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Yoghurt is one of the most prevalent vehicles for the delivering of probiotic bacteria to the consumer. A minimal concentration of 106 colony forming units (CFU)/ml of a product is required for optimal probiotic functionality. In this study, a new quantitative real-time PCR (qPCR) assay based on Bifidobacterial single-copy tuf gene was developed for the detection and quantification of Bifidobacterium animalis subsp. lactis BB-12. The specificity of designed primer set was evaluated by operation PCR reactionswith DNAs from common probiotic Bifidobacteria and Lactobacilli strains presented in probiotic yoghurts. Finally,BB-12 was detected and enumerated through tuf gene-based PCR, tuf gene-based qPCR and selective plate count during shelf life and after the expiry date of commercial probiotic yoghurts. Statistical comparison of enumeration by selective plate count and qPCR methods was also investigated. The PCR assay confirmed the specificity of tuf gene-based primer set for BB-12. The obtained standard curve of tuf gene-based qPCR reactions from 104-109CFU/ml was linear (R2=0.98) with the efficiency of 90.4%. Significant differences were observed among BB-12 counts measured in yoghurts with the qPCR and selective plate count. Total bacterial count averages were higher with the qPCR method compared to selective plate count. Although the counts of B.animalis subsp.lactis BB-12 had a significant decrease during shelf-life, but these counts didn't fall below CODEX standard106CFU/ml) until the expiry date of the products. In conclusion, despite the fact that the new qPCR assay developed here is a specific, rapid and easy method for quantification of both cultivable and dormant BB-12 cells, but it does not distinguish dead and viable cells. Moreover, selective plate count method doesn't detect dormant bacterial populations. We deducethat the choice of enumeration method for probiotic bacteria may have a significant effect on the results of the analysis. [ABSTRACT FROM AUTHOR]

Abstract Purpose: To study the genetic basis and clinical manifestations of Wolfram syndrome in a multi-affected family. Methods: Complete clinical examinations including urological, ophthalmic, neurological, and endocrinologic assessment were performed for three affected family members. Genomic DNA was extracted from peripheral blood leukocytes with salting out method and all WFS1 exons and their flanking regions were sequenced. Candidate variation was screened for segregation in the pedigree by Sanger sequencing. Results: A known pathogenic missense mutation in WFS1 gene (c.1885C > T which leads to p.Arg629Trp in the encoded protein) was identified in all affected individuals. Both clinical and genetic investigations confirmed Wolfram syndrome diagnosis with variable phenotypic features. Conclusion: Identical mutations in the Wolfram syndrome causative gene can lead to variable manifestations of the syndrome even in the same family. Although the medical findings and clinical examination are imperative for the diagnosis of Wolfram syndrome, genetic testing is useful to confirm the diagnosis, especially in cases with possible reduced penetrance of the characteristic signs.

Gene families are considered as groups of homologous genes which they share very similar sequences and they may have identical functions. Members of gene families may be found in tandem repeats or interspersed through the genome. These sequences are copies of the ancestral genes which have underwent changes. The multiple copies of each gene in a family were constructed based on gene duplications and reverse transcription in the genome, which in turn, would give rise to gene variability in an individual or population. Furthermore, it would provide the cell's vital demands for duplication, transcription, and translation. Differences in family size due to gene duplication and gene loss in cell-specific lineages may provide insights of evolutionary forces that have shaped the mammalian genome. Positive selection and concerted evolution are the main forces and the original candidates of shaping gene families and their larger partner, gene superfamily. [ABSTRACT FROM AUTHOR]

Objective: Mechanically ventilated patients experience significant suffering in intensive care units (ICUs). Recognising and understanding these patients' distressing experiences can greatly improve the quality of care provided. This study aims to explore the lived experiences of conscious intubated patients in ICUs in Iran., Design: A qualitative study was conducted using an interpretative phenomenological approach. In-depth interviews served as the primary means of data collection. Subsequently, the collected data was analysed using the method of Diekelmann et al (1989)., Setting: The study was conducted in the ICU., Participants: A purposive method was employed to select 13 patients who underwent conscious intubation for over 24 hours., Results: Three main themes and seven subthemes emerged from the data analysis of the lived experience: (1) interpersonal discourse complexity (semantic misalignment and others' impressionability), (2) sensory disquietude (pharyngeal discomfort, thirst beyond the quench and disgust with oral hygiene) and (3) resilient adaptation (emotional responses and coping strategies)., Conclusions: The findings of the lived experiences reveal a nuanced understanding of the intricate interplay between communication barriers, sensory discomfort and the adaptive capacities of conscious intubated patients in the ICU. This comprehensive analysis contributes to a deeper appreciation of their multifaceted experiences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: During the COVID-19 pandemic, healthcare workers face the stigmatization of those caring for COVID-19 patients, creating a significant social problem. Therefore, this study investigated the stigmatization of healthcare workers in the context of the COVID-19 pandemic., Methods: In this scoping review study, searches were conducted from December 2019 to August 2023 in Persian and English using various databases and search engines including PubMed (Medline), Embase, Scopus, ISI Web of Science, ProQuest, Science Direct, Springer, Cochrane Library, Google Scholar, and national databases. The study used English keywords such as Social Stigma, Health Personnel, Healthcare Worker, Medical Staff, Medical Personal, Physicians, doctors, Nurses, nursing staff, COVID-19, and coronavirus disease 2019, and their Persian equivalents, and their Persian equivalents to explore healthcare workers' experiences of COVID-19-related stigma., Results: From a total of 12,200 search results, 77 eligible studies were included in this study. stigmatization of healthcare workers caring for COVID-19 patients was evident from the literature because of fear, misinformation, and negative self-image. Manifestations were violence and deprivation of social rights, resulting in adverse biopsychosocial, occupational, and economic consequences. This condition can affect negatively health staff themselves, their families, and society as well. Anti-stigmatization measures include informing society about the realities faced by healthcare workers, presenting an accurate and empathetic image of health workers, providing psychosocial support to health workers, and encouraging them to turn to spirituality as a coping mechanism. There are notable research gaps in comprehending the phenomenon, exploring its variations across diverse healthcare roles and cultural contexts, examining its long-term effects, and monitoring shifts in stigma perceptions over time., Conclusion: The COVID-19 pandemic has resulted in the stigmatization of healthcare workers, causing mistreatment and rights violations. This stigma persists even post-pandemic, posing a psychological dilemma for caregivers. Addressing this requires comprehensive strategies, including tailored stigma prevention programs and research to understand its psychological impact., (© 2024. The Author(s).)

Competing Interests: The authors declare that they have no conflict of interest.

Competing Interests: None

Background and Objectives: The presence of fungi in the respiratory tract as mycobiome, particularly Candida species (spp.), remains a serious problem due to increasing numbers of immunocompromised patients. The confirmed reliable existence of these pathogens due to frequent colonization is essential. This investigation aimed to recognize Candida spp. among isolates from bronchoalveolar lavage of immunocompromised and critically ill patients and to evaluate their susceptibility to antimycotic drugs., Materials and Methods: Bronchoalveolar lavage fluid was collected from 161 hospitalized patients presenting with suspected respiratory fungal infection /colonization. The specimens were examined by standard molecular and mycological assays. Candida spp. were recognized with sequence assessment of the D1-D2 section of the large subunit ribosomal DNA. The susceptibility of Candida isolates to common antimycotic drugs was distinguished by standard broth microdilution., Results: Seventy-one clinical isolates of Candida spp. were recognized. Candida albicans was the most frequent, followed by C. glabrata, C. krusei ( Pichia kudriavzevii ), C. dubliniensis, C. parapsilosis, and C. tropicalis. We found 5.1% of C. albicans isolates and 8% of C. glabrata isolates to show resistance to fluconazole. The whole of the Candida spp. were sensitive to amphotericin B and caspofungin., Conclusion: This study demonstrated that C. albicans and C. glabrata are the most common isolates of bronchoalveolar lavage fluid in patients, and the drug susceptibility screening confirmed that amphotericin B and caspofungin are effective against Candida spp. but some C. glabrata and C. albicans isolates showed resistance to fluconazole., (Copyright© 2024 The Authors. Published by Tehran University of Medical Sciences.)

Background: Professional misconduct by nurses is a critical challenge in providing safe quality care, which can lead to devastating and extensive outcomes. Explaining the experiences of clinical nurses and nursing managers in this regard using an in-depth qualitative method can be beneficial. This study was conducted with the aim of explaining the experiences of nurses regarding the outcomes of professional misconduct., Methods: The present study used a qualitative descriptive with a conventional content analysis approach. A total of 22 clinical nurses and nursing managers were selected through purposive sampling until data saturation was reached. Data were collected using semi-structured in-depth interviews and analyzed using Graneheim and Lundman's approach., Results: Analyzed data were categorized into four main themes and 11 subthemes: (1) Physical outcomes: critical threat and weakening patients' safety; (2) Psychological outcomes: psycho-emotional responses of patients and their families, moral distress, and cautionary tale of nurses; (3) Financial outcomes: imposing costs on the patient and financial loss of the nurse; (4) Organizational outcomes: the normalization of misconduct, chaos in the organization, waste of the organization's resources, and reputational damage to the organization., Conclusion: Professional misconduct by nurses can have adverse outcomes for patients in physical, mental, and financial dimensions, their families, nurses, and healthcare organizations. Therefore, it is indispensable to adopt management strategies to reduce the rate of professional misconduct., (© 2024. The Author(s).)

Allocation of water in the situation of climate change presents various uncertainties. Consequently, decisions must be made to ensure stability and functionality across different climatic scenarios. This study aims to examine the effectiveness of adaptation strategies in the agricultural sector, including a 5% increase in irrigation efficiency (S1) and a shift in irrigation method to Dry-DSR (direct seeded rice) under conditions of climatic uncertainty using a decision-making approach. The study focuses on the basin downstream of the Sefidroud dam, encompassing the Sefidroud irrigation and drainage network. Initially, basin modeling was conducted using the WEAP integrated management software for the period 2006-2020. Subsequently, the impact of climate change was assessed, considering RCP2.6, RCP4.5, and RCP8.5 emission scenarios on surface water resources from 2021 to 2050. Runoff and cultivated area, both subject to uncertainty, were identified as key parameters. To evaluate strategy performance under different uncertainties and determine the efficacy of each strategy, regret and satisfaction approaches were employed. Results indicate a projected decrease in future rainfall by 3.5-11.8% compared to the base period, accompanied by an increase in maximum and minimum temperatures (0.83-1.62 °C and 1.15-1.33 °C, respectively). Inflow to the Sefidroud dam is expected to decrease by 13-28%. Presently, the Sefidroud irrigation and drainage network faces an annual deficit of 505.4 MCM, and if current trends persist with the impact of climate change, this shortfall may increase to 932.7 MCM annually. Furthermore, satisfaction indices for strategy (S2) are 0.77 in an optimistic scenario and 0.70 in strategy (S1). In a pessimistic scenario, these indices are 0.67 and 0.56, respectively. Notably, changing the irrigation method with Dry-DSR is recommended as a robust strategy, demonstrating the ability to maintain basin stability under a broad range of uncertainties and climate change scenarios. It is crucial to note that the results solely highlight the effects of climate change on water sources entering the Sefidroud dam. Considering anthropogenic activities upstream of the Sefidroud basin, water resource shortages are expected to increase. Therefore, reallocating water resources and implementing practical and appropriate measures in this area are imperative., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Statement of the Problem: Health information technology is used in dentistry worldwide. Despite the limited specialized resources for providing orthodontic treatment in Iran, the need to examine the technology acceptance model (TAM) seems necessary and is a significant step in the successful acceptance of teleorthodontic technology., Purpose: The present study has identified and investigated the factors affecting the acceptance of teleorthodontic technology among orthodontists based on the TAM3 with the aim of successful implementation and deployment of this technology., Materials and Method: In this descriptive-analytical research, 300 Iranian orthodontists who were members of the Iranian Orthodontic Association were selected by census sampling. The data was gathered through a modified and accommodated questionnaire called the acceptance model 3. The validity was confirmed. Moreover, the reliability was calculated based on Cronbach's alpha, which was equal to 0.870. Multiple linear regression analysis was also utilized to investigate the relationships between dependent, independent, and mediator variables. Besides, the final model was designed by the Amos software., Results: The results of 251 orthodontic specialists proved that subjective norm, job relevance, output quality, results in demonstrability, and job relevance on output quality could significantly affect perceived usefulness. Similarly, the perception of external control was identified to have a significant influence on perceived ease of use. On the other hand, the perceived usefulness does not play a mediating role between perception and subjective norm. Furthermore, perceived usefulness was confirmed as a mediating factor in relationship to both perceived ease of use and behavioral intention., Conclusion: The findings of the present study revealed valuable scientific evidence to identify and apply the key factors affecting the acceptance and use of modern teleorthodontic technology in Iran. Besides, the structure of the TAM3 was recognized as fruitful and worthwhile for predicting the acceptance of this new technology and also in identifying key effective factors., Competing Interests: The authors stated that there was no conflict of interest., (Copyright: © Journal of Dentistry.)

Background: The emerging working conditions triggered by the COVID-19 pandemic have imposed numerous ethical challenges on the nurses, which, in turn, can negatively impact the nurses' physical and mental health, and thus their work performance through intensifying negative emotions and psychological pressures., Aim: The purpose of this study was to highlight the nurses' perceptions of the ethical challenges that they faced regarding their self-care during the COVID-19 pandemic., Research Design: A qualitative, descriptive study with a content analysis approach., Participants and Research Context: The data were collected through semi-structured interviews with 19 nurses working in the COVID-19 wards of two university-affiliated hospitals. These nurses were selected using a purposive sampling method and the data were analyzed using a content analysis approach., Ethical Considerations: The study was approved by the TUMS Research Council Ethics Committee under the code: IR.TUMS.VCR.REC.1399.594. In addition, it is based on the participants' informed consent and confidentiality., Findings: Two themes and five sub-themes were identified, including ethical conflicts (the conflict between self-care and comprehensive patient care, prioritization of life, and inadequate care) and inequalities (intra- and inter-professional inequalities)., Conclusion: The findings demonstrated that the nurses' care is a prerequisite for the patients' care. Considering that the ethical challenges faced by nurses are related to unacceptable working conditions, organizational support, and lack of access to facilities such as personal protective equipment, it seems essential to support nurses and provide adequate working conditions to provide patients with quality care.

Biotin- and digoxigenin (DIG)-conjugated therapeutic drugs are critical reagents used for the development of anti-drug antibody (ADA) assays for the assessment of immunogenicity. The current practice of generating biotin and DIG conjugates is to label a therapeutic antibody with biotin or DIG via primary amine groups on lysine or N-terminal residues. This approach modifies lysine residues nonselectively, which can impact the ability of an ADA assay to detect those ADAs that recognize epitopes located at or near the modified lysine residue(s). The impact of the lysine modification is considered greater for therapeutic antibodies that have a limited number of lysine residues, such as the variable heavy domain of heavy chain (VHH) antibodies. In this paper, for the first time, we report the application of site-specifically conjugated biotin- and DIG-VHH reagents to clinical ADA assay development using a model molecule, VHHA. The site-specific conjugation of biotin or DIG to VHHA was achieved by using an optimized reductive alkylation approach, which enabled the majority of VHHA molecules labeled with biotin or DIG at the desirable N-terminus, thereby minimizing modification of the protein after labeling and reducing the possibility of missing detection of ADAs. Head-to-head comparison of biophysical characterization data revealed that the site-specific biotin and DIG conjugates demonstrated overall superior quality to biotin- and DIG-VHHA prepared using the conventional amine coupling method, and the performance of the ADA assay developed using site-specific biotin and DIG conjugates met all acceptance criteria. The approach described here can be applied to the production of other therapeutic-protein- or antibody-based critical reagents that are used to support ligand binding assays.

Introduction: Young adulthood is a period of prosperity and freshness characterized by developmental achievement, which can be inhibited by various diseases such as cancer. Typically considered a terminal disease, if diagnosed in young adulthood, cancer may trigger a tremendous psychosomatic shock. The nature of facing a recent cancer diagnosis affects the whole coping process. Addressing young adults' experiences at the confirmation point of cancer diagnosis will facilitate supporting them through the early recognition of probable problems in the future. Therefore, the present study aimed to analyse the lived experiences of young adults facing a recent cancer diagnosis., Methods: This qualitative study adopted an interpretive phenomenology design. In this study, 12 patients (with an age range of 20-40) were selected using the purposive sampling method. Data collection was done through in-depth, semistructured interviews. The data were analysed following the method proposed by Diekelmann et al. FINDINGS: Three main themes and nine subthemes were extracted from the data: (1) spiritual detachment and then acceptance through spirituality in the form of denial and then forced acceptance, sense of guilt and spiritual help-seeking, and anger towards God and then humbleness, (2) the shock of facing an extraordinary life shaped by disturbed role-play and unusual lifestyle, (3) anticipatory anxiety concerning the sense of rejection, negative perspective towards future, inability to afford the costs and worries about the future of the family members., Conclusion: This was the first study providing significant insights into the experiences of young adults facing a recent cancer diagnosis. The diagnosis of cancer can shadow all aspects of young adults' lives. The findings of the present study empower healthcare professionals to provide newly diagnosed young adults with appropriate health services., Patient Contributions: To identify and recruit the participants, we explained the objectives of the present study to the unit managers either by phone or in person. The participants were approached and interviewed by three authors. Participation was voluntary and the participants received no financial contribution for their time., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries., Material and Methods: This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians., Results: The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system., Conclusion: Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered., (© 2023. The Author(s).)

Aim: To explore nurses' perspectives on and experiences of safety-related organisational challenges during the coronavirus disease 2019 (COVID-19) outbreak by Iranian nurses., Background: In different clinical contexts, nurses face numerous organisational challenges threatening their safety because of the COVID-19 pandemic., Introduction: Exploring nurses' perceptions towards safety-oriented organisational challenges might inform nurse managers, healthcare managers, educators and policymakers on the priorities that should be considered to increase organisations' readiness and safety., Methods: This qualitative descriptive study is reported according to the Consolidated Criteria for Reporting Qualitative Research guidelines. Through purposeful sampling, 19 participants were involved. The research data were collected from March to August 2021 by conducting semi-structured interviews that were analysed through the content analysis approach., Findings: Three organisation-related safety challenges experienced were related to (1) human resource, (2) educational and (3) workforce protection issues., Discussion: Nurses experienced several safety issues related to the complexity faced by the health care organisations during the pandemic, exacerbated by previous frailties of the nursing system., Conclusion: The three challenges that emerged might be considered a priority in building pandemic plans, transforming the experiences of nurses as a source of learning for all, capitalising on their suggestions and rendering healthcare facilities ready to deal safely with future crises., Implications for Nursing and Health Policy: Adopting appropriate measures to decrease human resource issues and that related to education, and promoting workforce health protection, are both recommended to improve nurses' work environment and satisfy their safety needs., (© 2022 International Council of Nurses.)

Background: It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID-19). However, the long-term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety., Objective: This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID-19 pandemic., Methods: This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature., Results: HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems., Conclusions: The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID-19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE., (© 2022 Wiley Periodicals LLC.)

Purpose: Telehealth utilization has increased dramatically over the past few years due to improvement in technology and the COVID-19 pandemic. To date, no study has examined whether a telehealth visit alone for preoperative evaluation is safe and sufficient before surgery. We examined the safety and feasibility of preoperative telehealth visits alone before minimally invasive urologic surgery. Materials and Methods: Single institution retrospective review of robotic prostate, kidney, and cystectomy procedures between April and December 2020. Cases were dichotomized into those who underwent preoperative evaluation by telehealth only vs traditional in-person visits. Outcomes included complications, blood loss, conversion to open surgery rates, and operative times. We assessed efficiency of care by measuring time from preoperative visit to surgery. Results: Three hundred fourteen patients were included in the study, with 14% of cases ( n  = 45) being performed after a preoperative telehealth visit. The majority of cases included in analysis were robotic surgeries of the prostate (56.1% of all cases, n  = 176) and the kidney (35.0% of all cases, n  = 110). Patients seen via telehealth alone preoperatively had no significant differences in any grade of complications, perioperative outcomes, blood loss, operative time, and length of stay. There was no difference in change in anticipated procedure between the groups, and there was no case of conversion to open surgery in the telehealth only group. Time from preoperative visit to surgery was significantly shorter for the telehealth group by 13 days. Conclusions: Our study is the first to analyze the safety of telehealth only preoperative visits before minimally invasive urologic surgery. We found no difference in perioperative outcomes including conversion to open surgery or change in planned procedure. Furthermore, telehealth preoperative visits appeared to facilitate shorter time to surgery. This study has important implications for expediting patient care and medicolegal considerations.

Although COVID-19 emerged as a major concern to public health around the world, no licensed medication has been found as of yet to efficiently stop the virus spread and treat the infection. The SARS-CoV-2 entry into the host cell is driven by the direct interaction of the S1 domain with the ACE-2 receptor followed by conformational changes in the S2 domain, as a result of which fusion peptide is inserted into the target cell membrane, and the fusion process is mediated by the specific interactions between the heptad repeats 1 and 2 (HR1 and HR2) that form the six-helical bundle. Since blocking this interaction between HRs stops virus fusion and prevents its subsequent replication, the HRs inhibitors can be used as anti-COVID drugs. The initial drug selection is based on existing molecular databases to screen for molecules that may have a therapeutic effect on coronavirus. Based on these premises, we chose two approved drugs to investigate their interactions with the HRs (based on docking methods). To this end, molecular dynamics simulations and molecular docking were carried out to investigate the changes in the structure of the SARS-CoV-2 spike protein. Our results revealed, cefpiramide has the highest affinity to S protein, thereby revealing its potential to become an anti-COVID-19 clinical medicine. Therefore, this study offers new ways to re-use existing drugs to combat SARS-CoV-2 infection., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Elsevier B.V. All rights reserved.)

Oral candidiasis is a fungal infection caused mainly by Candida albicans and it is a major problem among hematologic malignancy patients. Biofilm formation is an attributable factor to both virulence and drug resistance of Candida species. The aim of the study was to evaluate the biofilm-producing ability of oral C. albicans isolates and to evaluate the inhibitory activity of eucalyptol on Candida biofilm, alone and in combination with antifungal agents. Samples were collected from the oral cavity of 106 patients with hematologic malignancy. The isolated yeasts were identified by PCR-sequencing. Then C. albicans isolates were analyzed for their biofilm-producing ability by crystal violet staining and MTT assay. The minimum biofilm inhibition concentrations (MBIC) of eucalyptol, amphotericin B, itraconazole, and nystatin and the in vitro interaction of eucalyptol with these drugs were tested according to CLSI-M-27-A3 protocol and checkerboard methods, respectively. From 106 patients, 50 (47.2%) were confirmed for oral candidiasis [mean ± SD age 39 ± 14 years; female 31 (62%) and male 19 (38%)]. C. albicans was isolated from 40 of 50 (80%) patients. From 40 C. albicans isolates, 24 (60%) and 16 (40%) were moderate and weak biofilm producer, respectively. The geometric mean MBIC of amphotericin B, itraconazole, nystatin and eucalyptol were 3.93 µg/mL, 12.55 µg/mL, 0.75 µg/mL and 798 µg/mL, respectively. Eucalyptol interacted synergistically with amphotericin B, itraconazole and nystatin against 12.5, 10, and 22.5% of isolates, respectively. Eucalyptol demonstrated promising activity against biofilm of C. albicans when tested alone or combined with antifungal drugs., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Usher syndrome, the most prevalent cause of combined hereditary vision and hearing impairment, is clinically and genetically heterogeneous. Moreover, several conditions with phenotypes overlapping Usher syndrome have been described. This makes the molecular diagnosis of hereditary deaf-blindness challenging. Here, we performed exome sequencing and analysis on 7 Mexican and 52 Iranian probands with combined retinal degeneration and hearing impairment (without intellectual disability). Clinical assessment involved ophthalmological examination and hearing loss questionnaire. Usher syndrome, most frequently due to biallelic variants in MYO7A (USH1B in 16 probands), USH2A (17 probands), and ADGRV1 (USH2C in 7 probands), was diagnosed in 44 of 59 (75%) unrelated probands. Almost half of the identified variants were novel. Nine of 59 (15%) probands displayed other genetic entities with dual sensory impairment, including Alström syndrome (3 patients), cone-rod dystrophy and hearing loss 1 (2 probands), and Heimler syndrome (1 patient). Unexpected findings included one proband each with Scheie syndrome, coenzyme Q10 deficiency, and pseudoxanthoma elasticum. In four probands, including three Usher cases, dual sensory impairment was either modified/aggravated or caused by variants in distinct genes associated with retinal degeneration and/or hearing loss. The overall diagnostic yield of whole exome analysis in our deaf-blind cohort was 92%. Two (3%) probands were partially solved and only 3 (5%) remained without any molecular diagnosis. In many cases, the molecular diagnosis is important to guide genetic counseling, to support prognostic outcomes and decisions with currently available and evolving treatment modalities., (© 2021. The Author(s).)

Objective: To evaluate the clinical and prognostic details of periurethral abscess (PUA) formation following urethroplasty (UP)., Methods: A retrospective review was performed to identify men who developed PUA after UP between 2007 and 2019 at a single tertiary care referral center. Patient demographics, stricture characteristics, and UP technique were recorded. Outcomes included time to PUA, presenting symptoms, wound cultures, imaging, and ultimate management. Comparative analysis between PUA and non-PUA patients was performed using Fisher's Exact test and Student's t-test., Results: Among 1499 UP cases, 9 (0.6%) developed PUA. Mean stricture length was 4.6 cm with most located in the bulbar urethra (5/9, 56%), while 4/9 (44%) had undergone prior UP. PUA rates were 7/288 (2.4%) and 2/815 (0.3%) for substitution and anastomotic UP respectively. Voiding cystourethrogram (VCUG) demonstrated extravasation in 67% (4/6) of available UP cases imaged. Subsequent VCUG confirmed leak improvement or resolution in all cases. Wound cultures were frequently polymicrobial (4/6, 67%). Management included antibiotics with (6/9) and without (3/9) incision and drainage (I/D). Urinary drainage was performed in 5 patients using suprapubic tube (3/5) and foley placement (2/5). PUA resolution was observed in all patients while stricture symptom recurrence was observed in 2/9 (22%) patients with mean time to recurrence of 15 months. Overall mean follow-up time was 22 months., Conclusion: PUA is a rare complication of UP that may be more common in setting of postoperative urine leak. PUA is safely managed with I/D, urethral rest, and antibiotics, with low risk of recurrent stricture formation thereafter., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To evaluate the distance from critical pelvic structures (CPS, defined as bladder and iliac vessels) among inflatable penile prosthesis (IPP) reservoirs placed into the space of Retzius (SOR) and high submuscular (HSM) locations using cross-sectional imaging. IPP reservoir placement into the HSM location has been proposed as a strategy to prevent injury due to greater distance from CPS., Methods: Our institutional database was retrospectively reviewed to identify men who underwent IPP insertion between 2007 and 2020 and had available cross-sectional abdominopelvic imaging after the time of surgery. Patients were grouped based on reservoir placement technique (SOR vs. HSM). Staff radiologists blinded to placement technique evaluated reservoir position to determine the shortest distance between CPS and the reservoir and if a mass effect was present on CPS. Variables were analyzed using chi-squared, Fisher's exact, and student's T-tests as indicated., Results: Among 1,010 IPP cases performed during the study interval, 139 (13%) were imaged. Compared with SOR reservoirs (n = 32), HSM reservoirs (n =107) were significantly less likely to induce a mass effect on the bladder (72 vs. 9%, P = <.01) or iliac vessels (34 vs. 4%, P = <.01) and were located roughly 5 times further from the bladder (10 ± 22 vs. 49 ± 36 mm, P = <.01) and iliac vessels (5 ± 9 vs. 23 ± 26 mm, P = <.01)., Conclusion: This study radiographically confirms that IPP reservoirs are located significantly further away from CPS following HSM placement compared to SOR placement., Competing Interests: Conflict of Interest Please copy this Conflict of Interest form and paste into your word processing software, type in each author and either indicate “no conflict” or specify any conflicts; it will be required that you submit the completed form (with all authors indicated) with the revised manuscript. Please list only conflicts of interest specific to this manuscript.Mehraban Kavoussi: No ConflictGrayden S. Cook: No ConflictShaun M. Nordeck: No ConflictBenjamin M. Dropkin: No ConflictGregory A. Joice: No ConflictSarah C. Sanders: No ConflictSteven J. Hudak: Dr. Steven Hudak is a paid speaker and consultant for Boston Scientific CorporationJeffrey H. Pruitt: No ConflictAllen F. Morey: Dr. Allen Morey receives honoraria for being a guest lecturer/meeting participant for Boston Scientific and Coloplast Corp., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aims: To examine the rate of lower urinary tract complications (LUTC) and urinary diversion (UD) after artificial urinary sphincter (AUS) explantation with the acute reconstruction of AUS cuff erosion defects., Methods: We performed a retrospective study of patients who underwent in-situ urethroplasty (ISU) for AUS cuff erosion from June 2007 to December 2020. Outcomes included LUTC (urethral stricture, diverticulum, fistula), AUS reimplantation, and UD. Defect size was prospectively estimated acutely and a subanalysis was performed to determine the impact of erosion severity (small erosions [<33% circumferential defect] and large erosions [≥33%]) on these outcomes. Kaplan-Meier curves were created to compare survival between the two groups., Results: A total of 40 patients underwent ISU for urethral cuff erosion. The median patient age was 76 years old with a median erosion circumference of 46%. The overall LUTC rate was 30% (12/40) with 35% (14/40) of patients requiring permanent UD. Secondary AUS placement occurred in 24/40 (60%) patients with 11/24 (46%) leading to repeat erosion. On subanalysis, small erosion was associated with improved LUTC-free and UD-free survival but not associated with AUS reimplantation., Conclusions: Lower urinary tract complications are common after AUS cuff erosion and can lead to the need for permanent UD. Patients with larger erosions are more likely to undergo UD and reach this end-stage condition earlier compared to patients with small erosions., (© 2021 Wiley Periodicals LLC.)

Background and Aim: Breast cancer-related lymphedema (BCRL) is a treatment-related inflammatory complication in breast cancer survivors (BCSs). This study was aimed to evaluate the effect of synbiotic supplementation on serum concentrations of IL-10, TGF-β, VEGF, adiponectin, and edema volume among overweight or obese BCSs with lymphedema following a low-calorie diet (LCD)., Method: In a randomized double-blind, controlled clinical trial, 88 obese and overweight BCSs women were randomized to synbiotic supplement ( n  = 44) or placebo ( n  = 44) groups and both groups followed an LCD for 10 weeks. Pre- and post-intervention comparisons were made regarding the anti-inflammatory markers which included IL-10, TGF-β, VEGF, adiponectin, edema volume, and anthropometric measurements. Also, the same factors were analyzed to find inter-group disparities., Results: There were no significant differences among participants in the baseline, except for IL-10 and adiponectin. Post-intervention, no significant differences were observed regarding the anti-inflammatory markers, including IL-10, VEGF, adiponectin, and TGF-β between the groups. After 10 weeks of intervention edema volume significantly decreased in the synbiotic group; additionally, anthropometric measurements (body weight, BMI, body fat percent, and WC) decreased in both groups significantly ( P  < 0.001 and P  < 0.005; respectively)., Conclusion: Synbiotic supplementation coupled with an LCD in a 10-week intervention had beneficial effects on increasing the serum TGF-β, IL-10, and adiponectin levels in women with BCRL. It also reduced arm lymphedema volume. Therefore, synbiotic supplementation can be effective in improving health status in BCRL patients.

Background: Critical inter-provincial differences within Iran in the pattern of non-communicable diseases (NCDs) and difficulties inherent to identifying prevention methods to reduce mortality from NCDs have challenged the implementation of the provincial health system plan. The Shahrekord Cohort Study (SCS) was designed to address these gaps in Chaharmahal and Bakhtiari, a province of high altitude in the southwest of Iran, characterized by its large Bakhtiari population, along with Fars and Turk ethnicity groups., Methods: This ongoing cohort, a prospective, large-scale longitudinal study, includes a unique, rich biobank and was conducted for the first time in Chaharmahal and Bakhtiari Province in Iran. SCS is a part of the PERSIAN (Prospective Epidemiological Research Studies in IrAN) cohort. The study began in 2015, recruited 10075 participants (52.8% female, 47.2% male) from both urban (n=7034) and rural (n=3041) areas, and participants will be annually followed up for at least 15 years. A cross-sectional analysis was conducted using baseline data from the SCS, using descriptive statistics and logistic regression. Data analysis was performed using Stata software., Results: The prevalence of NCDs was 9.8% for type 2 diabetes, 17.1% for hypertension, 11.6% for thyroid disease, 0.2% for multiple sclerosis and 5.7, 0.9 and 1.3% for ischemic heart disease, stroke and myocardial infarction, respectively. The prevalence of multimorbidity (≥2 NCDs) was higher in women (39.1%) than men (24.9%). The means (standard deviations) of age, BMI, systolic blood pressure and fasting blood glucose were 49.5 (9) years, 27.6 (4.6) kg/m 2 , 115.4 (17.3) mmHg and 96.7 (27.3) mg/dL, respectively. Logistic regression models showed that older age, female gender, living in an urban area, non-native ethnicity, high wealth index, unemployment, obesity, low physical activity, hypertriglyceridemia, high fasting blood sugar, alkaline urine pH and high systolic and diastolic blood pressure were associated with increased prevalence of NCDs., Conclusions: The SCS provides a platform for epidemiological studies that will be useful to better control NCDs in the southwest of Iran and to foster research collaboration. The SCS will be an essential resource for identifying NCD risk factors in this region and designing relevant public health interventions., (© 2021. The Author(s).)

Background: Inflatable penile prosthesis (IPP) reservoirs are typically placed into the Space of Retzius (SOR) or alternative locations including the High Submuscular (HSM) space via transinguinal (TI) or counter incision (CI) techniques. A cadaver study showed variability in reservoir location after TI-HSM placement., Aim: To evaluate reservoir location using cross-sectional imaging following IPP insertion., Methods: We retrospectively reviewed our institutional database and identified men who underwent virgin penoscrotal IPP insertion between 2007 and 2019. We then identified those men who subsequently underwent cross-sectional imaging prior to October 2019. Radiologists evaluated cross-sectional imaging in a blinded manner and categorized reservoir locations as follows: 1) submuscular; 2) posterior to the external oblique fascia and lateral to the rectus abdominis musculature; 3) preperitoneal; 4) retroperitoneal; 5) intraperitoneal; 6) inguinal canal; 7) subcutaneous. Patients were stratified by reservoir placement technique, transinguinal space of Retzius (TI-SOR), transinguinal high submuscular (TI-HSM), or counterincision high submuscular (CI-HSM). Clinical characteristics and outcomes were reviewed and compared. Statistical analysis was performed using Chi-squared and Fisher's exact tests., Outcomes: Variability exists in the TI placement of SOR and HSM reservoirs, CI-HSM reservoirs were associated with a low level of variability., Results: Among 561 men who underwent virgin IPP insertion during the 12-year study period, 114 had postoperative cross-sectional imaging (29 TI-SOR, 80 TI-HSM, and 5 CI-HSM). Among the 114 patients imaged, TI-HSM reservoirs were more likely than TI-SOR to be located anterior to the transversalis fascia (48 vs 14%, P < .01) and were less likely to be located in the preperitoneal space (18 vs 62%, P < .01). Rates of intraperitoneal reservoir location were similar between the TI-HSM and TI-SOR groups (5 vs 7%, P = .66). Among imaged CI-HSM reservoirs, 4 (80%) were anterior to the transversalis fascia and 1 (20%) was within the inguinal canal. Among all 536 transinguinal cases (131 TI-SOR and 405 TI-HSM), rates of reservoir-related complications requiring operative intervention were similar between groups (5 vs 2%, P = .24). No complications were noted among the 25 patients in the CI-HSM cohort., Clinical Implications: The level of variability seen in this study did not seem to impact patient safety, complications were rare in all cohorts., Strengths and Limitations: This study is the first and largest of its kind in evaluating reservoir positioning in live patients with long-term follow-up. This study is limited in its retrospective and nonrandomized nature., Conclusions: Despite variability with both TI-HSM and TI-SOR techniques, reservoir related complications remain rare. Kavoussi M, Cook G, Nordeck S, et al. Radiographic Assessment of Inflatable Penile Prosthesis Reservoir Location Variability in Contemporary Practice. J Sex Med 2021;18:2039-2044., (Copyright © 2021 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Vulvovaginal candidiasis (VVC) is a vaginal mucosal infection that usually affects women in their reproductive age. When the signs of VVC persist on a daily basis or last for a long time and repeat at least three times per year, the disease is considered chronic and recurrent., Objective: The purpose of this study was to evaluate the frequency of HLA-DRB1 alleles in patients with recurrent vulvovaginal candidiasis (RVVC)., Study Design: 120 patients with RVVC and 136 age-matched healthy controls underwent low-resolution HLA-DRB typing performed using the polymerase chain reaction-sequence-specific primers (PCR-SSP) technique., Results: In the present work, we studied different genes that encode HLA-DRB (HLA-DRB1 / HLA-DRB3 / HLA-DRB4 / HLA-DRB5) and showed that HLA-DRB1×14, found in 25% of the patients. In the present study, the significant frequency of HLA-DRB1×10 in the control group suggests a resistant role of this allele to RVVC infections CONCLUSIONS: In the HLA-DRB region, the DRB1×14 allele showed a higher frequency in the patients with RVVC than in the controls. Moreover, the higher frequency of DRB1×10 observed in the controls than in the patients with RVVC. These results demonstrate the HLA-DRB1 alleles are in relation with both susceptibility and immunity factors in RVVC infection and possible susceptible role of HLA-DRB1×14., Competing Interests: Disclosure and conflict of interest All authors declare to have no conflicts of interest., (Copyright © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Background/objectives: This study aims to report the developmental and histopathological features of ocular tissues from an electively aborted human fetus with mutations in cytochrome p4501B1 , and thus predisposed to primary congenital glaucoma in comparison to an age-matched healthy fetal globe., Subjects/methods: Both eyes of two 17-week gestational aged fetuses, the first with CYP1B1 mutations and the second as healthy control fetus, were studied. Hematoxylin and eosin, Periodic acid-Schiff, Gomori's trichrome, and Verhoeff-Van Gieson staining protocols in addition to immunohistochemistry staining using anti-cytochrome p4501B1, anti-fibrillin-1, and anti-4-hydroxy-2-nonenal antibodies, as primary antibodies, were performed to assess the effect of the mutations on tissue development, cytochrome p4501B1 protein expression, extracellular matrix structure, and oxidative stress in the developing fetus eye. Quantitative analyses were performed using ImageJ software. Student's t -test was used for statistical analysis and P -values <0.05 were considered as significant., Results: Delayed development in ocular tissues, decreased expression of cytochrome p4501B1 protein, irregular extracellular matrix structure, and increased oxidative stress biomarker were evident in the ocular tissues of the fetus with cytochrome p4501B1 mutations as compared to a normal globe from an age-matched fetus., Conclusion: To the best of our knowledge, this is the first report of prenatal diagnosis of primary congenital glaucoma. We also describe histopathological changes in the primary congenital glaucoma-affected globes revealing the effect of cytochrome p4501B1 deficiency on ocular tissues during early fetal development contributing to the glaucoma phenotype.

Objectives: To analyze our institutional experience transitioning from overnight observation (OBS) to same day surgery (SDS) for artificial urinary sphincter (AUS) procedures. Prior research has questioned the need for OBS following AUS surgery., Methods: We retrospectively reviewed AUS surgeries performed by a single surgeon at our tertiary academic medical center between 08/2013 and 01/2020. Patients were grouped based on discharge status: OBS vs SDS. Cost savings associated with SDS were estimated using room and bed charges from a contemporary group of AUS patients., Results: We identified 525 AUS cases that met inclusion criteria. Men in the SDS group (n = 318) were more likely to have undergone a virgin AUS insertion and were slightly younger and healthier. Men in the OBS group (n = 207) were more likely to suffer an immediate postoperative complication (1% vs 0%, P < .01) and to be readmitted within 90 days of surgery (15% vs 5%, P < .01). The groups did not vary with respect to multiple other perioperative outcomes measures. Among patients who underwent AUS surgery between 09/2017 and 08/2020, those with OBS status (n = 39) had mean additional room and bed charges of $ 745 ± 302 vs none for SDS patients (n = 183)., Conclusion: SDS for AUS insertion is safe, effective, and associated with significant cost savings. Routine overnight observation after AUS insertion appears to be unnecessary., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The existence of synthetic dyes and heavy metals in textile wastewater is a serious problem. These compounds should be removed before discharge into the environment by an appropriate method. The present study was conducted for the characterization of efficient multi-functional strain Bacillus cereus MS038EH for the simultaneous removal of Reactive Black-5 and Chromium(VI). Maximum decolorization efficiency of 94.74% was achieved at pH 7, 35 °C, and 4% inoculum size for 900 mg/L of Reactive Black-5. Also, 94.10% efficiency was observed in the presence of 8 g/L of yeast extract as an optimum nitrogen source, while carbon sources had no significant effect on decolorization. It should be pointed out that the decolorization efficiency was decreased from 94 to 64% by increasing NaCl concentrations from 0 to 50 g/L, respectively. Bacillus cereus strain MS038EH could decolorize 94.31% of Reactive Black-5 (900 mg/L) and remove 87.31% of chromium(VI) (30 mg/L) within 36 h. Results of Gas chromatography-mass spectrometry and Fourier transform-infrared spectroscopy proved that Reactive Black-5 was cleaved into the lower molecular weight products without any azo bonds. However, the phyto-toxicity analysis showed that Reactive Black-5 was not toxic for Triticum aestivum and Maize, while biologically treated Reactive Black-5 was toxic for seeds. Therefore, ultraviolet-C/H 2 O 2 was applied for the detoxification of biotransformed products. When ultraviolet-C/H 2 O 2 was applied as post-treatment, the seeds were germinated completely. It is demonstrated that the application of ultraviolet-C/H 2 O 2 after anaerobic treatment is effective for toxicity reduction of textile wastewater., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: In this study, we taught learners the interpretation of the bundle branch block in two ways of storytelling and usual lecture, then compare the effect of these two methods on the level of learning and satisfaction. Storytelling can lead to deep learning, promoted critical thinking of students and enhanced clinical skills. It is an effective teaching method engaging nursing and midwifery students in clinical education., Design: A quasi-experimental study., Methods: We conducted this study in the training hospital, Ardabil, Iran, from 2019 to 2020. We selected 70 nursing students of semesters 6th and 7th through convenience sampling then allocated them randomly into two groups of intervention (n = 40) and control (n = 30). We taught the same topics to the intervention group via the storytelling method and the control group via lecturing. Data collection tools included a standard questionnaire of satisfaction with the teaching method and learning how to interpret an electrocardiogram. Data were analyzed using chi-square and independent t-tests. The significance level was considered less than 0.05., Results: Students in the control group had a higher mean score of satisfaction with the teaching method (30.00 ± 2.00) than students in the intervention group (29.00 ± 3.00). Also, There was no significant difference between the two groups regarding learning quality (P = 0.20)., Conclusion: Both methods of storytelling and lecturing were effective in increasing students' satisfaction. However, the liking of the teaching method, learning in a short time and high motivation for learning in the intervention group were higher. It is suggested to teach electrocardiogram interpretation to nursing students first through lecturing and then stabilize the concepts in their minds through storytelling., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The application of halotolerant microorganisms capable of decolorizing is attractive. Decolorization mechanism, the effect of different parameters on the decolorization percentage, and toxicity analysis of Reactive Black 5 before and after decolorization were investigated in the present study. The decolorization percentage for live cells of Staphylococcus sp. strain MEH038S was more than dead cells, which demonstrated that Reactive Black 5 was decolorized through the degradation process. The results confirmed that an FMN-dependent NADH-azoreductase gene was responsible for the decolorization and then was identified as Staphylococcus sp. EFS01 azoreductase from a moderately halotolerant Staphylococcus strain for the first time. The maximal decolorization of 98.15% was observed at pH 6.5 and 35 ° C for 50 mg/L of Reactive Black 5. In addition, more than 90% decolorization was achieved with 5-40 g/L of NaCl. The results of Gas chromatography-mass spectrometry and Fourier transform infrared spectroscopy showed that Reactive Black 5 was broken to the lower molecular weight compounds without any chromophoric azo groups. Phytotoxicity and fish toxicity proved that the biotransformed metabolites of Reactive Black 5 degradation were more toxic than the original dye. The moderate halotolerant strain exhibited a remarkable decolorization capability and can be applied for textile wastewater treatment. PRACTITIONER POINTS: An azoreductase gene from a moderately halotolerant Staphylococcus was identified. More than 90% decolorization efficiency was observed under high-salt conditions. Biotransformed metabolites of RB5 degradation were identified. Toxicity analysis of biotransformed metabolites was investigated., (© 2021 Water Environment Federation.)

The clinical diagnosis of Acute Invasive Fungal Rhinosinusitis (AIFRS) is technically difficult because it presents with non-exclusive and nonspecific clinical symptoms. Laboratory confirmation (usually via histopathologic techniques such as formalin-fixed paraffin-embedded (FFPE)) is necessary but it is time-consuming, despite the urgent need for timely diagnosis of AIFRS for effective management. This study aimed to investigate the sensitivity and specificity of the GMS frozen-section biopsy in the diagnosis of AIFRS and compare the same with that of different tissue staining methods to provide valid decision-grounds that may guide clinicians in prompt diagnosis of acute fungal invasive rhinosinusitis. A cross-sectional study was conducted in the Medical Mycology Laboratory, Faculty of Medicine, Iran University of Medical Sciences between 2018 and 2020 on 200 patients with suspected AIFRS referred to Baqiyatallah and Imam Khomeini Hospital, Tehran. All patients were subjected to diagnostic nasal endoscopy and computed tomography (CT) scan of paranasal sinuses. Magnetic resonance imaging (MRI) was done in cases of suspected intracranial extension. After screening by routine mycological examination, the diagnosis was confirmed using complementary molecular methods. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the frozen-section biopsy were also compared with FFPE. Of the 200 suspect patients, 47 cases (23.5%) met the criteria for AIFRS. Species of the genus Aspergillus were the predominant 27 (57.4%) followed by Mucorales species 10 (21.3%), and Fusarium spp 3 (6.4%). Also, 3 cases (6.4%) of co-infection due to Aspergillus/Rhizopus were reported. The accuracy, sensitivity, specificity, PPV, and NPV of frozen section assessments were 99.5%, 97.9%, 100%, 100% and 99.3%, respectively. For GMS frozen-section alone, sensitivity, specificity, NPV, and PPV was 100%. Overall, the calculated accuracy of FFPE was 98.5%, sensitivity was 94%, specificity was 100%, PPV was 100%, and NPV was 98.1%. Examination of the frozen-section biopsy is a highly predictive tool for a rapid and effective diagnosis of patients with suspected AIFRS. We observed that GMS frozen-section is a fast and reliable exam to confirm the diagnosis of fungal invasion, with good accuracy, sensitivity, and specificity compared to the gold-standard FFPE biopsy., (Copyright © 2021 Elsevier Ltd. All rights reserved.)