Kamyar Ghabili

Sulfur mustard toxicity: History, chemistry, pharmacokinetics, and pharmacodynamics

Sulfur mustard (SM) and similar bifunctional agents have been used as chemical weapons for almost 100 years. Victims of high-dose exposure, both combatants and civilians, may die within hours or weeks, but low-dose exposure causes both acute injury to the eyes, skin, respiratory tract and other parts of the body, and chronic sequelae in these organs are often debilitating and have a serious impact on quality of life. Ever since they were first used in warfare in 1917, SM and other mustard agents have been the subjects of intensive research, and their chemistry, pharmacokinetics and mechanisms of toxic action are now fairly well understood. In the present article we review this knowledge and relate the molecular-biological basis of SM toxicity, as far as it has been elucidated, to the pathological effects on exposure victims.

Mustard gas toxicity: the acute and chronic pathological effects

Ever since it was first used in armed conflict, mustard gas (sulfur mustard, MG) has been known to cause a wide range of acute and chronic injuries to exposure victims. The earliest descriptions of these injuries were published during and in the immediate aftermath of the First World War, and a further series of accounts followed the Second World War. More recently, MG has been deployed in warfare in the Middle East and this resulted in large numbers of victims, whose conditions have been studied in detail at hospitals in the region. In this review, we bring together the older and more recent clinical studies on MG toxicity and summarize what is now known about the acute and chronic effects of the agent on the eyes, skin, respiratory tract and other physiological systems. In the majority of patients, the most clinically serious long‐term consequences of MG poisoning are on the respiratory system, but the effects on the skin and other systems also have a significant impact on quality of life. Aspects of the management of these patients are discussed. Copyright

Contributions of Medieval Islamic physicians to the history of tracheostomy.

Tracheostomy was first described by Greco-Roman physicians, including Paulus of Aegina. Medieval Islamic clinicians extended the Greco-Roman ideas with substantial contributions to the field of surgery, including tracheostomy. Although Al-Zahrawi (936–1013 CE) stated that he had not heard or read of any Islamic physicians having performed tracheostomy, there is evidence that many prominent Islamic surgeons did practice this lifesaving procedure during medieval times. Throughout the Islamic Golden Age, Muslim physicians advanced the practice of tracheostomy with many modifications of the procedure, instrumentation, and adjuvant medicinal prescriptions.

Polymorphisms in GDF9 and BMP15 Associated with Fertility and Ovulation Rate in Moghani and Ghezel Sheep in Iran

The genetic base of fertility and ovulation rate in Moghani and Ghezel sheep in northwestern Iran and northeastern Turkey is important because of their fat-tailed meat and carpet quality wool. The genes encoding bone morphogenetic (BM) protein 15 and growth differentiation (GD) factor 9, respectively BMP15 and GDF9 have been shown to affect female productivity in domesticated sheep. Recently, numerous investigations have been performed on a variety of breeds to determine the association between mutations in these genes and fertility. Thus, in this study, we assessed such mutations in the Moghani and Ghezel breeds using polymerase chain reaction (PCR)-based restriction fragment length polymorphism (RFLP) with appropriate enzymes. Our data were similar to those of the previous studies showing that the genotypes were heterozygous for GD (G -->A) and BM (C -->T) mutations. These heterozygous genotypes resulted in higher ovulation rates, illustrating that one copy of each of the BMP15 and GDF9 mutations had equivalent effects on the ovulation rate. We demonstrate for the first time that the BM variant may not be sufficient on its own for infertility. In addition, although the previous studies have shown no notable relationship between the GD variant, known as the non-effecting mutation and sterility, we report that this mutation has an important role in the Moghani and Ghezel breeds.

Discourse on pulse in medieval Persia—the Hidayat of Al-Akhawayni (?–983AD)

In a period of compilation, original observations and expansion (900-1100 A.D.), Persians described new clinical manifestations of the diseases and expanded the earlier knowledge of materia medica. In the epoch of the Arabic language domination in the scientific literature of this period, advent of medical authors to write in Farsi shined in the Persian principalities. Akhawayani Bokhari was by far the most outstanding scholar of the time who wrote one of the earliest pandects of medicine of the period, the Hidayat al-Mutallimin fi al-Tibb (Learners Guide to Medicine) in new Persian. The Hidayat is a relatively short and simplified digest of medicine at the time providing a glimpse of high level of medical education at the Samanid period (819-999). The present article is a translation of the sections of the Hidayat related to the pulse and its characters and conditions affecting the pulse in an attempt to increase our knowledge of the medicine, and particularly the pulse examination throughout the medieval era.

Sleep paralysis in medieval Persia - the Hidayat of Akhawayni (?-983 AD)

Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular.

Illicit methylphenidate use among Iranian medical students: prevalence and knowledge

Background: Methylphenidate, a medication prescribed for individuals suffering from attention-deficit/hyperactivity disorder, is increasingly being misused by students. Objective: The aims of this study were to evaluate the frequency of methylphenidate use among a group of Iranian medical students and to assess their knowledge of methylphenidate. Methods: Anonymous, self-administered questionnaires were completed by all medical students entering the university between 2000 and 2007. Results: Methylphenidate users’ mean knowledge score was higher than that of nonusers (15.83 ± 3.14 vs 13.66 ± 3.10, P = 0.008). Age, gender, and school year were positively correlated with knowledge score (P < 0.05). Data analysis demonstrated that 27 participants (8.7%) had taken methylphenidate at least once in their lifetime. The respondents believed that the most common motive for methylphenidate use among youths was that it aided concentration and therefore ability to study. Conclusion: This study indicates a relatively low level of knowledge about methylphenidate among Iranian medical students. More educational programs regarding the use of methylphenidate are required and should be focused on the student suppliers, clinicians, pharmacists, and medical students.

Unexplained pulmonary hypertension in peritoneal dialysis and hemodialysis patients

OBJECTIVES To compare the prevalence of unexplained pulmonary artery hypertension (PAH) in hemodialysis (HD) and peritoneal dialysis (PD) patients and to compare laboratory parameters between patients with unexplained PAH and those with normal pulmonary artery pressure (PAP). METHODS We retrospectively reviewed the medical records of 278 chronic HD and 145 chronic PD patients. Laboratory findings including hemoglobin, calcium, phosphorus, alkaline phosphatase, albumin, parathyroid hormone level, serum iron, total iron binding capacity, ferritin, creatinine and blood urea nitrogen were documented. The results of transthoracic Doppler echocardiography were used to determine the pulmonary artery pressure (PAP). PAH was defined as a systolic pulmonary artery pressure (SPAP) ≥35 mmHg. To rule out secondary PAH, patients with cardiac disease, pulmonary disease, collagen vascular disease, volume overload at the time of echocardiography and positive human immunodeficiency virus test were excluded. RESULTS Data from 34 patients in group HD and 32 individuals in group PD were analyzed. The median age of the study population was 57 (45-68) years. The median SPAP value in patients with PAH was 37.5 (35-45)mmHg. According to the echocardiographic findings, PAH was found in 14 (41.1%) patients of HD group and in 6 (18.7%) patients of PD group (P=0.04). The median serum iron and hemoglobin was significantly lower in patients with PAH compared to those in patients with normal PAP (P<0.05). CONCLUSION Unexplained PAH seems to be more frequent in patients undergoing HD than patients in PD group. Moreover, hemoglobin and serum iron levels are lower in patients with PAH compared to those in normal PAP group.

Do pediatric patients undergoing cardiac surgeries require larger-size cuffed endotracheal tubes? A prospective study

There is a controversy over using either smaller‐ or larger‐size endotracheal tubes (ETT) in children undergoing cardiac surgery, and some anesthesiologists prefer to use ETT sizes different from the formula‐based sizes. The aim of the present study was to compare proper‐size cuffed ETT in children undergoing cardiac vs noncardiac surgeries.

Ultrasonography in diagnosis of pulmonary hydatid cysts

methods are more reliable and less operator-dependent than ultrasound for the diagnosis of pulmonary hydatid cysts, the scarcity of these methods in developing countries is a major concern. Therefore, non-invasive and cost-effective imaging methods such as ultrasonography should not be overlooked for the diagnosis of pulmonary hydatid cysts. Accordingly, appropriate ultrasonographic criteria should be developed for more accurate and reliable diagnosis.