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Additional file 1: Table S1. Frequency of hospital admissions and deaths by county in Kermanshah Province, Iran, during the first year COVID-19 pandemic. Table S2. Outcomes for patients hospitalized with COVID-19 based on hospital. Table S3. Duration from hospitalization to discharge/ death for patients hospitalized for COVID-19 based on hospital.

Naser Nazari,1 Saeedeh Shojaee,2 Mehdi Mohebali,2 Aref Teimouri,2,3 Keyghobad Ghadiri,4 Saber Raeghi,5 Mohammad Reza Shiee,2,3 Yousef Azarakhsh,6 Arezoo Bozorgomid4 1Department of Medical Parasitology and Mycology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 3Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; 4Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 5Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran; 6Department of Biology, Razi University, Kermanshah, IranCorrespondence: Arezoo BozorgomidInfectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranTel +98 918 872 8269Email arezoobozorgomid@yahoo.comPurpose: Rodents live in proximity to humans and domestic animals. These creatures can serve as reservoir hosts for many zoonotic parasites; therefore, they increase the risk of human infections. The aim of this study was to investigate Toxoplasma gondii and Neospora caninum in rodents caught in Meshgin-Shahr District, Iran.Patients and methods: In a cross-sectional study, brain samples were collected from 70 rodents caught in Meshgin-Shahr District during March and December 2015. The specimens were examined for exposure to T. gondii and N. caninum with molecular methods.Results: Seventy rodents were caught, including 50 Meriones persicus, 11 Mus musculus and 9 Cricetulus migratorius. Thirty rodents were female and 40 were males. Using PCR (B1 gene), T. gondii was detected in 7.1% (5/70) of the rodents while N. caninum was not detected. The prevalence of Toxoplasma infection was higher in female rodents (4.28%) compared to male rodents (2.86%), but the difference was not significant.Conclusion: The results showed a low risk of T. gondii and N. caninum among rodents. Finally, further research is needed to understand the role of these rodent species in the transmission of the above protozoan pathogens to humans and livestock in this area.Keywords: rodents, Neospora, Toxoplasma, prevalence, PCR, Iran

Dear Editor-in-Chief, In Annals of Parasitology 2021, 67(1), 55-65, a paper entitled "Genetic characterization and phylogenetic analysis of Fasciola species based on ITS2 gene sequence, with first molecular evidence of intermediate Fasciola from water buffaloes in Aswan, Egypt" was published with great interest [1]. After reading the article carefully and critically, we think some points should be noted. Fasciola species are meiotically functional diploid, can produce sperm and temporarily and store in the seminal vesicles. This type is named spermic fluke [2]. On the other hand, intermediate Fasciola with morphological characteristics intermediates between F. hepatica and F. gigantica with no sperm or aspermic and no sperm in seminal vesicles. However, this is also seen in older flukes [3-5]. It seems that morphological studies based on spermatogenesis ability were necessary for this study. Also, this parasite's anthelmintic resistance is due to aspects of biology, and population structure depends on genetic diversity [6]. We question whether there are any documents about and sequences of mitochondrial markers as COX (Cytochrome Oxidase) and NAD (Nicotinamide Adenine Dinucleotide) to analyze intraspecific phylogenetic relationship in addition to nuclear gene? In Table 3, the pairwise distances between three groups of Fasciola spp. from different livestock animals were low, ranging from 0.004 to 0.01 with an overall mean of 0.008. Genetic diversity is described as a tendency of genetic characteristics to vary and serves as a way for the population to adapt to changing hosts and environments [7]. The nature of the nuclear gene (ITS) is instability. It is better to use mitochondrial sequence data to compare diversity. Also, genetic discrimination grade from infra population to meta population is annotated by Fst value ranging; 0 to 1. Fst values between 0-0.05 indicated a low genetic differentiation population [8]. It seems that by calculating Fst and showing the gene migration based on mitochondrial sequences data of specimens, this study's species population will be obtained. Also, Tajima's D and Fu's F in all loci populations based on GenBank data may show the Fasciola haplotypes' population proximity. Here we recommend, that Omar et al. [1] studies that molecular phylogeny with mitochondrial DNA efectively used for appropriate diferentiation of haplotypes and spermatogenic ability by carmen allium staining helps them find the physiological aspects. Of course, more prominent populations are needed to find intermediate types. [1] Omar M.A, Elmajdoub L.O., Ali A.O., Ibrahim D.A., Sorour S.S., Al-Wabel M.A., Suresh M., Metwally A.M. 2021. Genetic characterization and phylogenetic analysis of Fasciola species based on ITS2 gene sequence, with first molecular evidence of intermediate Fasciola from water buffaloes in Aswan, Egypt. Annals of Parasitology 67: 55-65. doi:10.17420/ap6701.312 [2] Sanderson A. 1953. Maturation and probable gynogenesis in the liver fluke, Fasciola hepatica L. Nature 172: 110-112. doi:10.1038/172110a0 [3] Hayashi K., Ichikawa-Seki M., Mohanta U.K., Singh T.S., Shoriki T., Sugiyama H., Itagaki T. 2015. Molecular phylogenetic analysis of Fasciola flukes from eastern India. Parasitology International 64: 334-338. https://doi.org/10.1016/j.parint.2015.04.004 [4] Ichikawa-Seki M., Tokashiki M., Opara M.N., Iroh G., Hayashi K., Kumar U.M., Itagaki T. 2017. Molecular characterization and phylogenetic analysis of Fasciola gigantica from Nigeria. Parasitology International 66: 893-897. doi:10.1016/j.parint.2016.10.010 [5] Rouhani S., Raeghi S., Mirahmadi H., Fasihi Harandi M., Haghighi A., Spotin A. 2017. Identification of Fasciola spp. in the east of Iran, based on the spermatogenesis and nuclear ribosomal DNA (ITS1) and mitochondrial (ND1) genes. Archives of Clinical Infectious Diseases 12:e57283. doi:10.5812/archcid.57283 [6] Hodgkinson J., Cwiklinski K., Beesley N., Paterson S., Williams D., Devaney E. 2013. Identification of putative markers of triclabendazole resistance by a genome-wide analysis of genetically recombinant Fasciola hepatica. Parasitology 140: 1523. doi:10.1017/S0031182013000528 [7] Bozorgomid A., Rouhani S., Harandi M.F., Ichikawa- Seki M., Raeghi S. 2020. Genetic diversity and distribution of Fasciola hepatica haplotypes in Iran: molecular and phylogenetic studies. Veterinary Parasitology: Regional Studies and Reports 19: 00359. [8] Rouhani S., Raeghi S., Spotin A. 2017. Spermatogenic and phylo-molecular characterizations of isolated Fasciola spp. from cattle, North West Iran. Pakistan Journal of Biological Sciences 20: 204-209.

Alisha Akya,1,2 Roya Chegenelorestani,1 Jila Shahvaisi-Zadeh,3 Arezoo Bozorgomid1 1Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Microbiology, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Arezoo Bozorgomid Infectious Diseases Research CenterImam Reza Hospital, Daneshgah St., Shahid Shiroodi Blvd., Kermanshah 6715847141, IranTel +98-918 872 8269Email arezoobzorgomid@yahoo.comIntroduction: Hospital wastewater contains highly resistant and virulent bacteria that can spread into the environment. This study was conducted to investigate the antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) in raw and treated hospital wastewater.Methods: During a three-month period, 40 sewage samples were collected from the hospital sewage (Kermanshah, Iran), and S. aureus were identified using culture and biochemical tests. MRSA was detected by resistance to cefoxitin. Antibiotic resistance (AR) was determined using disk diffusion according to the Clinical and Laboratory Standards Institute (CLSI) in 20 MSSA (10 raw and 10 treated sewage) and 40 MRSA isolates (20 raw and 20 treated sewage). The antimicrobial resistance genes (ARGs) were determined by PCR.Results: Eleven and eight percent of the isolates were MRSA in raw and treated sewage samples, respectively. Out of 60 isolates, 59 (98%) were multidrug resistant (MDR). The most common ARGs were mecA (raw=100%, treated=100%), aacA-D (raw=100%, treated=85%) and tetK (raw =95%, treated =45%) in MRSA, while the tetM gene was the most abundant gene (raw=50%, treated=80%) in MSSA. None of isolates (n=60) was positive for the vanB gene. MSSR (n=20) had the highest level of resistance against penicillin (100%), clindamycin (raw=90%, treated=90%), azithromycin (raw=80%, treated=90%). All MRSA isolates (n=40,100%) in both raw and treated sewage samples were non-susceptible to penicillin, oxacillin and azithromycin. There was no significant difference in the frequency AR and ARGs between raw and treated sewage samples (p> 0.05).Conclusion: The results indicated a high frequency of MDR and ARGs in both raw and treated sewage isolates which could be released into the environment through sewage system and pose a serious threat to public health. Hospital wastewater treatment processes should be improved in order to prevent the dissemination of the most resistant strains of S. aureus.Keywords: antibiotic resistance, antibiotic resistance genes, hospital wastewater, Staphylococcus aureus

Alisha Akya,1 Arezoo Bozorgomid,1 Kayghobad Ghadiri,1 Mahnaz Ahmadi,2 Azam Elahi,1 Hadi Mozafari,3 Afshin Almasi,4 Parvin Namadi,2 Roya Chegenelorestani1 1Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Fertility and Infertility Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; 4Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranCorrespondence: Roya ChegenelorestaniInfectious Diseases Research Center, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, IranTel/Fax +98 8334262252Email lorestani25@gmail.comBackground: Human brucellosis is a multisystem disease with a wide range of clinical signs which often leads to misdiagnosis and treatment delay. Early diagnosis of this disease can prevent the serious complications and mismanagements. This study aimed to evaluate the hematological parameters with predictive value for the diagnosis of brucellosis.Methods: In this prospective case–control study which was done during 2015– 2017 in Imam Reza Hospital, Kermanshah Province, west Iran, 100 patients with a confirmed diagnosis of brucellosis (brucellosis group) and 100 healthy individuals (control group) were studied. The hematological parameters, including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC) count, lymphocyte count, neutrophil count, platelet count (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of both groups were recorded. The data were statistically compared between the brucellosis and the control groups.Results: The mean age of patients and healthy groups was 44.04 ± 23.11 and 37.92 ± 24.80, respectively (P = 0.062). The WBC, CRP and neutrophil counts were significantly higher in the brucellosis group (P < 0.05). Based on the receiveroperating characteristic (ROC) analysis, the sensitivity and specificity were 54% and 66% for the WBC, 45% and 71% for the neutrophil and 65% and 72% for the CRP, respectively. There was no statistically significant difference between the two groups in terms of Hb, RBC, WBC, lymphocyte and platelet count, MPV, PDW and ESR (P > 0.05).Conclusion: The results of this study indicate that WBC, CRP and neutrophil count can be used as valuable markers in the preliminary diagnosis of brucellosis. However, further researches are required to standardize these parameters for various forms of brucellosis.Keywords: brucellosis, diagnosis, blood cell count, blood parameters

Homayoon Bashiri,1,2 Abbas Esmaeilzadeh,3 Hassan Vossoughinia,3 Kamran Ghaffarzadegan,4 Hamid Reza Raziei,5 Arezoo Bozorgomid1 1Infectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran; 2Department of Internal Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran; 3Gastroenterology and Hematology Department, Faculty of Medicine, Ghaem Hospital, Mashhad, Iran; 4Pathology Department, Education and Research Department, Razavi Hospital, Mashhad, Iran; 5Department of Oncology and Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranCorrespondence: Arezoo BozorgomidInfectious Diseases Research Center, Kermanshah University of Medical Sciences, Kermanshah, IranTel +98 918 872 8269Email arezoobozorgomid@yahoo.comPurpose: Mucosa-associated lymphoid tissue (MALT) is the most common endoscopic finding in Helicobacter pylori positive patients that can progress to MALT lymphoma after a prolonged antigenic contact. This study was aimed to evaluate the prevalence of lymphoid follicles and aggregates (precursors of MALT lymphomas) in gastric mucosal biopsies and their correlation with H. pylori infection.Patients and methods: In this study, 100 patients who had undergone an upper gastrointestinal endoscopy were enrolled. Five biopsy specimens were taken each patient through screening endoscopy and histopathological changes were evaluated and graded using the Wotherspoon System. The clinical background and H. pylori infection status were also investigated.Results: Among the 100 cases in our series, 79 patients (79%) showed evidence of MALT in at least one biopsy specimen taken from the stomach and 21 cases (21%) had no evidence of MALT. H. pylori infection was detected in 74 (74%) patients. Lymphoid follicles were detected more frequently in H. pylori-positive patients (59%) compared to H. pylori-negative cases (3%) (P