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Extended Abstract Background: The Hyrcanus boxwood is the only type of boxwood in the Hyrcanus forests of Iran and one of the few evergreen broadleaf trees in the Hyrcanus forests. Today, boxwood is included in Iran's red list of endangered plants. On the one hand, a major part of the boxwood forests of the Hyrkani region have been destroyed due to the excessive exploitation of boxwood trees during the past decades. On the other hand, the occurrence of the boxwood leaf burn fungal disease and, more importantly, the outbreak of the boxwood moth pest have destroyed large areas of these forests (more than 80-90 percent of them). Due to the importance of the Caspian boxwood and its high value in terms of biodiversity, forest managers are trying to investigate factors affecting this pest in the forest ecosystem. The present study intends to investigate the effect of the boxwood moth pest on the above-below-ground vegetation in the two monitoring periods, namely 2010 and 2022 (before and after the boxwood moth pest outbreak, respectively) in the Buxus hyrcanus Pojark reserve in Sisangan. Methods: The above-ground vegetation was studied with the Braun-Blanquet method at peak vegetation cover by the systematic-selective method in 200 and 400-meter grid dimensions by considering the indicator stand concept in 2010 (and 2022 (before and after the moth pest outbreak, respectively). First, a list of all plant species was recorded in each sample plot by the vegetative form, and then the abundance and predominance of plant species were recorded based on the Brown-Blanke scale. Then, they were accurately identified using the available resources, including Flora Iranica, Persian Flora Collection of Iran, and Color Flora of Iran. The biological form of plants was determined based on the Rankier classification, followed by drawing the biological spectrum. This classification of plants is divided based on the location of regenerating buds where new branches and leaves originate after an unfavorable season. To investigate the geographical distribution or chorology of the plants, their distribution areas were first determined using the mentioned floral sources, and then the chorotypes of the species were divided based on the classification of geographical areas and toxic floristic areas. The geographical distribution spectrum of plants in the region was also drawn in the form of a histogram. Results: The results showed that 52 and 69 species in 2010 and 2022 were respectively identified in the Sisangan boxtree (B. hyrcanus Pojark) forest reserve. In 2010, Phanerophytes and Cryptophytes with 44% (23 species) and 19% (10 species) were the most present trees, respectively. In 2022, Phanerophytes and Trophytes with 38% (26 species) and 23% (16 species) were the most important biological spectrums, respectively. The results of examining species diversity, evenness, and species richness indices revealed a significant difference (P < 0.001) between the values of species diversity, evenness, and species richness indices in two monitoring periods (2010 and 2022). The indicators of species diversity, uniformity, and species richness of Rosemary cover were significantly different (P < 0.001/001) between the values of Rosemary species diversity, uniformity, and species richness indicators in two monitoring periods (2010 and 2022). In the examination of the degree of similarity between past and present vegetation of the Shamshad Sisangan Reservoir using Jaccard and Sorenson functions, the degree of similarity of Rosemary vegetation was small in the two monitoring periods. The occurrence of any natural disturbance in the forest communities causes a change in the sequence of vegetation and a decrease in the similarity between the vegetation before and after the disturbance. Therefore, the results of this research showed that species richness and diversity increased with the intensity of leaf-eating by the pest of boxwood moth and the opening of the canopy. Because the characteristics of the disturbance regimes strongly affect the dynamics and sequence of the forest, the use of a conservation management strategy can play an important role in reducing its effects. Conclusion: This research demonstrates that species richness and diversity increase with the intensity of defoliation by the boxwood pest and opening the canopy. Additionally, because the aboveground in the infected areas is often covered with pioneer and herbaceous species, management strategies should be prioritized to direct the succession path in this reservoir toward the climax stages.

Abstract Background Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19. Case presentation We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery. Conclusions Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis.

Background: One of the challenges in medicine has been the exaggerated use of antibiotics. The purpose of this study was to investigate the prevalence of antibiotic usage in children in Arak, Iran (2019-2020) to determine the factors related to antibiotic prescription and consumption in children. Methods: This was a population based, cross-sectional study conducted in Arak, the capital city of Markazi Province, Iran. Stratified random sampling was applied to recruit children who were up to five years old, and registered in the healthcare system between Jan. 2019 and Jan. 2020. A response rate of 85% was obtained from the subjects’ parents. Face-to-face interviews were used to collect the data from the children’s mothers. Univariate and adjusted linear regression analyses were applied to assess the determinants of antibiotic consumption in these children. Results: A total of 1483 children were enrolled in the study; most of them were boys with the mean age of 2.1±1.5 years old. The annual prevalence of antibiotic consumption in Arak was found to be 62.4% for at least one antibiotic. The most consumed antibiotic was azithromycin (24.2%). Among antibiotic groups, the most consumed group was macrolides (26.9%). Upon multiple logistic regression analyses, a lower consumption rate was observed among the younger children with older mothers, and children whose fathers had permanent jobs than other children groups. A higher consumption rate was observed among families with higher parity. Conclusion: The annual prevalence of antibiotic consumption in this study was very high, with the most consumed drug being azithromycin. We recommend that the use of antibiotics be reconsidered by drawing future healthcare policies, aiming at reducing the heavy antibiotics consumption in children.

Introduction. Although COVID-19 is not currently a public health emergency, it will affect susceptible individuals in the post-COVID-19 era. Hence, the present study aimed to develop a model for Iranian patients to identify at-risk groups based on past medical history (PMHx) and some other factors affecting the death of patients hospitalized with COVID-19. Methods. A secondary study was conducted with the existing data of hospitalized COVID-19 adult patients in the hospitals covered by Iran University of Medical Sciences. PMHx was extracted from the registered ICD-10 codes. Stepwise logistic regression was used to predict mortality by PMHx and background covariates such as intensive care unit (ICU) admission. Crude population attributable fraction (PAF) as well as crude and adjusted odds ratio (OR) with 95% confidence interval (CI) were reported. Results. A total of 8879 patients were selected with 19.68% mortality. Infectious and parasitic diseases’ history showed the greatest association (OR = 5.72, 95% CI: 4.20, 7.82), while the greatest PAF was for cardiovascular system diseases (20.46%). According to logistic regression modeling, the largest effect, other than ICU admission and age, was for history of infectious and parasitic diseases (OR = 3.089, 95% CI: 2.13, 4.47). A good performance was achieved (area under curve = 0.875). Conclusion. Considering the prevalence of underlying diseases, many mortality cases of COVID-19 are attributable to the history of cardiovascular disease. Future studies are needed for policy making regarding reduction of COVID-19 mortality in susceptible groups in the post-COVID-19 era.

Objectives: This paper aims to determine the Staphylococcus aureus bacteremia (SAB) in-hospital mortality rate and its associated risk factors during the COVID-19 pandemic. Methods: A total of 167 SAB samples were collected between March 2020 and March 2022 at a teaching hospital in Tehran, Iran. The patient's baseline data and antibiograms were collected. The outcome of the study was in-hospital mortality. Results: The overall in-hospital mortality rate was 41.9 %, with higher mortality observed in patients over 60 years old (P = 0.032), those with community-acquired Staphylococcus aureus bacteremia (P = 0.010), and those admitted to the ICU (P = 0.016). Antibiotic resistance profiles indicated a higher mortality in resistant S.aureus strains but only significant for ciprofloxacin (P = 0.001), methicillin (P = 0.047), and sulfamethoxazole (P = 0.023). Multivariate analysis identified age, sex, ICU admission, and the source of bacteremia as independent predictors of mortality, while COVID-19 coinfection and resistance to antibiotics were not found to be significant predictors. Conclusion: SAB remains a challenging infection that is amplified by the pandemic. Older age and ICU admission are significant mortality predictors. In settings with a high prevalence of MRSA, factors like age, sex, and quality of care outweigh pathogen-related factors such as antibiotic resistance.

Abstract Background Mounting evidence indicates an association between endothelial dysfunction and the coronary slow flow phenomenon (CSFP). In the present study, we aimed to evaluate the possible role of endothelial nitric oxide synthase (eNOS) 894G/T and interleukin-1β (IL-1β) 315C/T polymorphisms as possible risk factors for CSFP. Methods This prospective study enrolled patients with CSFP and individuals with normal coronary arteries. Genotypes were assessed using regular polymerase chain reaction and direct Sanger-sequencing techniques. Results The study population consisted of 267 individuals: 180 patients with CSFP (49 women [27.2%]) at a median age of 55 (48–62) years and 87 controls with normal coronary arteries (56 women [64.4%]) at a median age of 47 (41–58) years. The allelic distribution of eNOS 894G/T was significantly associated with CSFP (odds ratio [OR], 1.58; 95% confidence interval (CI), 1.04–2.42; P = 0.03). This polymorphism increased the risk of CSFP under the dominant model (OR 1.73; 95% CI I.02–2.95; P = 0.04). However, the allelic frequencies (1.05; 95% CI 0.68–1.59; P = 0.83) and genotypic frequencies (0.88; 95% CI 0.52–1.49; P = 0.63) of the IL-1β 315C/T polymorphism were not associated with the incidence of CSFP in the Iranian population. Conclusions The CSFP and control groups were statistically different regarding the eNOS 894G/T polymorphism. Our findings also demonstrated that the IL-1β 315C/T polymorphism was not a risk factor for CSFP.