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Background and Aims: Hepatitis C virus (HCV) is an important infectious disease that imposes a significant burden on healthcare systems. Determining the prevalence of HCV genotypes in a area is essential for the successful implementation of HCV elimination programs and allocation of financial resources to direct-acting antiviral direct-acting antivirals (DAA) treatments against prevalent HCV genotypes. Accordingly, we conducted a registry-based cross-sectional cohort study to investigate the prevalence of HCV genotypes and factors associated with cirrhosis, fatty liver, and viral load in Kermanshah Province, Western Iran., Methods: Patients presenting to the Hepatitis Clinic of the Research Center for Infectious Diseases affiliated with Kermanshah University of Medical Sciences between 1999 and 2023 were enrolled in this study. Serum samples were collected to assess HCV genotypes and viral load. Additionally, demographic data and the status of cirrhosis and fatty liver were extracted from the registry system records throughout the study period., Results: Records of 828 patients with an average age of 40.38 ± 11.72 years (range: 11-80 years) were included in the study that 721 individuals were male, and 107 were female. The prevalence of fatty liver and cirrhosis was 30.3% and 12.9%, respectively. Four genotypes (1, 2, 3, and 4) and four subtypes (1a, 1b, 3a, and 3b) were identified, with subtype 3a (55.7%) being the most prevalent, followed by subtype 1a (34.3%). None of the variables including age, gender, viral load level, and genotypes 1 and 3 were associated with fatty liver or cirrhosis. However, age, gender, and genotype were correlated with the viral load ( p  ≤ 0.05)., Conclusion: The most common HCV subtypes in Kermanshah were 3a and 1a. Genotypes 2 and 4 were identified in one case each. Further studies on identifying HCV subtypes in different regions of the country are recommended to manage HCV infection and predict the prognosis., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Rodents are the largest group of mammals that adapt to different ecosystems and may act as the potential reservoirs of significant pathogens including gastrointestinal (GI) helminths. Rodent-borne parasitic pathogens have been and remain a great concern for animal and human health. The aim of this systematic review and meta-analysis is thus to clarify and better understand the pooled prevalence of GI helminthic infections and the associated risk factors in rodents in Iran. Multiple databases (PubMed, Scopus, Web of Science, Google Scholar, SID, Magiran and Irandoc) were searched for relevant literature published up to March 2022. A random-effects meta-analysis model was applied to estimate the pooled prevalence with 95 % confidence interval. Moreover, heterogeneity among studies was evaluated using the Cochran's Q test and the I 2 -statistic. Out of the 5438 publications searched, 28 articles (30 datasets) were ultimately eligible for inclusion in the study. Thus, 3649 captured rodents belonging to 6 families, 20 genera, and 35 species were examined for GI helminths in Iran. Then, 54 helminth species were identified in the present research, including 33 nematodes, 16 cestodes, 4 trematods, and 1 acanthocephalan. The prevalence rate of GI parasitic infections was 56 % (95 % CI: 50-63 %). Hymenolepis diminuta , Syphacia obvelata and Rodentolepis nana were the most common helminthic infections (13 %, 9 %, and 8 %, respectively). Moreover, 11 potential zoonotic helminths were found. There was no significant difference in pooled prevalence between male and female rodents (P = 0.40). Considering geographical areas, northern and eastern provinces had the highest prevalence of GI helminthic infections among rodents. The prevalence of GI worms in Iranian rodents was as high as 56 % with 11 zoonotic helminths. Therefore, it is suggested to observe the health of the environment, destroy the biological nests of rodents, avoid half-finished constructions, repair and improve streams and sidewalks, organize and collect garbage, and carry out biological and chemical control to handle the population of rodents. Increasing the awareness of local people about the harmful effects of rodents and the ways of transmission and prevention of rodent-borne intestinal worms transmitted to humans should be prioritized in health decisions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Introduction: Brucellosis is a common global zoonotic disease with a wide range of complex and nonspecific clinical manifestations that may lead to misdiagnosis and delayed treatment. Osteoarticular involvement is the most common complaint in brucellosis., Objective: This present study aims to describe the clinical and laboratory characteristics and treatment of brucellosis patients with arthritis and sacroiliitis., Methods: This retrospective descriptive study was performed on patients presenting to a teaching hospital in Kermanshah, Iran with a diagnosis of brucellosis from 2011 to 2019. The demographic and clinical characteristics, complications, laboratory findings, and treatment were recorded during the study period. Then, the difference in the collected data was investigated between brucellosis patients with and without arthritis or sacroiliitis., Results: Of 425 patients studied, 130 (30.58%) had osteoarticular involvement. Among them, 41 (9.64%) and 58 (13.6%) patients were diagnosed with arthritis and sacroiliitis, respectively. There were no significant demographic differences between patients with and without brucellar arthritis or sacroiliitis ( p  > 0.05). The patients with Brucella arthritis had a significantly higher frequency of arthralgia and radiculopathy ( p  ⩽ 0.05). Sacroiliitis was significantly more common in patients with arthralgia, neck pain, and low back pain, positive flexion-abduction-external rotation (FABER) test, radiculopathy, and vertebral tenderness compared to patients without sacroiliitis ( p  ⩽ 0.05), while fever and headache were significantly more common in patients without sacroiliitis ( p  ⩽ 0.05). The median Wright and 2-Mercapto Ethanol titers were higher in brucellosis patients with arthritis or sacroiliitis versus patients without arthritis or sacroiliitis, but the difference was not significant ( p  > 0.05). Synovial fluid had been analyzed in 20 cases. The mean white blood cell count, glucose, and protein level were 3461 ± 2.70 cells/mm 3 , 58.54 ± 31.43 mg/dL, and 8.6 ± 11.85 g/dL, respectively. In 80% of the subjects, neutrophil cells were predominant. There were no significant laboratory differences between patients with and without brucellar arthritis or sacroiliitis, except for a higher median platelet count in patients with arthritis and higher median levels of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) in patients with sacroiliitis. Most cases of arthritis and sacroiliitis were diagnosed with ultrasound (31.8%) and FABER test (79.3%), respectively., Conclusion: Arthritis and sacroiliitis were the two most important and common manifestations of brucellar osteoarthritis with a frequency of 9.64% and 13.6%, respectively. Any complaints of low back pain and radiculopathy as well as the presence of spondylitis in patients should raise suspicion of sacroiliitis. High levels of AST and ALP and a high platelet count may be associated with brucellar sacroiliitis and arthritis, respectively. The use of imaging methods such as MRI and bone scan seems necessary for the diagnosis of sacroiliitis., (© The Author(s), 2024.)

Introduction: Trichomonas vaginalis genome is among the largest genome size and coding capacities. Combinations of gene duplications, transposon, repeated sequences, and lateral gene transfers (LGTs) have contributed to the unexpected large genomic size and diversity. This study is aimed at investigating genomic exchange and seeking for presence of the CRISPR CAS system as one of the possible mechanisms for some level of genetic exchange. Material and Methods . In this comparative analysis, 398 publicly available Trichomonas vaginalis complete genomes were investigated for the presence of CRISPR CAS. Spacer sequences were also analyzed for their origin using BLAST., Results: We identified a CRISPR CAS (Cas3). CRISPR spacers are highly similar to transposable genetic elements such as viruses of protozoan parasites, especially megavirals, some transposons, and, interestingly, papillomavirus and HIV-1 in a few cases. Discussion . There is a striking similarity between the prokaryotes/Archaean CRISPR and what we find as eukaryotic CRISPR. About 5-10% of the 398 T. vaginalis possess a CRISPR structure., Conclusion: According to sequences and their organization, we assume that these repeated sequences and spacer, along with their mentioned features, could be the eukaryotic homolog of prokaryotes and Archaean CRISPR systems and may involve in a process similar to the CRISPR function., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Azra Kenarkoohi et al.)

I read with great interest the article by Islam et al. entitled "Helminth parasites among rodents in the Middle East countries: a systematic review and meta-analysis" published in Animals in December 2020 [...].

Background: Trichobilharzia regenti (T. regenti) is an avian schistosomatid fluke species that causes human cercarial dermatitis (HCD) in areas of aquaculture in northern Iran. Understanding the phylogenetic relationships and genetic diversity of this thread-like fluke will deepen our thoughtful of avian schistosomiasis epidemiology and lead to more effective HCD control in the region., Objectives: To determine the life cycle of nasal Trichobilharzia in aquatic birds as well as aquatic snails and also identify the haplotype diversity of the isolates in Mazandaran Province, northern Iran., Methods: In the present study, adult or egg of Trichobilharzia isolated from aquatic birds as well as schistosomes cercariae isolated from aquatic snails in Mazandaran Province, northern Iran, belonged to the authors' previous research, were examined. Molecular studies and phylogenetic analysis were carried out on these schistosomes samples., Results: The phylogenetic analysis of the ITS1 and COX1 genes in isolated schistosomes revealed that all samples belong to the T. regenti clade. Remarkably, based on phylogenetic results, these schistosomes samples from Anas platyrhynchos domesticus, A. platyrhynchos, Spatula clypeata and Lymnaea stagnalis grouped together with previously sequenced samples from Iran (Trichobilharzia cf. regenti). Unlike the phylogenetic tree and haplotype network of COX1 gene, ITS1 did not show distinct clusters., Conclusion: This study completed the puzzle of the disease in Mazandaran Province by isolating and genotyping furkocercariae from L. stagnalis that was consistent with the isolated new genotype from ducks. For the first time in Iran, this confirmed the potential role of L. stagnalis snails in the transmission of the disease., (© 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Neosporosis has been considered a cause of abortion in dairy and beef cattle worldwide. Rodents are reservoir hosts for several infectious diseases. It is necessary to determine the prevalence of Neospora caninum in rodents to improve the current understanding of the transmission dynamics of Neospora as well as its life cycle and risk of transmission to livestock. Therefore, the objective of the present study was to estimate the pooled global prevalence of N. caninum in different rodent species., Methods: Published studies on the prevalence of N. caninum in different rodent species were searched in the MEDLINE/PubMed, ScienceDirect, Web of Science, Scopus and Google Scholar and the reference lists of the retrieved articles until July 30, 2022. The eligible studies were selected using inclusion and exclusion criteria. The extracted data were verified and analysed using the random-effect meta-analysis., Result: For this meta-analysis, a total of 4372 rodents from 26 eligible studies were included. The global prevalence of N. caninum in rodents was estimated at 5% (95% CI 2%-9%), with the highest prevalence in Asia (12%; 95% CI 6%-24%) and lowest prevalence in America (3%; 95% CI 1%-14%) and Europe (3%; 95% CI 1%-6%). N. caninum was more prevalent in females (4%; 95% CI 2%-9%) than in males (3%; 95% CI 1%-11%). The most common diagnostic test was polymerase chain reaction (PCR) (21 studies). The pooled prevalence of N. caninum in rodents based on the diagnostic method was as follows: immunohistochemistry: 11% (95% CI 6%-20%), NAT: 5% (95% CI 4%-7%), IFAT: 5% (95% CI 2%-13%) and PCR: 3% (95% CI 1%-9%)., Conclusion: The results of this study showed a relatively low but widespread prevalence of N. caninum infection in rodents., (© 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background and Aims: Cutaneous leishmaniasis (CL) is a severe parasitic disease affecting people, mostly in underdeveloped nations. As a zoonotic infection yearly incidence of CL depends on several parameters such as demographic, epidemiological, and environmental factors as well as prevention and control measures. The sudden outbreak of pandemics such as SARS-Corona-Virus-2 pandemic, can probably affect the incidence or reporting of other diseases, especially infectious diseases, in various ways such as pressure on health systems, providing sanitary services and its components, lockdowns and changes in people's living habits., Aim: This study aimed to evaluate the COVID-19 impact on the incidence and other epidemiological aspects as well as control measures of CL in Ilam Province-Iran., Methods: Required data was extracted from the CL registration system in Ilam from 2014 to 2021 to demonstrate the trend of CL incidence before and after COVID-19 pandemic., Results: Based on our results, a declining pattern of CL incidence was observed, accompanied by the advent and intensification of the viral pandemic in Iran and Ilam province. Although, this decreasing pattern was not integral in all areas, and even increase in CL detection was emphasized in some regions., Conclusion: It may be inferred that the COVID-19 pandemic may disrupt treatment programs of CL cases, rodent nest destruction, and fighting vector insects., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: Healthcare workers are at risk for HBV infection through percutaneous or mucosal contact with infected blood, body secretions, or blood products or via sharps injury. Hepatitis B vaccination, despite immunogenicity, may not induce a proper immune response in 5-10% of the general adult population. Increased immune response in healthcare providers that do not respond properly to conventional hepatitis B vaccination is an important health challenge. Therefore, the aim of the present study was to evaluate the effectiveness of hepatitis B vaccination plus oral levamisole as adjuvant in healthcare providers non-responsive to routine vaccination., Materials and Methods: The healthcare workers that were non-responsive to previous hepatitis B vaccination were enrolled in a double-blind randomized placebo-controlled clinical trial. The participants were then randomized to two groups including hepatitis B vaccination (as a three-dose series on a 0, 1, and 2-month schedule in the deltoid muscle) plus levamisole (levamisole group) and hepatitis B vaccination plus placebo (placebo group) at a 1:1 ratio. The outcome measure was the HBs antibody titer one month after receiving each dose as well as the seroprotection ratio. The side effects were also evaluated in all participants., Results: In total, 22 subjects finished the trial (11 individual in per group). The median antibody titer one month after receiving the first and third doses increased more in the levamisole group compared to the placebo group but the difference was not significant (p ​= ​0.34, p ​= ​0.66, respectively).The seroprotection ratio after three doses was similarly high in both groups (90.9% in per group). Furthermore, the seroprotection ratio and median antibody titer had no significant correlation with age, sex, BMI, and history of smoking in intervention and control groups (p>0.05). No serious side effects were noted in both groups., Conclusions: Re-vaccination can boost the immune response in healthcare professionals that were non-responsive to previous vaccination although the mean antibody titer was higher in the levamisole group., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Purpose: Neosporosis is an important widespread parasitic infection caused by N. caninum. It infects a wide range of warm-blooded animals as intermediate hosts and dogs as the definitive host. Nevertheless, there are a number of questions regarding the life cycle and epidemiological aspects of N. caninum. Also, the role of felids (domestic and non-domestic) in the life cycle of N. caninum has been little described. Therefore, this study was conducted to evaluate the global prevalence of N. caninum in domestic and wild felids., Methods: PubMed, Scopus, Google Scholar, Web of Science, and ScienceDirect databases were searched for articles published on the prevalence of N. caninum in felids until Aprill 2, 2022 and the reference lists of retrieved articles were screened. A random-effects meta-analysis model was used to estimate the pooled prevalence and 95% confidence interval. Heterogeneity among studies was evaluated using Cochran's Q and the I 2 statistic., Results: After exclusion of irrelevant articles and duplication removal, 30 studies were eligible for quantitative analysis including 20 studies on domestic cats and 10 studies on wild felids. The overall prevalence of neosporosis infection in cats was 15% (95% CI 10-21%) that was significantly higher in wild felids (26%, 95% CI 13-38%) than in domestic cats (11%, 95% CI 6-16%) (P = 0.03). There was no significant difference in pooled prevalence between male and female domestic cats (P = 0.75). Regarding continent, the lowest prevalence of neosporosis infection was in Asia (9%, 95% CI 1-20%) and the highest was in North America (43.6%, 95% CI 33.9-53.2%) and Africa (18%, 95% CI 9-46%). Higher prevalence was obtained when using the NAT with 22% (95% CI 7-37%), compared to the IFAT (17%, 95% CI 9-24%) and ELISA (6%, 95% CI 2-9%) (P = 0.01)., Conclusion: The findings highlighted the importance of felids as potential intermediate hosts of neosporosis despite the fact that the source of the parasite for these animals was unknown. Further studies should be performed to investigate the role of this top predator (felids) in maintaining both domestic and sylvatic cycles of Neospora caninum., (© 2023. The Author(s) under exclusive licence to Witold Stefański Institute of Parasitology, Polish Academy of Sciences.)

Background: Several markers have been described to characterise the population structure and genetic diversity of Fasciola species (Fasciola hepatica (F. hepatica) and Fasciola gigantica (F. gigantica). However, sequence analysis of a single genomic locus cannot provide sufficient resolution for the genetic diversity of the Fasciola parasite whose genomes are ∼1.3 GB in size., Objectives: To gain a better understanding of the gene diversity of Fasciola isolates from western Iran and to identify the most informative markers as candidates for epidemiological studies, five housekeeping genes were evaluated using a multilocus sequence typing (MLST) approach., Methods: MLST analysis was developed based on five genes (ND1, Pepck, Pold, Cyt b and HSP70) after genomic DNA extraction, amplification and sequencing. Nucleotide diversity and phylogeny analysis were conducted on both concatenated MLST loci and each individual locus. A median joining haplotype network was created to examine the haplotypes relationship among Fasciola isolates., Results: Thirty-three Fasciola isolates (19 F. hepatica and 14 F. gigantica) were included in the study. A total of 2971 bp was analysed for each isolate and 31 sequence types (STs) were identified among the 33 isolates (19 for F. hepatica and 14 for F. gigantica isolates). The STs produced 44 and 42 polymorphic sites and 17 and 14 haplotypes for F. hepatica and F. gigantica, respectively. Haplotype diversity was 0.982 ± 0.026 and 1.000 ± 0.027 and nucleotide diversity was 0.00200 and 0.00353 ± 0.00088 for F. hepatica and F. gigantica, respectively. There was a high degree of genetic diversity with a Simpson's index of diversity of 0.98 and 1 for F. hepatica and F. gigantica, respectively. While HSP70 and Pold haplotypes from Fasciola species were separated by one to three mutational steps, the haplotype networks of ND1 and Cyt b were more complex and numerous mutational steps were found, likely due to recombination., Conclusions: Although HSP70 and Pold genes from F. gigantica were invariant over the entire region of sequence coverage, MLST was useful for investigating the phylogenetic relationship of Fasciola species. The present study also provided insight into markers more suitable for phylogenetic studies and the genetic structure of Fasciola parasites., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of this infectious disease vary from a country to another and from one peak to the next. The aim of the present study was to describe the COVID-19 patients hospitalized in Kermanshah, a city in the west of Iran, in the third peak of the disease and to identify in-hospital mortality determinants in this disease. Methods: In this retrospective study, the clinical and demographic characteristics, laboratory findings, prescribed treatments and outcome of all COVID-19 patients (definitive, suspected, and probable) were collected from the medical records department of Farabi Hospital affiliated with Kermanshah University of Medical Sciences, Kermanshah, Iran from 22 October to 20 November 2020. Results: In total, 665 COVID-19 patients (265 females and 400 males, mean age: 58.7 years) were enrolled, including 479 confirmed, 15 probable, and 30 suspected cases. About 84% of the patients presented with low oxygen saturation levels. The most common comorbidities were hypertension (15%), diabetes (10%), and cardiovascular disease (3%). The median (IQR) length of hospital stay was 6 (Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021 (4., 5., 6., 7., 8.)) and 7 (Javadi Mamaghani et al., 2021; Abdolahnejad et al., 2022; Nojomi et al., 2021; Flores-Vega et al., 2022; Fattahi et al., 2021; Cusinato et al., 2022; Avatef Fazeli et al., 2021; Sayad et al., 2021; Hesni et al., 2022; Buttenschøn et al., 2022; Smits et al., 2022; Rosenberger et al., 2021; Shi et al., 2022 (2., 3., 4., 5., 6., 7., 8., 9., 10., 11., 12., 13., 14.)) day in discharged and deceased patients, respectively. Eighty-two out of 655 patients admitted to the hospital and 39of the 60 patients admitted to the ICU died. In total, in-hospital mortality rate was 12.33%. Regarding lab variables, in the adjusted model, no significant difference was observed between discharged and deceased patients.The results of multivariable logistic regression showed that each one-unit increase in oxygen saturation (SPO 2 ) increased the odds of survival by 0.88 times (aOR 0.88, 95% CI 0.78-0.99, p = 0.043). Moreover, each one-day increase in the length of ICU stay reduced the odds of mortality by 0.49 times (aOR 0.82, 95% CI 0.26-0.95, p = 0.035). Conclusion: Hospitalized COVID-19 patients were generally more ill during the third peak so that about 85% of the patients had SPO 2  ≤ 93%. The in-hospital mortality rate was also high. Demographic and paraclinical variables (except SPO 2 level) were not suitable predictors of mortality., (© 2023 Elsevier España, S.L.U. All rights reserved.)

Toxoplasma gondii is an obligate intracellular parasite that causes toxoplasmosis. It has been shown that the severity of symptoms depends on the functioning of the host immune system. Although T. gondii infection typically does not lead to severe disease in healthy people and after infection, it induces a stable immunity, but it can contribute to severe and even lethal Toxoplasmosis in immunocompromised individuals (AIDS, bone marrow transplant and neoplasia). The antigens that have been proposed to be used in vaccine candidate in various studies include surface antigens and secretory excretions that have been synthesized and evaluated in different studies. In some studies, secretory antigens play an important role in stimulating the host immune response. Various antigens such as SAG, GRA, ROP, ROM, and MAG have been from different strains of T. gondii have been synthesized and their protective effects have been evaluated in animal models in different vaccine platforms including recombinant antigens, nanoparticles, and DNA vaccine. Four bibliographic databases including Science Direct, PubMed Central (PMC), Scopus, and Google Scholar were searched for articles published up to 2020.The current review article focuses on recent studies on the use and usefulness of recombinant antigens, nanoparticles, and DNA vaccines., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: This study aimed to evaluate the implementation of the prevention of mother-to-child transmission (PMTCT) of the HIV-PMTCT program in Kermanshah, west of Iran, from 2014 to 2021., Methods: The data of all HIV-infected mothers and their infants who were monitored by the Kermanshah behavioral diseases counseling center was extracted and recorded in a checklist., Results: Out of 95 included infant, 45 (47.4%) were girls and 50 (52.6%) were boys. The mothers were mostly infected with HIV via their infected spouse. The pregnancies of 77 cases (82.1%) were in accordance with the national guideline. The average length of treatment for this group was 185 days. Of the 18 mothers who did not receive treatment, nine were diagnosed during childbirth and nine had no available information. All infants born from infected mothers underwent after-birth-antiretroviral prophylaxis, and all remained healthy. There was no statistically significant relationship between the birth weight and height of neonates with maternal age, maternal last viral load, disease stage, education, and maternal CD4 levels. Only a statistically significant relationship was observed between the duration of treatment and the infants' weight., Conclusion: The results suggest the feasibility and effectiveness of the PMTCT program for HIV-positive mothers in Kermanshah. It seems that if pregnant HIV-positive women are diagnosed early and covered by a good prevention program on time, the risk of HIV to their babies will be reduced, significantly., (© 2023. The Author(s).)

We aimed to present an alternate method instead of PCR-RFLP and also develop an optimized method for rapid, time-saving and affordable molecular-based approach to discriminate species of liver fluke, Fasciola hepatica and F. gigantica. Seventy-six samples of F. hepatica and 28 F. gigantica were collected from the slaughterhouses of endemic regions in Iran. Following a comprehensive analysis of the mitochondrial complete sequences of both F. hepatica and F. gigantica, the extracted DNAs from all samples were used as templates in multiplex PCR reactions containing two sets of primers specific for cytochrome c oxidase I (cox I) gene of both species. In a parallel experiment, PCR-RFLP was performed for each sample using internal transcribed spacer (ITS1) sequence. Furthermore, following a PCR amplification for cox I gene, the amplicons were purified for sequencing. To assess the validity of the multiplex PCR approach, the obtained data from the multiplex PCR and PCR-RFLP experiments were compared with each other. By sequence analysis of 104 samples, 76 and 28 samples were identified as F. hepatica and F. gigantica, respectively. Results revealed 100% and 92% of accuracy as for multiplex PCR and PCR-RFLP. The designed multiplex PCR strategy offers a valid alternative approach to the conventional methods with distinctive features including convenience, cost-effectiveness, time-saving (3 hours from sampling to obtain final results) and high efficacy.

Human infection with Enterobius vermicularis occurs worldwide, particularly in children. The role of E. vermicularis in appendicitis is neglected. This study was designed to investigate genotypes of E. vermicularis detected from appendectomy specimens in the human population from Iran and clarify the intra-species variation of the parasite. Seventy appendectomies for acute clinical appendicitis isolates from Azerbaijan and North Khorasan of Iran were used in the present study. The genetic information of Tehran and Hamedan regions was also obtained from GenBank for comparison and analysis. The nucleotide sequence of cytochrome c oxidase subunit 1 (cox1) gene was analyzed to perform genetic differentiation, haplotype network analysis, and population structure. Phylogenetic analysis of all the isolates were included in type B haplogroup. The number of haplotypes in all geographical locations of Iran is not much. Network analysis of sequences for regions such as Thailand, Iran, Denmark, and Poland show three classified subtypes B1, B2, and B3 in the B haplogroup. It seems that the haplotypes of E. vermicularis detected from appendectomy are B type, and divided into three subtypes. Further research using another genetic marker is required to elucidate the genetic variation of the parasites in detail., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Zoonotic visceral leishmaniasis (VL) is caused by Leishmania infantum, of which dogs are the main reservoir. VL is endemic in the Middle East, also in some parts of Iran. Following reports of new cases of VL in children in Maragheh County, the non-endemic area of the disease, we encouraged to conduct a preliminary study on domestic dogs and cats to identify their potential role as reservoirs for the disease., Materials and Methods: This study was conducted during a period of 3 years from 2018 to 2021. Two hundred ownership dogs and 25 cats from Maragheh County, north-west of Iran, were randomly screened. Blood samples were collected. A direct agglutination test (DAT) was used for the detection of anti-L. infantum antibodies. Furthermore, buffy coat samples from the L. infantum seropositive animals were examined to detect parasite presence using polymerase chain reaction., Results: Out of the total of 200 ownership dogs evaluated, 170 (85%) were male and 30 (15%) were female with a mean age of 4.3 years. Anti-L. infantum antibodies (IgG cut-off ≥ 1:320) were observed in 3.5% of dogs (7/200) by the DAT test. All seropositive dogs were identified in the first year of examination. Regarding molecular approaches in seropositive dogs, two samples were positive for a 565 bp kDNA minicircle gene specific for L. infantum. During the study period, no seropositive case was detected in the cats examined., Conclusions: This study shows that the domestic cycle of L. infantum has been established in the studied region. It is necessary to increase the awareness and monitoring of the disease with the study of wild reservoirs periodically., (© 2022 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: We aimed to detect the genetic diversity of samples identified morphologically as Fasciola spp. from sheep, cattle and goat from Lorestan Province, western Iran using PCR-RFLP method. Besides, we evaluated the genetic diversity indices, sequencing and phylogenetic analysis using mitochondrial gene ( ND1 and CO1 )., Methods: PCR-RFLP analysis of ribosomal ITS1 fragment by RsaI restriction enzyme to investigate the genetic characteristics of Fasciola species obtained from different hosts (18 sheep, 21 cattle, and 17goats) was conducted. The samples were sequenced. Sequences were evaluated using BLAST software and the parasite species were identified with similarity percentage and overlap with the species registered in the gene bank. Then similarity and diversity of intra-species and intra-species diversity of Fasciola species were calculated., Results: In Lorestan, based on RFLP pattern, 93% (52) of the Fasciola spp. isolates had a RFLP pattern related to F. hepatica and 7% (4) were F. gigantica . No hybrid forms were detected. The CO1 gene could clarify 19 haplotypes against ND1 gene that found 22 haplotypes among livestock. Sequencing results of the mtDNA showed intra-species identity 98. 5%-100% and Intra-species-diversity: 0-1.5% compared to the GenBank sequences., Conclusion: Using PCR-RFLP method, two species of F. hepatica and F. gigantica , were present in Lorestan Province, but F. hepatica was more prevalent. Mitochondrial genes could better test variability indices in different hosts than ribosomal genes, consequently among mitochondrial genes, the ND1 gene could better examine differences and similarities than CO1., Competing Interests: Conflict of Interest The authors declare there is no conflict of interest., (Copyright © 2022 Heydarian et al. Published by Tehran University of Medical Sciences.)

Background: Since the first official report of SARS-CoV-2 infection in Iran on 19 February 2020, our country has been one of the worst affected countries by the COVID-19 epidemic in the Middle East. In addition to demographic and clinical characteristics, the number of hospitalized cases and deaths is an important factor for evidence-based decision-making and disease control and preparing the healthcare system to face the future challenges of COVID-19. Therefore, this cohort study was conducted to determine the demographics, clinical characteristics, and outcomes of hospitalized COVID-19 patients in Kermanshah Province, west of Iran., Methods: This multicenter retrospective cohort study included all suspected, probable, and confirmed cases of COVID-19 hospitalized in Kermanshah Province, Iran during the first year of the COVID-19 pandemic. Demographics, clinical characteristics, outcomes and other additional information of hospitalized patients were collected from the COVID-19 database of the Medical Care Monitoring Center (MCMC) of Kermanshah Province., Results: Kermanshah Province experienced three waves of COVID-19 infection considering the hospitalization and mortality rates between February 20, 2020 and February 19, 2021. A total of 27,256 patients were included in the study: 5203 (19.09%) subjects were suspected, 9136(33.52%) were probable, and 12,917 (47.39%) were confirmed COVID-19 cases. The mean age of the patients was 53.34 ± 22.74 years and 14,648 (53.74%) were male. The median length of hospital stay among COVID-19 survivors and non-survivors patients were 4 (interquartile range [IQR] 1-6) and 4 (IQR 1-8) days, respectively. Among patients with COVID-19, 2646 (9.71%) died during hospitalization. A multivariable logistic regression revealed that odds of death among patients ≥ 85 years was significantly greater than among patients < 15 years (adjusted odds ratio [aOR] 4.79, 95% confidence interval [CI] = 3.43-6.71, p≤ 0.001). Patients with one (aOR 1.38, 95% CI 1.21-1.59, p = 0.04), two (aOR 1.56, 95% CI 1.27-1.92, p = 0.001) or more (aOR 1.50, 95% CI 1.04-2.17, p = 0.03) comorbidities had higher odds of in-hospital death compared to those without comorbidities. The male sex (aOR 1.20, 95% CI 1.07- 1.35, p = 0.002), ICU admission (aOR 4.35, 95% CI 3.80-4.97, p < 0.001), intubation (aOR 11.09, 95% CI 9.58-12.84, p < 0.001), respiratory distress (aOR 1.40, 95% CI 1.22-1.61, p < 0.001), loss of consciousness (aOR 1.81, 95% CI 1.45-2.25, p < 0.001), anorexia (aOR 1.36, 95% CI 1.09-1.70, p = 0.006) and peripheral oxygen saturation (SpO2) < 93(aOR 2.72, 95% CI 2.34-3.16, p < 0.001) on admission were associated with increased risk of death in patients with SARS-CoV-2 infection. Having cough (aOR 0.82, 95% CI 0.72-0.93, p = 0.003) and headache (aOR 0.70, 95% CI 0.50-0.97, p = 0.03) decreased the odds of death., Conclusion: The mortality rate of the patients admitted to the general wards and ICU can be a guide for allocating resources and making appropriate plans to provide better medical interventions during the COVID-19 pandemic. Several risk factors are associated with the in-hospital mortality of COVID-19, including advanced age, male sex, ICU admission, intubation, having comorbidity, SpO2 < 93, respiratory distress, loss of consciousness, headache, anorexia, and cough. These risk factors could help clinicians identify patients at high risk for death., (© 2022. The Author(s).)

Background: Emergency medical centers are globally one of the most important pillars of pre-hospital care. The most important purpose of this system is to provide satisfactory services in the shortest possible time and in accordance with the modern scientific standards of the world. The present study aimed to compare the effect of virtual and face-to-face training methods on the quality of service provided by Kermanshah pre-hospital emergency personnel, Iran., Methods: This was a randomized educational intervention trial performed among the staff of Kermanshah Emergency Medical Center. Individuals were randomly divided into two training groups of virtual and face-to-face. Participants in the face-to-face group received slides, lectures, and practical work with moulage for 6 h a day. Subjects were taught the four skills of intubation, laryngeal mask airway (LMA), cardiopulmonary resuscitation (CPR) and attenuated electrical device (AED). Participants in the virtual group received the same content in the form of a training video on CD with a full explanation of the project's objectives. Pre- and post-test scores of participants were compared within and between the groups by Stata 14.0 software., Results: Eighty-seven individuals were participated in the study, 43 of whom were assigned to the face-to-face training group and 44 to the virtual training group. There was no significant difference between the two groups in terms of work experience and educational level (P > 0.05). Post-training scores in both groups were significantly higher than pre-training in the four skills (P ≤ 0.005). After adjusting for educational level and work experience, however, the quality of CPR, intubation, and AED was higher in the face-to-face training group than in the virtual group. However, the increase in the mean score of LMA in the virtual training was not significantly different than that of the face-to-face training group., Conclusion: The results of our study showed the same efficacy of both face-to-face and virtual methods in improving the performance of personnel in tracheal intubation, LMA, CPR and AED shock skills. E-learning methods can be used as a complement to face-to-face methods in education., (© 2022. The Author(s).)

Background: We aimed to evaluate the rate of infection by endoparasites amongst rodents in the western regions of Iran to enhance the level of knowledge amongst health authorities in this entity., Methods: This study was conducted in the west and southwest of Kurdistan Province, including the cities of Sanandaj, Marivan, and Sarvabad. The field mission of this work was performed in three seasons' spring, summer, and autumn. The rodents were captured alive and their gastrointestinal tracts were evaluated for the worm endoparasites., Results: Herein, 208 rodents from 15 types of seven species, including Apodemus , Meriones , Mus , Sciurus , Cricetulus , Microtus , and Dryomys , were captured. In addition, 67 (32.21%) rodents were infected with endoparasites and 10 types of worms endoparasites, including Syphacia muris , Streptophagus spp., Mastophorus muris , Skrjabinema spp., Trichostrongylus spp., Trichuris muris , Hymenolepis nana, Hymenolepis dimimuta , Heligmosomoide spp ., and other oxiuros were isolated from their gastrointestinal tracts. Most of these parasites (60%) were isolated from their small intestine whereas they were least (10%) found in their stomach and cecum., Conclusion: Having compared the results of this study with other studies in different regions of Iran, there is a higher variety of rodents and worm parasites in these regions of Iran., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Mohammadi et al. Published by Tehran University of Medical Sciences.)

Background: COVID-19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino-orbital mucormycosis in patients with COVID-19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID-19 associated with mucormycosis infection., Methods: The medical records of COVID-19 patients with rhino-orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics., Results: Twelve patients with COVID-19-associated rhino-orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID-19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy-five per cent of patients received corticosteroids for COVID- 19 treatment. The sites of involvement were rhino-sino-orbital (83%) and rhino-sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first-line therapy. The overall mortality rate was 66.7% (8/12)., Conclusions: We found a high incidence of mucormycosis among COVID-19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life-threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed., (© 2021 Wiley-VCH GmbH.)

Leishmaniasis is a zoonotic infectious disease caused by Leishmania species. The identification of parasite species and the type of disease is beneficial for treatment and preventive modalities. Leishmania tropica and L. major have been reported as the main etiological agents of cutaneous leishmaniasis (CL) in Iran. The incidence of zoonotic CL has increased and different in distinct loci of Iran. Hence, we perused the Leishmania species and its genetic traits in the North East of Iran. The investigation was conducted on 200 positive smears prepared from patients' lesions suffering from CL referred to the health care centers of northeastern provinces in Iran from 2013 to 2019. The obtained positive microscopy samples were divided to score the ranges from + 1 to + 6, of them 40 smears exhibited low-parasitemia. Leishmania species analyzed using PCR-RFLP, genetic diversity indices evaluation, phylogenetic analysis, and sequencing comparison with other species in the GeneBank based on ITS1 gene. The isolated L. major strains were similar to other Iranian isolates in this region. Pairwise fixation index (F ST ) index was statistically significant in different L. major populations and showed the genetic differences in pairwise population of different geographical locations of Iran. The current study confirmed an old pattern endemicity of zoonotic CL in North-east of Iran. Therefore, in order to assess the hybrid formation, more epidemiological, ecological, and gene polymorphism studies are needed to understand the pathogenic role of Leishmania species in Iran., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interest., (© Indian Society for Parasitology 2021.)

Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the COVID-19 pandemic. The majority of patients experience asymptomatic to mild self-limited disease, but some cases progress to respiratory and multi-organ failure. However, so far, no approved antiviral therapy has been available for treatment of COVID-19. Sofosbuvir/velpatasvir (SOF/VEL) is an approved anti-HCV drug that is capable of suppressing other families of positive-sense RNA viruses with conserved polymerase and may be effective against SARS-CoV-2. This study was conducted to evaluate the efficacy of the SOF/VEL combination in addition to the national standard of care versus the national standard of care alone (hydroxychloroquine and lopinavir/ritonavir as well as supportive care) in patients with moderate to severe COVID-19 infection., Methods: This single-centre, randomized, open-labelled, prospective clinical trial was done in patients with moderate to severe COVID-19 admitted to Farabi Hospital in Kermanshah Province, Iran. Eligible patients were randomly assigned in a 1:1 ratio to the SOF/VEL arm (SOF/VEL plus the national standard of care) or the control arm (the national standard of care alone). The main outcome of the study was the mortality on Day 28 after randomization. Secondary outcomes were time from the start of medication to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and conversion of RT-PCR results from positive to negative from the time of randomization to discharge. Adverse events were evaluated in all patients who started their assigned treatment., Results: Between 11 April and 8 June 2020, 80 patients were recruited and randomly assigned into the SOF/VEL (n = 40) and control (n = 40) arms. The primary outcome was not significantly different between the two arms (P = 1.00). Secondary outcomes, including time to clinical improvement, hospital length of stay, need for mechanical ventilation, duration of mechanical ventilation and RT-PCR conversion, were not significantly different between arms either (P > 0.05). SOF/VEL treatment and the national standard of care were tolerated similarly., Conclusions: Although treatment with SOF/VEL was safe, adding SOF/VEL to the standard of care did not improve the clinical status or reduce mortality in patients with moderate to severe COVID-19. However, larger randomized clinical trials including more parameters are needed for accurate estimation of the efficacy of SOF/VEL., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Leishmania infantum is the main cause of human visceral leishmaniasis (HVL; also known as kala-azar) in the Middle East and may be fatal if left untreated. This disease was first reported in 1949 in Iran. Despite marked improvements in hygiene and sanitation conditions, the disease is still endemic in some parts of Iran. It is difficult to determine the current prevalence of HVL in Iran due to the scarcity of comprehensive studies in this regard. In response to this gap, a systematic review and meta-analysis was conducted to gain better understanding of HVL epidemiology in the general population of Iran. English and Persian databases were searched for studies reporting the prevalence and risk factors associated with HVL in the Iranian people from January 1995 to December 2019. The reported data were selected according to inclusion and exclusion criteria. The pooled prevalence of HVL infection and its 95 % confidence intervals were calculated. Quality assessment, heterogeneity testing and publication bias assessment were also done. Literature search revealed 3634 studies, of which 35 studies met our eligibility criteria, with a total of 50,716 individuals. The meta-analysis was performed on 31 out of 35 included studies. The estimated pooled prevalence of HVL infection according to seropositivity was 2% (95 % CI: 1-2%) in the general population of Iran in which western and northern provinces had the lowest and the highest prevalence, 0.5 % (95 %CI, 0.2-0.7%) and 3% (95 %CI, 1-5 %), respectively. The seroprevalence of HVL among females (2%; 95 %CI, 1-2 %) was more than males (1%; 95 %CI, 1-2 %). The ≤10 and >10 years age groups had similar seroprevalence rates (1%, 95 %CI, 1-2 % versus 1%, 95 %CI, 0-1 %, respectively). There was no significant difference in terms of geographic area, age and sex. Of 31 studies included in the meta-analysis, the most common diagnostic test was the direct agglutination test (96.77 %). To the best of our knowledge, this is the first systematic review of the prevalence of HVL in Iran. The results showed a low seroprevalence of HVL infection. However, the lack of published reports of HVL in an area does not exclusively mean the absence of the disease or carrier. We therefore recommend further studies in this regard., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

COVID-19 is a pandemic disease caused by novel corona virus, SARS-CoV-2, initially originated from China. In response to this serious life-threatening disease, designing and developing more accurate and sensitive tests are crucial. The aim of this study is designing a multi-epitope of spike and nucleocapsid antigens of COVID-19 virus by bioinformatics methods. The sequences of nucleotides obtained from the NCBI Nucleotide Database. Transmembrane structures of proteins were predicted by TMHMM Server and the prediction of signal peptide of proteins was performed by Signal P Server. B-cell epitopes' prediction was performed by the online prediction server of IEDB server. Beta turn structure of linear epitopes was also performed using the IEDB server. Conformational epitope prediction was performed using the CBTOPE and eventually, eight antigenic epitopes with high physicochemical properties were selected, and then, all eight epitopes were blasted using the NCBI website. The analyses revealed that α-helices, extended strands, β-turns, and random coils were 28.59%, 23.25%, 3.38%, and 44.78% for S protein, 21.24%, 16.71%, 6.92%, and 55.13% for N Protein, respectively. The S and N protein three-dimensional structure was predicted using the prediction I-TASSER server. In the current study, bioinformatics tools were used to design a multi-epitope peptide based on the type of antigen and its physiochemical properties and SVM method (Machine Learning) to design multi-epitopes that have a high avidity against SARS-CoV-2 antibodies to detect infections by COVID-19., Competing Interests: Conflict of interestAll authors declared there is no conflict of interest., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature 2021.)

Competing Interests: Conflict of interest The authors declare that there is no conflict of interest.

Introduction: Blastocystis is a common intestinal parasite of human and animal hosts. The parasite has 17 subtypes, and among those at least nine subtypes (ST1-ST9) are found in human hosts., Objective: The aim of the present study was to investigate the presence of different subtypes of Blastocystis spp. among the patients referred to Velayat hospital of Qazvin province, Iran., Methods: Overall, 864 stool samples were examined by using formalin-ethyl acetate concentration method and Trichrome staining. All specimens were cultured in clotted fetal bovine medium. Later, DNA extraction and PCR amplification of 18S ribosomal RNA gene region was conducted and phylogenetic tree constructed., Results: The results revealed 7.9% (68/864) of the study population were infected with Blastocystis . Intestinal symptoms were observed in 61% (36/59) of individuals positive for Blastocystis , with abdominal pain in 58% (21/36) of cases which was more frequent than other intestinal signs. No significant relationship was observed among the study variables. By molecular and phylogenetic analysis, three subtypes ST1 (45%), ST2 (30%) and ST3 (23%) of parasite were identified., Conclusion: This study showed ST1 subtype was the predominant subtype among the positive specimens, meanwhile the highest haplotype and nucleotide diversity were clarified in ST3 subtype., (© 2020 Delshad A et al.)

Introduction: Hospital wastewater contains highly resistant and virulent bacteria that can spread into the environment. This study was conducted to investigate the antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in raw and treated hospital wastewater., Methods: During a three-month period, 40 sewage samples were collected from the hospital sewage (Kermanshah, Iran), and S. aureus were identified using culture and biochemical tests. MRSA was detected by resistance to cefoxitin. Antibiotic resistance (AR) was determined using disk diffusion according to the Clinical and Laboratory Standards Institute (CLSI) in 20 MSSA (10 raw and 10 treated sewage) and 40 MRSA isolates (20 raw and 20 treated sewage). The antimicrobial resistance genes (ARGs) were determined by PCR., Results: Eleven and eight percent of the isolates were MRSA in raw and treated sewage samples, respectively. Out of 60 isolates, 59 (98%) were multidrug resistant (MDR). The most common ARGs were mecA (raw=100%, treated=100%), aacA-D (raw=100%, treated=85%) and tetK (raw =95%, treated =45%) in MRSA, while the tetM gene was the most abundant gene (raw=50%, treated=80%) in MSSA. None of isolates (n=60) was positive for the vanB gene. MSSR (n=20) had the highest level of resistance against penicillin (100%), clindamycin (raw=90%, treated=90%), azithromycin (raw=80%, treated=90%). All MRSA isolates (n=40,100%) in both raw and treated sewage samples were non-susceptible to penicillin, oxacillin and azithromycin. There was no significant difference in the frequency AR and ARGs between raw and treated sewage samples (p>0.05)., Conclusion: The results indicated a high frequency of MDR and ARGs in both raw and treated sewage isolates which could be released into the environment through sewage system and pose a serious threat to public health. Hospital wastewater treatment processes should be improved in order to prevent the dissemination of the most resistant strains of S. aureus ., Competing Interests: The authors declared no conflicts of interest in this work., (© 2020 Akya et al.)

Over the last decade, diagnostic tools to detect and differentiate Fasciola species have improved, but our understanding of the distribution of haplotypes and population structure of this parasite is less clear. This study was designed to survey this gap in the F. gigantica epidemiology in Kermanshah province, western Iran from 2015 to 2017. Sixty-eight Fasciola isolates were collected from slaughterhouses from this province. We evaluated the PCR-RFLP assay of the ITS1 genes for the identification of Fasciola species using the RsaI enzyme. After Fasciola species identification, the partial sequence of mitochondrial NADH dehydrogenase subunit 1 (ND1) gene of F. gigantica was used for subsequent construction of the phylogenetic tree and network analysis. Based on the PCR-PRFLP profile, one (6.25%) of sheep isolates and 19 (39.60%) of cattle isolates were detected as F. gigantica , whereas 93.75% of sheep isolates, 60.40% of cattle isolates and all of the goat isolates were F. hepatica . In the 20 analyzed flukes, five ND1 haplotypes were detected. Statistically significant genetic differentiation was demonstrated between the Iran population and all the other populations. Evidence is presented for the existence of two well-separated populations: African and West Asian gigantica flukes and East Asian gigantica flukes. Genetic relationships among haplotypes were associated with geographical divisions. Also, our results have heightened our knowledge about the genetic diversity of F. gigantic , providing the first evidence for the existence of two well-separated populations of this parasite., (© 2020 Urmia University. All rights reserved.)

Background/aim: Nonalcoholic fatty liver disease (NAFLD) is known to be the most prevalent chronic liver disease all over the world. The incidence of this disease has dramatically increased during the last decade. Studies have shown a strong relationship between the level of ferritin and the severity of NAFLD. The objective of the present study was to assess the effect of adding Hijamat, as an iron reducing procedure, to standard lifestyle modification on the improvement of insulin resistance and liver enzymes in patients with NAFLD., Materials and Methods: One hundred and twenty NAFLD patients participated in a randomized, controlled, single-blind trial design of study. The control group received counselling for nutrition and physical activity for a period of 6 months. The treatment group received the above items plus Hijamat for 3 times during 1 month. Ultrasound images of liver, HOMA-IR, and laboratory data including ALT, AST were assessed pre- and postintervention., Results: At the end of the study, a significant decrease was demonstrated in the serum level of HOMA-IR (–1.30 ± 0.88 vs –.02 ± 0.47, P < 0.001) and serum levels of ALT (–6.50 ± 4.92 vs –2.38 ± 3.92, P < 0.001) and AST (–2.78 ± 4.29 vs –1.30 ± 2.33, P = 0.021) in the Hijamat group were compared to the control group. Ultrasound images of the liver improved in 23.3% of the patients in the Hijamat group, while the rate of improvement in the control group was 10% (P = 0.050). Hijamat therapy was safe and tolerable in this trial., Conclusions: Hijamat resulted in a relative improvement in fatty liver severity and improved HOMA-IR and liver enzymes more than lifestyle modification alone in patients with NAFLD., Competing Interests: The authors declare that they have no conflict of interest., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

Background: Efforts to find a reliable non-molecular means of identification has been the main purpose of the current work that always is persuaded by researchers interested in the field of parasitology., Methods: Adult fasciolids were obtained from the slaughterhouses in different parts of Iran in 2017, and investigated using the classical old fashion morphological appearances of the worms implementing a camera lucida equipped microscope. Histological procedure was subsequently performed for almost the entire collected adult worms followed by Hematoxylin and Eosin (H&E) staining technique. DNA extraction and RFLP-PCR technique were carried out for the entire fasciolid liver flukes. To attain more comparable morphological conclusions, Scanning Electron Micrographs were also implemented for two molecularly identified fasciolids., Results: Based on spine morphology observed in worm's tissue sections two types of tegumental spines, "pointed" and "molar" shapes have been identified addressing to distinguish F. hepatica and F. gigantica species respectively. The present identification has been also supported by Molecular analysis using RFLP-PCR technique., Conclusion: There are some hidden morphological characters implemented in species identification for certain helminths. Meanwhile, the emergence of computer image analysis system (CIAS) on the scene of taxonomy, has revolutionized the accuracy of measurement in morphology by employing detailed parameters that have not been regarded before. The current study has illustrated the tegumental spines of two Fasciola species in tissue sections which has not been enough considered in helminthological publications so far., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © Iranian Public Health Association & Tehran University of Medical Sciences.)

Background: Our knowledge of the epidemiology of rodents' parasitic agents in Iran is scarce, although some of these pathogens play an important role in human and veterinary medicine, such as Toxoplasma gondii and Neospora caninum . The purpose of this study was to determine the seroprevalence of Toxoplasma gondii and Neospora caninum in rodents of northwestern Iran between Mar and Dec 2015., Methods: Overall, 157 serum samples from rodents (101 Meriones persicus , 41 Mus musculus , and 15 Cricetulus migratorius ) were assayed by the indirect fluorescence antibody test (IFAT) for antibodies to T. gondii and N. caninum ., Results: We found a prevalence of 20.38% (32/157) for N. caninum, 35% (55/157) for T. gondii . Co-presence of antibodies to N. caninum and T. gondii was found in 10 (6.36%) rodents. A significant association was found between the rodents species and seropositivity to N. caninum ( P <0.05) but there was no association with rodents species for T. gondii . The overall prevalence of the aforementioned parasites was higher in male versus female rodents., Conclusion: The high seroprevalence of toxoplasmosis and neosporosis in rodents in the study area has implications for translocation of these infections across wider geographical regions since these rodents are mostly preyed on by cats or dogs; hence, which can transfer the parasite to other hosts., Competing Interests: Conflicting interest The authors declare that they don’t have any conflict of interest, (Copyright© Iranian Society of Parasitology & Tehran University of Medical Sciences.)

Background: Human brucellosis is a multisystem disease with a wide range of clinical signs which often leads to misdiagnosis and treatment delay. Early diagnosis of this disease can prevent the serious complications and mismanagements. This study aimed to evaluate the hematological parameters with predictive value for the diagnosis of brucellosis., Methods: In this prospective case-control study which was done during 2015-2017 in Imam Reza Hospital, Kermanshah Province, west Iran, 100 patients with a confirmed diagnosis of brucellosis (brucellosis group) and 100 healthy individuals (control group) were studied. The hematological parameters, including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC) count, lymphocyte count, neutrophil count, platelet count (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of both groups were recorded. The data were statistically compared between the brucellosis and the control groups., Results: The mean age of patients and healthy groups was 44.04 ± 23.11 and 37.92 ± 24.80, respectively (P = 0.062). The WBC, CRP and neutrophil counts were significantly higher in the brucellosis group (P < 0.05). Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 54% and 66% for the WBC, 45% and 71% for the neutrophil and 65% and 72% for the CRP, respectively. There was no statistically significant difference between the two groups in terms of Hb, RBC, WBC, lymphocyte and platelet count, MPV, PDW and ESR (P > 0.05)., Conclusion: The results of this study indicate that WBC, CRP and neutrophil count can be used as valuable markers in the preliminary diagnosis of brucellosis. However, further researches are required to standardize these parameters for various forms of brucellosis., Competing Interests: The authors report no conflicts of interest in this work., (© 2020 Akya et al.)

Purpose: Mesalazine formulations are the drug of choice in the treatment of ulcerative colitis (UC). They are released at alkaline pH in order to deliver 5-aminosalicylic acid to the colon. The colonic pH is significantly lower in UC patients than in normal patients. This study was conducted for the first time to evaluate the clinical efficacy of co-administration of pantoprazole and Asacol in the treatment of ulcerative colitis patients who excrete intact Asacol tablets in the feces., Patients and Methods: Thirty patients with mild-to-moderate active ulcerative colitis who reported passing intact Asacol tablets in stools received oral Asacol plus pantoprazole for 2 weeks. The demographic characteristics of the patients and the body mass index were collected through interviews. For each patient, the stool frequency, visible blood, and presence of intact Asacol tablets in the stool were compared before and pantoprazole treatment., Results: There was a significant difference in the stool frequency (number of daily stools) before and after pantoprazole treatment (mean ± sd, 6.06 ± 1.04 vs 1.5± 0.5; P<0.001). In addition, pantoprazole administration statistically reduced visible blood in the stool (100%; P<0.001). Co-administration of pantoprazole and Asacol was effective in all age groups and both sexes. None of the patients reported the presence of intact Asacol tablets in their stools., Conclusions: Co-administration of pantoprazole and Asacol would be useful for symptom management UC patients that excrete intact Asacol tablets in their feces through increasing the gastric pH and releasing the maximum concentration of the drug in the proximal gastrointestinal tract., Competing Interests: The authors declared no conflicts of interest in this work., (© 2020 Bashiri and Bozorgomid.)

Fasciolosis is a zoonotic disease caused by Fasciola hepatica and Fasciola gigantica. Over the last decade, diagnostic tools to detect and differentiate Fasciola species have improved, but our knowledge of the distribution of haplotypes and gene flow of this parasite is not comprehensive yet. The purpose of this study was to investigate this gap in the epidemiology of F. hepatica in different provinces of Iran between 2015 and 2017. Isolated Fasciola were collected from abattoirs in 9 provinces. The partial sequence of mitochondrial NADH dehydrogenase subunit 1 (ND1) gene was used for the identification and molecular analysis of F. hepatica isolates. The amplified PCR products were purified and subjected to direct sequencing for subsequent construction of phylogenetic tree and network analysis. In the 130 subjects analyzed, 37 ND1 haplotypes were detected. This is the first study in Iran which investigates F. hepatica population and its genetic structure, based on mitochondrial ND1 marker in different geographical regions of Iran., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: Rodents live in proximity to humans and domestic animals. These creatures can serve as reservoir hosts for many zoonotic parasites; therefore, they increase the risk of human infections. The aim of this study was to investigate Toxoplasma gondii and Neospora caninum in rodents caught in Meshgin-Shahr District, Iran., Patients and Methods: In a cross-sectional study, brain samples were collected from 70 rodents caught in Meshgin-Shahr District during March and December 2015. The specimens were examined for exposure to T. gondii and N. caninum with molecular methods., Results: Seventy rodents were caught, including 50 Meriones persicus , 11 Mus musculus and 9 Cricetulus migratorius . Thirty rodents were female and 40 were males. Using PCR (B1 gene), T. gondii was detected in 7.1% (5/70) of the rodents while N. caninum was not detected. The prevalence of Toxoplasma infection was higher in female rodents (4.28%) compared to male rodents (2.86%), but the difference was not significant., Conclusion: The results showed a low risk of T. gondii and N. caninum among rodents. Finally, further research is needed to understand the role of these rodent species in the transmission of the above protozoan pathogens to humans and livestock in this area., Competing Interests: The authors report no conflicts of interest in this work., (© 2019 Nazari et al.)

Background: The human immunodeficiency virus ( HIV ) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of Pneumocystis jirovecii colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016., Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with Pneumocystis admitted to Behavioral Counseling Center of Kermanshah . Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment., Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22.8%) patients had Pneumocystis . All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9-186). The median CD4 count increased from 91 cells/mm 3 pre-trimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm 3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia., Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. jirovecii infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.)

Purpose: Mucosa-associated lymphoid tissue (MALT) is the most common endoscopic finding in Helicobacter pylori positive patients that can progress to MALT lymphoma after a prolonged antigenic contact. This study was aimed to evaluate the prevalence of lymphoid follicles and aggregates (precursors of MALT lymphomas) in gastric mucosal biopsies and their correlation with H. pylori infection., Patients and Methods: In this study, 100 patients who had undergone an upper gastrointestinal endoscopy were enrolled. Five biopsy specimens were taken each patient through screening endoscopy and histopathological changes were evaluated and graded using the Wotherspoon System. The clinical background and H. pylori infection status were also investigated., Results: Among the 100 cases in our series, 79 patients (79%) showed evidence of MALT in at least one biopsy specimen taken from the stomach and 21 cases (21%) had no evidence of MALT. H. pylori infection was detected in 74 (74%) patients. Lymphoid follicles were detected more frequently in H. pylori -positive patients (59%) compared to H. pylori -negative cases (3%) (P<0.001)., Conclusion: The frequency of lymphoid follicles and aggregates in gastric mucosal is associated with H. pylori infection. Further community-based studies in larger sample sizes using a combination of microscopic methods and PCR assay are required for effective monitoring of H. pylori infection., Competing Interests: The authors report no conflicts of interest in this work., (© 2019 Bashiri et al.)

Aim: The prevalence of cutaneous leishmaniasis (CL) is growing in Iran, and new sources of the disease have been found in the country. The purpose of this study was to describe the epidemiology of CL in Qasr-e Shirin County, Kermanshah Province, West of Iran. Qasr-e Shirin is located near the Iran-Iraq border, and several million pilgrims pass through this area to Iraq every year., Materials and Methods: A descriptive cross-sectional study was carried out for active case detection from April 1, 2014, to March 31, 2015. All individuals with suspicious lesions were identified through house-to-house visits in the aforementioned area. A questionnaire was filled out for everyone with clinical suspicion of CL. A diagnosis was made based on parasitological examination of the lesion exudate. The annual incidence and prevalence of CL were estimated., Results: In total, 5277 individuals were randomly screened for the presence of active lesions or scars suspected of CL. The overall prevalence of CL in the County was 4.8% (60 cases had active lesions and 194 cases had scars). All age groups were affected, but the highest incidence of CL was seen in the age group 20-29 years (1.9%). The incidence and prevalence were higher in women than men (5.5% vs. 4%). Most cases (45.6%) had a single lesion or scar and 44 (17.4%) patients had five or more lesions or scars., Conclusion: The incidence of CL in Qasr-e Shirin County is high. There is a need for further studies on reservoirs and vectors of leishmaniasis in this area. The results of such studies help to perform more efficient and timely spraying against phlebotomine sandfly or detect and decrease the animal reservoir population.

Background: The shortage of nurses is a global health problem and one of the main challenges for healthcare systems throughout the world including Iran. One of factors that affect the migration trends is psychological needs satisfaction. This study aimed at identifying the psychological factors which persuade Iranian nurses to migrate and suggesting necessary measures in this regard., Methods: This qualitative study was conducted through a traditional content analysis approach on 20 working Iranian nurses who are migrating to other countries between 2015 and 2017. Data were collected through interviews and observation in different wards of hospitals in Iran. Data were written and analyzed after reduction, naming them, obtaining analytical codes, and identifying the categories and subcategories using traditional method., Results: Three main categories in relation to satisfaction of the psychological needs and reasons for migration were obtained after data analysis. The first category was "authority" with two subcategories of independent decision-making power and being unconsidered, the second category was "social support" with three subcategories of communication with health team members, communication with nurse colleagues, and communication with nurse managers, and the third category was "job promotion" with four subcategories of addressing the routines, nurse role, job promotion opportunities, and teaching organizational environment., Conclusion: Identifying problems and obstacles to achieve the goal is the first step to solve the problem. This study provided further and clearer understanding of psychological causes regarding decision of nurses to migrate to developed countries, and nurses noted that the decision to migrate is in the search to meet their psychological needs., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests.

Background: We aimed to determine the prevalence of fasciolosis in the definitive hosts (human and livestock) and intermediate ( Lymnaea snails) hosts in Kermanshah Province, western Iran from 2014-2016., Methods: The study on animals was descriptive and retrospective one. All daily records of animals slaughtered in the abattoirs were analyzed. For the study of human fascioliasis, 975 serum samples were collected from different parts of Kermanshah Province and analyzed using ELISA based on excretory-secretory antigens. Moreover, 4400 Lymnaea snails were collected from 25 habitats. The snails were identified and examined for presence of cercariae by shedding method., Results: Fasciolosis was diagnosed in 1.7% of slaughtered animals, which was significantly greater than the other species ( P <0.005). There was significant difference ( P <0.001) between the prevalence of fasciolosis and seasonal pattern. As for human cases, five cases (0.5%) were positive for fascioliasis. Regarding the seropositivity to fasciolosis, no significant differences were found for age groups, sex, level of education and occupation. No Fasciola infection was seen in snails of the family Lymnaeidae., Conclusion: The prevalence of Fasciola parasite was lower compared to other provinces. This is probably due to sequential decline in rainfall and hot climate that makes conditions difficult for the snail intermediate host snails and the larval stages of fasciolid trematodes. The habitual food of people is another important point., Competing Interests: Conflict of Interest The authors declare that there is no conflict of interests.

Fascioliasis is a foodborne zoonotic disease caused by the two parasite species Fasciola hepatica and F. gigantica . In spite of the presence of both species of Fasciola in the livestock, to our knowledge, to date, no cases of human F. gigantica infection have been reported in Iran officially. Here, we report such a case in a 25 yr old woman referred to The Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2016. CT imaging and MRCP revealed an ill-defined lesion of segments of liver. Specific ELISA produced a positive result besides detecting egg of the parasite via stool exam. The identification of parasite species was performed by the DNA extracted from the eggs and sequencing ITS-1, in addition to comparison to GenBank retrieved sequences, using the BLAST search tool. The sample showed 100% identity with F. gigantica . She was treated for fasciolosis with a single dose of Egaten® 10 mg/kg with positive response. This is the first case of human fasciolosis due to F. gigantica reported in Iran., Competing Interests: Conflict of interest We have no conflict of interest related to this work.

Despite the broad distribution of leishmaniasis among Iranians and animals across the country, little is known about the genetic characteristics of the causative agents. Applying both HSP70 PCR-RFLP and sequence analyses, this study aimed to evaluate the genetic diversity and phylogenetic relationships among Leishmania spp. isolated from Iranian endemic foci and available reference strains. A total of 36 Leishmania isolates from almost all districts across the country were genetically analyzed for the HSP70 gene using both PCR-RFLP and sequence analysis. The original HSP70 gene sequences were aligned along with homologous Leishmania sequences retrieved from NCBI, and subjected to the phylogenetic analysis. Basic parameters of genetic diversity were also estimated. The HSP70 PCR-RFLP presented 3 different electrophoretic patterns, with no further intraspecific variation, corresponding to 3 Leishmania species available in the country, L. tropica, L. major, and L. infantum. Phylogenetic analyses presented 5 major clades, corresponding to 5 species complexes. Iranian lineages, including L. major, L. tropica, and L. infantum, were distributed among 3 complexes L. major, L. tropica, and L. donovani. However, within the L. major and L. donovani species complexes, the HSP70 phylogeny was not able to distinguish clearly between the L. major and L. turanica isolates, and between the L. infantum, L. donovani, and L. chagasi isolates, respectively. Our results indicated that both HSP70 PCR-RFLP and sequence analyses are medically applicable tools for identification of Leishmania species in Iranian patients. However, the reduced genetic diversity of the target gene makes it inevitable that its phylogeny only resolves the major groups, namely, the species complexes.

Background: The aim of this study was the seroepidemiological survey for detecting the status of human fasciolosis in Lorestan Province, western Iran., Methods: This cross-sectional study was conducted in 2015-16. Based on statistical estimations, 1256 serum samples were collected from different parts of Lorestan Province, western Iran, and stored at -20 °C until use. The collected serum samples were analyzed at Tehran University of Medical Sciences, Tehran, Iran using indirect ELISA method., Results: Anti- Fasciola antibodies were detected in 16 (1.3%) individuals. Regarding the seropositivity to fasciolosis, no significant differences were found between age groups, sex, level of education and occupation; however significant differences were observed regarding location, consuming local freshwater plants and water resources ( P <0.02.)., Conclusion: Local freshwater plants and unfiltered water resources were probably the main sources of the infection. Health education by local health centers to elevate awareness of people, and providing facilities for safer drinking water, especially in rural areas may help decrease the risk of fasciolosis infection in this region., Competing Interests: Conflict of Interests The authors declare there is no conflict of interests.

A series of ( 5-nitrofuran-2-yl)-1, 3, 4-thiadiazole-2-yl derivatives 6a-6e have been synthesized and screened for in-vitro anti-leishmanial activity against the promastigote form of L. major . The structure of Schiff bases were confirmed by 1 H NMR, IR. Screening results indicate that all of the designed and synthesized final compounds (6a-6e) significantly reduced the viability of promastigotes of L. major in comparison toglucantime (IC 50 3× 10 3 μg/mL). Meta and Para substitutions in benzene ring containing compounds were more potent than other derivative and the most potent compounds were 6d, 6e with IC 50 value 94 µm and 77.6 µm, respectively. The experimental data proposes that ( 5-nitrofuran-2-yl)-1, 3, 4-thiadiazole-2-yl derivatives may be further investigated as a candidate drug for treatment of cutaneous leishmaniasis.

Background: We aimed to describe morphological and morphometrical characteristics of Fasciola spp. in livestock from Ardabil Province, Northwest Iran., Methods: Forty adult flukes were collected from different definitive hosts (cattle and sheep). Previously specimens were identified as F. hepatica or F. gigantica based on PCR-RFLP of the ITS-1 region with RsaI enzyme. We identified Fasciola spp. based on morphological and metric assessment of external features of fresh adults, morphological and metric assessment of internal anatomy of stained mounted worms. Statistical analysis was conducted using the Student's t-test implemented in SPSS 15.0 (SPSS, Chicago, Illinois). Then the morphometric criteria of Fasciola samples were compared with PCR-RFLP data. The results of PCR-RFLP were confirmed by COI gene sequence., Results: The differences between the body length, area of the body, peripheral of the body, succer area, cone length, cone width, in two species were significant ( P < 0.05). Based on Morphological characterizations, 6 specimens had the intermediate morphological features and 19 and 15 specimens had morphological features of F. hepatica and F. gigantica , respectively. In contrast, RFLP results showed, F. hepatica was present in 20 of the isolates, and F. gigantica in 20 isolates. No hybrid forms were detected., Conclusion: PCR-RFLP method can be used for differentiation of Fasciola species, which is more reliable method than morphology. Using morphology methods, merely, is not efficient for determination of genetic diversity.