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Canine visceral leishmaniasis (CVL) is endemic in the southern parts of Iran. The current study aimed at molecular and serological evaluation of zoonotic visceral leishmaniasis in dogs in Fars province, southern Iran. Blood samples were collected from 60 dogs in the three villages in Fars Province. Serum samples were tested for antibodies against L. infantum by direct agglutination test (DAT). DNA was extracted from each dog's buffy coat and tested by PCR, targeting the Leishmania ITS‐2 region. From a total of 60 studied dogs, 25 (41.7%) were female, and 35 (58.3%) were male. Dogs' age ranged from 1 to 7 years, with a mean age of 2.97 (±1.4) years. Anti‐Leishmania antibodies were detected in sera samples of 28 (46.7%) dogs, (titre ≥ 1:320). Out of 28 seropositive cases, 13 (46.4%) were female, and 15 (53.6%) were male. Association between seropositivity and dogs’ clinical signs was statistically significant (p, ​

Leishmania infantum is the most common cause of visceral leishmaniasis (VL) in Iran, where mainly the patients are children under the age of 5 years. Timely, less invasive, and accurate diagnosis and proper treatment of the disease are necessary. This retrospective study aimed to search for a less invasive but robust algorithm on VL diagnostic tests in children. Four hundred and fifteen patients with clinical suspicion of VL, 50 healthy children from VL endemic areas, 46 healthy individuals from non-endemic VL areas, and 47 non-VL diseases were tested using three diagnostic tests: indirect immunofluorescent antibody test (IFAT), rK39-rapid diagnostic test (rK39-RDT), and quantitative PCR (qPCR). One hundred and two suspected VL cases were positive in at least one test and were cured after receiving appropriate treatment. Of these 102 VL patients, 94 were positive in qPCR, 84 in IFAT, and 79 in rK39-RDT. None of the tests detected all the patients, but overall, qPCR is capable of detecting more VL patients than serological tests, i.e., 92.2%, compared to IFAT, 82.4%, and rK39, 77.5%. There was only a significant difference between the sensitivity of qPCR and rK39-RDT (p = 0.024). The specificity was 100% for qPCR and IFAT (≥128) and 98.6% for rK39-RDT. qPCR alone is capable of detecting most of the VL-suspected children. Serological tests like IFAT and rk39-RDT are recommended to increase the overall sensitivity of detection in patients with a negative molecular test. Combining qPCR with a serological test (IFAT or rK39-RDT) can help diagnose 98% of VL. In laboratories without molecular facilities, we recommend testing with the combination of rK39-RDT and IFAT yielding a combined sensitivity of 93.1% equivalent to that of qPCR in our study.

It has been documented that the genotypic traits in symptomatic and asymptomatic cases of visceral leishmaniasis (VL) may be different. The current study aimed to find out and compare the genotype and intraspecies diversity of Leishmania Internal Transcribed Spacer 1 (ITS1) from asymptomatic and symptomatic VL cases in southern Iran. Methods. Buffy coat samples from seven VL patients, with clinical signs and symptoms, and seven asymptomatic VL cases, were evaluated in this study. Samples of asymptomatic individuals were obtained from children living in a VL endemic area in southern Iran, while the samples of symptomatic subjects were obtained from patients admitted to hospitals with a diagnosis of VL. DNA was extracted from the buffy coats of the samples and PCR-amplified, targeting the ITS1of Leishmania. The PCR products were sequenced, and the consensus sequences were assembled and multiple-aligned with a set of Leishmania strains retrieved from the GenBank, using Clustal W. The phylogenetic tree was rooted, using MEGAX software, and the diversities based on haplotype and nucleotides, as well as the number of polymorphic sites, were measured using DnaSP v5.0 software. The results of ITS1 sequencing in 5 out of 7 asymptomatic VL cases showed 99.25% to 100% similarity with the Leishmania infantum ITS1 sequence (accessed number: MN648746), and one isolate was considered as just Leishmania sp. In one sample, 99.75% similarity was seen with the ITS1 sequence of Crithidia fasciculata. Of the symptomatic VL patients, the PCR product revealed a 340 bp band corresponding to L. infantum in all of the samples. By analyzing the ITS1 sequences, all seven sequences formed a clade somewhat different from other Leishmania species and considered as Leishmania sp. Haplotype and nucleotide diversity were much more prevalent in symptomatic cases where six haplotypes were seen in the ITS1 of Leishmania from symptomatic patients and only two haplotypes were observed in the samples from asymptomatic cases. The findings of the current study showed that the Leishmania ITS1 from symptomatic VL and asymptomatic cases has significant genetic differences. Besides, infection with Crithidia fasciculata was reported, for the first time, in an asymptomatic case, which deserves further study.

Generalized lymphangiomatosis (GLA) is a rare lymphatic abnormality, mostly affects children and young individuals and can be a diagnostic challenge because of wide spectrum of clinical manifestations. A 26-year-old woman presented to the emergency department of our institution with respiratory distress and hypoxia. The patient reported similar episodes for the past 10 years without a definite diagnosis. The imaging study demonstrated findings suggestive of GLA with pulmonary, retroperitoneal and osseous involvements which was confirmed on pathological studies from a lung biopsy. A concise review of the clinical, imaging and pathological findings of GLA is provided in this study. A comprehensive history and physical examination, laboratory and pathological work up and imaging is required to make the diagnosis of GLA. The characteristic imaging findings play an essential role to rule out other possible diagnoses and raise the possibility of GLA.

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease that causes chronic synovial inflammation. Reactor-producedβ-particle emitting radionuclides is a new therapeutic strategy in the management of RA. This study was conducted in 2019and analyzed the toxicity and feasibility of 188Re-tin colloid injection, Three-Phase Positive Bone Scan, and Refractory KneePain. Ten patients with RA were administered radiosynovectomy with 188Re-tin colloid. The main complications after theintervention were assessed and compared with patients’ pre-intervention condition. Patients showed alleviation of pain,tenderness, and morning stiffness after the administration of radiosynovectomy. Only one RA patient received a corticosteroidinjection; the other 6 patients did not need a corticosteroid injection after radiosynovectomy. Intra-articular 188Re-tin colloidinjection seems to be an effective treatment modality for refractory knee joint pain in rheumatoid arthritis patients. Thus, it issuggested as a safe and effective strategy to apply.

Background Head and neck squamous cell carcinoma (HNSCC) includes a group of heterogeneous tumors with generally invasive behavior. The PI3K/AKT pathway plays an important role in the pathogenesis of HNSCC. Methods In the current study, we investigated the expression of two negative feedback regulators of the PI3K pathway, namely PHLDA3 and GRHL3, in 45 paired samples of HNSCC and adjacent non-cancerous tissues (ANCTs). Results While expression of GRHL3 was down-regulated in tumoral tissues compared with ANCTs by the factor 4.21, PHLDA3 expression levels were up-regulated by 5.99-times. Gender-based analysis revealed a significant down-regulation of GRHL3 gene expression level in male patients compared with the control samples and significant up-regulation of PHLDA3 gene expression level in both sexes compared with the control samples. Differences in the expressions of both genes were significant in patients aged more than 60 years, but not in the younger patients. Expression of GRHL3 was only down-regulated in patients with positive smoking history. Expression of GRHL3 was decreased in grades 2 and 3 samples compared with controls. There was a significant increase in transcript levels of PHLDA3 in stages II and III HNSCC samples compared with the controls group. ROC curve analysis indicated that the expression level of PHLDA3 could be a promising marker for the diagnosis of HNSCC patients with a sensitivity and specificity of 0.666 and 0.688, respectively. In addition, sensitivity and specificity of GRHL3 were 0.755 and 0.577, respectively. Discussion The current study indicates dysregulation of regulators of PI3K pathway in HNSCC and their potential application as putative biomarkers for this cancer.

Due to the increase in the number of cancer patients, because of environmental parameters, high stress, low immunity, etc., there is an urgent need to develop cost-effective sensors for early targeted detection of cancerous cells with adequate selectivity and efficiency. Early disease diagnosis is important, as it is necessary to start treatments before disease progression. On the other hand, we need new, more efficient cancer treatment approaches with minimized side effects, more biocompatibility, and easy disposal. Nanobiotechnology is a field that can assist in developing new diagnostic and treatment approaches, specifically in fatal cancers. Herein, a study on the different applications of nanofibers in cancer detection as well as its treatment has been done. Here, a very brief survey on the main structure of biosensors and their different categories has been conducted and will precede the discussion of the study to serve as a reference and guide the reader's understanding.

Background Kinesin-related gene diversity among strains and species of Leishmania may impact the sensitivity and specificity of serodiagnostic tests for visceral leishmaniasis (VL). Methods In this study, we report on the recombinant expression of this novel Iranian Leishmania infantum (MCAN14/47) homologue of rK39 (Li-rK39), in L. tarentolae. The diagnostic potential of the Li-rK39 antigen was evaluated in an ELISA, using sera from 100 VL patients, 190 healthy endemic controls, 46 non-endemic healthy controls and 47 patients with other infections. Results The results showed a sensitivity of 96% and a specificity of 93.8%. A commercial rK39 immunochromatographic test (ICT) was 90% sensitive and 100% specific on the same cohort. Conclusions Here, we show that the K39 gene from an Iranian L. infantum isolate is heterozygous as compared to the sequence of the Brazilian L. infantum (former L. chagasi), whose antigen is incorporated in most rK39-based immunochromatographic tests. Therefore, Li-rK39 has the potential to be used as an alternative for VL diagnosis in Iran.

Introduction:Human coronavirus disease 2019 (COVID-19) is an emerging respiratory disease that has become pandemic worldwide. The patients have a range of mild to severe symptoms, such as pneumonia, acute respiratory distress syndrome, arrhythmia, shock, and other organs involvement. Clinical and hematological evidence can serve as a prognostic factor to detect severe cases of COVID-19. Objectives: The present study aimed to evaluate hematological parameters related to the severity of the disease in COVID-19 patients in Mashhad, Eastern Iran. Patients and Methods: All the individuals with positive real-time reverse transcription-polymerase chain reaction test results and the patients with clinical symptoms whose computed tomography scan results were matched with the diagnosis of viral pneumonia were included in the study. The hematological examinations and complete blood count of the patients were performed by the healthcare personnel through collecting blood samples at the time of admission and discharge from the hospital. Results: In total, 189 COVID-19 patients were included in the study, 47.6% and 58.73% of whom were over 60 years old and male, respectively. Investigation of the hematological parameters revealed that the number of white blood cells, mean value of corpuscular volume, number of platelets, and lymph count had significantly increased at the time of discharge (PPP=0.021). Conclusion: It can be concluded that hematological parameters and inflammatory biomarkers in COVID-19 patients could potentially act as the independent factors and affect the prognosis of the disease.

Introduction: Toxocariasis, also known as Visceral Larva Migrans (VLM) syndrome, is a parasitic disease caused by the ascaris larva migrans of dogs and cats, especially Toxocara canis. The eggs of this parasite enter the human body through contaminated food, water, and soil. Aim: To determine the prevalence of Toxocara spp. eggs in the soil of public parks in Ilam city, Iran. Materials and Methods: In this descriptive cross-sectional study, 40 soil samples (100 grams per sample from the depth of 3 to 5 cm) were randomly collected from 10 public parks of Ilam city in the summer season of 2018. After washing, grinding, and separating large particles from the samples, parasitic eggs were isolated using 150-micron filters and sucrose flotation method. The data was analysed using SPSS 20 software. Results: Five of ten parks (50%) were contaminated with Toxocara spp. eggs. From 40 soil samples collected from the public parks, 16 (40%) were contaminated with Toxocara spp. eggs. Most of the contaminated samples were collected from walking and flowering areas in all the parks. Microscopic studies showed an average of 1-4 Toxocara spp. eggs per microscopic field in each sample indicating 4 to16 eggs per 100 grams of soil in each contaminated park. Conclusion: Due to the high level of contamination with Toxocara spp. eggs in Ilam city parks, it is necessary to prevent dogs and cats from entering to lawns and playgrounds in public parks by fencing.

Background: Stroke is one of the common causes of disability and death in the world. Furthermore, diabetes mellitus is among the main risk factors for cerebrovascular events. However, a high percentage of individuals with diabetes mellitus are unaware of their disease. Objectives: To determine the frequency of Undiagnosed Diabetes mellitus (UD) in patients with stroke. Materials & Methods: In a descriptive cross-sectional study, all patients with stroke hospitalized in neurology ward of an academic hospital in the north of Iran were included in the study in 2016. A questionnaire was used to collect data including all demographic, laboratory and clinical factors such as high blood pressure, hypercholesterolemia and stroke type. Finally, the data were analyzed using Chi square, Fisher’s exact test and multinomial binary logistic regression in SPSS V. 21. Results: Most samples were male (53.8%) with a mean age of 69.2±10.1 years. The percentage of the UD was 21.7% based on level of HbA1c. The highest percentage of UD was observed in Subarachnoid Hemorrhage(SAH) (66.7%). The frequency of UD in patients with family history of diabetes mellitus (16.7%) was lower than that in patients without that history (27.7%). There was a significant relationship between UD and cholesterol and triglyceride levels and, in general, dyslipidemia (P

Objective Besides their communication and socialization problems, many children with Intellectual Disability (ID) have difficulties with their parents, siblings, and teachers. The enduring nature of social reactions easily leads to social isolation. Thus, many children and adults with ID have few friends, even though they may desperately want to be liked. This can set up a vicious circle in which they attempt to win friends by latching onto the least chance for interaction with others. Regarding the characteristics of nonviolent communication program training, it seems that this program could reduce communication problems and improve mother-child interaction of children with ID. The nonviolent communication training program is one method for improvement of communication skills in parents of the children with ID because these parents are often facing problem in communication with their children. Nowadays, much effort is made for improving mother-child interaction, especially in mothers of children with ID. Therefore, the purpose of the present study was to investigate the effect of nonviolent communication program training on mother-child interaction in mothers of children with ID. Materials & Methods The present research was a quasi-experimental study with pretest-posttest and a control group. The study population included all of the mothers of children with ID who attend to Alborz Educational and Rehabilitation Institute which is located in Alborz Province, Iran under the supervision of welfare organization. The study sample included 30 mothers selected by convenience sampling method and assigned to two groups. The experimental group participated in a communication skills training program based on life language for 8 sessions (90 minutes for per session; twice a week), while the control group received no such training. The study instrument was the Pianta mother-child interaction scale (1992). The Pianta mother-child interaction scale was completed by mothers for all subjects in pretest and posttest. The study data were collected through the questionnaire before and after the training sessions. Multivariate analysis of covariance was performed in SPSS (Version 22) for analyzing the obtained data. Results First, the normality of study variables and contingency of variance and covariance assumptions were tested. The Kolmogorov-Smirnov test showed that all variables were normally distributed (P>0.05). Also, the Box test confirmed the contingency of variance-covariance assumption. So, assumptions of the MANCOVA test were confirmed and MANCOVA test can be used for analysis of data. The results of MANCOVA revealed that posttest scores of experimental and control groups had a significant difference with regard to mother-child interaction (P

Deficiency of the proteins involved in oxidative phosphorylation (OXPHOS) can lead to mitochondrial dysfunction. Polyribonucleotide nucleotidyltransferase 1 (PNPT1) is one of the genes involved in the OXPHOS and encodes the mitochondrial polynucleotide phosphorylase (PNPase) which is implicated in RNA-processing exoribonuclease activity. Herein, we report a 34-month-old boy who presented with global developmental delay, muscular hypotonia, hearing impairment, and movement disorders including chorea and dystonia. Mitochondrial genome sequencing and whole-exome sequencing (WES) were performed and a variant in PNPT1:c.1453A>G; p. (Met485Val) was identified. A number of patient's neurologic problems had been already reported in previous studies, however, lower limbs spasticity and bulbar dysfunction were novel phenotypic findings. In addition, delayed myelination during infancy, progressive basal ganglia atrophy, and brain stem abnormal signals including transverse pontine fibers and superior colliculus involvement were also novel neuroimaging findings in this case. Different crystallographic modeling and stereochemical analysis of the c.1453A>G; p. (Met485Val) variant showed this variant affects the active site of the protein and disrupts the normal protein function.

Objectives The current study aimed to evaluate the prevalence of parasitic infections and their possible association with irritable bowel syndrome (IBS), through a case–control study. Stool samples were collected from patients with IBS and healthy subjects and were examined microscopically to detect intestinal parasites. Results A total of 200 subjects were enrolled in the study including 100 patients with IBS and 100 healthy controls. The patients were selected based on the Rome III criteria. Of the 100 patients with IBS, 65 (65%) were female and 35 (35%) were male, with a mean age of 42.57 (± 4.07) years. Of these, 30 (30%) were infected with at least one intestinal parasite; the most common ones were Blastocystis hominis and Giardia lamblia. Of the control cases, 64 (64%) were female and 36 (36%) were male, with a mean age of 41.82 (± 11.75) years. Of these, 16 (16%) were infected with at least one intestinal parasite; the most common were B. hominis and Endolimax. There was a significant difference between the rate of parasitic infections between the patients with IBS and the control in particular, B. hominis and G. lamblia. The findings of the study support a possible link between parasitic infections and IBS.

Introduction: Leukodystrophies constitute heterogenous group of rare heritable disorders primarily affecting the white matter of central nervous system. These conditions are often under-appreciated among physicians. The first clinical manifestations of leukodystrophies are often nonspecific and can occur in different ages from neonatal to late adulthood periods. The diagnosis is, therefore, challenging in most cases. Area covered: Herein, the authors discuss different aspects of leukodystrophies. The authors used MEDLINE, EMBASE, and GOOGLE SCHOLAR to provide an extensive update about epidemiology, classifications, pathology, clinical findings, diagnostic tools, and treatments of leukodystrophies. Comprehensive evaluation of clinical findings, brain magnetic resonance imaging, and genetic studies play the key roles in the early diagnosis of individuals with leukodystrophies. No cure is available for most heritable white matter disorders but symptomatic treatments can significantly decrease the burden of events. New genetic methods and stem cell transplantation are also under investigation to further increase the quality and duration of life in affected population. Expert opinion: The improvements in molecular diagnostic tools allow us to identify the meticulous underlying etiology of leukodystrophies and result in higher diagnostic rates, new classifications of leukodystrophies based on genetic information, and replacement of symptomatic managements with more specific targeted therapies. Abbreviations: 4H: Hypomyelination, hypogonadotropic hypogonadism and hypodontia; AAV: Adeno-associated virus; AD: autosomal dominant; AGS: Aicardi-Goutieres syndrome; ALSP: Axonal spheroids and pigmented glia; APGBD: Adult polyglucosan body disease; AR: autosomal recessive; ASO: Antisense oligonucleotide therapy; AxD: Alexander disease; BAEP: Brainstem auditory evoked potentials; CAA: Cerebral amyloid angiopathy; CADASIL: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; CARASAL: Cathepsin A–related arteriopathy with strokes and leukoencephalopathy; CARASIL: Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy; CGH: Comparative genomic hybridization; ClC2: Chloride Ion Channel 2; CMTX: Charcot-Marie-Tooth disease, X-linked; CMV: Cytomegalovirus; CNS: central nervous system; CRISP/Cas9: Clustered regularly interspaced short palindromic repeat/CRISPR-associated 9; gRNA: Guide RNA; CTX: Cerebrotendinous xanthomatosis; DNA: Deoxyribonucleic acid; DSB: Double strand breaks; DTI: Diffusion tensor imaging; FLAIR: Fluid attenuated inversion recovery; GAN: Giant axonal neuropathy; H-ABC: Hypomyelination with atrophy of basal ganglia and cerebellum; HBSL: Hypomyelination with brainstem and spinal cord involvement and leg spasticity; HCC: Hypomyelination with congenital cataracts; HEMS: Hypomyelination of early myelinated structures; HMG CoA: Hydroxy methylglutaryl CoA; HSCT: Hematopoietic stem cell transplant; iPSC: Induced pluripotent stem cells; KSS: Kearns-Sayre syndrome; L-2-HGA: L-2-hydroxy glutaric aciduria; LBSL: Leukoencephalopathy with brainstem and spinal cord involvement and elevated lactate; LCC: Leukoencephalopathy with calcifications and cysts; LTBL: Leukoencephalopathy with thalamus and brainstem involvement and high lactate; MELAS: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke; MERRF: Myoclonic epilepsy with ragged red fibers; MLC: Megalencephalic leukoencephalopathy with subcortical cysts; MLD: metachromatic leukodystrophy; MRI: magnetic resonance imaging; NCL: Neuronal ceroid lipofuscinosis; NGS: Next generation sequencing; ODDD: Oculodentodigital dysplasia; PCWH: Peripheral demyelinating neuropathy-central-dysmyelinating leukodystrophy-Waardenburg syndrome-Hirschprung disease; PMD: Pelizaeus‐Merzbacher disease; PMDL: Pelizaeus-Merzbacher-like disease; RNA: Ribonucleic acid; TW: T-weighted; VWM: Vanishing white matter; WES: whole exome sequencing; WGS: whole genome sequencing; X-ALD: X-linked adrenoleukodystrophy; XLD: X-linked dominant; XLR: X-linked recessive

ObjectiveSentinel lymph node (SLN) biopsy aims to assess lymph node status with reduced surgical morbidity. The aim of the study was to determine the accuracy and safety of SLN biopsy in the management of early cervical carcinoma using a double technique (technetium-99m (Tc-99m) nanocolloid and methylene blue dye injection).MethodsThis was a 10-year study from January 2009 to January 2019 that recruited 103 consecutive women undergoing surgery for early cervical carcinoma, FIGO 2009 stage IA1 (grade 3, and grade 2 with lymphovascular space invasion) to IB1 (ResultsAt least one SLN was detected in all 103 patients, using at least one of the combined methods (Tc-99m nanocolloid or blue dye). Bilaterally SLN were removed in 85/103 women with an 83% bilateral detection rate. The median SLN count was 2.3 (range 1–6) nodes. Of 103 patients, 7 (6.7%) patients had lymph node involvement. There were no pelvic or para-aortic lymph node recurrences with a median follow-up of 53 (range 8–120) months. The specificity and negative predictive value of a negative SLN was 100%. None of our 103 patients reported lower extremity lymphedema.ConclusionIn carefully selected patients with early cervical carcinoma, SLN biopsy alone appears to be a safe method for lymph node assessment of women undergoing surgical staging. Ultrastaging is an essential part of histologic examination of SLN.

Background: A World Health Organization (WHO) February 2018 report recently has shown that the rate of deaths because of brain or central nervous system (CNS) cancer has the highest rate in the Asian continent. Timely and accurate diagnosis of brain tumor is crucial where small errors pose many risks to treatment. Classifying the types of tumors is an important factor in targeted treatment. Since tumor diagnosis is highly invasive, time-consuming, and costly, there is an urgent need for a precise tool to develop a non-invasive, cost-effective, and efficient tool for brain tumor description and grade estimation. Brain scans by using magnetic resonance imaging (MRI), computed tomography (CT), and other imaging techniques are fast and safe to detect tumors. Methods: In this paper, we used a standard dataset containing 3064 images from different skull views. The size and position of tumors at different angles make it difficult to detect the tumor in the specimens. This MRI dataset consisted of 3064 slices and 1047 coronal images. Coronal images were recorded from behind. Axial images taken from above included 990 images. Also, there were 1027 sagittal images extracted from the skull side. Images in this dataset belonged to 233 patients. The dataset consisted of 708 Meningioma, 1426 Glioma, and 930 Pituitary tumors; thus, we isolated images from different angles of sagittal, coronal, and axial images and then trained them in different categories by using Inception-V3 and Resent, which are deep learning classification methods to make this process more accurate and faster. Results: Finally, by adjusting the hyper-parameters of each of these methods with performing pre- processing and weighting combinations, we obtained an acceptable evaluation compared to previous methods.

Background The fibrinogen receptor is an integrin on the platelet surface and is shaped from two types of glycoprotein (GP) subunits, GPIIb and GPIIIa. Membrane glycoprotein IIb/IIIa plays an important role in platelet function. The gene encoding the glycoprotein IIIa shows a common polymorphism, PLA2 that increases the binding of the receptor to fibrinogen and enhances the platelet aggregation. The clinical impact of PLA2 polymorphism has been studied in some diseases, but the definition of its exact role on venous thromboembolism complications has been challenging. The present systematic review aimed to clarify the association of PLA2 polymorphism and venous thromboembolism. Main text In this study, Electronic databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library were searched. All the assessed studies focused on the relationship between PLA2 polymorphism and venous thromboembolism. Five studies were eligible for systematic review. One study revealed a significant correlation between PLA2 polymorphism and venous thromboembolism. PLA2 polymorphism was associated with deep vein thrombosis in one study and pulmonary thromboembolism in another one. Conclusion The published data supported the hypothesis that having the PLA2 polymorphism of GPIIIa may be a risk factor for venous thromboembolism, but the association cannot be concluded; it needs more clinical investigation.

Background Infantile Sandhoff disease (ISD) is a GM2 gangliosidosis that is classified as a lysosomal storage disorder. The most common symptoms of affected individuals at presentation are neurologic involvement. Here we report clinical course and demographic features in a case series of infantile Sandhoff disease. Enzymatically and some genetically proven cases of ISD were extracted from the Iranian Neurometabolic Registry (INMR) in Children’s Medical Center, Iran, Tehran from December 2010 to December 2016. Result Twenty five cases of infantile SD (13 female, 12 male) were included in this study. The age range of patients was 9–24 months with a mean of 15.8 months. The consanguinity rate of parents affected families was about 80%. The mean age of patients at disease onset was 6.4 months and the mean age at diagnosis was 14 months. Patients were diagnosed with a mean delay of 7.8 months. Eleven of patients died due to aspiration pneumonia and intractable seizure. The most common features at presentation (92%) were developmental delay or regression in speech and cognitive domains. Cherry red spots were detected in 17 patients (68%). Organomegaly was detected only in two patients. Enzyme studies showed marked reductions of both Hexosaminidase A and B in all patients. HEXB gene mutation studies performed in eight patients identified 6 different mutations, which five of them were novel. Conclusion Infantile SD should be considered for each child presented with neurologic symptoms such as developmental delay and regression and cherry red spots in ophthalmic examination. Organomegaly is not a frequent clinical finding in infantile SD. Additionally; there are a genetic heterogenisity among Iranian patients.

Visceral leishmaniasis (VL) is a major health concern in patients with HIV infection in endemic areas of VL. In these areas, a substantial number of infected individuals are asymptomatic and the risk of acute VL infection in HIV/VL co-infected cases is high. The current study aimed to determine the prevalence of asymptomatic VL infection among HIV-infected patients in Fars province, southern Iran. Subjects of the study were 251 HIV-confirmed patients who all were clinically asymptomatic for leishmaniasis. Blood samples were obtained from each participant. Anti-Leishmania antibodies were detected in the sera using ELISA. DNA was extracted from the buffy coat of each subject and PCR amplified, targeting an ITS-2 gene of Leishmania. PCR products were purified from the gel and were sequenced. Overall, 19 out of 251 (7.6%) HIV-infected patients were found to be infected with Leishmania, using serological or molecular methods. Anti-Leishmania antibodies were detected in 13 (5.2%) patients and leishmanial DNA in 8 (3.2%) of the patients. The sequence analysis of DNA-positive cases revealed the species of the parasite as L. infantum. The high prevalence of VL among the patients with HIV is a serious challenge which demands further attention to improve the prophylaxis and treatment measurements of VL/HIV co-infection and thereby promoting the life expectancy and quality of life of these patients.

Objectives Gangliosidosis is an inherited metabolic disorder causing neurodegeneration and motor regression. Preventive diagnosis is the first choice for the affected families due to lack of straightforward therapy. Genetic studies could confirm the diagnosis and help families for carrier screening and prenatal diagnosis. An update of HEXB gene variants concerning genotype, phenotype and in silico analysis are presented. Patients and Methods Panel based next generation sequencing and direct sequencing of four cases were performed to confirm the clinical diagnosis and for reproductive planning. Bioinformatic analyses of the HEXB mutation database were also performed. Results Direct sequencing of HEXA and HEXB genes showed recurrent homozygous variants at c.509G>A (p.Arg170Gln) and c.850C>T (p.Arg284Ter), respectively. A novel variant at c.416T>A (p.Leu139Gln) was identified in the GLB1 gene. Panel based next generation sequencing was performed for an undiagnosed patient which showed a novel mutation at c.1602C>A (p.Cys534Ter) of HEXB gene. Bioinformatic analysis of the HEXB mutation database showed 97% consistency of in silico genotype analysis with the phenotype. Bioinformatic analysis of the novel variants predicted to be disease causing. In silico structural and functional analysis of the novel variants showed structural effect of HEXB and functional effect of GLB1 variants which would provide fast analysis of novel variants. Conclusions Panel based studies could be performed for overlapping symptomatic patients. Consequently, genetic testing would help affected families for patients’ management, carrier detection, and family planning’s.

The breast cancer as the most life-threatening disease among the woman has emerged in the worldwide. It is supposed that the early testing and treatment for breast cancer detection would be avoided the surgeries and increase the survival rate. A variety of research studies have motivated to improve the diagnostic methods for early diagnosis of breast cancer. This study investigates the automatic and semi-automatic image-based approaches for breast cancer diagnosis. The scope of this research has limited to the images based diagnosis application journal that are published between 2016 and 2020 years. The principles and associated risk factors for diagnosis the breast cancer and existing imaging techniques are presented. The steps of diagnosis including preprocessing, segmentation, extracting tumor features, and tumor classification are investigated. The publicly available datasets for breast imaging are briefly introduced as well. The application issues, challenges of breast imaging technologies and future directions are discussed. Based on the detailed study, most proposed methods use one type of imaging modalities, however, the doctor need to investigate the multiple imaging techniques to accurate diagnosis and effective treatment. Moreover, handling the multiple imaging require the processing of big data using a cluster computing framework.

Background Ribonucleases (RNases) are crucial for degradation of ribosomal RNA (rRNA). RNASET2 as a subtype of RNASEs is a 256 amino acid protein, encoded by RNASET2 gene located on chromosome six. Defective RNASET2 leads to RNASET2-deficient leukoencephalopathy, a rare autosomal recessive neurogenetic disorder with psychomotor delay as its main clinical symptom. The clinical findings can be similar to congenital cytomegalovirus (CMV) infection and Aicardi-Goutieres syndrome (AGS). Methods Herein, we presented a patient with motor delay, neurological regression, infrequent seizures and microcephaly at 5 months of age. Brain imaging showed white matter involvement, calcification and anterior temporal cysts. Basic metabolic tests, serum and urine CMV polymerase chain reaction (PCR) were requested. According to clinical and imaging findings, screening of RNASET2 and RMND1 genes were performed. The clinical data and magnetic resonance imaging (MRI) findings of previous reported individuals with RNASET2-deficient leukodystrophy were also reviewed and compared to the findings of our patient. Results Brain MRI findings were suggestive of RNASET2-deficient leukoencephalopathy, AGS and CMV infection. Basic metabolic tests were normal and CMV PCR was negative. Molecular study revealed a novel homozygous variant of c.233C > A; p.Ser78Ter in exon 4 of RNASET2 gene compatible with the diagnosis of RNASET2-deficient leukoencephalopathy. Conclusions RNASET2-deficiency is a possible diagnosis in an infant presented with a static leukoencephalopathy and white matter involvement without megalencephaly. Due to overlapping clinical and radiologic features of RNASET2-deficient leukoencephalopathy, AGS and congenital CMV infections, molecular study as an important and helpful diagnostic tool should be considered to avoid misdiagnosis.

Megalencephalic leukoencephalopathy with subcortical cysts (MLC), a demyelination leukodystrophy, is usually characterized by early-onset macrocephaly and gradually progressive motor and mild mental deterioration. Variable clinical expression has been reported in MLC especially in adult cases. In this study, a multi affected family with variable phenotypes including an asymptomatic adult individual is reported to expand the clinical spectrum of MLC. A seven-year old boy was referred to our hospital due to macrocephaly and gait disturbance. According to brain magnetic resonance imaging (MRI) findings, molecular studies were done to confirm the probable diagnosis of MLC in index case followed by family segregation analysis. A homozygous splice site variant, c.177+1G>T in MLC1 gene was found in proband, his mother and two aunts. Aunts were clinically affected but his mother had no clinical symptoms despite bi-allelic mutation in MILC1. The clinical data and available MRI findings were reviewed for these cases. A comprehensive search was conducted on clinical variations of MLC. Phenotypic variability and/or reduced penetrance are important phenomena in MLC. We extended phenotypic variation in MLC by reporting an asymptomatic adult case with a known pathogenic mutation in MLC1 gene.

Leukodystrophies are heterogeneous group of genetic white matter disorders with a wide range of neurologic and systemic manifestations. Defects in genes encoding aminoacyl tRNA (transfer ribonucleic acid) synthetase enzymes (aaRSs) are recently identified as the etiology of some leukodystrophies. Herein, we described two unrelated children referred to Children's Medical Center, Tehran, Iran, with developmental delay, nystagmus, seizures, psuedo-bulbar palsy and dystonia. Whole exome sequencing (WES) in both patients identified a homozygous (c.2T > C) variant in exon one of RARS gene, encoding cytoplasmic arginyl-tRNA synthetase. Our finding was confirmed by segregation analysis. In silico analyses of the c.2T > C variant showed its possible pathogenic role due to the absence of the start codon. Severe hypomyelination was the common neuroimaging finding of both cases. Spinal cord involvement was found in one of our patients which was not previously reported in studies. We, therefore, showed that RARS-related hypomyelination might affect spinal cord.

Ovarian Hyperstimulation Syndrome (OHSS) is a serious complication of Assisted Reproductive Technology (ART). Some studies show that intravenous calcium infusion decreases the risk of OHSS in high-risk patients. Some life-threatening complications may occur following intravenous calcium gluconate infusion, but oral calcium carbonate is a cheap and easy-to-use medication with no/minor side-effects. The present clinical trial was therefore designed to identify the role of oral calcium in OHSS prevention in high-risk patients. A total of 99 patients who had received an antagonist protocol for ovarian stimulation in their ART cycles and were at risk of OHSS were recruited for the study. The patients were allocated into two groups to receive either 500-mg BID calcium carbonate tablets or placebo tablets from their puncture date for five days. The findings showed no significant differences in oocyte and grade A, B and C embryo counts between the two groups. Moreover, the clinical pregnancy rate and the frequency of OHSS symptoms were not significantly different between the two groups. The frequencies of mild, moderate and severe OHSS were not significantly different between the two groups either. Since oral calcium is an easy-to-use method with limited side-effects, we recommend further studies to examine its effects on OHSS prevention in high-risk patients.

Background Head and neck squamous cell carcinoma (HNSCC) is recognized as one of the most common malignancies worldwide, representing high mortality and morbidity. Here, we attempted to study the expression levels of DUSP6, DAB2IP, and RKIP genes, as the critical hallmarks involved in various central mechanisms including Mitogen-activated protein kinases (MAPK) pathway, in patients with HNSCC. Methods The mRNA expression levels of mentioned genes were evaluated in 45 HNSCC tissues and normal adjacent samples by quantitative Real-time PCR. Samples were obtained from AmirAlam Hospital Complex in Tehran, Iran. We, also, examined the correlation coefficient and receiver operating characteristic (ROC) curve for our data. Results The expression levels of DUSP6 and DAB2IP genes were significantly up-regulated and decreased, respectively, in HNSCC samples, compared with control (p Discussion Given the dysregulated mRNA expression levels of DUSP6 and DAB2IP genes, along with exhibited correlations and ROC curve analysis, the pivotal importance of studied genes and their network can be suggested in patients with HNSCC. Recognizing such molecular dysregulations in central cellular pathways can pave the road to potential therapeutic interventions and to improve medical diagnosis.

Background: Toxoplasma gondii is a zoonotic protozoan that threatens the health of the people infected with human immunodeficiency virus (HIV). HIV-positive subjects are at risk of cerebral toxoplasmosis. Objectives: The current study was designed to find out the seroprevalence of toxoplasmosis in HIV-infected individuals in Fars province, in the South of Iran. Methods: This cross-sectional study was performed on 251 HIV-infected individuals referred to Shiraz HIV/AIDS Research Center in Fars province, Southern Iran, in 2016. Blood samples (5 mL) were collected from each individual and sera as well as buffy coat were isolated from each sample. Demographic and HIV-associated data were obtained from the patients’ medical records. Anti-Toxoplasma antibodies (both IgG and IgM) were determined by ELISA, using a commercial kit. In addition, PCR, targeting a 529 bp gene of T. gondii was performed on the patients’ buffy coats for detection of Toxoplasma DNA. Results: Anti-Toxoplasma antibodies were detected in the sera of 42 out of 251 (16.7%) HIV infected patients. Of these, 39 cases (15.5%) were seropositive only for IgG and 3 (1.2%) were positive only for IgM. Seropositive subjects mainly belonged to 40 - 49 year age group. None of the subjects were positive for Toxoplasma DNA when evaluated by the PCR. No significant associations were found between Toxoplasma seropositivity and gender, age, and CD4+ cell level (P > 0.05). Conclusions: Findings of this study demonstrated a significant rate of seroprevalence of Toxoplasma in HIV infected subjects in Fars province, Southern Iran. The seropositive cases are at risk of Toxoplasma reactivation and subsequent cerebral encephalitis. Treatment and also prevention of toxoplasmosis in HIV positive people should be considered.

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common lymphatic neoplasm, accounting for about 30–40% of non-Hodgkin’s lymphoma cases. Objectives: DLBCL is a progressive disease with clinical, genetic and molecular heterogeneity. The prognostic value of B-cell lymphoma 2 (BCL2) and Ki-67 in DLBCL patients has been controversial. Patients and Methods: In this study, we investigated the correlation of BCL2 and Ki-67 expression with clinical features such as age, gender, B symptoms and lactate dehydrogenase (LDH) levels, subtypes of DLBCL, its staging and prognosis in 36 cases of DLBCL. The expression of BCL2 and Ki-67 was measured by immunohistochemistry. Results: There was no significant correlation between BCL2 expression and staging (P=0.082), however Ki-67 expression had a significant correlation with staging (P=0.002). There was no statistically significant correlation between BCL2 and Ki-67 with prognosis of the disease. We found a significant correlation between the germinal center B-cell (GCB) and non- GCB subtypes with BCL2 expression (P=0.024), since patients with non- GCB subtype had a higher BCL2 expression. Our study also demonstrated a significant relationship between BCL2 and Ki-67 expression, therefore, with the increase of the expression of a marker, another increases (P=0.045). Conclusion: BCL2 and Ki-67 expressions were not associated with prognosis. Overexpression of Ki-67 was associated with higher clinical stages. BCL2 expression is higher in non-GCB subtype of DLBCL. Therefore, our study shows that the subsequent studies of BCL2 and other biomarkers in the DLBCL should be based on the DLBCL subtypes.

The current study was performed to find out the seroprevalence of Toxocara infection in children living in a rural community in Fars province, southern Iran. Venous blood was taken from 617 children and evaluated for anti-Toxocara antibodies, using an ELISA system. Of the 617 studied children, 318 (51.5%) were boys and 299 (48.5%) were girls. Mean age of the participants was 9.2 (±10.7) years. Most cases of the recruited subjects (37.4%) were in the age group of 0-5 years. Anti-Toxocara antibodies were detected in sera of 39 (6.3%) of children. From these, 23 (62.2%) were boys and 14 (37.8%) were girls. The infection rate was almost the same in different age groups. No statistically significant differences were seen between seropositivity to Toxocara infection and gender or age of the participants. Dogs or cats ownership was not associated with Toxocara seropositivity. The adjusted associations of the study variables suggested that the visceral leishmaniasis (VL) seropositivity is significantly associated with the seroprevalence of Toxocara infection (P

Introduction: Vanishing white matter disease (VWM) is considered as one of the most frequent types of inherited childhood leukoencephalopathies. Various neurological and non-neurological manifestations have been reported in this type of leukodystrophy; however, seizures are rarely described in infantile type of VWM. Case Presentation: To patient is a 12 months old boy who experienced frequent seizures at 4th month of age. The seizures were resistant to anti-epileptic drugs and caused 3 periods of hospitalization. Magnetic resonance imaging (MRI) demonstrated demyelinating pattern and whole exome sequencing (WES) reported homozygous mutation (c.922G > A) in EIF2B2 gene in exon 8 leading to an amino-acid substitution (p.Val308Met). Conclusions: Infantile onset of vanishing white matter disease can be considered as one of few childhood leukodystrophies that are associated with early onset seizures.

Latex agglutination test (KAtex) has been used in the last two decades for the diagnosis of visceral leishmaniasis (VL) in different VL-endemic areas. Here, we present a meta-analysis of studies which evaluated the KAtex for the diagnosis of VL to find out its overall diagnostic performance. A database search was performed on PubMed, Scopus, ISI Web of Science, Iranmedex and Google Scholar. The search of databases found 57 papers, of which 17 articles fulfilled our eligibility criteria. Meta-analysis of diagnostic accuracy (MADA) and Hierarchical Summary Receiver Operating Curve (HSROC) packages were used to do the meta-analysis and to obtain pooled estimates of sensitivity and specificity. Fixed effect bivariate analysis was conducted, using Mantel-Haenszel estimator, to measure the performance and diagnosis odds ratio (DOR) of the test. Heterogeneity of the test results was assessed by Chi-squared test. The sensitivity of individual studies ranged from 39.8 to 100%, and the specificity ranged from 64 to100%. The combined sensitivity and specificity estimates of KAtex were 77% (95% CI, 70-83%), and 97% (95% CI, 93-97%), respectively. Comparing the performance of the test by region suggests a significant difference where the lowest and highest sensitivities are reported from Nepal/Tunisia and Europe/Middle East respectively (p < 0.05). On the other hand, the lowest and highest rates of specificity were reported from Sudan and America/Middle East respectively. The overall specificity of KAtex is satisfactory. However, KAtex suffers from low sensitivity and this shortcoming should be improved. The test provides a rapid and simple diagnosis of VL and improvement of its sensitivity deserve further studies.

The current study aimed to evaluate the seroprevalence of visceral leishmaniasis in asymptomatic healthy children in a rural area of Fars province, Southern Iran. Blood samples were taken from 617 asymptomatic healthy children and serum samples along with buffy coat were separated from the blood. The serum samples were assessed for antibodies againstLeishmania infantumby an indirect ELISA and the buffy coats were tested for the presence ofL. infantumDNA by molecular method. Of the 617 recruited children, 297 (48.1%) were female and 317 (51.4%) were male. Anti-Leishmaniaantibodies were detected in 17 (2.8%) of the children. From those 17 seropositive cases, 5 (29.4%) were male and 12 (70.6%) cases were female. Children aged 5–8 years had the highest seroprevalence rate; however, no associations were found between seropositivity toLeishmaniaand gender or age of the children. Moreover,L. infantumDNA was detected in buffy coat of 8 (1.3%) of 617 children. Three of the PCR-positive cases were seropositive whereas 14 of seropositive subjects (82.3%) were PCR-negative. Findings of the current study revealed a considerable subclinical leishmanial infection in children in the studied rural area in the south of Iran. Results of the current study could be used for surveillance, prevention, and control of VL in the area.

The molecular basis of Alzheimer’s disease (AD) is a critical aspect for understanding the role of A β fibrils in neurotoxicity and for designing therapeutic strategies against AD. Molecular insight into the prevention of A β peptide aggregates in the presence of P7C3, a derivative of dibromocarbazole, molecule is presented for the first time. P7C3 protects newborn neurons from apoptotic cell death, but mechanistic details are lacking. The ability of P7C3 to prevent the onset or to slow the progression of the Alzheimer’s disease was studied by using molecular dynamics (MD) simulations. Two different mechanisms were considered: the disruption of A β aggregation by direct binding of P7C3 to A β and alterations in amyloid precursor protein processing through the inhibition of β -secretase. The results indicate that P7C3 molecule can efficiently bind to the β -secretase active site. The direct interactions of P7C3 with A β peptide are also important but in a lesser extent.

There are contradictory reports about the efficacy of minocycline for treating schizophrenia. This is a randomized, placebo-controlled clinical trial investigating the effectiveness of minocycline for treating schizophrenia. Forty three patients with schizophrenia diagnosed according to DSM-IV were randomly allocated into minocycline (200mg/d) + risperidone group (n = 21) or placebo + risperidone group (n = 22). Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Syndrome Scale for schizophrenia (PANSS), Beck's Depression inventory, and Abnormal Involuntary Movement Scale (AIMS) were used. Assessments occurred at baseline, week 4 and week 8. Thirty five patients completed the trial. The changes of SANS total score from baseline to week 4 were not statistically different between the two groups. However, at week 8, there was a statistically significant difference between the two groups. SANS score decreased in the minocycline group more than that of the placebo group (12.2(7.9) versus 6.8(8.6), respectively). The decline of PANSS Negative score from baseline to week 8 in the minocycline group was more than placebo group (4.3(4.2) versus 3.2(3.3). However, the difference was not statistically significant. No one dropped out due to adverse effects. This trial supports the effectiveness of minocycline as an adjuvant treatment with risperidone for treating negative symptoms of patients with schizophrenia. Some patents on the use of tetracycline for the treatment of schizophrenia are also outlined.

To determine usage of polytetrafluoroethylene, Gore-Tex, as a stent in patients with congenital cervicovaginal agenesis. Follow-up study. Tertiary center referral hospital. Eight patients with Mullerian agenesis who had congenital cervical agenesis, associated with partial or complete vaginal aplasia. Laparoscopic uterovaginal anastomosis with placement of a polytetrafluoroethylene stent for reconstruction of cervical agenesis. In cases associated with vaginal agenesis, modified McIndoe vaginoplasty was done concomitantly. Eight patients with cervical agenesis who had partial and complete vaginal aplasia underwent vaginoplasty. Mean (SD) follow-up after surgery (3 years old). All patients except three of them, (62.5 %) experienced relief of abdominal pain and regular menstruation. Due to ascending infection three of them (37.5 %) needed reoperation. So, they underwent laparotomy. Two of these three patients had total abdominal hysterectomy and one case tolerated resection of right obstructed side of didelphys uterus, then she became pregnant spontaneously. Four out of these eight cases were married and the others were single. One out of our married patients conceived three times. Her first pregnancy was aborted. She delivered two alive babies after inserting transabdominal Shirodkar suture in her other pregnancies. Uterovaginal anastomosis assisted laparoscopy with polytetrafluoroethylene (Gore-Tex) is effective and hopeful to relieve patients’ symptoms, menstruation regularity, and saving fertility. If ascending infection threatening health happens, hysterectomy will be recommended.

TAFRO syndrome is a new presentation of idiopathic multicentric Castleman disease which is termed as thrombocytopenia, anasarca, myelofibrosis, renal failure and organomegaly (TAFRO). The exact pathophysiology of TAFRO syndrome is unclear and management is mostly based on case reports and expert opinion. In this report, a 37 years old male patient with TAFRO syndrome is discussed. The patient was referred with fever, sweating, anorexia, abdominal distension and generalized edema which has been hospitalized multiple times for such complaints. The patient also developed skin lesions dispersed in red nodules, which was reported as "granuloid hemangioma". Renal biopsy suggested mesangioproliferative glomerulonephritis and bone marrow specimen showed hypercellular active marrow with reticulin fibrosis. The lymph node biopsies were reported as Castleman disease. This report demonstrates that different manifestations of TAFRO syndrome may overlap with other syndromes and can be managed by Bortezomib and Tocilizumab.

Background Accurate and accessible diagnosis is key for the control of visceral leishmaniasis (VL). Yet, current diagnostic tests for VL have severe limitations: they are invasive or not suitable as point of care (POC) test or their performance is suboptimal in East Africa. We analysed the antigens in the VL serodiagnostics development pipeline to identify shortcomings and to propose strategies in the development of an alternative POC test for VL in East Africa. Objectives The objective of this study was to identify and to analyse all antigens for VL serodiagnosis that have been published before 2018 in order to identify candidates and gaps in the pipeline for a new POC test in East Africa. Methods A systematic literature search was performed on PubMed for original research articles on Leishmania-specific antigens for antibody detection of VL in humans. From each article, the following information was extracted: the antigen name, test format and characteristics, its reported sensitivity and specificity and study cohort specifications. Results One hundred and seven articles containing information about 96 tests based on 89 different antigens were included in this study. Eighty six of these tests, comprising 80 antigens, were evaluated in phase I and II studies only. Only 20 antigens, all of which are native, contain a carbohydrate and/or lipid moiety. Twenty-four antigens, of which 7 are non-native, are composed of antigen mixtures. Nineteen tests, comprising 18 antigens, have been evaluated on East African specimens, of which only 2 (rK28 based immunochromatographic test and intact promastigote based indirect fluorescent antibody technique) consistently showed sensitivities above 94 and specificities above 97% in a phase III study and one in a phase II study (dot blot with SLA). Only rK28 is a non-native mixture of antigens which we consider suitable for further evaluation and implementation. Conclusions The development pipeline for an alternative serodiagnostic test for VL is almost empty. Most antigens are not sufficiently evaluated. Non-protein antigens and antigen mixtures are being neglected. We propose to expand the evaluation of existing antigen candidates and to investigate the diagnostic potential of defined non-native carbohydrate and lipid antigens for VL serodiagnosis in East Africa., Author summary Visceral leishmaniasis is a potentially fatal disease that affects more than 20 000 people every year. Its diagnosis is difficult since the clinical symptoms are not specific and the existing diagnostic tests are not useful in limited resource countries or they a not accurate enough in East Africa. In this review we performed a systematic search of the published literature to analyse the potential candidate antigens in the pipeline for a new antibody detection test in East Africa. We found 96 tests based on 89 antigens. Eighty six of these tests were evaluated in a study design that is insufficient (phase I and II) to make conclusions on their performance in clinical practice. We found that the candidate antigens either lacked carbohydrate or lipid structures or are based on single antigens as opposed to mixtures or are extracted from the causative parasite itself, making them expensive and prone to variations. Considering that the most widely used diagnostic test does not detect all cases of visceral leishmaniasis in East Africa, we analysed how many of the candidate antigens were tested on East African specimens: We found that only 2 tests (rK28 based immunochromatographic test and the intact promastigote based indirect fluorescent antibody technique) that were tested in a phase III study and only one (dot blot with SLA) that was tested in a phase II study performed well according to our criteria. Due to the antigen characteristics we consider only the rK28 based test as suitable for further evaluation and implementation.

Cytokines are the main factors involved in the normal functions of the placenta and delivery process. The aim of this project was to compare serum levels of interleukin-8 (IL-8), IL-6, tumour necrosis factor α (TNF-α) and transforming growth factor β (TGF-β) in term and prolonged-pregnancy mothers and their neonates. This study was performed on 240 participants including 60 term and prolonged-pregnancy neonates and their corresponding mothers. Serum levels of IL-8, IL-6, TNF-α and TGF-β were evaluated by the enzyme-linked immunosorbent assay technique. The results revealed that IL-8 serum levels were significantly lower in the prolonged-pregnancy mothers and their neonates when compared with term mothers and their neonates. Data analysis also revealed a negative correlation between TGF-β and age of prolonged-pregnancy mothers. A poor positive correlation between IL-6 and head circumference of term neonates was also observed. IL-8 may play crucial roles in the process of on-time delivery and age may significantly affect TGF-β production in prolonged-pregnancy mothers. Pro-inflammatory cytokines, such as IL-6, can also be considered as main factors involved in fetal growth.

Rhabdomyolysis is a common condition with potentially devastating complications, and only few therapeutic options are available for the treatment of acute Rhabdomyolysis. In this case, a 56-year-old male who had been drinking alcohol, presented to the emergency department for evaluation of slurred speech, ataxic gait, mood instability, and cognitive disorder. On admission, his creatine kinase (CK) level was 2882 U/L. Despite aggressive fluid repletion, his CK level continued to increase, peaking at 11350 U/L. On administration and after the fluid transfusion with isotonic saline, his CK levels and clinical symptoms improved dramatically. We report this case as it is a rare condition of rhabdomyolysis due to alcohol, with the intent to highlight its clinical features and paraclinical finding.

The purpose of this study is to evaluate the influence of body mass index (BMI) on the reproductive outcomes and clinical pregnancy rate after in vitro fertilization (IVF).This retrospective study was performed on 230 women undergoing first cycle of standard IVF between October 2008 and February 2010. The patients were classified into three groups according to their BMI (BMI20 kg/m², 20 kg/m²BMI27.9 kg/m² and BMI28 kg/m²). Information regarding clinical pregnancy was compared within these three groups.There was no significant relation between BMI and age, the number of aspirated follicles, transferred embryos, mature oocytes, days of taking human menopausal gonadotropin (HMG) ampules and the total number of HMG ampules among three BMI studied groups. Statistically significant difference was detected between BMI and endometrial thickness.BMI has no effect on IVF outcomes and clinical pregnancy after IVF. However, losing weight in obese women seems reasonable to prevent possible obstetrics complications.

Background:There are therapeutic dilemmas regarding fertility-preserving treatment among young women with well-differentiated endometrial carcinoma.Materials and Methods:Twenty-one patients with stage IA well-differentiated endometrial adenocarcinoma were enrolled in a prospective study. The treatment initiated with 160 mg/d of megestrol acetate. The patients underwent dilatation and curettage and hysteroscopy after 3 months, and in cases of normal pathology, the therapy continued for another 3-month period. In patients who did not respond to treatment, the dosage of the drug was doubled (320 mg/d), and the therapy continued for another 3 months. At the second time, patients who did not respond to treatment were recommended for hysterectomy, and in patients who responded to treatment, an additional 3 months of treatment with megestrol acetate (320 mg/d) was administered.Results:Our results showed a response rate of 85.71% (18 patients), and 3 patients underwent hysterectomy. The mean (SD) treatment duration was 8.85 (2.00) months (range, 6-12 months). The response to therapy was observed in 5 patients (27.78%) with a dosage of 160 mg/d, and the remaining patients with 320 mg/d. Pregnancy occurred in 5 patients (27.78%). Recurrence happened in 3 (16.67%) of 18 patients who responded to treatment who did not give a permit to undergo hysterectomy and received medication again. Two (66.67%) of these patients experienced remission again, whereas the other one was candidate for hysterectomy.Conclusions:The results of this study show that, when an initial response is not achieved or when disease recurs, use of 320 mg/d seems to be associated with a better therapeutic response. Furthermore, serious complications were not observed with this dosage.

The association between polymorphisms of glutathione S-transferase Z1 (GSTZ1) and susceptibility to bipolar disorder (BPD) is investigated. This study was performed on 228 BPD patients and 234 control subjects. Among early-onset patients, the variant alleles of Glu32Lys and G-1002A increased BPD susceptibility. The haplotype "-1002G, 32Glu, 42Gly" versus the other haplotypes was significantly decreased among early-onset patients compared to controls (P=0.016).