intervention and thrombolytic therapy, which have proved to be effective in reducing the mortality from myocardial infarction in the west. Wider application of primary percutaneous coronary intervention, in particular, is recommended.     

Sterol compositions and susceptibilities to amphotericin B of environmental Cryptococcus neoformans isolates are changed by murine passage.

Previous studies have shown that sequential isolates from patients with persistent Cryptococcus neoformans meningoencephalitis can vary in sterol composition and susceptibility to antifungal drugs. To investigate the potential of host factors as mediators of this phenomenon, we compared fungal susceptibilities of environmental and clinical isolates from a limited geographic area. Clinical isolates were less susceptible to amphotericin B than environmental isolates. Five environmental isolates were passaged through BALB/c murine hosts; the passaged isolates had changes in sterol composition and reduced amphotericin B susceptibilities relative to those of the parent isolates. In contrast, murine passage of these isolates did not alter their susceptibilities to fluconazole. The results confirm that changes in sterol composition and antifungal susceptibility can occur in vivo as a result of host factors and suggest that human infection can result in selection of variants with reduced susceptibilities to amphotericin B.     

Identification of peptides specific for antibodies in vitiligo using a phage library

Patients with vitiligo produce specific autoantibodies that can be detected in their sera. These antibodies are believed to play a role in the pathogenesis of this disease. A random peptide library displayed on phage is a technique that can be used to identify the epitopes that react with monoclonal and polyclonal antibodies. We used this technique to identify the epitopes that react specifically with the vitiligo autoantibodies. By screening the random peptide phage library and using ELISA, two clones that showed a higher frequency of reactivity with the antibodies in the sera of patients with vitiligo were identified. The peptides do not show any similarity with the autoantigens so far implicated in vitiligo, indicating that these epitopes may mimic conformational epitopes in proteins.     

Deletion of phospholipase C β4 in thalamocortical relay nucleus leads to absence seizures

Absence seizures are characterized by cortical spike-wave discharges (SWDs) on electroencephalography, often accompanied by a shift in the firing pattern of thalamocortical (TC) neurons from tonic to burst firing driven by T-type Ca²⁺ currents. We recently demonstrated that the phospholipase C β4 (PLCβ4) pathway tunes the firing mode of TC neurons via the simultaneous regulation of T- and L-type Ca²⁺ currents, which prompted us to investigate the contribution of TC firing modes to absence seizures. PLCβ4-deficient TC neurons were readily shifted to the oscillatory burst firing mode after a slight hyperpolarization of membrane potential. TC-limited knockdown as well as whole-animal knockout of PLCβ4 induced spontaneous SWDs with simultaneous behavioral arrests and increased the susceptibility to drug-induced SWDs, indicating that the deletion of thalamic PLCβ4 leads to the genesis of absence seizures. The SWDs were effectively suppressed by thalamic infusion of a T-type, but not an L-type, Ca²⁺ channel blocker. These results reveal a primary role of TC neurons in the genesis of absence seizures and provide strong evidence that an alteration of the firing property of TC neurons is sufficient to generate absence seizures. Our study presents PLCβ4-deficient mice as a potential animal model for absence seizures.     

Voriconazole (UK-109,496) inhibits the growth and alters the morphology of fluconazole-susceptible and -resistant Candida species.

The effects of voriconazole on the growth, ultrastructure, and leakage of cytoplasmic materials of Candida species were investigated. MIC data showed that voriconazole was more active than fluconazole. Exposure of yeast to voriconazole caused growth inhibition, cell wall thinning, and cell membrane degradation. Neither cell collapse nor release of cytoplasmic materials was observed in the treated cells.     

ATM Gene Mutations Detection in Iranian Ataxia-Telangiectasia Patients

Ataxia-Telangiectasia (AT) is an autosomal recessive disorder involving cerebellar degeneration, immunodeficiency, radiation sensitivity and cancer predisposition. The ATM gene on human chromosome 11q22.3 has recently been identified as the gene responsible for ataxia-telangiectasia (AT). The gene mutated in AT, which has been designated as the ATM gene, encodes a large protein kinase with a PI-3 kinase-related domain. More than 100 mutations are broadly distributed throughout the ATM gene. The large size of the ATM gene (66 exons spanning ~150kb of genomic DNA) together with the diversity and broad distribution of mutations in AT patients, greatly limits the utility of direct mutation screening as a diagnostic tool. In this study, 20 families with at least one affected child clinically suspected to have ataxia-telangiectasia were examined and their DNA was extracted and amplified with standard methods. Sequencing methods were used to detect the new point mutation. Four exons which were hot spots for point mutations in ATM gene were detected by PCR-SSCP or PCR-RFLP.     

Serum Antibodies against Hepatitis C Virus in Iranian Patients with Graves' Disease

Hepatitis C virus (HCV) infection has been associated with a plethora of immune and autoimmune perturbations. A variety of conditions ranging from endocrinopathies to different skin diseases has been described in HCV infection. The aim of this study was to investigate the prevalence and clinical significance of HCV infection in patients with graves' disease (GD). A total of 55 patients with GD (30 women, 25 men, mean age: 35.24 +/- 12.27 years) and 50 control subjects (28 women, 22 men, mean age: 33.34 +/- 11.99 years) were examined. Third generation ELISA test was used for detection of antibodies to HCV in human sera, and anti-HCV seropositivity was confirmed by recombinant immunoblot assay (RIBA).All normal controls were anti-HCV negative whereas anti-HCV antibody was present in 1 patient with GD and confirmed by Western blotting. These results indicate that there was no significant difference of anti-HCV antibodies between patients and controls.In this study no relationship was found between GD and HCV infection, which imply that hepatitis C virus has not a direct causal role in the pathogenesis of GD, however, this does not rule out a "hit and run" virus induced disease.     

Surgical Techniques and Return to Work Following Carpal Tunnel Release: A Systematic Review and Meta-Analysis

Introduction This systematic review was conducted to evaluate return to work (RTW) following minimally invasive carpal tunnel surgery versus open carpal tunnel release. This study also assesses how RTW as an outcome measure was examined in previous randomized controlled trials (RCTs). Methods The bibliographic databases Medline, AMED and CINAHL were systematically searched. We found 15 relevant RCTs. Meta-analysis was possible only for four studies. Results The result indicates that minimally invasive surgery offers earlier return to work compared to open carpal tunnel release (mean difference −7.2 days; 95% CI −10 to −4.4 days). There were remarkable inconsistencies in how return to work as an outcome measure was examined in different RCTs. Conclusions Calculating standardised mean difference in future RCTs would allow future reviews to be more inclusive of the evidence. The authors suggest more consistent approach for evaluating work-related features in future studies. We recommend that new fit note categories introduced by UK Department of Work and Pension (unfit for all work/return to modified work or work adaptations/return to normal work) would be used to identify different levels of return to work.