Effects of road deicing salt on the quality of ground water resources in hamadan province, west of iran

Background: Self care of diabetes is essential for control of disease and improvement of quality of patients' life. The aim of this study was to assess factors influencing self-care practice of patients in urban area of Urmia, Northwest of Iran. Methods: In this cross-sectional study, 400 diabetic patients were randomly selected from eight healthcare centers in Urmia City in 2010. Data collection tools was a questionnaire included data on demographic characteristics, diabetes statues, and self-care practice. Patients' self-care practice was classified to good, moderate, and poor levels. ANOVA and Chi-square tests were used to exam the association between self-care practice and clinical and behavioral factors. Spearman's rho correlation was used to examine the relation between self-care practice and control of glycemia. Results: The patients' self-care practice was good in 15.1%, moderate in 58.7%, and poor in 26.2%. There was a significant association between education (P=0.030), duration of disease (P=0.04), and treatment intensity (P=0.001) and self-care practice of patients. Conclusion: Despite the important role of self-care practice in management of diabetes and preventing its serious complications, most patients who have medical record in health care centers had inappropriate self-care practice especially in SMBG, which has critical role in controlling diabetes.     

Persistence of IL-2 expressing Th17 cells in healthy humans and experimental autoimmune uveitis

Compared with other T-helper subsets, Th17 cell numbers are very low in human blood but become elevated in chronic inflammatory diseases. In this study, we investigated mechanisms that may explain the frequent involvement of Th17 cells in autoimmune diseases such as uveitis. We compared Th17 and Th1 subsets and found that Th17 cells expressed lower IL-2 levels during Ag-priming and this correlated with their decreased susceptibility to activation-induced cell death (AICD). However, complete depletion of IL-2 with IL-2 neutralizing antibodies rendered Th17 cells as susceptible to apoptosis as Th1 cells, suggesting that the low levels of IL-2 produced by Th17 cells conferred survival advantages to this subset. We describe here a Th17 subtype that constitutively produces very low levels of IL-2 (Th17-DP). The Th17-DP population increased dramatically in the blood and retina of mice during experimental autoimmune uveitis, indicating their potential involvement in the etiology of uveitis. We further show that the majority of the memory Th17 cells in human blood are Th17-DP and are targets of daclizumab, an IL-2R antibody used in treating recalcitrant uveitis. Thus, Th17 cells may persist in tissues and contribute to chronic inflammation by limiting IL-2 production to levels that cannot provoke IL-2-induced AICD yet are sufficient to promote Th17 homeostatic expansion.     

Double-blind randomized parallel-group clinical trial of efficacy of the combination fluoxetine plus modafinil versus fluoxetine plus placebo in the treatment of major depression

Background: There is growing interest in the identification of novel therapeutic agents for the treatment of affective disorders, with modafinil being one promising substance. The purpose of the present investigation was to compare the efficacy of a combination of fluoxetine plus modafinil with that of fluoxetine plus placebo in the treatment of major depression in a 6‐week double blind and placebo‐controlled trial. Methods: Forty‐six adult outpatients who met the DSM‐IV‐TR criteria for major depression participated in the trial. Patients had a baseline Hamilton Rating Scale for depression score of at least 18. Patients were allocated in a random fashion, 23 to fluoxetine 40 mg/day plus modafinil 400 mg/day (200 mg bid) (morning and evening) and 23 to fluoxetine 40 mg/day plus placebo. Patients were assessed at baseline and after 1, 2, 4, and 6 weeks after start of medication. Results: Forty‐four patients completed the trial. Fluoxetine+modafinil and fluoxetine+placebo significantly decreased the Hamilton Rating Scale score for Depression over the trial period. However, the combination of fluoxetine and modafinil was significantly superior over fluoxetine alone in the treatment of symptoms of major depression. The difference between the two treatments was significant as indicated by the effect of group, the between‐subjects factor ( df = 1, F = 4.42, P = 0.046). There were no significant differences in the two groups in terms of observed side‐effects. Conclusion: These findings suggest modafinil as a well‐tolerated and potentially effective agent in combination with fluoxetine in the management of patients with major depression. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Simultaneous Transcatheter Closure of Ventricular Septal Defect and Pulmonary Valvuloplasty

Background

Transcatheter balloon valvuloplasty has been the accepted first line treatment for congenital pulmonic stenosis (PS) in children. Transcatheter closure of perimembranous ventricular septal defect (VSD) with Amplatzer VSD occluder is an alternative to surgical repair.

Case Presentation

A 12 year old boy presented with history of exertional dyspnea and atypical chest pain. Physical findings were suggestive of severe pulmonic stenosis. Transthoracic echocardiography, right and left ventricular angiography showed medium to large sized perimembranous VSD and severe valvar pulmonary stenosis. Transcatheter closure of VSD was done first so as to avoid large left to right shunt across VSD after balloon pulmonary valvuplasty.

Conclusion

We demonstrated the feasibility and success in treating combined ventricular septal defect and severe pulmonary valve stenosis with transcatheter interventional procedure in the same session.