The concentration of phthalates in drinking water in Iran: A systematic review and meta-analysis

PAE and PC polymers, such as BPA, are utilized to make water bottles. Due to the lack of polymer-chemical interaction, PAE can enter drinking bottles during production, wrapping, and keeping. Phthalates can transfer from the bottle to the water depending on keeping conditions (temperature, time, sunlight intensity), pH, and bottle capacity. Since there haven't been previous studies published on the subject, the aim of this meta-analysis and systematic review research is to determine the level of phthalates in drinking water consumed in Iranian cities. Web of Science, Science of Direct, Scopus, and PubMed, databases have been used in this study. Eight studies were selected from 556 initial publications after screening for duplication and irrelevant information. Articles from January 1, 2000, to February 10, 2024, were found in the mentioned databases. Among the types of phthalates, the concentration of DEHP was reported higher than the others Because its concentration has been reported in seven out of eight studies. The highest concentration of DEHP was reported by Mehraie(2.22 µg/l), Zare Jeddi (0.8 µg/l), Yousefi (0.77 µg/l), Abtahi (0.76 µg/l), Zare Jeddi (0.42 µg/l), Abdolahnejad(0.15 µg/l), and Pourzamani (0.08 µg/l). The highest concentration of DEP, DBP, BBP, and PA was reported by Abtahi (0.77 µg/l) and Esteki (2.25 µg/l), Mehraie(0.93 µg/l), and Pourzamani (0.83 µg/l). The results of this study showed that the most important phthalates measured in drinking water include DEP, DEHP, DBP, BBP, and PA. According to the results of the present studies, the most important factor in the increase of phthalates is the storage conditions of drinking water (temperature, sunlight, and the type of pipe or bottle).

Health risk assessment for consuming rice, bread, and vegetables in Hoveyzeh city

Introduction

People are continuously exposed to contamination, which mainly consists of heavy metals (HMs) and organic compounds. Several metals can get into grains, veggies, and bread through various methods. We estimated the health risk of HM exposure from the consumption of bread, veggies, and rice, considering the per capita amounts of these foods in the Iranian food basket, especially in Hoveyzeh and Azadegan Plain.

Material and method

The food products analyzed for the assessment of HMs include different veggies, rice, and bread. The health risk assessment was done with the Hazard Quotient and cancer risk formulae. The buying of vegetables, rice, and bread was done in random order during the fall and wintertime seasons.

Result

Tarom rice has the maximum reported levels of Cd (0.55 mg/kg), but Pakistani rice has the lowest level (0.18 mg/kg). Radish shows the highest concentrations of As, Pb, Cr, and Ni among vegetation, while Cress shows the lowest level. The study findings showed that Lavash bread had the highest levels of As (1.31 mg/kg), Cd (0.2 mg/kg), and Ni (1.2 mg/kg), whereas it indicated the lowest level of Cr (0.056 mg/kg). While the non-carcinogenic risk of HMs was evaluated between two groups of adults and children, both groups' HI and HQ levels were less than 1. The maximum HQ and HI scores for children were associated with Arsenic (As), specifically 0.0127 and 0.0137 for Tarom rice, respectively. Nevertheless, the highest HQ and HI scores for adults were associated with As, namely 0.0059 and 0.0064 for Tarom rice, respectively.

Conclusion

The evaluation of the carcinogenic risk caused by HM exposure in kids and adults showed that both groups' accumulated lifetime CRs and ILCRs were lower than 1*10-6. Hence, the consumption of veggies, rice, and bread within the study's area does not show an association with the occurrence of chronic diseases resulting from hazardous HMs.

Consumption of foods contaminated with heavy metals and their association with cardiovascular disease (CVD) using GAM software (cohort study)

Introduction

Heavy metals can enter the environment and food through industrial activities, acid rain, chemical fertilizers, pesticides, and sewage. A large amount of these metals is dangerous because they tend to bio accumulate. A concern with these metals is the long-term, low-dose exposure seen in the general population. HMs can cause disorders in the cardiovascular system through various mechanisms such as the production of free radicals, DNA damage, lipid peroxidation, and oxidative stress.

Material and method

Food items measured in the present study included rice, bread, and vegetables. 210 participants (105 controls and 105 patients) were randomly selected for this study. The demographic information of the subjects was obtained from the Hoveyzeh Cohort Center. The relationship between heavy metals in food and cardiovascular diseases is investigated by The Generalized Additive Model (GAM).

Result

The results of the present study showed that when urine Cd was smoothed based on rice Cd, there was a significant correlation between urine Cd and Cd consumed in vegetables and rice. The GAM coefficient for urinary Cd excreted in case-control groups and Cd consumed in vegetables were 479.79(SE: 6.49-73.87) and 818.56(SE: 11.96-68.43), respectively, and for rice consumed, it was 0.03(SE: 0.015-2.103) and 0.04(SE: 0.017-2.338), respectively. The GAM coefficient for As consumption in vegetables and As in urine of case and control groups was 1.61 (SE: 9.48-0.16) and 22.36 (SE: 13.60-1.64), respectively. The same coefficient for rice consumption in case and control groups was 4.5 (SE: 0.62-7.22) and 10.48 (SE: 1.46-7.16), respectively. There was a very strong and significant correlation between the Sr in the urine of both groups and the Sr in the food consumed, so that the urinary Sr in the control group is excreted more than in the cardiovascular group.

Conclusion

GAM analysis indicates that As in vegetable and rice is more than the standard limitation value. Also, Sr and Cd in vegetables, rice, and bread were more than the standard limitation value. According to the GAM model As had a significant value in rice and vegetables indicating that As is more than the standard limitation value, therefore, it is associated with CVD.

Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer

Proton radiotherapy offers a dosimetric advantage compared to photon therapy in sparing normal tissue, but the clinical evidence for toxicity reductions in the treatment of head and neck cancer is limited. The Danish Head and Neck Cancer Group (DAHANCA) has initiated the DAHANCA 35 randomised trial to clarify the value of proton therapy (NCT04607694). The DAHANCA 35 trial is performed in an enriched population of patients selected by an anticipated benefit of proton therapy to reduce the risk of late dysphagia or xerostomia based on normal tissue complication probability (NTCP) modelling. We present our considerations on the trial design and a test of the selection procedure conducted before initiating the randomised study.

Association of the corona virus (Covid-19) epidemic with environmental risk factors

The current outbreak of the novel coronavirus SARS-CoV-2 (coronavirus disease 2019; previously 2019-nCoV), epicenter in Hubei Province (Wuhan), People's Republic of China, has spread too many other countries. The transmission of the corona virus occurs when people are in the incubation stage and do not have any symptoms. Therefore, the role of environmental factors such as temperature and wind speed becomes very important. The study of Acute Respiratory Syndrome (SARS) indicates that there is a significant relationship between temperature and virus transmission and three important factors, namely temperature, humidity and wind speed, cause SARS transmission. Daily data on the incidence and mortality of Covid-19 disease were collected from World Health Organization (WHO) website and World Meter website (WMW) for several major cities in Iran and the world. Data were collected from February 2020 to September 2021. Meteorological data including temperature, air pressure, wind speed, dew point and air quality index (AQI) index are extracted from the website of the World Meteorological Organization (WMO), The National Aeronautics and Space Administration (NASA) and the Moderate Resolution Imaging Spectroradiometer (MODIS) sensor. Statistical analysis carried out for significance relationships. The correlation coefficient between the number of infected people in one day and the environmental variables in the countries was different from each other. The relationship between AQI and number of infected was significant in all cities. In Canberra, Madrid and Paris, a significant inverse relationship was observed between the number of infected people in one day and wind speed. There is a significant positive relationship between the number of infected people in a day and the dew point in the cities of Canberra, Wellington and Washington. The relationship between the number of infected people in one day and Pressure was significantly reversed in Madrid and Washington, but positive in Canberra, Brasilia, Paris and Wuhan. There was significant relationship between Dew point and prevalence. Wind speed showed a significant relationship in USA, Madrid and Paris. AQI was strongly associated with the prevalence of covid19. The purpose of this study is to investigate some environmental factors in the transmission of the corona virus.

Associated health risk assessment due to exposure to BTEX compounds in fuel station workers

OBJECTIVES

The purpose of this review study was to assess the risk of exposure to BTEX compounds in gas station workers and operators.

CONTENT

The main components of BTEX compounds are Benzene, Toluene, Ethyl benzene and Xylene. Petroleum, coal large quantities in crude oil and its products are the most important sources of BTEX compounds. These compounds have both high solubility (found in surface and underground waters) and evaporate quickly. Gas stations are one of the most important sources of emission of these compounds in communities. Workers who work in these places have a lot of exposure to these compounds. Exposure to these dangerous compounds can cause many problems for workers. This study was a narrative review article. According to different databases: PubMed, Web of Science, Springer, Cochran and Science Direct, 451 articles were retrieved. 55 full-text articles entered into the analysis process. Finally, 32 articles were selected in this study. The search was restricted to English-language papers published between 1 February 1995 and 13 August 2022. The results of our study showed that the carcinogenic risk (ILCR) for gas station workers in Bangkok (1.82 ∗ 10^-4 - 2.50 ∗ 10^-4), Shiraz (6.49∗10^-7 - 1.27 ∗ 10^-5), Brazil (1.82 ∗ 10^-4), Ardabil (390∗10^-6 ± 1884 ∗ 10^-6) and Johannesburg (3.78 ∗ 10^-4) was high. The non-cancer risk for oil industry workers of Dilijan (Iran) who were exposed to toluene was also reported in the range of 10-6∗176. The health of gas station workers is affected by exposure to BTEX and gasoline vapor emissions. According to the result this study, BTEX compounds cause genotoxic changes, chromosomal and genetic abnormalities.

SUMMARY AND OUTLOOK

Genotoxicity at high levels in gas station workers can cause cancerous and non-cancerous risks. Improving the production process of diesel fuel and gasoline in refineries, using periodical examinations of workers and operators at gas and fuel stations, using Euro 4 and 5 fuels, and replacing worn out cars can play an important role in reducing the emission of BTEX compounds and thus reducing health risks and carcinogenic.

Effects of sulfur dioxide inhalation on human health: a review

Sulfur dioxide (SO2) is one of the most important gaseous air pollutants and the chemical index of sulfur oxides (SOx). SO2 is one of the six criteria pollutants in the air quality index (AQI). SO2 can be emitted by natural and anthropogenic sources. Although efforts have been made to reduce sulfur dioxide emissions worldwide, this pollutant and its adverse effects remain a major concern, especially in developing countries. The aim of this study was the investigated the effects of sulfur dioxide inhalation on human health. This narrative review was done based on the literature published from 2000 to 2022 through PubMed, Springer, Web of Science, Science Direct, and Google Scholar databases. In this study, was done screened first based on the abstract and Final assessment done based on the full text of the article. Finally, 38 articles were selected for inclusion in the study. The results of this study showed that sulfur dioxide has adverse health effects on the human respiratory, cardiovascular, and nervous systems and causes type 2 diabetes and non-accidental deaths. Although some evidence suggests that sulfur dioxide in given concentrations has no adverse health effect, its synergistic effects in combination with other air pollutants may be significant. Among the most important practical results of this study can be mentioned to increase the health awareness of the general public, help the politicians of the health sector in making decisions in the health field, creating awareness among polluting producing units and industries and efforts to reduce the emission of Sulfur dioxide.

Coenzyme Q10 reduces expression of apoptotic markers in adult rat nucleus accumbens dopaminergic neurons treated with methamphetamine

BACKGROUND

Abuse of addictive drugs such as methamphetamine (METH) has become a global problem, leading to many social, economic, and health disturbances, including neurological and cognitive disorders. Neuronal damage is reported in chronic METH abusers. The neuroprotective role of CoQ10 has been shown in many studies. In the present study, we aimed to assess the pre and post-efficacy of CoQ10 on the dopaminergic neurons of the Nucleus Accumbens (de Miranda et al. in Food Res Int 121:641-647, 2019) in the male adult rats treated with METH.

METHODS

80 rats were randomly divided into eight groups (n = 10), including: negative control (intact), positive control (received 5 mg/kg/day METH/IP), three post-treatment groups (METH + 5, 10, 20 mg/kg CoQ10) and three pre-treatment groups (received 5, 10, 20 mg/kg CoQ10 as pre-treatment for 14 days before METH injection). The expression of Bax, Bcl-2, Bax/Bcl-2 ratio, P53, Caspase-3 and tyrosine hydroxylase in NAc studied using western blotting. Nissl staining was used to study the neuronal density of NAc.

RESULTS

Our results showed that the different doses of CoQ10 in METH-treated animals significantly changed pro-apoptotic proteins' expression in the benefit of neuronal survival of NAc (P < 0.05). Neuronal density in NAc were significantly lower in the METH group compared to the control and CoQ10 treated groups. Pre- and post-treatment with different doses of CoQ10 restored the neuronal damage in NAc.

CONCLUSIONS

CoQ10 could decrease the activation of pro-apoptotic proteins and reduce the neurodegenerative effects induced by METH. From a clinical point of view, it seems that certain antioxidants such as CoQ10 should receive more attention in clinical trial research. We believe that antioxidants could be the promising for drug abuse treatment in the future.

The outcome of olfactory impairment in patients with otherwise paucisymptomatic coronavirus disease 2019 during the pandemic

OBJECTIVE

This study aimed to measure the duration and recovery rate of olfactory loss in patients complaining of recent smell loss as their prominent symptom during the coronavirus disease 2019 outbreak.

METHOD

This was a prospective telephone follow-up observational study of 243 participants who completed an online survey that started on 12 March 2020.

RESULTS

After a mean of 5.5 months from the loss of smell onset, 98.3 per cent of participants reported improvement with a 71.2 per cent complete recovery rate after a median of 21 days. The chance of complete recovery significantly decreased after 131 days from the onset of loss of smell (100 per cent sensitive and 97.7 per cent specific). Younger age and isolated smell loss were associated with a rapid recovery, whereas accompanying rhinological and gastrointestinal symptoms were associated with longer loss of smell duration.

CONCLUSION

Smell loss, occurring as a prominent symptom during the coronavirus disease 2019 pandemic, showed a favourable outcome. However, after 5.5 months from the onset, around 10 per cent of participants still complained of moderate or severe hyposmia.

Early Mortality after Radical Radiotherapy in Head and Neck Cancer - A Nationwide Analysis from the Danish Head and Neck Cancer Group (DAHANCA) Database

AIMS

Curative-intent radiotherapy (RT) or chemoradiation (CRT) of squamous cell carcinoma of the head and neck (HNSCC) produces high survival rates, but is associated with substantial toxicity. However, there are no commonly accepted quality metrics for early mortality in radiation oncology. To assess the applicability of early mortality as a clinical quality indicator, this study investigated the temporal distribution, risk factors and trends of 90- and 180-day overall and non-cancer mortality in a nationwide cohort of HNSCC patients treated with RT/CRT.

MATERIALS AND METHODS

Information on all HNSCC patients treated with curative-intent RT/CRT in Denmark between 2000 and 2017 was obtained from the national Danish Head and Neck Cancer Group clinical database. Deaths in patients with residual or recurrent disease after RT/CRT were classified as cancer-related. Possible risk factors were investigated using logistic regression analysis.

RESULTS

Data from 11 419 patients were extracted. In total, 90- and 180-day mortality risks were 3.1% and 7.1%, respectively. There was a uniform temporal distribution of 180-day mortality. In multivariable analysis, increasing age, stage, performance status, earlier treatment year and hypopharyngeal cancer were significantly associated with an increased risk (P < 0.05). Risk factor estimates were comparable for 90- versus 180-day mortality as well as for overall versus non-cancer mortality. Between 2000 and 2017 there was a significant decrease in 180-day mortality, which was driven by a reduction in cancer-related events.

CONCLUSION

The distribution of 180-day overall and non-cancer mortality did not indicate a well-defined early high-risk period. Moreover, risk factor estimates were highly similar across risk periods and groups. Taken together, our findings question the applicability of early mortality as a standard metric for treatment-associated toxicity.

Ambient particulate matter concentration levels of Ahvaz, Iran, in 2017

Dust storm in Khuzestan region is strongly influenced by transportation and influx of large amount of particulate matter from internal sources (Hawizeh Marshes and East Ahwaz) and external sources (the Arabian Desert in Saudi Arabia, Jordan, Syria and the Sahara Desert). Particulate matter is one of the main components of indoor and outdoor air quality that can be very dangerous for human. The principal objective of this study was the pinpoint of the source of airborne particulate matter by the NOAA HYSPLIT model in Ahvaz City, southwest of Iran. The investigation of dust storm and their origin was performed by the GFSG Meteorological Data (backward trajectories ending analysis of the NOAA HYSPLIT model) and collecting particulate samples with high-volume air samplers during the fall and winter seasons. The results showed the average ambient particulate matter concentration in the cold and warm seasons was 158 and 161 µg/m³, respectively. Moreover, the average particulate matter concentration in the cold season was significantly higher than the standard level as presented in the National Ambient Air Quality Standard. Consequently, it seems essential to develop green space, decrease particulate emission from source and make determined efforts to control dust at governmental and international scales.

Health risk assessment on human exposed to heavy metals in the ambient air PM10 in Ahvaz, southwest Iran

Heavy metals (HM) are one of the main components of urban air pollution. Today, megacities and industrial regions in southwest of Iran are frequently suffering from severe haze episodes, which essentially caused by PM₁₀-bound heavy metals. The purpose of this study was to evaluate the health risk assessment on human exposed to heavy metals (Cr, Ni, Pb, and Zn) in the ambient air PM₁₀ in Ahvaz, southwest Iran. In this study, we estimated healthy people from the following scenarios: (S3) residential site; (S2) high-traffic site; (S1) industrial site in Ahvaz metropolitan during autumn and winter. In the current study, high-volume air samplers equipped with quartz fiber filters were used to sampling and measurements of heavy metal concentration. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was utilized for detection of heavy metal concentration (ng m^-3). Also, an estimate of the amount of health risk assessment (hazard index) of Cr, Ni, Pb, and Zn of heavy metal exposure to participants was used. Result of this study showed that the residential and industrial areas had the lowest and the highest level of heavy metal. Based on the result of this study, average levels of heavy metal in industrial, high-traffic, and residential areas in autumn and winter were 31.48, 30.89, and 23.21 μg m^-3 and 42.60, 37.70, and 40.07 μg m^-3, respectively. Based on the result of this study, the highest and the lowest concentration of heavy metal had in the industrial and residential areas. Zn and Pb were the most abundant elements among the studied PM₁₀-bound heavy metals, followed by Cr and Ni. The carcinogenic risks of Cr, Pb, and the integral HQ of metals in PM₁₀ for children and adults via inhalation and dermal exposures exceeded 1 × 10^-4 in three areas. Also, based on the result of this study, the values of hazard index (HI) of HM exposure in different areas were significantly higher than standard. The health risks attributed to HM should be further investigated from the perspective of the public health in metropolitans. The result of this study showed increasing exposure concentrations to heavy metal in the studied scenarios have a significant potential for generating different health endpoints, while environmental health management in ambient air can cause disorders in citizenship and causing more spiritual and material costs.

Electrocoagulation process to Chemical and Biological Oxygen Demand treatment from carwash grey water in Ahvaz megacity, Iran

In this work, we present the result of an electric coagulation process with iron and aluminum electrodes for removal of chemical and biological oxygen demand (COD and BOD) from grey water in different car washes of Ahvaz, Iran. Nowadays, one of the important dangerous that can contaminate water resources for drinking, agriculture and industrial is Car wash effluent [1,2]. In this study, initial COD and BOD concentration, pH of the solution, voltage power and reaction time was investigated. The concentration level of remaining COD and BOD in samples was measured, using DR/5000 UV–vis HACH spectrophotometer [3,4]. The effects of contact time, initial pH, electrical potential and voltage data on removal of COD and BOD were presented. Statistical analysis of the data was carried out using Special Package for Social Sciences (SPSS 16).

Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) one expulsive anger and impulsive behaviors

INTRODUCTION

The purpose of this study is to measure Effectiveness of group dialectical behavior therapy (based on core distress tolerance and emotion regulation components) on Expulsive Anger and Impulsive Behaviors.

MATERIALS & METHODS

Research method is a semi experimental socio-statistic approach consisting of experimental group (dialectical behavior therapy) and control group. Participants were patients referred to Amir Kabir Hospital in Arak who suffered from Expulsive Anger and Impulsive Behaviors. Based on stratified random sampling, 16 patients (women) were placed in each group. Research tools included the structured diagnosis interview according to DSM-IV-TR (2000), Barrat impulsivity scale(1994) Distress Tolerance Scale (2005) Difficulties of Emotion Regulation Scale (2004) and dialectical behavior therapy were done for two months,8 group-sessions).

FINDINGS

Dialectical behavior therapy was effective on Expulsive Anger and Impulsive Behaviors.

DISCUSSION & CONCLUSION

Distress tolerance and emotion regulation components were effective on Expulsive Anger and Impulsive Behaviors.

Hemoglobin fructation promotes heme degradation through the generation of endogenous reactive oxygen species

Protein glycation is a cascade of nonenzymatic reactions between reducing sugars and amino groups of proteins. It is referred to as fructation when the reducing monosaccharide is fructose. Some potential mechanisms have been suggested for the generation of reactive oxygen species (ROS) by protein glycation reactions in the presence of glucose. In this state, glucose autoxidation, ketoamine, and oxidative advance glycation end products (AGEs) formation are considered as major sources of ROS and perhaps heme degradation during hemoglobin glycation. However, whether fructose mediated glycation produces ROS and heme degradation is unknown. Here we report that ROS (H2O2) production occurred during hemoglobin fructation in vitro using chemiluminescence methods. The enhanced heme exposure and degradation were determined using UV-Vis and fluorescence spectrophotometry. Following accumulation of ROS, heme degradation products were accumulated reaching a plateau along with the detected ROS. Thus, fructose may make a significant contribution to the production of ROS, glycation of proteins, and heme degradation during diabetes.

Antiglioma activity of GoPI-sugar, a novel gold(I)-phosphole inhibitor: chemical synthesis, mechanistic studies, and effectiveness in vivo

Glioblastoma, an aggressive brain tumor, has a poor prognosis and a high risk of recurrence. An improved chemotherapeutic approach is required to complement radiation therapy. Gold(I) complexes bearing phosphole ligands are promising agents in the treatment of cancer and disturb the redox balance and proliferation of cancer cells by inhibiting disulfide reductases. Here, we report on the antitumor properties of the gold(I) complex 1-phenyl-bis(2-pyridyl)phosphole gold chloride thio-β-d-glucose tetraacetate (GoPI-sugar), which exhibits antiproliferative effects on human (NCH82, NCH89) and rat (C6) glioma cell lines. Compared to carmustine (BCNU), an established nitrosourea compound for the treatment of glioblastomas that inhibits the proliferation of these glioma cell lines with an IC50 of 430μM, GoPI-sugar is more effective by two orders of magnitude. Moreover, GoPI-sugar inhibits malignant glioma growth in vivo in a C6 glioma rat model and significantly reduces tumor volume while being well tolerated. Both the gold(I) chloro- and thiosugar-substituted phospholes interact with DNA albeit more weakly for the latter. Furthermore, GoPI-sugar irreversibly and potently inhibits thioredoxin reductase (IC50 4.3nM) and human glutathione reductase (IC50 88.5nM). However, treatment with GoPI-sugar did not significantly alter redox parameters in the brain tissue of treated animals. This might be due to compensatory upregulation of redox-related enzymes but might also indicate that the antiproliferative effects of GoPI-sugar in vivo are rather based on DNA interaction and inhibition of topoisomerase I than on the disturbance of redox equilibrium. Since GoPI-sugar is highly effective against glioblastomas and well tolerated, it represents a most promising lead for drug development. This article is part of a Special Issue entitled: Thiol-Based Redox Processes.

A novel missense mutation in exon 7 of the ECM1 gene in an Iranian lipoid proteinosis patient

Lipoid proteinosis (LP) is a rare autosomal recessive disorder. Classical clinical features include warty skin infiltration, papules on the eyelids, skin scarring, as well as extracutaneous abnormalities such as hoarseness of the voice, epilepsy, and neuropsychiatric abnormalities. A defect in the ECM1 gene is responsible for this disease. A 21-year-old female patient from consanguineous parents (first cousins) was referred to our clinic with many symptoms of LP, such as hoarse voice from infancy, diffuse acneiform scars on her face, and hyperkeratosis on her knees and elbows. The entire ECM1 gene was screened using PCR and sequencing. A novel missense mutation was found in exon 7 of this patient. We report a novel missense mutation in exon 7 of the ECM1 gene found in an Iranian LP patient that causes a C269Y amino acid exchange.

P-glycoprotein quantitation in acute leukemia

Multi drug resistance(MDR) is a major problem in the treatment ofcancer and hematological malignancies. This resistance is multi factorial and is the result of decreased intra cellular drug accumulation. This is partly due to the presence of a 170KD intra membranous protein termed P-glycoprotein(P-gp) that is an energy- dependent efflux pump which has increased expression on drug-resistance cells. In this study we identified the presence of P-gp by staining with Fluorescent Iso Thio Cyanate (FITC) conjugated anti P-gp in acute leukemia patients and flow cytometry in addition to performing immunophenotype analysis and French, American British (FAB) classification. Results revealed that one fifth of leukemic patients expressed P-gp and this phenotype was more prevalent in Acute Undifferentiated Leukemia(AUL) and Acute Myelogenous Leukemia (AML) than in Acute Lymphoblastic Leukemia(ALL). Other findings showed a logical relationship between this phenotype and age groups. There was not any association between P-gp+ phenotype and FAB and Immunophenotyping sub classification, but there was a linear relationship between CD34 and CD7 expression and P-gp+ phenotype. The accumulation of P-gp molecule that was stated as Mean Fluorescence Intensity (MFI) on the blasts' membrane of AUL and AML patients showed marked increase in comparison to ALL. Furthermore MFI in P-gp+ relapsed patients was much more than P-gp+ pretreatment patients. Kepvords: Leukemia, Drug resistance, P-glycoprotein, Flowcytometry, FAB classification, Immunophenotyping, Mean Fluorescence Intensity.

Intensive Care Unit nosocomial sinusitis at the Rasoul Akram Hospital: Tehran, Iran, 2007-2008

BACKGROUND

Nosocomial rhino sinusitis causes major problems in all Intensive Care Units (ICUs).

OBJECTIVE

To describe incidence, epidemiologic, clinical manifestations, and microbiologic findings in ICUs admitted cases with nosocomial sinusitis. METHODS#ENTITYSTARTX00026;

MATERIALS

A prospective, cross sectional study done in Pediatric & Adult ICUs in Rasoul Akram Hospital; Tehran Iran (2007-2008). Para-nasal sinus computed tomography (CT) was performed in all adults with fever of unknown origin (FUO) within 48h of admission and repeated thereafter (4-7 days). Infectious sinusitis was diagnosed by microbiological analysis of sinus fluid aspirates.

RESULTS

Acute bacterial nosocomial sinusitis proved in 82% (51/ 63) of all cases. Head trauma was the most common cause; (n = 22, 45%) of cases. The results of culture were positive for 45 cases (82%). Of 45 culture positives, 19 yielded Gram negative organisms (41%) and 9 (22%) gave Gram positives (S. aureous, Streptococus spp). The remainders (n = 17, 37%) consisted of mixed aerobic/anaerobic bacteria. Seven cases, were positive in gram staining of sinus drainage and these were positive in culture for S. pneumonia (n = 5), Hemophilus influenza (n = 2). The type of organisms were not related to Glasgow Coma Scale in cases (P = 0.3).

CONCLUSION

Nosocomial organisms isolated were quite different from community acquired rhino sinusitis cases. Investigation of CT scan and drainage of Para-nasal sinuses would be helpful in undiagnosed FUO cases, especially in traumatic patients. Optimal treatment usually consists of removal of the tubes, mobilizing the patient, and administration the broad-spectrum antibiotics.

Use of image guidance in endoscopic endonasal surgeries: a 5-year experience

PROBLEMS/OBJECTIVES

Endoscopic endonasal surgery (EES) is standard practice in sinonasal disease and is becoming more accepted in the performance of anterior skull base resections. We report our experience with image-guided surgery (IGS) in difficult cases of paranasal sinus (PNS) and skull base pathologies and discuss advantages and disadvantages of this technique.

METHODOLOGY

A retrospective chart review was performed for the period 2004-2009. Degree of PNS involvement, indication for IGS, incidence of major complications, need for revision surgery, and technical data regarding the system were gathered.

RESULTS

Sixty-two of 86 patients were followed for at least one year and therefore included in the analysis. Indications for IGS were mostly revision surgery for polyposis (42%), chronic rhinosinusitis (CRS) of frontal and/or sphenoid sinuses (14.5%), skull base tumours (30.6%), and foreign body removal (4.8%). Revision rates after IGS in polyposis, CRS, and benign skull base tumours were 7.7%, 11.11%, and 7.1%, respectively.

CONCLUSIONS

IGS is of particular benefit in the management of sinonasal polyposis, benign skull base tumours, palliative surgery, and foreign body removal. IGS may avoid trauma to the orbit and anterior skull base and reduces the rate of revision surgeries rendering more meticulous and complete operations possible. We also think it could be helpful for foreign body removal.

Perineal mesh rectopexy with sterile talc in children with rectal prolapse

BACKGROUND

With such a wide variety of treatment options available for rectal prolapse and a variable success rate, the optimal treatment for this condition in children is still debated. In this study, we evaluated a technique of perineal mesh rectopexy with a sterile talc-soaked mesh and compared the success rates and complications of this method with those of abdominal rectopexy.

METHODS AND MATERIALS

To examine the effect of therapeutic interventions, a randomized control trial (children were randomized into the case group or the control group) was carried out. In the control group, children were operated on by abdominal posterior mesh rectopexy. In the case group, a 30-cm sterile asbestos-free talc-soaked mesh was placed in the presacral space in a spiral fashion with the end exiting from the perineal incision. From 5 (th) day after surgery onward, the mesh was gradually extracted (10 cm per day) and completely removed by the 7 (th) postoperative day. On postoperative assessment, the duration of hospitalization, the postoperative complications and the success rates after surgery were compared. Patients were followed up for one year.

RESULTS

In this study we evaluated 120 children. Mean age of the patients was 5.1±0.081 years in the case group and 4.91±0.59 years in the control group (p=NS). 34 patients in the case group were male vs. 41 patients in the control group. Results indicated that there was no statistically significant difference in postoperative complications between groups. The infection rate was 1.6% in the case group and 6.6% in the control group (p=NS).There was a higher resolution of constipation in the perineal rectopexy group (68.4% in the control group and 96.8% in the case group; p=0.002). The duration of hospitalization was 6.34±0.28 days in the case group and 6.68±0.31 days in the control group (p=NS).

CONCLUSION

Our findings suggest that perineal mesh rectopexy with sterile talc can be an alternative approach to abdominal surgery and offers an acceptable outcome with a low rate of complications.

Open-set speech perception in adult cochlear implant users with ossified cochleae

This study describes open-set speech recognition in cochlear implant subjects with ossified cochleae and compares it to a control group with open cochleae. Twenty-one postlingually deafened adults with a Med-El Combi 40/40+GB split- electrode implant were matched to patients using a Med-El cochlear implant with a standard electrode. Speech recognition was assessed over an 18-month period. Split- electrode patients improved significantly over time, but their scores were significantly lower and increased significantly slower than those of controls. Of 14 patients with a duration of deafness less than 20 years, average sentence test scores were 50%, and average monosyllabic word test scores were 31%. This study provides evidence that cochlear implantation is beneficial to patients with ossified cochleae, but early implantation is advisable.

Sensorineural hearing loss due to Toxoplasma gondii in children: a case-control study

OBJECTIVE

Sensorineural hearing loss (SNHL) can follow congenital toxoplasmosis. Treatment in the first year of life is associated with diminished occurrence of this sequel. In various parts of Iran, the prevalence of antibodies to Toxoplasma gondii ranges from 24% to 57.7%. We evaluate the possible role of Toxoplasma gondii infection on the occurrence of SNHL in children.

DESIGN AND SETTING

This case-control study was performed in a tertiary care center in Tehran between 2002 and 2003. This study was carried out based on diagnostic parameters of the American Academy of Otolaryngology criteria for SNHL and a healthy control group.

MAIN OUTCOME MEASURES

We compared the specific Toxoplasma gondii antibodies (IgM & IgG) measured by ELISA in 95 blood samples of infants with SNHL and 63 healthy matched infants.

RESULTS

Acute (IgM) and previous (IgG) immunity to Toxoplasma gondii was found in 12 and 21.2% of SNHL children, respectively. Most cases with previous infections (IgG positive) were children aged less than 1 year old (i.e. maternal immunity), but acute infection (IgM positive) was higher in 3-5 year old age group. Acute infection (IgM) was significantly more frequent in the SNHL group, and previous immunity was higher in the controls (CI 95%, P-value = 0.01; 0.01).

CONCLUSION

With respect to seropositive children, as we were unable to differentiate congenital from acquired cases, we recommend prevention of congenital toxoplasmosis by treatment of Toxoplasma infection in pregnant women and treatment of acquired Toxoplasma gondii infection after birth to minimise the risk of SNHL in children.

A new technique during septoplasty to prevent saddle nose

During septoplasty, especially in patients with severe deviation of the nasal septum, there is the risk of septal instability, which may result in a saddle nose deformity. Therefore, prevention of this unwanted outcome is very important and removes surgeon's anxieties. This article describes a simple technique during septoplasty to prevent the development of this serious complication. In this surgical technique, the dislocated nasal septum is lifted and stabilised with a temporary traction suture. This traction suture holds the mobile septal cartilage in the proper position to restore and support the nasal dorsum and provides it with a normal contour. The advantages of this technique are that it is (i) easy to perform, (ii) not time-consuming, (iii) is less traumatic compared to other methods, (iv) is comfortable for the patient and (v) provides long-term stability.

Cochlear implantation in children with Waardenburg syndrome

Waardenburg syndrome is an autosomal-dominant trait resulting from mutations occurring in different genes. It is often characterized by varying degrees of: congenital hearing loss; dystopia canthorum; synophrys; broad nasal root; depigmentation of hair (white forelock), skin or both; and heterochromic or hypochromic irides. A retrospective case study was done to assess speech perception, speech production, general intelligence and educational setting in six profoundly hearing-impaired children with Waardenburg syndrome (four with type I, one with type II and one with type III) ranging in age from two years to 14 years, seven months (mean = six years, six months). None of the patients had malformation of the cochlea and were implanted using Nucleus 22/24 and Med-el combi40+. Five out of the six cases were of average intelligence and one had a borderline intelligence quotient. The follow-up period ranged from one year, 10 months to six years, six months (mean = three years, six months) after implantation. The evaluation of auditory perception in patients was accomplished using the Persian Auditory Perception Test for the Hearing-Impaired, a Persian Spondee words test and the Categories of Auditory Performance Index. The Speech Intelligibility Rating test was used to evaluate speech production ability. All the patients' speech perception and speech intelligibility capabilities improved considerably after receiving the implants, and they were able to be placed in regular educational settings. Patients used their cochlear-implant devices whenever awake, implying that they benefitted from the devices. We suggest that any further expansion of cochlear-implantation criteria in children include those with Waardenburg syndrome.

Auditory electrical tinnitus suppression in patients with and without implants

The aim of this study was to evaluate the effectiveness of electrical tinnitus suppression in two groups of chronic severe tinnitus sufferers. Through standard tinnitus questionnaires, we compared the effectiveness of extratympanic and intratympanic auditory electrical stimulation (AES) by cochlear implants (CI) for the suppression or abolition of the perception of tinnitus and the decrease of its associated complaints. We made otolaryngological and comprehensive audiological assessment and also tinnitus measurement in each group of patients before and after AES and 50 days later. We investigated the dimensions of psychological complaints due to chronic and disabling tinnitus by means of the tinnitus questionnaire (TQ). The control examination during at least seven sessions (50 days) after AES in the group of patients without implants showed improvement in 20 of 32 patients (62.5%); 12 (37.5%) did not notice any change. In the comparative group of patients with implants, improvement occurred in 16 of 20 patients (75%); during the switch-on of the speech processor, these patients reported significant attenuation or complete suppression of their tinnitus. Complete suppression of the tinnitus after CI was observed for 11 patients (55%), and 5 patients (25%) demonstrated significant attenuation of tinnitus. Nonsuppression of tinnitus was observed for only 4 patients (25%). None of our patients was affected by an increment in the tinnitus owing to CI. The differences of means of scores in the standard TQ were significant in both groups of patients. A comparison of TQ score differences between patients with and without implants showed no significance. We concluded that AES is a useful and effective therapeutic intervention in patients with tinnitus. Extratympanic AES reduces the effects of the tinnitus but presents limitations, mainly owing to the short duration of the electrical residual inhibition of the tinnitus. CI is shown to be more efficient for the treatment of tinnitus, mainly because the electrical stimulation affects a wider area of the cochlea and is presented for longer sessions. Therefore, patients affected by incapacitating tinnitus should be considered for continuous use of electrical stimulation.

Calcium transport proteins in active secretory zones: Na-Ca exchange isoforms and exchanger kinetic properties in chromaffin granules and plasma membranes

We have found that Na-Ca exchange influences Ca(2+) efflux, signal decay, and the rate of secretion in chromaffin cells. We now report the presence of two distinct splicing variant isoforms of Na-Ca exchange proteins in bovine chromaffin cells and their transport properties in chromaffin granules and plasma membrane vesicles.

Intravital microscopy reveals novel antivascular and antitumor effects of endostatin delivered locally by alginate-encapsulated cells

The current study describes new, antivascular, and antitumor effects of human endostatin. A novel system for continuous, localized delivery of antiangiogenic compounds to brain tumors was used. The delivery system was composed of endostatin-producing 293 cells encapsulated into immuno-isolating sodium alginate. Intravital multifluorescence microscopy was used to assess vascular and antitumor effects of endostatin in C6 glioma spheroids implanted into an ectopic as well as an orthotopic setting. Analysis of total and functional vascular density, microvascular diameters, vessel perfusion, tumor growth, and tumor cell migration were performed repetitively. Tumor growth was reduced by 35% in treated animals. It was of interest that tumor cell invasion into the surrounding tissue was also inhibited. The total vascular density was reduced by 67.6%, perfusion by 67%, and vessel diameters by 37%. This resulted in a significant reduction in tumor perfusion, although the vessel permeability was not influenced. We have demonstrated that human endostatin not only reduces total vascular density, as shown previously, but also greatly reduces the functionality and the diameters of the vessels. Furthermore, we show that this therapeutic approach also inhibits tumor cell invasion, thus supporting the hypothesis that tumor angiogenesis and invasion represent two interrelated processes. Finally, this work further confirms the new therapeutic concept using alginate cell-encapsulation technology for the localized delivery of therapeutic compounds to central nervous system malignancies.

Glioma cell migration is associated with glioma-induced angiogenesis in vivo

To simultaneously assess glioma cell invasion and glioma angiogenesis in vivo by non-invasive and quantitative means, DiI-labeled C6 glioma spheroids were implanted into the dorsal skinfold chamber preparation of nude mice (n = 6). Heat-inactivated spheroids served as controls to distinguish between active and passive cell spread. Using multi-fluorescent intravital videomicroscopy, glioma cell migration was analyzed on days 1-4, 6, and 10 and spheroid vascularization was analyzed on days 3, 6, and 10 after implantation. Additionally, C6 glioma spheroids were implanted into the chronic cranial window of nude mice as an orthotopic implantation site (n = 4). In the dorsal skinfold chamber, spheroids were vascularized within 10 days and revealed a tumor-specific microvasculature. In parallel, individual glioma cells detached from the spheroid edge and migrated centrifugally demonstrating an affinity to tumor and host vessels. Glioma cells demonstrated a heterogeneous pattern of their regional migratory activity (0.2-9.6 microm/h) which correlated well with regional glioma angiogenesis (r = 0.733). Using the cranial window, glioma cells spread similarly demonstrating an affinity to the perivascular space of pial/subpial vessels with preference to the arteriolar segments. Intravital fluorescence microscopy represents a versatile technique to assess the complex relationship between glioma-driven angiogenesis and glioma cell invasion.