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Diabetes mellitus (DM) is a chronic disease and a threatening problem for world health. Allopathic medications are not efficient enough in controlling DM and its complications. Therefore, much attention has been directed towards the traditional medicine system. Plant derived-natural compounds with medicinal properties play an essential role in DM management and treatment. Artemisia is a varied and widespread genus of the family Asteraceae, which has more than 500 species with beneficial economic and therapeutic significance. Electronic databases such as Science Direct, Scopus, Pubmed, Web of Science, medRixv, and Wiley were used to search scientific literature. In folklore medicine, Artemisia species have been widely utilized for diabetes management. Molecular investigations have revealed that the NF-κB suppression, Notch 1 inhibition, cell cycle stop at S+G2/M-phase, enhanced Bax protein concentrations, mitochondrial membrane potential attenuation, activation of p53 and caspase, Bcl-2 regulation, and ROS formation are crucial mechanisms that could be targeted via various Artemisia species. Anti-diabetic effects of single or multiple doses of alcoholic and aqueous extracts of Artemisia species are due to the presence of bioactive compounds, and they are completely efficient in lowering levels of blood glucose in experimental examinations. In spite of the available anti-diabetic drugs, therapeutic agents obtained from the mentioned plants have been used for the treatment of this disease and its complications with less adverse impacts. Taken together, multiple lines of evidence indicated that Artemisia species could be introduced as a potential therapeutic candidate in the treatment and management of diabetes.

Purpose 177Lu-Dotatate is an emerging treatment modality for patients with unresectable or metastatic well-differentiated NETs. This study examines survival predictors in patients who received 177Lu-Dotatate. Methods A retrospective single-center review was conducted, examining 47 individuals with progressive well-differentiated NETs treated with 177Lu-Dotatate (four induction cycles of 5.5 GBq at 10-week intervals followed by eight maintenance cycles of 3.7 GBq at 6-month intervals). Results Median follow-up was 63.1 months with a median progression-free survival (PFS) of 34.1 months. However, median overall survival (OS) was not reached at the time of analysis. The presence of ≥ 5 bone metastases (hazard ratio HR 4.33; p = 0.015), non-gastroenteropancreatic (non-GEP) NETs (HR 3.22; p = 0.025) and development of interim ascites (HR 3.15; p = 0.047) independently predicted a worse OS. Patients with chromogranin A of ≥ 4 × upper limit of normal (ULN) had shorter OS (p p = 0.004). Similarly, those with pre-existing ascites demonstrated a worse OS (p = 0.009) and PFS (p = 0.026). Liver metastases involving greater than 50% liver volume and the existence of unusual metastatic locations had a negative impact on OS (p = 0.033) and PFS (p = 0.026), respectively. Conclusion High burden of skeletal and hepatic metastases, non-GEP-NETs, chromogranin A of ≥ 4 × ULN, unusual metastatic sites, pre-existing and interim ascites are predictors of poor outcomes in patients treated with 177Lu-Dotatate. These common indicators can be used for the risk stratification and identification of patients most likely to benefit from PRRT. Trial registration ClinicalTrials.gov identifier: NCT02236910, Retrospectively registered on September, 2014.

Background Microsporidia are a large family of obligate intracellular protozoa; these medically important species are recognized as opportunistic agents in intestinal complications in HIV+/AIDS patients. Methods The current cross-sectional study was designed and conducted from October 2018 to June 2019 to determine intestinal microsporidia in HIV+/AIDS patients by trichrome/Zeihl-Neelsen staining and SYBR Green-based real-time PCR. Results Out of 80 HIV+/AIDS patients, 23.75% (n=19) and 12.5% (n=10) were identified by molecular and microscopic methods, respectively. The predominant species in patients was Encephalitozoon (94%), which was found by quantitative real-time PCR and its high resolution melting tool. Conclusion As far as we know, this is the first report from the Alborz region. The prevalence of intestinal microsporidiosis in this area in HIV+/AIDS patients was higher than both the global and national average. In addition to the need for further studies to prove protozoan pathogenicity in the aforementioned group, preventive measures should be considered.

Background Pityriasis rosea (PR) is a common, self-limited, inflammatory papulosquamous skin disease with a possible viral etiology. Objective The goal of this study was to evaluate skin biophysical properties in patients with PR compared with uninvolved skin to better understand the pathogenesis of PR. Methods Stratum corneum hydration, transepidermal water loss, surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, R5), thickness, and echodensity of the epidermis and dermis were measured on lesions of classic PR in 21 patients and compared with control sites (average of uninvolved perilesional and symmetrical skin) with a paired t test. Results Stratum corneum hydration (p

The goal of this study was evaluation of the skin biophysical properties in early patch/plaque stage of mycosis fungoides (MF) and its comparison with uninvolved skin in order to gain a better understanding of the pathogenesis of diseases.The stratum corneum hydration, transepidermal water loss (TEWL), surface friction, pH, sebum, melanin, erythema, temperature, elasticity parameters (R0, R2, R5), thickness, and echo density of epidermis and dermis were measured on lesions of 21 patients and compared with controls (average measures of uninvolved perilesional and symmetrical skins) by paired sample t test.Stratum corneum hydration (P 0.001) and echo density of dermis (P = 0.044) were significantly lower, whereas pH (P-value = 0.007), erythema (P 0.001), and melanin content (P = 0.007) were significantly higher in lesions. There was not any significant difference in TEWL, friction index, sebum, temperature, R0, R2, R5, thickness of epidermis and dermis, and echo density of epidermis between lesions and normal skin.Parapsoriasis/MF lesions are specified by a set of certain changes in biophysical properties which are mainly correlated with histological changes. These sets of alterations may help in noninvasive, early diagnosis of parapsoriasis/MF.

BACKGROUND: The aim of the present study is to determine the incidence/progression of hiatal hernia (HH) after robotic-assisted coronary artery bypass grafting (RA-CABG) surgery. METHODS: We reviewed the pre- and post-operative computed tomography (CT) of 491 patients who underwent RA-CABG between 2000 and 2017. Post-operative CT was acquired prospectively in a research protocol. CT was reviewed to assess the presence and the size of HH. RESULTS: We found 444/491 (90.4%) had pre-operative CT, while 201/491 (40.9%) had post-operative CT. In total, 155/491 (31.6%) had both pre- and long-term post-operative CT with a mean follow-up of 6.2 (±3.5) years. HH was more prevalent on post-operative CT, 64/155 (41.3%) compared to pre-operative CT, 44/155 (28.4%), P

Peptide receptor radionuclide therapy (PRRT) has been recently established as a treatment option for progressive gastro-entero-pancreatic neuroendocrine tumors (NETs) including four 200 mCi induction cycles. The purpose of this phase 2 trial is to expand use of PRRT to different types of NETs with the application of dose adjustment and evaluate value of maintenance therapy in patients who had disease control on induction therapy. Forty-seven PRRT na&iuml, ve NET patients with different primary origin received 177Lu-DOTATATE induction therapy, ranging from 75 to 150 mCi per cycle, based on patients&rsquo, clinical status such as liver and renal function, extent of metastases, and previous therapies. Thirty-four patients underwent additional maintenance therapy (50&ndash, 100 mCi per cycle) following induction course until they developed disease progression. The estimated median progression-free survival (PFS) was 36.1 months. The median PFS in our MNET subgroup was 47.7 months, which is markedly longer than NETTER-1 trial with median PFS of 28.4 months. The median PFS was significantly longer in patients who received PRRT as first-line treatment after disease progression on somatostatin analogs compared to patients who received other therapies first (p-value = 0.04). The total disease response rate (DRR) and disease control rate (DCR) was 32% and 85% based on RECIST 1.1 and 45% and 83% based on Choi criteria. This trial demonstrates longer PFS with the addition of low dose maintenance therapy to induction therapy compared to NETTER-1 trial that only included induction therapy. Also, we observed considerable efficacy of PRRT in various types of advanced NETs.

Background Breast cancer is reported as one of the most common cancers among females worldwide. Infectious agents especially viruses have been considered as role players in the development of breast cancer. Although some investigations suggest an association between bovine leukemia virus (BLV) and breast cancer, the involvement of this virus as a risk factor remains controversial. The present study aimed to find out any possible association between BLV and breast cancer through conducting a systematic review and meta-analysis. Methods Systematic literature search was performed by finding related case-control articles from the PubMed, Google Scholar, Web of Science, Scopus, and EMBASE databases. The heterogeneity and the multivariable-adjusted OR and corresponding 95% CI were applied by meta-analysis and forest plot across studies. All statistical analyses were performed using Stata 14.1. Result Based on a comprehensive literature search, 9 case-control studies were included for meta-analysis. The combination of all included studies showed that BLV infection is associated with an increased risk of breast cancer [summary OR (95% CI) 2.57 (1.45, 4.56)]. Conclusion This is the first meta-analysis to analyze a potential association between BLV infection and the risk of breast cancer. Control of the infection in cattle herds and screening of the milk and dairy products may help to reduce the transmission of the virus to humans.

Background: Nowadays noninvasive techniques are performed to evaluate the biophysical properties of skin in vivo. Aims: The aim of this study was to evaluate the biophysical and ultrasonographic properties of skin in chronic contact or atopic dermatitis to provide better insight into pathogenesis, diagnosis, and treatment response. Materials and Methods: The stratum corneum hydration, transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, temperature, elasticity parameters (R0, R2, and R5), the thickness and echo-density of epidermis, dermis, and subepidermal low-echogenic band (SLEB) were measured on lesional, perilesional, and symmetrical skin of 22 chronic dermatitis patients. The average of perilesional and symmetrical skin values (control) was compared with lesional values. Results: Stratum corneum hydration (P

Background The potential association between Parvovirus B19 and heart disease has been controversial. The aim of the present study was to report the prevalence of B19 in myocarditis and dilated cardiomyopathy (DCM) as well as measure the statistical association between them. Methods Our systematic search was carried out to retrieve published articles between January 2000 and March 2021 using three major databases: PubMed, Scopus, and Web of Science, as well as the Google Scholar search engine. The overall prevalence of HAV, pooled odds ratio, and heterogeneity were estimated by comprehensive meta-analysis (V2.2, Biostat) software. Results The overall prevalence results in myocarditis and DCM were 23.7% (95% CI: 18.7%–29.5%) and 34.1% (95% CI: 23.8%–46.1%) respectively; in addition, the overall OR for B19 and myocarditis was 4.317 (95% CI, 1.831–10.180) versus 1.163 (95% CI: 0.706–1.916) for B19 and DCM. Conclusion Our findings have shown a significant association between Parvovirus B19 and myocarditis with a high prevalence. In the case of DCM, no significant association was found while the prevalence of the virus was relatively high.

As a health problem, obesity has several risk factors; it has been suggested that human adenovirus type 36 (HAdV-36) infections may possibly be associated with obesity. This updated meta-analysis was designed and conducted with an emphasis on articles published from 2015 to 2020. The PubMed, Web of Science, and Scopus databases were searched up to 1 December 2020. Overall, pooled prevalence and odds ratio of antibodies against HAdV-36 in people with obesity and controls was assessed among different ages. Case-control and cohort studies were included in the analysis. The overall prevalence of HAdV-36 infection in obese population was 31% (CI: 0.24%-0.38%) which was 32% in cases and 27% in controls, respectively; a significant association was found between the cases and the controls (OR, 1.84; 95% CI, 1.39-2.43), especially in children younger than 18 years of age (OR, 2.44; 95% CI, 1.85-3.22). A significant association between adenovirus infection and obesity was found, especially in adolescents.

Background: This study aimed to evaluate the possible role of EBV/HPV co-infection as an etiologic factor in prostate cancer (PCa) development.Methods: The present case‐control research was conducted on 67 cases with prostate cancer and 40 controls. The expression of cellular and viral factors involved in inflammation, tumor progression, and metastasis were quantitated using ELISA and qRT-PCR.Results: The EBV/HPV co-infection was reported in 14.9% of case group and 7.5% of control group. The high-risk type of HPV, including HPV 16 and 18, were responsible for 50% and 30% of 10 HPV/EBV co-infected PCa samples, respectively. According to the results, a significant relationship was not observed between the PCa and HPV/EBV co-infection (OR=2.9, 95%CI=0.18-45.2, P=0.31). However, the highest percentage of HPV genome integration was found in HPV/EBV coinfected PCa group (8/10, 80%). Moreover, the mean expression levels of inflammatory factors (IL-17, IL-6, TNF-α, NF-κB, VEGF, ROS and RNS), anti-apoptotic mediators (Bcl-2 and Survivin), and anti-anoikis factors (TWIST, N-cad) were higher significantly in the HPV/EBV co-infected PCa cases when comparing with the non-coinfected PCa samples. Nevertheless, the tumor suppressor proteins (p53 and Rb) and the E-cad (inhibiting anoikis resistance) had a significant downregulation in the HPV/EBV co-infected PCa cases than in the non-coinfected PCa samples. Conclusion: HPV/EBV co-infection probably can act as an etiologic factor in PCa through modulation of cellular behavior.

Objective: Non-parathyroid hormone (PTH) mediated hypercalcemia in young patients is rare. It encompasses a broad differential including malignancy, granulomatous diseases, Addison disease, and toxicity of vitamin A and D. We present an unusual case of non-PTH mediated hyper-calcemia in a previously healthy bodybuilder, secondary to multifocal granulomatous disease from paraffin oil injections. Methods: The patient was evaluated with laboratory tests including serum calcium, 25-hydroxyvitamin D, 1,25-hydroxyvitamin D, parathyroid hormone, and parathyroid hormone-related peptide. Imaging studies such as thorax computed tomography and bone scans were also performed. Results: A 31-year-old male bodybuilder presented with severe hypercalcemia (corrected calcium 3.1 mmol/L) and renal failure (creatinine 840 μmol/L), with suppressed PTH 1.0 pmol/L (normal, 1.6 to 6.9 pmol/L), and 1,25-vitamin D 205 pmol/L (normal, 60 to 208 pmol/L). He had used anabolic steroids for bodybuilding purposes for 8 years, with the possibility that he may also have used paraffin oil injections. Computed tomography imaging along with patient history suggested multiple paraffinomas in the pectoralis muscles causing granulomatous foreign body reaction as a potential cause for his hypercalcemia. He was prescribed a trial of prednisone, but he discontinued it due to symptoms of acne. Unfortunately, due to poor adherence with medical direction, management of his hypercalcemia remains challenging with inconsistent use of steroids and pamidronate infusions. Conclusion: Granulomatous foreign-body reactions are a rare side effect of paraffin oil injections used for muscle augmentation. These can lead to serious long-term side effects of severe hypercalcemia and renal failure, as seen in our patient. Prognosis is generally poor, with long term steroids as the preferred treatment. Abbreviations: CT computed tomography CYP24A1 24-hydroxylase ED Emergency Department PTH parathyroid hormone

Introduction: In the current time where we face a COVID-19 pandemic, prevention, and rapid diagnosis of infected patients is crucial. Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features. Method: We searched all relevant literature published up to February 28, 2020, from Embase, Scopus, PubMed, Web of Science, and the Cochrane library to collect the studies that reported clinical and laboratory characteristics of corona-infected patients. The study quality was assessed with the Critical Appraisal Checklist. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Result: Overall 114 articles included in this study; 52,251 COVID-19 confirmed patients (20 studies), 10,037 SARS (51 studies), and 8,139 MERS patients (43 studies) were included. The most common symptom among COVID-19 85.6 % (95% CI 73 -93, p < 0.001), SARS 96 % (95% CI 93-97.6, p < 0.001), and MERS 74 % (95% CI 63.5 -83.5, p < 0.001) was fever, respectively. Analysis showed that 84 % (95% CI 78-8.5, p < 0.001) of COVID-19 patients, 86% (95% 77-92, p < 0.001) of SARS patients, and 74.7% (95% 56.5-87, p < 0.001) of MERS patients had an abnormal chest X-ray. The mortality rate in COVID-19 5.6% (95% CI 2.5-12.5, p < 0.001), SARS 13 % (95% 9-17, p < 0.001), and MERS were 35 % (95% CI 31-39, p < 0.001) between all confirmed patients. Conclusions: Fever and cough are the most common symptoms of COVID-19, SARS, and MERS infected patients. Thrombocytosis in COVID-19 patients was more than twice as frequent as in SARS, and MERS confirmed cases. At the time of submission, the mortality rate in COVID-19 confirmed cases is lower than SARS and MERS infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and it should be considered when interpreting the data. Funding Statement: Dr. Bahr receives funding from the National Institutes of Neurological Diseases and Stroke of the National Institutes of Health, K23 NS110470. Declaration of Interests: The authors have declared that no competing interests exist. Ethics Approval Statement: Study has been registered in the PROSPERO database (ID 176106).

Chemoresistance is often referred to as a major leading reason for cancer therapy failure, causing cancer relapse and further metastasis. As a result, an urgent need has been raised to reach a full comprehension of chemoresistance-associated molecular pathways, thereby designing new therapy methods. Many of metastatic tumor masses are found to be related with a viral cause. Although combined therapy is perceived as the model role therapy in such cases, chemoresistant features, which is more common in viral carcinogenesis, often get into way of this kind of therapy, minimizing the chance of survival. Some investigations indicate that the infecting virus dominates other leading factors, i.e., genetic alternations and tumor microenvironment, in development of cancer cell chemoresistance. Herein, we have gathered the available evidence on the mechanisms under which oncogenic viruses cause drug-resistance in chemotherapy. © 2021 Elsevier Ltd

Background Globally, hepatitis B and schistosomiasis (Mansoni) together affect about 300 million people; which cause hepatic disorders worldwide. Given that little is known about co-infections with hepatitis B and schistosoma mansoni, the present study investigates these two health problems alone and together and their possible correlation. Methods A search was conducted for reports published between January 1990 and October 2020 by using Embase, Scopus, PubMed, Web of Science databases; Out of a total of 20 studies, 14 cross-sectional studies (6329 people) and 6 case-control studies (2138 individual) were reviewed. The pooled prevalence of hepatitis B virus (HBV), S.mansoni infections, and their co-infections; heterogeneity and the Odds Ratio (OR) were evaluated by Stata 11.2. Findings Among the included studies in the inclusion criteria, the pooled prevalence of hepatitis B, S. mansoni was 34% (95% CI, 0.23–0.46), 41% (95% CI, 0.24–0.59) and their co-infections was 18% (95% CI, 0.11–0.25) by regions. The hepatitis B and S. mansoni correlation was significant in populations with schistosoma compared to control group (OR, 2.12; 95% CI, 1.36–3.30). Commentary Our results showed that in addition to the high global prevalence of hepatitis B- S. mansoni (co) infections in the included studies, there is a significant association between them, especially in people suffering from schistosoma. These results highlight the importance of integrated interventions measurements against coexistence of parasitic and viral diseases. We know that more research studies need to be done in this field and global monitoring should be considered for the co-infection of these two important complications.

Cryptosporidiosis, caused by the protozoan parasite Cryptosporidium spp., is an important zoonotic disease and is considered a global public health concern. Dogs are suggested as one of potential reservoirs for transmitting the Cryptosporidium infection to humans. However, there is a paucity of information about global patterns of occurrence of Cryptosporidium in dogs. A systematic review and meta-analysis were carried out to evaluate the global prevalence of Cryptosporidium infection among dogs. In this study, PubMed, Scopus, Web of Science and Google Scholar databases were systematically searched for relevant studies up until October 30, 2019. Finally, 127 articles (including 160 datasets) were eligible for inclusion in the systematic review and meta-analysis. The overall prevalence of Cryptosporidium infection was estimated at 8% (95 % CI: 5-11 %) using microscopic methods, 7% (95 % CI: 4-10%) using coprogantigenic methods and 6% (95 % CI: 4-9%) using molecular diagnostic methods. Molecular methods revealed that dogs were most frequently infected by C. canis (3.64 %) and C. parvum (1.28 %). The pooled prevalence different of subgroups (WHO regions, geographic and climate parameters, diagnostic methods, type of dog) were analyzed separately. The pooled odds ratio (OR) of Cryptosporidium was significantly higher than one for diarrhea status, with dogs suffering from diarrhea having a higher likelihood of Cryptosporidium infection, compared to dogs without diarrhea (OR; 3.61 95 % CI: 1.89-6.90%). The present study is the first systematic review and meta-analysis providing a comprehensive view of the global prevalence of Cryptosporidium in dogs and its related risk factors. Awareness of Cryptosporidium prevalence, risk factors, and disease complications for the health authorities, physicians, veterinarians and dog's owners is important for developing effective strategies to prevent infection.

Background Metallic allergens such as nickel are among the most common causes of allergic contact dermatitis (ACD), but frequencies of contact dermatitis to these allergens may vary in different areas. Objectives This study aimed to determine the frequencies of ACD caused by three common metallic allergens: nickel sulfate; potassium dichromate; and cobalt chloride. Methods Data for 1137 patients with clinical diagnoses of contact dermatitis and/or atopic dermatitis evaluated by patch testing in Iran during a 5-year period were retrospectively studied to establish the frequencies of hypersensitivity to these metallic allergens. Results A total of 313 patients (27.5%) gave positive patch test results for at least one metallic allergen. Allergy to nickel (229 cases, 20.0%) was the most commonly observed, followed by allergy to cobalt (90 cases, 8.0%) and allergy to chromium (70 cases, 6.2%). Nickel allergy was significantly more frequent in females and in subjects aged 40 years. Sensitivity to nickel or chromium was a risk factor for cobalt allergy. Conclusions Nickel was most commonly identified as a metallic allergen in Iran and tended to affect women aged

Acute leukemia is the most common malignancy in childhood, which mainly involves children less than 15 years of age. The growing skeleton is the main site of involvement in children. Leukemic cells proliferate within the massive red bone marrow in children. So besides the pallor, petechia, purpura and ecchymosis in the skin and mucosal surfaces, bone pain and other bony lesions are other manifestations of leukemia. On the other hand, bony lesions are more prevalent in children than adults with no poor prognosis in comparison to patients without bone lesions. These bony lesions may precede other laboratory tests so familiarity with these presentations is very important for earlier diagnosis. In this pictorial essay, we tried to gather the most common bony lesions that may be seen in acute leukemia in different cases admitted to our hospital with general malaise and localized tenderness and discomfort leading us to perform plain X-ray for further evaluation. Finding these bony lesions helps clinicians to reach the diagnosis quickly. These findings include metaphyseal lucent band and erosion, periosteal reaction, small lucent bone lesion and permeative appearance, reduced bone density and collapsed vertebra.

Background: The presence of vesicoureteral reflux (VUR) has been documented in 1.3% of the general population, 70% of infants with urinary tract infection (UTI), and 15–25% of children with UTI. Objectives: The main aims of this prospective cohort study were to compare the efficiency of different imaging techniques [renal ultrasonography, cortical scintigraphy with technetium-99m dimercaptosuccinic acid (99mTc DMSA)] in detecting VUR in patients with acute pyelonephritis. Patients and Methods: Between June 2003 and March 2010, we recruited a prospective cohort of patients aged 1 month to 14 years. Pediatric patients with documented urinary tract infections and imaging evidence of upper tract involvement were examined by DMSA scintigraphy, renal ultrasonography, and voiding cystourethrography (VCUG). The assessments included UTI profiling, kidney ultrasonography, and DMSA scans. Data were expressed as mean ± SD. Statistical tests were two-tailed and were considered significant when P ≤ 0.05. Results: A total of 1500 pediatric patients were eligible to receive treatment for pyelonephritis. DMSA scans were normal in 20.2% of the patients and abnormal in the remaining 79.8%, and the kidney ultrasonographies yielded normal results in 68.5% of the patients and abnormal results in the remaining 31.5%. There was a significant difference between the ultrasonography reports of patients with normal and abnormal DMSA scans. The VCUG results were normal in 74.1% of the patients and indicated VUR in the remaining 25.9% (VUR grade I in 10.7%, grade II in 7.3%, grade III in 4.7%, grade IV in 1.7%, and grade V in 1.5%). The refluxes were unilateral in 62.9% of the patients and bilateral in the remaining 37.1%. We found a significant correlation between the presence of VUR in VCUG and urological abnormality in ultrasonography (r = 0.14, P < 0.001). The incidence of VUR among patients showing severe abnormalities in DMSA scintigraphy, was significantly higher than that among patients with normal DMSA results or those showing mild to moderate changes in DMSA scintigraphy. Conclusions: We concluded that kidney ultrasonography and DMSA scans can be performed before VCUG in children with UTI. In addition, we recommend performing VCUG in cases of pyelonephritis only when the patients show abnormal kidney ultrasonography or DMSA scan results.

Background: Skin biometrology is a useful method for evaluation of inflammatory skin disorders such as dermatitis, psoriasis, and lichen planus. The current study tries to compare the biophysical features of skin in dermatitis, psoriasis, and lichen planus. Methods: By a convenient sampling method, 22 mild to moderate chronic dermatitis, 26 psoriasis, and 21 lichen planus patients were recruited in the study. Stratum corneum (S.C.) hydration, Transepidermal water loss (TEWL), pH, erythema, melanin, sebum, friction, elasticity parameters (R0, R2, and R5), skin temperature, skin thickness, and echo-density of epidermis and dermis were measured on the lesional (selected active lesion), uninvolved perilesional, and uninvolved symmetrical skin. The average of perilesional and symmetrical uninvolved parameters was used as control, while the percentage change of each parameter [(lesion - control / control) ×100] was calculated, and compared among three diseases by ANOVA test using SPSS software version 18. The significance level was set at α=0.05. Results: Comparison of percentage changes showed that the changes in TEWL, friction index, sebum content, R2 (gross elasticity), R5 (net elasticity), skin temperature, dermal thickness, and epidermal density are not significantly different among three skin diseases. But there were significant differences in three diseases considering the decrease in S.C. hydration (p

Background Fragrances are considered as one of the most common causes of allergic contact dermatitis. About 1–4% of the general population suffer from fragrance contact allergy (FCA). Objectives To determine the frequency of FCA and its clinical relevance in a sample of Iranian patients with history of contact and/or atopic dermatitis from January 2004 to December 2008. Methods Standardized patch testing with 28-allergen screening series recommended by the German Contact Dermatitis Research Group and European Standard Series was used at six dermatological clinics in Iran. Fragrance allergens comprised of fragrance mix I (FM I), Myroxylon pereirae (MP; balsam of Peru), Lyral®, turpentine and FM II. Results Fragrance contact allergy was detected in 7.2% of the patients. The frequency of positive reactions to FM I, MP and FM II were 3.7% (41/1105), 2.8% (32/1135) and 1.1% (3/267) respectively. 82.4% of the reactions to fragrance allergens were clinically relevant. The most common involved areas were hands (68.4%) and face (35.4%). Fragrance allergy predominantly affected women aged more than 40 years (P = 0.008). Positive reaction to more than two allergens was significantly higher in FCA patients compared with other contact dermatitis patients (P

A 14-year-old boy had giant confluent brown patches that were bilaterally distributed on his back, chest, and upper arms, and partially covered by dark coarse hairs. A clinical diagnosis of Becker nevus was made and confirmed histopathologically. We report this patient for the rarity of presentation. Different clinical features of Becker nevi, associated findings, differential diagnoses, and treatment options are discussed.

Background: Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology in infants and young children. Ultrasonography (US) has been considered to be a reliable diagnostic tool for GERD but the severity of GERD and the clinical implications based on imaging findings has not been evaluated. Aims: To compare the diagnostic value of lower esophageal US with that of barium swallow in demonstrating the severity of GERD. Materials and methods: Fifty one pediatric patients, age between 1 month to 12 years, 34 male and 17 female with clinical suspicion of GERD were included. The patients were initially submitted to barium swallow (BS) and subsequently to transabdominal US. During BS, the number of gastroesophageal reflux episodes was documented in a 5-minute period. Transabdominal US documented the number and duration of reflux episodes during a 5-minute period, the angle of His, mucosal thickness, and intraabdominal esophageal length (IAEL). Results: Duration and number of reflux episodes in US were significantly higher in patients that had severe gastroesophageal refluxes at BS. At US the cutoff point of 9.5 seconds (sensitivity 80%, specificity 60%) for reflux duration and more than 2 episodes in 5 minute ultrasound study (sensitivity 75%, specificity 58%) were defined to correlate with severe gastroesophageal reflux at BS.The angle of His, the esophageal wall mucosal thickness, and the IAEL did not cor- relate with the severity of GERD detected in BS. Conclusion: US can predict the severity of GERD. Therefore, except in the case of specific patients in whom mechanical causes are suspected to be responsible for GERD, BS can be replaced by US.

Background Abdominopelvic fluid collection and abscess management and their outcomes have improved in the recent years due to innovation of the image-guided drainage technique and improvement of surgical procedures. Objectives This study was undertaken to evaluate the efficacy of CT-guided percutaneous drainage in treating abdominopelvic abscesses. Patients and methods In this study, the data of 41 patients who had abdominal abscess or fluid collections, and underwent treatment by percutaneous CT-guided drainage were analyzed. Treatment was assessed by reduction of collection size, relief of symptoms and signs including abdominal pain and fever and imaging findings. Any morbidity such as wound infection, sepsis, hematoma formation or peritonitis was followed up to six months after the procedure. Results The average age of the patients was 54 years (range 12 to 79), including 21 (51%) men and 20 (49%) women. The common signs and symptoms were pain (83%) and fever (80.5%). The most prevalent abdominal abscess etiology was previous surgery in 31 cases (75.5%). Abscess diameter ranged between 5 and 12 cm (mean, 7.8 cm). The average hospital stay was 8 days (4-15). Thirty five cases (86%) were successfully treated. Only one case (2.5%) developed complication (peritonitis) after the procedure. Conclusions According to our findings, CT-guided percutaneous drainage is a safe and effective procedure in the treatment of abdominal abscess and fluid collection.

Pelizaeus­-Merzbacher-like disease (PMLD) is a hypomyelinating leukoencephalopathy disorder with a genetically heterogeneous pattern. Mutations in the GJA12/GJC2 gene cause one form of autosomal recessive Pelizaeus­-Merzbacher-like disease. Here, we report a new mutation in a ­10-month-old girl with nystagmus, psychomotor delay, hypotonicity, head nodding and dysmyelination from healthy second cousin parents. The genetic study showed a homozygote deletion as c902-918del in the exone 2. According to our study and recent reports from other Middle East countries, we suggest GJA12 gene mutations are common in this area, but we didnot find any previous report about this new mutation (c902-918Del).

Background: Congenital cystic adenomatoid malformations (CCAMs) are considered rare develop- mental anomalies of the lower respiratory tract. These are hamartomatous abnormalities of the lung with adeno- matoid proliferation of cysts resembling bronchioles and usually occur sporadically and unilaterally with single lobe involvement. Method: A 6-year-old girl was admitted to our center because of prolonged fever and non-productive cough lasting3 months before admission. Results: The only other complaint was night sweating. She did not have dyspnea and did not mention any re- spiratory symptoms. On examination, coarse crackle and decreased lung sounds in the left side were detected. White blood cell count was 9.100 /μL, hemoglobin was 11.2 g/dL, erythrocyte sedimentation rate was 50 and C- reactive protein was 1+. IgA and IgM for hydatid cyst were tested and both were raised (14 and 1.4, respectively). Conclusion: The patient underwent surgery, with the probable diagnosis of hydatid cyst but in operating room diagnosis was changed and it was adenomatoid cystic malformation. In follow-up, she was in good general condition without any post-surgical complaints (Fig. 3, Ref. 11). Full Text in PDF www.elis.sk.

Dermatological conditions are observed in an estimated 90% or more of all HIV infected people worldwide. Microbial infections, inflammatory conditions and neoplasms are the three main causes for the development of dermatological findings in HIV patients. A total of 276 HIV patients were examined by a dermatologist to identify skin, hair and nail pathologies. CD4 count was measured; Liver function test (LFT) and complete blood count (CBC) were also done. Skin biopsies were obtained and sent for pathological study. Analysis showed 90 (32.6%) of patients had at least one identifiable dermatological ailment. The most common dermatologic manifestations were dermatitis (22.3%), seborrheic dermatitis (13.8%), folliculitis (6.7%), dermatophytosis (6.7%), oral candidiasis (6.7%), warts (6.7%) and Herpes Zoster (3.6%). CD4 count was positively and significantly associated with occurrence of a dermatologic manifestation. Moreover, the type of antiretroviral drug was correlated with these manifestations. Due to high prevalence of skin diseases, severity of complications and overall influence on the patient’s quality of life, considerations should be given to timely diagnosis and treatment of dermatologic complications among HIV/AIDS patients. Key words: Dermatologic, HIV/AIDS, prevalence.

Scope of this study is to synthesize a nano-dendrimer and its conjugate with C595 MAb against breast cancer cell, followed by its chelating agent with Gd3+. At the end, its use as a dual nanosized probe for detection and treatment was investigated. Anti-MUC-1 MAb C595 was coupled to a biodegradable biocompatible anionic linear globular dendrimer, ALGDG2, Poly ethylene glycol PEG core and citric acid shell followed by loading with Gd3+ to make novel MR imaging contrast agents. Anticancer effects and MR imaging parameters of the prepared nanoconjugate was investigated in vitro: cell toxicity, apoptosis and TNF-alpha, hemolysis, LDH evaluations as well as toxicity, biodistribution and MR imaging of cancer place were investigated. Results showed good tumor accumulation and detection, no in vivo toxicity, and potential selective anti-breast cancer activity. In conclusion, findings of this study showed that Gd3+-ALGDG2-C595 nano-probe is potentially both, a selective breast molecular imaging tool as well as a therapeutic agent. Further, subsequent clinical trials appear warranted.

Human papilloma virus genital infection remains a treatment dilemma; there is still no gold standard therapy, treatment options are limited, expensive and often ineffective, and recurrence rates are relatively high. The primary objective of this study is to establish the efficacy, safety, and tolerability of cryotherapy in the treatment of these lesions. From 1999 to 2003, 100 consecutive patients with at least ten genital warts were treated with liquid nitrogen cryotherapy using a cotton-tipped applicator and two freeze-thaw cycles at the outpatient dermatology clinic of Hazrat-e Rasool University Hospital. Treatment was repeated every 3 weeks until the disappearance of all visible lesions was achieved. Patients were followed up every 4 months for 18 months. Complete clinical cure (CCC) was defined as complete clearance of all lesions and no evidence of disease for a minimum of 18 months. The CCC and relapse rate were evaluated based on different demographic and clinical characteristics. Overall, 86 percent of the patients achieved CCC after an average of 3.31 treatment sessions. All of the failed cases were attributed to recurrence of warts in new sites. The cure rate increased in parallel with increasing treatment sessions until the 6th session, after which it remained constant. The cure rate was lower and the number of treatment sessions higher in older patients. The age of the patient and number of treatment sessions affect the cure rate. The recurrence rate was significantly higher for the married or multi-partner group than for unmarried patients. We concluded that cryotherapy is an effective method for treatment of anogenital warts. The age of the patient and size of the lesions affect the cure rate. However, the most important factor in relapse of the lesions is unprotected sexual contact during and after treatment.

The pathogenesis of fixed drug eruption (FDE) is still unknown. One of the most common associations of FDE is the use of sulfonamides. Cotrimoxazole (trimethoprim with sulfamethoxazole) is one of the most commonly prescribed sulfonamide drugs. Non-pigmenting FDE (NPFDE) is a a relatively rare condition and only a few cases have been reported. We describe a case of unilateral NPFDE in a 45-year-old man whose lesions were on his right leg and foot as well as his ipsilateral penile skin. Cotrimoxazole was suspected as the offending drug and its role was confirmed by an oral challenge test.

BACKGROUND: Cutaneous leishmaniasis (CL) is a neglected infectious disease and a major health problem in several developing countries. Despite some reasonable explanation for their potential benefits, there is only trace evidence regarding the role of dressings in the treatment of CL. METHODS: This randomized, assessor-blind, controlled, clinical trial was conducted in an endemic area for CL caused by Leishmania major in Iran to assess the efficacy of administration of weekly intralesional meglumine antimoniate (i.l.MA) either alone or combined with application of a silver or a non-silver polyester dressing on their lesions for 6 weeks. After screening of 241 patients with CL lesions, 83 eligible patients with 158 lesions were randomly allocated in three arms of the study. Eligibility criteria included parasitologically confirmed CL, age of 12 to 60 years; willingness to participate, duration of lesion

Macular amyloidosis is a relatively common cutaneous disease in Asia and the Middle East. It is characterized by a reticulated or rippled pattern of pigmentation mostly in the upper back. This study was performed not only to determine the disease sex and age distribution, but also to evaluate its risk factors and the frequency among the dermatology clinic patients. Based on the clinical and random histopathologic findings, 100 macular amyloidosis patients were evaluated in a period of 3 years. Although the sex distribution (9 : 1, female : male ratio) differed dramatically from most of the previous reports, it was consistent with few other series. Eighty one percent of patients were between 21 and 50 years of age. The mean age of the female patients was higher than that of the males (difference of two means was 10.26 years and P = 0.027). Backscatching during bathing probably is not a common practice in Iran, therefore we could not consider this as a risk factor in our study. We found no evidence of any other associated risk factors.

Background: The aim of this study was to explore the experiences of patients who suffer from acute cutaneous leishmaniasis in Iran, focusing on quality of life.Methods: The study was conducted at two different sites in Iran in 2010–2011. Individual in-depth interviews were conducted with six men and six women parasitologically confirmed acute cutaneous leishmaniasis. Interviews were recorded, transcribed verbatim, and translated into English. Qualitative content analysis was used for data analysis.Results: The participants, aged 23 to 63yr, had mild to severe disease. Based on the analysis four main themes were developed. "Fearing an agonizing disease" reflects patients' experiences of disease development resulting in sadness and depression, "struggling to cope" and "taking on the blame" both illustrate how patients experience living with the disease, which included both felt and enacted stigma as major social concerns. "Longing for being seen and heard" refers to patients' experiences with healthcare as well as their expectations and demands from communities and healthcare to be involved in closing the knowledge and awareness gap.Conclusion: Mental and social dimensions of cutaneous leishmaniasis were complex and adversely affected patients' lives by causing psychological burden and limiting their social interactions. Health authorities have to plan programs to increase the disease awareness to prevent the existing stigma to improve patients' social condition and medical care.