A single-centre prospective evaluation of left bundle branch area pacemaker implantation characteristics.

BACKGROUND: Left bundle branch area pacing (LBBAP) has recently been introduced as a physiological pacing technique with synchronous left ventricular activation. It was our aim to evaluate the feasibility and learning curve of the technique, as well as the electrical characteristics of LBBAP. METHODS AND RESULTS: LBBAP was attempted in 80 consecutive patients and electrocardiographic characteristics were evaluated during intrinsic rhythm, right ventricular septum pacing (RVSP) and LBBAP. Permanent lead implantation was successful in 77 of 80 patients (96%). LBBAP lead implantation time and fluoroscopy time shortened significantly from 33 ± 16 and 21 ± 13 min to 17 ± 5 and 12 ± 7 min, respectively, from the first 20 to the last 20 patients. Left bundle branch (LBB) capture was achieved in 54 of 80 patients (68%). In 36 of 45 patients (80%) with intact atrioventricular conduction and narrow QRS, an LBB potential (LBBpot) was present with an LBBpot to onset of QRS interval of 22 ± 6 ms. QRS duration increased significantly more during RVSP (141 ± 20 ms) than during LBBAP (125 ± 19 ms), compared to 130 ± 30 ms without pacing. An even clearer difference was observed for QRS area, which increased significantly more during RVSP (from 32 ± 16 µVs to 73 ± 20 µVs) than during LBBAP (41 ± 15 µVs). QRS area was significantly smaller in patients with LBB capture compared to patients without LBB capture (43 ± 18 µVs vs 54 ± 21 µVs, respectively). In patients with LBB capture (n = 54), the interval from the pacing stimulus to R­wave peak time in lead V6 was significantly shorter than in patients without LBB capture (75 ± 14 vs 88 ± 9 ms, respectively). CONCLUSION: LBBAP is a safe and feasible technique, with a clear learning curve that seems to flatten after 40-60 implantations. LBB capture is achieved in two-thirds of patients. Compared to RVSP, LBBAP largely maintains ventricular electrical synchrony at a level close to intrinsic (narrow QRS) rhythm.

Geometry of Triple Junctions during Grain Boundary Premelting.

Grain boundaries (GBs) whose energy is larger than twice the energy of the solid-liquid interface exhibit the premelting phenomenon, for which an atomically thin liquid layer develops at temperatures slightly below the bulk melting temperature. Premelting can have a severe impact on the structural integrity of a polycrystalline material and on the mechanical high-temperature properties, also in the context of crack formation during the very last stages of solidification. The triple junction between a dry GB and the two solid-liquid interfaces of a liquid layer propagating along the GB cannot be defined from macroscopic continuum properties and surface tension equilibria in terms of Young's law. We show how incorporating atomistic scale physics using a disjoining potential regularizes the state of the triple junction and yields an equilibrium with a well-defined microscopic contact angle. We support this finding by dynamical simulations using a multiphase field model with obstacle potential for both purely kinetic and diffusive conditions. Generally, our results should provide insights on the dynamics of GB phase transitions, of which the complex phenomena associated with liquid metal embrittlement are an example.

The BUSCOPAN study: a randomized-controlled non-inferiority trial of a continuous butylscopolamine infusion versus placebo in patients with a renal colic not responding to oral non-steroidal anti-inflammatory drugs.

PURPOSE: To investigate whether placebo is non-inferior to continuous infusion of butylscopolamine in patients with renal colic. METHODS: We conducted a placebo-controlled, multicenter, double-blind randomized clinical trial (RCT) including 128 patients with renal colic (confirmed by ultrasound or CT-scan). Patients were randomized to receive either continuous IV butylscopolamine 100 mg/24 h or placebo (saline). Primary outcome is the amount of opioid escape medication used, measured in doses administered. Secondary outcomes are pain measured on a Numeric Rating Scale (NRS), side effects, and time of drug administration. Non-inferiority was assessed using linear regression with robust standard errors, with non-inferiority limit set at 0.5 units of escape medication. RESULTS: Median number of doses of escape medication was one in both groups. The number of extra doses in the placebo group compared with the butylscopolamine group was 0.05, with a 95% robust confidence interval (CI) of 0.38-0.47. Upper limit of the CI remained below the non-inferiority limit of 0.5 (p = 0.04). No differences in secondary endpoints were seen between the groups. CONCLUSION: Placebo is non-inferior to continuous IV butylscopolamine for pain relief in patients with renal colic. Based on this study and previous evidence, there is no role for continuous butylscopolamine IV in the treatment of renal colic. Trial NL7819.

Molecular typing and prevalence of extended-spectrum ß-lactamase genes in diarrhoeagenic Escherichia coli strains isolated from foods and humans in Mashhad, Iran.

AIMS: Present study was aimed to determine ESBL-encoding genes distribution in Diarrhoeagenic Escherichia coli (DEC) isolated from animal-source food products and human clinical samples in Mashhad, Iran. The strains were also further studied to analyse genotypic diversity and find genetic relationships between them. METHODS AND RESULTS: The number of 85 DEC strains including 52 and 33 strains isolated from 300 food and 520 human stool samples, respectively. Randomly amplified polymorphic DNA (RAPD), and repetitive extragenic palindromic-PCR (rep-PCR) typing methods were used to track their genetic relationships. The ESBL-encoding genes prevalence was approximately 70% in both groups of isolates. The blaTEM , blaCTX-M and blaSHV were prevalent in 67·1, 20 and 10·6% of isolates, respectively. The ESBL-positives showed significantly higher resistance rates to gentamicin, co-trimoxazole, tetracycline, aztreonam and chloramphenicol (P < 0·05). Fingerprinting patterns-based dendrograms divided DEC strains into separate clusters irrespective of their sources and pathotypes. In typing field, rep-PCR provided more discriminatory power (Simpson's index of diversity (SID) = 0·925) than RAPD (SID = 0·812). CONCLUSION: Molecular similarity between certain animal-sourced food products and clinical sample strains supported food-borne transmission routes for genotypic elements such as ESBL-encoding genes. SIGNIFICANCE AND IMPACT OF THE STUDY: Findings emphasize the importance of resistance issues, the need to improve treatment guidelines and routine surveillance of hygienic measures during food processing.

A Mini Review on Discovery and Synthesis of Remdesivir as an Effective and Promising Drug against COVID-19.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as a new human coronavirus has begun spreading over Wuhan City/China in December 2019, and then spread rapidly worldwide, causing pneumonia called COVID-19. Up to now, the scientists have extensively attempted to find effective vaccines and drugs for treatment of coronavirus infections. To this end, various pharmaceutical agents are undergoing the clinical studies to assess their potency and efficacy against COVID-19. Based on the new findings, the U.S. food and drug administration (FDA) has issued an emergency use authorization for remdesivir as an effective anti-viral for remedying the hospitalized COVID-19 patients. Recently, the European medicines agency has authorized the use of remdesivir for the treatment of COVID-19. Remdesivir as a nucleotide prodrug exhibits broad-spectrum antiviral activities against RNA viruses. In this short review, we have rendered a brief overview of discovery and synthesis for remdesivir.

Mapping habitat suitability for gastrointestinal nematodiasis of ruminants in southern Caspian Sea littoral: a predicted risk pattern model based on the MaxEnt.

Herein, we provide the ecological niches of gastrointestinal nematode infections in Guilan, Mazandaran, and Golestan provinces. For this purpose, 2688 fecal specimens of sheep and cattle were subjected to the flotation method. For modeling procedure, the results were analyzed by considering 23 bioclimatic and environmental variables as well as 96 points/locations. Maximum entropy (model MaxEnt) was used to visualize the spatial distribution of gastrointestinal nematodes. The relative importance of all variables was also assessed by using jackknife analysis. The highest proportion of sheep infection with strongyle-type egg was observed in Golestan province (57.8%) and the lowest in Guilan province (49.5%), and eggs per gram (EPG) was around 21-29. The parasites with the highest proportion of infection in both domestic animals included strongyle-type eggs. Among the different bioclimatic and environmental variables, the biggest contributor to habitat suitability of the gastrointestinal nematode presence was found to be minimum temperature of the coldest month (Bio6), precipitation of driest quarter (Bio17), precipitation of coldest quarter (Bio19), and altitude. The MaxEnt model was able to provide a suitable guidance for predicting the probability distribution of gastrointestinal nematodes under bioclimatic and environmental variables, and the findings pave way for integrated gastrointestinal nematode surveillance and control strategies in the southern strip of Caspian Sea. In addition, the low intensity of gastrointestinal nematodiasis in ruminants may be associated with the frequent administration of anthelmintic drugs, where actions are needed to investigate drug resistance in the areas concerned and to provide anthelmintic drugs administration in a targeted manner.

Susceptibility of herpes simplex virus type 1 to monoterpenes thymol, carvacrol, p-cymene and essential oils of Sinapis arvensis L., Lallemantia royleana Benth. and Pulicaria vulgaris Gaertn.

In recent years, with increased the prevalence of viral infections and having no specific for  their treatment  and also the continuous appearance of resistant viral strains, the finding of novel antiviral agents is necessary. In this study, monoterpenes of thymol, carvacrol, p-cymene and essential oils from Sinapis arvensis L., Lallemantia royleana Benth. and Pulicaria vulgaris Gaertn. were screened for their inhibitory effect against herpes simplex virus type 1 (HSV-1) in vitro on Vero cell line CCL-81-ATCC using a plaque reduction assay. The antiviral activity of three monoterpenes (thymol, carvacrol and p-cymene) and three essential oils were evaluated by cytotoxicity assay, direct plaque test. In addition, the modes of antiviral action of these compounds were investigated during the viral infection cycle. Results showed that the inhibitory concentrations (IC50) were determined at 0.002%, 0.037%, >0.1%, 0.035%, 0.018% and 0.001% for thymol, carvacrol, p-cymene, S. arvensis oil, L. royleana oil and P. vulgaris oil, respectively. A manifestly dose-dependent virucidal activity against HSV-1 could be exhibited for compounds tested. In order to determine the mode of the inhibitory effect, compounds were added at different stages during the viral infection cycle. At maximum noncytotoxic concentrations of the compounds, plaque formation was significantly reduced by more than 80% when HSV-1 was preincubated with p-cymene. However, no inhibitory effect could be observed when the compounds were added to the cells prior to infection with HSV-1 or after the adsorption period. CONCLUSION: These results indicate that compounds affected HSV-1 mostly before adsorption and might interact with the viral envelope. Thymol exhibited a high selectivity index and seems to be a promising candidate for topical therapeutic application as antiviral agent for treatment of herpetic infections.

Bioactive chemical compounds in Eremurus persicus (Joub. & Spach) Boiss. essential oil and their health implications.

The genus Eremurus is native to Eastern Europe and temperate Asia. Particularly, Eremurus persicus (Joub. & Spach) Boiss. is highly valued in traditional foods and medicine. Scientific knowledge about E. persicus chemical composition and bioactivity is required. Therefore, the present study is aimed to determine the volatile composition of E. persicus essential oil (EO) by means of gas chromatography coupled to flame ionization/mass spectrometry detection. Moreover, the antioxidant, antimicrobial, anticancer, and acetylcholinesterase inhibitory activities of the EO were tested. Interestingly, the anti-dermatophyte potency was close to that of the drug griseofulvin, with minimum fungicidal concentration ranging between 0.7 and 4.5% depending on the fungi strain. The EO was also effective against hepatocellular carcinoma (Hep-G2) and breast adenocarcinoma (MCF-7) human cancer cell lines in a concentration (200-1500 ng/mL)-dependent manner, with a decrease of the cell viability up to 65% and 52%, respectively. The E. persicus EO was rich in terpenes and oxygenated terpene derivatives. Individually, limonene (16.25%), geranylgeraniol (15.23%), n-nonanal (9.48%), geranyl acetone (9.12%), benzene acetaldehyde (8.51%), linalool (7.93%), α-pinene (6.89%), and 1,8-cineol (5.22%) were the most abundant volatile compounds and could be chosen as analytical markers of this essential oil. In conclusion, our results suggested that this EO possesses a wide range of bioactive properties that could be useful in nutraceutical, functional foods and cosmeceutical formulations.

"Assessment of relationship between xerostomia and oral health-related quality of life in patients with rheumatoid arthritis".

OBJECTIVE: To determine the relationship between xerostomia and oral health-related quality of life in patients with rheumatoid arthritis. MATERIALS AND METHOD: Two hundred patients with rheumatoid arthritis were assessed using Fox and OHIP-14 questionnaires concerning xerostomia and oral health-related quality of life, respectively. The sum of decayed, missing, and filled teeth (DMFT) was determined via an intra-oral examination. In addition, intergroup comparisons were evaluated using t test, chi-square, regression, and Tukey analysis. RESULT: Among rheumatoid arthritis patients, 51% had been afflicted with xerostomia. We found a statistically significant relationship between xerostomia and oral health-related quality of life (p-value=.004), as xerostomia cases have significantly worse oral health-related quality of life. Also, there was a statistically significant association between oral health-related quality of life and gender as well as DMFT. CONCLUSION: Because there seem to be a high prevalence of xerostomia in patients with rheumatoid arthritis, screening in such population is highly recommended. Therefore, educational programs and/or workshops should be encouraged among healthcare providers to prevent worsening of oral health-related quality of life.

Anti-methicillin-resistant Staphylococcus aureus (MRSA) activity of Rubiaceae, Fabaceae and Poaceae plants: A search for new sources of useful alternative antibacterials against MRSA infections.

In this study, we evaluated the effects of the extracts of the leaves of species from the Rubiaceae (Galium aparine L. and Asperula arvensis L.), Fabaceae (Lathyrus aphaca L. and Vicia narbonensis L.) and Poaceae (Digitaria sanguinalis (L.) Scop. and Hordeum murinum L.) plant families on a wide and extensive panel of isolated methicillin-resistant Staphylococcus aureus strains (MRSA). The effects of the methanolic leaf extracts of Rubiaceae, Fabaceae and Poaceae plants on MRSA were evaluated by the disc diffusion assay and the broth dilution method. Among a total of 177 S. aureus isolates, 92 (51.97%) were found to be methicillin-resistant in an antibiogram and this was confirmed by the presence of the mecA gene in polymerase chain reaction method. All MRSA isolates were sensitive to all extracts. There were dose-dependent inhibitions on tested microorganisms for all plant extracts which showed maximum inhibition zones at a concentration of 300 mg/L. L. aphaca, G. aparine and H. murinum exhibited the highest antibacterial activity on the MRSA strains compared to the positive control (P < 0.05), as well as higher total polyphenol and flavonoid contents than other plant extracts. Minimum inhibitory concentrations on MRSA isolates ranged from 388.4 ± 0.2 mg/L, in D. sanguinalis, to 5.5 ± 0.1 mg/L, in L. aphaca. The methanolic extracts of L. aphaca (Fabaceae), G. aparine (Rubiaceae), and H. murinum (Poaceae) proved to have high antibacterial activity on MRSA isolates, thus representing promising antimicrobial agents in clinical settings.

A comparison between PLGA-PEG and NIPAAm-MAA nanocarriers in curcumin delivery for hTERT silencing in lung cancer cell line.

Lung cancer is the most common cancer among men. Since the main reason of cancer cells immortality is telomerase activity, targeting of such enzyme can be a promising approach in cancer therapy. Curcumin is a safe and efficient anticancer agent in this context, but its applications in cancer therapy are limited because of its hydrophobic structure and low solubility in water. Today, using nanocarriers for delivery of such anticancer agents is a well performed method. Here, we developed and compared the efficiency of two nanocarriers (PLGA-PEG and NIPAAm-MAA) in delivery of curcumin and also in levels of hTERT silencing in lung cancer cell line (calu-6). Scanning electron microscopy, MTT assays and real-time PCR were used for imaging, cytotoxicity testing and measuring the expression levels of hTERT after treatment of cells with different concentrations of free curcumin and curcumin loaded nanocarriers. The MTT results demonstrated that the IC50 values of curcumin loaded nanocarriers were in lower concentrations than free curcumin. The hTERT expression levels were decreased by curcumin loaded PLGA-PEG more than curcumin loaded NIPAAm-MAA and free curcumin. Our results showed that the curcumin loaded PLGA-PEG can be a useful nano based carrier for delivery of anti-cancer agents such as curcumin to fight lung cancer.

Anti-bacterial effect of essential oil from Xanthium strumarium against shiga toxin-producing Escherichia coli.

Shiga toxin-producing Escherichia coli (STEC) serotype O157:H7 is one of the most important human pathogenic microorganisms, which can cause life-threatening infections. Xanthium strumarium L. is a plant with anti-bacterial activity against gram-negative and gram-positive bacteria. This study aims to demonstrate in vitro efficacy of the essential oil (EO) extracted from Xanthium strumarium L. against E. coli O157:H7. Using the agar test diffusion, the effect of Xanthium strumarium L. EO (5, 10, 15, 30, 60, and 120 mg/mL) was verified at each of the four different growth phases of E. coli O157:H7. Cell counts of viable cells and colony forming unit (CFU) were determined at regular time points using Breed's method and colony counting method, respectively. No viable cell was detectable after the 1 hour-exposure to X. strumarium EO at 30, 60, and 120 mg/mL concentrations. No bacterial colony was formed after 1 h until the end of the incubation period at 24 h. At lower concentrations, the number of bacteria cells decreased and colonies could be observed only after incubation. At the exponential phase, the EO at 15 mg/mL was only bacteriostatic, while from 30 mg/mL started to be bactericidal. X. strumarium EO antibacterial activity against Shiga toxin-producing E. coli O157:H7 is dependent on EO concentration and physiological state of the microorganisms tested. The best inhibitory activity was achieved during the late exponential and the stationary phases.

Antibacterial activities of essential oils from Iranian medicinal plants on extended-spectrum ß-lactamase-producing Escherichia coli.

The extended-spectrum beta-lactamase (ESBL) -producing Escherichia coli strains can lead to various infections particularly urinary tract infections. The main objective of this investigation was to evaluate the antibacterial activities of essential oils (EOs) from different Iranian medicinal plants against TEM gene positive ESBL-producing E. coli strains isolated from urine samples of patients with urinary tract infections. EOs were extracted using hydrodistillation method. E. coli strains were isolated by different specific Medias. ESBL-producing E. coli strains were isolated from urine samples of patients with urinary tract infections in Shiraz hospital, Iran. Then, ESBL- producing strains were identified using double disk synergy test, phenotypic disc confirmatory test and polymerase chain reaction (PCR) for TEM gene detection. The antibacterial activity of the EOs from different plants (Achillea wilhelmsii C. Koch, Echinophora platyloba DC., Lallemantia royleana, Nepeta persica Boiss., Pulicaria vulgaris Gaertn., Salvia nemorosa, and Satureja intermedia C.A.Mey) and antibiotics against ESBL-producing strains was studied using the microdilution method for the evaluation of the minimum inhibitory concentration (MIC). The 103 out of 295 E. coli strains with 97 (90.65%) TEM gene distributions were identified as ESBL-producing strains. All of the EOs derived from different plants displayed high inhibitory effects against ESBL-producing E. coli strains. The results of our investigations may propose a good treatment option against resistant infectious bacteria.

Mutagenic, antimutagenic, antioxidant, anti-lipoxygenase and antimicrobial activities of Scandix pecten-veneris L.

Scandix pecten-veneris L. or Shepherd's-needle is a weed species used in some countries for medicinal purposes. In this study S. pecten-veneris leaves were shade dried, powdered and extracted with methanol. The purpose of this study was to assay the in vitro mutagenic, antimutagenic, antioxidant, antilipoxygenase and antimicrobial activities of S. pecten-veneris leaf extract. The methanolic extract indicated no mutagenicity when tested with Salmonella typhimurium strains TA98 and TA100. Antimutagenic activity was reported with inhibition of mutagenicity in a concentration dependent fashion. The methanolic extract demonstrated antioxidant activity in the DPPH radical-scavenging test (IC50 = 4.57 mg/mL), comparable to ascorbic acid and BHT. Moreover, the extract presented a remarkable and potent inhibition against soybean lipoxygenase (IC50 = 641.57 µg/mL). The methanolic extract was examined for its antimicrobial powers against four different bacteria with MIC values >100. Our results introduced this plant as a useful factor for the treatment of cancer, inflammatory and infectious diseases.

Inhibitory activity on type 2 diabetes and hypertension key-enzymes, and antioxidant capacity of Veronica persica phenolic-rich extracts.

Veronica genus (Plantaginaceae) is broadly distributed in different habitats. In this study, the inhibitory activity of free soluble and conjugated phenolic extracts of Veronica persica on key enzymes associated to type 2 diabetes (α-glucosidase and α-amylase) and hypertension (angiotensin I converting enzyme, ACE) was assessed, as well as their antioxidant power. Our results showed that both the extracts inhibited α-amylase, α-glucosidase and ACE in a dose-dependent manner. In particular, free phenolic extract significantly (P<0.05) inhibited α-glucosidase (IC50 532.97 µg/mL), whereas conjugated phenolic extract significantly (P<0.05) inhibited α-amylase (IC50 489.73 µg/mL) and ACE (290.06 µg/mL). The enzyme inhibitory activities of the extracts were not associated with their phenolic content. Anyway, the inhibition of α-amylase, α-glucosidase and ACE, along with the antioxidant capacity of the phenolic-rich extracts, could represent a putative mechanism through which V. persica exerts its antidiabetes and antihypertension effects.

Tordylium persicum Boiss. & Hausskn extract: A possible alternative for treatment of pediatric infectious diseases.

Antimicrobial herbal compounds are one of the important medical resources, and in order to help alleviate the spread of the pediatric infectious diseases, identification of additional bioactive phytochemicals and herbal extracts will be practical in treating illnesses. In the present work, antimicrobial activities various extracts of Tordylium persicum Boiss. & Hausskn aerial parts were determined against five Gram-positive bacteria, five Gram-negative bacteria, two fungi, and Echinococcus granulosus. Antimicrobial activities were assayed using both disk diffusion and microbroth dilution methods. Scolicidal activity was assayed by the Smyth and Barrett method. Also total phenol and total flavonoid contents for plant extracts were assayed. Results showed that the methanolic extract was more effective on all microbes. The results showed that Streptococcus pyogenes was the most susceptible to the methanolic extract (MIC = 25.9 ± 0.0 µg/mL), while Proteus vulgaris was the most resistant strain (MIC = 295.3 ± 0.0 µg/mL) among all bacteria evaluated. The extracts showed significant activity versus E. granulosus (P < 0.5) with dose-dependent inhibitions of the protoscolices. The high concentration of total polyphenolics (294.5 ± 0.1 GAE/g DW) and flavonoids (105.7 ± 0.3 mg CE/g DW) may be responsible for these activities. Our study is first evaluation on antimicrobial and scolicidal activities of T. persicum. Due to the appearance of antibiotic-resistance, ourstudy suggested that methanol extracts of this plant are appropriate candidate for traditional curative uses and it can be utilized in the pediatric infectious disease therapy, especially pediatric infectious disease.

Plants of the genus Allium as antibacterial agents: From tradition to pharmacy.

Plants belonging to the genus Allium are widely cultivated and used all over the world as food and medicinal plants. Since ancient times, these plants, particularly garlic (Allium sativum L.) and onion (Allium cepa L.), have represented important components of typical recipes and traditional healing systems. Not the least of which, their use as food biopreservatives is well documented, due to the relevant antibacterial activity of their extracts and essential oils. In addition to garlic and onion, this review article deals with the main members of the genus Allium, including A. ampeloprasum (Leek), A. schoenoprasum (Chive) and A. ascalonicum (Shallot), focusing both on their ethnonutritional uses and potential as promising food biopreservative agents. Noteworthy, recent research has demonstrated Allium derivatives to be novel components in active edible coatings as well as nanoformulates.

Molecular genotyping of Echinococcus granulosus using formalin-fixed paraffin-embedded preparations from human isolates in unusual tissue sites.

Cystic echinococcosis (CE) caused by Echinococcus granulosus remains a serious problem worldwide for issues relating to public health and the economy. The most predominantly affected sites are the liver and the lungs, but other organs such as the heart, the spleen and the peritoneum can also be infected. Access to cysts from uncommon sites has limited genomic and molecular investigations. In the present study, genotypes of E. granulosus sensu lato were identified from formalin-fixed paraffin-embedded tissues (FF-PETs) implicated in human CE. Tissue samples were obtained from 57 patients with histologically confirmed CE. DNA samples were analysed using Egss 1 polymerase chain reaction (PCR) specific to the mitochondrial 12S rRNA gene of E. granulosus sensu stricto. All cysts were typed as E. granulosus sensu stricto with up to 35% of the liver and 16.6% of lungs being the most frequently infected, and up to 48.4% of samples being from rare sites. No correlation was found between cyst site and either the gender or the age of patients. This study demonstrates the possibility of exploiting atypical cysts using FF-PET samples and highlights the predominance of E. granulosus sensu stricto species in the Tunisian population, even in unusual infection sites.

Identifying delayed left ventricular lateral wall activation in patients with non-specific intraventricular conduction delay using coronary venous electroanatomical mapping.

BACKGROUND: Delayed left ventricular (LV) lateral wall activation is considered the electrical substrate that characterises patients suitable for cardiac resynchronisation therapy (CRT). Although typically associated with left bundle branch block, delayed LV lateral wall activation may also be present in patients with non-specific intraventricular conduction delay (IVCD). We assessed LV lateral wall activation in a cohort of CRT candidates with IVCD using coronary venous electroanatomical mapping, and investigated whether baseline QRS characteristics on the ECG can identify delayed LV lateral wall activation in this group of patients. METHODS: Twenty-three consecutive CRT candidates with IVCD underwent intra-procedural coronary venous electroanatomical mapping using EnSite NavX. Electrical activation time was measured in milliseconds from QRS onset and expressed as percentage of QRS duration. LV lateral wall activation was considered delayed if maximal activation time measured at the LV lateral wall (LVLW-AT) exceeded 75 % of the QRS duration. QRS morphology, duration, fragmentation, axis deviation, and left anterior/posterior fascicular block were assessed on baseline ECGs. RESULTS: Delayed LV lateral wall activation occurred in 12/23 patients (maximal LVLW-AT = 133 ± 20 ms [83 ± 5 % of QRS duration]). In these patients, the latest activated region was consistently located on the basal lateral wall. QRS duration, and prevalence of QRS fragmentation and left/right axis deviation, and left anterior/posterior fascicular block did not differ between patients with and without delayed LV lateral wall activation. CONCLUSION: Coronary venous electroanatomical mapping can be used at the time of CRT implantation to determine the presence of delayed LV lateral wall activation in patients with IVCD. QRS characteristics on the ECG seem unable to identify delayed LV lateral wall activation in this subgroup of patients.

The additive effect of excimer laser on non-cultured melanocyte-keratinocyte transplantation for the treatment of vitiligo: a clinical trial in an Iranian population.

BACKGROUND: Non-cultured cellular grafting is specified for stable vitiligo treatment as a novel surgical technique, however, the additive effect of excimer laser on melanocytes-keratinocytes transplantation (MKT) have not experienced yet. OBJECTIVE: To assay the additive effect of excimer laser on MKT for the treatment of vitiligo in an Iranian population. METHODS AND MATERIALS: In this non-randomized clinical trial, 39 patches were evaluated. Nine patches treated by MKT alone, 10 patches treated by MKT and excimer laser, 10 patches treated with excimer alone and 10 patches left without any treatments as control patches. RESULTS: In the patches treated with excimer, the percentage reduction of depigmented area from baseline varied, ranging from 0 to 43.9%. In the nine patches treated with non-cultured MKT, the median percentage reduction of depigmented area from baseline was 15.9%. The median percentage reduction of depigmented area in excimer + MKT was 41.9% .In the untreated patches, the median percentage reduction of depigmented area was 0.1%. After controlling for the effect of 'depigmented area at baseline', significant reductions were observed in depigmented area of the patches treated with combination therapy of excimer and non-cultured MKT in comparison with the other therapies and untreated patches. CONCLUSION: Although pigmentation in our patients was lower than previous reports from Iran and other countries, however, we signified adding excimer to MKT increased the pigmentation rate in treated patches. Further investigations are recommended with longer follow-up and larger series to validate the findings reported here.