Abtin Shahlaee

Sucrose-induced analgesia in mice: role of nitric oxide and opioid receptor-mediated system.

Background: The mechanism of action of sweet substance-induced analgesia is thought to involve activation of the endogenous opioid system. The nitric oxide (NO) pathway has a pivotal role in pain modulation of analgesic compounds such as opioids. Objectives: We investigated the role of NO and the opioid receptor-mediated system in the analgesic effect of sucrose ingestion in mice. Materials and Methods: We evaluated the effect of intraperitoneal administration of 10 mg/kg of NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME) and 20 mg/kg of opioid receptor antagonist, naltrexone on the tail flick response in sucrose ingesting mice. Results: Sucrose ingestion for 12 days induced a statistically significant increase in the latency of tail flick response which was unmodified by L-NAME, but partially inhibited by naltrexone administration. Conclusions: Sucrose-induced nociception may be explained by facilitating the release of endogenous opioid peptides. Contrary to some previously studied pain models, the NO/cyclic guanosine monophosphate (cGMP) pathway had no role in thermal hyperalgesia in our study. We recommend further studies on the involvement of NO in other animals and pain models.

Clinical characteristics and medical management of Iranian patients with ankylosing spondylitis

Abstract Objectives. Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease with variable clinical expression. Ethnic, racial and geographical factors have been associated with disease occurrence and expression. We intended to describe the clinical characteristics and assess the disease severity and treatment status in Iranian AS patients. Methods. A total of 320 AS patients were assessed for demographic variables, clinical manifestations, human leukocyte antigen (HLA) status, disease severity, functional capacities, quality of life and treatment status. Results. A gender ratio of 3.8:1, an average age onset of 27 ± 7.3 and a mean diagnostic delay of 8 years were observed. Eleven percent had juvenile onset AS. Positive family history was higher than that observed in most other countries. Enthesitis was a very common finding involving more than two-thirds of our patients. Uveitis was the leading extra-articular manifestation. We found an HLA-B27 prevalence of 73% and four HLA-B27 subtypes. Disease activity was high and the functional status was poor as indicated by mean Bath AS Disease Activity, Functional and Metrology indices. Quality of life was considerably impaired in our patients. We found a low percentage of patients on biological medications and a relatively higher percentage on disease modifying anti-rheumatic drugs and corticosteroids. Conclusions. Our results demonstrate a broad characterization of Iranian AS patients providing a better understanding of this disease. A national multicenter registry would enable larger- scale prospective studies to be carried out further evaluating the disease burden on patients and society.

Sketched x-rays: Calcinosis universalis

Calcinosis universalis (CU) is a known complication of dermatomyositis manifesting as calcified nodules and plaques localized in subcutaneous tissue, fascial planes, tendons, or intramuscular regions. We report a case and image of CU in a 9-year-old boy diagnosed with juvenile dermatomyositis (JDM).

Mercury ingestion from a broken thermometer

A 3-year-old boy was presented to our emergency department after biting on a glass mercury thermometer. H©-is parents had removed the thermometer along with some glass particles immediately after realising the problem. There was no …

Nonhealing Ulcers: An Infectious Viewpoint

58-year-old woman residing in a rural area in southern Iran was admitted to the hospital with multiple nonhealing ulcers of 6 months’ duration on her right lower extremity. The lesions had started as small nonpruritic erythematous papules in the form of insect bites and developed graduallyoverthefollowingmonths,increasing in size and ulcerating into an open wound. The patient had no history of other symptoms, diseases, or use of medications. On physical examination the lesions consisted of 3 painless, nonpruritic, roughly circular ulcers with erythematous and indurated margins on the anterior aspect of the right shin and ankle (Figures 1-5), one of which was covered by a yellowish-brown crust (Figure 4). There was no lymphadenopathy. Routine laboratory test resultswerenormal.Askinbiopsywasobtained and sent for histopathological examination, whichconfirmedadiagnosisofcutaneousleishmaniasis with the presence of numerous leishmania bodies. The patient was treated with meglumine antimoniate (Glucantime). After cardiac consultation and assessment of renal function, Glucantime was administered at a dose of 20 mg/kg via 2 daily intramuscular injections for 20 days. Leishmania infections are characterized by a spectrum of clinical manifestations ranging from localized cutaneous leishmaniasis to disseminated visceral infection. The first sign of cutaneous infection is typically a small erythema developing after a variable prepatent period at the site of a sandfly bite. The erythema develops into a papule, then a nodule that progressively ulcerates over a period of 2 weeks to 6 months

A 2.5-Month-Old Infant With Refractory Vomiting and Failure to Thrive

Question: A 2.5-month-old infant was referred to our hospital owing to refractory vomiting, feeding intolerance, abdominal distention, and failure to thrive. He had passed meconium within the first 24 hours after birth. Vomiting first started on the second day of life, 15 minutes after feeding and persisted thereafter up to the day of admission. Vomiting occurred 10–12 times a day and primarily contained only ingested milk and gradually became bilious. There was no associated hematemesis, jaundice, or fever. On physical examination, the baby seemed dehydrated, malnourished, and pale. No obvious congenital anomalies were detected. Epigastric distention was present, but no mass or organomegaly was palpated. Hematologic parameters revealed anemia (hemoglobin, 7 g/dL); biochemical laboratory findings were within normal limits except for hypokalemia (2.6 mEq/L). Plain abdominal x-ray showed a distended stomach extending to the pelvic area (Figure A). Upper GI series further revealed a dilated stomach and proximal duodenum with contrast material present in the distal bowel (Figure B). Abdominal ultrasonography failed to show the level of obstruction owing to a distended gaseous stomach. After initial fluid resuscitation and correction of anemia and hypokalemia, the patient underwent laparotomy. What is the diagnosis? See the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. Acknowledgments: S.B.J. and A.S. contributed equally to this work and share first authorship.