The effect of Ramadan fasting on LH, FSH, oestrogen, progesterone and leptin in pregnant women.

Many pregnant Muslim women fast during Ramadan. Leptin has an important role in the reproductive system and hormones. In this study, FSH, LH, oestrogen, progesterone and leptin were measured in the first, second and fourth week of Ramadan and the second week post-Ramadan, in 30 fasting pregnant women. Data were analysed using repeated measures ANOVA by SPSS. The weight and BMI did not change during the study. A significant change in FSH, oestrogen, progesterone and leptin was observed (p < 0.05). The lowest value of FSH was in the second week of Ramadan. Progesterone increased at the end of Ramadan and the second week after. Oestrogen increased significantly during Ramadan and decreased after Ramadan. A decreasing trend was seen in LH during the Ramadan and 2 weeks after (p < 0.1). Leptin decreased significantly 2 weeks after Ramadan. We found poor weight gain and hypoleptinaemia in pregnant fasted women during the study. Food restriction in pregnant fasted women during Ramadan may induce poor weight gain during pregnancy. These data confirm that Ramadan fasting by pregnant women may have potential risks during pregnancy. We recommend further study to evaluate long-term effects of Ramadan fasting during pregnancy in different countries with different food habits and traditions, to obtain reliable and documented data.

The influence of subclinical hypothyroidism on serum lipid profile, PCSK9 levels and CD36 expression on monocytes.

BACKGROUND: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease and a secreted protein which increases cholesterol levels in plasma via inducing degradation of low-density lipoprotein receptor (LDLR). Cluster of differentiation 36 (CD36) is a member of a family of cell surface proteins in many cells. CD36 is known as fatty acid translocase (FAT) because it imports fatty acids inside cells and participate in triglyceride storage. It has been suggested that PCSK9 regulates CD36 in some tissues. METHODS: Data and serum levels of TSH, FT4, lipid profile and PCSK9 and the expression of CD36 on monocytes from 40 new untreated patients with subclinical hypothyroidism (SH) and 40 age- sex- and BMI-matched euthyroid controls were analyzed in a cross-sectional study. Then the relationships between these parameters were examined. RESULTS: Patients with SH had higher TSH, FT4, total cholesterol (TC) and triglyceride (TG) Low-density lipoprotein (LDL) and PCSK9 levels than controls. There were significant and positive correlations between serum TSH levels and lipid parameters except HDL-C. PCSK9 had a significant and negative correlation with FT4. No significant correlation could be found in relation to PCSK9 and CD36. CONCLUSIONS: PCSK9 inhibitors are used to reduce blood cholesterol levels as drugs. If it will be proven that PCSK9 can induce CD36 degradation, taking these drugs may have unwanted side effects. This study showed that serum PCSK9 and lipid profile levels increase in patients with subclinical hypothyroidism and there is no relationship between PCSK9 and CD36 in these patients.

The prediction incidence of the three most common cancers among Iranian military community during 2007-2019: a time series analysis.

OBJECTIVE: Cancers are one of the most important public health problems in Iran. Because of the importance of cancers, the purpose of the current study was to the prediction of the future incidence of the most common cancers among Iranian military community (MC) by using the time series analysis during 2007 to 2019. METHODS: In the current cross-sectional study, all registered cancers among Iranian MC entered the study. To select the best model of prediction, various methods including autocorrelation function (ACF), partial autocorrelation function (PACF), and Akaike information criterion (AIC) statistics were used. All analysis was performed by using ITSM, stata14, and Excel2010 software. RESULTS: The most prevalent cancers among Iranian MC were breast, prostate, and colon cancers respectively. The time series analysis was shown that the trend of all mentioned cancers in Iranian MC will increase in the coming years. CONCLUSIONS: The trend of most prevalent cancers among Iranian MC was increasing but the different factors like the growth of population size and improving the registration system should be regarded.

Spatial changes in the distribution of malaria vectors during the past 5 decades in Iran.

BACKGROUND: Global warming and climate change affect various aspects of mankind, including public health. Anopheles mosquitoes are of Public Health importance and can be affected by global warming and other environmental variables. Here, we studied the distribution of Anopheles vectors of malaria in relation to environmental variables in Iran. METHODS: Long-term meteorological and entomological data of about 50 years in retrospect were collected and arranged in a geo-database and analyzed using ArcGIS ver. 9.3 and exported to SPSS ver. 20 for statistical analysis. RESULTS: Distribution maps have been updated for seven species of Anopheles vectors of malaria which involved Anopheles culicifacies s.l., An. fluviatilis s.l., An. stephensi, An. dthali, An. sacharovi, An. maculipennis.l. and An. superpictus in Iran. Distribution maps of vectors were made based on district areas using Kriging model. Historical and recent records were demonstrated for each Anopheles based on climatic factors in the distribution areas of each Anopheles vectors. DISCUSSION: Iran, like other parts of the world is faced with warming and this probably affected the distribution of Anopheles vectors. Despite the warming phenomenon, the country's climate had changed during the cold season as temperatures became colder or cooler. This study shows that some vectors had migrated from the central part of Iran with dry and sunny landscape, moved towards the mountainous areas of the north or the warm and humid areas of the south. Historical records show that these anophelines have previously been distributed in lowland areas. If this process continues in the future, Anopheles mosquitoes may be seen in low lands with cold areas in central and northern parts of the country or will occupy humid and warm climates in the southern parts of the country where water is more available.

A comparative evaluation of oral ofloxacin versus intravenous cefotaxime therapy for serious skin and skin structure infections.

In a single-blind, placebo-controlled randomized trial, 100 successive patients were enrolled with serious skin and soft-tissue infections, whose illnesses had precipitated an initial hospital admission or an extension of inpatient care. There were 93 evaluable patients who received either ofloxacin, 400 mg orally every 12 hours plus an intravenously administered placebo every eight hours, or cefotaxime, 2.0 g intravenously every eight hours plus an orally administered placebo every 12 hours. The average length of therapy was 12 days. Both patient groups had similar demographics and underlying conditions. Wound infection was the most common diagnosis, followed by abscess, cellulitis, and trophic ulcer. Multiple pathogens were commonly isolated from infected sites (1.4 pathogens/patient). The most common pathogen was Staphylococcus aureus, followed by Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia marcescens, Proteus/Providencia spp., and Enterobacter spp. Persistence of the initial pathogen at the end of therapy was observed in 22.5 percent of the cefotaxime-treated group, but in only 10 percent of the ofloxacin-treated group. There was one clinical failure in the cefotaxime group, caused by a susceptible strain of Enterobacter cloacae, and there was one clinical failure in the ofloxacin group, in which the patient had an Acinetobacter calcoaceticus var. anitratus wound infection and subsequently developed a P. aeruginosa superinfection. Adverse experiences, including rash, insomnia, and nausea, occurred in 16 percent of the patients in each group. It was concluded that oral ofloxacin is as safe and efficacious as parenteral cefotaxime in the treatment of serious skin and skin structure infections.

New approaches to the diagnosis and treatment of infective endocarditis: review of 100 consecutive cases.

To assess the effect of our new, more aggressive approach to treating infective endocarditis, we retrospectively reviewed our recent experience with this disease. Between 1983 and 1989, we treated 100 patients with endocarditis, in 94 of whom the diagnosis was confirmed. Fifty-four (57%) of the 94 patients had native valve endocarditis, and the other 40 patients (43%) had prosthetic valve endocarditis. The patients' mean ages were 50 years for native valve disease and 58 years for prosthetic valve disease (p < 0.05). The male-to-female ratio was 4:1. Among the patients with confirmed endocarditis, 87 (93%) had significant underlying risk factors for endocarditis. Upon physical examination of the 94 patients, 16 (17%) were afebrile, 15 (16%) had negative blood cultures, and 26 (28%) had no cardiovascular symptoms or immunologic findings. Echocardiography was of limited value: its sensitivity was 56% for native valve endocarditis and 33% for prosthetic valve endocarditis. The ratio of affected valves was 5 aortic:4 mitral: 1 tricuspid in both forms of the disease. Viridans streptococcus was isolated in 23 (25%) of the confirmed cases, Enterococcus faecalis in 17 (18%), Staphylococcus aureus in 13 (14%), and coagulase-negative staphylococcus in 14 (15%). Gram-negative, anaerobic, and fungal organisms accounted for only 13 (14%) of the confirmed cases. The mean duration of intravenous therapy was 29 days. Twenty (37%) of the native valve patients and 16 (40%) of the prosthetic valve patients received antibiotics on an outpatient basis. Vancomycin was used in 44 (47%) of the cases, nafcillin or ampicillin in 40 (44%), and other beta-lactam agents in 9 (10%). The mean hospital stay was significantly longer for prosthetic valve endocarditis patients than for those with native valve disease (29 versus 23 days; p < 0.01). Cardiac catheterization was performed in 9 native valve patients (17%) and 6 prosthetic valve patients (15%). Valve surgery was performed in 33 native valve patients (61%) and 22 prosthetic valve patients (55%). Failure, defined as in-hospital death or recurrent endocarditis, accounted for 14 (28%) of the native valve cases (17% death and 11% relapse) and 8 (20%) of the prosthetic valve cases (10% death and 10% relapse), for an overall failure rate of 24%. The rate of failure was independent of the infecting pathogen or the type of antimicrobial therapy applied. Our experience verified that, in many patients with significant underlying risk factors, the diagnosis of endocarditis may be made on an empiric basis.

Bifidobacterium longum NCC3001 inhibits AH neuron excitability.

BACKGROUND: Bifidobacterium longum (B. longum) NCC3001 can affect behavior and brain biochemistry, but identification of the cellular targets needs further investigation. Our hypothesis was that the communication with the brain might start with action on enteric sensory neurons. METHODS: Ileal segments from adult mice were used to create a longitudinal muscle-myenteric-plexus preparation to expose sensory after-hyperpolarizing (AH) neurons in the myenteric plexus to allow access with microelectrodes. The intrinsic excitability of AH neurons was tested in response to the perfusion of conditioned media (B. longum culture supernatant) or unconditioned media (growth medium, MRS). KEY RESULTS: B. longum conditioned medium significantly reduced the excitability of AH neurons compared to perfusion with the unconditioned medium. Specifically, a reduction was seen in the number of action potentials fired per depolarizing test pulse, the instantaneous and time-dependent input resistances and the magnitude of the hyperpolarization-activated cationic current (Ih ). CONCLUSIONS & INFERENCES: The probiotic B. longum reduces excitability of AH sensory neurons likely via opening of potassium channels and closing of hyperpolarization-activated cation channels.

The anxiolytic effect of Bifidobacterium longum NCC3001 involves vagal pathways for gut-brain communication.

BACKGROUND: The probiotic Bifidobacterium longum NCC3001 normalizes anxiety-like behavior and hippocampal brain derived neurotrophic factor (BDNF) in mice with infectious colitis. Using a model of chemical colitis we test whether the anxiolytic effect of B. longum involves vagal integrity, and changes in neural cell function. Methods Mice received dextran sodium sulfate (DSS, 3%) in drinking water during three 1-week cycles. Bifidobacterium longum or placebo were gavaged daily during the last cycle. Some mice underwent subdiaphragmatic vagotomy. Behavior was assessed by step-down test, inflammation by myeloperoxidase (MPO) activity and histology. BDNF mRNA was measured in neuroblastoma SH-SY5Y cells after incubation with sera from B. longum- or placebo-treated mice. The effect of B. longum on myenteric neuron excitability was measured using intracellular microelectrodes. KEY RESULTS: Chronic colitis was associated with anxiety-like behavior, which was absent in previously vagotomized mice. B. longum normalized behavior but had no effect on MPO activity or histological scores. Its anxiolytic effect was absent in mice with established anxiety that were vagotomized before the third DSS cycle. B. longum metabolites did not affect BDNF mRNA expression in SH-SY5Y cells but decreased excitability of enteric neurons. CONCLUSIONS & INFERENCES: In this colitis model, anxiety-like behavior is vagally mediated. The anxiolytic effect of B. longum requires vagal integrity but does not involve gut immuno-modulation or production of BDNF by neuronal cells. As B. longum decreases excitability of enteric neurons, it may signal to the central nervous system by activating vagal pathways at the level of the enteric nervous system.

Increased levels of IL-10, IL-12, and IFN- in patients with visceral leishmaniasis.

Visceral leishmaniasis remains a serious public health problem in developing countries. Cytokines have a crucial role in the pathogenesis of this disease. We evaluated plasma levels of IL-10, IL-12 and IFN- in 32 patients with active visceral lieshmaniasis, in 29 siblings of the patients and in 23 normal individuals in an endemic area to look for correlations between the clinical outcome of infection and the plasma cytokine levels. An analysis was made with a skin test and a quantitative sandwich enzyme immunoassay. Data were analyzed with the Mann Whitney test and the Kruskal Wallis test. The cytokine levels were significantly higher in the patients than in the control groups. We concluded that normalization of the plasma level of IFN- can serve as a reliable parameter for considering the patient as cured.

Basic concepts in meta-analysis: A primer for clinicians.

With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.

Increased levels of IL-10, IL-12, and IFN- in patients with visceral leishmaniasis

Visceral leishmaniasis remains a serious public health problem in developing countries. Cytokines have a crucial role in the pathogenesis of this disease. We evaluated plasma levels of IL-10, IL-12 and IFN- in 32 patients with active visceral lieshmaniasis, in 29 siblings of the patients and in 23 normal individuals in an endemic area to look for correlations between the clinical outcome of infection and the plasma cytokine levels. An analysis was made with a skin test and a quantitative sandwich enzyme immunoassay. Data were analyzed with the Mann Whitney test and the Kruskal Wallis test. The cytokine levels were significantly higher in the patients than in the control groups. We concluded that normalization of the plasma level of IFN- can serve as a reliable parameter for considering the patient as cured.