Background: Cutaneous leishmaniasis (CL) continues to be an increasing public health problem in Iran. The dominant etiologic agents of CL in the Old World are Leishmania major and Leishmania tropica. One of the important endemic foci of CL in Iran is Yazd. Recently, previous studies showed the equal prevalence of L. major and L. tropica as the agents of cutaneous leishmaniasis in this area. This prompted us to identify the genotype of L. major isolates obtained from patients with cutaneous leishmaniasis. Materials and Methods: After completing a clinical/epidemiologic data questionnaire for 218 patients with suspected skin lesions, scraping samples were collected, and each specimen was examined using both direct microscopy and molecular assay of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Results : Results showed that of the 218 samples, Leishman body was observed in 77 by direct smear and 104 by PCR assay. Molecular assay indicated 50 cases as L. major, 52 cases as L. tropica, and two cases as unknown. Molecular characterization of L. major isolates showed four patterns, named LmA1, LmA2, LmA3, and LmA4. Conclusion: Our study is the first report for molecular characterization of L. major from one of the important central province of Iran that could affect the control strategies in this field.

The purpose of this article is to provide an overview of the highly prevalent risk factors influencing growth and development among pre-school children in rural population of developing countries. A child's brain during the first 3 years of life is rapidly developing through generation of neurons, synaptogenesis, axonal, and dendric growth and synaptic pruning each of which build upon each other. Any interruption in this process, such as trauma, stress, under-nutrition or lack of nutrients can have long-term effects on the brain's structure and on the child's socio-emotional development. Children's development is essentially cumulative in nature and hence, the early years of life are the foundation for later development. A Med-line search was done to review relevant articles in English literature on evaluation of risk factors influencing child development. Data were constructed and issues were reviewed from there. Influences upon children's development tend to be specific in nature and developmental influences rarely operate in isolation from each other. Developmental risk factors tend to cluster together thereby, interventions designed to facilitate development must be multifocal in nature, integrating influences from different domains.

Background: Current treatment strategies of psoriasis are not completely satisfactorily. By inhibiting inflammatory cytokines, nicotinamide may enhance the effects of current topical treatments. We investigated whether the combination of topical calcipotriol and nicotinamide is more effective than calcipotriol alone in treatment of psoriasis. Materials and Methods: Adult patients with mild to moderate psoriasis were randomized to receive topical calcipotriol 0.005% and nicotinamide 4% in combination or calcipotriol 0.005% alone, twice daily for 12 weeks. Patients were visited by a dermatologist at baseline and then after the first and third month of therapy, and psoriasis severity was evaluated using the modified psoriasis area and severity index (PASI). Also, patient's satisfaction was evaluated at the end of the trial using a 10-point rating scale. Results: Sixty-five patients (35 males, mean age = 36.5 ± 8.5 years) completed the trial. Lesions on both sides were similar regarding baseline PASI score. At the end of the trial, PASI score was more reduced with calcipotriol+nicotinamide compared to calcipotriol alone (83.6 ± 7.9% vs. 77.8 ± 9.7%, P < 0.001). Patients were also more satisfied with the improvement of lesions with calcipotriol+nicotinamide compared with calcipotriol alone (P < 0.001). Side effects included mild erythema and pruritus (4.6%) and moderate burning and sensitivity to light (3.0%). Conclusions: Nicotinamide can enhance the efficacy of calcipotriol when used in combination for topical psoriasis treatment, and it may be a good adjuvant to the current treatment regimens of psoriasis.

Background: Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingment syndrome without rotator cuff complete tear. Materials and Methods: This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: Case group by 20 mg of sodium hyaluronate (Fermathron™) and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t-test. Results: In both groups mean VAS has decreased, but more significantly in case group (P < 0.001). Mean constant score was significantly higher in case group 12 weeks after last injection (P < 0.001). The constant score improved 12 weeks after the last injection in both groups with a significantly better result in case group (P < 0.001). Conclusion: Subacromial injections of sodium hyaluronate are effective in treating rotator cuff disease without complete tears.

Background: Nicotine replacement therapy (NRT) with gradual decreasing of nicotine is one of the smoking cessation methods. Muccoadhesive formulations are among the novel drug delivery systems that are available in the form of tablets and films, and can be used for NRT. Muccoadhesive nicotine tablets when placed in the upper gum will attach to the buccal mucosa and release nicotine content in a controlled manner. This will meet the immediate and long-term need of the individual to the nicotine, such that the person can decrease his/her dependency on smoking. ^[1] Materials and Methods: In this study, the tablets were prepared using different conventional bioadhesive polymers such as Hydroxypropyl Methycellulose (HPMC) 50cps, sodium carboxy methyl cellulose (NaCMC), and carbapol 934 (CP934) in singular or mixture form. Magnesium hydroxide were used as the pH increasing agent; magnesium stearate as the lubricant; and lactose as the excipiente. Nicotine hydrogen bitartrate, more stable than the liquid, was used in different formulations. Pharmaceutics characteristics such as adhesion degree and drug release rate were evaluated. Results: Increasing of HPMC 50cps in the formulations decrease speed release of nicotine. The carbapol in formulations beget slow releasing of nicotine. With increasing the percent of lactose, the rate of release in formulations was increased. Formulations, which have HPMC 50cps has best adhesiveness and the formulations contains carbapol had not suitable adhesiveness. Formulations contains NaCMC were very fast release and had not suitable adhesiveness. Conclusion: The formulation contains mixture of HPMC50cps and CP934 was the best because of suitable adhesiveness and minimum swing in release.

Background: We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor. Materials and Methods: Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R) during the first period and entonox and saline (group P) during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention. Results: In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline). However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia. Conclusion: Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n't make more parturient and neonatal side-effects.

Background: During the last decades there has been great attention paid to aflatoxins. They are highly toxic, immunosuppressive, mutagenic, teratogenic, and carcinogenic compounds. Aflatoxin M ₁ (AFM1), a hydroxylated metabolite of aflatoxin B ₁ (AFB1), is formed in the liver and excreted into the breast milk. It is considered to cause certain hygienic risks for infant health. The aim of this study was to evaluate the presence of the AFM1 in the breast milk using AFM1 in milk as a biomarker for exposure to aflatoxin B ₁ and determine the level of AFM1 contamination in the lactating mothers in Isfahan, Iran. Materials and Methods: This study was carried out on 80 lactating women randomly selected from two urban health centers. Mother's milk samples and information on food intake were collected from the participants using structured food-frequency questionnaire. Breast milk samples were tested for AFM1 by a competitive ELISA technique. Results: Our findings showed that only one sample was contaminated with AFM1 with concentrations of 6.8 ng/L. However, the AFM1 level in this sample was lower than the maximum tolerable limit (25 ng/L) accepted by the European Communities and Codex Alimentarius. Conclusion: Although the concentration of AFM1 in none of the samples was higher than the acceptable level, the presence of AFM1 in only one of them confirms the need for developing strategies to reduce exposure to aflatoxin in foods and to carry out biological monitoring of aflatoxins as a food quality control measure routinely.

Introduction: Haloperidol has an established role in nausea and vomiting prophylaxis and possible effects on multiple aspects of postoperative recovery including pain and sedation. The purpose of this study was to evaluate the effects of low-dose intraoperative intravenous haloperidol on quality of recovery (QoR) and pain control after general anesthesia and surgery. Methods: Ninety eight American Society of Anesthesiologists (ASA) physical status I-II patients undergoing elective general, gynecologic or orthopedic surgery under general anesthesia were enrolled. Participants were randomly allocated to receive either haloperidol 2 mg or sterile water intravenously after induction of anesthesia. All patients were given elastometric morphine patient-controlled analgesia (PCA) pump for pain control after the surgery. Post-operative QoR was evaluated within 20 min in the recovery room and 6 h post-operatively. Pain intensity and demand for additional analgesic was measured in the 6 ^th post-operative hour. Results: The QoR score in two measurements was not statistically different between the two groups. Haloperidol significantly reduced the nausea in the recovery. The visual analog scale pain score showed that the severity of pain in the haloperidol group was more than the placebo group (4.7 ± 2.4 vs. 3.8 ± 2.5, P = 0.05). Conclusion: Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.

Pulmonary arteriovenous fistula (PAVF) is a venous malformation that permits right to left shunting of blood, bypassing the pulmonary capillary bed. Often PAVFs are seen in association with hereditary conditions. On the other hand, isolated PAVFs are rare and asymptomatic. There have been few reports of isolated PAVF related complications. A patient was referred to us with dysarthria and diplopia and history of surgically-treated PAVF. Further evaluations revealed a stroke in thalamic region. We found an open PAVF in a case of thalamic stroke.

Background: Notch signaling is a key factor for angiogenesis in physiological and pathological condition and γ-secretase is the regulator of Notch signaling. The main goal of this study was to assess the effect of (N-[N-(3,5-Diflurophenaacetyl-L-alanyl)]-S-phenylglycine t-Butyl Ester) DAPT, a γ-secretase inhibitor, on serum angiogenic biomarkers, and tumor angiogenesis in control mice. Materials and Methods: Tumor was induced by inoculation of colon adenocarcinoma cells (CT26) in 12 male Balb/C mice. When tumors size is reached to a 350 ± 50 mm ³ , the animals were randomly divided into two groups: control and DAPT (n = 6/group). DAPT was injected subcutaneously 10 mg/kg/day. After 14 days, blood samples were taken and the tumors were harvested for immunohistochemical staining. Results: Administration of DAPT significantly increased serum nitric oxide concentration and reduced vascular endothelial growth factor receptors-1 (VEGFR1) concentration without changes on serum VEGF concentration. DAPT reduced tumor vascular density in control mice (280.6 ± 81 vs. 386 ± 59.9 CD31 positive cells/mm ² ), although, it was not statistically significant. Conclusion: It seems that γ-secretase inhibitors can be considered for treatment of disorders with abnormal angiogenesis such as tumor angiogenesis.