The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis

Objectives@#This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. @*Methods@#We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. @*Results@#A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. @*Conclusion@#Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.

Effect of orthodontic forces on root length of immature mandibular second premolars: a split-mouth randomized clinical trial

ABSTRACT Objective: To assess the effect of orthodontic forces on changes in root length of immature mandibular second premolars. Methods: Sixty-four mandibular second premolars (MSP) with immature apices (left and right sides) of 32 patients aged between 10 and 13 years were evaluated. Orthodontic treatment was started after obtaining periapical radiographs (T1) from the MSPs of each patient. Brackets were bonded, except the ones of MSPs (left or right by random as control MSP, and the other side as test MSP). After 9-12 months, a second periapical radiograph (T2) was obtained from the MSPs of each patient. Then, brackets were bonded to the control MSPs, which were not bonded before. After 18 ± 3 months, a third periapical radiograph (T3) was obtained. Changes in root length were evaluated by using a new formula. The test and control MSPs at T1, T2 and T3 were compared using repeated measures ANOVA and parametric tests. P-value smaller than 0.05 was statistically significant. Results: There was no significant difference between the test and control groups in the mean root length of MSP at T1 (p= 0.48) and T3 (p= 0.078). The root length at T2 (p= 0.001) was significantly different between test and control MSPs, and the test group showed longer root length than the control group. Conclusions: Orthodontic force applied for leveling and alignment of immature MSPs may not have destructive effects on the roots, and may accelerates root formation in short-term. Normal root length was achieved at the end of root development.

RESUMO Objetivo: Avaliar o efeito das forças ortodônticas nas mudanças do comprimento radicular de segundos pré-molares inferiores com raízes incompletas. Métodos: Foram avaliados 64 segundos pré-molares inferiores (SPI) com raízes incompletas (lados direito e esquerdo da mandíbula) de 32 pacientes com idades entre 10 e 13 anos. O tratamento ortodôntico teve início após a obtenção de radiografias periapicais (T1) dos SPIs de cada paciente. Foram colados braquetes em todos os dentes, com exceção dos SPIs (do lado esquerdo ou direito, de forma aleatória, como grupo controle; e o SPI contralateral como grupo teste). Após 9 a 12 meses, uma segunda radiografia periapical (T2) foi obtida dos SPIs de cada paciente. Então, braquetes foram colados nos SPIs do grupo controle, que não haviam sido colados anteriormente. Após 18 ± 3 meses, uma terceira radiografia periapical (T3) foi obtida. As mudanças no comprimento radicular foram avaliadas por meio de uma nova fórmula. Os SPIs teste e controle foram comparados em T1, T2 e T3 usando ANOVA para medidas repetidas e testes paramétricos. Valores de p< 0,05 foram considerados estatisticamente significativos. Resultados: Não foi encontrada diferença significativa no comprimento radicular médio dos SPIs entre os grupos teste e controle em T1 (p= 0,48) e T3(p= 0,078). O comprimento radicular dos SPIs em T2 (p= 0,001) foi significativamente diferente entre os lados teste e controle, sendo que o grupo teste apresentou maior comprimento radicular do que o grupo controle. Conclusões: As forças ortodônticas aplicadas para o alinhamento e nivelamento de SPIs com raízes incompletas podem não ter efeitos danosos nas raízes, podendo, inclusive, acelerar a formação radicular em curto prazo. O comprimento radicular normal foi alcançado ao fim da formação radicular.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial

ABSTRACT Objective: The current study investigated the correlation between pulpal sensitivity to the electric pulp tester (EPT) and external apical root resorption (EARR) in four types of maxillary anterior teeth of fixed orthodontic treatment patients. Methods: In this prospective cohort study, 232 anterior teeth of 58 patients (mean age 18.96 ± 6.13 years) treated with fixed orthodontic treatment were examined. The EPT readings were recorded at twelve time points immediately before archwire insertion. Root resorption of four maxillary incisors were measured by means of parallel periapical radiographs at three time intervals (six months interval from the start) through design-to-purpose software to optimize data collection. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of EPT values and observed EARR (p< 0.05). Results: The highest level of EPT measurement was recorded at initial visit, and then there was a decreasing trend in EPT level during treatment for the next six and twelve months. There was another increasing trend after six months till the finishing time of the treatment. There was a significant correlation between changes in root length and time of recording the root length (p< 0.001). There was significant positive correlation between changes in EPT level and amount of observed root resorption (p< 0.001). Conclusion: The relative decrease in electric pulp test level could be a diagnostic sign of root resorption during orthodontic treatment. Further studies with longer follow up are needed to confirm the current results.

RESUMO Objetivo: O presente estudo investigou a correlação entre a sensibilidade pulpar ao teste pulpar elétrico (TPE) e a reabsorção radicular apical externa (RRAE) nos quatro dentes anteriores superiores de pacientes em tratamento ortodôntico com aparelho fixo. Métodos: Nesse estudo de coorte prospectivo, foram avaliados 232 dentes anteriores de 58 pacientes (idade média 18,96 ± 6,13 anos) tratados com aparelho ortodôntico fixo. As leituras do TPE foram registradas em doze tempos de avaliação, imediatamente antes da inserção dos arcos. As reabsorções radiculares dos quatro incisivos superiores foram aferidas por meio da média das radiografias periapicais, em três intervalos de tempo (em intervalos de seis meses desde o início) por um software desenvolvido para essa finalidade, com o intuito de otimizar a coleta de dados. Para aferir a associação entre os valores de TPE e as RRAE observadas (p< 0,05), foram utilizados o modelo de regressão linear múltiplo e o coeficiente de correlação de Pearson. Resultados: O nível mais alto das medidas do TPE foi registrado na primeira visita e, daí em diante, houve uma tendência de diminuição no nível do TPE durante o tratamento, nos seis a doze meses seguintes. Houve, também, outra tendência de aumento após os seis meses até o término do tratamento, além de uma correlação significativa entre as mudanças no comprimento radicular e o tempo de registro do comprimento radicular (p< 0,001), bem como uma correlação positiva significativa entre as mudanças no nível do TPE e a quantidade de reabsorção radicular observada (p< 0,001). Conclusão: Uma diminuição relativa no nível de sensibilidade ao teste pulpar elétrico pode ser um sinal diagnóstico de reabsorção radicular durante o tratamento ortodôntico. Estudos futuros com acompanhamentos mais longos são necessários para confirmar os presentes resultados.

Antifungal effect of sesame medicinal herb on Candida Species: original study and mini-review

The aim of this study was to evaluate the antifungal susceptibility patterns of three antifungals, methanolic extracts and N-hexane oil of sesame seeds on C. albicans and C. glabrata, isolated from oral cavity of liver transplant recipients. The results were compared with other reports to develop a mini review as well. Candida species were isolated from liver transplant recipients. To evaluate the antifungal activity of sesame seed oil and methanolic extract, fluconazole, caspofungin and nystatin, the corresponding minimum inhibitory concentrations were determined by CLSI M27-A3 standard method. Minimum fungicidal concentration was also evaluated. The most prevalent species was C. albicans, followed by C. glabrata. Findings indicated sensitivity to antifungal agents and resistance to methanolic extract and N-hexane oil for all C. albicans and C. glabrata isolates. The rate of Candida colonization in the oral cavity of liver transplant recipients was high. Our results revealed that the methanolic and N-hexan extracts of sesame seeds are not effective on C. albicans and C. glabrata species, isolated from the patients. The sesame seed oil pulling and mouthwash cannot effectively cleanse and remove the Candida species in the mouth. Investigation of other medicinal plants or other parts of sesame like leaves and roots are suggested.

Interaction effect of RsaI and BamHI polymorphisms of TGF-alpha, BMP2 and BMP4 on the occurrence of non-syndromic cleft lip and palate in Iranian patients

Background: Orofacial cleft is the most common congenital defect of the maxillofacial region. Its non-syndromic type is multi-factorial, and several genes are involved in its occurrence. This study aimed to assess the interaction effect of Rsal and BamHI polymorphisms of Transforming Growth Factor-alpha [TGFa] gene and Bone Morphogenetic Protein-2 [BMP2] and BMP4 variants on the occurrence of Non-Syndromic Cleft Lip and Palate [NSCLP] in the Iranian population

Methods: This case-control study was conducted on 120 children with NSCLP and 215 healthy children. Genotyping of the TGFA/BamHI [rs11466297], TGFA/RsaI [rs3732248], BMP4 [rs17563] and BMP2 [rs235768] was performed by Polymerase Chain Reaction [PCR] and Restriction Fragment Length Polymorphism [RFLP] methods. Logistic regression was applied to determine the effective factors and the interaction effect of different variants on the occurrence of NSCLP

Results: Gender of patients had no significant association with the occurrence of NSCLP [p=0.335]. Multiple logistic regression showed that the interaction effect of the aforementioned polymorphisms on the occurrence of NSCLP was not statistically significant [p=1.000]

Conclusion: Although the individual effect of each of the BMP4, BMP2, RsaI and BamHI variants on the occurrence of NSCLP in the Iranian population has been previously confirmed, their interaction does not play a role in this respect

Biosynthesis of gold nanoparticles by two bacterial and fungal strains, Bacillus cereus and Fusarium oxysporum, and assessment and comparison of their nanotoxicity in vitro by direct and indirect assays

Background: Although nanoparticles (NPs) have many advantages, it has been proved that they may be absorbed by and have toxic effects on the human body. Recent research has tried to evaluate and compare the nanotoxicity of gold nanoparticles (AuNPs) produced by two types of microorganisms in vitro by two different methods. AuNPs were produced by Bacillus cereus and Fusarium oxysporum, and their production was confirmed by visible spectral, transmission electron microscope, and X-ray diffraction (XRD) analyses. The human fibroblast cell line CIRC-HLF was treated with AuNPs, and the induced nanotoxicity was measured using direct microscopic and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Results: The results showed that the produced AuNPs had a maximum absorbance peak around 510­530 nanometer (nm), with spherical, hexagonal, and octagonal shapes and average sizes around 20­50 nm. The XRD results confirmed the presence of GNPs in the microbial culture supernatants. An MTT assay showed that GNPs had dose-dependent toxic effects, and microscopic analysis showed that GNPs induced cell abnormalities in doses lower than the determined half-maximal inhibitory concentrations (IC50s). Conclusions: In conclusion, the biologically produced AuNPs had toxic effects in the cell culture, and direct techniques such as microscopic evaluation instead of indirect methods such as MTT assay were more useful for assessing the nanotoxicity of the biologically produced AuNPs. Thus, the use of only MTT assay for nanotoxicity evaluation of AuNPs is not desirable.

Analysis of transforming growth factor- beta 1 expression in resorptive lacunae following orthodontic tooth movement in an animal model

Objective: Root resorption is a complication of orthodontic treatment and till date, there is a dearth of information regarding this issue. The aim of this study was to determine whether the expression of transforming growth factor-beta 1 [TGF-beta 1, an inflammatory cytokine] is related to orthodontic force. Moreover, if associated, the expression level may be helpful in differential diagnosis, control and ultimate treatment of the disease

Materials and Methods: In this experimental study, a total of 24 eight-week-old male Wistar rats were selected randomly. On day 0, an orthodontic appliance, which consisted of a closed coil spring, was ligated to the upper right first molar and incisor. The upper left first molar in these animals was not placed under orthodontic force, thus serving as the control group. On day 21, after anesthesia, the animals were sacrificed. The rats were then divided into two equal groups where the first group was subjected to histological evaluation and the second group to reverse transcriptase-polymerase chain reaction [RT-PCR]. Orthodontic tooth movement was measured in both groups to determine the influence of the applied force

Results: Statistical analysis of data showed a significant root resorption between the experimental group and control group [P<0.05], however, there was no significant difference in the expression level of the inflammatory cytokine, TGF-beta 1

Conclusion: Based on the findings of this study, we suggest that there is a direct relationship between orthodontic force and orthodontic induced inflammatory root resorption. In addition, no relationship is likely to exist between root resorption and TGF-beta 1 expression in the resorptive lacunae

[Evaluation of IgG and IgM antibodies against Varicella zoster virus in children with acute lymphoblastic leukemia]

Background and Objective: Varicella zoster virus [VZV] can cause a moderate disease in children, but with high risk of serious disease or death in children with acute lymphoblastic leukemia [ALL] Vaccination from infection can be safe, immunogenic, and effective in children with leukemia. This study was done to evaluate the IgG and IgM antibodies against VZV in children with acute lymphoblastic leukemia

Methods: The descriptive-analytic study was performed on 66 children who were on chemotherapy in Dr Shigh hospital in Mashhad, Iran during 2012. Patients were receivied VZV vaccine. The title negative or positive serum sample for IgG-anti-VZV avidity was determined by using a test kit before and after injection of vaccines VZV for considering the efficacy of vaccines on pediatric patients

Results: Title serum sample IgG were positive in 32.6% patients, these children have history of chicken pox disease and to be safe against of VZV. 78.3% of the patients were negative for IgG antibody and sensitive against of VZV

Conclusion: Children with ALL receiving chemotherapy are sensitive to chicken pox disease according to negative IgG titer against VZV

[Drug susceptibility testing of clinical isolates of Candida albicans against Amphotericin B and Ketoconazole by microdilution and disk diffusion methods]

Background and Objective: Candida albicans is the normal flora of the body as opportunistic fungi. It causes candidiasis in immunocompromised condition. This study was done to drug susceptibility testing of Candida albicans isolated from patients against Amphotericin B and Ketoconazole

Methods: In this descriptive - analytic study, drug susceptibility of 30 Candida albicans isolated from patients admitted to Tehran hospitals, Iran was tested against Amphotericin B and Ketoconazole by micro dilution method in accordance with CLSI M27-A2 guideline and disk diffusion method in accordance with CLSI M44-S2 guideline. Standard isolate Candida albicans PTCC [5027] and Candida krusei PTCC [5295] were used for quality control

Results: The minimum and maximum MIC against Amphotrericin B was 0.0625 micro g.ml[-1] and 4 micro g.ml[-1], respectively. The minimum and maximum MIC against Ketoconazole was 0.5 micro g/ml[-1] and 32 micro g/ml[-1], respectively. The minimum and maximum zone diameter was 6 and 28 mm for both drugs. The results of drug susceptibility testing by two methods did not show significant differences. 25 isolates [83.3%] against ketoconazole and 2 isolates [6.7%] against Amphotericin B were resistant

Conclusion: Amphotericin B administration seems better choice in candidiasis treatment in comparision with Ketoconazole

effect of an angiogenic cytokine on orthodontically induced inflammatory root resorption

Objective: Orthodontically induced inflammatory root resorption [OIIRR] is an undesirable sequel of tooth movement after sterile necrosis that takes place in periodontal ligament due to blockage of blood vessels following exertion of orthodontic force. This study sought to assess the effect of an angiogenic cytokine on OIIRR in rat model

Materials and Methods: In this experimental animal study, 50 rats were randomly divided into 5 groups of 10 each: E10, E100 and E1000 receiving an injection of 10, 100 and 1000 ng of basic fibroblast growth factor [bFGF], respectively, positive control group [CP] receiving an orthodontic appliance and injection of phosphate buffered saline [PBS] and the negative control group [CN] receiving only the anesthetic agent. A nickel titanium coil spring was placed between the first molar and the incisor on the right side of maxilla. Twenty-one days later, the rats were sacrificed. Histopathological sections were made to assess the number and area of resorption lacunae, number of blood vessels, osteoclasts and Howship's lacunae. Data were statistically analyzed using ANOVA and Tukey's honest significant difference [HSD] test

Results: Number of resorption lacunae and area of resorption lacunae in E1000 [0.97 +/- 0.80 and 1. 27 +/- 0.01×10-3, respectively] were significantly lower than in CP [4.17 +/- 0.90 and 2.77 +/- 0.01×10-3, respectively, P=0.000]. Number of blood vessels, osteoclasts and Howship's lacunae were significantly higher in E1000 compared to CP [P<0.05]

Conclusion: Tooth movement as the outcome of bone remodeling is concomitant with the formation of sterile necrosis in the periodontal ligament following blocked blood supply. Thus, bFGF can significantly decrease the risk of root resorption by providing more oxygen and angiogenesis

Evaluating the correlation between serum NT-proBNP level and diastolic dysfunction severity in beta-thalassemia major patients

Background: N-terminal pro-brain natriuretic peptide [NT-proBNP] is a sensitive biomarker for the detection of asymptomatic left ventricular [LV] dysfunction. Since beta-thalassemia major patients suffer from early diastolic dysfunction due to iron deposition of chronic blood transfusion, we tried to evaluate the correlation between the serum NT-proBNP level and the severity of LV diastolic dysfunction determined by echocardiography in these patients

Methods: Fifty beta-thalassemia major patients with normal LV systolic function were studied by tissue Doppler echocardiography, and blood samples were taken at the same time to measure the serum NT-proBNP level. Using flow velocity through the mitral valve on the tissue velocity of the mitral annulus in early ventricular filling [E/E'] as an LV diastolic function indicator, the patients were divided into 3 groups: group 1] no diastolic dysfunction [E/E' < 8], group 2] suspected diastolic dysfunction [E/E' = 8-15], and group 3] documented diastolic dysfunction [E/E' >15]. Other variables assessed included sex, age, method of chelator therapy, and mean hemoglobin and ferritin levels for the past 2 years

Results: According to the echocardiographic findings of all the 50 patients [29 male and 21 female] with an age range of 11-35 years [mean = 17.98 y], 46% were classified in group 1, 54% in group 2, and none in group 3. The NT-proBNP level was 1070 +/- 566 ng/mL in group 1 and 974 +/- 515 ng/mL in group 2. The t-test showed no significant difference between groups 1 and 2 in the NT-proBNP level [p value = 0.536]

Conclusions: Due to specific conditions in thalassemia major patients, the correlation between the serum NT-proBNP level and the severity of diastolic dysfunction seems to be not meaningful

Effect of intra-canal direct current electric stimulation on orthodontic tooth movement: an experimental study in canines

Objectives: the purpose of this study was to evaluate whether intra-canal application of controlled direct electric current [DEC] could accelerate the amount of orthodontic tooth movement [OTM] in young adult mixed breed dogs

Methods: fourth premolars of both jaws of five young adult mixed breed dogs were divided into two groups of control and experimental groups. Orthodontic force was applied to both groups using an active NiTi push coil spring. Direct electric stimulation [15µA DC] was conducted by intra-canal usage of electric potential [1.5v]. The experimental teeth were compared with controls in terms of clinical OTM results measured with an electronic caliper every two weeks [four time intervals]. The animals were sacrificed one month [T2] or two months [T4] after initiation; and tissue sections were decalcified for histological evaluation. The data were analyzed using SPSS 16, Shapiro-Wilk test and paired t-test

Results: measurements revealed a statistically significant increase in OTM at electrically stimulated sites compared to the control sites in just one time interval [T3: after four weeks] [P< 0.05]. Histological sections also showed increased osteoblastic and osteoclastic activity at tension and compression sides of the experimental group compared to the control group, respectively at both time intervals [T2 and T4]

Conclusion: direct intra-canal electric current applied by a miniature electric device is effective for increasing the rate and amount of OTM in canine experimental model

[Factors Associated with the Incidence of Medication Errors and Nurses' Refusal to Error Reporting]

Introduction: Medication errors may occur at every stage of the medicines prescription and distribution processes and as nurses can give more than 150 medicines to patients in one work shift, they are in the first line of medical errors. This study was done to investigate the factors associated with nurses' refusal to error reporting in one of the largest teaching hospitals affiliated to Mashhad University of Medical Sciences

Method: In this cross - sectional, descriptive analytic study, a medication errors questionnaire containing 66 questions was distributed among 100 nurses in different hospital departments which were selected by stratified and simple random sampling. Descriptive statistics was used to determine the most important occurred errors and the reasons for them and one way ANOVA and independent t-test were used to determine the relationship of the causes of medication errors and refusal to error reporting with nurses' demographic factors. Data were analyzed through SPSS18 software

Results: According to the obtained findings, 87.6% of nurses were female, 85.9% were married and 47.1% were circulating nurses. "Giving medicines to the patients earlier or later than the prescribed time" was the most occurred error [48.8%]. "Fear of getting involved with law enforcement," was the most important cause of refusal to error reporting [3.48+/-1.53] and "heavy workload" was the main reason of error occurrence [4.18+/-1.1]

Conclusion: Medication errors, however minor, can cause complications. To reduce medication errors, re-education classes in relation to pharmacological information, encouragement of nurses to report medical errors and positive reaction of head nurses are required

Nanolipoparticles-mediated MDR1 siRNA delivery: preparation, characterization and cellular uptake

Lipid-based nanoparticles [NLP] are PEGylated carriers composed of lipids and encapsulated nucleic acids with a diameter less than 100 nm. The presence of PEG in the NLP formulation improves the particle pharmacokinetic behavior. The purpose of this study was to prepare and characterize NLPs containing MDR1 siRNA and evaluate their cytotoxicity and cellular uptake. MDR1 siRNA could be used in multidrug resistance reversal in cancer therapy. siRNAs were encapsulated into NLPs consisted of mPEG-DSPE/DOTAP/DOPE [10:50:40 molar ratio] by the detergent dialysis method. The particle diameters of NLPs and their surface charge were measured using dynamic light scattering. siRNA encapsulation efficiency was determined by an indirect method via filtration and free siRNA concentration determination. NLPs cytotoxicity was investigated by MTT assay. The ability of NLPs for siRNA delivery checked in two human cell lines [MCF-7/ADR and EPP85-181/RDB] by fluorescence microscopy and compared with oligofectamine. NLPs containing MDR1 siRNA were prepared with the stable size of 80-90 nm and the zeta potential near to neutral. The siRNA encapsulation efficacy was more than 80%. These properties are suitable for in vivo siRNA delivery. NLPs cytotoxicity studies demonstrated they were non-toxic at the doses used. NLPs improved siRNA localization in both cell lines. NLPs containing MDR1 siRNA can be a good candidate for in vivo siRNA delivery studies

Cationic immune stimulating complexes containing soluble leishmania antigens: preparation, characterization and in vivo immune response evaluation

Background: Cationic immune stimulating complexes [PLUSCOMs] are particulate antigen delivery systems. PLUSCOMs consist of cationic immunostimulatory complexes [ISCOMs] derivatives and are able to elicit in vivo T cell responses against an antigen

Objective: To evaluate the effects of PLUSCOMs containing Leishmania major antigens [SLA] on the type of immune response generated in the murine model of leishmaniasis

Methods: PLUSCOMs consisting of 1, 2-dioleoyl-3-trimethylammonium-propane [DOTAP] were used as antigen delivery system/immunoadjuvants for soluble SLA. BALB/c mice were immunized subcutaneously, three times in 2-week intervals. Footpads swellings at the site of challenge and parasite loads were assessed as a measure of protection. The immune responses were also evaluated by determination of IgG subclasses and the level of IFN- gamma and IL-4 in cultured splenocytes

Results: There was no significant difference [p<0.05] between the sizes of lesions in mice immunized with different formulations. Also, there was no significant difference in the number of parasites in the footpad or spleen of all groups compared with the control group. The highest level of IFN- gamma secretion was observed in the splenocytes of mice immunized with PLUSCOM/SLA [p<0.001] and lower amounts of IL-4 was observed in PLUSCOM group [p<0.001] as compared to negative control

Conclusion: Our results indicated that SLA in different formulations generated an immune response with mixed Th1/Th2 response that was not protective enough despite the activation of CD4+ T cells with secreting IFN- gamma in groups which received PLUSCOM with antigen

Opportunistic invasive fungal infections: diagnosis & clinical management.

Invasive fungal infections are a significant health problem in immunocompromised patients. The clinical manifestations vary and can range from colonization in allergic bronchopulmonary disease to active infection in local aetiologic agents. Many factors influence the virulence and pathogenic capacity of the microorganisms, such as enzymes including extracellular phospholipases, lipases and proteinases, dimorphic growth in some Candida species, melanin production, mannitol secretion, superoxide dismutase, rapid growth and affinity to the blood stream, heat tolerance and toxin production. Infection is confirmed when histopathologic examination with special stains demonstrates fungal tissue involvement or when the aetiologic agent is isolated from sterile clinical specimens by culture. Both acquired and congenital immunodeficiency may be associated with increased susceptibility to systemic infections. Fungal infection is difficult to treat because antifungal therapy for Candida infections is still controversial and based on clinical grounds, and for molds, the clinician must assume that the species isolated from the culture medium is the pathogen. Timely initiation of antifungal treatment is a critical component affecting the outcome. Disseminated infection requires the use of systemic agents with or without surgical debridement, and in some cases immunotherapy is also advisable. Preclinical and clinical studies have shown an association between drug dose and treatment outcome. Drug dose monitoring is necessary to ensure that therapeutic levels are achieved for optimal clinical efficacy. The objectives of this review are to discuss opportunistic fungal infections, diagnostic methods and the management of these infections.

Initial treatment of respiratory distress syndrome with nasal intermittent mandatory ventilation versus nasal continuous positive airway pressure: a randomized controlled trial

Neonatal respiratory distress syndrome [RDS] in premature infants who survived and its complications are a common problem. Due to high morbidity and mechanical ventilation [MV] nowadays researchers in interested minimizing MV. To determine, in very low birth weight [BW] preterm neonates with RDS, if initial treatment with nasal intermittent mandatory ventilation [early NIMV] compared with early nasal continuous positive airway pressure [early NCPAP] obtains more favorable outcomes in terms of the duration of treatment, and the need for endotracheal tube ventilation. In this single-center randomized control trial study, infants [BW 30%. Primary outcomes were failure of noninvasive respiratory support, that is, the need for MV in the first 48 h of life and for the duration of noninvasive respiratory support in each group. 98 infants were enrolled [44 in the NIMV and 54 in the NCPAP group]. The Preventive power of MV of NIMV usage [95.5%] was not lower than the NCPAP [98.1%] strength [hazard ratio: 0.21 [95% confidence interval: 0.02-2.66]; P: 0.23]. The duration of noninvasive respiratory support in the NIMV group was significantly shorter than NCPAP [the median [range] was 24 [18.00-48.00] h versus 48.00 [22.00-120.00] h in NIMV versus NCPAP groups; P < 0.001]. Similarly, the duration of dependency on oxygen was less, for NIMV [the median [range] was 96.00 [41.00-504.00] h versus144.00 [70.00-1130.00] h in NIMV versus NCPAP groups; P: 0.009]. Interestingly, time to full enteral feeds and length of hospital stay were more favorable in the NIMV versus the NCPAP group

Optimization of a method to prepare liposomes containing HER2/Neu-derived peptide as a vaccine delivery system for breast cancer

The purpose of this study was to optimize a method for the encapsulation of P5 peptide, a new designed peptide containing MHC class I epitopes from rat HER2/neu protein, into liposomes as an approach for breast cancer vaccine formulation. The efficiency of liposomal encapsulation of peptides is generally low and development of an optimized method to increase encapsulation efficiency is a big challenge. In this study, P5 peptide was encapsulated into liposomes using the following three different methods based on film-hydration procedure. In method A, the lipid film containing P5 was hydrated using buffer and then extruded to 100 nm using polycarbonate filter. In method B all the steps were the same as method A, except that the lipid film was hydrated in buffer containing 10% [v/v] of DMSO and P5 peptide. In method C, P5 peptide was added to preformed liposomes [40 mM] in the presence of ethanol [30% v/v] and incubated at 25 [degree sign]C for 1h. The highest peptide encapsulation efficiency was achieved using method C [44%]. The presence of P5 peptide in purified liposomes was also confirmed using SDS- PAGE analysis. Investigation on the effects of procedure parameters of method C on encapsulation efficiency demonstrated that method is an optimized procedure for encapsulating P5 peptide. Maximal recovery from liposomes for the accurate quantification of peptide was discovered using acidified isopropanol at 1:2 of sample to solvent ratio [v/v]. In conclusion, the optimal methods of encapsulation and peptide content determination in liposomes can accelerate the development of liposomal vaccine formulations

Comparison of dexamethasone and Anti-D Immune globulin for immune thrombocytopenia purpura in children

Different therapeutic options in children with immune thrombocytopenic purpura include observation alone, periodic treatment with corticosteroids, intravenous immunoglobulin [IVIG] or anti-D, chronic administration of immunosuppressive agents, and splenectomy. Preference of the type of therapy depends on the degree of thrombocytopenia and clinical bleeding manifestations. Dexamethasone is safe but its side effects are the main disadvantages for its usage. Anti-D is more expensive than dexamethason but the side effect is rare and not dangerous and response to treatment is assessed in approximately 3 days after infusion

Suprapubic bladder aspiration or urethral catheterization: which is more painful in uncircumcised male newborns?

The aim was to compare the intensity of pain caused by Suprapubic aspiration [SPA] and urethral Catheterization for urine sampling in premature infants. A prospective randomized controlled design with 80 premature infants in Alzahra University Hospital, Isfahan, Iran was conducted. Premature newborns who needed urine samples for microbiologic analysis were randomly assigned into two groups: SPA group and urethral Catheterization group. Newborn faces and upper parts of the body were videotaped during the study and the pain was assessed during urine collection using Premature Infant Pain Profile [PIPP] score. Furthermore, crying time compared between groups. The mean crying time was significantly higher in SPA than urethral Catheterization group [77 vs. 34.4 s] [P < 0.001]. The PIPP score was significantly lower in urethral Catheterization group [13.4] than SPA group [11.5] P < 0.001. The success rate of SPA was 53% compared with 71% success rate of urethral Catheterization. SPA is more painful than urethral Catheterization in premature male infants as assessed by PIPP score and is more likely leads to procedure failure