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Ameneh Jafari,1,2 Mostafa Rezaei-Tavirani,1 Samira Karami,3 Mohsen Yazdani,4 Hakimeh Zali,1,5 Zahra Jafari6 1Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Hematopoietic Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4Department of Bioinformatics, Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran; 5Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 6 9Dey Manzariye Hospital, Isfahan University of Medical Sciences, Isfahan, IranCorrespondence: Hakimeh Zali Department of Tissue Engineering and Applied Sciences, School of Advanced Technologies in MedicineShahid Beheshti University of Medical Sciences, Tehran, IranTel +989123367156Fax +982122439848Email hakimehzali@gmail.comMostafa Rezaei-TaviraniProteomics Research Center, School of Allied Medical SciencesShahid Beheshti University of Medical Sciences, Tehran, IranTel +982122439787Email tavirany@yahoo.comAbstract: New cases of the novel coronavirus, also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are increasing around the world. Currently, health care services are mainly focused on responding to and controlling the unique challenges of the coronavirus disease 2019 (COVID-19) pandemic. These changes, along with the higher susceptibility of patients with cancer to infections, have profound effects on other critical aspects of care and pose a serious challenge for the treatment of such patients. During the COVID-19 pandemic, it is important to provide strategies for managing the treatment of patients with cancer to limit COVID-19-associated risks at this difficult time. The present study set out to summarize the latest research on epidemiology, pathogenesis, and clinical features of COVID-19. We also address some of the current challenges associated with the management of patients with cancer during the COVID-19 pandemic and provide practical guidance to clinically deal with these challenges.Keywords: coronavirus, SARS-CoV-2, cancer, pandemic, health care

Zahra Yazdani,1 Alireza Rafiei,1 Mohammadreza Yazdani,2 Reza Valadan1 1Department of Immunology, Molecular and Cell Biology Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; 2Department of Chemistry, Isfahan University of Technology, Isfahan 84156-83111, IranCorrespondence: Alireza RafieiDepartment of Immunology, Molecular and Cell Biology Research Center, School of Medicine, Mazandaran University of Medical Sciences, KM 18 Khazarabad Road, Khazar Sq, Sari, IranTel +981133543614Fax +98-11-3354-3087Email rafiei1710@gmail.comBackground: To date, no specific vaccine or drug has been proven to be effective against SARS-CoV-2 infection. Therefore, we implemented an immunoinformatic approach to design an efficient multi-epitopes vaccine against SARS-CoV-2.Results: The designed-vaccine construct consists of several immunodominant epitopes from structural proteins of spike, nucleocapsid, membrane, and envelope. These peptides promote cellular and humoral immunity and interferon-gamma responses. Also, these epitopes have a high antigenic capacity and are not likely to cause allergies. To enhance the vaccine immunogenicity, we used three potent adjuvants: Flagellin of Salmonella enterica subsp. enterica serovar Dublin, a driven peptide from high mobility group box 1 as HP-91, and human beta-defensin 3 protein. The physicochemical and immunological properties of the vaccine structure were evaluated. The tertiary structure of the vaccine protein was predicted and refined by Phyre2 and Galaxi refine and validated using RAMPAGE and ERRAT. Results of ElliPro showed 246 sresidues from vaccine might be conformational B-cell epitopes. Docking of the vaccine with toll-like receptors (TLR) 3, 5, 8, and angiotensin-converting enzyme 2 approved an appropriate interaction between the vaccine and receptors. Prediction of mRNA secondary structure and in silico cloning demonstrated that the vaccine can be efficiently expressed in Escherichia coli.Conclusion: Our results demonstrated that the multi-epitope vaccine might be potentially antigenic and induce humoral and cellular immune responses against SARS-CoV-2. This vaccine can interact appropriately with the TLR3, 5, and 8. Also, it has a high-quality structure and suitable characteristics such as high stability and potential for expression in Escherichia coli .Keywords: SARS-CoV-2, multi-epitope vaccine, structural proteins, humoral immunity, cellular immunity, adjuvant

BACKGROUND AND OBJECTIVE: Abnormal vaginal bleeding under the age of 10 is rare among girls. In such cases, local lesions, trauma, intra–vaginal foreign body, malignant genital tumors, and precocious puberty should be taken into account. Leech infestation is one of the rare causes of severe prepubertal vaginal bleeding. One case of prepubertal vaginal bleeding due to leech infestation is presented here. CASE REPORT: An eight–year–old girl referred to the emergency department after three days of painless vaginal bleeding. The bleeding was moderate during the first two days and the patient experienced intensified bleeding and large menstrual clots on the third day. The patient had no history of trauma, coagulation disorder, systemic illness, and drug use, but noted the history of swimming in the muddy creek within a few days before referral to the emergency department. After examining the genital system, a black mass with wavelike movements was observed in the lower one-third of the vagina, and a piece of it was slightly out of the hymen. The leech was removed by forceps without damaging hymen. After a short time, the bleeding stopped. On the next visit, the patient had no vaginal bleeding and was discharged without any problem. CONCLUSION: In cases of prepubertal vaginal bleeding, accurate examination of the genital system and evaluating the history of swimming or bathing in contaminated creeks, springs, qanats and pools are essential.

In order to manage a project with integrity, a cohesive communication is needed between its various sections; possible risks, identification of stakeholders, providing the necessary resources on time and managing their availability, focusing on the approved budget and satisfactory quality the project can be successfully done. In the recent year BIM has as new aspects to engineering and architecture, and has become an accepted platform for planning and executing construction projects and contributed to integration of various fields and. also, project management standards, such as PMBOK, have come to aid construction managers. Through the basic capacities of BIM, and questionnaires according to aspects of PMBOK, the present study tries to identify the superior effects of BIM on project management. Moreover, it seeks to recognize the most significant aspects of BIM application on project management. by employing the FANP-AVIKOR decision making method to prioritize the parameters of the collected results, the study’s conclusion will indicate that almost all of PMBOK aspects equally benefit from using BIM; in addition, it will show that 3D BIM capacities, including clash detection, plan correction, are superior in comparison with 6D BIM and 7D BIM capacities.

N-acetylcysteine (NAC) and vitamin D provide effective neuroprotection in animal models of severe or inflammation-sensitized hypoxic ischemic encephalopathy (HIE). To translate these FDA-approved drugs to HIE neonates, we conducted an early phase, open-label trial of 10 days of NAC (25, 40 mg/kg q12h) + 1,25(OH)(2)D (calcitriol 0.05 mg/kg q12h, 0.03 mg/kg q24h), (NVD), for pharmacokinetic (PK) estimates during therapeutic hypothermia and normothermia. We paired PK samples with pharmacodynamic (PD) targets of plasma isoprostanoids, CNS glutathione (GSH) and total creatine (tCr) by serial MRS in basal ganglia (BG) before and after NVD infusion at five days. Infants had moderate (n = 14) or severe HIE (n = 16), funisitis (32%), and vitamin D deficiency (75%). NVD resulted in rapid, dose-responsive increases in CNS GSH and tCr that correlated positively with plasma [NAC], inversely with plasma isofurans, and was greater in infants with lower baseline [GSH] and [tCr], suggesting increases in these PD markers were titrated by neural demand. Hypothermia and normothermia altered NAC PK estimates. NVD was well tolerated. Excluding genetic syndromes (2), prolonged ECMO (2), lost-to-follow-up (1) and SIDS death (1), 24 NVD treated HIE infants have no evidence of cerebral palsy, autism or cognitive delay at 24-48 months. These data confirm that low, safe doses of NVD in HIE neonates decreased oxidative stress in plasma and CNS, improved CNS energetics, and are associated with favorable developmental outcomes at two to four years.