Standardised mortality ratios in people exposed to sulphur mustard during the Iran-Iraq war: a retrospective study with 39-year follow-up

OBJECTIVES

Sulphur mustard (SM) is a chemical weapon agent that was extensively used by Iraqi troops during the Iran-Iraq war (1980-1988), resulting in exposure among Iranian military personnel and civilians. However, there is limited and conflicting information about the long-term mortality effects of SM exposure. This study aimed to determine the standardised mortality ratios (SMRs) in individuals exposed to SM gas during the Iran-Iraq war.

STUDY DESIGN

This was a retrospective follow-up study.

METHODS

Data were obtained from the Veterans and Martyr Affair Foundation of Iran (VMAF) regarding all confirmed individuals who were exposed to SM during the Iran-Iraq war (1980-1988) up to 30 March 2019. The mortality rate, cumulative mortality and SMR with 95 % confidence intervals (CIs) were calculated to assess mortality in chemical warfare survivors (CWS), and results were compared with the general Iranian population. Overall survival was analysed using the Kaplan-Meier curve, and the log-rank test was employed to compare survival probability across different categories.

RESULTS

Among the 48,067 confirmed CWS, a total of 4358 (9.1 %) individuals had died by the end of the study period (30 March 2019), with a mean age of 55.5 ± 14.4 years at the time of death. Overall, at the 39-year follow-up, the mortality rate due to all causes of death for people who were exposed to SM was lower than the general Iranian population (SMR: 0.70, 95 % CI: 0.68-0.72). However, cause-specific SMR analysis showed that the mortality rate due to liver cancer (SMR: 1.98, 95 % CI: 1.59-2.45), poisonings (SMR: 1.92, 95 % CI: 1.52-2.38), respiratory disorders (SMR: 1.59, 95 % CI: 1.46-1.73) and multiple myeloma (SMR: 1.72, 95 % CI: 1.06-2.62) were approximately twofold higher in CWS than the general population.

CONCLUSIONS

This study provides valuable insights into the mortality effects of SM exposure among the Iranian population affected by the Iran-Iraq war. The results emphasise the importance of continued monitoring and support for individuals exposed to SM, particularly in the context of managing and addressing the heightened risks associated with liver cancer, poisonings, respiratory disorders and multiple myeloma. Further research and interventions may be necessary to mitigate these specific health challenges in the affected population.

Neutralising the testosterone enanthate-induced oxidative stress in rats uterine tissue by propolis and chicory as natural antioxidants

The objective of this study was to investigate the effect of eight weeks of propolis and chicory on oxidative stress of uterine tissue in rats consuming testosterone enanthate. Thirty-five female Wistar rats (8 weeks old and weighing 200±12 g) were randomly divided between five groups (n=8) resistance training+ testosterone enanthate (RT+TE), resistance training+ testosterone enanthate+ chicory (RT+TE+CH), resistance training+ testosterone enanthate+ propolis (RT+TE+PR), control (CO), and sham (RT). The protocols were as follows: exercise protocol including climb on a 1-meter ladder with 26 steps five days a week for eight weeks, received a dose of 20 mg/kg of body weight of testosterone weekly for eight weeks, and received a dose of 400 mg/kg proplis and 6 g/kg chicory of body weight all days a week for eight weeks. Superoxide dismutase (SOD), glutathione peroxidase (GPX), and malondialdehyde (MDA) were measured as oxidative stress markers. Testosterone treatment resulted in a significant decrease in the amount of SOD and GPX only in RT+TE group compared to the RT+TE+CH and RT+TE+PR groups (P=0.001). There was no significant difference in mean SOD and GPX levels between RT+TE+CH and RT+TE+PR with CO and RT groups (P>0.05). MDA level was significantly higher in RT+TE group compared to the other groups (P=0.001). This level was also significantly higher in RT+TE+CH group compared to the CO group (P=0.000) and in RT+TE+PR group compared to CO (P=0.000) and RT (P=0.003) groups. Although testosterone enanthate leads to oxidative stress in uterine tissue, propolis and chicory reduced this oxidative stress. It seems that more research can be done on the potential effects of natural antioxidants to neutralise the harmful effects of steroids.

Ultrafine particle exposure for bicycle commutes in rush and non-rush hour traffic: A repeated measures study in Copenhagen, Denmark

Ultrafine particles (UFP), harmful to human health, are emitted at high levels from motorized traffic. Bicycle commuting is increasingly encouraged to reduce traffic emissions and increase physical activity, but higher breathing rates increase inhaled UFP concentrations while in traffic. We assessed exposure to UFP while cycling along a fixed 8.5 km inner-city route in Copenhagen, on weekdays over six weeks (from September to October 2020), during morning and afternoon rush-hour, as well as morning non-rush-hour, traffic time periods starting from 07:45, 15:45, and 09:45 h, respectively. Continuous measurements were made (each second) of particle number concentration (PNC) and location. PNC levels were summarized and compared across time periods. We used generalized additive models to adjust for meteorological factors, weekdays and trends. A total of 61 laps were completed, during 28 days (∼20 per time period). Overall mean PNC was 18,149 pt/cm³ (range 256-999,560 pt/cm³) with no significant difference between morning rush-hour (18003 pt/cm³), afternoon rush-hour (17560 pt/cm³) and late morning commute (17560 pt/cm³) [p = 0.85]. There was substantial spatial variation of UFP exposure along the route with highest PNC levels measured at traffic intersections (∼38,000-42000 pt/cm³), multiple lane roads (∼38,000-40000 pt/cm³) and construction sites (∼44,000-51000 pt/cm³), while lowest levels were measured at smaller streets, areas with open built environment (∼12,000 pt/cm³), as well as at a bus-only zone (∼15,000 pt/cm³). UFP exposure in inner-city Copenhagen did not differ substantially when bicycling in either rush-hour or non-rush-hour, or morning or afternoon, traffic time periods. UFP exposure varied substantially spatially, with highest concentrations around intersections, multiple lane roads, and construction sites. This suggests that exposure to UFP is not necessarily reduced by avoiding rush-hours, but by avoiding sources of pollution along the bicycling route.

Exposure to ultrafine particles while walking or bicycling during COVID-19 closures: A repeated measures study in Copenhagen, Denmark

Ultrafine particles (UFP; particulate matter <0.1 μm diameter) emitted from motorized traffic may be highly detrimental to health. Active mobility (walking, bicycling) is increasingly encouraged as a way to reduce traffic congestion and increase physical activity levels. However, it has raised concerns of increased exposure to UFP, due to increased breathing rates in traffic microenvironments, immediately close to their source. The recent Coronavirus Disease 2019 (COVID-19) societal closures reduced commuting needs, allowing a natural experiment to estimate contributions from motorized traffic to UFP exposure while walking or bicycling. From late-March to mid-July 2020, UFP was repeatedly measured while walking or bicycling, capturing local COVID-19 closure ('Phase 0') and subsequent phased re-opening ('Phase 1', '2', '2.1' & '3'). A DiSCmini continuously measured particle number concentration (PNC) in the walker/bicyclist's breathing zone. PNC while walking or bicycling was compared across phased re-openings, and the effect of ambient temperature, wind speed and direction was determined using regression models. Approximately 40 repeated 20-minute walking and bicycling laps were made over 4 months during societal re-opening phases related to the COVID-19 pandemic (late-March to mid-July 2020) in Copenhagen. Highest median PNC exposure of both walking (13,170 pt/cm³, standard deviation (SD): 3560 pt/cm³) and bicycling (21,477 pt/cm³, SD: 8964) was seen during societal closures (Phase 0) and decreased to 5367 pt/cm³ (SD: 2949) and 8714 pt/cm³ (SD: 4309) in Phase 3 of re-opening. These reductions in PNC were mainly explained by meteorological conditions, with most of the deviation explained by wind speed (14-22%) and temperature (10-13%). Highest PNC was observed along major roads and intersections. In conclusion, we observed decreases in UFP exposure while walking and bicycling during societal re-opening phases related to the COVID-19 pandemic, due largely to meteorological factors (e.g., wind speed and temperature) and seasonal variations in UFP levels.

The Effects of 8-Week Combined Exercise Training on Inflammatory Markers in Women with Multiple Sclerosis

PURPOSE

The present study was designed to investigate the effects of 8-week combined endurance, resistance, and balance exercise training on IL-6, CRP, and IL-10 concentrations in women with multiple sclerosis.

METHODS

Thirty participants with multiple sclerosis (Expanded Disability Status Scale ≤6) were randomized into either an exercise and control groups. The exercise group performed 8-weeks of endurance, resistance, and balance exercise training. Serum concentrations of IL-6, CRP, and IL-10 were measured before and after the 8-week intervention. Moreover, anthropometric measures were determined at the onset of and after the intervention. For within- and between groups comparisons of all variables, t test (independent and dependent) was used (p < 0.05).

RESULTS

The results revealed that IL-6 and CRP levels significantly decreased after exercise training (from 6.8 ± 1.52 to 3.2 ± 0.96, p < 0.001 and from 2.76 ± 0.98 to 1.55 ± 0.44, p = <0.001; respectively). Also, exercise training significantly increased IL-10 in the exercise group (from 16.4 ± 2.74 to 23.2 ± 2.11, p < 0.001). There was a significant difference between the 2 groups in all markers in the after 8-week exercise (p < 0.05).

CONCLUSIONS

One of the characteristics of MS disease is inflammation. Exercise training through physiological mechanisms and without aggravating the inflammatory pathology can be effective in functional and symptom reduction of patients with MS. In confirmation of this, the present study showed that 8 weeks of combined exercise training decreased pro-inflammatory markers (IL-6 and CRP) and increased anti-inflammatory cytokine (IL-10). Our findings suggested that an exercise training program can be an effective strategy for managing the immune system of women with MS at least by its significant effect on inflammatory markers.

Quantitative analysis of taste disorder in COVID-19 patients, the hypersensitivity to salty quality

Recently, many of the studies have illustrated that the new pandemic SARS-CoV-2 can affect Central Nervous System through the olfactory bulb. In addition to investigating anosmia or hyposmia induced by this virus, a quantitative analysis was needed to clarify the taste and smell disorder of the new coronavirus. The four basic taste quality with five concentrations for sweet, sour, bitter, and salty were administered to 75 subjects divided into three groups: COVID-19 patients with taste disorder, COVID-19 patients without taste disorder, and control group.

The results indicated the increment of sweet (2.68 ± 0.14), sour (3.34 ± 0.12) and bitter (3.39 ± 0.2) thresholds in COVID-19 patients with taste disorder in comparison with patients without taste disorder that the threshold were: 2 ± 0.16, 2.11 ± 0.2 and 2.55 ± 0.5 for sweet, sour, and bitter respectively. On the other hand, the patients inversely showed a significant decrease in the salty taste threshold (0.51 ± 0.03) compared to COVID-19 positive control groups (1.11 ± 0.11).

Additionally, despite taste disorder in almost all of the patients with smell deficiency, only 30% of cases with taste disorder reported smell deficiency. It may be concluded that some of the taste disorders in patients with COVID-19 disorder could be associated with taste receptors dysfunction or the spread of infection to the cranial nerves responsible for the conduction of tastes sensation.

COVID-19 pandemic-induced physical inactivity: the necessity of updating the Global Action Plan on Physical Activity 2018-2030

To prevent and reduce inactivity, the World Health Organization (WHO) designed a global plan called Global Action Plan on Physical Activity 2018–2030 (GAPPA) in 2017. In this plan and according to the state of physical activity in 2016, actions and goals were set. However, the world is facing a COVID-19 pandemic, which has affected various aspects of lifestyle, including physical activity. Some studies have shown that physical activity reduced during the pandemic. For this reason, the WHO should review the GAPPA and update goals and actions according to the state of physical activity in 2020.

Effects of vibration therapy and vitamin D supplement on eccentric exercise-induced delayed onset muscle soreness in female students

Delayed onset muscle soreness (DOMS) appears after unaccustomed exercise and peaks 24-48 h after exercise. Vitamin D micronutrient and vibration therapy may have an effect on DOMS. The present study investigated the effects of vitamin D micronutrient and vibration therapy on DOMS. Sixty female students were randomly assigned to one of the four groups (n=15 in each group): vitamin D, vibration therapy, vitamin D + vibration therapy, and control. The participants of vitamin D groups received vitamin D (3,800 IU, 1 session daily for 7 days), while the participants of the control groups received placebo. The participants of vibration therapy groups received vibration therapy (50 Hz; 3 sets of 1 min, 1 session daily for 7 days). One day later, the participants performed eccentric exercise (a quadriceps leg extension exercise). Immediately after this exercise protocol, the participants received vitamin D or vibration therapy on basis of their groups. Pain perception, creatine kinase (CK), interleukin (IL)-6, superoxide dismutase and malondialdehyde (MDA) concentration were measured at baseline (before 7 days of intervention), after 7 days of intervention (before eccentric exercise) and 24, 48 and 72 h after eccentric exercise. Statistical analysis was employed and P≤0.05 was considered as the significant level. CK and IL-6 concentrations, as well as pain perception, were significantly lower in the vibration therapy and vitamin D groups compared to the control group 24 to 48 h after eccentric exercise. MDA concentration was significantly lower in the vibration therapy and vitamin D groups compared to the control group 48 to 72 h after eccentric exercise. In conclusion, the present study suggests that vibration therapy and vitamin D supplement may have effects against eccentric exercise-induced delayed onset muscle soreness in female students.

Avian gametologs as molecular tags for sex identification in birds of prey of Iran

Global environmental change and rapid destruction of natural habitats necessitate the conservation of endangered and threatened birds of prey. Recently, molecular sex identification methods based on amplification of introns of chromodomain-helicase DNA binding protein1 (CHD1) have provided valuable tools for ecological study and conservation breeding programs of birds. These methods employ a primer pair flanking an intron which varies considerably in length between the avian gametologs CHD1Z and CHD1W. Herein, we test the applicability of CHD1Z and CHD1W as universal tags for molecular sex identification in birds of prey of Iran. We showed successful sex identification in 22 species of birds of prey using feathers as the source of DNA. The results suggest that the regions of CHD1W and CHD1Z amplified in this study are conserved among most of Falconiformes, enabling accurate sex identification in birds of prey.

Sensor-less force-reflecting macro-micro telemanipulation systems by piezoelectric actuators

This paper establishes a novel control strategy for a nonlinear bilateral macro-micro teleoperation system with time delay. Besides position and velocity signals, force signals are additionally utilized in the control scheme. This modification significantly improves the poor transparency during contact with the environment. To eliminate external force measurement, a force estimation algorithm is proposed for the master and slave robots. The closed loop stability of the nonlinear micro-micro teleoperation system with the proposed control scheme is investigated employing the Lyapunov theory. Consequently, the experimental results verify the efficiency of the new control scheme in free motion and during collision between the slave robot and the environment of slave robot with environment, and the efficiency of the force estimation algorithm.

Isolation of free-living amoebae from sarein hot springs in ardebil province, iran

BACKGROUND

Free-living amoebae (FLA) are a group of ubiquitous protozoan, which are distributed in the natural and artificial environment sources. The main aim of the current study was to identify the presence of FLA in the recreational hot springs of Sarein in Ardebil Province of Iran.

METHODS

Seven recreational hot springs were selected in Sarein City and 28 water samples (four from each hot spring) were collected using 500 ml sterile plastic bottles during three month. Filtration of water samples was performed, and culture was done in non-nutrient agar medium enriched with Escherichia coli. Identification of the FLA was based on morphological criteria of cysts and trophozoites. Genotype identification of Acanthamoeba positive samples were also performed using sequencing based method.

RESULTS

Overall, 12 out of 28 (42.9%) samples were positive for FLA which Acanthamoeba and Vahlkampfiid amoebae were found in one (3.6%) and 11 (39.3%) samples, respectively. Sequence analysis of the single isolate of Acanthamoeba revealed potentially pathogenic T(4) genotype corresponding to A. castellanii.

CONCLUSION

Contamination of hot springs to FLA, such as Acanthamoeba T(4) genotype (A. castellanii) and Vahlkampfiid amoebae, could present a sanitary risk for high risk people, and health authorities must be aware of FLA presence.

Relationship between GDx VCC and Stratus OCT in juvenile glaucoma

PURPOSE

To compare the ability of scanning laser polarimetry (GDx VCC) and optical coherence tomography (OCT) to discriminate eyes with juvenile glaucoma from normal eyes and to assess the relationship between their parameters.

METHODS

A total of 24 glaucomatous eyes of 24 patients and 24 normal eyes were enrolled. The age range of the patient was 11-40 years with a mean age of 25.1+/-8.2 years. Control groups consisted 24 eyes of 24 individuals without glaucoma with a mean age of 33.2+/-8.2 years. All subjects underwent a full ophthalmic examination, automated perimetry, GDx VCC, and OCT. Correlation coefficients between the parameters of OCT and GDx VCC were calculated. We calculated the area under the receiver operating characteristic curve (AROC) for the main parameters of GDx VCC and OCT.

RESULTS

Statistically significant correlations were observed between GDx VCC and OCT parameters. Pearson coefficients ranged from 0.75 for inferior average to 0.86 for nerve fibre indicator (NFI)/average thickness OCT. The greatest AROC parameter in OCT (inferior average: 0.92) had a lower area than that in GDx VCC (NFI: 0.99). There was a significant statistical significance in all visual field, GDx VCC, and OCT variables between two groups (P<0.05).

CONCLUSIONS

Many GDx VCC parameters were significantly correlated with those of the OCT in patients with juvenile glaucoma. Inferior average and NFI had the greatest AROC parameter in OCT and GDx VCC, respectively. NFI had high sensitivity and specificity for the diagnosis of JOAG.

Avian influenza virus monitoring in wintering waterbirds in Iran, 2003-2007

Background

Virological, molecular and serological studies were carried out to determine the status of infections with avian influenza viruses (AIV) in different species of wild waterbirds in Iran during 2003-2007. Samples were collected from 1146 birds representing 45 different species with the majority of samples originating from ducks, coots and shorebirds. Samples originated from 6 different provinces representative for the 15 most important wintering sites of migratory waterbirds in Iran.

Results

Overall, AIV were detected in approximately 3.4% of the samples. However, prevalence was higher (up to 8.3%) at selected locations and for certain species. No highly pathogenic avian influenza, including H5N1 was detected. A total of 35 AIVs were detected from cloacal or oropharyngeal swab samples. These positive samples originated mainly from Mallards and Common Teals.

Of 711 serum samples tested for AIV antibodies, 345 (48.5%) were positive by using a nucleoprotein-specific competitive ELISA (NP-C-ELISA). Ducks including Mallard, Common Teal, Common Pochard, Northern Shoveler and Eurasian Wigeon revealed the highest antibody prevalence ranging from 44 to 75%.

Conclusion

Results of these investigations provide important information about the prevalence of LPAIV in wild birds in Iran, especially wetlands around the Caspian Sea which represent an important wintering site for migratory water birds. Mallard and Common Teal exhibited the highest number of positives in virological and serological investigations: 43% and 26% virological positive cases and 24% and 46% serological positive reactions, respectively. These two species may play an important role in the ecology and perpetuation of influenza viruses in this region. In addition, it could be shown that both oropharyngeal and cloacal swab samples contribute to the detection of positive birds, and neither should be neglected.

Hydrogen sulfide removal by Thiobacillus thioparus bacteria on seashell bed biofilters

The aim of this research is to achieve an efficient and cheap methods to remove H2S from the factories emissions. Four serial cylinders are designed, 40 cm in height and 15 cm in diameter each. They are filled with bivalve seashells with 63% porosity which contains Thiobacillus thioparus bacteria to the maximum height of 27.5 cm. By mixing phosphoric acid and sodium sulfide, H2S gas is released and its concentration is measured as mg m(-3) before injecting into the cylinders. A permanent measuring instrument is equipped to control the gas coming out of the cylinders. In order to prevent the outdoor environment from pollution, first the gas is sent through two activated carbon columns and then sent through a ferrous chloride scrubber. Finally it is burnt directly by flames. There were 550 sample readings in 15 weeks. The changes in the discharge of the air which carries the gas are considered between 1-12 L min(-1) and the concentration of the influent pollutant is considered between 1-140 mg m(-3). Also the humidity in the atmosphere is fixed between 77-93% and the optimum temperature required for growing of the microorganisms is retained between 20.5-30 degrees C. After feeding the system for three weeks the efficiency started to increase so that by the end of the final week of this research the efficiency reached to 90% with the discharge of 6 L min(-1) of the carrier gas. The results achieved from this research show that because of not using Filamentous bacteria, clogging did not occur in the biological system in biofilters. The amount of head loss in cylinder was only 2 mm water and during this research, head loss was the same due to unclogging of filter. On the other hand the traditional methods are expensive in terms of using chemicals, carbon recycling and using fuel and etc. Therefore researchers have started new studies in this field. The above mentioned method, according to high efficiency, inexpensiveness and easiness of control and maintenance is considered one of the best methods.

Pharmacokinetics, efficacy, and safety of Iminoral compared with Neoral in healthy volunteers and renal transplant recipients

This study sought to evaluate the bioequivalence of Iminoral (test) versus Neoral (reference) in healthy volunteers, as well as safety and efficacy of Iminoral treatment in renal transplant recipients following conversion from Neoral.

METHODS

After an overnight fast, 18 healthy volunteers received the assigned treatment (test or reference, 200 mg single dose) in a cross-over fashion with a washout period of 14 days. The blood samples were drawn at various times after drug administration. Cyclosporine blood concentration was measured by high-performance liquid chromatography using an ultraviolet detector. In the second phase of study, stable renal transplant patients who were on Neoral were enrolled in the study in an open-label manner. They were converted from Neoral to Iminoral based on a 1:1 dose equivalence. Cyclosporine trough levels and changes in serum creatinine, lipid profile, electrolytes, and uric acid were measured before and periodically after conversion for 6 months.

RESULTS

The 90% confidence interval of the test/reference ratio was within the acceptable limits of 0.8 to 1.25. Relative bioavailability of Iminoral in healthy subjects was 99.0%. There was no significant difference in cyclosporine concentrations and serum creatinines following conversion to Iminoral in renal transplant patients (n=41). There were no reports of major toxicity or of graft rejection and no need for dose adjustment related to Iminoral.

CONCLUSIONS

Single doses of Neoral and Iminoral are bioequivalent in healthy subjects. Renal transplant recipients maintained on Neoral can be safely and effectively converted to Iminoral on a 1:1 conversion ratio.

Non-affective Acute Remitting Psychosis: a preliminary report from Iran

OBJECTIVE

To investigate the concept of 'Non-affective Acute Remitting Psychosis' (NARP) in a group of patients with first episode psychosis in Iran.

METHOD

This is a 24-month follow-up study of 54 patients with first-episode psychosis admitted consecutively to a psychiatric hospital in Tehran, Iran. At the end of follow-up, consensus judgments were made on fulfillment of the NARP criteria as well as illness course and treatment. NARP was defined as a psychotic illness with acute onset (developed within 1 week), short duration (remission within 6 months), and the absence of prominent mood symptoms.

RESULTS

Of 49 patients who completed the follow-up, 15 (30.6%) had NARP, accounting for 60% of non-affective psychoses. Ten patients with NARP remained relapse free, four had a very short-lived relapse, and only one developed a chronic illness. Throughout the follow-up, patients with NARP received fewer months of treatment than did patients with other non-affective psychoses.

CONCLUSION

The high proportion of NARP among patients with first episode psychosis, and the favorable course is in keeping with previous studies in developing countries.

Ascorbate reduces morphine-induced extracellular DOPAC level in the nucleus accumbens: A microdialysis study in rats

Most drugs of abuse increase dopamine and 3,4-dihydroxyphenylacetic acid (DOPAC) release in the shell of the nucleus accumbens. The effects of ascorbate, which is known to modulate dopamine neurotransmission, on the extracellular level of DOPAC in the nucleus accumbens of naive rats and of rats treated acutely with morphine were studied by using in vivo microdialysis and high performance liquid chromatography with electrochemical detection (HPLC-ECD). Acute morphine (20 mg/kg ip) treatment increased the level of DOPAC in the nucleus accumbens to approximately 170% of basal level. Acute treatment with ascorbate (500 mg/kg ip) alone did not alter nucleus accumbens' DOPAC level, but pretreatment with ascorbate (500 mg/kg ip) 30 min before morphine administration attenuated the effects of acute morphine on the level of DOPAC. These results suggest that ascorbate modulates the mesolimbic dopaminergic pathway.

Comparison of mirtazapine and fluoxetine in the treatment of major depressive disorder: a double-blind, randomized trial

BACKGROUND

Depression is an international public health problem. The aim of this study was to compare the efficacy and tolerability of mirtazapine and fluoxetine treatment in a sample population consisting of Iranian patients suffering major depressive disorder.

METHODS

Thirty-six inpatients and outpatients with a diagnosis of major depressive disorder (Diagnostic and Statistical Manual of Mental Disorders-IV) and a score > or = 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D-17) were randomly assigned to 6 weeks of treatment with mirtazapine (30 mg/day) or fluoxetine (20 mg/day). Efficacy was assessed by HAM-D-17. Information about adverse events was obtained by questioning of participants and/or their examination. Assessments were performed at weeks 0, 1, 2, 3, 4 and 6.

RESULTS

Sixteen of mirtazapine-treated patients and fifteen of fluoxetine-treated patients completed the 6-week study period. Both treatment groups were well matched at baseline with respect to demographic and disease characteristics. Both drugs showed a significant improvement over the 6 weeks of treatment (P < 0.001). There was no statistically significant difference between the mean +/- SEM HAM-D scores of two groups at weeks 1, 2, 3, 4, and at the end point. There were no significant differences between two groups in terms of response to treatment (> or = 50% decrease from baseline in HAM-D-17 total score) and remission (HAM-D-17 score of < or = 7). None of the differences in reported adverse events was statistically significant.

CONCLUSION

In this study, mirtazapine and fluoxetine were equally effective and well tolerated after 6 weeks of treatment in patients with major depressive disorder.

Cyproheptadine in the treatment of autistic disorder: a double-blind placebo-controlled trial

OBJECTIVE

Autism is a childhood-onset disorder of unknown, possibly of multiple aetiologies. The core symptoms of autism are abnormalities in social interaction, communication and behaviour. The involvement of neurotransmitters such as 5-HT has been suggested in neuropsychiatric disorders and particularly in autistic disorder. Increased platelet 5-HT levels were found in 40% of the autistic population, suggesting that hyperserotonaemia may be a pathologic factor in infantile autism. Therefore, it is of interest to assess the efficacy of cyproheptadine, a 5-HT2 antagonist in the treatment of autistic disorder. In this 8-week double-blind, placebo-controlled trial, we assessed the effects of cyproheptadine plus haloperidol in the treatment of autistic disorder.

METHODS

Children between the ages 3 and 11 years (inclusive) with a DSM IV clinical diagnosis of autism and who were outpatients from a specialty clinic for children at Roozbeh Psychiatric Teaching Hospital were recruited. The children presented with a chief complaint of severely disruptive symptoms related to autistic disorder. Patients were randomly allocated to cyproheptadine + haloperidol (Group A) or haloperidol + placebo (Group B) for an 8-week, double-blind, placebo-controlled study. The dose of haloperidol and cyproheptadine was titrated up to 0.05 and 0.2 mg/kg/day respectively. Patients were assessed by a third-year resident of psychiatry at baseline and after 2, 4, 6 and 8 weeks of starting medication. The primary measure of the outcome was the Aberrant Behaviour Checklist-Community (ABC-C) and the secondary measure of the outcome was the Childhood Autism Rating Scale (relating to people and verbal communication). Side effects and extrapyramidal symptoms were systematically recorded throughout the study and were assessed using a checklist and the Extrapyramidal Symptoms Rating Scale, administered by a resident of psychiatry during weeks 1, 2, 4, 6 and 8.

RESULTS

The ABC-C and the Childhood Autism Rating Scale scores improved with cyproheptadine. The behaviour of the two treatments was not homogeneous across time (groups-by-time interaction, Greenhouse-Geisser correction; F = 7.30, d.f. = 1.68, P = 0.002; F = 8.21, d.f. = 1.19, P = 0.004 respectively). The difference between the two treatments was significant as indicated by the effect of group, and the between-subjects factor (F = 4.17, d.f. = 1, P = 0.048; F = 4.29, d.f. = 1, P = 0.045 respectively). No significant difference was observed between the two groups in terms of extrapyramidal symptoms (P = 0.23). The difference between the two groups in the frequency of side effects was not significant.

CONCLUSION

The results suggest that the combination of cyproheptadine with a conventional antipsychotic may be superior to conventional antipsychotic alone for children with autistic disorder. However the results need confirmation by a larger randomized controlled trial.

Rapid determination of ranitidine in human plasma by high-performance liquid chromatography without solvent extraction

A simple high-performance liquid chromatographic procedure was developed for the determination of ranitidine in human plasma. The method entailed direct injection of the plasma samples after deproteination using perchloric acid. The chromatographic separation was accomplished with an isocratic elution using mobile phase consisting of 21 mM disodium hydrogen phosphate-triethylamine-acetonitrile (1000:60:150, v/v), pH 3.5. Analyses were run at a flow-rate of 1.3 ml/min using a microbondapak C18 column and ultraviolet detection at a wavelength of 320 nm. The method was specific and sensitive, with a quantification limit of approximately 20 ng/ml and a detection limit of 5 ng/ml at a signal-to-noise ratio of 3:1. The mean absolute recovery was about 96%, while the within- and between-day coefficient of variation and percent error values of the assay method were all less than 8%. The linearity was assessed in the range of 20-1000 ng/ml plasma, with a correlation coefficient of greater than 0.999. This method has been used to analyze several hundred human plasma samples for bioavailability studies.

Biosynthesis of the endogenous cyclic adenosine monophosphate (AMP) antagonist, prostaglandylinositol cyclic phosphate (cyclic PIP), from prostaglandin E and activated inositol polyphosphate in rat liver plasma membranes

The endogenous cyclic adenosine monophosphate (AMP) antagonist, cyclic PIP, has been identified as a prostaglandylinositol cyclic phosphate. It inhibits protein kinase A 100% and activates protein serine phosphatase about sevenfold. It is biosynthesized by an enzyme of the plasma membrane when the assay mixture contains adenosine triphosphate (ATP), Mg2+, prostaglandin E and a novel inositol polyphosphate, which cannot be substituted by commercially available inositol phosphates. This novel inositol polyphosphate is a very labile compound. On anion exchange chromatography it elutes in the range of ATP, which may indicate the presence of three phosphate groups. It adsorbs on charcoal, which suggests the presence of a hydrophobic component, possibly a guanosine. Pyrophosphates obtained from inositol 1,4- and inositol 2,4-bisphosphate are accepted by cyclic PIP synthetase for the synthesis of cyclic PIP. The biosynthesis is characterized by enzyme kinetic parameters like dependence on time, enzyme and substrate concentration. The pH optimum of the enzyme is in the range 7.5-8. The enzyme functions optimally with prostaglandin E and poorly with prostaglandin A as the substrate. The presence of fluoride in the assay causes a three- to fourfold increase in cyclic PIP synthesis, which may be correlated with activation via G proteins. These data support previous reports on the chemical structure and action of cyclic PIP. With respect to the possible isomers of cyclic PIP, these indicate that it is most likely the C4-hydroxyl group of the inositol which binds the C15-hydroxyl group of prostaglandin E. A model of hormone-stimulated synthesis of cyclic PIP is proposed: phospholipase A2 and phospholipase C, activated by G proteins upon alpha-adrenergic stimulation, liberate either unsaturated fatty acids or inositol phosphates, which are transformed to prostaglandins and to novel inositol polyphosphate with an energy-rich bond. The cyclic PIP synthetase combines these two substrates to cyclic PIP.

The effect of ibuprofen on the level of discomfort in patients undergoing orthodontic treatment

Studies have shown that patients undergoing orthodontic tooth movement can experience varying degrees of discomfort. The objective of this study was to determine whether nonsteroidal antiinflammatory agents, such as aspirin or ibuprofen, which inhibit prostaglandin synthesis through acetylation and inactivation of the enzyme cyclooxygenase, can suppress orthodontic discomfort by inhibiting the inflammatory response normally observed after orthodontic adjustments. A total of 77 patients were included in a double-blind, randomized, parallel, placebo-controlled, single-dose, analgesic efficacy evaluation of ibuprofen and aspirin. Patients were divided into three groups. Group A received one dose of the drug ibuprofen (400 mg), group B received aspirin (650 mg), and group C received a placebo (beta-lactose). The level of discomfort was assessed using a visual analogue scale at 2, 6, and 24 hours and 2, 3, and 7 days after the insertion of either orthodontic separators or an initial arch wire. A repeated measures analysis of variance and post hoc studentized range statistics showed that the placebo group had significantly more discomfort than either the ibuprofen or the aspirin group at all the time intervals tested. In addition, ibuprofen produced significantly less discomfort than aspirin at the 6 and 24-hour and 2-day time phase after separator placement; and 2 and 6 hours and 2, 3, and 7 days after arch wire placement. These results support a recommendation for ibuprofen as a preferred analgesic in the treatment of discomfort because of postorthodontic adjustments.

Blood pressure and rural--urban migration in Iran

To find the possible association between rural-urban migration and elevation of blood pressure a cross-sectional study was carried out with 379 subjects 40--59 years of age in rural areas of East Azarbaijan, northwest Iran. Another cross-sectional study was carried out in Teheran City in which 403 migrants from the same rural areas and also 357 non-migrant urban residents of the same age group from both sexes were examined. Comparison of the three groups showed that, in all age and sex groups, migrants had higher systolic and diastolic blood pressure than did the people in the rural areas of origin. The blood pressure levels of migrants and non-migrants in the city were not much different from each other. The effect of other variables on the levels of blood pressure was investigated. Age, sex and body build (as measured by ponderal index) were also associated with blood pressure. None of these factors however explained the differences in blood pressure levels between rural-urban migrants and people in the rural areas of origin.

Present status of kala-azar in Iran

Sporadic cases of visceral leishmaniasis have been reported from all parts of Iran except the deserts and very arid zones in the southeast. About 120 cases have been reported up to the present time, the majority from the mountainous areas of the southwest. Most patients (76%) have been children under 10 years of age. The probable reservoirs of infection are wild carnivores, infection of man and dog being accidental. During a survey conducted in the Caspian area and northeastern part of Iran in 1970, 20 jackals and 10 foxes were shot; examination of smears from bone marrow and spleen showed the infection in a jackal (Canis aureas) and in a fox (Vulpes vulpes). On the basis of epidemiological evidence, Phlebotomus major is the probable vector of kala-azar in Iran.

In vivo and in vitro availability of commercial vitamin C tablets

In vitro release of vitamin C from commercial tablets of three different manufacturers was measured by the Levy beaker, a modified USP basket and Magnetic Basket techniques and this was correlated with urinary excretion of the drug from normal, healthy, human males of 23 to 25 years of age weighing 50-72 Kg. Results showed that there was dissolution variability between the different brands of vitamin C tablets as well as between the in vitro dissolution methods used. There was also an inverse correlation between the time of in vitro release and the percent vitamin C excreted at the end of 2 hours. However, at the end of 24 hours the most rapidly dissolving tablets in vitro indicated only 66 percent excretion of the vitamin C as compared with nearly 83 percent for the slow dissolving types. It is concluded that to determine the total drug from a particular formulation, only disintegration and/or dissolution is not a good measure for an unstable and relatively rapid dissolving substance such as vitamin C. It is further suggested that perhaps if unstable rapid-dissolving substances were made more slowly released by formulation, a greater quantity of the drug would be physiologically avaiable.