Molecular epidemiology of Crimean- Congo hemorrhagic fever virus genome isolated from ticks of Hamadan province of Iran.

BACKGROUND & OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) virus is a tick-borne member of the genus Nairovirus, family Bunyaviridae. CCHFV has been isolated from at least 31 different tick species. The virus is transmitted through the bite of an infected tick, or by direct contact with CCHFV-infected patients or the products of infected livestock. This study was undertaken to study the genetic relationship and distribution of CCHFV in the tick population of Hamadan province of Iran. METHOD: In this study, RT-PCR has been used for detection of the CCHFV genome. RESULTS: This genome was detected in 19.2% of the ticks collected from livestock of different regions of the Hamadan province in western Iran. The infected species belonged to Hyalomma detritum, H. anatolicum, Rhipicephalus sanguineus and Argas reflexus. With one exception, genetic analysis of the virus genome isolates showed high sequence identity to each other. Even though they clustered in the same group with the strain circulating in Iran, they had a closer relationship to the Matin strain. INTERPRETATION & CONCLUSION: Vector control programs should be applied for reducing population density of potential tick vectors in this province. Further surveys are indicated in this region to provide a better view of the distribution and epidemiology of the virus.

Phylogenetic analysis in a recent controlled outbreak of Crimean-Congo haemorrhagic fever in the south of Iran, December 2008.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus is transmitted to humans through the bite of Ixodid ticks or contact with blood or tissues of CCHF patients or infected livestock. In December 2008, a re-emerging outbreak of CCHF occurred in the southern part of Iran. Five people were hospitalised with sudden fever and haemorrhaging, and CCHF was confirmed by RT-PCR and serological assays. One of the cases had a fulminant course and died. Livestock was identified as the source of infection; all animals in the incriminated herd were serologically analysed and more than half of them were positive for CCHFV. We demonstrated that two routes of transmission played a role in this outbreak: contact with tissue and blood of infected livestock, and nosocomial transmission. Phylogenetic analyses helped to identify the origin of this transmission. This outbreak should be considered as a warning for the national CCHF surveillance system to avoid further outbreaks through robust prevention and control programmes.

Crimean-Congo hemorrhagic fever in Iran and neighboring countries.

Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic viral disease that is asymptomatic in infected livestock, but a serious threat to humans. Human infections begin with nonspecific febrile symptoms, but progress to a serious hemorrhagic syndrome with a case fatality rate of 2-50%. Although the causative virus is often transmitted by ticks, livestock-to-human and human-to-human transmissions also occur. The disease is one of the most widely distributed viral hemorrhagic fevers occurring in Africa, the Middle East, Asia, and some parts of Europe. In this study, we have focused on the CCHF situation in Iran and neighboring countries and provide evidence of over 5000 confirmed cases of CCHF in a single period/season.

Surveillance and laboratory detection system of Crimean-Congo haemorrhagic fever in Iran.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonotic disease with a high mortality rate in humans. The CCHF virus (CCHFV) is transmitted to humans through the bite of Ixodid ticks or by contact with blood or tissues of infected livestock. In addition to zoonotic transmission, CCHFV can be spread from person to person and is one of the rare haemorrhagic fever viruses able to cause nosocomial outbreaks in hospitals. Crimean-Congo haemorrhagic fever is a public health problem in many regions of the world such as Eastern Europe, Asia, the Middle East and Africa. In addition to clinical symptoms, the diagnosis of CCHF is based on the use of serological tests for the detection of immunoglobulin M and immunoglobulin G antibodies and on the use of molecular tools such as RT-PCR. From 1970 to 1978, serological and epidemiological studies were performed in humans and in livestock of Iran. After two decades and observations of CCHF in some provinces of Iran, a CCHF surveillance and detection system was established in 1999, leading to a dramatically decreased mortality rate from 20% (year 2000) to 2% (year 2007).

What kind of curriculum can better address community needs? Problems arisen by hypothetical-deductive reasoning.

The aim of this study was to identify problems arisen by conventional curricula, the guidelines for development of an appropriate educational model for 21st century, and the advantages and disadvantages of the last two curricular models. The medical education literature published from 1995 through 2002 of four reputable journals in medical education were searched (Academic Medicine, Teaching and Learning in Medicine, Medical Education, and Medical Teacher). First the possibly best articles were identified. During the second screening process 76 of 180 articles were found to be highly relevant to our questions. A review of the chosen articles revealed a concept map which starts from currently applied hypothetical-deductive reasoning (HDR)-based curricula in many medical schools all around the world. Results revelaed that continuing cyclical process might be time consuming, enhance burden of faculty and might be stressful for students involved. Current issues in health care system are possibly attributable to current HDR-based curricular models including PBL. Advantages of reiterative PBL theory can not be denied, but it appears that its limited application should be mainly seen in some academic classes to develop some generic transferable skills simultaneously with other teaching methods. Therefore vast application of HDR in clinical settings is not recommended according to our study. However the relationships demonstrated between factors and outcomes mentioned in the concept map can be used to run some new studies to test some hypotheses.

Creeping attachment: autogenous graft vs dermal matrix allograft.

For many years, free autogenous grafts have been used as a method of gaining keratinized tissue around teeth with mucogingival problems. Creeping attachment using autogenous graft material has been actively studied. In addition, biocompatible, acellular connective-tissue material has recently been used as an alternative to free gingival grafts to increase the zone of keratinization. This report presents a patient with bilateral mucogingival defects in the canine and premolar areas. The patient received an autogenous graft on one side and a dermal matrix allograft on the contralateral side. Creeping attachments were measured and compared at 3 months and 12 months after surgery. After 12 months of healing, an average of 1.23 mm of creeping attachment was measured on the free gingival graft side and 0.96 mm of creeping attachment was measured with the dermal matrix allograft.

New-generation bonded reinforcing materials for anterior periodontal tooth stabilization and splinting.

Teeth are splinted and stabilized in the anterior region for a variety of reasons. This article presents the techniques for periodontal splinting with an adhesive technique using direct placement ribbon reinforced composite resins. The research supporting this technique is also reviewed.

Mucogingival surgical procedures: a review of the literature.

This article provides an in-depth review of the literature on mucogingival surgical techniques. Indications and contraindications of various surgical procedures are discussed with reference to the literature. Surgical techniques and indications for increasing the zone of keratinized tissue, such as free autogenous grafts, applications of freeze-dried skin, and dermal matrix allografts, are described. Procedures to attain root coverage, such as various autogenous grafts and guided tissue regeneration techniques, along with application of chemicals such as citric acid to improve their success, are also described.

The use of an acellular dermal skin graft to gain keratinized tissue.

For decades, free gingival grafting has been a predictable and widely used procedure to gain keratinized tissue around teeth with mucogingival problems. Recently, a biocompatible, acellular, connective tissue material (AlloDerm) made from human dermis has been introduced as an alternative to the conventional use of autogenous tissue. This material eliminates the need for donor sites, and it minimizes postoperative discomfort and complications. It also integrates well to the recipient site, and it provides an excellent color match with the surrounding tissues, making it esthetically pleasing.

Elasticity of agr-Cristobalite: A Silicon Dioxide with a Negative Poisson's Ratio.

Laser Brillouin spectroscopy was used to determine the adiabatic single-crystal elastic stiffness coefficients of silicon dioxide (SiO(2)) in the alpha-cristobalite structure. This SiO(2) polymorph, unlike other silicas and silicates, exhibits a negative Poisson's ratio; alpha-cristobalite contracts laterally when compressed and expands laterally when stretched. Tensorial analysis of the elastic coefficients shows that Poisson's ratio reaches a maximum value of -0.5 in some directions, whereas averaged values for the single-phased aggregate yield a Poisson's ratio of -0.16.

A review of 80 endometrial resections for menorrhagia.

OBJECTIVE: To assess the efficacy of endometrial resection in treating menorrhagia. DESIGN: A clinical audit of 80 consecutive patients. SETTING: The department of gynaecology, Ealing Hospital, London. SUBJECTS: Eighty women referred by their general practitioner with the primary complaint of menorrhagia. INTERVENTIONS: Endometrial resection by hysteroscopic electro-diathermy. MAIN OUTCOME MEASURES: Subjective assessment of the change in menstrual blood loss by the 75 patients, who were followed up for at least one year. RESULTS: Of 75 women assessed after 1 year 45 (60%) had a successful outcome and nine (12%) had 'some improvement'. There were 21 failures; 14 reported 'no improvement' initially and seven were late failures after a good result at 6 months. Fifteen underwent a second procedure with 83% success at 6 months. Complications included uterine perforation in three women, excessive glycine absorption in two, and two women had problems with haemorrhage. Four women came to hysterectomy. CONCLUSIONS: Endometrial resection is an effective treatment for menorrhagia. Improvements in operative technique and equipment gave better results and fewer complications in the second half of the series.

Phase Transition and Thermal Expansion of MgSiO3 Perovskite.

Results from in situ x-ray diffraction experiments with a DIA-type cubic anvil apparatus (SAM 85) reveal that MgSiO(3) perovskite transforms from the orthorhombic Pbnm symmetry to another perovskite-type structure above 600 kelvin (K) at pressures of 7.3 gigapascals; the apparent volume increase across the transition is 0.7%. Unit-cell volume increased linearly with temperature, both below (1.44 x 10(-5) K(-1)) and above (1.55 x 10(-5) K(-1)) the transition. These results indicate that the physical properties measured on the Pbnm phase should be used with great caution because they may not be applicable to the earth's lower mantle. A density analysis based on the new data yields an iron content of 10.4 weight percent for a pyrolite composition under conditions corresponding to the lower mantle. All current equation-of-state data are compatible with constant chemical composition in the upper and lower mantle; thus, these data imply that a chemically layered mantle is unnecessary, and whole-mantle convection is possible.

Twinning in MgSiO3 Perovskite.

Crystals of MgSiO(3) perovskite synthesized at high pressures and temperatures have orthorhombic symmetry under ambient conditions. Examination by transmission electron microscopy shows that the microstructure of crystals synthesized at 26 gigapascals and 1600 degrees C is dominated by a large number of twin domains that are related by reflection operations with respect to {112} and {110} planes. These twins may be associated with the transformations of MgSiO(3) perovskite from the cubic to tetragonal and tetragonal to orthorhombic phases, respectively, upon decreasing pressure and temperature. These observations suggest that under the experimental synthesis conditions, and perhaps in the earth's lower mantle, the stable phase of MgSiO(3) might have the cubic perovskite structure.

Elasticity of MgSiO3 in the Perovskite Structure.

The single-crystal elastic moduli of MgSiO(3) in the perovskite structure, the high-pressure polymorph of MgSiO(3) pyroxene, have been determined. The data indicate that a mantle with either pyrolite or pyroxene stoichiometry is compatible with the seismic models appropriate to the earth's lower mantle, provided that the shear modulus of MgSiO(3) perovskite exhibits a strong negative temperature derivative. Such a temperature derivative falls outside of the range expected for a well-behaved refractory ceramic and could result if the pressure-temperature regime of the earth's lower mantle is near that required for a ferroelastic phase transformation of the perovskite phase.

Effect of different pre-operative vaginal preparations on morbidity of patients undergoing abdominal hysterectomy.

Three methods of vaginal preparation carried out before abdominal hysterectomy are compared. The lowest post-operative morbidity was associated with the use of a povidone-iodine douche and gel during the pre-operative preparation of the patient.

Comparison of oral prostaglandin E2 and intravenous oxytocin for induction of labour.

A carefully controlled, prospective study was undertaken in 100 patients to compare orally administered prostaglandin E2 capsules with intravenous oxytocin in the induction of labour at term. Orally administered prostaglandin E2 induced labour in slightly more patients than did intravenous oxytocin (48 out of 50 v. 45 out of 50) and a larger trail is in progress to evaluate this observation further. Mild gastro-intestinal symptoms occurred in 28% of the patients when oral prostaglandin was given. However, the oral route is more convenient and more comfortable for the patient and the administration requires less adjustment by the nursing staff.

Comparison of transverse and vertical skin incisions for Caesarean section.

A comparison is made of the transverse and the vertical skin incision for Caesarean section. The advantages of the transverse incision are clearly demonstrated and discussed.