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Background: Pott's Puffy tumor (PPT) is a complicated frontal sinusitis that is also described as frontal bone osteomyelitis and a localized sub periosteal abscess. Early diagnosis and immediate active treatment are necessary to prevent severe neurologic sequelae. Case Presentation: Here, we report on a case of Pott's puffy tumor in a previously healthy 13-year-old girl with a worsening headache and swelling of the frontal bone accompanied by vomiting and fever. Magnetic resonance imaging revealed osteomyelitis of the frontal bone. A foreign body was discovered and removed via endoscopy which was then followed by 6 weeks of parenteral and enteral antibiotic therapy, resulting in resolution of all symptoms. Conclusion: A complete history in terms of trauma and insect bite or foreign body in the nose is paramount for a correct diagnosis, and performing a full examination of ear, nose and throat (ENT) to rule out a foreign body is advised. [ABSTRACT FROM AUTHOR]

This study investigates the application of Artificial Neural Networks (ANN) supplemented with optimization algorithms for modeling and mapping groundwater quality in an extensive unconfined aquifer in Northern Iran, a task traditionally performed through labor-intensive and costly water sampling and lab analysis. A comprehensive collection of groundwater samples from monitoring wells scattered across the region facilitated the calculation of the Groundwater Quality Index (GWQI) for each well. These GWQI readings were subsequently categorized into four distinct quality classes very poor, poor, good, and excellent. Key variables impacting groundwater quality were identified, including proximity to industrial and residential areas, population density, aquifer transmissivity, precipitation, evaporation, geology, and elevation. These factors were compiled and processed within a GIS environment. To establish a relationship between the GWQI and these determinants, an ANN model was employed. This was enhanced by the application of two optimization algorithms, Particle Swarm Optimization (PSO) and Grey Wolf Optimizer (GWO), to determine the optimal weight and structure of the ANN model. The study's results indicated that the ANN-PSO model (overall accuracy = 0.88) surpassed both the standard ANN (overall accuracy = 0.71) and ANN-GWO (overall accuracy = 0.83) models in accuracy. The region with the best and poorest groundwater quality was identified in the west and the northern section of the study area respectively. The feature analysis identified precipitation and population as the critical factors influencing groundwater quality in the region. [ABSTRACT FROM AUTHOR]

Background: Pyelonephritis in children is a serious condition that is commonly encountered in clinical practice. Urinary tract abnormalities increase the risk of urinary tract infections (UTIs) and consequently antibiotic resistance. Our study aimed to evaluate the local trend in terms of bacterial uropathogen resistance in Babol, Iran, in children with pyelonephritis considering urinary tract abnormalities. Methods: We recruited pediatric cases aged 1 month to 18 years who were admitted to Amirkola hospital with a diagnosis of pyelonephritis from 2016 to 2019. Children with negative urine cultures or incomplete imaging were excluded from the study. Causative agents were identified based on biochemical features. Antimicrobial in vitro resistance tests were performed using the disk diffusion agar test. Results: A total of 105 children were included in the study. E. coli was the most common causative agent found in 93 (88.6%) patients. Most of the bacterial isolates were sensitive to amikacin and imipenem, and only 12.4% and 13.3% of isolates were resistant to this antibiotic. On the other hand, nalidixic acid represented the least effective treatment, with a resistance rate of 88.6%. A statistically significant difference was observed in resistance to nitrofurantoin and nalidixic acid between children with and without anomalies (p < 0.05). Conclusion: High antibiotic resistance, especially in children with urinary tract anomalies, was identified for frequently used antibiotics. Our findings provide important implications regarding local patterns of uropathogens and antibiotic resistance in children with pyelonephritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this retrospective study, we investigated the outcomes and demographic characteristics of COVID-19 patients with and without a history of CVD. METHODS: This large retrospective, multicenter study was performed on inpatients with suspected COVID-19 pneumonia who were admitted across four hospitals in Babol, Northern Iran. Demographic data, clinical data, and cycle threshold value (Ct) results of Real Time PCR were obtained. Then, participants were divided into two groups: (1) cases with CVDs, (2) cases without CVDs. RESULTS: A total of 11097 suspected COVID-19 cases with a mean ± SD age of 53 ±25.3 (range: 0 to 99) years were involved in the present study. Out of whom 4599 (41.4%) had a positive RT-PCR result. Of those, 1558 (33.9%) had underlying CVD. Patients with CVD had significantly more co-morbidities such as hypertension, kidney disease, and diabetes. Moreover, 187 (12%) and 281 (9.2%) of patients with and without CVD died, respectively. Also, mortality rate was significantly high among the three groups of Ct value in patients with CVD, with the highest mortality in those with Ct between 10 and 20 (Group A = 19.9%). CONCLUSION: In summary, our results highlight that CVD is a major risk factor for hospitalization and the severe consequences of COVID-19. Death in CVD group is significantly higher compared to non-CVD. In addition, the results show that age-related diseases can be a serious risk factor for the severe consequences of COVID-19. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran. Methods: In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14. Results: In total 225 patients with median age of 55 (26–96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4–10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively. Conclusions: The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients. [ABSTRACT FROM AUTHOR]

Background: A limited number of studies described the clinical aspects of the new coronavirus outbreak in the infant population. This study was conducted to describe the clinical features and laboratory findings in infants younger than 2 months of age hospitalized with confirmed coronavirus disease 2019 (COVID-19) infection. Methods: This observational retrospective cohort study included all infants aged <2 months, admitted to two pediatric state hospitals, north of Iran, between February 19, 2020, and January 1, 2021, with confirmed COVID-19 infection. The patients whose pharyngeal or rectal specimens examined for coronavirus disease using a real-time polymerase chain reaction (RT-PCR) assay was positive, were included in the research. All patients were followed until they were discharged from the hospital. Results: Totally, 13 infants with an age range from 1 to 50 days have been recognized. More than one-third of the study patients (38.5%) have been hospitalized immediately after birth. Dyspnea and gastrointestinal symptoms were the most typical manifestations of the patients. One patient had positive RT-PCR results in cerebrospinal fluid examination Conclusion: The median length of stay in the hospital was seven days. More than 90% of infants younger than 2 months of age hospitalized with confirmed COVID-19 infection are expected to be cured. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to investigate the one-year prevalence of SARSCoV- 2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate. [ABSTRACT FROM AUTHOR]

Background: World Health Organization (WHO) declared COVID -19 infection a global pandemic. Children have milder disease than adults but different aspects of disease in children are not fully understood. Case presentation: We describe 5 pediatric patients with COVID-19 that referred to Amirkola Children's Hospital, Babol, Iran. The youngest patient was 4 years old and the oldest was 12 years old. Three patients were males. None of the patients had a history of contacts with symptomatic patients with COVID -19. The most common symptoms included fever, cough, anorexia, weakness and diarrhea. One patient had gastrointestinal symptoms without respiratory symptoms. All patients had elevated ESR and CRP. Three of them had lymphopenia. RT-PCR was positive in all patients. Management included supportive care, antibiotics, antiviral treatment and hydroxychloroquine. All patients were discharged with good condition. Conclusion: Children may have a variety of symptoms including respiratory or gastrointestinal symptoms. Mortality is rare in children and prognosis is better than the adults. [ABSTRACT FROM AUTHOR]

Background and Aim: Urinary tract infection (UTI) is one of the most common infections in children. Arbitrary use of antibiotics has increased the resistant strains and transmits these resistant factors to other pathogens. Therefore, this study was designed to follow the resistance trend in 9-years in children with urinary tract infections referred to the Amirkola Children's hospital (Northern Iran). Materials and Methods: In this cross-sectional study, all children who had Urinary tract infections between 1994 to1998 and 2013 to 2018 with one month to 18 years old were included. Data (covering 9 years), such as age, sex, antibiotic resistance profile, urine culture results, and history of UTI, were collected retrospectively from patients' records. Cases were selected based on clinical and microbiological criteria. Antimicrobial susceptibility was determined by the Kirby–Bauer disk diffusion method. Results: Escherichia coli was the most predominant organism isolated from urine samples. The highest drug resistance was related to cefazolin (83.3%). Resistance to nitrofurantoin was higher in children older than 5 years (P≤0.001). Moreover, the resistance pattern to gentamicin, amikacin, ceftriaxone, cephalexin, and imipenem differed in females and males (P>0.05). Conclusion: A 9-year study showed that 91.4% of the strains are still sensitive against amikacin which is a suitable treatment option in the studied strains. The establishment of antimicrobial stewardship programs and regular monitoring of antimicrobial resistance could help to reduce inappropriate prescribing for UTIs. [ABSTRACT FROM AUTHOR]

Background: Limping is a common complaint of children presenting to the emergency departments of hospitals; therefore, it is important to identify its causes and avoid unnecessary measures. In this study, common etiologies for limping in children presenting to the emergency department of Pediatric Hospital of Amirkola in Babol, Iran were evaluated. Methods: All children under 15 years of age presented to the emergency department of Pediatric Hospital of Amirkola, during 2017- 2018, with complaints of acute limping were retrospectively evaluated. Initially, 71 patients were found among whom 53 were selected based on inclusion and exclusion criteria of the study. The census method was used to obtain the required samples. Patient information including demographic data, clinical signs, and symptoms at admission were gathered. Statistical analysis was done using SPSS v22 software (IBM, USA), and p<0.05 was considered statistically significant. Results: Of 53 children, 33 (62.3%) were boys and 20 (37.7%) were girls. The mean age of participants was 4.53±2.79 years old, and the mean length of hospital stay was 10.5±7.2 days. Inflammation and infections were the most common etiologies with a cumulative prevalence of 58.49 and 28.30%, respectively. Transient synovitis was the most common differential diagnosis with a prevalence of 43.4%, and the most affected joints were hips with a prevalence of 73.5% (p-values=0.001). Conclusion: Most of the diseases for acute limping in children are self-limited, but this should not lead to disregard for infection as a differential diagnosis. [ABSTRACT FROM AUTHOR]

Background and Objective: Hypomagnesemia can lead to bronchial smooth muscle contraction and is associated with wheezeing, airway hyperactivity and impairment of lung function. The aim of this study was to compare serum magnesium levels between asthmatic and healthy children. Methods: This case-control study was performed from September 2018 to February 2019. Totally, 125 children (78 asthmatic and 47 healthy non-asthmatic children) aged 3-14 years referred to Amirkola Children's Hospital in Iran were entered to the study. Sampling was done using the available method based on inclusion criteria. Serum magnesium levels were measured in all children in the laboratory of Amirkola Children's Hospital. P<0.05 was considered a significant level. Findings: The mean age of children was 81.21±35.45 months, among them, 77 (61.6%) and 48 (38.4%) were male and female, respectively. The mean serum magnesium level of children was 2.08 and 2.04 mg/dl in the control and asthma groups, respectively and there was no statistically significant difference between the two groups (p=0.49). Conclusion: Based on the findings of this study, there is no significant difference between serum magnesium levels in asthmatic patients and the control group and it is not necessary to routinely measure magnesium levels in these patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: As the extent of the pandemic and its seroprevalence pattern has been less clarified in pediatrics to date, we aimed to conduct this study to investigate the clinical and laboratory characteristics of COVID-19 in Iranian children, with a focus on evaluating the antibody prevalence and its relation with the laboratory tests. METHODS: All children with highly suspected COVID-19 were included. Anti-nucleoprotein SARS-CoV-2 were measured using SARS-CoV-2 immunoglobulin M (IgM) and SARS-CoV-2 IgG ELISA kits. Hypothesis testing was carried out through SPSS to unravel any association between the measurement tools and important clinical and laboratory characteristics. RESULTS: In this study, 254 patients were evaluated and 117 cases (46%) were male. The nucleic acid detection results for patient 55 were negative, but the IgM and IgG results were positive. Totally, 190 patients were tested for IgM in which only 14 (7.3%) had positive tests. Positive IgG was detected in 51 (20%) out of 254 patients; among them, 30 patients had negative SARS-CoV-2 RT-PCR (59%). Lower level of platelets in IgG positive group in comparison with the IgG negative group was observed (P value: 0.015). Moreover, higher alanine aminotransferase (ALT) was observed in the in IgG positive group (P value: 0.02). In patients with positive IgM, relative hypocalcemia (median of 8.25; IQR: 8.02–8.62) was found which appeared to be significant (P value: 0.02). CONCLUSION: This is the first largest study describing the SARS-CoV-2 seropositivity among children in Iran and provides important insight about the COVID-19 infection in children. [ABSTRACT FROM AUTHOR]

Purpose: Cystic echinococcosis (CE), caused by the metacestode of Echinococcus granulosus, is highly endemic over large parts of Iran. The purpose of this study was to investigate the prevalence rate of hydatidosis and mitochondrial cox1 real-time PCR with high-resolution melting curve (HRM) analysis of E. granulosus isolated from human and livestock. Methods: In this cross-sectional study, 61 formalin-fixed paraffin-embedded tissue isolates were collected from human CE cases and 83 hydatid cysts from the liver and lung lesions of the livestock in Khorasan Razavi province, Northeast Iran. DNA was extracted from each isolate and amplified by real-time PCR and analyzed using the HRM method. Results: The HRM analysis using the cox1 gene of 40 E. granulosus human isolates showed that 35 (87.5%), 4 (10%), and 1 (2.5%) of the isolates were categorized as G1, G3, and G6 genotypes, respectively. Out of the total 1342 livestock inspected, 39 (4%) goats and 44(12%) cattle were found harboring hydatid cysts all belonging to E. granulosus sensu stricto. Conclusion: The results confirmed that the high prevalence of E. granulosus sensu stricto in intermediate hosts is remarkable in northeast of Iran coupled with the high prevalence of infection in livestock, which reinforced the need for hydatidosis control programs in this region. [ABSTRACT FROM AUTHOR]

Objectives: Genetic determinants conferring resistance to macrolide, lincosamide, and streptogramin B (MLSB) via ribosomal modification such as, erm, msrA/B and ereA/B genes are distributed in bacteria. The main goals of this work were to evaluate the dissemination of MLSB resistance phenotypes and genotypes in methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from clinical samples. Methods: A total of 106 MRSA isolates were studied. Isolates were recovered from 3 hospitals in Tehran between May 2016 to July 2017. The prevalence of MLSB-resistant strains were determined by D-test, and then M-PCR was performed to identify genes encoding resistance to macrolides, lincosamides, and streptogramins in the tested isolates. Results: The frequency of constitutive resistance MLSB, inducible resistance MLSB and MSB resistance were 56.2%, 22.9%, and 16.6%, respectively. Of 11 isolates with the inducible resistance MLSB phenotype, ermC, ermB, ermA and ereA were positive in 81.8%, 63.6%, 54.5% and 18.2% of these isolates, respectively. In isolates with the constitutive resistance MLSB phenotype, the prevalence of ermA, ermB, ermC, msrA, msrB, ereA and ereB were 25.9%, 18.5%, 44.4%, 0.0%, 0.0%, 11.1% and 0.0%, respectively. Conclusion: Clindamycin is commonly administered in severe MRSA infections depending upon the antimicrobial susceptibility findings. This study showed that the D-test should be used as an obligatory method in routine disk diffusion assay to detect inducible clindamycin resistance in MRSA so that effective antibiotic treatment can be provided. [ABSTRACT FROM AUTHOR]

Objectives: Obesity is a significant risk factor for a number of chronic diseases, including diabetes, cardiovascular diseases, and cancer. Obesity usually results from a combination of causes and contributing factors, including genetics and lifestyle choices. Many studies have shown an association of single nucleotide polymorphisms (SNPs) in the fat mass and obesity-associated (FTO) and the melanocortin-4 receptor (MC4R) genes with body mass index (BMI). Therefore, recognizing the main genes and their relevant genetic variants will aid prediction of obesity risk. The aim of our study was to investigate the frequency of rs9939609 and rs17782313 polymorphisms in FTO and MC4R genes in an Iranian population. Methods: We enrolled 130 obese patients and 83 healthy weight controls and calculated their BMI. Genomic DNA was extracted from peripheral blood and the frequency of rs9939609 and rs17782313 polymorphisms in FTO and MC4R genes was determined using the tetra-primer amplification refractory mutation system-polymerase chain reaction (ARMS-PCR). Results: Significant associations were found between FTO rs9939609 and BMI. Where homozygous risk allele carriers (A-A) have significant higher odds ratio (OR) of being obese than individuals with normal BMI (OR = 6.927, p < 0.005, 95% confidence interval (CI): 3.48-13.78). No significant correlation between MC4R rs17782313 and obesity were observed when compared to healthy weight individuals. Although subjects with C-C genotype had higher odds of obesity (OR = 1.889, p = 0.077, 95% CI: 0.92-3.84). Conclusions: This study shows a relationship between FTO polymorphism and increased BMI, therefore, SNP in the FTO gene influence changes in BMI and can be considered a prognostic marker of obesity risk. [ABSTRACT FROM AUTHOR]

Backgrounds: Vitamin D deficiency is a public health concern even in sunny areas, so we decided to assess the prevalence of vitamin D deficiency and its related factors among university students in Shiraz. Methods: This cross-sectional study was carried out on 254 (128 male and 126 female) university students. Demographic questionnaires and a questionnaire on exposure to sun light and sun protection were completed by the participants. Serum 25OH-vitamin D was measured using a radioimmunoassay kit. Data analysis was done using Statistical Package for Social Sciences (SPSS) software # 16. A P value less than 0.05 was considered as significant. Results: Mean ± standard deviation (SD) of serum 25OH-vitamin D was 49.29 ± 12.87 (nmol/l) and 27.46 ± 10.37 (nmol/l) among male and female students, respectively. 51.2% of female students were vitamin D insufficient and 44% of them had vitamin D deficiency. Prevalence of vitamin D insufficiency and marginal status among male students were 49.5 and 48%, respectively. Serum vitamin D of female students was significantly less than the males (P < 0.001). Serum vitamin D was negatively correlated to sun protection score (P < 0.001, r = 0.50), but there was no correlation between serum vitamin D and sun exposure. Conclusions: Vitamin D deficiency especially among female students is alarmingly prevalent. Increasing use of sunscreen lotion and clothing style could be the main factors inhibiting endogenous vitamin D synthesis which results in its deficiency. [ABSTRACT FROM AUTHOR]

Grain hardness has a considerable effect on milling yield, particle size, and water absorption of wheat (Triticum aestivum L.) flour and is considered an integral trait in wheat end-use classification. Kernel hardness in wheat is controlled by theHardnesslocus on chromosome 5D. In this study, we investigated genotypic variation of genes involved in grain hardness in wheat cultivars developed in Iran or CIMMYT. We have used two allele-specific PCR marker methodologies to identify allelic variation ofPina-D1andPinb-D1genes. We also determined the force required for seed rupture by compression testing (CT) in selected number of cultivars. Two alleles (Pina-D1aandPina-D1b) forPina-D1and three alleles (Pinb-D1a, Pinb-D1b, andPinb-D1d) forPinb-D1were detected. The most common genotype observed wasPina-D1a/Pinb-D1a. The second most frequent genotype wasPina-D1b/Pinb-D1a. GenotypesPina-D1a/Pinb-D1dandPina-D1b/Pinb-D1dwere also observed but at very low frequencies. In general, compression testing data were in agreement with the grain hardness expected from each genotypic class. MostPina-D1b-carrying germplasm were those from the CIMMYT global wheat program. The allelePinb-D1dwas found in combination withPina-D1aand withPina-D1b. The allelePinb-D1ddid not increase grain hardness as expected. [ABSTRACT FROM AUTHOR]

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Background: Amphibian skins possess various antibacterial compounds that are effective against some microbial pathogens and are mostly released in response to environmental stress. In fact, the skin of Rana ridibunda, a large green frog, is a rich source of antimicrobial compounds that can be developed for therapeutic use. In the present study, the skin extract of Iranian Rana ridibunda was evaluated for its antimicrobial, hemolytic and cytototoxic activities. Methods: The frog specimens were collected from Minoodasht located in Golesten province in Iran, during 2009. Subsequently, their skins were removed and the intended compounds were extracted. The crude extract was partially purified by gel filtration chromatography. The antimicrobial effects of skin extract were assessed against various microorganisms such as Escherchia coli, methicillin-resistant and -sensitive Staphyloccus aureus, vancomycin-resistant and -susceptible Enteroccus fecalis, Pseudomonas aeroginosa and Candida albicans. In addition, its minimum inhibition concentration, cytotoxic and hemolytic activities were determined. Results: The crude extract of Rana ridibunda skin had valuable antimicrobial effects against methicillin-resistant and -susceptible S. aureus in comparison with E.coli and vancomycin-resistant and -susceptible E. fecalis. Besides, no antimicrobial activities were seen against P. aeroginosa or C. albicans. Moreover, the hemolytic and cytotoxic activities of the skin extract were minimal. Conclusion: The antimicrobial activity of Iranian Rana ridibunda was comparable to those isolated from other Rana species. In conclusion, the skin extract of Rana ridibunda had the potential for a new therapeutic agent against the emerging drugresistant bacteria, particularly methicillin-resistant and -sensitive S. aureus. [ABSTRACT FROM AUTHOR]

Proline and glutamine-rich wheat seed endosperm proteins are collectively referred to as prolamins. They are comprised of HMW-GSs, LMW-GSs and gliadins. HMW-GSs are major determinants of gluten elasticity and LMW-GSs considerably affect dough extensibility and maximum dough resistance. The inheritance of glutenin subunits follows Mendelian genetics with multiple alleles in each locus. Identification of the banding patterns of glutenin subunits could be used as an estimate for screening high quality wheat germplasm. Here, by means of a two-step 1D-SDS-PAGE procedure, we identified the allelic variations in high and low-molecular-weight glutenin subunits in 65 hexaploid wheat ( Triticum aestivum L.) cultivars representing a historical trend in the cultivars introduced or released in Iran from the years 1940 to 1990. Distinct alleles 17 and 19 were detected for Glu-1 and Glu-3 loci, respectively. The allelic frequencies at the Glu-1 loci demonstrated unimodal distributions. At Glu-A1, Glu-B1 and Glu-D1, we found that the most frequent alleles were the null, 7 + 8, 2 + 12 alleles, respectively, in Iranian wheat cultivars. In contrast, Glu-3 loci showed bimodal or trimodal distributions. At Glu-A3, themost frequent alleles were c and e. At Glu-B3 the most frequent alleles were a, b and c. At Glu-D3 locus, the alleles b and a, were the most and the second most frequent alleles in Iranian wheat cultivars. This led to a significantly higher Nei coefficient of genetic variations in Glu-3 loci (0.756) as compared to Glu-1 loci (0.547). At Glu-3 loci, we observed relatively high quality alleles in Glu-A3 and Glu-D3 loci and low quality alleles at Glu-B3 locus. [ABSTRACT FROM AUTHOR]

Unfortunately, the affiliation of Majid Fasihi‑Harandi needs to be edited. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to identify gastrointestinal (GI) and liver injury presentations in children admitted with COVID-19 infection. Methods: In this retrospective study, we studied all children with suspected symptoms of COVID-19, referred to Amirkola Children's Hospital. Clinical manifestations of the digestive and respiratory systems and liver function tests were evaluated for all cases. Results: Eighteen children were studied. The most common clinical symptoms were fever, anorexia, weakness, nausea and vomiting, cough, diarrhea, and abdominal pain, respectively. Also, 5/18 (27.8%) and 7/18 (38.9%) of cases had abnormally high alanine aminotransferase (ALT), aspartate aminotransferase (AST), respectively. Additionally, in icteric cases, direct bilirubin was raised. There was no significant relationship between pulmonary lesions and abnormal excess in ALT (P = 0.59) and AST (P = 0.62). Conclusion: The findings showed that there were no severe clinical GI symptoms in children with COVID-19 infection. Besides, children with increased liver enzymes did not have more respiratory involvement than those without a rise in liver enzymes. [ABSTRACT FROM AUTHOR]

This report describes the first case of visceral leishmaniasis (VL) resistant to pentavalent antimonials and also the first use of combinational therapy in Iran. The patient was a two-year old boy, from a non-endemic area for leishmaniasis in northern Iran, presenting with pentavalent antimonial resistant VL. Additional treatment with conventional and liposomal amphotericin B was not effective. A complete cure was achieved following a three week treatment with liposomal amphotericin B (5 mg/kg/day for 5 days, then on the 14th and 21st days), allopurinol (25 mg/day for 5 days, then on the 14th and 21st days) and interferon gamma (50 μg/m2 subcutaneously three times weekly). Our results suggest a need for further studies to identify resistant Leishmania species and their susceptibility to different treatment regimens. [ABSTRACT FROM AUTHOR]

Objective: Self-burning is one way that some people choose to commit suicide, and it has been seen in many nations. This problem is considered as an uncommon method in developed countries and a common method of suicide in developing countries. The present study aimed to identify the factors associated with self-burning among Iranian women in reproductive age., Method: This case-control study was conducted among 228 (57 cases and 171 controls) women in reproductive age from the Imam Khomeini Hospital of Ilam. A self-report questionnaire was used to determine factors associated with self-burning, including job status, domestic violence, mental health status, education levels, smoking and alcohol use, forced marriage, socioeconomic status, drug history, and family history of self-burning. Data analysis was performed using simple and multiple logistic regression to control the effects of possible confounders., Results: There was a significant positive association between self-burning and being unemployed and a housewife. Also, the presence of self-burning was increasingly associated with high domestic violence and having history of forced marriage and decreasingly associated with post-diploma education level and a high socioeconomic level., Conclusion: It is recommended that health and social policy makers pay attention to the social and economic aspects that cause self-burning in women to prevent this problem.

Objectives: To avoid worsening from mild, moderate, and severe diseases and to reduce mortality, it is necessary to identify the subpopulation that is more vulnerable to the development of COVID-19 unfavorable consequences. This study aims to investigate the demographic information, prevalence rates of common comorbidities among negative and positive real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) patients, and the association between SARS-CoV-2 cycle threshold (Ct) at hospital admission, demographic data, and outcomes of the patients in a large population in Northern Iran., Methods: This large retrospective cross-sectional study was performed from 7 March to 20 December 2020. Demographic data, including gender, age, underlying diseases, clinical outcomes, and Ct values, were obtained from 8,318 cases suspected of COVID-19, who were admitted to four teaching hospitals affiliated to Babol University of Medical Sciences (MUBABOL), in the north of Iran., Results: Since 7 March 2020, the data were collected from 8,318 cases suspected of COVID-19 (48.5% female and 51.5% male) with a mean age of 53 ± 25.3 years. Among 8,318 suspected COVID-19 patients, 3,250 (39.1%) had a positive rRT-PCR result; 1,632 (50.2%) patients were male and 335 (10.3%) patients died during their hospital stay. The distribution of positive rRT-PCR revealed that most patients (464 (75.7%)) had a Ct between 21 and 30 (Group B)., Conclusion: Elderly patients, lower Ct, patients having at least one comorbidity, and male cases were significantly associated with increased risk for COVID-19-related mortality. Moreover, mortality was significantly higher in patients with diabetes, kidney disease, and respiratory disease., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2022 Farzin Sadeghi et al.)

Introduction: Echinococcosis, as an important zoonotic infection, has a major worldwide distribution. Pediatric echinococcosis has still become health concerning issue in developing countries, particularly, in the Middle East and Iran. The aim of this study was to investigate the human echinococcosis in children in northern Iran., Methods: Patients admitted to the pediatric subspecialty hospital of Amir Kala, Babol, Iran, from 2011 to 2016 with a confirmed diagnosis of echinococcosis, were reviewed. Records of the patients, including demographic data, clinical manifestations of the disease, type of cysts, and other related factors, were collected., Results: Sixteen pediatric patients, twelve (75%) male, and four (25%) female were evaluated. All cases had cystic echinococcosis. The results showed that fever (75%) following vomiting, nausea, and coughing (44%) were the most common clinical manifestations. The most common localizations of cases were determined as liver (n=10, 62.5%) and lung (n=9, 56%). The frequency of the involvement of more than one organ was 31% (5 cases). The co-occurrence of liver and lung was seen in 2 (12.5%) cases, and in one case, the co-occurrence of the liver and spleen was reported. In one case, lung, liver and, the pelvis was involved, while in another case, liver, sub diaphragm and kidney involvement were observed., Conclusion: Cystic echinococcosis should be kept in mind when a cystic lesion is encountered anywhere in the body, particularly, in patients lining in the endemic regions. Since cystic echinococcosis has a considerable economic impact in Iran, the implementation of a control program and the surveillance system are highly recommended to reduce the economic burden of this disease., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: The aim of this study was to identify gastrointestinal (GI) and liver injury presentations in children admitted with COVID-19 infection., Methods: In this retrospective study, we studied all children with suspected symptoms of COVID-19, referred to Amirkola Children's Hospital. Clinical manifestations of the digestive and respiratory systems and liver function tests were evaluated for all cases., Results: Eighteen children were studied. The most common clinical symptoms were fever, anorexia, weakness, nausea and vomiting, cough, diarrhea, and abdominal pain, respectively. Also, 5/18 (27.8%) and 7/18 (38.9%) of cases had abnormally high alanine aminotransferase (ALT), aspartate aminotransferase (AST), respectively. Additionally, in icteric cases, direct bilirubin was raised. There was no significant relationship between pulmonary lesions and abnormal excess in ALT ( P = 0.59) and AST ( P = 0.62)., Conclusion: The findings showed that there were no severe clinical GI symptoms in children with COVID-19 infection. Besides, children with increased liver enzymes did not have more respiratory involvement than those without a rise in liver enzymes., (© 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

During the coronavirus disease 2019 (COVID-19) pandemic, a new phenomenon manifesting as a multisystem inflammatory syndrome in children (MIS-C) which has a similar clinical presentation to Kawasaki disease, toxic shock syndrome and severe sepsis has emerged. Although the number of MIS-C reports is increasing, rare reports in Asia is still available. To our knowledge, this study is the largest series of published MIS-C cases in Iran. We performed a retrospective study of all patients with case definition for MIS-C admitted to the three paediatric hospitals in Iran. All of these hospitals are located within the most active COVID-19 pandemic areas (Tehran, Qom and Mazandaran) in Iran. Demographic characteristics, clinical data, laboratory findings, imaging and echocardiographic findings, treatment and outcomes were collected. Between 7 March and 23 June 2020, 45 children were included in the study. The median age of children was 7 years (range between 10 months and 17 years). Common presenting symptoms include fever (91%), abdominal pain (58%), nausea/vomiting (51%), mucocutaneous rash (53%), conjunctivitis (51%) and hands and feet oedema (40%) with median duration of symptoms prior to presentation of 5 (interquartile range (IQR) 3, 7) days. Fifty-three percent of children showed lymphopaenia. Overall, the majority of cases at admission had markedly elevated inflammatory markers erythrocyte sedimentation rate (ESR) (95.5%) and C-reactive protein (CRP) (97%). Ferritin was abnormal in 11 out of 14 tested patients (73%), and it was highly elevated (>500 ng/ml) in 47% of cases. Median fibrinogen level was 210 (IQR 165, 291) mg/dl, D-dimer was 3909 (IQR 848, 4528) ng/ml and troponin was 0.6 (IQR 0.1, 26) ng/ml, respectively. Twenty out of 31 patients (64.5%) had hypoalbuminaemia. In addition, hyponatraemia was found in 64% of cases. Twenty-five patients (56%) presented with cardiac involvement and acute renal failure was observed in 13 cases (29%). Pleural, ascitic, ileitis and pericardial effusions were found in 18%, 11%, 4% and 2% of cases, respectively. In conclusion, this is a first large case series of hospitalised children who met criteria for MIS-C in Iran. There was a wide spectrum of presenting signs and symptoms; evidence of inflammation with abnormal values of CRP, ESR, D-dimer, ferritin and albumin; and multi-organ involvement.

Aims and Objectives: The present work aimed to evaluate the frequency of aminoglycoside- modifying enzymes encoding genes in the E. faecalis and E. faecium and their antibiotic resistance profile., Methods: A total of 305 different clinical samples were subjected for identification and antibiotic susceptibility test. The high-level aminoglycoside resistance was identified by MIC and Kirby Bauer disc diffusion method. The prevalence of aac (6')-Ie-aph (2'')-Ia, aph (3')-IIIa and ant (4')- Ia genes was determined by multiplex- PCR. In total, 100 enterococci strains were isolated. The prevalence of E. faecalis and E. faecium isolates was 78% and 22%, respectively., Results: All isolates were susceptible to linezolid. So, all E. faecalis were susceptible to vancomycin but, 36.4% of E. faecium were resistant to it. The prevalence of multiple drug resistance strains was 100% and 67.9% of E. faecium and E. faecalis, respectively. High-level-gentamicin and streptomycin resistant rates were as follows; 26.9% and 73.1% of E. faecalis and 77.3% and 90.1% of E. faecium. Conclucion: The results of the current study showed a high frequency of aac (6')-Ie-aph (2'')-Ia genes among enterococcal isolates. A high rate of resistance to antimicrobials in Enterococcus is obviously problematic, and a novel policy is needed to decrease resistance in these microorganisms., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

A comprehensive meta-analysis study was performed to estimate the reliable national prevalence and molecular epidemiology of amoebiasis in Iran. Nine English and Persian databases were searched to achieve the relevant studies. Pooled estimates were generated and meta-regression was performed. We identified 71 eligible articles involving 330 930 subjects from 25 provinces to be included in the final analysis. Moreover, 17 studies compromising 462 polymerase chain reaction (PCR)-positive isolates performed molecular analysis to inter-species differentiation. The pooled prevalence of Entamoeba infection among Iranian population was about 1% (95% CI 0.8-2.0%). Moreover, regarding Human Development Index (HDI), a higher prevalence was observed in undeveloped provinces. Out of 462 PCR-positive isolates, 83% (95% CI 69-94%) and 12% (95% CI 3-24%) were Entamoeba dispar, Entamoeba histolytica, respectively. In subgroup analysis based on molecular results, in general, population prevalence of Entamoeba dispar and E. histolytica were 91% (95% CI 80-99%) and 7%, (95% CI 0-19%), respectively, while prevalence of these species in patients with gastrointestinal disorders were 75% (95% CI 45-96%) and 18% (95% CI 1-43%), respectively. Our findings indicate the low burden of amoebiasis in Iran. E. dispar, that is mostly non-pathogenic, was identified as most prevalent species. Nevertheless, we suggest more public health interventions in areas with lower HDI.

Objectives: Bloodstream infections (BSIs) are a major cause of paediatric morbidity and mortality worldwide. This study describes the epidemiology and antimicrobial resistance of Gram-negative bacteria (GNB) from BSIs in children admitted to an Iranian paediatric hospital., Methods: Clinical and microbiological data of patients with positive blood cultures were collected from March 2011 to September 2016. Standard laboratory methods were used for blood culture and bacterial identification. Antimicrobial sensitivity was evaluated by the Kirby-Bauer disk diffusion and broth microdilution methods., Results: Of 2325 bacterial pathogens isolated from blood cultures, 41.1% (n=956) were GNB. Most clinical isolates (n=208; 21.8%) were identified in the cardiac intensive care unit. Predominant bacterial isolates were Klebsiella pneumoniae subsp. pneumoniae (n=263; 27.5%), Escherichia coli (n=192; 20.1%), Serratia marcescens (n=151; 15.8%), Pseudomonas aeruginosa (n=111; 11.6%) and Enterobacter spp. (n=100; 10.5%). Enterobacter isolates showed a high level of ampicillin resistance. Escherichia coli were highly resistant to chloramphenicol (100%), cefixime (100%), ceftriaxone (100%) and ampicillin (96%). Cefixime had the least efficacy against Haemophilus spp. (100% resistant). All K. pneumoniae (100%) were ampicillin-resistant. All S. marcescens were ceftazidime-resistant. No Acinetobacter baumannii were resistant to colistin. All P. aeruginosa were resistant to cefotaxime and trimethoprim/sulfamethoxazole., Conclusions: These results demonstrate the increasing trend in antibiotic resistance among GNB associated with BSI in children, emphasising the importance of continuous screening and surveillance programmes for detection of antibiotic resistance in BSI pathogens for selection of appropriate treatment regimens., (Copyright © 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.)

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) (MIM #604004) is a rare autosomal recessive neurological disorder characterized by macrocephaly, motor and cognitive decline, ataxia, spasticity and occasional seizures. Magnetic resonance imaging (MRI) shows diffusely abnormal and swollen white matter of the cerebral hemispheres and subcortical cysts in the anterior temporal and frontoparietal region. Mutations in MLC1(22q13.33) and GLIALCAM have been identified in patients with MLC. Mutations in MLC1 account for approximately 75% of the cases. MLC was suspected in eighteen Iranian patients from sixteen families based on positive clinical findings including macrocephaly beginning in the first year, neurocognitive deterioration, seizure or loss of consciousness after minor head trauma. All except two were born to consanguineous parents. Brain MRI images were compatible with MLC and confirmed the diagnosis. Sequencing of entire coding region of MLC1 was performed for seventeen patients and mutations in MLC1 were detected in all of them. Eight novel mutations and seven previously reported mutations were identified. This report shows that MLC is relatively common in Iranian population, as expected for rare diseases with high inbreeding, with a surprisingly high frequency of novel mutations., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: Work engagement is a new concept in the field of psychology and human resource management. Increased vitality and enthusiasm is a social phenomenon that brings work engagement for society. This study aimed to evaluate work engagement and its determinants in Kermanshah hospitals' staff., Methods: This cross-sectional study was conducted on 387 hospital administrative, clinical, paraclinical, and service staff. The sample size was calculated using Krejcei-Morgan table. The data were collected using a questionnaire including demographic characteristics and job engagement components. Then, the data were analyzed using descriptive statistics as well as independent sample t-test and one-way ANOVA., Results: The participants' mean (SD) of age was 32.63±2.7 years and most of them were female (57.6%). The results revealed a significant relationship between work engagement and age group (P=0.01) and work experience (P=0.04). However, no significant relationship was found between work engagement and sex, education level, and job unit., Conclusion: The results of this study showed that only job experience and age were associated with work engagement. However, no significant relationship was found between work engagement and education level, sex, and job. Thus, further studies are suggested to investigate the cultural factors and personality traits associated with job enthusiasm among the hospital staff, especially nurses.

This study evaluated the time performance in the emergency response center to provide pre-hospital emergency services in Kermanshah. This study was a descriptive retrospective cross-sectional study. In this study 500 cases of patients from Shahrivar (September) 2012 to the end of Shahrivar (September) 2013 were selected and studied by the non-probability quota method. The measuring tool included a preset cases record sheet and sampling method was completing the cases record sheet by referring to the patients' cases. Data were analyzed using SPSS version 18 and the concepts of descriptive and inferential statistics (Kruskal-Wallis test, benchmark Eta (Eta), Games-Howell post hoc test). The results showed that the interval mean between receiving the mission to reaching the scene, between reaching the scene to moving from the scene, and between moving from the scene to a health center was 7.28, 16.73 and 7.28 minutes. The overall mean of time performance from the scene to the health center was 11.34 minutes. Any intervention in order to speed up service delivery, reduce response times, ambulance equipment and facilities required for accuracy, validity and reliability of the data recorded in the emergency dispatch department, Continuing Education of ambulance staffs, the use of manpower with higher specialize levels such as nurses, supply the job satisfaction, and increase the coordination with other departments that are somehow involved in this process can provide the ground for reducing the loss and disability resulting from traffic accidents.

Background: HIV, HBV and HCV is major public health concerns. Because of shared routes of transmission, HIV-HCV coinfection and HIV-HBV coinfection are common. HIV-positive individuals are at risk of coinfection with HBV and HCV infections. The prevalence rates of coinfection with HBV and HCV in HIV-patients have been variable worldwide depending on the geographic regions, and the type of exposure., Aim: This study aimed to examine HBV and HCV coinfection serologically and determine the shared and significant factors in the coinfection of HIV-positive patients., Methods: This descriptive, cross-sectional study was carried out on 391 HIV-positive patients including 358 males and 33 females in Lorestan province, west Iran, to survey coinfection with HBsAg and anti-HCV. The retrospective demographic data of the subjects was collected and the patients' serums were analyzed by ELISA kits including HBsAg and anti-HCV. The collected data was analyzed with SPSS software (15) and Chi-square. Fisher's exact test with 5% error intervals was used to measure the correlation of variables and infection rates., Results: The results of the study indicated that the prevalence of coinfection in HIV-positive patients with hepatitis viruses was 94.4% (370 in 391), out of whom 57 (14.5%) cases were HBsAg positive, 282 (72%) cases were anti-HCV positive, and 31 (7.9%) cases were both HBsAg and anti-HCV positive., Conclusion: There was a significant correlation between coinfection with HCV and HBV and/or both among HIV-positive patients depending on different variables including sex, age, occupation, marital status, exposure to risk factors. (p < 0.001).