High level isoniazid resistance correlates with multiple mutation in the katG encoding catalase proxidase of pulmonary tuberculosis isolates from the frontier localities of Iran

The aim of this study was to investigate the significance of multiple-mutations in the katG gene, predominant nucleotide changes and its correlation with high level of resistance to isoniazid in Mycobacterium tuberculosis isolates that were randomly collected from sputa of 42 patients with primary and secondary active pulmonary tuberculosis from different geographic regions of Iran. Drug susceptibility testing was determined using the CDC standard conventional proportional method. DNA extraction, katG gene amplification, and DNA sequencing analysis were performed. Thirty four (80%) isolates were found to have multiple-mutations (composed of 2-5 mutations) in the katG gene. Increased number of predominant mutations and nucleotide changes were demonstrated in codons 315 (AGC-->ACC), 316 (GGC-->AGC), 309 (GGT-->GTT) with a higher frequency among patients bearing secondary tuberculosis infection with elevated levels of resistance to isoniazid (MIC ≥ 5-10 μg/mL). Furthermore, it was demonstrated that the combination of mutations with their predominant nucleotide changes were also observed in codons 315, 316, and 309 indicating higher frequencies of mutations among patients with secondary infection respectively. In this study, 62% (n= 21) of multi-mutated isolates found to have combination of mutations with predominant nucleotide changes in codons 315 (AGC-->ACC), 316 (GGC-->GTT), 309 (GGT-->GGT), and also demonstrated to be more frequent in isolates of patients with secondary infections, bearing higher level of resistance to isoniazid (≥ 5-10 μg/mL).     

Pharmacological evidence of involvement of nitric oxide pathway in anti‐pruritic effects of sumatriptan in chloroquine‐induced scratching in mice

Chloroquine (CQ) induces histamine‐independent itch in human and mice. We recently reported the role of intradermal nitric oxide (NO)/cyclic guanosine monophosphate pathway in CQ‐evoked scratching in mice. Chloroquine stimulates neuronal nitric oxide synthase (nNOS) activity to over‐producing NO in the skin. Sumatriptan, a 5‐hydroxytryptamine 1b/1d receptors (5‐HTR1b/1d) agonist, is involved in pain and used to treat migraine and cluster headaches. According to previous studies, sumatriptan inhibits NOS activity. Thus, we aimed to investigate the effect of sumatriptan on CQ‐induced scratching. We used the rostral back model of itch. Chloroquine was injected intradermally into the rostral back of NMRI mice, and the scratching behavior was evaluated by measuring the number of bouts over 30 min. We evaluated the effect of sumatriptan and combination of sumatriptan and a non‐selective NO synthase inhibitor, L‐N‐nitro arginine methyl ester (L‐NAME), on the scratching behavior. Additionally, the changes of skin, hippocampus, and cortical nitrite level after different treatments were studied. Intraperitoneal and intradermal sumatriptan attenuates CQ‐induced itch which reversed by GR‐127935, the selective 5‐HTR1b and 5‐HTR1d antagonist. Co‐administration of subeffective doses of sumatriptan and L‐NAME significantly decreases the scratching behavior. Intradermal injection of CQ significantly increases the intradermal nitrite levels while it does not have any significant effects on hippocampal or cortical nitrite concentrations. Likewise, the effective doses of intraperitoneal and intradermal sumatriptan significantly reduce intradermal nitrite levels. We concluded that sumatriptan suppresses CQ‐induced itch most likely by activating 5‐HT1b/1d receptors. This effect probably mediates through NO pathway.     

On Growth and Morphology of TiO2 Nanotubes on Ti6Al4V by Anodic Oxidation in Ethylene Glycol Electrolyte: Influence of Microstructure and Anodization Parameters

Different studies demonstrated the possibility to produce TiO₂ nanotubes (TNTs) on Ti6Al4V alloy by electrochemical anodization. However, the anodizing behavior of α and β-phases in organic electrolytes is not yet clarified. This study reports on the anodizing behavior of the two phases in an ethylene glycol electrolyte using different applied potentials and anodizing times. Atomic force and scanning electron microscopies were used to highlight the anodic oxides differences in morphology. It was demonstrated that the initial compact oxide grew faster over the β-phase as the higher Al content of the α-phase caused its re-passivation, and the higher solubility of the V-rich oxide led to earlier pores formation over the β-phase. The trend was inverted once the pores formed over the compact oxide of the α-phase. The growth rate of the α-phase TNTs was higher than that of the β-phase ones, leading to the formation of long and well defined nanotubes with thin walls and a honeycomb tubular structure, while the ones grown over the β-phase were individual, shorter, and with thicker walls.     

Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: a structural equation modeling approach

Predicting the significant determinants of health-related quality of life through the application of structural equation modeling in adolescents has received little attention in the health education and health promotion literature. The purpose of this study was to investigate the relationships between self-efficacy, barriers, social support, health-promoting lifestyle, and health-related quality of life among Iranian adolescent girls. Pender's health promotion model guided this study. This was a cross-sectional survey of 500 students who were recruited in Kashan, Iran. Their health-related quality of life was measured by using the Short Form Health Survey. A path analysis was conducted to predict the health-related quality of life determinants. The results indicated that 71% of the variance in health-related quality of life could be predicted by the variables. The results affirmed that self-efficacy was the most significant predictor of the students' health-related quality of life. It was concluded that interventions that are aimed at improving self-efficacy can lead to the enhancement of health-related quality of life among adolescent girls in the developing country of Iran.     

A Meta-Analysis of the Efficacy of Sulfasalazine in Comparison with 5-Aminosalicylates in the Induction of Improvement and Maintenance of Remission in Patients with Ulcerative Colitis

Background Historically, sulfasalazine (SSZ) and 5-aminosalicylates (5-ASAs) have been a mainstay of mild-to-moderate ulcerative colitis (UC) remission induction and maintenance therapy. Considering the pivotal role of intestinal microbial flora in pathophysiology of UC and antimicrobial activity of sulfapyridine, we hypothesized that SSZ might be more effective than 5-ASAs in the management of UC. Aim To compare the efficacy and tolerability of SSZ with each of the 5-ASAs (mesalamine, olsalazine, and balsalazide) by a meta-analysis technique. Methods Pubmed, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched for studies compared efficacy and/or tolerability of SSZ with 5-ASAs in the management of UC. The search terms were: “sulfasalazine” or “sulfasalazine” and “5-aminosalicylic acid,” “mesalazine,” “mesalamine,” “olsalazine” or “balsalazide” and “ulcerative colitis.” Data were collected from 1966 to April 2008. There was no language restriction. “Overall improvement,” “relapse rate,” “total adverse events,” and “withdrawals because of adverse events” were the key outcomes of interest. Results Twenty randomized placebo controlled trials met our criteria and were included in the meta-analysis. Comparison of SSZ with mesalamine yielded a nonsignificant relative risk (RR) of 1.04 (95% confidence interval of 0.89–1.21, P = 0.63) for overall improvement, a nonsignificant RR of 0.98 (95% CI 0.78–1.23, P = 0.85) for relapse, a nonsignificant RR of 0.76 (95% CI 0.54–1.07, P = 0.11) for any adverse events, and a nonsignificant RR of 0.78 (95% CI 0.46–1.3, P = 0.33) for withdrawals due to adverse events. Comparison of SSZ with olsalazine yielded a nonsignificant RR of 1.14 (95% CI 0.91–1.43, P = 0.25) for overall improvement, a nonsignificant RR of 0.93 (95% CI 0.77–1.12, P = 0.42) for relapse, a nonsignificant RR of 1.21 (95% CI 0.9–1.61, P = 0.20) for any adverse events, and a nonsignificant RR of 1.53 (95% CI 0.93–2.52, P = 0.09) for withdrawals due to adverse events. Comparison of SSZ with balsalazide yielded a nonsignificant RR of 1.3 (95% CI 0.93–1.81, P = 0.12) for overall improvement, and a significant RR of 0.17 (95% CI 0.06–0.49, P = 0.001) for withdrawals because of adverse events. Conclusion SSZ does not differ from mesalamine or olsalazine in terms of efficacy and tolerability in UC. Withdrawal from study due to adverse events was significantly lower for balsalazide compared with SSZ. Convincing conclusions on the comparison of effectiveness and safety of balsalazide and SSZ in UC remains to be elucidated by further clinical trials. Considering the lower cost of treatment with SSZ and the equal rate of adverse events with other 5-ASAa, it is not surprising to suggest SSZ as a first-choice treatment for UC and reserve 5-ASAs for when SSZ intolerability occurs.     

Late listeriosis after fludarabine plus prednisone treatment

SUMMARY. Fludarabine plus prednisome treatment in patients with chronic lymphocytic leukaemia has recently been correlated with an increased incidence of Listeria monocytogenes infections. We observed a patient with chronic lymphocytic leukaemia who received fludarabine plus prednisone and developed a fatal listeriosis 7 months later. A further case of listeriosis has recently been described in a man who developed the infection 2 years after successful fludarabine treatment while he had a normal CD4 lymphocyte count. These cases suggest that the risk period for the development of such an unusual infection could be unexpectedly and unpredictably long. This data could be important in the evaluation of a possible antibacterial prophylaxis schedule and in the wariness about the potential danger of food known to contain L. monocytogenes .     

Evaluation of lactate and C-reactive protein in the assessment of acute myocardial infarction

PURPOSE: The purpose of this study was to assess the usefulness of lactate and C-reactive protein as early markers of acute myocardial infarction (AMI) in conjunction with established markers, such as creatine phosphokinase (CPK)-MB and troponin I. METHODS: The study population consisted of all patients admitted with suspected AMI regardless of age, race, gender, or comorbid conditions. All patients in cardiac heart failure or cardiogenic shock were excluded. Lactate and C-reactive protein were drawn at admission, and then at 2 and 4 hours, respectively. The positive and negative predictive values of these markers were calculated in relation to the primary outcome measure. RESULTS: A total of 62 patients were enrolled in the study. Of those, 18 patients had documented AMI and all underwent thrombolysis, thrombolysis with angioplasty, or stent placement. The lactate was measured at 2 and 4 hours, and lactate levels correlated with CPK and CPK-MB, in addition to troponin I. In our cohort, lactate had a sensitivity of 75% and a specificity of 95.5%, with a positive predictive value of 85.7% and a negative predictive value of 91.3%. CONCLUSION: As an inexpensive and readily available marker for AMI, lactate seems to be reliable and could be used in an emergency setting to facilitate the decision-making process for chest pain syndrome. It would be a helpful adjunct on whether the patient can be safely discharged or should be promptly admitted.