[Cogan's syndrome: a case report]

Cogan's syndrome is a chronic inflammatory disorder of unknown cause affecting mostly young adults. Two main observation of the disease are bilateral interstitial keratitis and vestibuloauditory dysfunction. Association between Cogan's syndrome and systemic vasculitis as well as aortitis are exist. The diagnosis of the disease is based upon the presence of inflammatory eye disease and vestibuloauditory dysfunction. In this article, the classic Cogan's syndrome has been reported in a 47-year-old woman. Two months prior to admission, the patient had been suffering from headache, vertigo, nausea, vomiting, right leg claudication, musculoskeletal pains, bilateral hearing loss and blindness. Ophthalmologic examination revealed that visual acuity was 0.1 bilaterally and on slit lamp examination, there was a conjunctival hyperemia, bilateral cataract and interstitial keratitis. Pure tone audiogram [PTA] and auditory brain stem response [ABR] showed bilateral sensorineural hearing loss. The patient was initially treated with pulse intravenous methylprednisolone and was followed by oral prednisolone and cyclophosphamide, which in follow-up showed partial improvement

[ comparison of shock wave therapy and corticosteroid injection on the treatment of plantar fasciitis]

Plantar Fasciitis is a common musculoskeletal disorder, which can reduce physical activity of the affected person. The usual treatments have short-term effects or they can cause adverse effects. In this study the injection of corticosteroid and shock wave therapy have been compared. This was a prospective, randomized and single blind clinical trial. In the physical medicine and rehabilitation clinic of two clinic in Tehran, through the year 2011, 37 feet were randomized to each treatment group. The first group received 40mg methylprednisolone and 2 cc lidocaine 2% and the second group was treated with 3 sessions of rESWT [2000 pulses, 10 Hz, 2.5 bar] weekly apart. The data was gathered by a questionnaire, 1 week, 1 month and 3 months after the intervention. Chi-square, T-test and mann-witney U test was used for data analyzing. In both groups 3 months after the intervention the severity of the symptoms were greatly improved. In short-term [1 month] corticosteroid effect was superior to shock wave's one [p<0.05]. This superiority declined through the time. In other words, the effects of the two treatments measured in the functional scale, didn't differ significantly 3 months after the initiation of the treatment [p>0.05]. Shock wave therapy can be an alternative treatment for plantar fasciitis

[Comparison of nomadic and non-nomadic lifestyles in transmission of visceral leishaniasis]

Epidemiology of Visceral Leishmaniasis is affected by combination quality and interaction of Parasite-Vector-Host and environmental conditions. So, disease cycle related and eco-social factors and environmental risk factors co-analyzing, help to understanding these interactions, prognosis and orientation in disease control and treatment. This study was done to determine the role of nomadic and non-nomadic lifestyle in transmission of Kala-Azar in the Northwest of Iran. In this case-control study, firstly the prevalence of Kala-Azar among people living in selected villages were determined by both serological test [Direct Agglutination Test: DAT] and immunological test [Montenegro Skin Test: MST] in the Northwest of Iran, on the way of Shahsavan tribe travelling in summer/winter quarters villages. Then DAT was conducted on the dogs presenting in those villages during 2006. One year later Seroconversion rate was calculated through collection of the individual's negative sera and re-analyzing them via DAT. Finally, occurrence of Visceral Leishmaniasis in relation with various involving factors like dog density/abundance and nomadic and non-nomadic lifestyle using Chi-Square test were determined. Both MST and DAT were significantly higher in the nomadic lifestyle than in the nonnomadic lifestyle [P<0.05]. Three values of prevalence [5.5%], seropositivity [2.7%] and seroconversion [2.5%] were higher in nomads than non-nomads. The GIS studies and electronically prepared maps showed that the endemicity and the infection rate are higher in nomads than non-nomads. There were a negative correlation between general distribution of Visceral Leishmaniasis in relation with environmental conditions altitude, mean temperature and rainfall. This study indicated that Nomadic lifestyle can play as a risk factor in transmission of Visceral Leishmaniasis due to nomads/dog contacting, their entering in the wild cycle of disease and travelling

Application of predictive degree day model for field development of sandfly vectors of visceral leishmaniasis in northwest of Iran.

Background & objectives: Temperature plays a significant role in insect’s development where a rise in temperature, accelerates the insect’s metabolic rates, increases egg production and makes blood feeding more frequent. It also shortens the time period required for the development of pathogens within insects. Visceral leishmaniasis (VL) is one of the most important vector-borne diseases transmitted by different sandfly species. In this study, a phenological model was used to estimate the number of generations, peak activity and temporal variability of sandflies in the main VL foci in northwest Iran. Methods: Development requirements of different life stages of a Phlebotomus papatasi laboratory colony were measured and were subjected to the formula for calculation of accumulated degree day (ADD) for field sandflies using the online soft (UC IPM), using horizontal cut-off method and single triangle model. Sandflies population dynamics was monitored in the field during the seasonal activity in the region and its association with the ADD was tested using SAS software. Results: Populations of sandflies accommodated well with the amount of accumulated degree days (ADD) in the region. During the seasonal activity, a total of 639 ADD were produced which was enough to support one complete life cycle and growth of the next generation up to late larval instar. Larvae of the second generation hibernate through winter and the first adult population appears in the mid to late June of the next year when they receive at least 182 ADD from the beginning of the spring. The highest population density of sandflies was observed in early August, followed by a rapid decrease in early September, with the adult population disappearing completely in late September. This is the first degree day model related to sandflies in the most important VL foci of Iran. Interpretation & conclusion: Further studies in various regions with variable climate are recommended in order to better estimate and understand the development time, population dynamics and activities of the vectors which in turn could be used in proper implementation of effective vector control programmes.

Effect of interactive group discussion among physicians to promote rational prescribing

This study assessed the effect of an educational intervention [interactive group discussion] on the prescribing behaviour of 51 general physicians from the north-west of Tabriz. Prescriptions were analysed pre-intervention and post-intervention [control and intervention groups] using a proforma with 8 indicators of correct prescribing. The mean number of drugs per prescription pre-intervention was 3.82. The percentage of prescriptions with antibiotics, corticosteroids and injections were 40.8%, 25.9% and 58.0%, respectively. Following the intervention there were slight but not significant changes in the indicators in both intervention and control groups compared with pre-intervention results

Relationship of pharmacist interaction with patient knowledge of dispensed drugs and patient satisfaction

A prospective survey of pharmacists' tasks and patients' knowledge and satisfaction was conducted in 35 randomly selected community pharmacies in Tabriz, Islamic Republic of Iran. The total pharmacist interaction received a mean score of 3.05 out of 5. Providing written directions for use attained the highest score of 0.98 out of 1. Patients scored 3.18 out of 5 for knowledge about their medicines. There was a close correlation between patients' knowledge of dispensed drugs and pharmacist interaction [r = 0.95]. Mean total prescription filling time was 7.6 min, but only 1.4 min was spent on pharmacist-patient counselling. The interaction between pharmacist and patient increases patients' knowledge about dispensed medicines and their satisfaction with the pharmacist's activities

Blood meal identification in field-captured sand flies: comparison of PCR-RFLP and ELISA assays

We aimed to develop a PCR-RFLP assay based on available sequences of putative vertebrate hosts to identify blood meals ingested by field female sand fly in the northwest of Iran. In addition, the utility of PCR-RFLP was compared with ELISA as a standard method. This experimental study was performed in the Insect Molecular Biology Laboratory of School of Public Health, Tehran University of Medical Sciences, Iran in 2006-2007. For PCR-RFLP a set of conserved vertebrate primers were used to amplify a part of the host mitochondrial cytochrome b [cyt b] gene followed by digestion of the PCR products by Hae III enzyme. The PCR-RFLP and ELISA assays revealed that 34% and 27% of field-collected sand flies had fed on humans, respectively. Additionally, PCR-RFLP assays could reveal specific host DNA as well as the components of mixed blood meals. Results of PCR-RFLP assay showed that the sand flies had fed on cow [54%], human [10%], dog [4%], human and cow [21%], dog and cow [14%], and human and dog [3%]. The results can provide a novel method for rapid diagnosis of blood meal taken by sandflies. The advantages and limitations of PCR and ELISA assays are discussed

effect of interactive group discussion among physicians to promote rational use of drugs

Rational use of drugs remains a problem in Iran. Polypharmacy, overuse of antibiotic, misuse and overuse of injections, short consulting time and poor patient compliance are common patterns of irrational use of drugs in Eastern Azarbydjan - Iran. Concerning the promotion of rational use of drugs, this study aimed the effect of educational intervention as interactive group discussion on prescribing behavior of Tabriz Northwest physicians. Fifty one general physicians from private and public sectors in Northwest of Tabriz were selected randomly and their prescriptions were analyzed. A questionnaire with 8 close questions was completed for each prescription to investigate all aspects of prescribing patterns. By a professional software the information of the prescriptions was analyzed and drug prescribing indicators such as percentage of patients receiving antibiotics, glucocorticoids and other drug groups were determined. The method of intervention included focus group and interactive group discussions. Focus group was built in group of health professionals to collect training material using pre-intervention results for interactive group discussion. The physicians were divided into two groups of control and intervention groups. Following pre-intervention study the physicians of intervention group were discussed and trained in one-day interactive group discussion course using pre-intervention data and educational materials obtained from the focus group discussion. The results of pre-intervention study showed that the average number of drugs in each prescription was 3.82. The percentage of patients receiving antibiotics, corticosteroids and injections were 40.81, 25.94 and 58.04%, respectively. The results of this survey show great differences from WHO and international standards. Following the intervention the indicators were similar in both intervened and non-intervened groups and also were same as the pre-intervention results. The results of this study show that a very close and effective method of training program as an interactive group discussion has no beneficial effects on improving rational prescription behavior of general physicians involved in this study. To promote rational prescription the underlying factors must be considered more

Atrazine adsorption desorption behavior in Darehasaluie Kavar corn field soil in Fars province of Iran

Adsorption desorption behaviors of widely applied atrazine soil were studied, employing a batch technique as a case study in Darehasaluie Kavar corn field in Fars Province in 2005. Samples were collected into 0 to 20 cm soil depth, where was cultivated under a crop rotation [corn-wheat] during the past 10 years. Sorption kinetics exhibited two phenomena: an immediate rapid sorption [1.31 microg/g soil after 12 hours] followed by a slow sorption process [1.37 microg/g soil after 24 hours]. Desorption behavior of atrazine was similar to its adsorption, but at a very slower rate. Atrazine desorption efficiencies were much less effective and incomplete even after a long equilibration time [only 9.16% after 96 hours]. The adsorption-desorption rate for most of the time was positively related to the amount of applied atrazine and the time required for equilibration [P<0.01]. Desorption data exhibited hysteresis phenomena. Atrazine adsorption data described well according to Freundlich [r2=0.95], Langmuir [r2=0.82] and Temkin [r2=0.84] isotherms. However, the fit to Freundlich adsorption model in a non linear form [1/n <1] was closer than the others. Desorption isotherm could be well described by the Temkin [r2=0.96] and Freundlich [r2=0.92] isotherms, but the fit to Temkin model was closer than that of Freundlich

Sphingomyelin metabolites as second messengers in airway smooth muscle cell proliferation

Sphingolipid metabolism was examined in guinea-pig airway smooth muscle cells stimulated by platelet-derived growth factor [PDGF] and 4[BETA]-phorbol 12-myristate 13-acetate [PMA], as mitogens and bradykinin [BK] as non-mitogen. Stimulation of the cells by PMA and PDGF for 60 min. at 37°C induced the following changes in sphingolipid metabolites: in cells prelabeled with [3] H palmitate, a 1.2 fold increase in radio-labeled sphingosine, a concomitant 20% decrease in radio-labeled ceramide and no significant change in sphingomyelin level. Stimulation of the cells by BK induced no changes in sphingolipid levels at any time tested. This study demonstrates the existence of a "sphingomyelin cycle" in airway smooth muscle cells. Such sphingolipid cycles may function in a signal transduction pathway and in cellular proliferation