Cutaneous leishmaniasis as an increasing threat for Iranian travellers attending religious ceremonies.

BACKGROUND: The Islamic Republic of Iran is one of the most important endemic foci of cutaneous leishmaniasis in the world. Annually, a large number of Iranian Shia pilgrims travel to Iraq from this area in order to participate in one of their most important religious ceremonies. This trip has coincided with the seasonal activity of sand flies in recent years. So, cutaneous leishmaniasis could be a serious threat for pilgrims on these trips. AIMS: To report cases of cutaneous leishmaniasis among Iranian Shia pilgrims attending a religious ceremony in Iraq during 2017. METHODS: Sixteen patients were referred to our laboratory in the Department of Parasitology and Mycology at Qazvin University of Medical Sciences. Dermal scrapings and stained slides prepared of skin lesions were used to morphological diagnosis. DNA extraction and PCR amplification were optimized to identification of Leishmania species. RESULTS: All of the patients were infected with cutaneous leishmaniasis in microscopic survey. L. major was detected by molecular approach. The number of lesions observed in patients were 1 (31%), 2 (25%), and ≥ 3 (44%). CONCLUSIONS: Since a large number of Shia Muslims participate in the annual religious ceremonies, serious measures must be taken to prevent the disease.

Cutaneous leishmaniasis as an increasing threat for Iranian travellers attending religious ceremonies

Background: The Islamic Republic of Iran is one of the most important endemic foci of cutaneous leishmaniasis in the world. Annually, a large number of Iranian Shia pilgrims travel to Iraq from this area in order to participate in one of their most important religious ceremonies. This trip has coincided with the seasonal activity of sand flies in recent years. So, cutaneous leishmaniasis could be a serious threat for pilgrims on these trips.Aims: To report cases of cutaneous leishmaniasis among Iranian Shia pilgrims attending a religious ceremony in Iraq during 2017.Methods: Sixteen patients were referred to our laboratory in the Department of Parasitology and Mycology at Qazvin University of Medical Sciences. Dermal scrapings and stained slides prepared of skin lesions were used to morphological diagnosis. DNA extraction and PCR amplification were optimized to identification of Leishmania species.Results: All of the patients were infected with cutaneous leishmaniasis in microscopic survey. L. major was detected by molecular approach. The number of lesions observed in patients were 1 (31%), 2 (25%), and ≥ 3 (44%).Conclusions: Since a large number of Shia Muslims participate in the annual religious ceremonies, serious measures must be taken to prevent the disease.

Evaluation of Aflatoxin M1 Enrichment Factor in Semihard Cow's Milk Cheese and Correlation with Cheese Yield.

HIGHLIGHTS: The aflatoxin M1 content in milk was not related to the enrichment factor. The enrichment factor in 45-day ripened semihard cheese was defined. The enrichment factor in cheese is affected by cheese yield.

The Role of Hemodynamics in Intracranial Bifurcation Arteries after Aneurysm Treatment with Flow-Diverter Stents.

BACKGROUND AND PURPOSE: Treatment of intracranial bifurcation aneurysms with flow-diverter stents can lead to caliber changes of the distal vessels in a subacute phase. This study aims to evaluate whether local anatomy and flow disruption induced by flow-diverter stents are associated with vessel caliber changes in intracranial bifurcations. MATERIALS AND METHODS: Radiologic images and demographic data were acquired for 25 patients with bifurcation aneurysms treated with flow-diverter stents. Whisker plots and Mann-Whitney rank sum tests were used to evaluate if anatomic data and caliber changes could be linked. Symmetry/asymmetry were defined as diameter ratio 1 = symmetric and diameter ratio <1 = asymmetric. Computational fluid dynamics was performed on idealized and patient-specific anatomies to evaluate flow changes induced by flow-diverter stents in the jailed vessel. RESULTS: Statistical analysis identified a marked correspondence between asymmetric bifurcation and caliber change. Symmetry ratios were lower for cases showing narrowing or subacute occlusion (medium daughter vessel diameter ratio = 0.59) compared with cases with posttreatment caliber conservation (medium daughter vessel diameter ratio = 0.95). Computational fluid dynamics analysis in idealized and patient-specific anatomies showed that wall shear stress in the jailed vessel was more affected when flow-diverter stents were deployed in asymmetric bifurcations (diameter ratio <0.65) and less affected when deployed in symmetric anatomies (diameter ratio ∼1.00). CONCLUSIONS: Anatomic data analysis showed statistically significant correspondence between caliber changes and bifurcation asymmetry characterized by diameter ratio <0.7 (P < .001). Similarly, computational fluid dynamics results showed the highest impact on hemodynamics when flow-diverter stents are deployed in asymmetric bifurcations (diameter ratio <0.65) with noticeable changes on wall sheer stress fields. Further research and clinical validation are necessary to identify all elements involved in vessel caliber changes after flow-diverter stent procedures.

Should indications for WEB aneurysm treatment be enlarged? Report of a series of 20 patients with aneurysms in "atypical" locations for WEB treatment.

BACKGROUND AND PURPOSE: Flow disruption with the WEB device is an innovative technique for the endovascular treatment of wide neck bifurcation aneurysms. Good clinical practice trials have shown high safety of this treatment with good efficacy. Technical developments (single layer devices and smaller microcatheters) facilitate the treatment, potentially leading to enlargement of indications. This series is collecting aneurysms in "atypical" locations for WEB treatment and analyzing safety and efficacy of this treatment. MATERIALS AND METHODS: In each participating center, patients with aneurysms treated with WEB were prospectively included in a local database. Patients treated for aneurysms in "atypical" locations were extracted. Patient and aneurysm characteristics, intraoperative complications, and anatomical results at the end of the procedure and at last follow-up were collected and analyzed. RESULTS: Five French neurointerventional centers included 20 patients with 20 aneurysms in "atypical" locations for WEB treatment treated with WEB. Aneurysm locations were ICA carotid-ophthalmic in 9 aneurysms (45.0%), ICA posterior communicating in 4 (20.0%), Pericallosal artery in 5 (25.0%), and basilar artery between P1 and superior cerebellar artery in 2 (10.0%). There were no complications (thromboembolic or intraoperative rupture) in this series. At follow-up (mean: 7.4 months), adequate occlusion was obtained in 100.0% of aneurysms. CONCLUSIONS: This series confirms that it is possible to enlarge indications of WEB treatment to "atypical" locations with good safety and efficacy. These data have to be confirmed in large prospective series.

Are Anatomic Results Influenced by WEB Shape Modification? Analysis in a Prospective, Single-Center Series of 39 Patients with Aneurysms Treated with the WEB.

BACKGROUND AND PURPOSE: Endovascular treatment with the flow-disrupter Woven EndoBridge aneurysm embolization system (WEB) is an innovative treatment for wide-neck bifurcation aneurysms. Prospective, multicenter studies have shown the high safety of this technique. Stability of aneurysm occlusion in long-term follow-up has been rarely studied. Moreover the "compression" phenomenon has been reported and seems to be associated with poor anatomic results. This prospective, single-center series analyzes the safety and efficacy of the WEB device in long-term follow-up in relation to WEB shape modification. MATERIALS AND METHODS: All patients with aneurysms treated with the WEB were prospectively included in a data base. Demographics, aneurysm characteristics, adverse events, and anatomic results were retrospectively analyzed. Anatomic results and modification of the WEB shape on the follow-up examinations were independently evaluated by a core laboratory. RESULTS: Thirty-nine patients were included. We observed few complications: intraoperative rupture in no patients (0.0%) and thromboembolic events in 3 patients (7.7%) with a permanent deficit in 1 (2.6%). At short-term, midterm, and long-term follow-up, adequate occlusion was obtained in 86.8%, 83.3%, and 87.5%, respectively. Retreatment rates were low (5.1%). At 6 months, WEB shape modification (compression/retraction) was observed in 31.6% of patients but was not associated with a lower rate of adequate occlusion. CONCLUSIONS: This prospective, single-center series with WEB devices used in 39 patients during 3.5 years confirms data from previous multicenter studies. Treatment can be accomplished with good safety and efficacy, with a high rate of adequate occlusion. Anatomic results were not worse in case of WEB shape modification.

Traitement endovasculaire de l'accident vasculaire cérébral

Ischemic stroke (IS) is an acute pathology that requires an urgent treatment and a complex organization for the health care systems. IS is the second mortality reason around the world and the third one in industrialized countries based on World Health Organization database. IV thrombolysis started in 1996 as a treatment for IS with the administration of reteplase or Rt-PA up to 4h30 after symptoms beginning with 30 to 40% of efficacy. Mechanical thrombectomy (MT) allows to expand therapeutic window further than IV thrombolysis and higher efficacy. Therapeutic decision is multidisciplinary with senior doctors and appropriate materials: stroke unity composed by interventional neuroradiologists, angio-room, department of Neurosurgery, Intensive Care and imaging equipments to perform neuroradiological examens. MT is considered the gold standard treatment for IS if Aspect Score is > to 5 and symptoms started not more 6 hours before endovascular treatment. Randomized studies showed the superiority of MT + IV thrombolysis over IV thrombolysis only. Endovascular treatment by MT requires financial support from health care systems, but the price is justified by the lower number of disabled patients because morbidity, functional impacts and quality of life at 90 days

Date (Phoenix dactylifera) Polyphenolics and Other Bioactive Compounds: A Traditional Islamic Remedy's Potential in Prevention of Cell Damage, Cancer Therapeutics and Beyond.

This review analyzes current studies of the therapeutic effects of Phoenix dactylifera, or date palm fruit, on the physiologic system. Specifically, we sought to summarize the effects of its application in preventing cell damage, improving cancer therapeutics and reducing damage caused by conventional chemotherapy. Phoenix dactylifera exhibits potent anti-oxidative properties both in vitro and in vivo. This allows the fruit to prevent depletion of intrinsic protection from oxidative cell damage and assist these defense systems in reducing cell damage. Macroscopically, this mechanism may be relevant to the prevention of various adverse drug events common to chemotherapy including hepatotoxicity, nephrotoxicity, gastrotoxicity, and peripheral neuropathy. While such effects have only been studied in small animal systems, research suggests a potential application to more complex mammalian systems and perhaps a solution to some problems of chemotherapy in hepato-compromised and nephro-compromised patients.

Intracranial dissection: incidence and long term endovascular treatment results of a not so rare disease.

OBJECTIVE: The objective of this communication was to study the incidence and course of ICD and the long term outcome of this severe disease. The second goal was to analyze the different endovascular treatment modalities according to their long term results. METHODS: It is a retrospective analysis of 14 patients with ICD admitted in a single center in two consecutive years, treated with endovascular procedures. Patients harbouring blister-like ruptured intracranial aneurysms were excluded from this study. RESULTS: In this case series, 12 patients presented with subarachnoid hemorrhage (SAH) and 2 with brain stem symptoms. Mean age was 51 years and 13 patients were female. Six patients (43%) died and 8 (57%) survived with a mRS at 0-1. Mean follow up was 21 months. CONCLUSIONS: ICD as a cause of SAH seems to be more frequent than previously thought and usually has a severe course. It requires a high level of suspicion to diagnosis and specific endovascular treatment modalities are required for each location to ensure long term stability and change the poor prognosis.

Total anti-oxidant status: a biochemical predictor of human male fertility.

The objective of the study was to assess whether seminal plasma total antioxidant status (TAS) can be used as a biochemical predictor of male fertility and its variation in different categories of infertile male subjects in our population. The study population consisted of 28 fertile and 127 infertile [teratozoospermic (30), asthenoteratozoospermic (30), azoospermic (21), oligoastheno-teratozoospermic (20), polyzoospermic (15) and oligozoospermic (11)] male subjects. Seminal plasma was separated by centrifugation and stored at minus 80 degree Celsius. Semen was analysed using computer-assisted semen analysis according to WHO criteria. Seminal plasma TAS was estimated by colorimetric method using Randox total antioxidant status kit. TAS of fertile male subjects was significantly (P < 0.001) higher than that of infertile patients. In whole studied population, seminal plasma TAS showed a significant positive correlation with sperm concentration (P < 0.001), sperm motility (P < 0.0001), and spermatozoa with normal morphology (P < 0.0001). In conclusion, this study suggests that TAS of seminal plasma is one of the important factors contributing to male infertility, and it can be used as a biochemical predictor for male fertility.

Quadruple spontaneous cervical artery dissection following aneurysm embolization: a rare posttreatment complication.

We present a unique case of multiple sCADs occurring after a ruptured intracranial aneurysm embolization. We discuss the impact of head extension during embolization as the prevailing factor in multiple artery dissections in this case and point out another cause of new-onset neurologic deficit in patients with aneurysmal SAH.

[Failure of transverse sinus dural fistula embolization using ethanol injection]. / Echec de l'embolisation transartérielle par l'alcool absolu d'une fistule durale du sinus transverse.

This is a case report of successful arterial embolization of a dural fistula using absolute alcohol. In this two-part embolization of a dural fistula of the left sagittal venous sinus, the use of n-BCA (n-butyl-cyanoacrylate) was followed by 1 ml of absolute alcohol four months later. The first procedure, using n-BCA via the external carotid, permitted exclusion of the arterial supply coming from the medial meningeal and occipital arteries. Persistence of the blood supply through the internal carotid prompted us to perform the second procedure, to occlude the tentorium marginalis artery, using 1 ml of 95% ethanol. This was followed by a cranial nerve (III) palsy that was reversible. The three-month follow-up was satisfactory, although arteriography after one year showed revascularization of the fistula, which was successfully treated by Onyx. Routinely used in the treatment of superficial vascular malformations, the use of absolute alcohol intracerebrally appears to be unreliable, with results that were only temporary.

A specific cadherin phenotype may characterise the disseminating yet non-metastatic behaviour of pseudomyxoma peritonei.

Pseudomyxoma peritonei (PMP) is a rare neoplasm of mainly appendiceal origin, characterised by excess intra-abdominal mucin production leading to high morbidity and mortality. While histological features are frequently indolent, this tumour disseminates aggressively throughout the abdominal cavity, yet seldom metastasises. This study determined the expression of several markers of colorectal differentiation (carcinoembryonic antigen (CEA), cytokeratins (CK20 and CK7), epithelial membrane antigen), mucin production (MUC-2, interleukin-9 (IL-9), IL-9 receptor (IL-9Ralpha)), and cell adhesion (N- and E-cadherin, vimentin) in PMP tissue (n=26) compared with expressions in normal colonic mucosa (n=19) and colorectal adenocarcinoma (n=26). Expressions of CEA and cytokeratins were similar for PMP as those in colorectal adenocarcinomas with the exception that the CK20-/CK7- pattern was rare in PMP (Fisher's exact test: P=0.001). Similarly, expressions of mucin-related proteins were comparable for adenocarcinoma and PMP, with the exception that IL-9 expression was uncommon in adenocarcinoma (P=0.009). Pseudomyxoma peritonei demonstrated a specific pattern of adhesion-related protein expressions of increased N-cadherin, reduced E-cadherin, and increased vimentin (P=0.004), a phenotype suggesting a possible epithelial-mesenchymal transition state. Primary PMP cell cultures were successfully maintained and demonstrated marker expressions similar to those seen in in vivo tissues. These early characterisation studies demonstrate similarities between PMP and colorectal adenocarcinoma, but also reveal a specific cadherin phenotype that may characterise the distinct non-metastasising behaviour of PMP, and form the basis for future mechanistic and therapy-targeting research.

[Isolated basilar artery dissection in a case of osteogenesis imperfecta]. / Dissection isolée de l'artère basilaire dans un cas d'ostéogénèse imparfaite.

Vascular dissection and osteogenesis imperfecta are very rarely associated. The authors report a unique case of basilar artery dissection and discuss the diagnostic imaging work-up.

Activating point mutations in cyclin-dependent kinase 4 are not seen in sporadic pituitary adenomas, insulinomas or Leydig cell tumours.

Cell cycle dysregulation is one of the defining features of cancer. Cyclin-dependent kinase 4 (CDK4), together with its regulatory subunit cyclin D, governs cell cycle progression through the G1 phase. Cyclin-dependent kinase inhibitors, including p16(INK4A) (encoded by CDKN2A), in turn regulate CDK4. In particular, dysregulation of the p16/CDK4/cyclin D complex has been established in a variety of types of human tumours. Dominant activating mutations affecting codon 24 of the CDK4 gene (replacement of Arg24 by Cys or His) render CDK4 insensitive to p16(INK4) inhibition and are responsible for melanoma susceptibility in some kindreds. However, 'knock-in' mice homozygous for the CDK4(R24C) mutation were noted to develop multiple neoplasia, most commonly including endocrine tumours: pituitary adenomas, insulinomas and Leydig cell testicular tumours. We therefore speculated that sporadic human endocrine tumours might also harbour such mutations. The aim of the current study was to analyze the CDK4 gene for the two characterized activating mutations, R24C and R24H, in sporadic human pituitary adenomas, insulinomas and Leydig cell tumours. We used DNA extracted from 61 pituitary adenomas, and paired tumorous and neighboring normal genomic DNA extracted from 14 insulinoma and 6 Leydig cell tumour samples. Genomic DNA from patients with familial melanoma harbouring the R24C or the R24H mutations served as positive controls. All samples were subjected to PCR, mutation-specific restriction digests and/or sequencing. Both methodologies failed to detect mutations at these two sites in any of the sporadic endocrine tumours including pituitary adenomas, benign or malignant insulinomas or Leydig cell tumours, while the positive controls showed the expected heterozygote patterns. Protein expression of CDK4 was demonstrated by immunohistochemistry and Western blotting in pituitary and pancreatic samples. These data suggest that the changes in the regulatory 'hot-spot' on the CDK4 gene, causing various endocrine tumours in CDK4(R24C/R24C )mice, are not a major factor in sporadic pituitary, insulin beta-cell or Leydig cell tumorigenesis.

Inappropriate expression of IgD from a transgene inhibits the function of antigen-specific memory B cells.

IgD expression has been shown to be downmodulated upon mitogenic or antigenic activation of B cells. To investigate whether this decrease is of functional significance we studied a mouse strain that expresses transgenic IgD on all B cells. The rearranged gene encoding the heavy chain of this IgD requires endogenous gene rearrangement before it can be expressed; therefore, normal B cell development is not affected. As a result, both transgenic IgD and endogenous IgM and IgD are expressed on all peripheral B cells. We show that the presence of extraneous IgD does not affect normal B cell activation by polyclonal stimulators, nor does it affect the primary IgM or IgG responses to TI or TD antigens. However, the secondary memory response is significantly diminished. The decrease is not attributable to a defective generation of memory B cells; instead the activation of memory cells appears to be compromised. Since the depressed response can be overcome by prior aggregation of the transgenic IgD with allotype-specific anti-IgD antibodies, it appears that persistence of the transgenic IgD on memory cells may influence their ability to be activated. Thus, the decrease in IgD expression on normal B cells after activation may be necessary for optimal activation of memory cells.

Hemodynamic consequences of cerebral vasospasm on perforating arteries: a phantom model study.

BACKGROUND AND PURPOSE: Hemodynamics of cerebral vasospasm after subarachnoid hemorrhage remain unclear, and the discrepancy between ultrasonographic or angiographic evidence of arterial narrowing and neurological ischemic deficit is still debated. Most blood flow studies have been involved with large arteries, and thus, very little is known regarding the hemodynamic behavior of small perforating vessels. Patients with symptomatic vasospasm, however, often present with neurological signs suggesting involvement of deep-sited areas of the brain supplied by perforating arteries. METHODS: A pulsatile pump was set to provide an outflow of 350 mL/min through a 10-mm-diameter C-flex tube at a perfusion pressure of 130/80 mm Hg. The perfusion fluid used was prepared to approximate blood viscosity. Perforating arteries were simulated by a 1-mm tube connected to the parent tube at a 90 degrees angle. Cylindrical stenotic devices of decreasing diameters were then introduced into the parent tube at the level of the aperture of the secondary tube and 1.5 diameters upstream of it. Velocity profiles both proximal and distal to the stenosis in the parent tube were obtained with a newly developed ultrasonographic flowmeter that allows for high spatial resolution. RESULTS: Increasing stenosis resulted in decreased outflow in the main tube, although it was significant only with severe stenosis. Whenever the simulated stenosis was placed upstream of the secondary tube, flow reduction was associated with a progressive change in the velocity profile, which gradually changed from laminar conditions to a jet stream limited to the center of the lumen. Further diameter reduction was responsible for the occurrence of flow separation with retrograde flow velocities in the periphery of the lumen. In the secondary tube, flow reduction was much more pronounced and began at a lesser degree of stenosis. Increasing fluid viscosity and decreasing perfusion pressure enhanced flow separation and prominently affected the outflow in the secondary tube. Conversely, whenever the simulated stenosis involved the branching area of the secondary tube, there was a slightly progressive decrease in the relative flow in the main tube as the stenosis became tighter. When the stenosis equaled the diameter of the secondary tube, the relative contribution of the secondary tube increased markedly at the expense of the main tube outflow. CONCLUSIONS: The present results show that local cerebral vasospasm induces changes in postvasospastic velocity profile affecting the shear rate and may eventually lead to flow separation. This phenomenon may, in turn, result in a venturi-like effect over the aperture of perforating arteries branching out of the postvasospastic portion of the affected parent artery. These alterations of cerebral hemodynamics may account for at least part of the vasospasm symptomatology, especially in the vertebrobasilar system, where vasospasm is commonly focal rather than diffuse. Furthermore, these changes proved to be affected significantly by manipulations of pressure and viscosity, supporting the use of hyperdynamic therapy in the management of cerebral vasospasm.

Prevalence of bacterial vaginosis in antenatal women.

Bacterial vaginosis is an established risk factor in pregnant women for premature rupture of membranes and preterm delivery. This study was carried out to find out the prevalence of Bacterial Vaginosis (BV) in antenatal women with vaginal discharge and the effect of treatment with Metronidazole gel on pregnancy outcome. One hundred and fifty symptomatic and fifty asymptomatic women in second trimester of pregnancy in the age group of 20-30 years were included in the study. Gram stained smears of vaginal discharge were examined for evidence of BV with a scoring system by Nugent et al and was found to be positive in 38.5% in symptomatic antenatal women. Intravaginal metronidazole gel application was found to be an effective therapeutic option. Incidence of preterm labour was more in untreated cases.