Endoscopic and histologic findings in Iranian patients with heartburn.

BACKGROUND: Heartburn is a common manifestation of gastroesophageal reflux disease. Barrett's esophagus and esophageal adenocarcinoma, known complications of this disease, appear to be less prevalent in Asia than in Western countries. We looked for endoscopic and histologic evidence of Barrett's esophagus in Iranian patients with heartburn. METHODS: During September 2001 to September 2003, endoscopy was done in all patients with heartburn, either lasting longer than 3 months (n=1182) or for 1-3 months but resistant to 4 weeks of omeprazole therapy (n=66). Biopsy was taken from columnar-lined mucosa above the GE junction, at 5 cm above the Z line in normal- appearing mucosa, and from any abnormal areas. RESULTS: Of the 1248 patients (mean age 45 [SD 15.5] years, 750 men; duration of heartburn 68 [SD 87.5] months), 960 (66.5%) had erosive esophagitis and 30 (2.4%) had Barrett's esophagus, including 10 and 20 with long- and short-segment involvement, respectively. Of 134 patients with normal-appearing mucosa, 122 had histologic evidence of esophagitis. CONCLUSION: Barrett's esophagus may be less common in Iran than in Western countries, despite presence of severe heartburn and erosive esophagitis.     

Traffic crash accidents in Tehran, Iran: Its relation with circadian rhythm of sleepiness

Purpose: Road traffic accidents are one of main problems in Iran. Multiple factors cause traffic accidents and the most important one is sleepiness. This factor, however, is given less attention in our country. Road traffic accidents relevant to sleepiness are studied. Methods: In this cross-sectional study, all road traffic accidents relevant to sleepiness, which were reported by police, were studied in Tehran province in 2009. Results: The risk of road traffic accidents due to sleepiness was increased by more than sevenfold (odds ratio=7.33) in low alertness hours (0:00-6:00) compared to other time of day. The risk of road traffic accidents due to sleepiness was decreased by 0.15-fold (odds ratio=0.15) in hours with maximum of alertness (18:00-22:00) of circadian rhythm compared to other time of day. Conclusion: The occurrence of road traffic accidents due to sleepiness has significant statistical relations with driving during lowest point of alertness of circadian rhythm.     

Impact of smoking on pemphigus

Background  A positive history of smoking is less common in patients with pemphigus than in healthy subjects. The aim of this case–control study was to compare the remission rate and clinical locations involved in smokers and nonsmokers with pemphigus vulgaris.
Methods  Seventy patients with pemphigus vulgaris, treated with a uniform protocol, were enrolled. The sites of involvement, average time needed for disease control, and number of relapses were compared in smokers and nonsmokers. At the end of the first and second years of treatment, the rate of remission was compared in the two groups.
Results  Ten of the patients were current cigarette smokers, but the other 60 (85.7%) had no history of smoking. There was no difference in the rate of cutaneous or mucosal involvement between smokers and nonsmokers. The predominant subtype was the mucocutaneous type in both groups. Smokers with pemphigus vulgaris achieved partial remission more frequently than nonsmokers at the end of the first year of treatment. The number of patients in remission at the end of the second year of therapy was significantly higher for smokers with pemphigus than for nonsmokers. The main reason for disease activity in both groups was recurrence.
Conclusions  Cigarette smoking may not affect the rate of cutaneous or mucosal involvement in pemphigus; however, the data indicate that remission may be achieved sooner in pemphigus patients who smoke.     

Fabrication of long-acting insulin formulation based on poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanoparticles: preparation,optimization, characterization,and in vitro evaluation

The purpose of this research was the fabrication, statistical optimization, and in vitro characterization of insulin-loaded poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) nanoparticles (INS-PHBV-NPs). Nanopar-ticles were successfully developed by double emulsification solvent evaporation method. The NPs were characterized for particle size, entrapment efficiency (EE%), and polydispersity index (PDI). The NPs also were characterized by scanning electron microscopy (SEM), Fourier transformed infrared spectroscopy (FTIR), X-ray diffraction (XRD), differential scanning calorimetry (DSC), and circular dichroism (CD). The optimum conditions were found to be 1.6% polyvinyl alcohol (PVA), 0.9% of PHBV, and 15?mg/ml of insulin with the aid of the Box–Behnken experimental design results. The optimized NPs showed spherical shape with particle size of 250.21?±?11.37?nm, PDI of 0.12?±?0.01, and with EE% of 90.12?±?2.10%. In vitro drug release pattern followed Korsmeyer–Peppas model and exhibited an initial burst release of 19% with extended drug release of 63.2% from optimized NPs within 27?d. In conclusion, these results suggest that INS-PHBV-NPs could be a promising candidate for designing an injectable sustained release formulation for insulin.     

Marasmus and pneumocystis carinii pneumonia in institutionalised infants

An endemic of interstitial plasmacell pneumonia due to pneumocystis carinii, leading to 68 deaths in an orphanage, is described. Artifical nutrition led to severe intestinal infections with prolonged diarrhoea, followed by atrophy of the upper intestinal mucosa and marasmus. The IgG levels fell below 200mg% by the 3rd to 4th month of life, which is one of the preconditions for an infection with pneumocystis carinii.Infants with much higher levels of immune-globulins could not survive before the advent of antibiotics. Epidemics with pneumocystis carinii were therefore not seen prior to World War II.Interstitial plasmacell pneumonia leads to immunity in those infants who survive and is therefore clearly distinct from the pneumocystosis, which occurs in congenital immunodeficiency syndromes and in patients who undergo persistent therapeutic immunosuppression.This study has been supported by NIH grant Al-06404.     

Pemphigus vulgaris in Iran: a clinical study of 140 cases

BACKGROUND: Pemphigus vulgaris (PV) is a rare autoimmune blistering disease of the skin and mucous membranes. It varies in its clinical profile and epidemiologic characteristics in different parts of the world. OBJECTIVE: To determine the clinical features of PV in Iran in a prospective manner. METHODS: The study included 140 patients with newly registered PV attending our dermatology clinic between January 2003 and June 2004. RESULTS The mean age at the onset of the disease was 41.5 +/- 15.7 years, with a female to male ratio of 1.59 : 1. At presentation to our clinic, both skin and mucosal involvement was observed in 95 patients (67.9%). Cutaneous lesions without the involvement of the mucous membranes were seen in nine patients (6.4%), and exclusive mucosal involvement was present in 36 patients (25.7%). The most common initial localization of the disease was the oral cavity, which was involved in 93 patients (77.5%). The most frequent cutaneous and mucosal sites involved were the thorax and oral cavity, respectively. CONCLUSION: Although minor differences were noted, the results of this study are in relatively good agreement with the literature with regard to the age, gender, and initial presentation of PV in Iran. Some skin sites, such as the scalp, thorax, and axilla, may be more commonly affected in men. Patients with initial mucosal lesions were significantly younger than those with initial cutaneous involvement. Mucosal lesions other than the oral mucosa may be more common than previously thought.     

A Modified CGM Algorithm Enhances Data Availability While Retaining iCGM Performance

The algorithm for the Dexcom G6 CGM System was enhanced to retain accuracy while reducing the frequency and duration of sensor error. The new algorithm was evaluated by post-processing raw signals collected from G6 pivotal trials ({"type":"clinical-trial","attrs":{"text":"NCT02880267","term_id":"NCT02880267"}}NCT02880267) and by assessing the difference in data availability after a limited, real-world launch. Accuracy was comparable with the new algorithm—the overall %20/20 was 91.7% before and 91.8% after the algorithm modification; MARD was unchanged. The mean data gap due to sensor error nearly halved and total time spent in sensor error decreased by 59%. A limited field launch showed similar results, with a 43% decrease in total time spent in sensor error. Increased data availability may improve patient experience and CGM data integration into insulin delivery systems.