[Prevalence and risk factors for retinopathy of prematurity in Isfahan]

To determine the prevalence and risk factors for retinopathy of prematurity [ROP] in high risk premature infants admitted to NICU wards in Isfahan from 2003 to 2008. In this retrospective case series, 604 records of high risk infants were reviewed in terms of gestational age, birth weight, oxygen supplementation, delivery method, history of consanguineous marriage, single or multiple births and gender. The prevalence of ROP was 17.5%. In univariate analysis, birth weight [P<0.01], gestational age [P<0.01] and supplemental oxygen [P=0.01] showed statistical difference between neonates with and without ROP. In other words, lower birth weight, lower gestational age and supplemental oxygen were associated with ROP. The relationship between other variables and ROP was not statistically significant. The prevalence of ROP in this study emphasizes the importance of neonatal screening in our country. Low birth weight and gestational age were significant risk factors for the disease

Isolated acute right ventricular myocardial infarction and ischemia in patients with exacerbation of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] increases the risk of cardiovascular disease 2-3 folds. The factors responsible for this association remain under evaluation. In this study, the prevalence of isolated right ventricular infarction [RVMI] and ischemia were compared with isolated RVMI in other patients. This observational and analytical case-control pilot study enrolled 100 patients [82 men and 18 women] with suspected exacerbation of COPD hospitalized in the emergency department of Noor Hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran from 2003 to 2005. Spirometry was performed with the equipment that met the American Thoracic Society performance criteria. Frequent electrocardiography [including V3R -V4R] and CK-MB enzyme assay were done. Of the 100 patients, 35 [35%] were excluded due to lack of criteria of the study. Echocardiography revealed that all patients with exacerbation of COPD had tricuspid regurgitation about 3-4 m/s, indicating moderate to severe pulmonary hypertension [PH]. OF the 65 patients, 6 [9.2%] with moderate to severe pulmonary obstruction had isolated right ventricular myocardial infarction. Also, 9 [13.8%] patients had ST segment depression >/= 1 m in V3R and/or V4R. The difference between the patients with and without exacerbation of COPD accompanying isolated RV MI was significant. Increase in the right ventricular pressure reduces the right coronary artery flow which results in ischemia, infraction and circulatory collapse. The results indicate that patients with exacerbation of COPD are at risk of isolated RV ischemia and infarction. Therefore, V3R and V4R lead should be taken

review article on herpes simplex encephalitis

Herpes Simplex encephalitis [HSE] is a life threatening outcome of Herpes simplex virus [HSV] infection of the central nervous system [CNS]. HSV accounts for 2-5 percent of all cases of encephalitis. One third of cases occur in those younger than 20 years old and one half in those older than 50 years old. Clinical diagnosis is recommended in the encephalopathic, febrile patients with focal neurological signs. However, the clinical findings are not pathogonomic because numerous other diseases of CNS can mimic HSE. Diagnosis should be confirmed based on medical history, analysis of cerebrospinal fluid [CSF] for protein and glucose contents, the cellular analysis and identifying the pathogens by serology and Polymerase Chain Reaction [PCR] amplification .The diagnostic gold standard is the detection of HSV DNA in the cerebrospinal fluid by PCR. But negative results need to be interpreted regarding the patients clinical signs and symptoms and the time of CSF sampling. Spike and slow wave patterns is observed in Electroencephalogram [EEG]. Neuroimaging, especially Magnetic Resonance Imaging [MRI] is essential for evaluating the patients, which shows temporal lobe edema or hemorrhage. All patients with HSE should be treated by intravenous Acyclovir [10mg/kg q8hr for 14-21 days]. After completing therapy, PCR of the CSF can confirm the elimination of replicating virus, assisting further management of the patient

[Chondro-protective effects of pomegranate on experimental osteoarthritis]

To study the effectiveness of pomegranate juice [PJ] on osteoarthritis [OA], we used mono-iodoacetate [MIA], an inhibitor of glycolysis, in tibiofemoral joint of mice that promotes loss of articular cartilage similar to that noted OA. Pomegranate juice [PJ] is increasing in popularity because of its high antioxidant content, already known to help prevent heart disease. However, no histopathological studies have undertaken in vivo to investigate whether PJ protect articular cartilage. We described the histopathology in the subchondral bone and cartilage of mice knee joint treated with a single intra-articular injection of MIA [0.1 mg] and sacrificed at 1, 14 and 28 days post injection. Then, the beneficial effect of oral PJ was studied in different groups; group 1: administration of PJ [4ml/kg], group 2: administration of PJ [10ml/kg] and group 3: administration of PJ [20ml/kg]. Histopathological changes in knee joints were studied after two weeks. Histologically, the early OA was characterized by areas of chondrocytes degeneration/ necrosis sometimes involving the entire thickness of the articular cartilage in the tibial plateaus and femoral condyles. Changes to the subchondral bone and proteoglycane contents, were observed and also, there was focal fragmentation and collapse of bony trabeculae with fibrosis and necrosis. Synovial cell proliferation was noted. Interestingly, administration of PJ in different group of mice prevented the negative effects of iodoacetate, in a dose dependent manner. Chondrocyte damages were significantly prevented and proteoglycane were less affected, especially in group receiving high amount of PJ and no cell proliferation and inflammatory cell were detected in synovium. Fast and progressive damage to articular cartilage is induced by single intra-articular injection of MIA, which mimic exactly human OA. In this study, the effectiveness of PJ in improvement of histopathological damages is emphasized and its chondroprotective effects in vivo are highlighted

[Modulatory effects of barbiturates and their binary combinations on human alpha-1 glycine receptors expressed in Xenopus Oocytes]

To test whether there is a common site of action for intravenous anaesthetics at the glycine receptor, the effects of binary combinations of thiopentone, pentobarbitone, and methohexitone have been tested on human alpha 1 glycine receptors expressed in Xenopus laevis oocytes using two-electrode voltage-clamp techniques. During this interventional study, recombinant human alpha-1 receptor gene was prepared and the mRNA was injected into cytoplasmic site of Xenopus oocytes. Two-electrod voltage clamp technique used for pharmacological studies of currents of chloride channels [receptors] from the membrane of oocytes. Then, the effect of three barbiturates on currents induced by agonist on the receptors was measured. Thiopentone [5-40microM], and pentobarbitone [25-400microM], [but not methohexitone] potentiated the glycine-induced [50microM] current in a dose-dependent manner, with the maximum potentiation observed to be 220%, and 400%, respectively. In binary combination with thiopentone, or pentobarbitone, methohexitone reduced potentiation compared to that by the individual anesthetics to 180%, and 280%, respectively. Combination of thiopentone and pentobarbitone [50microM] increased potentiation, compared to that by thiopentone alone. Our results indicate that thiopentone and pentobarbitone both act as positive allosteric modulators at the alpha-1 glycine receptor. In contrast, methohexitone has no action alone but acts as a competitive antagonist to thiopentone and pentobarbitone. We suggest that these three intravenous barbiturate anaesthetics share a common site of action at the glycine receptor

[Atypical Kawasaki: the often missed diagnosis]

Kawasaki disease is an acute febrile vasculitis of childhood first described by Dr. Tomisaku Kawasaki in Japan in 1967. The disorder occurs worldwide, with Asians at highest risk. Approximately 20% of untreated patients develop coronary artery abnormalities including aneurysms, with the potential for the development of coronary artery thrombosis or stenosis, myocardial infarction, aneurysm rupture, and sudden death. Kawasaki disease has replaced acute rheumatic fever as the leading cause of acquired heart disease in children. The disease is characterized by fever, bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, changes in the extremities, rash, and cervical lymphadenopathy. The classic diagnosis of Kawasaki disease has been based on the presence of /= 4 of the 5 principle clinical features. During the past few years there have been several reports of patients with coronary aneurysms corresponding to changes in Kawasaki disease who did not exhibit the other required symptoms. The diagnosis of Atypical Kawasaki, in addition to coronary aneurysms, requires the presence of three to four of the major symptoms. Atypical Kawasaki is more common in infants than in older children, making accurate diagnosis and timely treatment especially important in these young patients who are at substantial risk of developing coronary abnormalities. Therefore, Kawasaki disease should be considered in an infant with prolonged, high fever in spite of atypical or incomplete presentation and echocardiography may help us to begin earlier treatment in these high risk patients