The importance of heteroresistance and efflux pumps in bedaquiline-resistant Mycobacterium tuberculosis isolates from Iran

BACKGROUND

Tuberculosis (TB) continues to pose a threat to communities worldwide and remains a significant public health issue in several countries. We assessed the role of heteroresistance and efflux pumps in bedaquiline (BDQ)-resistant Mycobacterium tuberculosis isolates.

METHODS

Nineteen clinical isolates were included in the study, of which fifteen isolates were classified as MDR or XDR, while four isolates were fully susceptible. To evaluate BDQ heteroresistance, the Microplate Alamar Blue Assay (MABA) method was employed. For screening mixed infections, MIRU-VNTR was performed on clinical isolates. Mutations in the atpE and Rv0678 genes were determined based on next-generation sequencing data. Additionally, real-time PCR was applied to assess the expression of efflux pump genes in the absence and presence of verapamil (VP).

RESULTS

All 15 drug-resistant isolates displayed resistance to BDQ. Among the 19 total isolates, 21.05% (4/19) exhibited a heteroresistance pattern to BDQ. None of the isolates carried a mutation of the atpE and Rv0678 genes associated with BDQ resistance. Regarding the MIRU-VNTR analysis, most isolates (94.73%) showed the Beijing genotype. Fifteen (78.9%) isolates showed a significant reduction in BDQ MIC after VP treatment. The efflux pump genes of Rv0676c, Rv1258c, Rv1410c, Rv1634, Rv1819, Rv2459, Rv2846, and Rv3065 were overexpressed in the presence of BDQ.

CONCLUSIONS

Our results clearly demonstrated the crucial role of heteroresistance and efflux pumps in BDQ resistance. Additionally, we established a direct link between the Rv0676c gene and BDQ resistance. The inclusion of VP significantly reduced the MIC of BDQ in both drug-susceptible and drug-resistant clinical isolates.

The Abundance of Plasmid-Mediated Quinolone Resistance Genes in Enterobacter cloacae Strains Isolated from Clinical Specimens in Kermanshah, Iran

Background

Enterobacter cloacae (E. cloacae) is one of the most common Enterobacteriaceae causing nosocomial infections. Plasmid-mediated quinolone resistance (PMQR) determinants have been considered recently. This study evaluated the abundance of PMQR genes in strains of E. cloacae obtained from clinical samples in Kermanshah, Iran.

Methods

In this descriptive cross-sectional study, after collecting 113 isolates of E. cloacae, their identity was confirmed using specific biochemical tests. After determining their drug resistance patterns using disc diffusion, the phenotypic frequency of extended-spectrum beta-lactamase (ESBL)-producing isolates was measured by the double-disk synergy test (DDST) method. The isolates were examined for the presence of qnrA, qnrB, qnrS, and aac(6')-Ib-cr genes by the polymerase chain reaction (PCR) assay.

Results

The antibiotic resistance rate of E. cloacae isolates varied from 9.7% to 60.2%; among them, 78% were multidrug-resistant (MDR). The highest quinolone resistance was observed in ESBL-producing strains of E. cloacae. The frequency of positive isolates for PMQR and ESBL was 79.6% and 57.5%, respectively. The genes aac(6')-ib-cr (70.8%) and qnrB (38.1%) had the highest frequency among other genes. The number of isolates simultaneously carrying 2 and 3 genes was 64 and 5 isolates, respectively.

Conclusion

The obtained results indicate a high degree of quinolone resistance among ESBL-producing E. cloacae strains. Nevertheless, there was a significant relationship between the PMQR gene and ESBL-positive isolates. Therefore, special attention should be paid to molecular epidemiological studies on antibiotic resistance to quinolones and beta-lactamases in these strains.

Tuberculosis prevention, diagnosis, and treatment financial profile during 2006-2021: PART A

BACKGROUND

Tuberculosis (TB) is a communicable disease that is a major cause of death and one of the leading causes of death worldwide. Currently, there is no analyzed data to examine the financial profile of TB by country, continent, and year; this article analyzed TB prevention, diagnosis, and treatment financial profile during the last two decades.

METHODS

Original research, reviews, and governmental databases are analyzed to present the financial profile of TB.

RESULTS

Analyzed data showed Europe (23137.133), Asia (20137.073), and Africa (15237.973) had the most allocated funds (US $ million), and Oceania (236.702), and America (4745.043) had the lowest allocated fund (US $ million) during 2006-2021. Additionally, the allocation of funds (domestic funds, global funds, and grants [excluding global funds]) in different countries and proper planning for TB eradication has caused that in the last two decades, the slope of the confirmed cases and deaths graph line is negative.

CONCLUSION

The number of confirmed cases and deaths reported globally is decreasing. The trend lines showed that the assigned funds are increasing, indicating that the TB eradication plan can be apprehended soon.

Diatomaceous earth foliar spraying along with adjuvants in pistachio orchards associated with the common pistachio psylla, Agonoscena pistaciae

The common pistachio psylla, Agonoscena pistaciae, is a serious global pest menacing pistachio orchards. Considering the dangers of using excessive chemical pesticides, it seems that using natural insecticides such as diatomaceous earth is a suitable way to lower the residual amount of highly hazardous pesticides. In this study, the effects of diatomaceous earth with different additives, including dipotassium hydrogen phosphate, polyurethane glue as a wood adhesive, and potassium silicate, were investigated in several concentrations over two years in orchard conditions. Although all treatments showed significant effects, the most effective treatments were (diatomaceous earth+dipotassium hydrogen phosphate) and (diatomaceous earth+polyurethane glue). Therefore, the use of diatomaceous earth combined with the additive materials mentioned can potentially be a safe method for the integrated management of the common pistachio psylla.

Molecular Analysis of Oxacillinase Genes and Identification of Drug Resistance Pattern in MDR Strains of Acinetobacter baumannii Isolated from Burn Wound Samples in Kermanshah, Iran

Introduction: Carbapenem Resistant Acinetobacter Baumannii (CRAB) is a dangerous nosocomial pathogen that can cause high mortality in patients. This bacterium has a remarkable ability to acquire various resistance mechanisms due to this it is considered as one of the health priorities. Aim: To investigate the prevalence of the OXA-23, OXA-24, and OXA-58 genes in Acinetobacter baumannii isolates collected from burn wound samples in Kermanshah, Iran. Materials and Methods: A cross-sectional study was done during 11 months period from December 2018 to October 2019, 74 A. baumannii isolates were collected from those admitted to the Burns Unit of Imam Khomeini Hospital in Kermanshah, Iran. The 74 A. baumannii isolates were detected using particular bacteriological methods. Following determination of the antibiotic sensitivity of the specimens using the disk diffusion technique, polymerase chain reaction was performed to determine the frequency of the OXA-23, OXA-24, and OXA-58 genes using their specific primers. Data were analysed using Fisher’s-exact test and Chi-squared test in Statistical Package for the Social Sciences (SPSS) version 20.0. A p-value <0.05 was considered statistically significant. Results: All the 74 A. baumannii isolates were MultidrugResistant (MDR) (41 from males and 33 from females). The highest drug resistance was against cefotaxime (100%) and piperacillin (98.6%), while all the isolates were sensitive to polymyxin B and colistin. Oxacillinase genes with the highest and lowest frequencies were OXA-23 (64.7%) and OXA-58 (3.5%), respectively. The highest frequency of isolates with two genes were related to OXA-23 and OXA-24. A significant relationship was observed among the existence of oxacillinase genes and resistance to some antibiotics. Conclusion: The results of this study indicated the significance of OXA carbapenemase genes in burn patients. Due to the high drug resistance of A. baumannii isolates collected from wound samples, the identification of carbapenemase-producing A. baumannii isolates is paramount in developing prevention and control programs for these drug-resistant isolates.

[Potential of fMRI for the Functional Assessment of the Pathological Visual System]

Current developments in functional magnetic resonance imaging (fMRI) of the human visual system have generated a set of powerful approaches that are of great promise for modern ophthalmology. These make it possible to perform an objective spatially resolved test of visual function in patients with strong visual impairment and even to investigate the functional organisation of the visual cortex in the blind. As a consequence, they open a broad field of applications for functional assessment in ophthalmology and provide fundamental insights into the interplay of pathology and plasticity in the human visual system. This is highlighted by current studies investigating patients with acquired or congenital defects of the macula, or with visual pathway abnormalities, extended retinal damage, and complete blindness. Therapeutic approaches targeting the restoration of visual input are expected to benefit from these fMRI applications, either for the estimation of the success rate of a planned retinal therapy or as an objective high-level biomarker for the readout of therapy success.

Study of the Frequency of Herpesvirus Infections Among Patients Suspected Aseptic Meningitis in the West of Iran

Background:

Aseptic meningitis is the most common type of meningitis and is characterized by meningeal inflammation that is not linked to identifiable bacterial pathogens in cerebrospinal fluid (CSF).

Objectives:

This study aimed to evaluate the frequency of aseptic meningitis caused by herpesviruses, namely herpes simplex types I and II (HSV-1, HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and varicella-zoster virus (VZV).

Patients and Methods:

A total of 196 CSF samples were collected from patients with suspected meningitis. All samples were smear- and culture-negative for bacterial pathogens. The biochemical and cytological findings of CSF samples were also recorded. DNA was extracted from samples and PCR with specific primers was carried out to detect viruses.

Results:

The 196 samples derived from 100 (52%) men and 96 (48%) women ranging in age from one day to 86 years with an average age of 32.3 ± 25.3 years. Of them, 8 (4.08%) samples yielded positive results, including 5 (2.55%) cases of VZV infection and 3 (1.53%) cases of HSV-1 infection. No cases of HSV-2, CMV or EBV infection were detected. CSF protein and glucose levels among positive cases were all in the normal range.

Conclusions:

The results indicate a considerable rate of herpesvirus infection in patients with aseptic meningitis, and that VZV is the most common herpesvirus to cause infection followed by HSV-1. Our results also showed that a moderate increase in the WBC count and predominance of lymphocytes can be valuable clues in diagnosing viral meningitis. Given the different approaches of drug therapy in bacterial and viral meningitis, use of molecular methods is necessary in hospitals to rapidly discriminate between them.

Prevalence and Clonal Dissemination of Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa in Kermanshah

Background:

Pseudomonas aeruginosa is an opportunistic pathogen associated with nosocomial infections. The emergence and dissemination of metallo-beta-lactamases (MBLs) has contributed to the high rate of resistance among P. aeruginosa isolates.

Objectives:

The purpose of this study was to describe the prevalence and the clonal dissemination of MBL- producing P. aeruginosa isolates collected from major hospitals in Kermanshah.

Materials and Methods:

Antibiotic susceptibility testing was performed using the minimal inhibitory concentrations. The MBLs were investigated using the Double-Disk Synergy Test (DDST) and Polymerase Chain Reaction. Molecular typing was performed by Pulsed-Field Gel Electrophoresis (PFGE).

Results:

Of the 60 P. aeruginosa isolates included in this study, 30 (50%) were resistant to Gentamicin, 38 (63.3%) to Piperacillin, 42 (70%) to Ceftazidime, and 45 (75%) to Cefepime. Twenty-nine (48.3%) isolates were MBL producers in the DDST test. Five (8.3%) isolates were positive for the VIM gene. PFGE analysis among the MBL producers revealed 12 distinct clonal patterns.

Conclusions:

The inter- and intra-hospital dissemination of resistant clones is a matter of concern and is an indicator of the level of the improvement and surveillance of standard hygiene, particularly disinfection and hand washing before and after contact with patients. Given the emergence of MBL-producing strains, surveillance has become an important procedure to control the transmission of resistant strains.

Comparison of nickel doped Zinc Sulfide and/or palladium nanoparticle loaded on activated carbon as efficient adsorbents for kinetic and equilibrium study of removal of Congo Red dye

In this study, the efficiency of nickel doped Zinc Sulfide nanoparticle loaded on activated carbon (Ni-ZnS-NP-AC) and palladium nanoparticles loaded on activated carbon (Pd-NP-AC) for the removal of Congo Red (CR) from aqueous solution was investigated. These materials were fully identified and characterized in term of structure, surface area and pore volume with different techniques such XRD, FE-SEM and TEM analysis. The dependency of CR removal percentage to variables such as pH, contact time, amount of adsorbents, CR concentration was examined and optimum values were set as: 0.03g Ni-ZnS-NP-AC and 0.04g of Pd-NP-AC at pH of 3 and 2 after mixing for 22 and 26min for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Subsequently, it was revealed that isotherm data efficiency can be correlated Langmuir with maximum monolayer adsorption capacities of 286 and 126.6mgg(-1) at room temperature for Ni-ZnS-NP-AC and Pd-NP-AC, respectively. Investigation of correlation between time and rate of adsorption reveal that the CR adsorption onto both adsorbents followed pseudo second order and interparticle diffusion simultaneously.

Frequency of Streptococcus pneumoniae infection in patients with suspected meningitis in Imam Reza Hospital of Kermanshah in the west of Iran

BACKGROUND AND OBJECTIVES

Streptococcus pneumoniae is the main causative agent of acute bacterial meningitis in the world. This study aimed to detect pneumoniae infection in cerebrospinal fluid (CSF) samples of patients with suspected meningitis.

MATERIALS AND METHODS

In this study, 200 CSF samples in patients with suspected meningitis and with negative bacterial cultures were tested. Demographic data of patients and the laboratory analysis of CSF samples were also collected in a questionnaire. Pneumococcal capsular gene spn9802 was examined by real-time PCR technique.

RESULTS

Of 200 CSF samples from patients with the average age of 32.1±25.3 year old, 20 were positive for S. pneumoniae in patients with the average age of 35.05±24.6. The biochemical and cytological analysis of positive samples showed significant changes, including, 39.7 mg/DL protein, 46.2 mg/DL glucose and 1173 white blood cells per microliter of CSF on average.

CONCLUSION

The results of this study showed the significant pneumococcal infection in culture negative CSF samples. The majority of this infection occurred in middle-aged patients and with a higher incidence rate in the winter. It seems that the traditional methods of cultivation are not sensitive enough to detect this bacterium in CSF. Alternatively, the molecular techniques such a real-time seem to be accurate, sensitive and rapid for the detection of this agent in CSF. The cytological and biochemical findings of CSF can provide valuable clues in the diagnosis of bacterial meningitis.

The validity of the Menopause-specific Quality of Life questionnaire in women with type 2 diabetes

OBJECTIVES

To examine the validity and reliability of the Menopause-specific Quality of Life (MENQOL) questionnaire in a sample of women with diabetes in Malaysia, with the secondary aim of determining whether MENQOL domain scores were associated with depression and diabetes.

METHODS

A total of 337 postmenopausal women (241 with diabetes, 96 controls) were evaluated. Construct validity was evaluated using principal components analysis (PCA) and comparing scale items against the mental component score of the Short Form-12 (SF-12 MCS), and against the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10). Consistency assessment was conducted using Cronbach's α.

RESULTS

The internal consistencies for the physical (PHS), psychosocial (PS), sexual (VSS) and vasomotor domains were 0.86, 0.79, 0.79 and 0.70, and 0.90 for the full scale of MENQOL. PCA revealed a four-factorial model. Diabetes and non-diabetes subjects experienced their first period (13.25 vs. 13.10 years, p = 0.680) and achieved menopause around the same age (49.35 vs. 48.87 years, p = 0.426). We found significant variations in the MENQOL's PHS and PS domain scores that could be explained by SF-12 PCS (25%) and SF-12 MCS (20%) sub-scales. The validity of the MENQOL domains was demonstrated through significant associations with the equivalent SF-12 MCS and PCS subscales. The PS domain of the MENQOL also predicted the likelihood of symptoms of depression (1.42, 95% confidence interval 1.01-2.02).

CONCLUSIONS

This study confirms the validity and internal consistency of the MENQOL questionnaire for measuring quality of life in postmenopausal women with diabetes, suggesting that the instrument can be used to screen people for menopausal symptoms.

Biochemical and histological changes in the liver tissue of rainbow trout (Oncorhynchus mykiss) exposed to sub-lethal concentrations of diazinon

The organophosphate insecticide diazinon is widely used to control pest in Iran. The purpose of the present study was to investigate the antioxidant and histopathological changes in the liver tissue of rainbow trout (Oncorhynchus mykiss) exposed to 0.1 and 0.2 mg/L of a commercial formula of diazinon for a period of 28 days. Antioxidant enzyme activities--catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase--were determined after 7, 14 and 28 days of exposure. Histopathological analyses were performed at the 28th day. All antioxidant enzymes were induced after 7 days of diazinon treatment in both concentrations of diazinon. Catalase and superoxide dismutase maintained elevated activities during all the treatment period. Glutathione peroxidase activity returned to the control values at the 14th day, decreasing to values below control at the 28th day in both diazinon concentrations. Glutathione reductase maintained increased activities at the 14th day in the 0.1 mg/L diazinon, decreasing to control values at the 28th day. In the 0.2 mg/L group, the activity returned to control values at the 14th and decreased below the control at the 28th day. Total antioxidant capacity of hepatocytes significantly decreased in fishes exposed to diazinon during all experimental periods. Hypertrophy of hepatocytes, vacuolization of cell cytoplasm and hepatocyte cloudy swelling were observed in the liver tissue of fish exposed to both concentrations of diazinon. The results showed that diazinon altered the activity of antioxidant enzymes and the cellular total antioxidant capacity inducing oxidative stress and cellular damage in hepatocytes evidenced by histopathological analysis.

The psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire

BACKGROUND

This study was carried out to evaluate the psychometric properties of an Iranian translation of the Work Ability Index (WAI) questionnaire.

METHODS

In this methodological study, nurses and healthcare workers aged 40 years and older who worked in educational hospitals in Ahvaz (236 workers) in 2010, completed the questionnaire and 60 of the workers filled out the WAI questionnaire for the second time to ensure test-retest reliability. Forward-backward method was applied to translate the questionnaire from English into Persian. The psychometric properties of the Iranian translation of the WAI were assessed using the fallowing tests: Internal consistency (to test reliability), test-retest analysis, exploratory factor analysis (construct validity), discriminate validity by comparing the mean WAI score in two groups of the employees that had different levels of sick leave, criterion validity by determining the correlation between the Persian version of short form health survey (SF-36) and WAI score.

RESULTS

Cronbach's alpha coefficient was estimated to be 0.79 and it was concluded that the internal consistency was high enough. The intraclass correlation coefficient was recognized to be 0.92. Factor analysis indicated three factors in the structure of the work ability including self-perceived work ability (24.5% of the variance), mental resources (22.23% of the variance), and presence of disease and health related limitation (18.55% of the variance). Statistical tests showed that this questionnaire was capable of discriminating two groups of employees who had different levels of sick leave. Criterion validity analysis showed that this instrument and all dimensions of the Iranian version of SF-36 were correlated significantly. Item correlation corrective for overlap showed the items tests had a good correlation except for one.

CONCLUSION

The finding of the study showed that the Iranian version of the WAI is a reliable and valid measure of work ability and can be used both in research and practical activities.

Effects of Watercress (Nasturtium nasturtium) extract on selected immunological parameters of rainbow trout (Oncorhynchus mykiss)

Watercress (Nasturtium nasturtium) is a medical plant containing diverse chemically-active substances with biological properties. The present study was conducted to investigate the immunomodulatory effects of watercress extract on immunological and hematological parameters of rainbow trout (Oncorhynchus mykiss). Fish were fed for 21 days with diet supplemented with 0.1% and 1% of watercress extract per 1 kg food and with a normal diet as control. Hematological parameters such as red blood cells (RBC) and white blood cells (WBC), hematocrit (Hct), hemoglobin (Hb), RBC index like mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) as well as immunological parameters such as peroxidase, lysozyme and complement activities, total protein, albumin and globulin levels were measured after 21 days of watercress extract treatment. The results indicated that oral administration of 1 % watercress extract in fish may enhance some hematological and immunological parameters including Hb and MCHC, lysozyme and complement activities, total protein and globulin levels, compared to the controls after 21 days of experimental period. In conclusion, on the basis of these results, oral administration of watercress extract may be useful to improve fish's immune system.

First Detection of Nosema ceranae, a Microsporidian Protozoa of European Honeybees (Apis mellifera) In Iran

BACKGROUND

Nosemosis of European honey bee (Apis mellifera) is present in bee colonies worldwide. Until recently, Nosema apis had been regarded as the causative agent of the disease, that causes heavy economic losses in apicultures. Nosema ceranae is an emerging microsporidian parasite of European honeybees, A. mellifera, but its distribution is not well known. Previously, nosemosis in honeybees in Iran was attributed exclusively to N. apis.

METHODS

Six Nosema positive samples (determined from light microscopy of spores) of adult worker bees from one province of Iran (Savadkouh- Mazandaran, northern Iran) were tested to determine Nosema species using previously- developed PCR primers of the 16 S rRNA gene. As it is difficult to distinguish N. ceranae and N. apis morphologically, a PCR assay based on 16 S ribosomal RNA has been used to differentiate N. apis and N. ceranae.

RESULTS

Only N. ceranae was found in all samples, indicating that this species present in Iran apiaries.

CONCLUSION

This is the first report of N. ceranae in colonies of A. mellifera in Iran. It seems that intensive surveys are needed to determine the distribution and prevalence of N. ceranae in different regions of Iran.

Understanding of and attitudes toward epilepsy among the urban Chinese population in Malaysia

INTRODUCTION

People with epilepsy are socially discriminated against on the grounds of widespread negative public attitudes, misunderstandings and defensive behaviour. The primary purpose of this study was to evaluate the public understanding of and attitudes toward epilepsy among the Chinese population in Malaysia.

METHODS

A validated, self-administered questionnaire comprising 23 questions was utilised to evaluate the understanding of and attitudes toward epilepsy among randomly approached respondents from the Chinese population living in the urban areas of Penang, Klang Valley, Kuala Lumpur and Sibu in Malaysia.

RESULTS

Out of 1,000 people approached, 697 (69.7 percent) respondents agreed to participate in the study. When asked whether people with epilepsy are slow learners and have intellectual functioning below normal, 448 (64.3 percent) respondents answered 'no'. This positive answer was mainly provided by female (35.6 percent) as compared to male (28.6 percent) respondents. Moreover, more than half responded positively to the following statements: people with epilepsy should not be isolated from the normal population; epileptics can perform daily activities; epileptics can receive academic education; and epileptics can become useful members of society. In addition, significant associations were discovered between the education level of the respondents and several statements, including whether epileptics are as intelligent as everyone else (p-value is 0.009), whether epilepsy can be treated with drugs (p-value is 0.037) and whether epileptics can be as successful as other people in their chosen career (p-value is 0.009). Positive responses were mainly acquired from those with secondary education and above. A large number of the respondents felt that people with epilepsy should not be employed as lorry drivers, firefighters, doctors and army personnel.

CONCLUSION

The general Chinese population in the urban areas of Malaysia had, at the time of the investigation, a relatively high level of understanding and positive attitudes toward certain aspects of epilepsy, although a minority of the study population demonstrated prejudice and discriminatory behaviours toward people with epilepsy.

Paraclinical evaluation of side-effects of Taxanes on auditory system

Ototoxicity is one of the major causes of hearing loss and balance system disorders. Taxanes are a new group of anti-neoplastic agents used for chemotherapy; examples include Paclitaxel and Docetaxel. In this study, ototoxicity of these drugs has been evaluated in order to provide a means of adjusting the doses to avoid these complications. A prospective analytical study was carried out on 103 known cases of breast and ovarian cancer, during 2004 to 2006 (20 months), in the Otolaryngology, Head and Neck Surgery Department of Ahwaz University of Medical Sciences of Tehran. All patients (mean age 45 +/- 2.3 years) were treated with Taxanes. The first evaluation of hearing (using pure tone audiometery) was performed before starting treatment, the second in the middle of the treatment period and the last at the end of treatment. Results showed that nausea and vomiting were the most common side-effects of the drugs used. No significant side-effects of Taxanes, on the audiovestibular system, were observed. In conclusion, little information concerning the ototoxic effect of Taxanes has been reported in other studies, and, in the present investigation, no significant effect on the auditory system was found.

Population genetic approaches to neurological disease: Parkinson's disease as an example

Parkinson's disease (PD) is a common, progressive, incurable disabling condition. The cause is unknown but over the past few years tremendous progress in our understanding of the genetic bases of this condition has been made. To date, this has almost exclusively come from the study of relatively rare Mendelian forms of the disease and there are no currently, widely accepted common variants known to increase susceptibility. The role that the "Mendelian" genes play in common sporadic forms of PD is unknown. Moreover, most studies in PD can really be described as candidate polymorphism studies rather than true and complete assessments of the genes themselves. We provide a model of how one might tackle some of these issues using Parkinson's disease as an illustration. One of the emerging hypotheses of gene environment interaction in Parkinson's disease is based on drug metabolizing (or xenobiotic) enzymes and their interaction with putative environmental toxins. This motivated us to describe a tagging approach for an extensive but not exhaustive list of 55 drug metabolizing enzyme genes. We use these data to illustrate the power, and some of the limitations of a haplotype tagging approach. We show that haplotype tagging is extremely efficient and works well with only a modest increase in effort through different populations. The tagging approach works much less well if the minor allele frequency is below 5%. However, it will now be possible using these tags to evaluate these genes comprehensively in PD and other neurodegenerative conditions.

Controlled trial of maintenance treatment of intravenous buprenorphine dependence

BACKGROUND

Buprenorphine dependence is a relatively novel addiction.

AIMS

To compare the treatment outcome in three groups over 12-weeks of treatment.

METHODS

Two hundred and four intravenous (i.v.)-buprenorphine-dependent patients were randomised into three groups. Subjects received 50 mg oral methadone tablet, or 5 mg sublingual buprenorphine tablet, or 50 mg oral naltrexone, and a weekly 30-minute clinical counselling session.

RESULTS

The majority (80%) had a history of opium or heroin dependency before they were introduced to i.v. buprenorphine. The main source of buprenorphine for misusers was street sale (91%). The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules (1 ampoule contains 0.3 mg of buprenorphine in 1 ml). Overall 59% of the patients completed the 12-week study. Retention in the 50 mg methadone group was significantly better than the 5 mg dose buprenorphine group (p=0.001) and the 50 mg dose naltrexone group (p=0.000). Retention in the 5 mg buprenorphine group was significantly better than the 50 mg naltrexone dose group (p=0.000).

CONCLUSIONS

These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients.

Controlled, randomized trial in maintenance treatment of intravenous buprenorphine dependence with naltrexone, methadone or buprenorphine: a novel study

AIMS

To test the effect of a 50-mg day-1 dose of naltrexone in the maintenance treatment of intravenous-buprenorphine dependence in comparison with a 50-mg day-1 dose of methadone and also a 5-mg day-1 dose of buprenorphine over a 24-week treatment period.

PARTICIPANTS

Two hundred and four intravenous-buprenorphine-dependent patients who met the DSM-IV criteria for opioid dependence were randomized to three equal groups and were treated in a clinic in Iran where they were also offered a weekly 0.5-h counselling session, in 2002.

FINDINGS

The mean age was 31.2 years (range 17-53). The majority [63.2%] was between 20 and 34 years of age. The educational level of most of them [55.4%] was between 6 and 12 years of study. Completion rates by groups were 83.8% for the 50-mg dose methadone group, 58.8% for the 5-mg dose buprenorphine group and 20.6% for the 50-mg dose naltrexone group (P = 0.000). Retention in the 50-mg methadone group was significantly better than in the 5-mg dose buprenorphine group (P = 0.001) and the 50-mg dose naltrexone group (P = 0.000). Retention in the 5-mg buprenorphine group was significantly better than in the 50-mg naltrexone dose group (P = 0.000).

CONCLUSIONS

Evaluation of the Iranian experience on this subject may be useful for other countries.

Synthesis and function of 3-phosphorylated inositol lipids

The 3-phosphorylated inositol lipids fulfill roles as second messengers by interacting with the lipid binding domains of a variety of cellular proteins. Such interactions can affect the subcellular localization and aggregation of target proteins, and through allosteric effects, their activity. Generation of 3-phosphoinositides has been documented to influence diverse cellular pathways and hence alter a spectrum of fundamental cellular activities. This review is focused on the 3-phosphoinositide lipids, the synthesis of which is acutely triggered by extracellular stimuli, the enzymes responsible for their synthesis and metabolism, and their cell biological roles. Much knowledge has recently been gained through structural insights into the lipid kinases, their interaction with inhibitors, and the way their 3-phosphoinositide products interact with protein targets. This field is now moving toward a genetic dissection of 3-phosphoinositide action in a variety of model organisms. Such approaches will reveal the true role of the 3-phosphoinositides at the organismal level in health and disease.

Cellular function of phosphoinositide 3-kinases: implications for development, homeostasis, and cancer

The phosphoinositide 3-kinase (PI3K) family of enzymes is recruited upon growth factor receptor activation and produces 3' phosphoinositide lipids. The lipid products of PI3K act as second messengers by binding to and activating diverse cellular target proteins. These events constitute the start of a complex signaling cascade, which ultimately results in the mediation of cellular activities such as proliferation, differentiation, chemotaxis, survival, trafficking, and glucose homeostasis. Therefore, PI3Ks play a central role in many cellular functions. The factors that determine which cellular function is mediated are complex and may be partly attributed to the diversity that exists at each level of the PI3K signaling cascade, such as the type of stimulus, the isoform of PI3K, or the nature of the second messenger lipids. Numerous studies have helped to elucidate some of the key factors that determine cell fate in the context of PI3K signaling. For example, the past two years has seen the publication of many transgenic and knockout mouse studies where either PI3K or its signaling components are deregulated. These models have helped to build a picture of the role of PI3K in physiology and indeed there have been a number of surprises. This review uses such models as a framework to build a profile of PI3K function within both the cell and the organism and focuses, in particular, on the role of PI3K in cell regulation, immunity, and development. The evidence for the role of deregulated PI3K signaling in diseases such as cancer and diabetes is reviewed.

Infants' growth charts for southern Iran

Currently there are no growth charts based on local norms available for infants in Iran, and their growth is assessed by the National Centre for Health Statistics (NCHS) reference data, which is misleading. Growth charts for a cohort of 317 infants (164 girls and 153 boys) born in Shiraz (Southern Iran) in 1996 and followed for 2 years from birth are presented. All the centiles of length and weight charts are slightly above those of the NCHS charts under the age of 6 months and fall substantially below those over the age of 6 months. However, the spread is similar, so there is no suggestion that the difference is due to the prevalence of gross malnutrition. The difference shows that the use of locally based growth charts are essential for assessing the growth of children in Iran. The representativeness of our data leads us to conclude that the charts presented here are likely to be applied to the urban infant population of Iran.

Human phosphoinositide 3-kinase C2beta, the role of calcium and the C2 domain in enzyme activity

The cDNA for a human Class II phosphoinositide 3-kinase (PI 3-kinase C2beta) with a C2 domain was cloned from a U937 monocyte cDNA library and the enzyme expressed in mammalian and insect cells. Like other Class II PI 3-kinases in vitro, PI 3-kinase C2beta utilizes phosphatidylinositol (PI) and PI 4-monophosphate but not PI 4, 5-biphosphate as substrates in the presence of Mg2+. Remarkably, and unlike other PI 3-kinases, the enzyme can use either Mg-ATP or Ca-ATP to generate PI 3-monophosphate. PI 3-kinase C2beta, like the Class I PI 3-kinases, but unlike PI 3-kinase C2alpha, is sensitive to low nanomolar levels of the inhibitor wortmannin. The enzyme is not regulated by the small GTP-binding protein Ras. The C2 domain of the enzyme bound anionic phospholipids such as PI and phosphatidylserine in vitro, but did not co-operatively bind Ca2+ and phospholipids. Deletion of the C2 domain increased the lipid kinase activity suggesting that it functions as a negative regulator of the catalytic domain. Although presently it is not known whether PI 3-kinase C2beta is regulated by Ca2+ in vivo, our results suggest a novel role for Ca2+ ions in phosphate transfer reactions.

Antibodies to Klebsiella pneumoniae lipopolysaccharide in patients with ankylosing spondylitis

The role of microbial lipopolysaccharides (LPS) in the aetiopathogenesis of ankylosing spondylitis (AS) is a matter of continuing debate. In this study, class-specific IgG, IgA and IgM antibodies against Klebsiella pneumoniae, Escherichia coli, Salmonella typhimurium and Salmonella enteritidis LPS were measured by enzyme-linked immunosorbent assay (ELISA) in 100 AS patients, 50 rheumatoid arthritis (RA) patients and 50 healthy control subjects. The AS patients had significantly elevated levels of IgG and IgA antibodies against K. pneumoniae LPS (P < 0.001) and IgA antibodies against E. coli LPS (P < 0.05) compared to healthy controls. There were no significant elevations of antibody levels against S. typhimurium and S. enteritidis in the three study groups. In addition, there was a correlation between IgG and IgA anti-K. pneumoniae LPS antibody levels and the acute-phase reactant C-reactive protein (P < 0.001).

Molecular mimicry: the geographical distribution of immune responses to Klebsiella in ankylosing spondylitis and its relevance to therapy

The discovery that HLA-B27 is linked to ankylosing spondylitis (AS) and HLA-DR1/DR4 to rheumatoid arthritis (RA) has provided new approaches to the study of the possible causation of these diseases. Several theories have been proposed to explain these associations but only one, namely "molecular mimicry", has provided a specific aetiological agent for each of these diseases. Molecular mimicry between HLA-B27 and two molecules in Klebsiella microbes: nitrogenase and pullulanase D has been reported whilst in Proteus microbes, the haemolysin molecule shows sterochemical similarity to HLA-DR1/DR4. Elevated immune responses to Klebsiella microbes have been demonstrated in AS patients from 10 different countries and this wide geographical distribution suggests that the same aetiological agent is probably acting in producing this condition. Furthermore RA patients show similar immune responses to Proteus microbes. Whether AS or RA are caused by these bacteria can only be resolved by tissue typing all rheumatological patients early, in the course of their disease and then assessing their response to antibiotic chemotherapy in longitudinal studies involving double-blind crossover trials. It is possible that in the future, the course of AS or even RA could be modified by adequate antibiotic chemotherapy or even diets which affect the substrates on which these bacteria grow.