Background: The treatment of human brucellosis is controversial. The purpose of this study was to search published clinical trial papers to provide a simple and effective treatment in brucellosis.
Methods: Many studies on brucellosis treatment in a twenty- year span from 1993 to 2012 were searched in PubMed, Web of Science (ISI), Scopus, Google Scholar, Magiran, Iranmedex and SID. The studies that were searched and classified in groups according to combination therapy and monotherapy and their results in treatment outcome were compared. Regimens with lower treatment failure or relapse were considered as more suitable for brucellosis treatment.
Results: The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen. The combined doxycycline/cotrimoxazole (DCTM) showed similar effect with DR. The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates. Higher relapse rate was searched in monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Although in children, clinical trials were limited but showed cotrimoxazole plus rifampin for six weeks was the best treatment regimen.
Conclusion: In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline- rifampin and doxycycline-cotrimoxazole should be the alternative regimens. The other oral regimens including quinolones may be considered as alternatives. Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen.
Brucellosis; Treatment; Streptomycin; Doxycycline; Relapse
Background: Both influenza A virus (IAV) and respiratory syncytial virus (RSV) cause acute respiratory infection (ARI) in infants and young children. This study was conducted to determine Influenza A virus and its co infection with RSV among the hospitalized children with ARI.
Methods: A total of 153 throat samples of the hospitalized young children aged between below one year and 5 years with the clinical signs of ARI were collected from the different hospitals in Khuzestan from June 2009 to April 2010. The samples were tested for Influenza A viruses by real time PCR. Positive IAV samples were tested for influenza A sub type H1N1 and for RSV by the nested PCR.
Results: In this study, from the total 153 samples, 35 samples (22.9%) including 15 (42.8%) females and 20 (57.2%) males were positive for influenza A viruses. From the 35 positive samples for IAV, 14 were positive for swine H1N1 subtype. All the positive samples for influenza showed negative for RSV infection which revealed no coinfection with RSV. The prevalence of influenza A among age/sex groups was not significant.
Conclusion: Influenza A is a prevalent viral agent isolated from young children with ARI. Influenza A subtype H1N1 was accounted for the 40 percent all laboratory-proven diagnoses of influenza in 2009. No evidence of coinfection of influenza A and RSV has been observed in the present study.
Respiratory syncytial virus; Influenza A virus; swine H1N1; Acute respiratory infection; Co-infection.
Background and aims
Temporomandibular disorders (TMD) account for the most common orofacial pains rising from musculoskeletal origin. The aim of this study was to investigate the level of knowledge, attitudes and practice of dental practitioners regarding TMD in Tehran, Iran.
Materials and methods
A questionnaire, containing 29 questions on etiology, signs and symptoms, diagnosis and treatment of TMD, was given to 200 randomly selected general dental practitioners and specialists as well as 11 TMD ex-perts.
An overall response rate of 97% was achieved among participants (mean age: 39 ± 8.2 years old; mean years in practice: 11.5 ± 7.4). The mean score of knowledge of TMD was found to be 10.85± 2.54 (of a total of 23). TMD specialists were significantly more knowledgeable than general dental practitioners (p<0.05). With respect to attitude, there was a significant difference among various age groups, and by increasing age and years in practice, the attitude towards TMD had weakened. However, no significant difference was recorded between general dental practitioners’ attitude and that of TMD experts towards TMD. There was a positive correlation between subjects’ knowledge and attitude (P= 0.007, r=0.138).
According to the results, the level of knowledge and attitude of general dental practitioners of Tehran regarding TMD is not desirable. The majority are not willing to admit and treat TMD patients.
Attitude, dentist; knowledge; practice; temporomandibular disorders
Glaucoma is an important disease, the impacts of which on vision have been shown to have implications for patients' health-related quality of life (HRQoL). The primary aim of this study is to estimate a mapping algorithm to predict EQ-5D and SF-6D utility values based on the vision-specific measure, the 25-item Visual Functioning Questionnaire (VFQ-25), as well as the clinical measures of visual function, that is, integrated visual field, visual acuity, and contrast sensitivity.
Ordinary least squares (OLS), Tobit, and censored least absolute deviations were compared using data taken from the Moorfields Eye Hospital in London, to assess mapping functions to predict the EQ-5D and SF-6D from the VFQ-25, and tests of visual function. These models were compared using root mean square error (RMSE), R2, and mean absolute error (MAE).
OLS was the best-performing model of the three compared, as this produced the lowest RMSE and MAE, and the highest R2.
The models provided initial algorithms to convert the VFQ-25 to the EQ-5D and SF-6D. Further analysis would be needed to validate the models or algorithms.
QALYs; vision; quality of life; EQ-5D; SF-6D; mapping
The BK virus (BKV) is a nonenveloped double-stranded DNA virus of the polyomavirus family that primarily affects immunocompromised people. BKV infects humans at an early age. Initial infections with BKV are mainly asymptomatic and usually remain latent in the brain, peripheral blood, kidneys, and urothelium. Following the primary infection, viruses persist indefinitely as ‘latent’ infections of the kidney and urinary system because the virus is urotheliotropic. Reactivation of the virus infections occurs in individuals with severe immunosuppression states such as kidney and stem cell transplantation and rarely in pregnancy. In this line, BKV has been implicated as a common cause of late-onset haemorrhagic cystitis (HC) in patients who have undergone stem cell transplantation. In contrast, reports of BKV-associated diseases in nontransplant paediatric patients are almost exclusively in patients with human immunodeficiency virus infection. Herein, we report the first case of a child with acute lymphoblastic leukaemia who developed BKV-associated HC without receiving stem cell transplantation while on standard maintenance chemotherapy.
BK virus; haemorrhagic cystitis; chemotherapy; acute leukaemia; nontransplantation
The rapidly rising prevalence and cost of Alzheimer’s disease (AD) in recent decades has made the imaging of amyloid-β (Aβ) deposits the focus of intense research. Several amyloid imaging probes with purported specificity for Aβ plaques are currently at various stages of FDA approval. However, a number of factors appear to preclude these probes from clinical utilization. As the available “amyloid specific” PET imaging probes have failed to demonstrate diagnostic value and have shown limited utility for monitoring therapeutic interventions in humans, a debate on their significance has emerged. The aim of this review is to identify and discuss critically the scientific issues contributing to the extensive inconsistencies reported in the literature on their purported in vivo amyloid specificity and potential utilization in patients.
amyloid imaging; amyloid ‘specific’ imaging probes; Amyvid; PIB; critical review; neuropathologic criteria; silent medial temporal lobe
Schizophrenia is a major mental disorder characterized by functional
impairment and the presentation, persistence, and severity of symptoms.
Characterized as a brain disorder, the etiology of schizophrenia remains
elusive. Nevertheless, neuroimaging modalities have advanced the understanding
of the neuroscientific community in regard to the structural and functional
abnormalities inherent in the brains of schizophrenics. Neurochemical and
molecular strategies are beginning to form a subtle consensus in the biomedical
community as to the specificities of the disease on an organic level. Developing
our understanding of the micro-abnormalities present in this disorder will allow
the medical community to advance our neuropharmological approach to treating,
curing, and perhaps preventing the onset of this disabling psychiatric
Neuroimaging; Neuropsychiatry; Mental Health; Schizophrenia
While artemisinin is known as anticancer medication with favorable remedial effects, its side effects must not be neglected. In order to reduce such side effects and increase artemisinin therapeutic index, nano technology has been considered as a new approach. Liposome preparation is supposed to be one of the new methods of drug delivery. To prepare the desired nanoliposome, certain proportions of phosphatidylcholine, cholesterol and artemisinin are mixed together. Besides, in order to achieve more stability, the formulation was pegylated by polyethylene glycol 2000 (PEG 2000). Mean diameter of nanoliposomes was determined by means of Zeta sizer. Encapsulation was calculated 96.02% in nanoliposomal and 91.62% in pegylated formulation. Compared to pegylated formulation, the percent of released drug in nanoliposomal formulation was more. In addition, this study reveals that cytotoxicity effect of pegylated nanoliposomal artemisinin was more than nanoliposomal artemisinin. Since artificial neural network shows high possibility of nonlinear modulation, it is used to predict cytotoxicity effect in this study, which can precisely indicate the cytotoxicity and IC50 of anticancer drugs.
Artemisinin; Cytotoxicity; Nanoliposome; Neural network
The interaction of the Gram-negative bacterium Stenotrophomonas maltophilia with eukaryotes can improve overall plant growth and health, but can also cause opportunistic infections in humans. While the quorum sensing molecule DSF (diffusible signal factor) is responsible for the regulation of phenotypes in pathogenic Stenotrophomonas, up until now, no beneficial effects were reported to be controlled by it. Our objective was to study the function of DSF in the plant growth promoting model strain S. maltophilia R551-3 using functional and transcriptomic analyses. For this purpose, we compared the wild-type strain with a mutant deficient in the rpfF (regulation of pathogenicity factors) gene that is essential for the synthesis of DSF. Oilseed rape seeds treated with the wild-type strain showed a statistically significant increase in germination rate compared with those treated with the rpfF mutant. Similarly, the wild-type strain exhibited better plant growth promotion and a greater efficiency in colonizing oilseed rape compared to the mutant strain. Moreover, only the wild-type was capable of forming structured cell aggregates both in vitro and in the rhizosphere, a characteristic mediated by DSF. Gene transcription analyses showed that numerous genes known to play a role in plant colonization (e.g. chemotaxis, cell motility, biofilm formation, multidrug efflux pumps) are controlled by the rpf/DSF system in S. maltophilia. In addition, we detected new potential functions of spermidine, primarily for both growth promotion and stress protection. Overall, our results showed a correspondence between the regulation of DSF and the positive interaction effect with the plant host.
The relationship between serum anti-heat shock protein (Hsp)27 antibody and high sensitive C-reactive protein (hs-CRP) levels and indices of cardiac function were investigated in patients undergoing coronary artery bypass grafting (CABG) or heart valve replacement. The changes in anti-Hsp27 antibody titers and hs-CRP levels were compared among patients undergoing off-pump and on-pump CABG or valvular heart replacement. Fifty-three patients underwent off-pump, on-pump CABG, and heart valvular replacement in each group. Serum anti-Hsp27 titers and hs-CRP values were measured 24 h before and after the operation and at discharge. Echocardiography was performed before surgery and before discharge. The results were compared with values from 83 healthy controls. hs-CRP levels increased and anti-Hsp27 antibody decreased following surgery (P < 0.001 and P < 0.05, respectively), although these changes were independent of operative procedure (P = 0.361 and P = 0.120, respectively). Anti-Hsp27 antibody levels were higher at the time of discharge (P = 0.016). Only in coronary patients were anti-Hsp27 antibody levels negatively associated with E/E′ (r = −0.268, P = 0.022), a marker of pulmonary capillary wedge pressure. In conclusions, anti-Hsp27 antibody levels are associated with indices of cardiac function in coronary patients. Cardiopulmonary bypass had no significant effect on the induction of changes in anti-Hsp27 levels. Moreover, anti-Hsp27 antibody levels fell in all groups postoperatively; this may be due to the formation of immune complexes of antigen–antibody, and antibody levels were higher at the time of discharge.
Electronic supplementary material
The online version of this article (doi:10.1007/s12192-012-0358-y) contains supplementary material, which is available to authorized users.
Heat shock protein 27; Valvular heart disease; Coronary artery bypass grafting; Cardiac function
Celiac disease (CD) is an immune mediated condition that leads to small bowel atrophy and improve with a gluten free diet (GFD). Extra-intestinal manifestations of CD include hypertransaminasemia. In this study, the effects of a GFD on hypertransaminasemia in patients with newly diagnosed CD were studied.
Ninety eight new diagnosed consecutive patients with CD 40 males and 58 females) with mean age of 32 ± 17.1 were studied. All patients with CD were treated with a GFD. Patients with hypertransaminasemia, at diagnosis, had a cirrhosis screen performed. Patients with a negative cirrhosis screen were reviewed, 6 months after the introduction of a GFD, and serum levels of liver transaminases were measured again.
Nine patients had hypertransaminasemia. One patient was Hepatitis B surface antigen positive and was excluded from this study. The 8 remaining patients had no obvious cause for the hypertransaminasemia. Mean (± SD) of baseline aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were 42.6 ± 16.5 IU/L (range: 16-66 IU/L) and 69.3 ± 9.3 IU/L (range: 52-81 IU/L). Six months after treatment with a GFD, mean AST and ALT levels decreased to 24.5 ± 5.1 IU/L (range: 18-31 IU/L) (P: 0.04) and 24.6 ± 6 IU/L (range: 17-32 IU/L) (P: 0.01), respectively. In 7 patients the hypertransaminasemia, at diagnosis had resolved.
This study provides further evidence that some patients with CD have a reversible hypertransaminasemia that resolves with a GFD.
Celiac disease; gluten-free diet; hypertransaminasemia; liver
Background: Although infectious diseases are the most common sources for the fever of unknown origin (FUO), but the spectrum of infectious diseases is changing overtime. The purpose of the study was to define the clinical spectrum and changing the pattern of FUO.
Methods: This existing data based study was undertaken from 2007 to 2011. One hundred-six patients fulfilling the modified criteria for FUO referred in a teaching hospital in Ahvaz were enrolled for analysis. The data extracted from the patient's medical files and etiologic agents caused FUO to be assessed.
Results: Infections were the most common cause of FUO in 48.4% of the patients. Among the infections, the most important causes of FUO were represented by extra-pulmonary tuberculosis 15 (31.9%), osteomyelitis 10 (21.3%) and abdominal abscesses 6 (12.8%).
Conclusion: The pattern of FUO in the region is thought to be changed to extra pulmonary TB and osteomyelitis. Tuberculosis is still the leading cause of FUO in our region.
Fever of unknown origin (FUO); Infectious diseases; Tuberculosis; Ahvaz
Neuroimaging enables highly accurate and specific identification of treatable brain injuries for the purposes of preventing secondary damage as well as providing useful prognostic information. This article addresses the range of currently employed neuroimaging techniques and their utility in assessing legal claims involving the presence of brain damage.
Computed tomography; magnetic resonance imaging; neuroimaging; positron emission tomography; traumatic brain injury
Some evidence suggests that a variety of genetic factors contribute to development of the tuberculosis (TB). TLR4 and TLR9 have been proposed as susceptibility genes for TB. This study was performed in 124 newly diagnosed TB cases and 149 healthy controls in a TB-endemic region of Iran. The TLR4 genes Asp299Gly, Thr399Ile, and TLR9 gene T-1486C polymorphisms were amplified by polymerase chain reaction (PCR) and then detected by PCR-restriction fragment length polymorphism (RFLP). The frequencies of the mutant alleles of TLR4 Arg299Gly, Thr399Ile, and TLR9 T-1486C polymorphisms were 0.8 versus 0.1, 5.6 versus 3, and 28.6 versus 25.2 in patients and controls, respectively, that were not significant. The synergic effect of TI,II/CC genotypes for TLR4 Thr399Ile and TLR9 T-1486C polymorphisms showed increased risk of PTB susceptibility. In conclusion, no significant relation was found between TLR4 and TLR9 polymorphisms alone and PTB. However, synergic effects of TLR4 Thr399Ile and TLR9-1486T/C polymorphisms might increase risk of PTB.
Pegylated interferon (PEG-IFN) treatment for hepatitis C virus (HCV) infection has neuropsychiatric side effects. Data on the impact of HCV treatment on mental health among injecting drug users (IDUs) are limited. We assessed mental health during treatment of recently acquired HCV, within a predominantly IDU population.
Participants with HCV received PEG-IFN α-2a (180µg/week) for 24 weeks; HCV/HIV received PEG-IFN with ribavirin. Depression was assessed using the Mini-International Neuropsychiatric Interview (MINI). Logistic regression was used to identify factors associated with depression at enrolment and during treatment. Also, the impact of depression prior to and during treatment on SVR was assessed.
Of 163 participants, 111 received treatment (HCV, n=74; HCV/HIV, n=37), with 76% ever reporting IDU. At enrolment, 16% had depression (n=25). In adjusted analysis, depression at enrolment occurred less often in participants full-/part-time employed (AOR 0.23; 95% CI: 0.06, 0.82, P=0.023) and more often in recent IDUs (AOR 3.04; 95% CI: 1.19, 7.72, P=0.019). During treatment, 35% (n=31) developed new-onset depression. In adjusted analysis, poorer social functioning (higher score) was associated with new-onset depression (score ≤9 vs. score ≥17; OR 5.69; 95% CI: 1.61, 20.14, P=0.007). SVR was similar among participants with and without depression at enrolment (60% vs. 61%, P=0.951) and in those with and without new-onset depression (74% vs. 63%, P=0.293).
Although depression at enrolment and during treatment was common among participants with recent HCV, neither impacted SVR. Participants with poor social functioning may be most at risk of developing depression during HCV therapy.
injecting drug users; HCV; depression; anxiety; psychiatric
Clear cell sarcoma of the kidney (CCSK) is a rare renal neoplasm of paediatrics, making up about 3% of all renal tumours in paediatrics, with a high tendency for developing bone metastasis. A seven year-old boy was referred to our clinic with two firm, large masses over the manubrium of the sternum and right frontal area, which pathologically were confirmed as a metastatic CCSK. The patient had a history of a renal mass three years earlier, for which radical nephrectomy had been performed, and histopathologic diagnosis was compatible with mesoblastic nephroma. Thus, no further investigation and therapy had been applied for the patient. CCSK is a rare but malignant and aggressive paediatric renal tumour, with a high tendency for developing distant bone metastases, leading to its poor prognosis. CCSK could be misdiagnosed as several other renal tumours such as mesoblastic nephroma, and thus CCSK should be taken carefully into consideration in the diagnosis of renal tumours.
clear cell sarcoma of the kidney; sternum; frontal bone; mesoblastic nephroma; bone metastasis
Engineering of the membrane-like tissue structures to be utilized in highly dynamic loading environments such as the cardiovascular system has been a challenge in the past decade. Scaffolds are critical components of the engineered tissue membranes and allow them being formed in vitro and remain secure in vivo when implanted in the body. Several approaches have been taken to develop scaffolds for tissue membranes. However, all methods entail limitations due to structural vulnerability, short-term functionality, and mechanical properties of the resulted membrane constructs. To overcome these issues, we have developed a novel hybrid scaffold made of an extra thin layer of metal mesh tightly enclosed by biological matrix components. This approach retains all the advantages of using biological scaffolds while developing a strong extracellular matrix that can stand various types of loads after implantation inside the body.
The effects of chronic valproic acid administration on bone health have been a matter of concern and controversy. In this study, the bone status following valproate intake was assessed by using several bone-related biochemical markers.
Materials and Methods:
In this case-control study, 62 epileptic patients and 40 age- and gender-matched controls were enrolled. The patients had been under chronic valproate therapy (758 ± 29 mg/day) for at least the past 6 months, without any vitamin D/or calcium supplementation. Serum markers of bone turnover (carboxy-terminal telopeptide of type I collagen (CTX) and bone-specific alkaline phosphatase [BALP]), calcium, phosphorus, total alkaline phosphatase, and parathyroid hormone levels were measured in both groups.
The markers of bone turnover as well as other measured bone biochemical parameters did not statistically differ between the two groups.
Valproate therapy at the mentioned doses does not seem to change bone turnover in adult epileptic patients.
Bone turnover markers; epilepsy; valproate sodium
The endophytic bacterium Pseudomonas poae RE*1-1-14 shows broad antagonistic activity and is applied to seeds as a biocontrol agent to suppress late root rot in the sugar beet. The completely sequenced 5.5-Mb genome reveals genes that putatively contribute to this antagonistic activity and the intimate plant-microbe interaction.
Childbirth might be a traumatic event for some women.
This study was conducted with the objective of investigating the prevalence of Post-Traumatic Stress Disorder (PTSD) following childbirth.
Patients and Methods
The study was designed using a descriptive correlation scheme. The participants were selected from the women referred to the healthcare centers affiliated with Zahedan University of Medical Sciences, Zahedan, Iran. Personal interviews were conducted with 600 women who were 6-8 weeks postpartum and had been undergone to this center for postpartum and child care.
One hundred and three (17. 2%) women had symptoms of PTSD following childbirth based on the PTSD Symptom Scale (PSS). The results of logistic regression analysis revealed a significant correlation between maternal occupation (P = 0.01), depression level (P < 0.001) and anxiety level (P < 0.001) with PTSD following childbirth.
PTSD from childbirth occurs in some women. Early identification of risk factors should lead to early therapeutic intervention in the mothers at risk of PTSD.
Natural Childbirth; Stress Disorders, Post-Traumatic Stress Disorder (PTSD), Incidence
The lab-scale upflow anaerobic biofilm reactor was successfully operated for the treatment of synthetic wastewater with high nitrogen load by Anammox (anaerobic ammonium oxidation) process. During the entire period of operation, the reactor temperature was kept at 35±1°C. The operational strategy consisted of both increasing the ammonium and nitrite concentrations from 60 to 700mgN/L and from 80 to 920 mgN/L, respectively and decreasing the hydraulic retention time from 24 to 6 h, at each step. The highest achieved removal efficiency of ammonium and nitrite were 91 and 93%, respectively. Consequently, due to their acceptable performance for nitrogen removal in previous researches, modified Stover-Kincannon and Grau second-order models were used in this study. According to the experiment results, the model validity testing showed that the Stover-Kincannon model was a little more appropriate for the description of nitrogen removal in the reactor, even though both models gave high correlation coefficients (R2=0.999).
Anammox; Nitrogen removal; Kinetics; Stover-Kincannon model; Grau model
Kawasaki disease (KD) is a systemic vasculitis of unknown etiology and a leading cause of acquired heart disease. It is assumed that there is an activation of the immune system by an infectious trigger in a genetically susceptible host. Neuroblastoma is the most common extracranial solid tumor in young children. It mainly originates from primordial neural crest cells that generate the adrenal medulla and sympathetic ganglia. A diagnosis of concurrent KD and neuroblastoma in a living child has been made in only one previous report. We report the second case and review the literature.