Treatment Failure in Cutaneous Leishmaniasis Patients Referred to the School of Public Health, Tehran University of Medical Sciences During 2008-2017

Background: Cutaneous leishmaniasis (CL) is a vector borne disease predominantly found in tropical and subtropical countries, including Iran. For more than 6 decades, pentavalent antimonials have been used successfully worldwide for the treatment of leishmaniasis, but over the past few years, clinical resistance to these medications has increased. In this study, we evaluated CL patients who did not show any desirable responses to the anti-leishmanial treatment within a 10-year period (2008 to 2017). Methods: All patients from different parts of Iran suspected of having cutaneous leishmaniasis, who were referred to the laboratory of leishmaniosis in Tehran University of Medical Sciences from 2008-2017 were parasitological examined. Results: During this period, a total of 1480 suspected CL patients were referred to the laboratory of leishmaniosis. Samples from 655 patients (70.8) suspected of having CL were positive microscopically. The failure rate in patients treated with anti-leishmaniasis medications for a minimum of three complete treatment periods was 1.83 (12 cases). There was no association between the number and size of skin lesions and patient characteristics. Also, the route of drug administration had no significant effect on the number and size of lesions. Conclusion: In the present study, treatment failure was found in some confirmed CL patients treated with meglumine antimoniate. Over the past few years, it seems that had been increased in resistance to these medications. So, a review of the correct implementation of the treatment protocol and/or a combination therapy may be helpful in preventing an increase in the rate of treatment failure

Do bright-light shock exposures during breaks reduce subjective sleepiness in night workers?

Night work has many harmful effects on the health, efficiency and safety of workers. This study evaluates the effects of bright-light exposure (BL) on subjective sleepiness during night work. Ninety night workers who have more than a year's experience at a metallurgy production plant volunteered to participate in this clinical pilot study. Workers were divided into two groups and every group was exposed to either bright light (2500-3000 lux) or normal light (300 lux) during break times at night for two consecutive nights. Fifteen-minute breaks were initiated at 22.00 h (before starting work) 24.00 h, 02.00 h and 04.00 h. The range of subjective sleepiness was assessed by the Stanford Sleepiness Scale (SSS) at 23.00 h, 01.00 h, 03.00 h and 05.00 h. We used SPSS 11.5 for data analysis. The result demonstrated that there were significant differences in the rate of sleepiness between the two groups by paired t-test analysis (P < 0.001). These findings suggest that photic stimulation in industrial settings could increase adaptation to night work

Twenty four Hours Circadian Cortisol Profile in Shift Work Nurses

ABSTRACT: Introduction & Objective: It is well established that adrenal hormone cortisol has long been used in human psychobiological studies as a biological marker of circadian rhythm, stress, and anxiety. There is little information, however, about the interrelationships of night work, plasma cortisol levels in females’ nurses of the developing countries. The aim of the present study was to compare circadian cortisol profile between two groups of nurses with shift and permanent work in a Hospital affiliated to Shiraz University of Medical Sciences, Iran, between January 2006 to September 2008. Materials & Methods: In this experimental study, we examined the reproducibility of plasma cortisol levels during one month period in 34 shift work nurses and 10 permanent day shift works. We evaluated potential associations between night work and hormone levels, using current and shift work information for the health care shift workers. Results: The results clearly revealed that shift work significantly increased nighttime cortisol levels (34.93 μg/dl) during night shift and decreased the peak levels of cortisol in the morning (39.03 μg/dl). During the work shift the plasma cortisol presented a decreased concentration in the morning and increasing levels (44.93 μg/dl) by the end of the evening. In contrast , the permanent day work nurses, who had never worked at night shifts, showed a lowest secretion of cortisol during the first half of night time sleep (10.02 μg/dl ), and a peak value of the cortisol after awakening at 07:00 h ( 59.75 μg/ml). We also observed a significant association between night work and increased levels of cortisol over the remaining of the day. Conclusion: It can be concluded that nurses with night shift work have an abnormal cortisol secretion profile. Shift work nurses on rotating night shifts seem to experience changes in hormones levels that may be associated with increased of circadian disorders risk observed among night – shift workers

The Effect of Bright Light on Physiological Circadian Rhythms and Subjective Alertness of Shift Work Nurses in Iran

In this study, the effects of bright light (BL) on the rhythms in body temperature, plasma melatonin, plasma cortisol and subjective alertness, in 34 shift work nurses at a university hospital were assessed. They were exposed to very BL (4 500 lx) during 2 breaks (21:15–22:00 and 3:15–4:00) or dim light (300 lx). The subjects were studied under 24 h of realistic conditions during which their plasma cortisol and melatonin were measured at 3-h intervals; their body temperature was also measured during and after night shift work. Subjective alertness was evaluated with the Karolinska sleepiness scale. Administration of BL significantly suppressed night-time melatonin levels. A one-way ANOVA revealed that BL tended to increase cortisol levels and body temperature and significantly improved alertness. These results demonstrate that photic stimulation in a hospital setting can have a powerful influence on the adjustment of the circadian system

A comparative evaluation of regulatory T cells profile among acute and chronic cutaneous leishmaniasis using flow cytometry

Background: Cutaneous leishmaniasis (CL) is described as a major health problem in many countries of the world. Regulatory T cells (Tregs) are characterized as one of immunologic indexes. One of the best methods to determine of Tregs percentage is flow cytometry. The aim of this study was determination of the role of Tregs profile among acute and chronic forms of human CL using flow cytometry analysis. Methods: This study was conducted on 24 patients referred to Laboratory of Leishmaniasis, Tehran University of Medical Sciences, Tehran, Iran with acute and 14 patients with chronic phases of CL as well as 15 healthy individuals as control group in 2015-2016. After microscopic examination, 2 ml of peripheral blood samples were collected for determining percentage of CD4 + CD25+ CD127 low Tregs by using flow cytometry method. Results: Using flow cytometry analysis, the average percentage of Tregs were calculated 5.73, 6.71 and 6.61 for acute, chronic and healthy individuals, respectively. With SPSS software and Scheffe multiple comparison tests, the differences within in these groups are statistically significant (P=0.04) and between the acute and chronic group, there was marginally significant with approximately 91 of confidence level (P=0.088). Conclusion: Marginally differences were found significantly among averages of Regulatory T cells, acute and chronic phases of CL. Further comprehensive studies can be needed to verify the role of Tregs in both phases of CL cases. © 2019, Tehran University of Medical Sciences (TUMS). All rights reserved