Non-Infectious Complications in B-Lymphopenic Common Variable Immunodeficiency

BACKGROUND AND OBJECTIVE

Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, non-infectious complications are also a major challenge among CVID patients.

METHODS

All registered CVID patients in the national database were included in this retrospective cohort study. Patients were divided into two groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, non-infectious organ involvements, autoimmunity, and lymphoproliferative diseases were evaluated.

RESULTS

Among 387 enrolled patients, 66.4% were diagnosed with non-infectious complications; however, 33.6% had only infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly higher among patients with B-cell lymphopenia. Among organ involvement, dermatologic, endocrine and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher compared to other types of autoimmunity independent from the B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were slightly introduced as the most common type of malignancy. Meanwhile, the mortality rate was 24.5%, and respiratory failure and malignancies were reported as the most common cause of death in our patients without significant differences between the two groups.

CONCLUSION

Considering that some of the non-infectious complications might be associated with B-cell lymphopenia, therefore, regular patient monitoring and follow-up along with proper medications (besides immunoglobulins replacement therapy) are highly recommended to prevent further sequels and increase the patients' quality of life.

A comparative study of the analgesic effects of intravenous ketorolac, paracetamol, and morphine in patients undergoing video-assisted thoracoscopic surgery: A double-blind, active-controlled, randomized clinical trial

Background:

Opioids are traditionally used as the drug of choice for the management of postoperative pain. However, their use is limited in patients undergoing Video-assisted thoracic surgery (VATS), due to their side effects, such as respiratory depression, nausea, and vomiting.

Aim:

In this double-blind active-controlled randomized study, we have compared the analgesic effects of ketorolac and paracetamol to morphine.

Methods:

Patients were randomly chosen from a pool of candidates who were undergoing VATS and were divided into three groups. During the first 24 h postsurgery, patients in the control group received a cumulative dose of morphine 20 mg, while patients in two treatment groups received ketorolac 120 mg and paracetamol 4 g in total. Doses were administered as bolus immediately after surgery and infusion during the first 24 h. Patients' pain severity was evaluated by visual analogue scale rating (VAS) at rest and during coughing episodes.

Results:

The average pain score at recovery time was 2.29 ± 2.13 and 2.26 ± 2.16 for ketorolac and paracetamol, respectively, and it was significantly lower than the morphine group with an average pain score of 3.87 (P = 0.003). Additionally, the VAS score during cough episodes was significantly higher in the control group throughout the study period compared to study groups. Comparison of mean morphine dose utilized as liberation analgesic (in case of patients had VAS >3) between three groups was not significantly different (P = 0.17).

Conclusion:

Our study demonstrates the non-inferiority of ketorolac and paracetamol to morphine in controlling post-VATS pain without causing any significant side effects. We also show that ketorolac and paracetamol are superior to morphine in controlling pain during 2 h postsurgery.

Under-expression of microRNA-146a and 21 and their association with Crohn's disease

MicroRNAs (miRNAs) can post-transcriptionally regulate gene expression and are involved in the immune response. Excessive immune response to the gut microbiota plays a major role in the pathogenesis of Crohn's disease (CD). Regarding the role of miRNAs in immune response, this study aimed to investigate the contribution of miRNAs in the pathogenesis of CD. A total of 53 participants, including 23 CD patients and 30 healthy controls (HCs) were enrolled in this study. miRNAs, including miR-21, miR-29a, miR-29b, miR-31, miR-146a, miR-155, miR-181a, and miR-181c were evaluated via TaqMan MicroRNA Assays. Among the eight miRNAs, the amounts of miR-146a and miR-21 were significantly decreased in the CD patients relative to HC subjects. Moreover, we showed that there was a negative correlation between miR-146a and Harvey-Bradshaw index (HBI), as well as a positive correlation of miR-21 and miR-29b with HBI. Under-expression of miR-146a and miR-21, which are critical for the regulatory function of regulatory T cells (Tregs), is remarkably associated with CD.

Reversal of Immunogenicity in Pediatric Inflammatory Bowel Disease Patients Receiving Anti-Tumor Necrosis Factor Medications

Loss of response to anti-tumor necrosis factor (anti-TNF) agents in the treatment of inflammatory bowel disease (IBD) is a major consideration to maintain sustained response. Reversal of immunogenicity can re-establish response and increase the durability of these agents. Strategies to reverse immunogenicity include dose-intensification and/or the addition of an immunomodulator. However, there is a relative paucity of data on the efficacy of such interventions in pediatric IBD patients. Available reports have not strictly utilized homogenous mobility shift assay, which reports on anti-drug antibodies even in the presence of detectable drug, whereas prior studies have been confounded by the use of drug sensitive assays. We report four pediatric inflammatory bowel disease patients with successful reversal of immunogenicity on an anti-TNF agent using dose intensification and/or addition of an immunomodulator.

Effect of Adding Magnesium Sulphate to Epidural Bupivacaine and Morphine on Post-Thoracotomy Pain Management: A Randomized, Double-Blind, Clinical Trial

Post-thoracotomy pain is very severe and may cause pulmonary complications. Thoracic epidural analgesia can greatly decrease the pain experience and its consequences. However, finding new methods to decrease the amount of administered opioids is an important issue of research. We aimed to evaluate the effect of adding epidural magnesium sulphate to bupivacaine and morphine on pain control and the amount of opioid consumption after thoracotomy. Eighty patients undergoing thoracotomy at a tertiary cardiothoracic referral centre were enrolled in a randomized, double-blind trial. Patients were randomly allocated to two groups. Bupivacaine (12.5 mg) and morphine (2 mg) were administered epidurally to all patients at the end of operation. Patients in the magnesium (Mg) group received epidural magnesium sulphate (50 mg), and patients in the control (C) group received normal saline as an adjuvant. Visual analogue scale (VAS) score and the amount of morphine consumption were measured during 24 hr post-operation. Thirty-nine patients in the Mg group and 41 patients in the C group completed the study. Patients in the Mg group had significantly less VAS score at recovery time (p < 0.05), 2 hr (p < 0.01) and 4 hr (p < 0.05) after surgery. The patient-controlled analgesia pump was started earlier in the C group than in the Mg group (p < 0.05). The amount of morphine needed in the Mg group was significantly lower than in the C group (5.64 ± 1.69 mg/24 hr versus 8.44 ± 3.98 mg/24 hr; p < 0.001). Pruritus was seen in the C group (9.7%) and absent in the Mg group (p < 0.05). Co-administration of magnesium sulphate with bupivacaine and morphine for thoracic epidural analgesia after thoracotomy leads to a reduction in post-operative pain score and the need for opioid administration.

High-Frequency Jet Ventilation in Nonintubated Patients

OBJECTIVES

High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it.

MATERIALS AND METHODS

Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation.

RESULTS

Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed.

CONCLUSION

High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.

Evaluation of cerebral oxygen saturation during hypotensive anesthesia in functional endoscopic sinus surgery

Background and Aims

Controlled hypotensive anesthesia in endoscopic sinus surgery would provide a clean surgical field. Cerebral oxygen saturation (ScO₂) is important in endoscopic sinus surgery patients and it may be low during controlled hypotension. The aim of the present study was to assess ScO₂ in these patients.

Material and Methods

In this observational study, 41 patients who underwent endoscopic sinus surgery with hypotensive anesthesia were enrolled for the study and all of the patients received the same anesthetic medication, nitroglycerin for controlled hypotension. Variables were measured prior to surgery, after induction of anesthesia, 5 min, and every 30 min after controlled hypotension. Near-infrared spectroscopy was used for ScO₂ evaluation. Mean arterial blood pressure (MAP) was maintained at 55-60 mmHg in the surgical duration. We used t-test, Wilcoxon, and repeated measures analysis of variance (ANOVA). We examined the cross-correlation functions of the time series data between end-tidal carbon dioxide (ETCO₂)/MAP and ScO₂.

Results

The mean of intraoperative ScO₂ was not significantly different from the baseline evaluation (P > 0.05). ETCO₂ was cross correlated with current ScO₂ [r: 0.618, confidence interval (CI) 95%: 0.46-0.78]. We found moderate cross correlation between the MAP and current ScO₂ (r: 0.728, CI 95%: 0.56-0.88). About 92% of the patients recovered within 30 min. Recovery time was associated with intraoperative MAP (P: 0.004, r: 0.438), intraoperative ETCO₂ (P: 0.003, r: 0.450), and ScO₂ (P: 0.026, r: 0.348).

Conclusions

Based on our findings, the assessment of ScO₂ and maintained MAP >55 mmHg may provide safe conditions for endoscopic sinus surgery.

Elevated levels of IL-2 and IL-21 produced by CD4+ T cells in inflammatory bowel disease

CD4+ T cells are considered as a subset of cells that play a pivotal role in the development of inflammatory bowel disease (IBD). The aim of this study was to assess the levels of interleukin (IL)-2, IL-21 and their receptors produced by CD4+ T cells in patients with inflammatory bowel disease. Thirty-two patients with ulcerative colitis (UC) and mean age of 37.93±10.37 years, as well as 22 patients with Crohn’s disease (CD) and mean age of 37.04±10.44 years, were studied. The healthy controls (HC) included 31 subjects with a mean age of 36.7±10.48 years. Peripheral blood mononuclear cells (PBMCs) were isolated from all the participants. The CD4+ T cells were isolated and the expression of IL-2 and IL-21 and also their receptors were examined by flow cytometry. The level of IL-2+ cells was significantly increased in UC patients compared with HC (40.71±6.04 vs 37.24±6.54, respectively, p=0.04). The level of IL-21+ cells was also significantly elevated in CD patients compared with HC (4.44±1 vs 3.83±0.74, respectively, p=0.02). Furthermore, we found a significant positive correlation between clinical activity index (CAI) and IL-21+ cells. According to the results, we hypothesize that the elevated level of IL-2+ and IL-21+ T cells and a positive correlation between IL-21+ cells with CAI in UC patients may contribute to the pathogenesis of disease. Moreover, the assessment of cells producing such cytokines constitutes a potential diagnostic and therapeutic strategy for IBD.

Right Ventricular Perforation with the Body of Swan-Ganz Catheter during Lung Transplantation by ECMO Support: A Case Report

A 46-year-old woman with a 12-year history of lymphangiomyomatosis (LAM) was admitted for lung transplantation in January 2017. We decided to apply veno-arterial extracorporeal membrane oxygenation (ECMO) to manage arrhythmia and hypotension during lung transplantation, since it was not controllable with inotropic drugs. After transplanting the right (first) lung and at the time of left pneumonectomy, the body of the Swan-Ganz catheter was suddenly observed to be protruding from the right ventricular (RV) wall. The catheter was found folded at part of its body and ran out 0.5 cm from the RV. The protruding part of the catheter was inserted before the perforated part of the cardiac muscle was repaired in order to control the bleeding. ECMO was used throughout the rest of the procedure and the patient was transferred to the intensive care unit (ICU) in good condition before being weaned from the ventilator after 16 hours. It seems that gentle manipulation, concurrent use of transesophageal echocardiography (TEE), insertion of the appropriate length of the catheter into the heart chambers, and a softer material in the structure of the catheters would be helpful to prevent these kinds of potentially fatal complications.

Paracetamol Instead of Ketorolac in Post-Video-Assisted Thoracic Surgery Pain Management: A Randomized Trial

Background

Video-assisted thoracic surgery (VATS) is a minimally invasive procedure that is growing more common around the world. Despite causing less pain compared open thoracic surgery, postoperative pain management is still important.

Objectives

The aim of the present study was to compare the analgesic effects of paracetamol and ketorolac in VATS patients.

Methods

This was a double-blinded randomized clinical trial conducted on 70 patients undergoing lobectomy or segmentectomy due to lung masses, using video-assisted methods. The patients were randomly divided into two groups (each n = 35): the ketorolac (K) group and the paracetamol (P) group. The K group received ketorolac 30 mg IV stat at the end of surgery and then a 90 mg/24 h infusion. The P group received paracetamol 1 g IV stat at the end of surgery and then a 3 g/24 h infusion. Pain scores were recorded during recovery and 2, 4, 8, 12, and 24 hours after drug administration. Pain scores, total doses of rescue analgesics, and patient satisfaction levels were compared between the groups.

Results

There was no significant difference between the K and P groups in pain scores in any of the evaluations. Seventeen (48.6 %) and 9 (25.7 %) patients in the K and P groups, respectively, did not require any rescue analgesia (P = 0.047). The mean doses of rescue analgesia in the K and P groups were 3.129 ± 4.27 mg and 4.38 ± 3.69 mg, respectively, which were similar (P = 0.144). There was no significant difference between the groups in satisfaction scores (P = 0.175).

Conclusions

Paracetamol 1 g stat + 3 g/24 h infusion is as effective as ketorolac 30 mg stat + 90 mg/24 h infusion in post-VATS pain management, with good tolerability and a low incidence of adverse effects.

Decrease of CD4(+) CD25(+) CD127(low) FoxP3(+) regulatory T cells with impaired suppressive function in untreated ulcerative colitis patients

Regulatory T (Treg) cells take part in immune homeostasis and play a pivotal role in maintaining peripheral tolerance. The aim of this study was to evaluate the frequency and function of Treg cells in active and untreated ulcerative colitis (UC) patients. Thirty-two subjects with newly diagnosed UC and 31 age-matched healthy controls were included in this survey. The frequency of Tregs was analyzed with flow cytometry using CD4, CD25, CD127 and FoxP3 markers. We used surface expression of CD4(+), CD25(+) and CD127(low) markers for isolation of a relatively pure Treg population. Suppressive activity of Tregs was determined by measuring their ability to inhibit the proliferation of T responder cells. UC patients had a lower frequency of CD4(+) CD25(+) CD127(low) FoxP3(+) Treg cells. Additionally, Treg cell-mediated suppression was lower in UC patients compared to controls. The frequency and suppressive capacity of Tregs and MFI of FoxP3 were inversely correlated with disease activity. These results suggest that CD4(+) CD25(+) CD127(low) FoxP3(+) Treg cells may contribute to immunopathogenesis of UC, and assessment of Treg cell frequency and function may have clinical value.

Comparing Nigella sativa Oil and Fish Oil in Treatment of Vitiligo

Background:

Vitiligo is one of the autoimmune skin diseases that destroy the melanocytes of the skin. Moreover, its prevalence varies in different countries and regions.

Objectives:

The aim of this study was to compare the effect of Nigella sativa and fish oil on vitiligo lesions of the patients referred to a dermatology clinic.

Materials and Methods:

This randomized, double blind clinical trial was conducted in the dermatology clinic of the Imam Khomeini Hospital Ahvaz, Iran, from June to December 2011. We used a randomized simple sampling. From 96 patients with vitiligo, 52 eligible patients were selected and allocated to two groups with equal size. The study medications were applied twice a day by patients on their lesions. After six months, the improvement rate of lesions was assessed by the Vitiligo Area Scoring Index (VASI). Data were analyzed using SPSS v. 15; P value < 0.05 was considered as statistically significant.

Results:

After six months, a mean score of VASI decreased from 4.98 to 3.75 in patients applying topical Nigella sativa and from 4.98 to 4.62 in those using topical fish oil. Most of the percent improvement observed in upper extremities, trunk, head, and neck of those who received Nigella sativa and head, neck, trunk, and feet of those who received fish oil. No adverse effect was reported by the patients.

Conclusions:

Nigella sativa oil and fish oil were effective in reduction the size of patient’s lesions; however, Nigella sativa was more effective in comparison to the fish oil. Therefore, using Nigella sativa with the major drugs in the treatment of vitiligo is recommended.

Ubiquitous Semantic Applications

Recently practical approaches for development of ubiquitous semantic applications have made quite some progress. In particular in the area of the ubiquitous access to the semantic data the authors recently observed a large number of approaches, systems and applications being described in the literature. With this survey the authors aim to provide an overview on the rapidly emerging field of Ubiquitous Semantic Applications (UbiSA). The authors conducted a systematic literature review comprising a thorough analysis of 48 primary studies out of 172 initially retrieved papers. The authors obtained a comprehensive set of quality attributes for UbiSA together with corresponding application features suggested for their realization. The quality attributes include aspects such as mobility, usability, heterogeneity, collaboration, customizability and evolvability. The primary studies were surveyed in the light of these quality attributes and the authors performed a thorough analysis of five ubiquitous semantic applications, six frameworks for UbiSA, three UbiSA specific ontologies, five ubiquitous semantic systems and nine general approaches. The proposed quality attributes facilitate the evaluation of existing approaches and the development of novel, more effective and intuitive UbiSA.

Angiotensin II regulates growth of the developing papillas ex vivo

We tested the hypothesis that lack of angiotensin (ANG) II production in angiotensinogen (AGT)-deficient mice or pharmacologic antagonism of ANG II AT(1) receptor (AT(1)R) impairs growth of the developing papillas ex vivo, thus contributing to the hypoplastic renal medulla phenotype observed in AGT- or AT(1)R-null mice. Papillas were dissected from Hoxb7(GFP+) or AGT(+/+), (+/-), (-/-) mouse metanephroi on postnatal day P3 and grown in three-dimentional collagen matrix gels in the presence of media (control), ANG II (10(-5) M), or the specific AT(1)R antagonist candesartan (10(-6) M) for 24 h. Percent reduction in papillary length was attenuated in AGT(+/+) and in AGT(+/-) compared with AGT(-/-) (-18.4 ± 1.3 vs. -32.2 ± 1.6%, P < 0.05, -22.8 ± 1.3 vs. -32.2 ± 1.6%, P < 0.05, respectively). ANG II blunted the decrease in papilla length observed in respective media-treated controls in Hoxb7(GFP+) (-1.5 ± 0.3 vs. -10.0 ± 1.4%, P < 0.05) or AGT(+/+), (+/-), and (-/-) papillas (-12.8 ± 0.7 vs. -18.4 ± 1.3%, P < 0.05, -16.8 ± 1.1 vs. -23 ± 1.2%, P < 0.05; -26.2 ± 1.6 vs. -32.2 ± 1.6%, P < 0.05, respectively). In contrast, percent decrease in the length of Hoxb7(GFP+) papillas in the presence of the AT(1)R antagonist candesartan was higher compared with control (-24.3 ± 2.1 vs. -10.5 ± 1.8%, P < 0.05). The number of proliferating phospho-histone H3 (pH3)-positive collecting duct cells was lower, whereas the number of caspase 3-positive cells undergoing apoptosis was higher in candesartan- vs. media-treated papillas (pH3: 12 ± 1.4 vs. 21 ± 2.1, P < 0.01; caspase 3: 3.8 ± 0.5 vs. 1.7 ± 0.2, P < 0.01). Using quantitative RT-PCR, we demonstrate that AT(1)R signaling regulates the expression of genes implicated in morphogenesis of the renal medulla. We conclude that AT(1)R prevents shrinkage of the developing papillas observed ex vivo via control of Wnt7b, FGF7, β-catenin, calcineurin B1, and α3 integrin gene expression, collecting duct cell proliferation, and survival.

Prevalence of undiagnosed diabetes and quality of care in diabetic patients followed at primary and tertiary clinics in Abu Dhabi, United Arab Emirates

AIMS

To investigate the prevalence of undiagnosed type 2 diabetes (T2D) at primary health care (PHC) clinics, and to assess the quality of care of diabetic patients followed at a tertiary hospital diabetes center in Abu Dhabi, United Arab Emirates (UAE).

METHODS

Between May 2009 and October 2010, adult patients attending two PHC clinics, and adult diabetic patients attending the diabetes center, were invited to participate in the study. After overnight fast, participants returned for interview and laboratory tests. Undiagnosed T2D was defined by FPG ≥ 7.0 mmol/l or HbA1c ≥ 6.5%. Quality of care was assessed by reported care practices and achievement of internationally recognized targets.

RESULTS

Out of 239 patients at PHC clinics without history of T2D, 14.6% had undiagnosed T2D, and 31% had increased risk of diabetes (FPG 5.6-7.0 mmol/l or HbA1c 5.7-6.5%). The independent predictors of undiagnosed T2D were age (adjusted OR per year 1.07, 95% CI 1.04-1.11, p < 0.001) and BMI ≥ 25 (adjusted OR 4.2, 95% CI 0.91-19.7, p = 0.033). Amongst all 275 diagnosed T2D patients, including those attending PHC clinics and those followed at the diabetes center, it was found that 40.1% followed dietary recommendations, 12% reported visiting a diabetes educator, 28.2% walked for exercise, and 13.5% attained recognized targets of HbA1c < 7%, blood pressure < 130/80 mmHg, and LDL cholesterol < 2.6 mmol/l.

CONCLUSIONS

Almost half of the adult patients attending PHC clinics had undiagnosed T2D, or increased diabetes risk. Care practices, and achievement of treatment targets, were suboptimal.

The effects of aqueous extract of vaccinium arctostaphylos leaves on blood pressure in renal hypertensive rats

BACKGROUND

The leaves of Vaccinium arctostaphylos (Qare qat) is advocated for the treatment of hypertension in Iran' folk medicine. The objective of was to examine the possible hypotensive activity of aqueous extract of Vaccinium arctostaphylos leaves in rat model of two-kidney, one-clip hypertension.

METHODS

Rats were subjected to sham operation of the placement of Plexiglass clip on left renal arteries. Four weeks later, renal artery clipped rats were given intravenous injection of normal saline or the extract at 10, 25, or 75 mg/kg, and mean blood pressure and heart rate were measured before and 20, 40 and 60 minutes after vehicle or drug administration.

RESULTS

Compared to sham group, renal artery clipped groups had a significantly higher mean blood pressure, heart and right kidney weights, lower left kidney weight and significantly indifferent heart rate. Compared to vehicle treatment, the extract at 75 mg/kg, but not at 10 or 25 mg/kg, did reduce the mean blood pressure at 20, 40 and 60 minutes after administration without changing the heart rate.

CONCLUSION

The findings showed that at a higher dose the extract did have hypotensive activity without changing the heart rate. The exact hypotensive mechanism remains to be investigated.

The effect of post-exercise carbohydrate ingestion on inflammatory responses to short time, high-force eccentric exercise

AIM

The aim of this study was to investigate muscle damage and inflammatory response following eccentric exercise as well as the effect of carbohydrate supplement on these responses in untrained men.

METHODS

Eighteen healthy untrained men were randomly allocated into two carbohydrate (age 21/33+/-0/7 years) and placebo (age 20/66+/-1/22 years) groups. Forty-five repetitions of eccentric elbow flexion were performed with 90% of one maximum repetition by each subject. The exercises were done as three sets of 15 repetitions with 3 minutes rest between sets. Venous blood samples were obtained at pre-exercise, immediately, 8h, and 24h after exercise. Subjects consumed a 6% carbohydrate or placebo drink immediately following the exercise session, every hour, for 10 hours.

RESULTS

CK activities and IL-6 levels were significantly greater than per-exercise in immediately, 8 h and 24 h after exercise in both groups (P<0.05). No significant increases was observed in CRP levels immediately, 8 h and 24 h after exercise versus baseline, in both groups (P>0.05), but in 8 h versus immediately after exercise, the augmentation in the carbohydrate group was significant(P<0.05). Blood glucose increased significantly 8 h after exercise versus baseline in both groups (P<0.05). There was significant difference in serum IL-6 between two groups in 8 h and 24 h after exercise (P<0.05) and it was greater in carbohydrate group. There was no significant difference in serum CK, CRP, and glucose between two groups (P>0.05).

CONCLUSION

According to results, carbohydrate increased the inflammatory (IL-6) response following resistance exercise, but had no effects on CRP and CK.

Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards

Background

This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital.

Methods

In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA-positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash.

Results

A total of 18 810 samples were processed, of which 850 (4·5 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 38·5 per cent (P &lt; 0·001), and MRSA wound isolates fell by 12·7 per cent (P = 0·031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 3·78 beds per year (£276 220), compared with the annual mean for the preceding 6 years. The cost of screening was £302 500, making a net loss of £26 280. Compared with 2005, however, there was a net saving of £545 486.

Conclusion

Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established.

Dynamic regimes of buoyancy-affected two-phase flow in unconsolidated porous media

The invasion and subsequent flow of a nonwetting fluid (NWF) in a three-dimensional, unconsolidated porous medium saturated with a wetting fluid of higher density and viscosity have been studied experimentally using a light-transmission technique. Distinct dynamic regimes have been found for different relative magnitudes of viscous, capillary, and gravity forces. It is shown that the ratio of viscous and hydrostatic pressure gradients can be used as a relevant dimensionless number K for the characterization of the different flow regimes. For low values of K, the invasion is characterized by the migration and fragmentation of isolated clusters of the NWF resulting from the prevalence of gravity and capillary forces. At high values of K, the dominance of viscous and gravity forces leads to an anisotropic fingerlike invasion. When the invasion stops after the breakthrough of the NWF at the open upper boundary, the invasion structure retracts under the influence of gravity and transforms into stable vertical channels. It is shown that the stability of these channels is the result of a balance between hydrostatic and viscous pressure gradients.

Urethral reconstruction using autologous and everted vein graft: an experimental study

Urethral reconstruction is one of the problematic issues in pediatric surgery. To evaluate the efficacy of vein graft for urethral reconstruction in rabbits, about 3 cm of distal urethra was excised under microscopic magnification. In groups A, B, and D, the urethra was replaced with the internal jugular vein. In group B, before performing anastomosis, vein grafts were everted. In group C (control group) after removing the urethra, a catheter was inserted without substituting the urethra and then fixed. Groups A, B, and C were kept for 3 months. Group D was divided into five subgroups each consists of two rabbits, which were killed at days 7, 10, 14, 22, and 30 for evolutionary histopathological studies. Gross evaluation, retrograde urethrography, and histopathological studies were also performed in other groups. Retrograde urethrography and gross evaluation revealed no sign of stricture and fistula formation in six and eight rabbits in groups A and B, respectively. However, those complications were observed in all the rabbits in group C. The grafted part of the neourethra was epithelialized with uroepithelium in all rabbits in group A (vein graft) and group B (everted vein graft) but only partial epithelialization was observed in three rabbits of group C. Severe fibrosis with stricture formation was developed in six rabbits in the control group. In group D, epithelialization gradually replaced necrosis and inflammation, within 1 month. This study showed that vein, everted or not, can be used as a substitute for urethra. It also suggests that new epithelialization might be formed from ingrowing of the uroepithelium from the proximal part.

Chronological and ultrastructural changes in camel (Camelus dromedarius) oocytes during in vitro maturation

Cumulus-oocyte complexes (COCs) were collected from non-pregnant camels at a local slaughterhouse by aspiration from antral follicles (2-6 mm). In Experiment I, camel COCs (n=304) were matured in vitro in Hams-F10, fixed at different time intervals (6, 12, 18, 24, 30, 36, 42, or 48 h) and stained with 1% aceto-orcein to assess nuclear changes in culture. A majority of the oocytes (81.5%) underwent germinal vesicle break down (GVBD) between 6 and 12h. Forty-eight percent of the oocytes were observed at the metaphase I (M I) stage by 18 h culture. The percentage of matured oocytes (M II stage) at 30 and 42 h were 66.5 and 71% respectively, which were significantly (p<0.05) different to that observed at 24 h (42.5%). In Experiment II, after different periods of culture (12, 24, 36, or 48 h), the COCs (n=26) were processed for transmission electron microscopy. Expansion of both the cumulus and corona radiate cells occurred between 12 and 24 h in the majority of oocytes concomitant with enlargement of the cumulus cell process endings (CCPEs) in the developed perivitelline space. After 12 h of culture disruption of the junctions between CCPEs and the oolemma was observed together with and breakdown of the GV. For 24-36 h of culture cortical granules had spread and aligned along the oolemma. Signs of degeneration in the cytoplasmic organelles of the oocytes were also observed from less than 36 h. After 48 h of culture, larger vesicles and lipid droplets had appeared in the central part of the oocytes and showed uneven distribution throughout the ooplasm. Predominantly non-penetrating CCPEs were also observed in four oocytes by 48 h. In conclusion, based on both light and electron microscopic evaluations, the optimal culture time for the development of competent Camelus dromedarius oocytes in vitro appears to be 30 h using Hams-F10 medium.

Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan

OBJECTIVE

There has been a general decline in mortality from cardiovascular diseases (CVDs) in most of the developed countries since the beginning of the 1970s. Still, in recent years developing countries have seen an increasing frequency in CVD mortality. However, mortality rate studies in these populations are scarce. Here we report all-cause and CVD mortality rates for men and women aged 25-74 years over a 16-year period in 24 cities in Iran with special reference to the city of Isfahan.

METHODS AND RESULTS

The study was based on national death records using the ninth international classification of diseases and age standardization was performed using the total population of Iran in 1985 as a standard. Due to limitations in available data, mortality rates for the specific categories of CVD for the whole country could not be provided. The in-hospital death rates following myocardial infarction in coronary care units (CCUs) and cardiology departments in Isfahan hospitals were also assessed. The completed medical records from hospitals or the relatives of decedents were reviewed by physicians certified in internal medicine, cardiology and neurology to assess the reliability of death certificate data regarding CVD by determining the sensitivity and specificity of the death certificates against the standard of the reviewers. The official circulatory diseases proportional mortality ratio continues to rise since 1981 with a steep increase since 1987, constituting 26.6% and 47.3% of all deaths in 1981 and 1995, respectively. Age-adjusted all-cause and CVD mortality data were decreasing since 1981 and increasing since 1990. During those years age-adjusted CVD, stroke and other CVD mortality rates were decreasing in Isfahan with a slight increase in ischaemic heart disease (IHD) death rates in both sexes. Mortality rates based on sex showed a 38% and 24.8% decline in all-cause and CVD mortality in men between 1981 to 1995, and a 35% and 34.9% decline for female mortality rates for the same period, respectively. The in-hospital death rate following myocardial infarction in Isfahan was increasing between 1993 and 1995 with a slight decrease thereafter. The results of death certification assessment showed a specificity of 0.89 and a sensitivity of 0.43 with the positive and negative predictive values of 0.82 and 0.57, respectively.

CONCLUSION

These data indicate that circulatory diseases remain a serious public health threat in Iran. It suggests the ongoing need for more regular, systematic and innovative surveillance data to improve the capability of measuring, explaining and predicting the disease trend on which the national public health policy depends.

Dynamics of anoxygenic photosynthesis in an experimental green sulphur bacteria biofilm

The dynamics of sulphide oxidation in an experimental biofilm of the green sulphur bacterium, Prosthecochloris aestuarii, were studied using a newly developed light-dark cycling procedure. The biofilm was grown for 6 weeks in a benthic gradient chamber, in which gradients of light, sulphide and oxygen were imposed experimentally. The H2S concentrations and pH were measured with microsensors as a function of depth in the biofilm and of time after a change in illumination status. The sulphide oxidation rates were calculated as a function of time and depth in the biofilm using a numerical procedure to solve the non-stationary general diffusion equation. A close agreement was found between the areal rates of anoxygenic photosynthesis during the cycling procedure and the steady state before the cycling experiment. For the different layers of the biofilm, the maximum activity was observed after 10-12min of light exposure. After this maximum, sulphide oxidation decreased concomitantly with sulphide concentration, indicating sulphide limitation of anoxygenic photosynthesis. This lag time limits the application of the standard dark-light shift method with a brief light exposure of a few seconds and, therefore, the numerical procedure described in this study enables the depth distribution of anoxygenic photosynthesis rates in microbial mats to be determined more accurately.

A study of immune responses to myelin and cardiolipin in patients with systemic lupus erythematosus (SLE)

Sera from 39 patients with SLE, 20 patients with cerebrovascular disease with no evidence of SLE, and 20 normal controls were tested for antibodies to cardiolipin (CL), brain total upper (UPG) and lower phase (LPG) glycolipids, myelin basic protein (MBP), myelin, and single strand DNA (ssDNA) by ELISA. Binding to the glycolipids and MBP was negative or negligible in all the groups, but significant binding was observed against CL, myelin and ssDNA in some of the SLE patients. Many sera from SLE patients with cerebral disorders and high CL binding also demonstrated high binding to myelin. These sera also labelled cell surface antigens on neonatal mouse neurons and astrocytes by immunofluorescence in tissue culture. A correlation was found to exist between anti-CL and antimyelin antibodies in SLE patients with cerebral lesions, but not between anti-ssDNA and anti-CL antibodies. As much as 80-90% of the specific activity of these antibodies could be absorbed out by the relevant antigens but only partially by the other antigens. In the control groups binding was low and no specific absorption could be demonstrated.