Search

According to ancient Iranian mythology, the world is depicted as a battleground between the forces of good and evil. Ahuramazda is revered as the ultimate source of goodness, while Ahriman is portrayed as the creator of all things malevolent, such as darkness, ignorance, pain, and disease. These mythological concepts have been passed down through references in the Avesta texts and Pahlavi literature, providing insights into the beliefs of ancient Iranians. In a scholarly exploration of these themes, the research delves into the textual evidence concerning illness, treatment, and the origins of these concepts as presented in the Bundahishn, a reliable source for understanding ancient Iranian beliefs. Ancient Iranian cosmology posits that afflictions and maladies stem from the destructive influence of Ahriman and his cohorts, who seek to wreak havoc upon creation. Conversely, the forces of Ahuramazda strive to counteract this demonic evil by imparting medical knowledge to humanity and teaching healing practices. Within this dualistic worldview, pain and disease are attributed to demonic origins, while medicine and treatment are associated with Ahuramazda. The ancient Iranians viewed the pursuit of medical knowledge and the practice of pharmacy as integral components of the eternal battle between good and evil. In this framework, safeguarding health and administering treatment are essential in the ongoing struggle against evil forces. This holistic perspective underscores the interconnectedness of physical well-being with spiritual beliefs, emphasizing the role of individuals in preserving their health as an act of resistance against demonic influences.

Abstract In this study, we report a biological temperature-sensing electrical regulator in the cytochrome c oxidase of the Devil Worm, Halicephalobus mephisto. This extremophile metazoan was isolated 1.3 km underground in a South African goldmine, where it adapted to heat and potentially to hypoxia, making its mitochondrial sequence a likely target of adaptational change. We obtained the complete mitochondrial genome sequence of this organism and show through dN/dS analysis evidence of positive selection in H. mephisto cytochrome c oxidase subunits. Seventeen of these positively selected amino acid substitutions were located in proximity to the H- and K-pathway proton channels of the complex. Surprisingly, the H. mephisto cytochrome c oxidase completely shuts down at low temperatures (20 °C), leading to a 4.8-fold reduction in the transmembrane proton gradient (ΔΨ m ) compared to optimal temperature (37 °C). Direct measurement of oxygen consumption found a corresponding 4.6-fold drop at 20 °C compared to 37 °C. Correspondingly, the lifecycle of H. mephisto takes four times longer at low temperature than at higher. This elegant evolutionary adaptation creates a finely-tuned mitochondrial temperature sensor, allowing this ectothermic organism to maximize its reproductive success across varying environmental temperatures.

Abstract The current scientific literature has extensively explored the potential role of proteasome inhibitors (PIs) in the NF-κB pathway of leukemia and lymphoma. The ubiquitin-proteasome system (UPS) is a critical component in regulating protein degradation in eukaryotic cells. PIs, such as BTZ, are used to target the 26S proteasome in hematologic malignancies, resulting in the prevention of the degradation of tumor suppressor proteins, the activation of intrinsic mitochondrial-dependent cell death, and the inhibition of the NF-κB signaling pathway. NF-κB is a transcription factor that plays a critical role in the regulation of apoptosis, cell proliferation, differentiation, inflammation, angiogenesis, and tumor migration. Despite the successful use of PIs in various hematologic malignancies, there are limitations such as resistant to these inhibitors. Some reports suggest that PIs can induce NF-κB activation, which increases the survival of malignant cells. This article discusses the various aspects of PIs’ effects on the NF-κB pathway and their limitations. Video Abstract

Adolescence is one of the most critical periods of life. The most behavioral inconsistencies, including the tendency to risky behaviors, appear in this period. This research aimed at predicting high-risk behaviors based on identity styles and parental monitoring in adolescents with the role of self-efficacy as a mediator. The research design was descriptive-correlational. The population included all secondary school students of Kohpayeh city in the academic year of 2022. By multi-stage cluster random sampling, 260 people were selected as a sample. The research tools were risk-taking scales for Iranian teenagers, Brozensky's identity styles, Singer's parental monitoring and Sherer's general self-efficacy. Statistical analysis of the data was done by Pearson correlation method and path analysis. The results of path analysis showed that normative identity style, parental monitoring and self-efficacy had direct effects on high-risk behaviors. The results of the bootstrap test showed that the self-efficacy variable played a mediating role in the relationship between parental monitoring of identity style and risky behaviors. As a result, it is recommended to plan relevant institutions and educate parents, considering the important role of parental monitoring, self-efficacy level and adolescent's identity style in the occurrence of high-risk behaviors.

Abstract Many COVID-19 survivors experience lingering post-COVID-19 symptoms, notably chronic fatigue persisting for months after the acute phase. Despite its prevalence, limited research has explored effective treatments for post-COVID-19 fatigue. This randomized controlled clinical trial assessed the impact of Amantadine on patients with post-COVID-19 fatigue. The intervention group received Amantadine for two weeks, while the control group received no treatment. Fatigue levels were assessed using the Visual Analog Fatigue Scale (VAFS) and Fatigue Severity Scale (FSS) questionnaires before and after the trial. At the study's onset, VAFS mean scores were 7.90 ± 0.60 in the intervention group and 7.34 ± 0.58 in the control group (P-value = 0.087). After two weeks, intervention group scores dropped to 3.37 ± 0.44, significantly lower than the control group's 5.97 ± 0.29 (P-value

IntroductionThere are different types of COVID-19 vaccines approved worldwide. Since no national studies focus on vaccine-related adverse reactions and breakthrough cases, this study aimed to investigate the rate of adverse events and COVID-19 infection in medical students in Iran.MethodsThis retrospective cohort study included Iranian medical students who received two doses of COVID-19 vaccines. The medical team gathered the demographic characteristics, comorbidities, type of vaccine, adverse events following vaccination, and history of COVID-19 infection data through a phone interview. The frequency of adverse events and breakthrough infection was stratified by vaccine type (ChAdOx1-S, Gam-COVID-Vac, and BIBP-CorV).ResultsA total of 3,591 medical students enrolled in this study, of which 57.02% were females, with a mean age of 23.31 + 4.87. A PCR-confirmed and suspicious-for-COVID-19 breakthrough infection rate of 4.51 and 7.02% was detected, respectively. There was no significant relation between breakthrough infection and gender, BMI, blood groups, and comorbidities. However, there was a significant difference in breakthrough infection rate among different types of vaccines (p = 0.001) and history of COVID-19 infection (p = 0.001). A total of 16 participants were hospitalized due to COVID-19 infection after vaccination for reasons such as dyspnea, abnormal imaging, or decreased oxygen saturation. No severe infection or death was observed in the studied population.ConclusionVaccination prevented severe COVID-19 infection, although a high breakthrough infection rate was evident among Iranian medical students during the Delta variant’s peak. Vaccine effectiveness may be fragile during emerging new variants and in high-exposure settings. Moreover, adverse events are rare, and the benefits of vaccination outweigh the side effects. However, many limitations challenged this study, and the results should be cautious.

Finding efficient and satisfactory energy storage systems (ESSs) is one of the main concerns in the industry. Flywheel energy storage system (FESS) is one of the most satisfactory energy storage which has lots of advantages such as high efficiency, long lifetime, scalability, high power density, fast dynamic, deep charging, and discharging capability. The above features are necessary for electric vehicles (EVs), railways, renewable energy systems, and microgrids. Also, electrical machines, power electronics converters, and control systems are the cores of energy transfer in FESS. Therefore, they have a critical role in determining efficiency, power rating, power factor, cost, angular velocity, and volume of FESS. So, in this study, the FESS configuration, including the flywheel (rotor), electrical machine, power electronics converter, control system, and bearing are reviewed, individually and comprehensively. Additionally, the mentioned components have been categorized to be a guide for future research. The investigated electrical machines are compared by Finite Element Analysis (FEA). Subsequently, our laboratory’s measurement results are reviewed experimentally showing the progress in the field of FESS, such as designing robust control algorithms and an Interior Permanent Magnet-Synchronous Reluctance Machine (IPM-SynRM) to use in FESS.

Background Tumors are the second-most common cause of death after cardiovascular diseases. Brain tumors are really different regarding location, symptoms and signs. The aim of this study was to determine the prevalence of different primary brain tumors in Iran. Methods This cross-sectional study analyzed the medical records of patients with primary brain tumor referred to university hospitals between January 2016 and January 2017. By examining the hospitalization records, clinical symptoms, pathological and imaging findings, data was collected on age, sex, hand dominance, type of tumor, and the involved hemisphere. A chi-square test of independence was used to analyze the relationship between hand dominance and tumor grade. P-values less than 0.05 were considered statistically significant. Results In total, 1113 patients with brain tumor with mean age of 41.89 ± 18.06 years, including 708 males (63.6%), were studied in Tehran, Iran. The most common brain tumors were glioblastoma with a frequency of 330 (29.6%) and astrocytoma 183 (16.4%). The rarest tumor types are ependymoblastoma with a frequency of 14 (1.3%). Overall, 551 (49.5%) patients had left hemisphere and 459 (41.2%) had right hemisphere involvement. There was no significant relationship between hand dominance and tumor grade (p>0.05). Conclusion Brain tumors are more common in the fourth and fifth decades of life, and glioblastoma and astrocytoma tumors are the most common brain tumors. The sex distribution of these patients in the present study shows a higher prevalence in men. There was a significant relationship between the hand dominance in patients and contralateral hemisphere involvement.

In this paper, an innovative infill wall is proposed and examined experimentally and parametrically. The proposed wall has an innovative design and is constructed with lightweight concrete strengthened by waste glass. The proposed wall not only demonstrates robust performance against out-of-plane loading, but also exhibits exceptional behavior under elevated temperatures. Additionally, the necessary equations used to predict the wall’s behavior are also presented. The results reveal that glass powders affect weight loss. During the initial temperature application, ranging up to 600 °C, specimens with 0% and 8% glass powder experienced maximum and minimum weight loss, respectively. At 200 °C, glass powder concentrations below 4% caused a reduction in compressive strength, fc′, while concentrations between 4% and 8% led to an increase in fc′. Consequently, the optimal glass powder volume was determined to be 6% for specimens under varying temperature conditions. The out-of-plane loading tests indicated that although the wall was exposed to heat up to 800 °C, the resistance did not decrease significantly. Given its role as a non-load-bearing wall without the application of gravity, this innovative structure is anticipated to perform admirably in fire scenarios during seismic events.

Abstract Background Meningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis. Methods We extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study. Results Headache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens. Conclusions The most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.

Understanding the effect of vaccination on emerging SARS-CoV-2 variants of concern is of increasing importance. Here, James et al. report that two doses of vaccination with the Pfizer-BioNTech vaccine induce more robust immune responses to the B.1.1.7 and B.1.351 SARS-CoV-2 lineages than does natural infection.

Abstract Epilepsy has garnered increased public health focus because patients who suffer from epilepsy experience pronounced and persistent health and socioeconomic disparities despite treatment and care advances. The epidemiology of epilepsy is diverse in different countries and regions. This nationwide population-based cross-sectional study was conducted to determine the life time prevalence and health related factors of epilepsy for the first time in Iran through a two-phase door-to-door survey method. In phase I, a screening for epilepsy was performed on 68,035 people. Then in phase II, after the neurological evaluation of participants and reviewing medical records, 1130 subjects with epilepsy was confirmed. The life time prevalence of epilepsy was achieved to be 16.6 per 1000 people (95% CI 15.4–17.8) with the average age onset 19.1 ± 21.1 (active prevalence 9.5 per 1000 people). Focal seizure (59.3%), generalized epilepsy (38%) and unknown types of epilepsy (2.7%) were detected among participants. The overall life time prevalence of febrile convulsion was 4.1 per 1000 people. The frequency of attacks per year and per month were 3.0 ± 1.6 and 0.5 ± 0.1, respectively. Age-specific life time prevalence was highest among the age group of 15–19 years old [32.7 per 1000 persons (95% CI 29.1–36.8)] and it was higher in male (53.8%) than female (46.2%) participants. Our results showed that the life time prevalence of epilepsy in Iran is higher than worldwide average.

Farghani as scholars have took a good attention to “knowledge”, “being”, “light”, and “mystical vision” , and explained them very brightly as much as they are the four fundamental aspects existing as epenthetic, without any aspiration, in the “First-Embodiment of the Real”, and plying the role of middle reneges between Oneness of First-Embodiment and its variety aspirations at next degrees. These four aspects are going in common for “discovering the hiding aspect”. Because they lead the first embodiment to become manifest in lower descending degrees. Albeit, we can find, also, the origins of this discussion in his master, Ghonavi,. But, Farghani’s explanation of these four aspects, “knowledge”, “Being”, “Light”, and “Mystical Vision” had been at the main case of attention after him for great scholars such as Fanari, Saiin- al-Din Inb Turaka, Jami and so on. Because of this, it has been one of the subject matter in theoretical mysticism agreed by mystics and they discussed of them in their works.

Staphylococcus aureus is an important infectious factor in the food industry and hospital infections. Many methods are used for detecting bacteria but they are mostly time-consuming, poorly sensitive. In this study, a nano-biosensor based on iron nanoparticles (MNPs) was designed to detect S. aureus. MNPs were synthesized and conjugated to Biosensors. Then S. aureus was lysed and nano-biosensor (MNP-TiO2-AP-SMCC-Biosensors) was added to the lysed bacteria. After bonding the bacterial genome to the nano-biosensor, MNPs were separated by a magnet. Bacterial DNA was released from the surface of nano-biosensor and researched by Nano-drop spectrophotometry. The results of SEM and DLS revealed that the size of MNPs was 20–25 nm which increased to 38–43 nm after modification and addition of biosensors. The designed nano-biosensor was highly sensitive and specific for the detection of S. aureus. The limit of detection (LOD) was determined as 230 CFU mL−1. There was an acceptable linear correlation between bacterial concentration and absorption at 3.7 × 102–3.7× 107 whose linear diagram and regression was Y = 0.242X + 2.08 and R2 = .996. Further, in the presence of other bacteria as a negative control, it was absolutely specific. The sensitivity of the designed nano-biosensor was investigated and compared through PCR.

Summary: Background: Previous infection with SARS-CoV-2 affects the immune response to the first dose of the SARS-CoV-2 vaccine. We aimed to compare SARS-CoV-2-specific T-cell and antibody responses in health-care workers with and without previous SARS-CoV-2 infection following a single dose of the BNT162b2 (tozinameran; Pfizer–BioNTech) mRNA vaccine. Methods: We sampled health-care workers enrolled in the PITCH study across four hospital sites in the UK (Oxford, Liverpool, Newcastle, and Sheffield). All health-care workers aged 18 years or older consenting to participate in this prospective cohort study were included, with no exclusion criteria applied. Blood samples were collected where possible before vaccination and 28 (±7) days following one or two doses (given 3–4 weeks apart) of the BNT162b2 vaccine. Previous infection was determined by a documented SARS-CoV-2-positive RT-PCR result or the presence of positive anti-SARS-CoV-2 nucleocapsid antibodies. We measured spike-specific IgG antibodies and quantified T-cell responses by interferon-γ enzyme-linked immunospot assay in all participants where samples were available at the time of analysis, comparing SARS-CoV-2-naive individuals to those with previous infection. Findings: Between Dec 9, 2020, and Feb 9, 2021, 119 SARS-CoV-2-naive and 145 previously infected health-care workers received one dose, and 25 SARS-CoV-2-naive health-care workers received two doses, of the BNT162b2 vaccine. In previously infected health-care workers, the median time from previous infection to vaccination was 268 days (IQR 232–285). At 28 days (IQR 27–33) after a single dose, the spike-specific T-cell response measured in fresh peripheral blood mononuclear cells (PBMCs) was higher in previously infected (n=76) than in infection-naive (n=45) health-care workers (median 284 [IQR 150–461] vs 55 [IQR 24–132] spot-forming units [SFUs] per 106 PBMCs; p

Prior studies have demonstrated that immunologic dysfunction underpins severe illness in COVID-19 patients, but have lacked an in-depth analysis of the immunologic drivers of death in the most critically ill patients. We performed immunophenotyping of viral antigen-specific and unconventional T cell responses, neutralizing antibodies, and serum proteins in critically ill patients with SARS-CoV-2 infection, using influenza infection, SARS-CoV-2-convalescent health care workers, and healthy adults as controls. We identify mucosal-associated invariant T (MAIT) cell activation as an independent and significant predictor of death in COVID-19 (HR = 5.92, 95% CI = 2.49-14.1). MAIT cell activation correlates with several other mortality-associated immunologic measures including broad activation of CD8+ T cells and non-Vδ2 γδT cells, and elevated levels of cytokines and chemokines, including GM-CSF, CXCL10, CCL2, and IL-6. MAIT cell activation is also a predictor of disease severity in influenza (ECMO/death HR = 4.43, 95% CI = 1.08-18.2). Single-cell RNA-sequencing reveals a shift from focused IFNα-driven signals in COVID-19 ICU patients who survive to broad pro-inflammatory responses in fatal COVID-19 -a feature not observed in severe influenza. We conclude that fatal COVID-19 infection is driven by uncoordinated inflammatory responses that drive a hierarchy of T cell activation, elements of which can serve as prognostic indicators and potential targets for immune intervention.

Dental Core Trainees (DCTs) in Oral and Maxillofacial Surgery (OMFS) units participate in a wide range of clinical activities. One such activity is performing biopsies. Research into the attitudes of General Dental Practitioners towards performing biopsies concludes an overall feeling of concern surrounding the lack of practical skills and the possibility of errors which may occur as a result. To the best of our knowledge, no research has been carried out investigating the attitudes of OMFS DCTs towards performing biopsies, an integral part of their post. To investigate how confident DCTs felt towards the various aspects of performing biopsies, paper questionnaires were distributed to the OMFS DCTs in the London, Kent Surrey and Sussex (LKSS) Deanery. 73% of respondents were expected to perform biopsies independently as part of their training post yet only 12% of DCTs felt completely confident doing so. Of the DCTs involved, 78% reported that undergraduate biopsy training was delivered in the format of lectures with only 2% of participants reporting hands-on biopsy experience as undergraduate students. In light of these findings, biopsy training sessions were devised and delivered to the new cohort of OMFS DCTs at the annual ‘’Basic Surgical Skills'’ course in the LKSS deanery. Post-training questionnaires yielded improved confidence in all aspects of performing a biopsy. The positive feedback received from the course attendees combined with the improved confidence levels demonstrates how biopsy training for new OMFS DCTs can have a positive impact on trainees and ultimately the patients treated.

Mucosal-associated invariant T (MAIT) cells are innate-like T cells present at considerable frequencies in human blood and barrier tissues, armed with an expanding array of effector functions in response to homeostatic perturbations. Analogous to other barrier immune cells, their phenotype and function is driven by crosstalk with host and dynamic environmental factors, most pertinently the microbiome. Given their distribution, they must function in diverse extracellular milieus. Tissue-specific and adapted functions of barrier immune cells are shaped by transcriptional programs and regulated through a blend of local cellular, inflammatory, physiological, and metabolic mediators unique to each microenvironment. This review compares the phenotype and function of MAIT cells with other barrier immune cells, highlighting potential areas for future exploration. Appreciation of MAIT cell biology within tissues is crucial to understanding their niche in health and disease.

We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45–6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99–3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07–2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28–0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25–2.21]) and Asian (1.51 [1.28–1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34–3.15]).

Background and Aim: Alzheimer disease (AD) is the most common cause of dementia. Currently, there is no disease-modifying therapy for AD. We aimed to evaluate the long-term efficacy and safety of MLC601 in the treatment of AD. Methods: In this open-label extension study, patients with mild to moderate AD according to DSM-IV criteria were recruited. Patients received MLC601 capsules 3 times a day for 4 years. Cognitive function was assessed every 6 months using Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) scores. Safety profiles, including adverse events (AEs), and treatment-related abnormality in laboratory tests were also reported. Results: Of a total of 122 patients, 105 completed the study. The mean age was 66.8 ± 6.3 years at the beginning of the study. Sixty-five (61.9%) were female. The mean (±SD) change in MMSE and ADAS-Cog scores at the end of the study was 2.1 (±3.8) and –5.1 (±8.7), respectively. Repeated measure analysis revealed a statistically significant change in both scores (p < 0.001). No patient left the study due to an AE. No abnormality was noted in lab tests. Gastrointestinal symptoms were the most commonly reported AEs. Conclusion: The efficacy of treating AD patients with MLC601 over 4 years has been demonstrated in the present study. Overall, it seems that the safety and efficacy of MLC601 is promising compared to currently prescribed treatments.

Abstract Background Although direct-acting antivirals can achieve sustained virological response rates greater than 90% in Hepatitis C Virus (HCV) infected persons, at present the majority of HCV-infected individuals remain undiagnosed and therefore untreated. While there are a wide range of HCV serological tests available, there is a lack of formal assessment of their diagnostic performance. We undertook a systematic review and meta-analysis to evaluate he diagnostic accuracy of available rapid diagnostic tests (RDT) and laboratory based EIA assays in detecting antibodies to HCV. Methods We used the PRISMA checklist and Cochrane guidance to develop our search protocol. The search strategy was registered in PROSPERO (CRD42015023567). The search focused on hepatitis C, diagnostic tests, and diagnostic accuracy within eight databases (MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde and WHO Global Index Medicus. Studies were included if they evaluated an assay to determine the sensitivity and specificity of HCV antibody (HCV Ab) in humans. Two reviewers independently extracted data and performed a quality assessment of the studies using the QUADAS tool. We pooled test estimates using the DerSimonian-Laird method, by using the software R and RevMan. 5.3. Results A total of 52 studies were identified that included 52,673 unique test measurements. Based on five studies, the pooled sensitivity and specificity of HCV Ab rapid diagnostic tests (RDTs) were 98% (95% CI 98-100%) and 100% (95% CI 100-100%) compared to an enzyme immunoassay (EIA) reference standard. High HCV Ab RDTs sensitivity and specificity were observed across screening populations (general population, high risk populations, and hospital patients) using different reference standards (EIA, nucleic acid testing, immunoblot). There were insufficient studies to undertake subanalyses based on HIV co-infection. Oral HCV Ab RDTs also had excellent sensitivity and specificity compared to blood reference tests, respectively at 94% (95% CI 93-96%) and 100% (95% CI 100-100%). Among studies that assessed individual oral RDTs, the eight studies revealed that OraQuick ADVANCE® had a slightly higher sensitivity (98%, 95% CI 97-98%) compared to the other oral brands (pooled sensitivity: 88%, 95% CI 84-92%). Conclusions RDTs, including oral tests, have excellent sensitivity and specificity compared to laboratory-based methods for HCV antibody detection across a wide range of settings. Oral HCV Ab RDTs had good sensitivity and specificity compared to blood reference standards.

Abstract Background Chronic Hepatitis B Virus (HBV) infection is characterised by the persistence of hepatitis B surface antigen (HBsAg). Expanding HBV diagnosis and treatment programmes into low resource settings will require high quality but inexpensive rapid diagnostic tests (RDTs) in addition to laboratory-based enzyme immunoassays (EIAs) to detect HBsAg. The purpose of this review is to assess the clinical accuracy of available diagnostic tests to detect HBsAg to inform recommendations on testing strategies in 2017 WHO hepatitis testing guidelines. Methods The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using 9 databases. Two reviewers independently extracted data according to a pre-specified plan and evaluated study quality. Meta-analysis was performed. HBsAg diagnostic accuracy of rapid diagnostic tests (RDTs) was compared to enzyme immunoassay (EIA) and nucleic-acid test (NAT) reference standards. Subanalyses were performed to determine accuracy among brands, HIV-status and specimen type. Results Of the 40 studies that met the inclusion criteria, 33 compared RDTs and/or EIAs against EIAs and 7 against NATs as reference standards. Thirty studies assessed diagnostic accuracy of 33 brands of RDTs in 23,716 individuals from 23 countries using EIA as the reference standard. The pooled sensitivity and specificity were 90.0% (95% CI: 89.1, 90.8) and 99.5% (95% CI: 99.4, 99.5) respectively, but accuracy varied widely among brands. Accuracy did not differ significantly whether serum, plasma, venous or capillary whole blood was used. Pooled sensitivity of RDTs in 5 studies of HIV-positive persons was lower at 72.3% (95% CI: 67.9, 76.4) compared to that in HIV-negative persons, but specificity remained high. Five studies evaluated 8 EIAs against a chemiluminescence immunoassay reference standard with a pooled sensitivity and specificity of 88.9% (95% CI: 87.0, 90.6) and 98.4% (95% CI: 97.8, 98.8), respectively. Accuracy of both RDTs and EIAs using a NAT reference were generally lower, especially amongst HIV-positive cohorts. Conclusions HBsAg RDTs have good sensitivity and excellent specificity compared to laboratory immunoassays as a reference standard. Sensitivity of HBsAg RDTs may be lower in HIV infected individuals.

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients.

Activity centers are areas of strong development of a particular activity, such as residence, employment, or services. Understanding the subway system impacts on the type, combination, distribution and totally the development of basic activities in these centers, have an important role in managing development opportunities created along the Tehran subway lines. The multi criteria and fuzzy nature of evaluating the activity centers development make the issue as complex as cannot be addressed with conventional logical systems. One of the most important methods of multi criteria evaluation is Fuzzy Inference System. Fuzzy inference system is a popular computing framework based on the concepts of Fuzzy Sets Theory, which is capable of accommodating inherent uncertainty in multi-criteria evaluation process. This paper analyze shifts in activity centers along two lines of the Tehran subway system based on three major criteria by designing a comprehensive fuzzy inference system. The data for the present study were collected through documentary analysis, questionnaires and semi-structured interview. The result revealed that the level of the subway system influence on the pattern and process of the development of activities varied with the location, physical environment and entity of each station. Furthermore, empirical findings indicated that the subway line might weaken residential activities while attracting employment and service activities to the city center. Specifically, residential estates moved away from the city center to the suburbs whereas employment and service activities expanded from the existing central business district (CBD). The results can be applied to suggest planning policies aiming at improving the effects of public transit on property developemnet and land use change in a developing country.

Abstract Introduction: Empowerment during pregnancy is defined as a sense of self- fulfillment and increased independence, promotion of interaction with individuals and environment leading to an increase in the spontaneous psychological energy to achieve successful pregnancy and childbirth. Education during pregnancy empowers women for better adjustment confronting physical and emotional changes associated with pregnancy and experiencing a satisfying delivery. Objective: Present study was conducted to determine the empowerment of pregnant women referring to Tonekabon health centers. Methods: This cross-sectional study was conducted on 200 pregnant women who referred for prenatal care clinics to in Tonekabon in 2013. Pregnant women participating in the study were at least literate and had no significant medical problems or obstetrical pregnancy indicating a high-risk pregnancy. Besides, they had no history of previous cesarean section and gave consent to participate in the study. Cluster sampling method was used. Two centers of clusters were randomly selected. All pregnant women referring to these two centers for prenatal care were included after obtaining the written consent. The data collection tool was a questionnaire designed in two parts. The first part contained demographic and obstetric information and the second part was pregnant women's empowerment questionnaire by Kameda, with 27 questions in five dimensions; Self-efficacy (6 questions), future image (6 questions), self- esteem (7 questions), support and assurance from others (4 questions), and joy of an addition to the family (4 questions) which were answered based on the Likert scale from strongly disagree to strongly agree with 1 to 4. Minimum score of 27 and maximum score of 108 were given to the answers. The mean score was used to judge about the answers. The data were analyzed using descriptive statistics and ANOVA (given the normal distribution of data) at significance level of 95% and p=0.05. Data collection was performed after approval by the Research Council of Azad University, Tonekabon Branch. Results: The mean age of subjects was 26.38 ± 3.76 years old. 36% of women were in their first trimester of pregnancy. The majority of pregnant women (55.55%) experienced their first pregnancy and had high school education (40%) and wanted pregnancies (79.5%). 90.5% of them were homemaker. This study found the mean and standard deviation of empowerment as 78.74 ± 6.71 (Minimum score 27 and maximum score 108). Of all empowerment dimensions, the highest mean score dedicated to self-esteem (19.19 ±1.82) and the lowest to the support and assurance from others (12.70± 1.59) and joy of an addition to the family (13.66 ± 1.79). The results showed a significant correlation between mother's education and empowerment score (p= 0.03). Moreover, the relationship between interest to continue the pregnancy and empowerment was statistically significant (p=0.005). No significant difference was observed between other variables such as pregnancy age, mother's age and number of pregnancy, mother's job and support of spouse, level of income and unwanted pregnancy and total score of empowerment. Conclusion: The findings of this study can be effective in assessment of prenatal care, planning and implementing delivery preparation classes and promotion of empowerment of pregnant women. Given the role of education in promoting women's empowerment it is suggested that the effect of natural childbirth in empowering pregnant women be considered in future studies. Prenatal education brings about positive feelings, happiness in the family, promoted ability to deal with new conditions, promoted maternal and newborn health, increased confidence, satisfaction of having children, active participation of family members in maintaining family health and promoted ability to adapt and cope with the problems and responsibilities of life.

Background & Objectives: Diabetes mellitus is one of the most common endocrine disorders affecting millions of people worldwide. Here, the effects of co-administration of zinc and vanadium sulfate on blood glucose levels in diabetic animals were studied. Notably, the study on the effects of the separation of zinc and vanadium has been done previously. Materials &methods: Moderate diabetic hyperglycemia was induced by streptozotocin (STZ) 40 mg/kg, ip injection. Five groups were selected (n=5), Group I: As normal group, during the trial did not receive any drug treatment and consumed tap water during 45 days. Group II: As control diabetic group, received STZ 40mg/kg, ip injection and consumed tap water, but they did not receive any drug treatment. The diabetic animals (STZ 40mg/kg, ip) with 500-600 mg/dl blood glucose levels were randomly divided into three groups: Group IIIAs under treatment 1, used drinkable water containing 1mg/ml of vanadium sulfate. Group IV: As under treatment 2, used drinkable water (0.25 mg/ml zinc sulfate). Group V: As under treatment 3, used drinkable water (1mg/ml of vanadium sulfate and 0.25 mg/ml zinc sulfate). Results: FBS remained high in group II (468±55.32mg/dl), whereas in group III vanadium reduced the FBS level to 209.2±32.29 mg/dl. In group IV zinc reduced the FBS level to 216.4±10.44 mg/dl. In group V vanadium and zinc sulfate reduced the FBS level to 139.2±92.9 mg/dl. Conclusion: Zinc and vanadium sulfate separately can lower the blood sugar and their simultaneous oral administration has stronger impact on lowering the blood sugar.

Background: Systemic Lupus Erythematosus (SLE) is an auto-immune systemic disorder that may affect multiple organ systems including central nervous system. Although involvement of the nervous system and eye is not uncommon in SLE, the presence of intracranial hypertension (IH) with papilledema in SLE a rare occurrence and it requires high level of suspicion to be diagnosed, especially when the combination of IH and papilledema is the initial presentation of SLE. Case presentation: A 21-year-old female presented with a month long history of progressively deteriorating bilateral frontotemporal headache of throbbing quality. In neurological examination the only finding was bilateral papilledema with mild peripheral visual field Constriction. A brain Magnetic Resonance Imaging (MRI), MR angiography and venography showed no abnormal findings. Cerebrospinal fluid (CSF) analysis revealed a high opening pressure (320 mm H2O) with normal CSF indices. She also had normocytic, normochromic anemia, mild thrombocytopenia, increased quantitative CRP, ESR and LE cell was also reported. Upon further work-up, it was revealed that she had positive ANA and Anti-ds-DNA, decreased level of complement C3 and C4. She, with SLE, was treated with corticosteroid which resulted in significant improvement in patient's manifestation of IH. Conclusions: The association of IH and SLE has already been established and one should be aware of this coexistence and in IH cases, SLE should also be considered as an underlying cause and subsequently appropriate diagnostic tests should be performed. Keywords: SLE, IIH, Papilledema

Background & Objectives: Diabetes mellitus is one of the most common endocrine disorders affecting millions of people worldwide. Here, the effects of co-administration of zinc and vanadium sulfate on blood glucose levels in diabetic animals were studied. Notably, the study on the effects of the separation of zinc and vanadium has been done previously. Materials &methods: Moderate diabetic hyperglycemia was induced by streptozotocin (STZ) 40 mg/kg, ip injection. Five groups were selected (n=5), Group I: As normal group, during the trial did not receive any drug treatment and consumed tap water during 45 days. Group II: As control diabetic group, received STZ 40mg/kg, ip injection and consumed tap water, but they did not receive any drug treatment. The diabetic animals (STZ 40mg/kg, ip) with 500-600 mg/dl blood glucose levels were randomly divided into three groups: Group IIIAs under treatment 1, used drinkable water containing 1mg/ml of vanadium sulfate. Group IV: As under treatment 2, used drinkable water (0.25 mg/ml zinc sulfate). Group V: As under treatment 3, used drinkable water (1mg/ml of vanadium sulfate and 0.25 mg/ml zinc sulfate). Results: FBS remained high in group II (468±55.32mg/dl), whereas in group III vanadium reduced the FBS level to 209.2±32.29 mg/dl. In group IV zinc reduced the FBS level to 216.4±10.44 mg/dl. In group V vanadium and zinc sulfate reduced the FBS level to 139.2±92.9 mg/dl. Conclusion: Zinc and vanadium sulfate separately can lower the blood sugar and their simultaneous oral administration has stronger impact on lowering the blood sugar.

Diverse studies suggest that interleukin-6 (IL6), as a member of cytokines family, has a major role in inflammatory processes of airways and lungs. In this study, an attempt was made to determine the serum level of IL6 in sulfur mustard (SM) injured patients and its comparison with controls. The measured IL6 mean level in patients with chemical injuries (0.76±0.3 ng/ml) was significantly higher than the control group’s mean level (0.34±0.12 ng/ml). Furthermore, patients with moderate to severe symptoms had a serum level of (0.95±0.92 ng/ml) which was significantly higher than mild (0.47±0.54) and control (0.34±0.12) groups. The outcome of this research program demonstrates that an increase in serum level of IL6 can have a role in pulmonary complications of SM, similar to other well defined pulmonary diseases. However, further studies are required to clarify the role and mechanism of IL6 in such patients.

Background: MLC601 is a possible modulator of amyloid precursor protein processing, and in a clinical trial study MLC601 showed some effectiveness in cognitive function in Alzheimer's disease (AD) patients. We aimed to evaluate the effectiveness and safety of MLC601 in the treatment of mild to moderate AD as compared to 3 approved cholinesterase inhibitors (ChEIs) including donepezil, rivastigmine and galantamine. Methods: In a multicenter, nonblinded, randomized controlled trial, 264 volunteers with AD were randomly divided into 4 groups of 66; groups 1, 2, 3 and 4 received donepezil, rivastigmine, MLC601 and galantamine, respectively. Subjects underwent a clinical diagnostic interview and a cognitive/functional battery including the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Patients were visited every 4 months, and the score of cognition was recorded by the neurologists. Results: There were no significant differences in age, sex, marital status and baseline score of cognition among the 4 groups. In total, 39 patients (14.7%) left the study. Trend of cognition changes based on the modifications over the time for MMSE and ADAS-cog scores did not differ significantly among groups (p = 0.92 for MMSE and p = 0.87 for ADAS-Cog). Conclusion: MLC601 showed a promising safety profile and also efficacy compared to 3 FDA-approved ChEIs.

Background: There is no data on the prevalence and the association of gastro esophageal reflux disease (GERD) with toxic fume inhalation. Therefore, we aimed to evaluate the frequency distribution of GERD symptoms among the individuals with mild respiratory disorder due to the past history of toxic fume exposure to sulfur mustard (SM). Materials and Methods: In a historical cohort study, subjects were randomly selected from 7000 patients in a database of all those who had a history of previous exposure to a single high dose of SM gas during war. The control group was randomly selected from adjacent neighbors of the patients, and two healthy male subjects were chosen per patient. In this study, we used the validated Persian translation of Mayo Gastroesophageal Reflux Questionnaire to assess the frequency distribution of reflux disease. Results: Relative frequency of GERD symptoms, was found to be significantly higher in the inhalation injury patients with an odds ratio of 8.30 (95% confidence interval [CI]: 4.73-14.55), and after adjustment for cigarette smoking, tea consumption, age, and body mass index, aspirin and chronic cough the odds ratio was found to be 4.41 (95% CI: 1.61-12.07). Conclusion: The most important finding of our study was the major GERD symptoms (heartburn and/or acid regurgitation once or more per week) among the individuals with the past history of exposure to SM toxic gas is substantially higher (4.4-fold) than normal populations.

Paraneoplastic neurologic syndrome (PNS) is an uncommon manifestation of cancer that is not caused by the tumor or metastasis. Trigeminal neuralgia (TN) is an initial symptom of this disease, but it has rarely been reported in the literature. Here, we report the case of a 76-year-old woman who presented with classic TN, followed by limbic encephalitis due to an underlying ovarian intestinal-type mucinous borderline tumor, with the presence of anti-Hu antibodies. She recovered quickly after removal of the tumor and was essentially free of symptoms 2 weeks after surgery. Because PNS precedes the tumor in approximately 60% of cases, its rapid detection and treatment are crucial. Therefore, we propose that PNS be considered during the management of TN when brain imaging is normal, as it is followed by other central and/or peripheral neurological manifestations as well as the presence of systemic symptoms such as anemia, fatigability, loss of appetite, or weight loss.

Background: Theophylline may reverse steroid resistance and decrease inflammation in patients with chronic pulmonary disease and sulfur mustard (SM) induced bronchiolitis. This study was designed to assess the effects of low-dose theophylline on improvement of pulmonary function tests (PFTs) of SM exposed patients.Methods: In this comparative observational study, a group of SM-exposed victims during the Iraq-Iran war who were treated with oral slow releasing (SR) theophylline, salmetrol, fluxitide, omeprazole and NAC (study group) were compared to a group of age and gender matched SM-exposed patients who received same medications except oral SR theophylline (historical control group). PFTs were measured at the beginning of the study and after 8 weeks of the treatment.Results: In total, 33 subjects in the study group and 27 subjects in the control group were studied. Mean (SD) age of all subjects was 51 (14.1) years. In the study group, on the 8th week post-treatment, PFTs decreased, though the differences of tests between before and after treatment were not significant. In the control group, all the tests decreased in the same period and these reductions were not also significant. However, the changes in PFTs were significantly different between the two groups. The results of most PFTs in the controls decreased in greater extents compared to theophylline treated patients. This shows that despite theophylline was unable to improve the patients; it was partially able to decelerate the reductions in PFTs.Conclusion: Theophylline may not improve PFTs of SM exposed patients but it may decelerate the progress of the underlying respiratory disease. Further studies in this setting with higher doses of theophylline and longer term of evaluation are needed to better understand the pathophysiological mechanism of SM induced bronchiolitis and the effectiveness of the treatment with theophylline. How to cite this article: Panahi Y, Poursaleh Z, Amini-Harandi A, Saburi A, Shohrati M, Ghanei M. Study on Effectiveness of Low Dose Theophylline as Add-on to Inhaled Corticosteroid for Patients with Sulfur Mustard Induced Bronchiolitis. Asia Pac J Med Toxicol 2013;2:126-130.

Background: About 100,000 Iranian have been exposed to chemical weapons during Iraq-Iran conflict (1980-88). After being spent of more than two decades, still about 30,000 of them are under follow-up treatment. The main aim of this study was to review various preventive and therapeutic methods for injured patients with sulfur mustard in different phases. Methods: For gathering information, we have used the electronic databases including Scopus, Medline, ISI, IranMedex, Irandoc sites. According to this search strategy, 104 published articles associated to respiratory problems and among them 50 articles related to prevention and treatment of respiratory problems were found and reviewed. Results: There is not any curative treatment for sulfur mustard induced lung injuries, but some valuable experienced measures for prevention and palliative treatments are available. Some useful measures in acute phase include: Symptomatic management, oxygen supplementation, tracheostomy in laryngospasm, use of moist air, respiratory physical therapy, mucolytic agents and bronchodilators. In the chronic phases, these measures include: Periodic clinical examinations, administration of inhaled corticosteroids alone or with long-acting beta 2 agonists, use of antioxidants, magnesium ions, long term oxygen supplement, therapeutic bronchoscopy, laser therapy, and use of respiratory tract stents. Conclusions: Most treatments are symptomatic but using preventive points immediately after exposure could improve following outcomes.

Objective: This study examines the effects of hydrostatic pressure on in vitro maturation (IVM) of oocytes derived from in vitro grown follicles.Materials and Methods: In this experimental study, preantral follicles were isolated from 12-day-old female NMRI mice. Each follicle was cultured individually in Alpha Minimal Essential Medium (α-MEM) under mineral oil for 12 days. Then, follicles were induced for IVM and divided into two groups, control and experiment. In the experiment group follicles were subjected to 20 mmHg pressure for 30 minutes and cultured for 24-48 hours. We assessed for viability and IVM of the oocytes. The percentage of apoptosis in cumulus cells was determined by the TUNEL assay. A comparison between groups was made using the student’s t test.Results: The percentage of metaphase II oocytes (MII) increased in hydrostatic pressure-treated follicles compared to controls (p

Background: The association of gastro-esophageal reflux (GER) with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR) in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40%) and the controls (6.7%) prior to anti-acid therapy (P < 0.0001). After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05) but did not change in the controls (P = 0.15). Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

Objectives: To determine the levels of vascular endothelial growth factor isoform consisting of 165 amino acids (VEGF165) in Bronchoalveolar Lavage Fluid from Mustard Exposed Patients.Methods: Bronchoscopy with Bronchoalveolar Lavage was performed on sulphur mustard exposed patients. A total of 39 patients with documented exposure to Sulfur Mustard during the Iran-Iraq war participated in this study, of which 38 patients were males and one patient was female.Results: The mean±SD age of patients was 41 ± 6.6 years. The mean time after exposure to sulfur mustard was 19 ±1.7 years. Eighteen patients had concomitant war injuries but they were not related to the respiratory system. While Twenty-two patients had a history of submassive persistent hemoptysis. There was no case with massive hemoptysis. Most of the patients had small airway obstruction (FEV1/FVC�0= 78.14 ± 9.76 and FEV1�0=82.79±18.23). Twenty-three patients had significant air trapping in the chest. High Resolution Computed Tomography was compatible with BOS. VEGF165 concentrations in BALF were 36.87 ± 34.68 pg/ml. When corrected to total protein of Bronchoalveolar Lavage Fluid (BALF) it was 0.76 ± 0.70 pg/mg. BALF of VEGF did not correlate with hemoptysis or air trapping in chest HRCT. Thus, there was also no correlation between level of VEGF165 in BALF and any of PFT indexes (FVC, FEV1, MMEF or PEF).Conclusions: Although VEGF is one of the cytokines which has an important role in chronic pulmonary disorders, it seems that it has no essential role in the severity of Mustard Lung Disease.

Sulfur mustard is one of the major potent chemical warfareagents. It was widely used against not only military personnelbut also civilian people of Iran during the last years (1984–1988) of the Iraq–Iran war. A number of studies were performedregarding the acute and long-term consequences ofsulfur mustard on respiratory system. Currently, many aspectsof leading respiratory disorder that was prescribed as “mustardlung” have been revealed. However, there is growing concernabout pathophysiological mechanisms behind the mustardlung. Herein available published materials about mustard lungare summarized, and it has been tried to highlight practicalpoints relevant to the diagnosis and treatment of the disease.Iran J Med Sci 2010; 35(4): 273-280.

Objective: Human mesenchymal stem cells (MSCs) have been recognized as potentialcandidates for cell therapy. In the present study, the ability of human bone marrow mesenchymalstem cells (hBMSCs) to differentiate into cells with characteristics of cardiomyocytesin vitro was investigated.Materials and Methods: hBMSCs cultured in enriched medium were treated with oxytocinand 5-azacytidin. The differentiation of hBMSCs into cells that expressed cardiacspecificgenes such as α3-actinin, alpha - myosin heavy chain (α-MHC), beta - myosinheavy chain (β-MHC), myosin light chain isoform 2a (MLC2a), myosin light chain isoform2v (MLC2v), artial natriuretic factor (ANF), GATA4 and oxytocin receptor (OTR) was investigatedby reverse transcription-polymerase chain reaction (RT-PCR). Protein expressionsof β-actinin and troponin I-C in the cells were analyzed through immunofluorescencestaining.Results: MSCs are spindle-shaped with irregular processes. Cells treated with oxytocinand 5-azacytidin connected with adjoining cells to form myotube-like structures. Expressionsof a number of cardiac-specific genes were detected by RT-PCR. Immunofluorescencestaining analysis showed that the differentiated cells stained positively for β-actininand troponin I-C protein.Conclusion: These results indicate that adult hBMSCs can differentiate into cardiomyocytesin vitro by treatment with oxytocin and 5-azacytidin, and can be considered as asource of cells for cellular cardiomyoplasty.

Objective: Recent evidence suggests that Leukemia Inhibitory Factor (LIF), a member ofinterleukin-6 family, has biological actions on preimplantation embryo development. Alsoit is established that Epidermal Growth Factor (EGF), a strong mitosis-promoting agent,improves the preimplantation embryo development by increasing the cell metabolism andproliferation. The purpose of the present study is to investigate the effects of these factors,alone and in combination together, on preimplantation and development of the embryo.Materials and Methods: Six to eight weeks old NMRI mice were super ovulated by injectionof 10IU PMSG and 10IU hCG, then the mated mice were killed 46 hours later. Theiroviducts were flushed, two-cell embryos collected and divided randomly to the four groupsas following: Control, treatment 1 (LIF), treatment 2 (EGF), treatment 3 (LIF+EGF). In eachgroup, the embryos were cultured in an incubator at 37°C with 5% CO2 and 90% humidityfor 72hrs. The state of embryo development was evaluated in 24,36,48,60 and 72hrsfollowing the embryos cultures. By the end of the cultures, cell apoptosis was studiedby the terminal deoxynucleotidyl transferas-mediated dUTP nick end-labeling (TUNEL)technique.Results: Significant difference was detected in the rate of hatching in the LIF and LIF+EGFgroups. This difference was also seen in the rate of blastocyst formation after 36hrs(p

Background. Dyspnea is one of the main complaints in a group of COPD patients due to exposure to sulfur mustard (SM) and is refractory to conventional therapies. We designed this study to evaluate effectiveness of nebulized morphine in such patients. Materials and Methods. In a double-blind clinical trial study, 40 patients with documented history of exposure to SM were allocated to two groups: group 1 who received 1 mg morphine sulfate diluted by 4 cc normal saline 0.5% using nebulizer once daily for 5 days and group 2 serving as control who received normal saline as placebo. They were visited by pulmonologist 7 times per day to check symptoms and signs and adverse events. Different parameters including patient-scored peak expiratory flow using pick flow meter, visual analogue scale (VAS) for dyspnea, global quality of life and cough, and number of respiratory rate, night time awaking for dyspnea and cough have been assessed. Results. The scores of VAS for dyspnea, cough and quality of life and also respiratory rate, heart rate, and night time awaking due to dyspnea and night time awaking due to cough improved significantly after morphine nebulization without any major adverse events. Also pick expiratory flow has been improved significantly after nebulization in each day. Conclusion. Our results showed the clinical benefit of nebulized morphine on respiratory complaints of patients due to exposure to SM without significant side effects.

Tumefactive demyelinating lesion is defined as large solitary demyelinating lesion with imaging characteristics mimicking neoplasm. These atypical features include size more than 2 cm, mass effect, edema, and/or ring enhancement. Distinguishing tumefactive lesions from other etiologies of intracranial space occupying lesions is essential to avoid inadvertent surgical or toxic chemotherapeutic intervention. Symptoms are generally atypical for multiple sclerosis (MS) and usually related to the pressure of a focal mass lesion without a history of MS. The clinical presentation and MRI appearance of these lesions often lead to biopsy. Here, we present a young man with fulminating neurological symptoms and multiple large tumefactive lesions on either hemisphere. Since patient and parents were not agreed on brain biopsy, a course of steroid therapy was commenced which ended to considerable improvement and confirmed the diagnosis of tumefactive MS. Thirteen months later, he experienced another relapse when his treatment was continued by weekly intramuscular injection of interferon b1a (Avonex). Two further MRIs showed shrinkage of tumefactive plaques and resolution of edema in the periphery of lesions.

During the last decade, sporadic combination of multiple sclerosis (MS) and myasthenia gravis (MG) has been reported repeatedly. Although these are anecdotal, they are important enough to raise concerns about co-occurrence of MG and MS. Here, we present a case of an MS patient who developed an MG crisis. She had received interferon for relapsing remitting MS. Interestingly, she developed an MG crisis 4 years after the diagnosis of MS. MS and MG have relatively the same distribution for age, corresponding to the younger peak of the bimodal age distribution in MG. They also share some HLA typing characteristics. Furthermore, some evidences support the role of systemic immune dysregulation due to a genetic susceptibility that is common to these two diseases. The association may be underdiagnosed because of the possible overlap of symptoms especially bulbar manifestations in which either MG or MS can mimic each other, leading to underestimating incidence of the combination. The evidence warrants physicians, especially neurologists, to always consider the possibility of the other disease when encountering any patients either with MS or MG. Anecdotal and sporadic reports of combination of multiple sclerosis (MS) and myasthenia gravis (MG) have been raised concerns about co-occurrence of them.

Rhino-orbital-cerebral zygomycosis afflicts primarily diabetics and immunocompromised individual, but can also occur in normal hosts rarely. We here presented an interesting case of facial nerve palsy and multiple cold abscesses of neck due to rhino-orbital-cerebral zygomycosis in an otherwise healthy man. Although some reports of facial nerve paralysis in conjunction with rhino-orbital-cerebral zygomycosis exist, no case of bilateral complete facial paralysis has been reported in the literature to date.

The process of bronchial tissue repair/remodeling depends on balance between production and degradation achieves the regulation of extracellular matrix turnover. We designed this study to evaluate relation between Transforming Growth Factor β1 (TGFβ1) and Tissue Inhibitory of Metaloproteinase 2 (TIMP2) as two main tissue mediators on activity and reversibility of asthma and chronic obstructive pulmonary disease (COPD). In a cross sectional study we evaluated TIMP2 and TGFβ1 expression in two groups of 29 asthmatic (14 males and 15 females) and 13 male COPD patients using semi-quantitative PCR on induced sputum samples. The relation between TIMP2 and TGFβ1 and PFT indices and disease free period were assessed. The COPD patients with raised expression of both TGFβ1 and TIMP2 had better pulmonary function test (PFT) indices and also longer disease free period. In contrast patients with chronic asthma could remain in well pulmonary function status with raised TIMP2 and decreased TGFβ1 expression. We supposed that underlying inflammatory process is the main reason for the different effect of cytokines in asthma and COPD. It raises concern about critical role of corticosteroids consumption on various cytokines expression. Furthermore TGFβ1 may be served as a biomarker in sputum for assessing disease activity and evidence based prescribing corticosteroids in patients with COPD and asthma.

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT (HRCT) scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 (n= 27) refused biopsy and each was treated with macrolide therapy, while Group 2 (n=8) underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 ± 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups (p< 0.001). Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease.

Background: Chronic bronchiolitis is the most important problems of chemical victims of mustard gas. Diverse studies suggest that substance P (SP) as a member of tachykinin neuropeptides, has a significant role in the neurogenic inflammation processes of the airways and lungs. We aimed to determine the serum level of SP in chemical victims of mustard gas and compare it with normal subjects. Materials and Methods: The chemical victims were divided into the 2 groups of 30:A group with mild to moderate pulmonary symptoms and other group with moderate to severe symptoms and compared with 3 rd group as healthy controls. After preparing our samples and using the SP kit, final analysis was performed with enzyme-linked immunosorbent assay reader. Results: The Concentration of circulatory SP levels in the chemical patients was 2.86 ± 1.47 ng/ml and had not a significant difference with the control group (3.15 ± 1.03 ng/ml) (P > 0.05). The circulatory SP levels were 2.48 ± 0.92 ng/ml and 3.28 ± 1.73 ng/ml in patients with moderate to severe symptoms and mild to moderates (P < 0.05) respectively. Conclusion: The SP may have a role in pulmonary complications of mustard gas. The lower level of SP in the moderate to severe patients may be due to corticosteroid consumption in such severe cases. However, further studies are needed to clarify the roles and mechanism of SP in this setting.

Retinoic acid (RA) plays key roles in pattern formation along the major body axis and vertebrate limb formation. Exposure to excess retinoic acid in utero generates congenital malformations in craniofacial , limbs and axial skeleton. The aim of this study was to determine, the retinoic acid induced limb malformations in mouse embryo and its effect on maternal blood. In this study NMRI mice were administered by 100 mg/kg RA on day 9,10 and 11 of pregnancy . In day 18 of pregnancy embryos were obtained through cesarean section. Maternal blood was examined for hematological studies . Embryos were studied in the case of skeletal elements and histological preparations. The results demonstrate that 9 days embryos carry 37.1% forelimb defects and 31.4% hindlimb defects and 100% of 10 and 11 days embryos show limb defects . These defects include shortened or bent limbs , absence of some long bones and a wide range of digital defects. Hematological studies indicated that amounts of hemoglobin and hematocrit as well as number of red and white blood cells were reduced (p