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Background and purpose: Lophomoniasis is a relatively common emerging parasitic disease caused by a pathogenic protozoan called Lophomonas, which mostly affects the lower respiratory tract (lungs and bronchi) of humans. The parasite lives symbiotically in the digestive system of insects such as cockroaches and mites. Acanthamoeba is a free-living amoeba that has two forms of trophozoite and cyst in its life cycle. The respiratory system and airways serve as passage and deployment sites for a wide range of non-pathogenic and pathogenic microorganisms, making it a suitable place for the entry and spread of different species of Acanthamoeba amoeba and the Lophomonas pathogen in the respiratory system, which can cause clinical manifestations similar to tuberculosis. Therefore, the present study aimed to investigate the frequency of these two parasites in sputum clinical samples from suspected tuberculosis patients referred to the tuberculosis laboratory in Babolsar City to rule out the two mentioned infections. Materials and methods: This descriptive-cross-sectional study was conducted on 201 sputum samples of people suspected of tuberculosis who were referred to the tuberculosis laboratory of Babolsar Health Center in Mazandaran province in 202-2023, and all the demographic and epidemiological information of the patients was recorded. In the morphological method, Giemsa staining was used for Lophomonas and Ziehl-Neelsen staining for Acanthamoeba. To identify the presence of Acanthamoeba, sputum samples were cultured in a 1.5% non-nutrient agar culture medium for 72 to 96 hours. Approximately 50 microliters of patients' sputum were added to the NNA medium, along with 20 microliters of trypticase-yeast extract and maltose (TYM) culture medium, and 20 microliters of an autoclaved Escherichia coli bacteria mixture to enrich the culture medium. The cultured plates were then placed in an incubator at 26ºC and checked daily under a light microscope for trophozoite growth. To accurately confirm the presence of parasites, DNA extraction was performed on the patient's sputum samples using the phenol-chloroform-isoamyl alcohol method. Subsequently, conventional polymerase chain reaction (PCR) was conducted using specific primers on the extracted DNA samples. Results: In the study of 201 people suspected of tuberculosis, it was found that 80 individuals (39.8%) lived in urban areas and 121 individuals (60.2%) lived in rural areas. The age range of participants varied from 7 to 88 years old. There were 113 females (56.2%) and 88 males (43.8%) in the study, with 12 individuals from Afghanistan living in urban areas. Out of the 201 sputum samples examined, a total of 23 samples (11.4%) tested positive for the Lophomonas parasite using the PCR method. Among these positive cases, 7 individuals (30.4%) resided in urban areas (Babolsar), while 16 individuals (69.5%) lived in rural areas. However, none of the samples tested positive for Acanthamoeba in this study using staining and PCR methods. Conclusion: The present study showed that due to the similarity of the clinical manifestations of tuberculosis and lophomoniasis, there is a possibility of mistaking these two diseases clinically. Therefore, it is recommended to check fresh sputum samples of people suspected of tuberculosis, especially in endemic areas, in terms of pulmonary lophomoniasis.

Leishmaniasis is one of the most common parasitic diseases in tropical and subtropical regions worldwide and poses a threat to public health. According to the World Health Organization (WHO), the number of leishmaniasis cases worldwide is estimated at 12 million, and the number of people at risk is 350 million. However, leishmaniasis therapies have their limitations, and today nanoparticle delivery systems such as liposomes are used. Liposomes are bilayered structures made of phospholipids and cholesterol, which contain hydrophilic and hydrophobic components in their structure and enable the uptake of hydrophobic, hydrophilic, or amphiphilic compounds. Since the leishmaniasis parasite is predominantly found in macrophages, drug delivery systems improve the therapeutic index of anti-leishmaniasis drugs and reduce the effective dose and toxic off-target effects of non-specific biodistribution. Targeted liposomal drug delivery systems are achieved by utilizing their different structural features such as particle size and surface charge and attaching other ligands to the surface of liposomes for targeted drug delivery. Today, sugar-coated liposomes, cationic liposomes, arsenoliposomes and peptide-targeted liposomes are used to deliver traditional anti-leishmaniasis drugs to Leishmania, and due to the importance of nanoliposomes and their many benefits, research continues in this field.

Key Clinical Message Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by Enterobius vermicularis. All members of her family were also infected by this helminth. Treatment with mebendazole was administered to all family members and it was found that the entire family had been cured. Abstract Vulvovaginitis, an inflammation of the vulvovaginal mucous membranes, is a common reason for pediatric gynecology consultations. One of the causes of this condition is a parasitic worm known as Enterobius vermicularis (E. vermicularis). In girls, adult worms can infiltrate the vagina and release eggs, leading to the development of vulvovaginitis. Furthermore, these worms have the ability to invade the endometrial cavity too. Here we present a case of a 4‐year‐old girl who suffered from vulvovaginitis caused by E. vermicularis. All members of her family were also infected by this parasitic helminth. In the vaginal sample, apart from the eggs, the female adult worm was observed under the microscope. Treatment with mebendazole was administered to all family members, and their progress was followed for a period of 3 weeks, during which it was found that the entire family had been cured. This patient experienced significant improvement in symptoms related to severe anxiety, nervousness, vaginal inflammation, itching, and vulvovaginitis caused by E. vermicularis. To prevent infection by E. vermicularis, it is crucial to disinfect underwear and bed sheets. In kindergartens, the spread of this parasite should not be underestimated, and asymptomatic individuals who have been exposed to infected persons should receive treatment to prevent an epidemic. Maintaining cleanliness and hygiene, especially after using the toilet, is of the most importance, particularly for girls who are more susceptible to E. vermicularis infection. Additionally, it is essential for all family members to be aware of the transmission routes of this parasite.

In this case report, we address the diagnostic challenges and clinical implications of severe infection with Lophomonas blattarum in a patient initially suspected of experiencing long COVID symptoms. We describe the patient's medical history, initial symptoms, diagnostic tests, and treatment. A female patient with diabetes in her early 60s presented with severe shortness of breath and was initially diagnosed with diabetic ketoacidosis (DKA). After resolution of her DKA symptoms, persistent respiratory issues led to a COVID-19 test, which was negative. A chest computed tomography scan revealed abnormalities, prompting bronchoscopy and bronchoalveolar lavage fluid analysis, which confirmed the presence of L. blattarum . Notably, the protozoan remained mobile and viable even after a 4-day transport at ambient temperature. This case emphasizes the importance of considering alternative diagnoses and improving awareness about L. blattarum infection in patients with respiratory symptoms, for timely and accurate management.

Mucosal leishmaniasis (ML) is a chronic and rare form of leishmaniasis that causes malignant lesions in the mucosa of the nasal, pharyngeal, and laryngeal regions. We describe a 29-year-old woman who had been suffering from an intranasal polyp for 3 years. The polyp recurred annually after surgical removal, and was diagnosed as nasal leishmaniasis.

Background: Brucellosis is one of the most common diseases between humans and animals. Therefore, the need for prevention and production of an efficient vaccine is necessary. The aim of the present study is to prepare a niosomal nanostructure containing trivalent immunogen (TF, Bp26 and Omp31) of Brucella as a nanovaccine candidate. Materials and Methods: In this study, after designing the immunogen structure by bioinformatics databases and software, in order to evaluate the immunogenicity of the designed recombinant protein, clone and gene expression were carried out in E.coli BL21. The protein extracted from the culture of said cells was purified by Ni-NTA column. Thin layer coating method was used to prepare niosomes carrying trivalent immunogen and were evaluated using DLS and Zetasizer characterization tests. Then, the amount of trivalent immunogen loading and release was calculated. Results: The results of the characterization confirmed the successful fabrication of niosomal nanosystem containing trivalent immunogen. The results showed that the produced niosomes are in a suitable range of size (100 nm). Trivalent immunogen with high efficiency (81.96%) is encapsulated in the system. The release of trivalent immunogen from Niosomal nanosystem was reported to be 97% after 96 hours. In addition, the trivalent immunogen release pattern of the coated system was more controlled and slower. This confirms the positive effect of the niosome nanosystem. Conclusion: The use of nisome as a nanovaccine agent has an effective role in controlling antigen release and can be considered as a vaccine candidate and increase the protective immune response against Brucella.

Introduction: As one of the diseases transmitted through water and food, shigellosis is one of the health problems in developing countries. This study was conducted in order to investigate the outbreaks of bloody diarrhea caused by Shigella in patients with positive cultures in Isfahan province during 2014-2016. Methods: This study was a cross-sectional descriptive-analytical study. Information of 280 infected patients with positive Shigella cultures based on demographic information, age, sex, place of residence, clinical symptoms, history of food consumption, and the date of illness and referral to medical centers were analyzed using SPSS16 software, checking percentages and frequencies, chi-square and t-tests were investigated. Results: The percentage of female patients of this study was 51.1% and male was 48.9% with a mean age of 25.53± 21.36; 27.1% of patients were housewives and 94.3% were Iranians. 97.1% of patients, in addition to positive cultures, red blood cells were also reported in microscopic examination of their stool samples. . 23.26% of patients had fever, 19.86% had nausea and 16.99% had obvious bloody diarrhea. 26.88% of patients had a history of consuming vegetables and 94.1% of them referred to medical centers in the first three days to receive medical services. Furthermore, 45.5% of these patients were hospitalized and 54.5% were treated as outpatients and finally 100% of patients recovered. Conclusion: Community education for food hygiene is one of the essential educational needs and also the development of vegetable preparation centers in the form of packaging and having a health code is one of the essential needs in terms of health and food security.

Background and Aim: Cutaneous leishmaniasis (CL) is an important health problem in Iran and one of the world ̛s neglected diseases which is caused by Leishmania spp. The aim of this study was to investigate the epidemiology of cutaneous leishmaniasis and its associated risk factors in an endemic center in Golestan Province. Materials and Methods: This descriptive cross-sectional study included patients with suspected CL who had been referring to the health centers of Gonbad–e Qabus town, between 2018 and 2020. Demographic and epidemiological data of CL patients were recorded and diagnosis of Leishmania spp. was made by Giemsa staining of direct smear. PCR was also used to determine and confirm the parasite species. Results: From 1979 suspected CL lesions, 1704(87.4%) had positive smears. 898 (52.7%) patients were male and 806 (47.3%) were female. The highest incidence rate was observed in the patients of less than 5 (25.93%) and those between 25 and 45 years of age (25.41%). In all samples in this study, Leishmania major was the only Leishmania spp detected by ITS-PCR. Also, Critidia fasciulata was identified in three patients. Conclusion: The study provided valuable data concerning the epidemiologic aspects of the CL in an old endemic focus in north of Iran, which can be used as the basis for planning future control strategies.

Background and Objectives: Coronavirus disease 2019 (COVID-19) rapidly spread throughout the world, including Iran. The main measures for preventing the spread of this disease are based on personal hygiene and observance of protocols such as social distancing. It is important for medical and non-medical students to be aware of this disease and how to face it. This study aims to investigate the knowledge, attitude, and practice (KAP) of medical and non-medical students in Mashhad, Iran against regarding COVID-19. Methods: In this analytical cross-sectional study, 650 medical and non-medical students from Mashhad participated, 322 medical students and 328 non-medical students. Sampling was done online using a convenience method. The data collection tools were a demographic form and a KAP questionnaire for COVID-19. Data analysis was performed in SPSS v. 21 software using descriptive and inferential statistics. Results: The mean knowledge scores of medical and non-medical students were 72.5% and 72.87%, respectively, which were not statistically significant (P=0.648). The mean attitude scores of medical and non-medical students were 76.89% and 75.95%, respectively, which was not statistically significant (P=0.297). The mean practice score of non-medical students (64.29%) was significantly higher than that of medical students (61.22%) (P=0.004). Conclusion: The medical and non-medical students in Mashhad have a good level of knowledge, attitude and practice regarding COVID-19. The KAP tool used in this study can be used in future studies.

Introduction: Today, the use of new technologies has expanded in various fields. One of these cases is the use of smartphones and barcode reader software and two-dimensional barcodes. In this study, we tried to evaluate the influence of barcode utilization in the training of residents. Methods: This was a descriptive cross-sectional study conducted in the emergency department of Ghaem Hospital, in which the effect of using educational barcodes on 30 medical residents of the emergency, internal medicine, and neurology was investigated. A questionnaire recording the performance of residents in medical emergency procedures was used. Also, demographic variables of residents were recorded. Data analysis was performed using descriptive and inferential statistics in SPSS software.Results: A total of 30 residents completed the study questionnaire before installing the poster, and 29 of them completed the post-test questionnaire. Of these, 10 (33.3%) were emergency medicine residents, 13 (43.3%) Internal medicine and 7 subjects (23.3%) were neurology residents. All of them (100%) found the use of QR codes practical and easy. Analysis of data related to pre-test and post-test scores of residents shows that their average scores in the pre-test, 7 ±2.39, and their average scores in the test post 10.86 ±2.431, which indicates a significant increase after using the QR code poster (P-value = 0.000) Conclusion: The use of QR codes has been practical, easy, and user-friendly. Also, comparing the average scores of participants before and after the installation of these codes, shows that it has had a significant effect on training residents.

Background and purpose: Stroke is the most common and the most deadly neurological disease that is accompanied with many complications. The aim of this study was to compare the diagnostic value of hs-CRP and ABCD2 criteria in predicting the future incidence of acute cerebrovascular events during follow-up in patients with transient ischemic attack (TIA). Materials and methods: This cohort study was performed in TIA patients during the first 24 hours of onset of symptoms. Blood samples were taken and demographic information was obtained, then hs-CRP was measured in all patients. History of hypertension, atherosclerosis, and ABCD2 scores were also recorded. Results: The patients (n= 135) included 69 (51.11%) male and 66 (48.88%) female cases. Eight subjects had a stroke within three months. There was no significant relationship between hs-CRP level and stroke incidence (P= 0.303), but ABCD2 cut-off scores of >1.5 had the most sensitivity (87.5%) and specificity (81.9) that could significantly predict the occurrence of stroke (P= 0.011). Systolic blood pressure (OR=1.04) and ABCD2 score (OR=2.43) could predict the occurrence of stroke (P

Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran. Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data. Results: In the present study, 25 studies that examined the countrychr('39')s medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61). Conclusion: The results of this study help to understand the current position of medical negligence studies in the country to identify the cause of the malpractice and develop new studies for the future.

Background: According to statistics, tramadol use is extremely prevalent in Iran. Besides, tramadol overdose is mostly observed in young individuals. Given the significance of this issue and the increasing prevalence of tramadol use in Iran, this study aimed to systematically review tramadol poisoning in Iran. Methods: In this review, a search was conducted in Persian databases of IranMedex, SID, Medlib, Magiran, as well as Google Scholar using the keywords of “poisoning and tramadol” without a time limitation. Results: Some of the main issues related to tramadol poisoning were as follows: the majority of cases consumed tramadol to commit suicide; most tramadol consumers were aged below 30 years; the majority of patients with tramadol poisoning were single and male; tramadol was mostly used orally; in most studies, patients were hospitalized for >24 hours; the majority of patients concomitantly took other medications with tramadol; in most studies, patients had a history of tramadol use; most studies reported a relationship between tramadol dose and seizures, and the most common cause of hospital referral was decreased consciousness level. Conclusion: Tramadol misuse and poisoning could lead to seizures and often death. Besides, most cases with tramadol poisoning were aged below 30 and consumed tramadol to commit suicide. Thus, it is crucial to improve the youth’s awareness about tramadol use, develop methods to prevent suicides, and limit access to this drug, especially in young adults.

Background and purpose: Toxoplasma gondii is one of the most common parasitic infections in humans and other vertebrates worldwide. This study aimed at determining the seroprevalence of Toxoplasma infection and associated risk factors in individuals attending a Reference Laboratory in Gorgan, Iran. Moreover, recent studies in Golestan province were reviewed. Materials and methods: A descriptive cross-sectional survey was conducted in 551 blood samples obtained from February-June 2017. Serum samples were isolated and examined for IgG and IgM antibodies against T. gondii using ELISA. Data were analyzed in SPSS applying logistic regression. Results: Total prevalence of T. gondii was 63.5% (350 out of 551). Among the samples, 306 (55.5%), 12 (2.17%), and 32 (5.8%) were found to be positive for IgG, IgM and both IgG and IgM against T. gondii, respectively. There were significant associations between T. gondii infection and age and soil contact (P< 0.05). However, no significant correlation was observed between T. gondii infection and sex, living area, level of education, occupation, etc (P>0.05). Conclusion: About two thirds of individuals were infected with T. gondii. Accordingly, a high number of subjects have been exposed to T. gondii in this area, which their seropositivity was seen to increase by age as a risk factor. High seropositivity indicates appropriate conditions for the life cycle of the parasite in this province. Therefore, preventive measurements at the community level, particularly in high-risk groups, are warranted.

Background and purpose: Stroke is the most common neurological disease. This study aimed to investigate the relationship between serum C-reactive protein (CRP) as a prognostic factor and ischemic and hemorrhagic cerebrovascular accident (CVA). Materials and methods: This cohort study was performed in patients over 18 years of age with symptoms of ischemic and hemorrhagic CVA attending the emergency department in Mashhad Ghaem Hospital during the first 6 hours of the onset of symptoms. CRP levels and prognosis of serum CRP levels were determined in diagnosing the severity of ischemic and hemorrhagic lesions in CVA patients. The severity of CVA was determined based on MRS and NIHSS scales. Patients' follow-up was considered 6 months later. Results: There were no significant differences between gender and age in study groups (P> 0.05). The median scores for MRS and NIHSS were significantly higher in hemorrhagic patients than ischemic patients. Analysis of CRP level in univariate regression model showed that CRP level is a bad prognosis for stroke (β = 0.149, P= 0.027). Mean age, gender distribution, type of stroke, symptoms, and underlying diseases were not significantly different between the group with and without stroke (P> 0.05). There were significant differences in CRP level and recurrence of stroke after 6 months between the groups studied (P= 0.009). Conclusion: Monitoring of CRP levels can be effective in early diagnosis and control of recurrent stroke.

Abstract The majority of rectal foreign bodies inserted by adults are for self‐gratification. As a result, they will probably be smooth, rounded, tubular, or egg‐shaped to make insertion and extraction easier. Herein, we describe a 50‐year‐old man who inserts a water bottle into a region 10 mm from the anorectal junction.

The aim of this study was to compare the relationship between shock index (SI) and respiratory adjusted shock index (RASI) scores with the final outcome of sepsis patients referred to the emergency department. This was prospective research that examined individuals who had been diagnosed with sepsis, determined by the presence of at least two of the three quick sepsis-related organ failure assessment (qSOFA) criteria and the presence of an infectious disease based on a diagnosis made by a hospital physician of Imam Reza and Ghaemshahr of Mashhad in 2019. Demographic information of patients, SI score, RASI score, and information related to the patient's clinical symptoms were recorded in the checklist. The final outcome of this study was considered mortality. Data analysis was performed using descriptive and inferential tests. In the present study, a total of 178 patients, 46 patients (25.8%) were transferred to the intensive care unit, and 98 patients (55.1%) were admitted to the normal wards. Eighty-five patients (47.75%) died and the mean length of hospital stay of all patients was 11.07 ± 9.23 days. Forty-four patients (24.7%) had referred with a decreased level of consciousness and 44 patients (24.7%) presented with confusion. The rest of the patients reported normal levels of consciousness. Kaplan Mir analysis with log-rank was performed to determine the difference in survival distribution in different SI groups: Survival distribution was not statistically different for the four defined groups (based on statistical quartiles (P = 0.320). Receiver operator curves were considered as the date of death in the case of the deceased and the date of discharge from the hospital in the case of the living as censored. The AUC of the RASI scoring system for predicting mortality was 0.614 (P = 0.009) while this value was not significant for SI (P = 0.152). In logistic regression analysis, it was found that by adjusting for the variables of age, sex, sepsis etiology, blood pressure and heart rate, level of consciousness, and gender, patients with the lower respiratory rate (OR 1.6, z = −0.159 p = 0.007), younger age (OR 1.6, z = −0.029 p = 0.006) and higher RASI score are more in risk of mortality (OR 1.29, z = 1.209, p = 0.031). The results of our study showed that RASI scoring can be a good criterion for predicting the chance of mortality in patients with sepsis and could be used complementary to previous criteria such as SI. Patients with high RASI scores should be given more attention to reducing the chance of death.

Background and purpose: Non-traumatic or spontaneous supratentorial hemorrhage (ICH) is a condition that may be difficult to diagnose and treat. In this study, ‎we decided to determine certain criteria for hospitalization ‎of patients with non-traumatic supratentorial ICH in Intensive Care Unit (ICU) ‏. Materials and methods: This cross-sectional study was performed in Mashhad Ghaem Hospital 2019. Patients with primary non-traumatic supratentorial ‎ICH were studied. Demographic information, main complaint, comorbidities ‎and comorbid symptoms, and level of consciousness of patients at the time of ‎referral (FOUR and GCS criteria) were recorded‏.‏ Data analysis was carried out in SPSS V21. Results: Patients (n=126) were studied based on the need for ICU admission (n= 84) or other admissions (n= 42). Older patients were 0.955 times more likely to be admitted to ICU and patients with increase in level of ‎consciousness at arrival were 0.812 times less prone to be admitted to ‎ICU. We found ICU admission 10.29 times higher in patients with intraventricular hemorrhage. Those with Babinski reflex were 0.14 times less likely to be admitted to ICU. Moreover, probability of ICU admission was 0.098 times less in patients with reduced four-limb ‎force. Mortality ‎rate was significantly higher in patients admitted to ICU (45%) than others (26.2%) (P= 0.036) ‎‏.‏ Conclusion: Current study could not provide a model for predicting the admission of ICH ‎patients to ICU or other wards, so, developing criteria for ICU admission in these patients requires further research.

Systemic sclerosis is a connective tissue disorder that involves the skin and many other organs, such as the heart, skin, and gastrointestinal tract. Cardiac involvement is in the form of pericarditis, pericardial effusion, and pulmonary hypertension. Several complications and super infections post-COVID-19 have been reported, such as fungal, bacterial infections, and Lophomonas blattarum . Lophomoniasis is an emerging pulmonary infection that mainly involves the lower respiratory tract. Herein, we present an ectopic Lophomonas infection in an unusual location (pericardial effusion) in a COVID-19 patient who had systemic sclerosis.

Abstract Cutaneous leishmaniasis is one of the most common forms of leishmaniasis in Afghanistan, which is caused by different Leishmania species that are transmitted to humans by sandflies. Its clinical manifestations are very diverse and depend on a variety of parasite and host factors.

Abstract Mucormycosis is a rare, invasive, quickly progressing fungal infection that generally affects patients who are immunocompromised. If left untreated, the disease is characterized by progressive necrosis and is often fatal. We present two cases of post‐COVID‐19 mucormycosis with a history of several years of uncontrolled diabetic mellitus.

Abstract Lophomonas is a neglected and emerging protozoan that infects the lower and upper respiratory tracts of humans. Here, we present two cases of lophomoniasis from Afghanistan that include symptoms such as fever, cough, hemoptysis, and pleural effusion.

Background and Aim: The recent Coronavirus Disease 2019 (COVID-19) outbreak has caused a lot of stress and anxiety in the world. Given that health care workers are at the forefront of fighting against COVID-19, they are the first to be exposed to this disease. Methods & Materials: This is a descriptive cross-sectional study conducted on 402 medical and administrative staff working in hospitals and health centers affiliated to Jahrom University of Medical Sciences in 2020. Data collection tools were a demographic form and the Corona Disease Anxiety Scale (CDAS). Ethical Considerations: This study was approved by the Vice-Chancellor for Research of Jahrom University of Medical Sciences (Code: IR.JUMS.REC.1399.046). Results: The mean score of psychological symptoms of anxiety in the medical staff (46.91) was higher than in the administrative staff (42.63). Its physical symptoms were also higher in the clinical staff (12.80) compared to the administrative staff (10.94). There was a significant difference between the clinical and administrative staff in terms of anxiety (P=0.030). Conclusion: Medical staff has higher psychological and physical symptoms of anxiety compared to the non-medical staff during the COVID-19 outbreak. Therefore, in order to reduce the anxiety of medical staff, health policymakers should take the necessary measures to take care of this group.

Background and Aim: The COVID-19 pandemic is capable of severely affecting the mental health of health care workers, who are at the forefront of this crisis; while the official staff of health organizations is facing the same danger. Therefore, monitoring awareness and other mental health issues to understand the mediating factors and awareness of appropriate interventions is a necessary priority. Therefore, the purpose of this study was to compare the level of knowledge, attitude, and practice of medical and administrative staff in facing the COVID-19 virus. Methods & Materials: This cross-sectional descriptive study was performed on 160 medical and administrative staff of Jahrom hospitals in 2020. Demographic information questionnaire and researcher-made questionnaire of knowledge, attitude and practice of medical personnel about coronavirus (Covid 19) were used to collect information. Data were analyzed using SPSS software version 21 and descriptive and inferential statistical tests. Results: 65% of subjects were women and the rest were men. In most of the answers given to each item in both groups, the medical and administrative staff’s answers were close to each other. In the case of the statement "I am more likely to get a corona", 54.4% of the medical staff chose the strongly agreed option, while this percentage is 16.5% for the administrative staff. This indicates that the medical staff is very afraid of getting COVID-19. According to the results, the mean knowledge scores of the medical staff (with an average of 94.35) were significantly higher than the administrative staff (with an average of 87.75) (t=5.96, p

Objective (s): Since cultural competency is an important issue for health care professionals. The aim of this study was to develop and validate a questionnaire to assess the cultural competency for medical graduates. Methods: first an item pool was s generated. Then the content and face validity was assessed by a panel of 15 experts familiar with clinical education and cultural competence. The structural validity of the questionnaire was assessed using the information obtained from 542 medical students working in medical centers in Tehran by exploratory factor analysis. The reliability of the questionnaire was assessed by examining internal consistency. Data were analyzed using SPSS software version 24. Results: Out of 103 items generated after content validity 64 items remained. The structural validity of the questionnaire as assessed by the exploratory factor analysis led to removing 14 items. The final version of the questionnaire contained 50 items tapping into 8 factors that jointly explained 53.45% of variance observed. The Cronbachchr('39')s alpha coefficient for the whole questionnaire was 0.96 and for the 8 factors ranged from 0.88 to 0.89. Conclusion: The findings suggest that the Medical Science Graduateschr('39') Cultural Competency Questionnaire is a valid and reliable measure that can be used as an instrument to assess the cultural competency of medical students.

There is a high prevalence of infections caused by Leishmania parasites and increasing rate of drug resistance. Lack of successful treatment with existing drugs calls for new therapeutic approaches. The main strategy in treatment of leishmaniasis is creating apoptosis and eliminating different forms of the parasite. So far, numerous drugs with specific mechanisms including 14-α-demethylase enzyme inhibition, inhibition of tubulin polymerization and cell division, radical formation, inhibiting the glycolytic and hydrolysis of fatty acids, and reducing the parasite's access to energy reserves such as ATP have been introduced. Moreover, different mineral compounds especially iron are needed for metabolism and survival of the parasite. This review article introduces iron-chelating compounds as a new therapeutic approach in treatment of leishmaniasis.

Leishmaniasis is a vector-borne zoonotic disease caused by various species of the genus Leishmania, (trypanosomatidae family) that is transmitted by phlebotomine sandflies. The disease can present in a range of clinical forms, including dermal lesions, metastasis mucocutaneous forms, and fatal visceral forms. In this non-systematic review, we aimed at introducing the role of kinetoplast DNA (kDNA) and dependent topoisomerases (TPI) as potential chemotherapeutic targets for treatment of leishmaniasis. The Leishmania parasite has a mitochondrial DNA located in the attached circles. KDNA replication process is very complex and a large number of proteins are involved. Some of them are classified as topoisomerases, which play major biological roles in the effective cell processes in the topology, synthesis, and organization of kDNA and constitute the main drug target in kinetoplast for leishmaniasis cure. Several studies have shown that the inhibitors of TPI exchange these enzymes into intracellular cell toxins and provide an appropriate tool for killing the parasite in the host. DNA binding drugs have also been reported as therapeutic agents against leishmanial infections.

Abstract Cystic echinococcosis is one of the most important zoonotic parasitic diseases caused by the tapeworm Echinococcus granulosus. To date, the genotype of multivesicular CE has not been identified. In this regard, the genotyping of multivesicular types of CE could help clinicians understand and manage the disease effectively.

Abstract Loss of consciousness (LOC) is one of the most common causes of emergency department (ED) visits. It may be due to intoxication or hypoglycemia. We present a 15‐year‐old girl who was referred with heavy head lice and LOC to the ED in the north of Iran.

Abstract Rhino‐orbito‐cerebral mucormycosis (ROCM) is a progressive and life‐threatening disease that is caused by a fungal infection. Every uncontrolled diabetic patient with a skin lesion on their head and neck, sinusitis symptoms, headache, and orbital edema should be evaluated for mucormycosis.

Abstract We report a case of lophomoniasis in a kidney post‐transplantation patient. The patient, 46‐year‐old man, had pneumonia, acute sinusitis, and tonsillitis on admission. We recommend that lophomoniasis should be essentially ruled out in all patients suffering from post‐transplantation infection, particularly in those who do not respond to routine antibiotic regimens.

Abstract Anaphylactic shock is an unexpected, life‐threatening, and sometimes fatal occurrence that affects patients in 75% of instances without a prior history of allergies. The severity of the reaction can vary among individuals. We report a case who died suddenly after being stung by bees in various parts of his body.

Abstract Acute methanol poisoning may be associated with a variety of symptoms, such as abdominal pain, blurred vision, loss of consciousness, and acute pancreatitis. We present a 37‐year‐old man with acute pancreatitis due to methanol poisoning during the COVID‐19 pandemic.

Abstract The patients with a history of intentional or unintentional consumption of rodenticide compounds, especially ZnP, it is necessary to assess ABG and abdominal radiography.

Abstract Due to long corticosteroid therapy in patients with COVID‐19, in case of cough, dyspnea, and weight loss, emerging pulmonary aspergillosis and lophomoniasis should be ruled out.

Abstract Conium maculatum toxicity may occur by mistakenly or intentionally eating this plant. Due to muscarinic or nicotinic symptoms associated with this plant toxicity, supportive care and treatment with atropine are urgently important.

Medial collateral ligament (MCL) injury is highly common in athletes and the elderly. This ligament is in the knee region and is often at the risk of injury. Severe pain and motor limitation are the most important signs in the acute phase of the injury. In patients receiving anticoagulants, damage to the knee joint may lead to intra-articular bleeding, which exacerbates the symptoms and prolongs the recovery period. The present study aimed to describe the case of a 76-year-old woman with a sudden spin on the left knee while getting off a car. After a few minutes of walking, the patients felt pain, heard a pop-like sound on the injured knee, and was unable to walk, experiencing pain in the knee. The patient was transferred to the emergency department by the caregivers. The present case report was focused on the MCL injury in a patient receiving an anticoagulant due to atrial fibrillation.

Background & objectives: Type 2 diabetes mellitus is characterized by metabolic disorders and elevated blood glucose. It is one of the most common diseases in developed countries. Thyme is one of the herbs which have been used in some drug content due to its high antioxidant properties. Thyme can increase the activity of mitochondrial oxidative enzymes and affect metabolic and hematological indices due to its phenolic compounds. So, the aim of this study was to determine the effect of Thymus migricus extract supplementation on the metabolic, hematological indices and oxidative stress in type 2 diabetic rats. Methods: For this purpose, 24 Wistar rats (220-240g) were divided randomly into three groups; group1: healthy control group (NC, n=8), group2: diabetic control group (D, n=8) that took fat diet for 2 weeks then were injected with streptozotocin (37 mg/kg), and group3: diabetic+Thyme group (Th+D,n=8). Thyme hydro-alcoholic extract dissolved in distilled water to the desired concentration (400 mg/kg) according to their daily water consumption (30 ml). Then glycemic, blood and lipid indices were measured in the peripheral blood of the rats. Results: The results revealed that thyme supplementation significantly decreased the fasting blood glucose level (356.35±40 mg/dl to 261.61±35 mg/dl) and HOMA-IR index (3.52±0.30 mg/dl to 2.2±0.33 mg/dl). Also significantly decreased the lipid profile level of the Th+D group compared to those of the D group (p

Background: According to statistics, at least four percent of people experience one or more nonfebrile seizures in their life span. Continuous Electroencephalography (cEEG) Monitoring is a useful diagnostic tool for seizure detection. The purpose of this study was to investigate EEG findings in first-time seizure patients referred to emergency department (ED). Methods: The present cross-sectional study was conducted on 80 first-time seizure patients admitted to ED, who were selected by convenience sampling method. The inclusion criteria were all patients aged more than 17 years with first-time seizure and informed written consent to participate in the study, and the exclusion criteria were cases where the seizure was not confirmed by a neurologist. An EEG was taken in the ED from the patient within 24 hours of the first attack. Finally, the frequency of pathological changes in EEG findings was determined in these patients. The statistical data were analyzed by SPSS software using descriptive statistics (measures of central tendency and dispersion and frequency distribution) and inferential statistics. Results: The patients consisted of 35 (43.8%) males and 45 (56.2%) females. The patients had a mean age of 52.54±19.33 years and a median of 53 years. Among the patients, 46 (57.5%) had normal EEG findings, and 34 (42.5%) had abnormal (pathological) EEG findings. Conclusion: According to the results of this study, 42.5% of patients had abnormal EEG findings, but it seems that accurate examination would require the use of other diagnostic tools along with EEG to diagnose patients with epilepsy and seizure more precisely.

Background and purpose: There are various clinical forms of cutaneous leishmaniasis (CL) and there is lack of access to diagnostic local laboratories especially in endemic regions. The present study aimed to conduct molecular examination of the typical and atypical clinical forms of CL in endemic area of Bam, Iran. Materials and methods: This cross-sectional study was carried out between 2013 and 2014. The diagnosis was performed by direct smears from skin lesions, Giemsa staining, and microscopic examination. Total DNA was extracted from positive and negative direct smears. PCR method was used to determine the genus and species of Leishmania. Results: In this study, 353 suspected cases of CL in Bam Health Center were investigated of whom 278 (78.7%) were positive by microscopic examination. Forty skin smears from typical lesions were positive by both PCR and microscopic examinations, but out of 40 skin smears from atypical lesions which were negative by microscopic observation, Leishmania DNA was detected in 6 (15%) samples. Leishmania tropica was identified in all positive samples. Conclusion: In current study, microscopy method was not found reliable enough for diagnosis of CL. Therefore, for early diagnosis of the disease PCR is recommended in negative smears of patients suspected of CL.

Background and purpose: Toxoplasma gondii (T. gondii) as a causative agent of toxoplasmosis, is an obligate intracellular parasite which is excreted by the cat's feces. Efforts have been made for the development of toxoplasmosis vaccine, but none led to developing a vaccine with protective immune response to the parasite. Adjuvants are essential for vaccine formulation to create strong immune responses. As an adjuvant, nanomaterials such as nano-alum, can stimulate both humoral and cellular immune responses. The present report aimed to investigate the protective effects of the alum-based nano-adjuvant formulated in killed T. gondii. Materials and methods: In this experimental study, the vaccine candidates were separately formulated in alum, complete Freund, and nano-alum adjuvants. The BALB/c mice were immunized three times with two-week intervals. To investigate the type of induced immune response, sera were analyzed by ELISA for total IgG, IgG1, and IgG2a isotypes and also IL-4, IFN-γ, TNF-α, and IL-2 cytokines. To evaluate lymphocyte proliferation, BrdU method was performed. Results: Immunization of mice with killed Toxoplasma vaccine formulated with nano-alum adjuvant increased lymphocyte proliferation, TNF-α, IL-4, IL-2, and IFN-γ cytokine responses, total antibodies, as well as IgG1 and IgG2a subtypes compared with those of other experimental groups. Conclusion: Compared with alum-based killed Toxoplasma vaccine, the nano-alum adjuvant could strongly induce cellular and humoral immune responses.

Background and purpose: Lack of clear boundaries and standard reference about the diagnosis of stroke, necessary evaluations and interventions, effective treatments, and referral of stroke patients resulted in various inconsistent services. Therefore, this study aimed at developing practical national strategies for stroke in Iran. Materials and methods: Clinical guidelines about diagnosis and management of stroke were extracted from different guidelines. Three guidelines were selected according to AGREE scoring system after quality assessment and evaluation of clinical guidelines. In order to adapt the guidelines, recommendations of the three clinical guidelines were recorded in the form of clinical questions. Evidence supporting each recommendation was identified based on references and compared in terms of initial outcomes. Cost of interventions, the side effects, and clinical benefits were also studied. Finally, the national guideline for management of stroke was developed. Results: The results of this investigation were presented as clinical recommendations for diagnosis and management of stroke (2016). For example, strict control of blood glucose level and fever in patients with aneurysmal subarachnoid hemorrhage was recommended in the guideline. Conclusion: The current indigenous stroke guide for the Iranian population is believed to be of great benefit in screening, referral, diagnosis, treatment, and follow-up of stroke.

Abstract Wound infections due to snake bites such as cellulitis and necrotizing fasciitis, although not common, are seen in snake bites and if left untreated can cause serious complications.

Abstract HRS is a rare and poor prognosis complication of chronic acetaminophen toxicity, which presents by progressive decline in renal function secondary to liver failure.

Background: Autism spectrum disorder (ASD) is a pediatric heterogeneous psychiatric and neurodevelopmental disorder with social and communication deficits, language impairment and ritualistic or repetitive behaviors. ASD has significant genetic bases but candidate genes and molecular mechanisms of disorder are not clarified. Neuregulin1 (NRG1) gene, located in 8p12 is involved in development of central nervous system and was indicated as candidate gene in schizophrenia. Methods: mRNA level of types I, II and III of NRG1 gene were studied in peripheral blood of 1540 ASD patients (IQ > 70) and 1490 control children by quantitative Real Time PCR. Also three domains of executive functions (working memory, response inhibition and vigilance) were examined in all subjects. Findings: All three types were significantly down regulated in ASD patients. Significant deficiencies in executive functions (EF) were found in ASD patients. EF deficiencies mostly were associated with down expression of mRNA level of types I and III. Also correlations were found between NRG1 expression with gender and severity of ASD symptoms. Interpretations: Findings primarily have been suggested involvement of NRG1 in etiology of ASD. Also correlation of NRG1 mRNA level with EF deficiencies could shed lights on EF mechanisms and may suggest targeted treatments to improve particular executive functions. Fund: Young researchers and elites club funded the project due to the annual grant of special talents of Club that gave to Arvin Haghighatfard. Keywords: Autism spectrum disorder, NRG1, Gene expression, Executive functions

The gastrointestinal system harbors various microorganisms, known as gut microbiota. Increase in prevalence of inflammatory bowel disease (IBD) in developed countries is associated with changes in the environment, such as decrease in incidence of parasitic infections, especially helminths, and changes in the intestinal flora. Probiotics are useful microbiota for human health. The parasitic worms (helminths) have evolved over the years with their host. Several studies have investigated the capability of helminths and probiotics to alter or control host immune responses in view of the fact that these organisms have immunomodulation effects. Given the contradictory results, further broad studies are needed to confirm the role of probiotics and helminths in the treatment of IBD.

Leishmaniasis is a major public health problem, but so far there are no effective commercially available vaccines for this disease. Its control strategy is only reliant on therapy, but currently the drugs available for the treatment of leishmaniasis are also limited and a great concern is the rapid rate of resistance to common drugs. The first step in discovery and development of new drugs is to identify an appropriate drug target. Accordingly, it is important to recognize the metabolic pathways in which the leishmania parasites live and selecting a target in the parasite biological pathway, absent in the host or different from the host homolog. Discovery of new drugs requires high costs and takes a lot of time (up to 15 years). Therefore, choosing the approved drugs in the market for various diseases, including leishmaniasis is very cost-effective considering the mechanism of drug action and other aspects. Miltefosin is an effective anti-cancer agent that is also used for different types of leishmaniasis. In recent years, researchers have focused on the anti-leishmanial effects of pharmaceutical compounds or anticancer drugs to find more effective compounds with lower side effects. The present article mainly reviews the anticancer drugs that have been tested for their anti-leishmanial effects in both in vitro and in vivo conditions.

Background and purpose: Acanthamoeba species are ubiquitous amphizoic organisms which can cause lethal diseases, such as keratitis and encephalitis in domestic animals and humans. The first stage in studies related to Acanthamoeba is achieving abundant amount of amoebae in culture medium. The aim of this study was to evaluate TYM medium as a rich medium for the diagnosis of Acanthamoeba keratitis in corneal scrapes. Materials and Methods: In this experimental study, we used one species of Acanthamoeba that was previously genotyped. Acanthamoeba was cultured in five plates of non-nutrient agar (NNA) medium with E.coli without TYM and in five plates of non-nutrient agar containing E.coli and TYM. Amoebae growth was observed for 24 to 48 hours by invert microscope. Results: According to current results using TYM medium increased the growth of trophozoites 8.8 folds and amoebas can be isolated form medium after 24 to 48 hours. Conclusion: Due to the significant growth of Acanthamoeba in NNA improved medium, it is recommended for agglutination and early detection of Acanthamoeba in clinical and environmental samples.

Background and purpose: Photocatalysis process with TiO2 is a well-known method for removal of pollutants from water. However, the small particle size of TiO2, and therefore difficulty in its separation after treatment impede its commercialization. The aim of this study was to synthetize the Fe3O4@SiO2@TiO2 magnetic nanoparticles (NPs) and evaluation of its efficiency in removal of metronidazole (MNZ) from aqueous solutions. Materials and methods: The NPs were synthetized via sol-gel method, and characterized using SEM, XRD, VSM, and BET analysis. Then, the effect of operational parameters, including catalyst dosage, pH, and initial concentration of MNZ on removal efficiency were examined. The order of reaction and kinetic model, as well as the reusability potential of the catalyst were all investigated in the optimum run. Finally, comparison was made between the adsorption, direct photolysis, application of commercial Degussa P25 TiO2 (p25), and Fe3O4@SiO2@TiO2 NPs. Results: The so-synthesized catalyst showed good superparamagnetic properties. The optimum conditions for the MNZ removal were pH=8, the catalyst dosage=1.5 g/L, and initial concentration of MNZ=40 mg/L under 180 min UV irradiation time. The kinetic study revealed that the photocatalytic degradation of MNZ followed the pseudo- first order (R2= 0.9912) and the Langmuir-Hinshelwood model (R2= 0.9976). Conclusion: According to the results, the Fe3O4@SiO2@TiO2 NPs were almost as effective as commercial catalyst Degussa P25 TiO2 in removal of MNZ (P> 0.05). Due to the simple separation with external magnetic field and reusability potential, Fe3O4@SiO2@TiO2 NPs can be considered as a suitable alternative for Degussa P25 TiO2.

Background and purpose: There are several methods for removing oil contaminations from the polluted environments. Bioremediation could be considered as one of the best and most practical methods in the removal of oil contaminations. The aim of this research was to determine the bioremediation efficiency for soils contaminated with diesel by the biological stimulation of bioreactors containing vermicompost and activated sludge. Materials and methods: In an experimental study, the soil samples were collected from an area which was free of any oil pollution and 5 reactors containing one kilogram of soil were contaminated with diesel at the mass concentration of 1%. Two reactors were mixed with vermicompost at 15% and 20% mass concentrations and two reactors were mixed with activated sludge at 5% and 10% mass concentrations. Additionally, one control reactor was used to control the process. The pH of the reactors was between 7.5 and 8 and the C:N:P ratio was 100:5:1. The amount of TPH was measured at seven retention times within three months with two repetitions. The total removal of petroleum hydrocarbons (TPHs) was evaluated by GC-FID device. Results: The highest removal efficiency of TPH (40.24%) was observed in bioreactors containing vermicompost at a 20% mass concentration. In this reactor, the highest percentage of removal was observed in lighter hydrocarbons (50.49%). In reactors containing activated sludge, the average percentage of TPH removal was 32% which was observed in the reactor containing the 10% concentration of sludge. In this reactor, the highest percentage of removal (44.86%) was also observed in lighter hydrocarbons. Conclusion: Vermicompost and activated sludge can be used in the bioremediation of soils contaminated with diesel. In current study, the performance of vermicompost was found to be more efficient. Also, the results showed that by increasing the concentration of biological modifiers, the removal rate would increase.