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In 2022, Archives of Academic Emergency Medicine (AAEM) has published 90 articles, all of which are indexed by SCOPUS, Web of Sciences, PubMed and some other databases. They have been authored by more than four hundred researchers from various countries, including but not limited to the United States, Japan, Korea, Canada, Ghana, France, Norway, India, China, Thailand, Malaysia, Pakistan, Greece, Viet Nam and Iran. In this editorial, we intend to provide an overview of the journal’s flow in 2022, like we did in 2021 (1), so that we can identify our strengths and weaknesses and provide a brief report on our performance to readers and authors, which they might find useful in becoming more familiar with the journal. This article could help the authors who are interested in publishing with us to become more familiar with the journal’s aim and scope, and also the editorial priorities and preferences.

Babesiosis is a zoonosis and an important blood-borne human parasitic infection that has gained attention because of its growing infection rate in humans by transfer from animal reservoirs. Babesia represents a potential threat to the blood supply because asymptomatic infections in man are common, and blood from such donors can cause severe disease in certain recipients. Extracellular vesicles (EVs) are vesicles released by cells that contain a complex mixture of proteins, lipids, glycans, and genetic information that have been shown to play important roles in disease pathogenesis and susceptibility, as well as cell–cell communication and immune responses. In this article, we report on the identification and characterization of EVs released from red blood cells (RBCs) infected by two major human Babesia species—Babesia divergens from in vitro culture and those from an in vivo B. microti mouse infection. Using nanoparticle tracking analysis, we show that there is a range of vesicle sizes from 30 to 1,000 nm, emanating from the Babesia-infected RBC. The study of these EVs in the context of hemoparasite infection is complicated by the fact that both the parasite and the host RBC make and release vesicles into the extracellular environment. However, the EV frequency is 2- to 10-fold higher in Babesia-infected RBCs than uninfected RBCs, depending on levels of parasitemia. Using parasite-specific markers, we were able to show that ~50%–60% of all EVs contained parasite-specific markers on their surface and thus may represent the specific proportion of EVs released by infected RBCs within the EV population. Western blot analysis on purified EVs from both in vivo and in vitro infections revealed several parasite proteins that were targets of the host immune response. In addition, microRNA analysis showed that infected RBC EVs have different microRNA signature from uninfected RBC EVs, indicating a potential role as disease biomarkers. Finally, EVs were internalized by other RBCs in culture, implicating a potential role for these vesicles in cellular communication. Overall, our study points to the multiple functional implications of EVs in Babesia–host interactions and support the potential that EVs have as agents in disease pathogenesis.

Aim:This study aimed to compare two different concentrations of Diphenhydramine vs. Lidocaine for median nerve block in terms of providing required anesthesia for repairing soft tissue injuries.Materials and Methods:This double-blind, randomized clinical trial was conducted in Tehran, Iran, in 2019. Participants were randomly assigned to three groups. Group A received 3 cc of 0.5% diphenhydramine (n=68), group B received 3 cc of 1% lidocaine (n=68), and group C received 3 cc of 1% diphenhydramine (n=68). The onset of action, duration of anesthesia, pain during injection, and patients’ satisfaction level were evaluated between the groups.Results:Two hundred two patients with the mean age of 35.09±13.5 years took part in this study (52.5% of the males). Age (p=0.879), onset of action (p=0.251) and duration of anesthesia (p=0.081) had no significant difference among the three groups. The pain during injection between groups A and B (p=0.001) and between groups B and C (p

Abstract Background Hookworm is a major contributor to worldwide disease burden with over 230 million people infected. It has been identified as one of the Neglected Tropical Diseases that can be controlled and even eliminated through mass drug administration and other effective interventions. Mathematical models have shown that hookworm can only be eliminated via a vaccine. Controlled Hookworm Human Infection (CHHI) models can facilitate rapid development of vaccines and drugs. Methods As a first step towards the establishment of CHHI in Africa, we held a stakeholders meeting in Lamberene, Gabon from 10 to 11 November 2019. Results Discussions revolved around the roles of the different regulatory institutions concerned; the need to strengthen existing regulatory capacity and the role of legislation; creating Gabon-specific ethical guidelines to govern Controlled Human Infection (CHI) studies; development of a study protocol; consideration of cultural and social peculiarities; the need for regular joint review meetings between interested parties throughout the process of protocol implementation; and participant compensation. Moreover, operational considerations concerning the introduction of CHHI in Gabon include the use of the local strain of hookworm for the challenge infections, capacity building for the local production of challenge material, and the establishment of adequate quality assurance procedures. Conclusion The workshop addressed several of the anticipated hurdles to the successful implementation of CHHI in Gabon. It is our aim that this report will stimulate interest in the implementation of this model in the sub-Saharan African setting.

Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory disorder with a tendency to affect the spinal cord and optic nerves. As NMOSDs have a predilection for women of reproductive age and adopt an aggressive course during pregnancy, appropriate treatment strategies before conception and during pregnancy should be well-considered. Case Presentation: In this report, the pregnancy outcome of eight pregnancies following rituximab treatment was assessed, which led to 50% live births with mean birth weight of 2777.50 (SD: 545.92) grams. Two patients had abortions due to doctor’s recommendation. One pregnancy led to intrauterine fetal death (IUFD) due to nuchal cord. No spontaneous abortions were encountered. Two patients received rituximab during pregnancy. No major malformations or serious neonatal infections were encountered. Conclusion: Rituximab should be administered by caution in NMOSD patients who want to be pregnant and the probable adverse effects of the drug should be discussed by patients.

The purpose of this study was to determine the effectiveness of cognitive emotion regulation training on the experiential avoidance of women with obsessive-compulsive disorder in Kermanshah city. The present study was a quasi-experimental. The quasi-experimental design of the present study was pre-test, post-test and follow-up with a control group. In order to select the participants of the study, using Cochran formula, 1500 women aged 20 to 45 years were selected by available sampling. Of the 169 people who received the diagnosis of OCD, 40 people were randomly selected and matched and randomly assigned to experimental and control groups. The members were assigned in such a way that 20 people in the experimental group receive treatment protocol related to cognitive emotion regulation training and 20 people in the control group did not receive any intervention. The Yale Brown Obsessive-Compulsive Disorder Questionnaire and the Multidimensional experiential avoidance Scale were completed in four stages: pre-test, post-test, and first and second follow-up at intervals (one month). For data analysis, the method of analysis of variance with repeated measures was used. The results showed that cognitive emotion regulation training was significant on experimental avoidance in post-test scores. Findings of this study had potentially significant practical effects for therapists to pay attention to the effectiveness of focused therapy on cognitive emotion regulation on the experiential avoidance of female patients with obsessive-compulsive disorder.

Objective: This study aimed to explain the parents’ attitude towards their children with disabilities based on religious belief and social support through the mediating role of marital satisfaction. Method: This was a descriptive cross-sectional study. The statistical population included 200 parents of the students in the schools and care centers for the students with disabilities in Tabriz. The parents were selected through the available sampling method. They completed the questionnaires on parental attitude, marital satisfaction, social support, and religious belief. The software of SPSS-25 and AMOS-18 was used to analyze the data. Findings: The findings of the correlation coefficient showed that there was the highest correlation (0.59) between the positive parents’ attitude towards the children with disabilities and religious belief. Furthermore, the findings of path analysis showed that the highest path coefficient was related to the effect of parents’ attitudes through religious belief (0.38), as well as marital satisfaction, and social support (0.20) respectively. Conclusion: According to these findings, the strong religious belief of people in the society and marital satisfaction and social support will cause the parents to have positive attitudes towards their children and accept them better.

Cellular metabolism is a key determinant of immune cell function. Here we found that CD14+ monocytes from Sub‐Saharan Africans produce higher levels of IL‐10 following TLR‐4 stimulation and are bioenergetically distinct from monocytes from Europeans. Through metabolomic profiling, we identified the higher IL‐10 production to be driven by increased baseline production of NADPH oxidase‐dependent reactive oxygen species, supported by enhanced pentose phosphate pathway activity. Together, these data indicate that NADPH oxidase‐derived ROS is a metabolic checkpoint in monocytes that governs their inflammatory profile and uncovers a metabolic basis for immunological differences across geographically distinct populations. [ABSTRACT FROM AUTHOR]

Chronic infection with Schistosoma mansoni parasites is associated with reduced allergic sensitization in humans, while schistosome eggs protects against allergic airway inflammation (AAI) in mice. One of the main secretory/excretory molecules from schistosome eggs is the glycosylated T2-RNAse Omega-1 (ω1). We hypothesized that ω1 induces protection against AAI during infection. Peritoneal administration of ω1 prior to sensitization with Ovalbumin (OVA) reduced airway eosinophilia and pathology, and OVA-specific Th2 responses upon challenge, independent from changes in regulatory T cells. ω1 was taken up by monocyte-derived dendritic cells, mannose receptor (CD206)-positive conventional type 2 dendritic cells (CD206+ cDC2), and by recruited peritoneal macrophages. Additionally, ω1 impaired CCR7, F-actin, and costimulatory molecule expression on myeloid cells and cDC2 migration in and ex vivo, as evidenced by reduced OVA+ CD206+ cDC2 in the draining mediastinal lymph nodes (medLn) and retainment in the peritoneal cavity, while antigen processing and presentation in cDC2 were not affected by ω1 treatment. Importantly, RNAse mutant ω1 was unable to reduce AAI or affect DC migration, indicating that ω1 effects are dependent on its RNAse activity. Altogether, ω1 hampers migration of OVA+ cDC2 to the draining medLn in mice, elucidating how ω1 prevents allergic airway inflammation in the OVA/alum mouse model. Author summary: Asthma is a chronic inflammatory disease, leading to cough, wheeze, and shortness of breath. The prevalence has increased drastically in Westernized societies and is now increasing in low- and middle-income countries. Chronic infection with the parasitic helminth, Schistosoma (S.) mansoni protects against allergic airway inflammation (AAI) in mice, and is associated with reduced skin prick test positivity to inhaled allergens in humans. Here we show that peritoneal administration of ω1, a single glycoprotein secreted by S. mansoni eggs, reduced OVA/alum-induced AAI. ω1 is taken up in the peritoneal cavity by dendritic cells (DCs) expressing the mannose receptor, reducing their expression of CCR7 and migratory capacity to the draining mediastinal lymph nodes. This results in accumulation of DCs in the peritoneal cavity of allergic mice and reduced numbers of DCs reaching the draining lymph nodes. The effects observed for ω1 is dependent on its RNAse activity, since the RNAse mutant form of ω1 was unable to reduce AAI nor affect DC migration. Our findings provide insights into how ω1 can modulated the immune response during allergic inflammation, and this may open new avenues for the development of novel therapeutic strategies for allergic asthma. [ABSTRACT FROM AUTHOR]

Schistosomiasis is an infection caused by contact with Schistosoma-contaminated water and affects more than 230 million people worldwide with varying morbidity. The roles of T helper 2 (TH2) cells and regulatory immune responses in chronic infection are well documented, but less is known about human immune responses during acute infection. Here, we comprehensively map immune responses during controlled human Schistosoma mansoni infection using male or female cercariae. Immune responses to male or female parasite single-sex infection were comparable. An early TH1-biased inflammatory response was observed at week 4 after infection, which was particularly apparent in individuals experiencing symptoms of acute schistosomiasis. By week 8 after infection, inflammatory responses were followed by an expansion of TH2 and regulatory cell subsets. This study demonstrates the shift from TH1 to both TH2 and regulatory responses, typical of chronic schistosomiasis, in the absence of egg production and provides immunological insight into the clinical manifestations of acute schistosomiasis. Editor's summary: Schistosomiasis infection causes more than 230 million infections worldwide, but immune responses during acute infection are not well understood. To better observe these responses, Houlder et al. used controlled human Schistosoma mansoni infections with either male or female cercaria-stage parasites. T helper 1 (TH1) cell–biased inflammatory responses dominated at early time points (4 weeks after infection), and male and female parasites induced similar responses. At 8 weeks after infection, TH2 and regulatory cell responses were more dominant and were consistent with responses seen during chronic infection. These results highlight the shift in immune responses occurring over the course of infection. —Christiana Fogg [ABSTRACT FROM AUTHOR]

Introduction There have always been two viewpoints on the human rights in the history of Western philosophy: some philosophers adhere to Natural Law, while the others follow Positive Law. Among modern philosophers, Thomas Hobbes and John Locke, and among the contemporary ones, Lon L. Fuller and John Finnis, are known to be followers of natural law. Positive law refers to the rights established by the legislator and recognized through interpersonal conventions and contracts; people and states may establish or lift them. As a matter of fact, this kind of law is focused on a set of rules and regulations which gains force through guarantee and acceptance of social institutions and governs a certain community during a specified time frame. Natural law, with its characteristics, i.e. universality, necessity, and stability, began to popularize in the West in the third century AD, but it is rather newly-established among Islamic scholar. It constitutes the origin of many governing rules in communities, so this topic deserves considerable debate and discussion by Islamic scholars. Rights, observance, setting up justice, and preventing injustice are of utmost importance in Islamic teachings; they also influence many religious acts, and Islamic doctrines strongly enjoin it and emphasize its moral, legal, and ideological necessity. Undoubtedly, the concept of human rights is one of the modern challenges facing Islam in comparison with the West, and it is going to take a more serious form in the future. The current paper did not search for strong and weak points of the theory of rational decency and obscenity and natural human rights and did not pass any judgment thereof; this paper aimed to analyze the ideas of Sadr al-Din Shirazi (Mulla Sadra) as the founder of transcendental philosophy/theosophy, esp. the theory of decency and obscenity, and sought to answer the following question from his viewpoint: In Mulla Sadra’s opinion, are decency and obscenity rational and inherent? If so, is it possible to attribute the belief in natural human rights to him? The Study of these items from the viewpoint of Mulla Sadra and the analysis and evaluation of them will provide answers to above questions. The current paper focused on proving the following line of argument based on its multiple premises: - Premise 1: Duties/obligations bring rights with them. - Premise 2: Duties are congeneric with their rights. For instance, if a duty is conventional, its interrelated right will be conventional too, and if it is religious, i.e. originating in a divine command, the interrelated right will be religious too, having its roots in a divine command and providence. - From Mulla Sadra’s perspective, duties, decencies, and obscenities are inherent. Conclusion: Mulla Sadra believes that rights accompanying duties are inherent, incorporated in the center of reality. Apophatic interpretation of the duty as it is necessary to respect the freedom/ liberties of humans (It is decent to respect the freedom of humans.) consists in: “Humans should not be deprived of freedom.” (It is obscene to deprive humans of the freedom.) This duty is interrelated with a human right: humans enjoy the right to freedom. 2. Methods and Material we did this within the framework of Mulla Sadra’s perspective on ethical values. The data were gathered through library research and the conclusions were reached using a logical, deductive method. 3. Results and Discussion Although the discussion of rights is apparently different from the discussion of ethical values, these two topics can be linked according to some views; the foundations raised in one area can be extended to another, and we may conclude that although Mulla Sadra did not expressly state his acceptance of natural human rights, his ideas were in conformity with Inherent Natural Rights based on evidence and rational reasoning taken from his moral views. 4. Conclusion This paper used sufficient evidence to show that the theory of Mulla Sadra chosen in this regard was rational and inherent decency and obscenity. Regarding the question of Mulla Sadra belief in rational or inherent decency and obscenity, this paper answered that he believed in inherent, and not divine, decency and obscenity, in terms of ontology (real/outside world and universe of permanent positiveness) and believed in rational decency and obscenity in terms of epistemology (understanding and proving), not religious decency and obscenity. Ash’aris supported divine and religious decency and obscenity, but Mulla Sadra said this view would dispel wisdom, reason, and religion. In relation to understanding decency and obscenity and the intellectual ability of humans, Mull Sadra maintained that only a perfect human was able to grasp the inherent properties of acts not all people. In addition, different views on the contradiction and interrelation of rights and duties were covered, and it was proved that most scholars approved the existence of a relationship between natural human rights and belief in inherent and rational decency and obscenity. Only those who accept inherent decency and obscenity may support natural, innate rights, because the duties are congeneric with their interrelated rights. Thus Mulla Sadra who was a moral realist and believed in inherent decency and obscenity and considered all duties, decencies, and obscenities inherent would adhere to inherence or naturalness of rights. In summary, Mulla Sadra believed that humans, qua humans, enjoy universal, necessary, fixed rights which result from their nature and character, unaffected by time and space. These rights which are in total coordination with creation and universe are called Natural, Inherent, or Innate rights. Although Mulla Sadra did not mention explicitly the inherent decency and obscenity of duties and the inherence and naturalness of humans rights, it is possible to deduce these two points from his theoretical foundations and some views plus supporting premises.

The goals of this study were to assess the microbiological quality and coastal water quality index (CWQI) in the Persian Gulf alongshore of Bandar Abbas city. Water samples were collected from five different coastal sites in spring and summer seasons. To assess the microbiological quality: Total Coliforms, Fecal Coliforms, Fecal Streptococci and Clostridium perfringens were measured. Also, eight physicochemical parameters (DO, BOD, TSS, Turbidity, Temperature, pH, Nitrate, Phosphate) were examined for calculating the CWQI. The mean for microbiological indicators was respectively, 3667, 1055, 50, 211 MPN/100ml. for physicochemical parameters, the average of water temperature was 32 °C, electrical conductivity was 57mmho/cm, the turbidity was 70.7 NTU, pH 8.1, and also the average concentration of phosphate, nitrate, nitrite, and ammonium was 180, 18.2, 4.9, 12.16μmol/L, and the mean of concentration BOD, COD and DO were 4.89, 11 and 6.8mg/L, respectively. In addition, the water quality index for all months and at selected stations was 65. The results showed that in the most samples the levels of microbiological indicators were exceeded the national standard and guideline values. Also, the computed CWQI showed that quality of water was weak. All the extracted results are closely related to the inlets connected to the sea. These inlets except the Ghadir station will affect the rest of the stations. In general, in low tide, the Bactria index was more than high tide.

Archives of Academic Emergency Medicine has published 70 articles in 2021, which have been authored by more than three hundred researchers from various countries, including but not limited to the United States, Australia, India, Japan, Thailand, Iraq, Pakistan, France, Greece, and Iran. In this editorial, we intend to provide an overview of our publications in 2021, so that we can identify our strengths and weaknesses and provide a brief report on our performance to readers and authors, which they might find useful in becoming more familiar with the journal.

Metabolomics provides a powerful tool to study physiological changes in response to various perturbations such as vaccination. We explored whether metabolomic changes could be seen after vaccination in a phase I trial where Gabonese adults living either in rural or semi-urban areas received the subunit hookworm vaccine candidates (Na-GST-1 and Na-APR-1 (M74) adjuvanted with Alhydrogel plus GLA-AF (n = 24) or the hepatitis B vaccine (n = 8) as control. Urine samples were collected and assayed using targeted 1H NMR spectroscopy. At baseline, a set of metabolites significantly distinguished rural from semi-urban individuals. The pre- and post-vaccination comparisons indicated significant changes in few metabolites but only one day after the first vaccination. There was no relationship with immunogenicity. In conclusion, in a small phase 1 trial, urinary metabolomics could distinguish volunteers with different environmental exposures and reflected the safety of the vaccines but did not show a relationship to immunogenicity.

Two hookworm vaccine candidates, Na-GST-1 and Na-APR-1, formulated with Glucopyranosyl Lipid A (GLA-AF) adjuvant, have been shown to be safe, well tolerated, and to induce antibody responses in a Phase 1 clinical trial (Clinicaltrials.gov NCT02126462) conducted in Gabon. Here, we characterized T cell responses in 24 Gabonese volunteers randomized to get vaccinated three times with Na-GST-1 and Na-APR-1 at doses of 30μg (n = 8) or 100μg (n = 10) and as control Hepatitis B (n = 6). Blood was collected pre- and post-vaccination on days 0, 28, and 180 as well as 2-weeks after each vaccine dose on days 14, 42, and 194 for PBMCs isolation. PBMCs were stimulated with recombinant Na-GST-1 or Na-APR-1, before (days 0, 28 and 180) and two weeks after (days 14, 42 and 194) each vaccination and used to characterize T cell responses by flow and mass cytometry. A significant increase in Na-GST-1 -specific CD4+ T cells producing IL-2 and TNF, correlated with specific IgG antibody levels, after the third vaccination (day 194) was observed. In contrast, no increase in Na-APR-1 specific T cell responses were induced by the vaccine. Mass cytometry revealed that, Na-GST-1 cytokine producing CD4+ T cells were CD161+ memory cells expressing CTLA-4 and CD40-L. Blocking CTLA-4 enhanced the cytokine response to Na-GST-1. In Gabonese volunteers, hookworm vaccine candidate, Na-GST-1, induces detectable CD4+ T cell responses that correlate with specific antibody levels. As these CD4+ T cells express CTLA-4, and blocking this inhibitory molecules resulted in enhanced cytokine production, the question arises whether this pathway can be targeted to enhance vaccine immunogenicity.