Effect of folic acid in women with and without insulin resistance who have hyperhomocysteinemic polycystic ovary syndrome.

OBJECTIVE: To study the effect of folic acid on homocysteine (Hcy) levels in women with insulin resistance and polycystic ovary syndrome (PCOS) in a prospective clinical trial. METHOD: Of 210 women with PCOS, 70 were hyperhomocysteinemic; and of these, 32 were insulin resistant and 38 were not. The 70 women were treated with folic acid for 3 months. Baseline and serum levels of Hcy and insulin were measured in both groups. RESULTS: In both groups Hcy concentrations were significantly decreased following folic acid supplementation. The mean+/-SD levels before and after treatment were 14.03+/-1.5 micromol/L and 12.53+/-1.72 micromol/L in group 1 (P<0.001), and they were 12.07+/-0.87 micromol/L and 8.83+/-0.78 micromol/L in group 2 (P<0.001). CONCLUSION: The Hcy levels of hyperhomocysteinemic women with PCOS were reduced after 3 months of folic acid supplementation, and the rate of reduction was higher among women without insulin resistance. No change was found in fasting insulin levels.     

Photodynamic therapy of head and neck basal cell carcinoma according to different clinicopathologic features

BACKGROUND AND OBJECTIVES: We aimed to treat different pathologic types of basal cell carcinomas (BCCs) using photodynamic therapy (PDT). STUDY DESIGN/MATERIALS AND METHODS: Thirty lesions in six patients underwent PDT. The photosensitizer used was Photoheme, a hematoporphyrin derivative IX. It was injected intravenously at the dose of 2-3.25 mg/kg. After 24 hours, the lesions were illuminated by laser light (lambda = 632 nm, light exposure dose = 100-200 J/cm2). Lesions were evaluated pre and post-operatively and at follow-up sessions (of up to 6 months). RESULTS: After a single session of PDT, the average response rate in different histopathologic kinds of basal cell carcinoma (e.g., ulcerative, superficial, nodular, and pigmented forms) were 100%, 62%, 90%, and 14%, respectively. In patients who responded completely, the cosmetic results were excellent and there were no recurrence at 6th month of follow-up. CONCLUSION: Although PDT seems to be an effective treatment modality for superficial, ulcerative, and nodular BCCs, it is not recommended for pigmented lesions.     

Army junior dental officer retention

OBJECTIVES: The objectives of the survey were to quantify the extent of indebtedness of junior dental officers and to determine the impact of a loan repayment program on career decisions. METHODS: We designed a customized survey instrument because no preexisting, validated, survey instrument was available. A query was performed in the Medical Operations Data System to identify all captains (0-3) currently on active duty in the Army (N = 348). The survey sample included 64 junior officers with a 2000 date of rank to captain (0-3), of whom only 52 were in the Medical Command Outlook address book or the Army Knowledge Online white pages. The questionnaire was sent out to these targeted junior dental officers through their official e-mail accounts. Dentists assigned to Korea and to dental field units do not use the same e-mail system as the rest of the Dental Command; therefore, their addresses were not available. In an attempt to increase response rates, commanders were asked to emphasize the importance of responding to the questionnaire. RESULTS: From the sample population of 52 officers who were queried directly, 34 responses were received, for a response rate of 65%. However, commanders forwarded the survey to all Dental Command captains and 102 responses were received. The respondents represented 30% of the total Army inventory of captains; 92% of respondents reported that they had dental school loans, with 43% reporting loans in excess of dollar 50,000. The average dental school indebtedness was approximately dollar 60,700. More than 60% of all respondents reported that loan repayment could change their minds about remaining on active duty. Officers not included in the original sample rated the impact of loan repayment statistically higher than did officers in the original sample. CONCLUSIONS: The findings were that the majority of junior Army dental officers had significant student loans and many of these officers indicated that they would consider remaining on active duty if loan repayment or other monetary inducements were offered.     

A survey of relationship between anxiety,depression and duration of infertility

Background  

A cross sectional study was designed to survey the relationship between anxiety/depression and duration/cause of infertility, in Vali-e-Asr Reproductive Health Research Center, Tehran, Iran.     

In vivo study on the roles of cytochrome P450 enzymes for metabolism of 3,4-methylenedioxymethamphetamine (Ecstasy) in rats

Some major metabolic pathways of 3,4-methylenedioxymethamphetamine (MDMA) have been shown to be dependent on cytochrome P450 (CYP) isozymes by in vitro studies. The aim of this study was to clarify the roles of these CYP enzymes for in vivo metabolism of MDMA with respect to two pathways using rats: N-demethylation of MDMA to 3,4-methylenedioxyamphetamine (MDA) and O-demethylenation of MDMA to 3,4-dihydroxymethamphetamine (HHMA)followed by O-methylation to 4-hydroxy-3-methoxymethamphetamine (HMMA). Rats were pretreated with phenobarbital (PB, 80 mg/kg i.p.) or β-naphthoflavone (BNF, 80 mg/kg i.p.) once a day for 3 days before administration of MDMA (10 mg/kg i.p.). Metabolic changes were monitored by measuring the urinary excretion of MDMA and its metabolites. Twenty-four hours after MDMA administration, MDA in rat urine was significantly decreased by 43% and 70%, and HMMA was significantly increased by 33% and 64% in urine samples from PB-pretreated and BNF-pretreated rats, respectively, as compared with the control values. Testosterone 6β-hydroxylase (CYP3A), pentoxyresorufin O-dealkylase (CYP2B1), ethoxyresorufin O-deethylase (CYP1A1), and methoxyresorufin O-demethylase (CYP1A2) activities were increased 2–6 fold in both PB-pretreated and BNF-pretreated rat liver microsomes sampled at 24 h after MDMA administration as compared with the control values. These results suggest that PB-induced and BNF-induced CYP enzymes have inhibitory effects on N-demethylation of MDMA to MDA in vivo in rats. If HHMA is the precursor of HMMA in rats, there is a possibility that the O-demethylenation of MDMA to HHMA is increased by the induced CYP enzymes. The decreased urinary concentration of MDMA and very low percent recoveries of MDA, HMMA, and (4-hydroxy-3-methoxyphenyl)acetone (HMPA) in the inducer-pretreated groups suggest that other metabolic pathways of MDMA exist and are activated under the present experimental conditions.     

Pediatric Psychiatric Emergencies

TOPIC: Pediatric psychiatric emergencies, on the increase in emergency departments, challenge mental health professionals and nurses. PURPOSE: To focus on the information needed to evaluate pediatric psychiatric emergencies and the information-gathering process. SOURCES: Personal observations and experiences, published literature. CONCLUSIONS: The efficiency and efficacy with which pediatric psychiatric evaluations are conducted depend on the evaluator's knowledge of the minimum required information for such assessment and the strategies available for overcoming barriers.