Mental health in three generations of Iranian medical students and doctors

Objective Despite research in Western countries finding high levels of psychological morbidity in medical students and doctors, little is known about difficulties faced by medical staff in the Middle East. The aim of the present study was to assess emotional disturbance and interpersonal attitudes in a representative sample of Iranian medical students and practitioners. Method A total of 82 medical students, 92 interns and 89 general practitioners (GPs) participated in the study. Participants rated the 28-item version of the General Health Questionnaire (GHQ-28) and a measure of interpersonal attitudes. Results A total of 44% of participants scored above the threshold of the GHQ-28, indicating probable psychiatric disorder. The GHQ-28 scores were higher in students than interns or GPs and in women compared with men. Medical students and doctors had high levels of indifference and cynicism. Conclusions This study suggests that psychological morbidity was common in Iranian medical students and practitioners, particularly women. Women were at particular risk. A high prevalence of emotional disturbance among health care practitioners is likely to compound existing problems of health care provision.     

Characteristics of the dextran-coated charcoal assay for estradiol receptor in breast cancer preparations.

The measurement of E2 receptor (E2R) in human breast cancer cytosol is significantly influenced by conditions usually employed in the dextran-coated charcoal assay. The incubation time and temperature have an influence on the rate of binding and stability of the receptor. Since lower temperatures preserve the integrity of the receptor, a 2 hr incubation at 4 degrees was selected as the standard incubation procedure. These conditions allow for the detection of at least 80% of the E2R. With supernatants from high-speed centrifugation of HBT biopsies or the human breast cancer cell line MCF-7, reducing agents increased the apparent E2R binding in the order: DTT greater than G-SH greater than MTG. The maximum enhancement of specific E2R binding by a given thiol agent was dependent on its concentration in the incubation medium. The optimum DTT level (7.5 mM) for MCF-7 cell homogenization and cytosol equilibration with tritiated E2 increased E2R to two times control (no DTT). For the HBT 150,000 g supernatant, 1 mM DTT was required to optimize the E2R quantitation. The duration of the dextran-coated charcoal extraction of the cytosol-[3H]E2 incubation had no effect on the level of E2R up to 21 hr. Minimum levels of nonspecific binding of [3H]E2 could be obtained after 4 hr extraction. Maximum depletion of specific [3H]E2 binding could be obtained by adding between 200- and 1000-fold molar excess of unlabeled E2. Greater amounts of unlabeled steroid displaced the radioactive E2 from the dextran-coated charcoal, thereby artifactually increasing the apparent nonspecific binding. This phenomenon may be overcome by utilizing more dextran-coated charcoal in the extraction. However, there was a 9% loss of specifically bound [3H]E2 per milligram of dextran-coated charcoal (1:10 dextran to charcoal by weight) when the cytosol protein was below 90 microgram per incubation. Supplementation with 200 microgram or more albumin per incubation prevented this loss. The dextran:charcoal ratio also prevented E2R loss in the order: 1:1 greater than 1:10 greater than 1:100. One milligram of dextran-coated charcoal (1:10) has the capacity to adsorb 0.3 to 0.4 microgram of free E2. Other unlabeled competitors are capable of displacing [3H]E2 on the receptor. Although DES was as effective as E2, U11,100A and estrone were inefficient competitors. It appeared that the levels of these two estrogen analogues required to maximally displace [3H]E2 on receptor also eluted labeled E2 from the dextran-coated charcoal. DES, however, was unable to displace significant quantities of the [3H] E2 from dextran-coated charcoal even at a molar excess of 50,000:1.     

Role of hormones in the growth and regression of human breast cancer cells (MCF-7) transplanted into athymic nude mice

The hormonal environments require by human breast cancer cells MCF-7 to produce solid tumors in nude mice are described. A 100% take was obtained within 7 days following inoculation of 2X10(6) actively growing (log phase) MCF-7 cells into the mammary fat pads of intact, athymic BALB/c nude mice. Tumors failed to develop, even with an inoculum of 20X10(6) cells/mouse, in ovariectomized mice or in mice made diabetic with streptozotocin and observed for 90 days after cell inoculation. A 100% incidence of tumors was obtained in mice that were either hypophysectomized or made diabetic but received injections of 0.2 IU insulin/day/mouse. A 100% incidence of tumors was also obtained in ovariectomized mice that received 17 beta-estradiol in the form of a pellet placed subcutaneously in the interscapular region at the time of cell inoculation. Palpable tumors also developed in ovariectomized mice treated with prolactin, perphenazine, estrone, or estriol, but no takes were observed in ovariectomized mice treated with progesterone, 5 alpha-dihydrotestosterone, or hydrocortisone. Growth of the MCF-7 tumor was stimulated five- to sixfold in both intact and hypophysectomized mice that each received a 17 beta-estradiol pellet. Removal of the 17 beta-estradiol pellets form tumor-bearing ovariectomized mice failed to induce tumor regression. Tumors that continued to grow in ovariectomized mice deprived of 17 beta-estradiol regressed by 50% or more of their initial volume when tamoxifen was injected for 7 days at 5 micrograms/mouse/day) +/- theophyline (1 mg/mouse/day), tumor growth arrest was observed during the 2-to 3-week treatment period. Streptozotocin-induced diabetes in tumor-bearing mice always resulted in complete tumor regression following a 3-week treatment period.     

Lectin histochemistry of the embryonic heart: Fucose-specific lectin binding sites in developing rats and chicks

Glycoconjugates, particularly their sugar side chains, play important roles in embryonic development. Changes in cell-surface-associated glyco-conjugates are known to affect cell differentiation, cellular interactions, and other developmental phenomena during embryogenesis. The embryonic heart goes through a series of complicated morphologic events during development. Of particular interest is morphogenesis of the outflow tract. This region of the embryonic heart originates from more than one cell population and undergoes a complex process of septation during formation of the great vessels. Histochemi-cal analysis with a series of fucose-specific lectins conjugated to horseradish peroxidase has revealed the presence of a fucosylated glycoconjugate in the outflow tract of the developing heart. The results reveal further that the expression of the fucosylated glycoconjugate is stage-dependent and thus probably genetically regulated. The timing and distribution of staining with the lectin OFA suggest that this fucosylated glycocoiyu-gate may play a role in directing the migration of neural crest cells into the heart and subsequent formation of the conus septum.     

Isolation of Exophiala dermatitidis from endotracheal aspirate of a cancer patient

Exophiala (Wangiella) dermatitidis is a melanised (darkly pigmented) yeast-like organism that has been reported from the environment and wild animals. The organism is a frequent coloniser of lungs of patients with cystic fibrosis and causes occasional disseminated phaeohyphomycosis and fungaemia. Exophiala dermatitidis is distributed worldwide, but cerebral cases are restricted to East Asia. We report a case of 54-year-old Qatari female patient with a known history of cancer, suffering from pulmonary disorder. Culture of endotracheal aspirate revealed the growth of E. dermatitidis concomitant with Candida krusei. The final diagnosis of E. dermatitidis and attribution to genotype B was achieved by sequencing the rDNA internal transcribed spacer (ITS) region. The present case concerns a pulmonary colonisation by E. dermatitidis, similar to that commonly seen in cystic fibrosis patients. For the detection of E. dermatitidis in clinical specimens culturing techniques are required. The patient finally expired with persistent cancer and C. krusei fungaemia. Review of literature and listing of E. dermatitidis cases published after 1992 show a sharp increase in clinical cases during the 1990s.     

Natural deaths in male prisoners: a 20-year mortality study

BACKGROUND: Although morbidity is high in prisoners compared with the general population, uncertainty exists over rates for natural causes of death. We investigated natural deaths in prisons in England and Wales over a 20-year period. METHODS: All men who died in English and Welsh prisons from 1978-1997 were identified. All deaths received a post-mortem. Death certificates were obtained to provide mortality information according to ICD-9. Standardised mortality ratios (SMRs) for major causes of natural death were calculated in those <60 years. RESULTS: 574 male prisoners died in custody from natural deaths, of which 307 (53%) deaths were from circulatory diseases and 91 (16%) from respiratory causes. Overall, SMRs for natural deaths were significantly lower than the general population (SMR = 0.70; 95% CI = 0.65-0.76). However, SMRs from respiratory pneumonia (SMR = 2.35; 1.75-3.16) and from other infectious causes were higher (SMR = 1.52; 1.03-2.23). CONCLUSION: There are important methodological challenges in calculating SMRs in prisoners. Bearing these in mind, we found increased mortality ratios for respiratory pneumonia and other infections. These findings highlight the need for the screening and effective treatment of infectious diseases in prisoners.     

Autosomal dominant cataract: intrafamilial phenotypic variability, interocular asymmetry, and variable progression in four Chilean families

PURPOSE: To document intrafamilial and interocular phenotypic variability of autosomal dominant cataract (ADC). DESIGN: Prospective observational case series. METHODS: We performed ophthalmologic examination in four Chilean ADC families. RESULTS: The families exhibited variability with respect to morphology, location with the lens, color and density of cataracts among affected members. We documented asymmetry between eyes in the morphology, location within the lens, color and density of cataracts, and a variable rate of progression. CONCLUSIONS: The cataracts in these families exhibit wide intrafamilial and interocular phenotypic variability, supporting the premise that the mutated genes are expressed differentially in individuals and between eyes; other genes or environmental factors may be the bases for this variability. Marked progression among some family members underscores the variable clinical course of a common mutation within a family. Like retinitis pigmentosa, classification of ADC will be most useful if based on the gene and specific mutation.