Update on the efficacy of statins in primary and secondary prevention of atrial fibrillation

Atrial fibrillation is the most common arrhythmia in adults and its prevalence is growing rapidly. It has been shown that AF is associated with increased risk of heart failure, ischemic and hemorrhagic stroke, and mortality. Hence, there is growing interest among researchers in seeking preventive and therapeutic interventions regarding AF. In recent decades, it has been suggested that statins may decrease the incidence of AF and may also decrease its recurrence after cardioversion and catheter ablation. These effects are thought to be mediated by different mechanisms such as modulating inflammation, altering the properties of transmembrane ion channels, interfering with activation of matrix metalloproteinases, and acting on endothelial function. In this article, we review and update current knowledge about the role of statins in primary and secondary prevention of AF in general and specific populations.     

Delayed Neurological Complications of Sulphur Mustard and Tabun Poisoning in 43 Iranian Veterans

Delayed neurotoxic complications of chemical warfare agents (CWA), such as sulphur mustard (SM) and tabun, in human beings have not been reported in detail. We thus aimed to investigate possible neurotoxic complications of these agents in Iranian veterans 22–27 years after exposure. After co‐ordination with the veteran foundation and obtaining the approval of the medical research ethics committee, 43 Iranian veterans with late complications of CWA exposure during the Iran–Iraq conflict were studied after obtaining signed written informed consent. Demographic and clinical findings were recorded on pre‐designed forms. Neurological examination was performed by a neurologist. Routine biochemical tests were performed for all the patients. Electromyography (EMG), nerve conduction velocity (NCV) and electroencephalography (EEG) were carried out as clinically indicated. The majority of the patients (38) had been exposed to SM and only five patients to tabun. Hyperaesthesia was the most objective finding (72.1%). Fatigue (93%), paraesthesia (88.3%) and headache (83.7%) were the most common subjective findings in the patients. Sensory nerve impairments, including paraesthesia (88.3%), hyperaesthesia (72.1%) and hypoesthesia (11.6%), were the most common observed clinical complications. EMG and NCV were impaired in seven patients (16.3%) who were all SM‐exposed patients but did not show any significant correlation with organ complications. EEG was negative even in the seized patients. Cholesterol, LDL and triglyceride levels were significantly above the normal ranges. Late neurological complications of CWA, particularly SM poisoning, are considerable even after three decades of exposure and require medical attention.     

A New,High Yield,Rapid, and Cost‐Effective Protocol to Deprotection of Cysteine‐Rich Conopeptide,Omega‐Conotoxin MVIIA

Almost all conopeptides purified from Conus venoms are cysteine‐rich peptides. Among them, omega‐conotoxin MVIIA, FDA approved peptide drug (Prialt^®), selected as a cysteine‐rich model that its protection from oxidation is critical during solid phase synthesis. Deprotection of cysteines is a crucial step after peptide synthesis. The current study aimed to set up a new highly efficient deprotection protocol for omega‐conotoxin MVIIA. Deprotection was performed based on mercury acetate with significant major modification. The protocol accomplished based on the best molar ratio of peptide/mercury/2‐ME that adjusted to 0.2 mm /3 mm /10 mm (50 μg/1 mg/10 μL). The yield and purity of omega‐conotoxin MVIIA obtained at 93 and 95%, respectively. The total time of protocol shortened to 90 min instead of 6–20 h in routine methods. In this study, omega‐conotoxin MVIIA was recovered in high yield and in the shortest time. Despite of other known protocols, molar ratio adjusted to minimum amount. In conclusion, this protocol would be suggested to cost‐effective deprotection of thiol groups for similar cysteine‐rich peptides.     

Effects of challenging games on manipulative motor skills of 4–6 years old children: an application of challenge point framework

The present study aimed to investigate the predictions of challenge point theory (2004) by comparing challenging and non-challenging games groups in developing manipulative fundamental motor skills. Thirty children, aged 4–6 years, from one of the kindergartens of Tehran were divided into the groups. The games were similar in both groups; however, the challenge of these games increased in the challenging group, while it was fixed in the non-challenging group. The sample received two 42-minute intervention sessions per week for 8 weeks and the children’s skills were assessed by TGMD-2. The results of MANOVA indicated there was no significant difference between the groups in manipulative skills and all subscales except catching, in which the challenging group outperformed the non-challenging group. In conclusion, although the predictions of the challenge point theory were not confirmed, improvement of the challenging group in catching indicated more effectiveness of this method in complex skills.     

Efflux pump inhibitory activity of biologically synthesized silver nanoparticles against multidrug-resistant Acinetobacter baumannii clinical isolates

This study was carried out to investigate the possible efflux pump inhibitory activity of biologically synthesized silver nanoparticles (AgNPs) against multidrug-resistant (MDR) Acinetobacter baumannii isolates. In this study, the physicochemical characteristics of synthesized AgNPs were investigated using scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier transform infrared spectrophotometer (FTIR) methods. Subsequently, MDR A. baumannii isolates were recovered from clinical samples and the phenotypic cartwheel efflux assay and polymerase chain reaction (PCR) were used to elucidate the possible presence of efflux pump in MDR strains. After treatment of MDR strains with sub-minimum inhibitory concentration (MIC) concentration of AgNPs, the expression level of efflux pump genes was evaluated using a quantitative real-time PCR technique. The synthesized AgNPs had a spherical nanostructure, with mean size 38.89 nm, according to SEM and TEM data. XRD and FTIR results confirmed the synthesis of AgNPs. The results of PCR revealed that among 50 strains, 12 A. baumannii strains had efflux pump genes and the expression level of AdeA, AdeC, AdeS, AdeR, AdeI, AdeJ, and AdeK efflux pump genes was downregulated significantly after the treatment with AgNPs. In addition, the inhibitory effect of AgNPs on efflux pumps can be detected when the MIC of ethidium bromide (EtBr) with AgNPs is lower than that of EtBr alone. According to the results, the biologically synthesized AgNPs exhibit efflux pumps inhibitory activity, which may be one of the possible mechanisms of their antibacterial activity against MDR A. baumannii strains.     

Antiproliferative Effect of Gaillardin from Inula oculus-christi in Human Leukemic Cells

Abstract

Gaillardin (GLN) is a sesquiterpene lactone isolated from the chloroform extract of Inula oculus-christi L. This natural compound has shown cytotoxicity in various cancerous cell line. However, its effect on leukemic cells is ambiguous. Due to the neurotoxicity of vincristine (VCR) in acute lymphoblastic leukemia (ALL), we aimed to examine the cytotoxic effects of GLN alone and in combination with vincristine on induction of apoptosis, and cell cycle progression in ALL cell lines (NALM-6 and MOLT-4). Our results displayed that GLN could induce cytotoxic effects in MOLT-4 and NALM-6 with IC₅₀ values of 7.3 and 6.1?μM, respectively. In this study, we demonstrated that GLN induces cytotoxicity through G0/G1 phase arrest followed by apoptosis in a dose-dependent manner. Fortunately, this natural compound did not show significant cytotoxic effects on normal cells. This study demonstrated that GLN was capable to extend chemotherapeutic sensitivity in ALL cells by reducing VCR concentration without constraining its effectiveness. Therefore, it might act as a promising anticancer agent for the treatment of leukemia.     

Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries

Clinical toxicology is not recognized as a clinical speciality in Iran. After the chemical war gas attack by the Iraqi army against the Iranian troops in the 1980s, health professionals and Iranian authorities noticed the importance of this field in clinical medicine. Collaboration between the clinical toxicologists and toxicologists of pharmacy schools resulted in the establishment of the Iranian Society of Toxicology and Poisonings in 1991 and the National Board of Toxicology in 1993. Clinical toxicology fellowship was also formed as a joint collaboration between the toxicology and internal medicine boards in 2010. Medical doctors who specialized in clinical medicine are eligible to take the entrance examination of the fellowship. In spite of the advancement of clinical toxicology and increased number of acute poisonings and drug abuse, undergraduate teaching in this field is still lacking and being taught as part of the forensic medicine curriculum since 1952. There is a lack of an efficient national poison information and control centre (s) in Iran, and no action plan and practical efforts have been done for poisoning prevention. Therefore, the number of drug abuse and acute poisonings has increased over the past four decades and induced cultural, social and health problems. According to Iranian legal medicine organization reports, poisoning is the second‐most occurring cause of unnatural death. The suicidal attempt is the most common method of acute poisoning in adults. Suicidal attempt including self‐poisoning is not accepted in the Islamic point of view, and thus self‐poisoning is mostly neglected and may not be treated appropriately in time in some regions of Iran. Accidental poisoning in children is also common in Iran and estimated to be between 20 000 and 25 000 cases annually over the recent years. In addition, social, cultural and economic problems have induced more health problems such as drug abuse and addiction even in children. Adulterated opium to lead for economic gaining has produced thousands of cases of lead poisoning over the past few years in nearly all opium addicts, which is still a major health problem in Iran. Ban on alcoholic beverages leads some people to make their own home‐made spirits, which is unfortunately contaminated with methanol. Thousands of cases of methanol poisoning and even some epidemics have occurred over the past four decades in some parts of the country. Lack of availability of essential antidotes such as succimer and fomepizole has been a major problem for the effective treatment of poisoned patients. Despite the well‐known fact that cases of poisoning and drug overdose constitute a significant proportion of hospital admissions in some developing countries, clinical toxicology education and medical care of the poisoned patients are lacking. Therefore, policymakers and health authorities should realize the importance of toxicology in clinical medicine. The Iranian Ministry of Health, medical care and Medical Education should implement clinical toxicology courses for medical students; establish effective national poisons information and control centres and advance clinical toxicology services for appropriate management of poisoned patients to improve public health and the overall health policy goals.