فهرست مطالب

  • Volume:3 Issue: 3, 2015
  • تاریخ انتشار: 1394/06/20
  • تعداد عناوین: 8
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  • Viroj Wiwanitkit * Page 1
  • Steven B. Karch *, Fabio Vaiano, Elisabetta Bertol Page 2
    Context: An epidemic of aminorex-associated pulmonary arterial hypertension (PAH), resulting in multiple fatalities, occurred in the 1970s ending only after the drug was removed from the market. In 2009, when it was found that horses de-wormed with the anthelmintic levamisole, metabolized that drug to aminorex, the same drug that caused the 1970s outbreak of PAH. The discovery would not have been cause for concern except to horseracing enthusiasts, who feared horse doping. However, at about the same time the relationship between levamisole and aminorex was discovered, cocaine cartels began adulterating cocaine with levamisole. The rationale for adulterating cocaine with levamisole remains to be established. The purpose of this short review article is to discuss possible reasons for levamisole contamination, new discoveries about the human pharmacokinetics of aminorex, and the possible relationship between aminorex and pulmonary arterial hypertension in man.
    Evidence acquisition: Medline contents, as well as estimates published by the U.S. drug enforcement agency (DEA), US state department, and the European monitoring center for drugs and drug abuse (EMCDDA) were reviewed and relevant articles retrieved. There is uniform agreement among the various monitoring agencies analyzed.
    Results
    Approximately 70 percent of the U.S. cocaine supply and 40 percent of the European cocaine supply is contaminated with levamisole. Aminorex has the same binding affinities for serotonin and other neurotransmitters as amphetamine. As serotonin is considered to be an important factor in the development of PAH, the possibility of another epidemic of aminorex-induced PAH, this time among cocaine abusers, seems real, and threatening.
    Conclusions
    The results of the first human pharmacokinetic studies of aminorex were first characterized in 2013. The results suggest that while humans could produce aminorex from levamisole, they probably do not convert very much. Even though cases of PAH have been reported in cocaine users, the latest pharmacokinetic studies suggest that very little aminorex is actually produced from the ingested levamisole, probably not enough to cause PAH. However, since both cocaine and aminorex can cause PAH the situation remains unclear. the lack of a clear answer is partially the development of an insidious pulmonary hypertension, producing subtle and non-specific symptoms in its early stages.
    Keywords: Levamisole, Aminorex, Cocaine, Amphetamine, Serotonin, Bone Morphogenetic Protein
  • Zhale Shariaty, Mohammad Reza Sheykhian, Saeed Dolatshahi * Page 3
    Background
    Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease which is recognized by symmetric inflammation of joints. Many factors have been proposed as its etiology including microbial infections. H. pylori has been considered as one of the infectious agents linked to RA; however, the data regarding this relation is controversial.
    Objectives
    To determine the effects of H. pylori on clinical course of disease, we compared the clinical course and laboratory findings of two groups of RA patients, with and without H. pylori infection, during one year follow up after H. pylori eradication.
    Patients and
    Methods
    One hundred adult RA patients (diagnosed according to the 2010 Revised ACR/EULAR Criteria) who referred to Rheumatology Clinic of Imam Reza Hospital were evaluated for H. pylori infection. Thirty-nine patients were positive for H. pylori; from them 30 patients underwent H. pylori standard treatment with three drugs including Amoxicillin (1 g/Bid), Clarithromycin (500 mg/Bid) and omeprazole (20 mg/Bid), for 10 days and PPI for one month. Seven H. pylori positive patients were excluded from the study because of inappropriate drug compliance and drug resistance and three patients did not refer for follow up. Overall, frothy RA patients, 20 with H. pylori infection, and 20 without H. pylori infection, were evaluated in the study. Patient's clinical findings and laboratory tests were evaluated in 5 consecutive visits; at the beginning of the study and every 3 months up to one year. H. pylori infection and its eradication were evaluated by fecal antigen test performed with Eliza method.
    Results
    Patients of H. pylori positive group had a higher number of joints inflammation and tenderness during 5 evaluation visits and the difference in number of joints involvement between two groups was statistically significant. The difference between two groups for pain based on visual analog scale (VAS), DAS-ESR and DAS-CRP was also significant and higher in H. pylori positive group. The other clinical and laboratory tests including ESR, CRP, RF and anti-CCP were not significantly different between two groups. H. pylori eradication did not improve clinical course of disease and laboratory tests.
    Conclusions
    Considering the results of this study, although having H. pylori infection in RA patients was accompanied with higher number of inflamed and tender joints, but H. pylori eradication did not improve patients’ clinical symptoms and laboratory tests. It seems that the effect of H. pylori infection eradication over disease activity in RA patients is not remarkable, if it does exist at all.
    Keywords: Eradication, Rheumatoid Arthritis, Helicobacter pylori
  • Mehdi Fathi, Saeid Jahanbakhsh*, Hosein Saadatfar, Alireza Bameshki, Marjan Joudi, Mehryar Taghvi Gilani, Azam Lotfi, Azra Izanloo, Azam Sabri Page 4
    Background
    Methods of reducing blood loss in surgical procedures such as spinal disc herniation, which are characterized by severe bleeding, can reduce the need for blood transfusion and thereby the risk of infectious diseases transmission, transfusion reactions, acute lung injury, graft-versus-host disease (GVHD), hypothermia, coagulation disorders and metabolic complications. Anti-fibrinolytic drugs (e.g. Aprotinin, aminocaproic acid, desmopressin and tranexamic acid) and controlled hypotension (monitored reduction by medication) are among these methods.
    Objectives
    In our clinical trial, two methods of aprotinin and controlled hypotension are compared in terms of their efficacy in reducing blood loss.
    Patients and
    Methods
    70 patients undergoing spinal disc herniation were randomly divided into two groups of controlled hypotension (treated with nitroglycerin: starting with 5 µg/minute to reach an MAP of 55 - 60 mmHg, with an increase of 5 µg/minute of the drug in every 3 - 5 minutes) and aprotinin (0.5 million units injection before surgery). The anesthesia was administered similarly to both groups and blood pressure and heart rate were recorded every 5 to 15 minutes. Moreover, the amount of bleeding and the surgeon satisfaction were measured.
    Results
    70 patients were identical in terms of demographics and the length of surgery. The two groups were not statistically different in terms of mean change in systolic, diastolic and mean blood pressure and heart rate at different times. The severity of blood loss measured on Boezarrt scale for low, medium and severe bleeding was respectively 21 (30%), 27 (39%), and 12 (31%). The extent of surgeon satisfaction with the operation room measured on a 3-point Likert scale (poor, medium and good) was 18 (26%), 40 (57%), and 12 (17%), respectively. The results were almost corresponding in both groups. Also, the two groups were identical in terms of calculated blood loss and the need for additional intraoperative medication.
    Conclusions
    In intervertebral herniated disc surgery, aprotinin and controlled hypotension treatments yielded similar results in terms of reducing blood loss and surgeon satisfaction with the field of operation.
    Keywords: Orthopedics, Hypotension, Controlled, Aprotinin
  • Mohammad Reza Hedayati, Moghaddam*, Farhad Fathimoghadam, Iman Eftekharzadeh, Mashhadi, Seyed Javad Pourafzali Page 5
    Background
    Risky behaviors such as tobacco and substance abuse, which often begin in adolescence, have been considered as the most important cause of morbidity and mortality in the world.
    Objectives
    This study was designed to assess the frequency of tobacco smoking, substance abuse and alcohol consumption among students of a university in Mashhad, Iran.
    Patients and
    Methods
    In this cross-sectional study, 944 university students in Mashhad were randomly selected from 11 faculties with 12183 students in 2008 and filled out a self-administer questionnaire. Kaplan-Meier survival analysis and log rank statistics were used to evaluate the mean initiation age of the behaviors. Logistic regression analysis was performed for the prediction of the behaviors using SPSS software.
    Results
    The overall frequency of smoking, alcohol drinking and substance abuse among students were 18.9%, 9.6% and 4.7%, respectively. Among students with a history of smoking, 69% had started smoking before 20 years of age. Moreover, 69.9% of individuals with a history of alcohol consumption and 56.5% of those with a history of substance abuse had reported their first use before 20 years of age. Older and human sciences students had a higher possibility to smoke tobacco (OR = 2.31 and OR = 1.27, respectively) and drink alcohol (OR = 2.20 and OR = 1.40, respectively).
    Conclusions
    Present study demonstrated that the frequency of tobacco and substance abuse is considerable among Iranian university students who thought to be more knowledgeable and concerned about their health. Thus, efficient educational programs are needed to reduce the high-risk behaviors before students enter to university.
    Keywords: Risk-Taking, Smoking, Substance Abuse, Iran
  • Elham Mousavi, Ali Esmaeili *, Soodabeh Shahid Saless Page 6
    Background
    Every individual’s quality of life, well-being and mental health are certainly influenced by physical and psychological aspects.
    Objectives
    The purpose of this study was to determine the effect of training positive thinking on quality of life and resiliency in female cancer patients hospitalized in Mashhad Omid hospital.
    Patients and
    Methods
    This study was an interventional and experimental trial, including pre-and post-test. The target population in this study includes all female cancer patients, monthly 500 patients, hospitalized as outpatient (for a day) or inpatient (more than a week) in Omid hospital, Mashhad. Simple random sampling was used in this study. From the invited subjects, 55 patients accepted to participate in the classes. Using random number table, 30 subjects (15 patients as experimental group, and 15 as control group) were selected. The intervention was performed through eight sessions of one and a half to two hours, and continued for three weeks. After finishing positive thinking sessions, the post-test was conducted for both the experimental group who received intervention and control group who did not receive intervention. Two questionnaires including Conner-Davison resilience scale, 2003, and quality of life (SF-36) along with the primary questions about the individual characteristics were used to collect the required data.
    Results
    To analyze the data, t-test and analysis of covariance (ANCOVA) was used. The result of this study showed that the positive thinking training course has a significant effect on resiliency (P = 0.00) and quality of life in cancer patients and changes are statistically significant (P = 0.00). These changes are the result of the effect of the independent variable.
    Conclusions
    The overall results of this study reveal that positive thinking training courses can be used to increase the quality of life and resiliency of cancer patients.
    Keywords: Quality of Life, Psychological Resilience, Neoplasm
  • Mohsen Salari Rad, Ehsan Bolvardi *, Sima Salari Rad Page 7
    Introduction
    Autoimmune progesterone dermatitis (APD) is an uncommon immunologic condition accompanied with dermatologic manifestations and caused by an immune response to endogenous or exogenous progesterone in women during their reproductive years. We report a case of APD in a pregnant woman who received exogenous progesterone to prevent preterm delivery.
    Case Presentation
    A 28-year-old female who was 17 weeks pregnant was referred to the emergency department with the complaint of progressive edema in the dorsal side of her right hand and progressive dyspnea. Intradermal skin test using 50 mg/mL progesterone resulted in 15 mm wheal in the injected area and approved the diagnosis of APD.
    Conclusions
    Patients with APD may have very different symptoms requiring immediate care; therefore, being informed about this condition is necessary for the physicians in emergency and obstetrics and gynecology departments. Also a positive history of such condition in a pregnant woman necessitates precautions in the management of her pregnancy due to the potential of anaphylactic events.
    Keywords: Autoimmune Progesterone Dermatitis, 17, alpha, hydroxyprogesterone, Pregnant
  • Erwin Josef Speckmann *, Hildegard Speckmann Page 8
    Two physicians, both grown up in West Europe, educated also in this area (supplemented by many visits of the United States), travelled 20 years ago to Japan for scientific reasons and they changed thereafter in their mental sight of the world. In a first part, the neurophysiologic basis of sensation from the sensory receptor up to the cerebral cortex (“bottom up”), the mechanisms of building memories and the influences of the contents of the memories on the bottom up (“top down”), thus constructing an apperception, are described. These functional elements provide a first approach to that what might be going on when Western brain encounters Japan. In a second part, the deduced neurophysiologic processes are illustrated by photographs (HS) and works of art (EJS). The sensory processes generate a “Gestalt” which is transformed to non-verbal “Extrakte Kunst”.
    Keywords: Brain, Neurophysiology, Japan, Memory