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The assassination of Major-General of the Quds Force Qasem Soliemani by the United States military jets on 2 January 2020 put relations between America and Iran on a knife-edge. The assassination has opened a new and possibly more devastating and deadly chapter in the relationship between a super-power and an emerging regional. While relations have long been characterized as bad between the United States and Iran, since just after 1978 when the Islamic Revolution forced the Shah to abdicate and when young revolutionaries took over the US Embassy in Tehran with 52 American hostages, today rapport between the two states is poised for a major war. However, Donald Trump, who ordered the assassination, has subsequently sought to de-escalate, saying the United States is not seeking military conflict with Iran, and merely wants it to renegotiate the 2015 Joint Comprehensive Plan of Action it signed with the different world powers. In this analysis, the author examines the factors that lead to the rising international tensions examining the different actors that have come into play including Iran and its political leadership starting from the country‟s supreme leader Ali Khamenei, Prime Minister Hassan Rouhani, and Jawad Zarif, the country‟s Foreign Minister. As well, as the international dimension that includes Russia and all members of the UN Security Council, Iran‟s regional role in the Arab world is examined with analysis centering on its implications and its interlocking aspects with world powers. United States relations with Iran had been long and checkered. In this respect, this paper focuses on the historical aspects of diplomacy between Tehran and Washington that started in the early 1950s and developed smoothly till 1978. [ABSTRACT FROM AUTHOR]

Background and Aims: Antibiotics are known as the most useful and effective drugs in the treatment of infectious diseases in humans and animals. The indiscriminate use of antibiotics directly or indirectly, for instance through raw animal products such as milk, can cause health problems in human societies. The specific aim of this study was to determine the level of antibiotic residue in raw and pasteurized milk in Gilan province. Materials and Methods: In this study 30 pasteurized milk samples of randomly selected brands and 570 raw cow milk samples from milk collection centers in 15 cities of Gilan province were collected. The samples were analyzed by coupon test. Results and Conclusions: Antibiotic residue was observed in 179 (31.4%) and 18 (60%) samples out of the 570 raw and pasteurized cow milk samples, respectively.. According to dairy per capita consumption in Gilan province, this rate of contamination affects a considerable part of the population. It can therefore be concluded that the contamination of dairy products to residual antibiotic can be considered an important factor threatening human health and should be considered in the quality control of milk and dairy products. [ABSTRACT FROM AUTHOR]

Introduction: Toxoplasmosis, one of the most common infectious diseases among humans and livestock, with its operating Toxoplasma gondii, a protozoa intracellular parasites, may cause serious infections in humans and animals to be domesticated. Epidemiologic studies show Toxoplasma antibodies in the serum for at least 1/3 adult population in most countries, however, previous infection and spread of organisms represents a broad and powerful contact and ability of Toxoplasma to infect humans. Serologic tests for the diagnosis of toxoplasmosis are often the size of the antibodies used. Objective: Prevalence of Serum Antibodies (IgM and IgG) Toxoplasma gondii in Guilan by ELISA Method Materials and Methods: In this descriptive and analytical study, 800 sera of individuals referred to the medical diagnostic laboratories in Guilan in 1391 were randomly selected, and using ELISA, IgG and IgM antibodies against Toxoplasmosis were measured. Results: Based on the results of total 800, of the 301 men and 499 women, 261 (62/32 percent) had IgG antibody against a Toxoplasmosis of IgM antibody and all were negative. Population of men (9/87 percent) and women (22/75%) of IgG antibody were detected. Using chi square test, no significant relationship was found between antibody prevalence and age, sex, job location and no history of contact with pets. Conclusion: The results confirm the necessary test to diagnose toxoplasmosis. Promotion of health awareness among people can also reduce the risk of toxoplasmosis. Conflict of interest: non declared [ABSTRACT FROM AUTHOR]

Introduction: Intestinal parasitic infections are among the most important health problems in different communities and even in developed countries. The adverse effects of these parasites on the development of human communities have been pointed out by WHO. Geographical situation, cultural and social behaviors, lack of safe drinking water and poor health standards, especially in rural areas are among the factors which affect the prevalence of parasitic infections in Iran. Objective: To evaluate the prevalence of intestinal parasitic infections in the urban areas of Bandar-Anzali district, northern Iran. Materials and Methods: A cross-sectional study was conducted from March 2010 to March 2011 in six different locations of Bandar-Anzali district, Guilan provine, northern Iran. A total of 700 fecal samples from different age groups were collected in clean plastic containers and examined for intestinal protozoa and helminthes using formalin- ether concentration and direct saline thin smear (for watery samples) techniques. Chi-square and Fisher's exact tests were used for statistical analysis. The p-values were considered statistically significant at p<0.05. Results: Of the 700 examined people, 457 cases (65.3%) were female and 243 cases (34.7%) were male. The overall prevalence of intestinal parasitic infections was 15.1%, of which 3.3% belong to pathogenic parasites. The most prevalent pathogenic parasites were sequentially Giardia lamblia (2.14%), Strongyloides stercoralis (0.9%) and Hymenolepis nana (0.3%). The highest prevalence of pathogenic parasites was seen in 10-49 age group and the lowest in ages over 50 years. Intestinal pathogenic parasitic infections were more endemic in females than that in males, 65.2% versus 34.8 %, respectively. Blastocystis hominis (6.4%), Endolimax nana (3.9%), Entamoeba coli (2.6%), Iodamoeba buetschlii (0.3%) and Entamoeba histolytica/E. dispar (0.1%) were the most non-pathogenic parasitic protozoa in the studied population. Conclusion: According to the results, the overall prevalence of intestinal parasitic infections in Bandar-Anzali was found to be 3.3% which indicates a significant decrease, in comparison to the reported prevalence in past decades. The explanation could be improvements in environmental and personal health, drinking water and food safety, public health education and proper waste disposal. Conflict of interest: non declared [ABSTRACT FROM AUTHOR]

Background: Fascioliasis is one of the most common zoonotic diseases in Iran and other parts of the world. Although the largest epidemic of this disease has occurred in northern provinces of Iran (Guilan) during the past two decades and a few cases have also been reported in Tehran and the other provinces, there has been no evidence of its' occurrence in western provinces of Iran such as Kermanshah before the outbreak which is being reported. Methods: The study was conducted by teamwork of infectious disease specialist, parasitologist, general practitioner, entomologist, and laboratory technician. It is an "epidemic investigation" and a cross sectional descriptive one. Clinical data and para-clinical changes are recorded considering all of the population of a village in Kangavar, one of the suburbs of Kermanshah (western Iran). Results: The mean age was 21.65, (SD=12.44). Fifty three percent were female, and all of them were farmers. Eighty two percent had a history of watercress ingestion in a period of 1-2 months before the admission and 18% consumed other vegetables. The average of eosinophils was 32.35% (SD=26). The patients' Enzyme Linked Immunosorbent Assay (ELISA) and Counter Current Immuno-electrophoresis (CCIE) serological tests were reported positive by the department of parasitology, Pasteur Institute of Iran. Treatment response to triclabendazole was excellent. A ten-year clinical and laboratory follow-up revealed no evidence of abnormality in treated patients. Conclusions: It was the first case of human fascioliasis in west Iran and was a real epidemic and an emerging infectious disease for this area at that time. The clinical symptoms were less severe compared with other reports. Health education to inhabitants and health care workers can lead to rapid detection of such outbreaks. [ABSTRACT FROM AUTHOR]

Background: The endemicity and transmission intensity levels of malaria are related to genetic diversity of the parasites. Merozoite surface protein 3β (MSP3β) is an important marker for assessing the polymorphic nature of Plasmodium vivax while it is also a vaccine candidate against the parasite. Patients and methods: In this study we investigated the genetic structure of P. vivax population by sequence analysis of a polymorphic region of the P. vivax MSP3β gene in isolates from Iran. Blood samples were collected from 100 patients with clinical symptoms. DNA was extracted and the target gene was amplified by polymerase chain reaction (PCR). The sequences of 17 samples were used for sequence analysis using nucleotide Blast search and ClustalW multiple alignment. Phylogenetic tree was derived to describe the geographical branching and relationships. Results: A large number of nucleotide insertions and deletions were observed in the sequences of polymorphic region of PvMSP3 β gene that were not specific in each biotype. Single nucleotide polymorphism (SNP) was found extensively in the sequences. The phylogenetic analysis did not show any significant geographical branching. Conclusion: The lack of any geographical branching and extensive polymorphism in MSP3β gene of P. vivax isolates suggests that more investigations are needed to find a more suitable gene in order to develop a vaccine. [ABSTRACT FROM AUTHOR]

Background: Quantifying the quality of care in high-cost and fatal conditions such as acute myocardial infarction (AMI) is a crucial step toward improving clinical outcomes in these patients. The main objective of this pilot study is to show whether abstraction of medical charts would be a useful method to systematically assess quality of care in patients hospitalized for AMI in a general hospital that has no interventional cardiac technology. Methods: A general physician and a cardiologist working with Shahid Gholipour Hospital in Bukan, Northwest Iran, retrospectively abstracted medical records of all patients with verified diagnoses of myocardial infarction who were hospitalized between April 1, 2010 and March 31, 2011. The targeted outcome variables were risk-adjusted mortality and risk-adjusted length of hospital stay. Process quality indicators were selected from those developed by the National Quality Forum (NQF) of the United States. We reported completeness of selected variables used to build and calculate quality indicators in this study. Results: For most variables, missing values were negligible. However, missing data on fields related to contraindications for prescribed medications were common. Conclusions: Medical chart abstractions provide useful first steps in assessing differences in the quality of hospital care for patients with AMI. Extension of our pilot study is highly recommended and may help trigger policy decisions to promote hospital quality in Iran. [ABSTRACT FROM AUTHOR]

In south-eastern Iran, the sulfadoxine-pyrimethamine (SP) combination has been used to treat malaria caused by chloroquine-resistant Plasmodium falciparum. To explore the molecular basis of antimalarial resistance in this region, the dhfr, dhps and pfcrt genes of 50 clinical isolates of P. falciparum, collected from cases of uncomplicated malaria in 2000-2001, were checked for the point mutations that appear associated with SP or chloroquine (CQ) resistance. The results of the study, which was based on a PCR followed by DNA sequencing, indicated that all 50 isolates presented the DHFR S108N mutation associated with pyrimethamine resistance. Seven isolates (14%) had a triple DHFR mutation (S108N, N51I, C59R) and 32 (64%) had a double mutation in this domain. Thirty-nine isolates (78%) had the wild-type DHFR 51 codon but only 15 (30%) had the wild-type DHFR 59 codon. Eleven isolates (22%) only had the DHFR S108N mutation. All isolates had the wild-type DHPS 436 and 540 codons and all but two of the isolates had the wild-type DHPS 437 codon. All isolates but one had the PFCRT K76T mutation associated with CQ treatment failure. The results of this preliminary investigation indicate that SP may remain the treatment of choice for cases of uncomplicated malaria in south-eastern Iran. [ABSTRACT FROM AUTHOR]

Background: Premature neonates need adequate nutritional support to provide sufficient essential nutrients for optimal growth. Calcium (Ca) is one of the important nutrients in parental nutrition support of premature infants. This study aimed to compare the effect of continuous and intermittent bolus infusion of Ca on the incidence of metabolic bone disease (MBD) in preterm infants., Methods: This randomized double-blind clinical trial was conducted on ninety preterm infants in the NICU of Al-Zahra Hospital in Tabriz, Iran. The preterm infants were randomly allocated to either a continuous infusion group (received 4-5 ml/kg/day of Ca gluconate 10% by PN solution in a 24-h period) or an intermittent bolus administration group (received 1-2 ml/kg/day Ca gluconate 10% three to four times per day). Serial serum levels of Ca, phosphorous, alkaline phosphatase (ALP), vitamin D and parathyroid hormone (PTH) were assessed on the 7th day, 30th day and 45th day of life., Results: A total of 78 infants completed the study. The serum ALP level on the 45th day after birth was 753.28 ± 304.59 IU/L and 988.2 ± 341.3 IU/L in the continuous infusion and intermittent bolus administration groups, respectively (P < 0.05). MBD in preterm infants with ALP levels above 900 IU/L on the 45th day of life was significantly lower in the continuous infusion group than in the intermittent bolus administration group (p < 0.05). The mean serum levels of calcium, phosphorus, vitamin D and PTH in 45-day-old infants were not significantly different between the two groups., Conclusion: The MBD in preterm infants who received continuous infusion of Ca was lower than that in preterm infants who received intermittent bolus administration of Ca., Trial Registration: The Iranian Registry of Clinical Trials ( http://www.irct.ir ) with the identification No. IRCT20210913052466N1., (© 2024. The Author(s).)

Purpose: Multi-drug resistant (MDR) Acinetobacter baumannii has introduced a worldwide health crisis. The purposes of this study were to characterize the clonal relatedness among MDR clinical strains and to introduce a new two-locus typing method confirmed by multi-locus sequence typing (MLST)., Methodology: In this study, we determined antimicrobial resistance, detected genes associated with carbapenem resistance and characterized clonal relatedness among 99 clinical isolates extracted from 82 hospitalized inpatients in a university hospital., Results: Of the 99 A. baumannii isolates, 92.9% (92/99) were resistant to imipenem and 97.9% (97/99) had an MDR profile. We found that the high prevalence of blaVIM [94.9% (94/99)] and blaOXA-23-like [93.93% (93/99)] is the main mechanism of carbapenem resistance. This study proposes a new two-locus typing (blaOXA-51-like and ampC) method for the rapid identification of clonal complexes (CCs). The results of this method and confirmation by MLST show that clinical isolates carry blaOXA-68 as well as ampC-10 or ampC-20 genes belonging to CC10 (ST10); blaOXA-66 and ampC-2 belonging to CC2 (ST2); and blaOXA-71 and ampC-3 belonging to CC3 (ST3). One isolate had blaOXA-90 with an undetermined allele number of ampC belonging to ST513., Conclusion: The high prevalence of MDR strains and the circulation of four limited clones, including ST10 (45/99), ST2 (41/99), ST3 (12/99) and ST513 (1/99), in the clinical setting highlights the importance of a rigorous infection control programme. The two-locus typing method has more discrimination than the application of each method separately and it could be applied for the rapid determination of the CC without performing MLST.

Background: Tick-borne relapsing fever is an acute febrile and endemic disease in Iran. For many reasons, the incidence of disease is on decrease, however tick-borne relapsing fever is still a health issue in the rural areas for travelers. This study was carried out during 1997-2006 to investigate the tick-borne relapsing fever in Iran., Methods: Based on a cross-sectional, retrospective and descriptive study in all the provinces, the residents in the endemic areas who were febrile and suspicious to tick-borne relapsing fever were enrolled in the study. Tick-borne relapsing fever is a notifiable disease in Iran and the national communicable disease surveillance data were used through questionnaires. The infectivity of Ornithodoros species to Borrelia also was studied in two highly endemic areas including Hamadan and Qazvin provinces., Results: During 1997-2006, a total of 1415 cases have been reported from the entire country. The highest prevalence was observed in year 2002 with the incidence rate of 0.41/100,000 population. Ardabil province is the first ranked infected area (625 out of 1415), followed by Hamadan, Zanjan, Kurdestan and Qazvin provinces sequentially. The disease is recorded during the whole year but its peak occurs during summer and autumn. There have been 87.6% of the cases recorded from June to November. Forty five percent of the infected cases were male and one third of the patients were under 5 years of age. Fifty four percent of the patients comprise the children under 10 years. Ninety two percent of the cases were living in rural areas where their dwellings were close to animal shelters. They were involved mainly with farming and animal husbandry activities. All the febrile patients with confirmed spirochetes in their blood samples were treated according to a national guideline for tick-borne relapsing fever treatment. Only 7% of the patients were hospitalized and 0.8% of them exhibited the Jarisch-Herxheimer reaction. The study of infectivity of Ornithodoros species to Borrelia revealed that Ornithodoros tholozani was infected with Borrelia persica and Ornithodoros erraticus with Borrelia microti., Conclusion: Travelers to the rural areas with high prevalence of the disease should be made aware of the risk of tick-borne relapsing fever and use of appropriate control measures. Communicable disease surveillance including tick-borne relapsing fever should be pursued as well.

The variable and conserved sequence boxes of kinetoplast DNA (kDNA) of 11 standard strains of 6 complexes of New and Old World Leishmania were amplified using PCR. Four strains from 2 complexes of Old World Leishmania - L. major (MRHO/IR/64/Nadim-1), with 2 bands at 850 and 620 bp, L. major (MHOM/SU/73/5-ASKH), with a band at 620 bp, L. donovani, with a band at 800 bp and L. infantum, with a band at 650 bp - could be differentiated from each other and from the New World strains, with the exception of L. infantum. Seven Leishmania strains from 4 complexes of New World Leishmania - L. mexicana and L. pifanoi, with a band at 730 bp, L. guyanensis, with 2 bands at 730 and 650 bp, L. peruviana, with a band at 710 bp and L. amazonensis, L. garnhami and L. braziliensis, each with a band at 650 bp - were identified. Of these strains, L. guyanensis and L. peruviana could be differentiated from each other and from the Old World strains. These results show that using PCR amplification of kDNA we could differentiate between New and Old World Leishmania at both complex and strain levels. The amplified kDNA PCR products, together with other techniques, could be useful as a diagnostic tool for the identification of Leishmania species.

The ultrastructure of cells of Borrelia persica was compared with that of cells of a new isolate of Barrelia (Borrelia "x"). This organism (B. "x") was isolated in a region of Iran where B. persica is already known to exist. The morphology of the cells of the two strains differed in mean cell length and cell diameter. Cells of B. persica were covered by a regularly structured surface layer, while those of B. "x" possessed an amorphous surface coat. Furthermore, the strains differed in their experimental pathogenicity for animals. It is concluded that the new isolate represents a new species of the genus Borrelia, and Borrelia baltazardi sp. nov. is proposed.