Search

Limited knowledge exists on the virulence factors of Candida tropicalis and the mechanisms of azole resistance that lead to an intensified pathogenicity and treatment failure. We aimed to evaluate the virulence factors and molecular mechanisms of azole resistance among C. tropicalis isolated from patients with candidemia. Several virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CSH), and biofilm formation, were evaluated. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of eight (4 fluconazole resistance and 4 fluconazole susceptible) clinical C. tropicalis isolates were assessed. The correlation between the virulence factors and antifungal susceptibility patterns was analyzed. During a 4 year study, forty-five C. tropicalis isolates were recovered from candidemia patients. The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 5 (11.1%), proteinase 31 (68.9%), esterase 43 (95.6%), hemolysin 44 (97.8%), biofilm formation 45 (100%) and CSH 45(100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. There was a significant positive correlation between micafungin minimum inhibitory concentrations (MICs) and hemolysin production (rs = 0.316). However, we found a negative correlation between fluconazole MICs and esterase production (rs = −0.383). We observed the high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates. C. tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes was considered one of the possible mechanisms of azole resistance.

Objective: Melatonin is the major secretory product of the pineal gland and may play a role in the etiology and clinical symptoms of rheumatoid arthritis (RA). This systematic review and meta-analysis were conducted to determine the morning serum melatonin level in patients with RA compared to non-RA patients. Materials and Methods: We searched English databases (PubMed, Web of Science, Scopus, and Google Scholar) for observational studies regarding the morning serum melatonin level in RA patients from January 2000 to October 2020. The weighted mean difference (WMD) was assessed. Heterogeneity was analyzed using the Q Cochrane test and the I2 measure. To assess the relationship between covariates and effect size, we performed a meta-regression analysis. Furthermore, we used the Egger test alongside the funnel plot for the assessment of publication bias. Results: The literature search revealed 214 studies, of which 7 studies met the eligibility criteria. We did not find heterogeneity (I2 = 0.0%). This study showed a higher level of morning serum melatonin levels in RA patients in comparison with the controls (WMD = 5.85). In meta-regression analysis, none of the variables had a significant relationship with the efficacy of effect size. The funnel plot showed all the included studies were symmetrically distributed in the triangle area. Egger's test also showed an absence of publication bias. Conclusions: Melatonin levels were higher in RA patients than the controls, but due to the small sample size of included studies, the power of this meta-analysis was low.

Aflatoxin M1 is a derivate of aflatoxin B1 and an important contaminant of milk and dairy products. This systematic review and meta-analysis was conducted on relevant Persian and English original articles in national and international databases with no time limits until 1 January 2018. In total 605 articles were found among which 70 articles met the inclusion criteria for meta-analysis. The prevalence (95% confidence interval (CI)) and mean concentration (95% CI) of aflatoxin M1 was found to be 64% (53-75%) and 39.7 ng/l (31.9-47.4 ng/l) in raw milk, 95% (89-98%) and 62.3 ng/l (40.6-84 ng/l) in pasteurised milk, 71% (56-84%) and 60.1 ng/l (30.9-89.3 ng/l) in sterilised milk, 59% (20-93%) and 5.5 ng/l (3.3-7.7 ng/l) in breast milk and 72% (61-81%) and 82.3 ng/kg (63.7-100.9 ng/kg) in dairy products. In general, 9% (4-16%) of milks and 10% (4-17%) of dairy products had aflatoxin M1 in concentrations exceeding the permitted level of Iranian standards (500 ng/l). Based on the maximum permitted aflatoxin M1 concentration in standards of Europe (50 ng/l), these percentages increase to 25% (18-32%) for milks and 18% (9-29%) for dairy products. According to the results, further control and preventive measures should be applied on livestock feeds because decreased aflatoxin B1 contamination at this level results in decreased aflatoxin M1 in milk and dairy products.

INTRODUCTION: Agricultural commodities contaminated by molds and mycotoxins can be considered as public health problems in less developed countries, particularly in Iran. Hence the main purpose of this study was to identify mold fungi and molecular analysis of the most important species of aflatoxin-B1-producing Aspergillus species in some dried nuts and grains in local markets in Tehran. MATERIALS AND METHODS: Two hundred fifty samples of wheat, rice, corn, pistachios, and peanuts were collected from the five different locations of Tehran between January 2018 and January 2019. The samples were analyzed by using direct seed inoculation method and grain crushing method. Fungal strains were identified as Aspergillus spp. on the basis of morphological characters and further confirmed by using of β-tubulin gene sequencing. To differentiate between aflatoxigenic and non-aflatoxigenic Aspergillus spp., the isolates were screened for the presence of aflatoxigenic genes (nor-1, ver-1, omtA, and aflR). RESULTS: One-handed forty-eight aflatoxigenic Aspergillus isolates (144 A. flavus and 4 A. parasiticus) were identified and aflR gene was the most frequent gene in these species. Five isolates (4 A. flavus, 1 A. parasiticus) had quadruplet pattern, 64 isolates (63 A. flavus, 1 A. parasiticus) had more than 1 gene and 39 isolates (38 A. flavus,1 A. parasiticus) did not have any genes. CONCLUSION: According to the contamination of dried nuts and grains by some aflatoxigenic fungi, an extensive surveillance is necessary to provide a wider view on these products. Moreover, effective and efficient aflatoxin control program requires identifying and managing key elements that are effective in reducing mycotoxin production at farm level or in storage conditions.

Background and Objectives: Pneumocystis jirovecii pneumonia (PJP) is a serious infection that usually affects those with a weak immune system. Since the prevalence of this infection in Iran and in the world is not clearly defined, the present study aimed to evaluate the incidence, clinical spectrum, and demographic characteristics of PJP among HIV and non-HIV immunocompromised patients. Materials and Methods: Bronchoalveolar Lavage (BAL) specimens were obtained from 3 groups of immunocompromised patients, including acquired immunodeficiency syndrome (AIDS) patients, diabetic patients, and patients receiving immuno- suppressive therapies. All were hospitalized in pulmonary units. The specimens were examined using microscopic methods (Giemsa and calcofluor white staining) and the nested-PCR technique based on mtLSU-rRNA gene. Results: A total of 120 BAL samples were collected. From 12.5% (5 from 40) of HIV-infected patients, 5% (2 from 40) of patients receiving immunosuppressive therapies, and 2.5% (1 from 40) of diabetic patients Pneumocystis jiroveci was iso- lated. There was not any association between the prevalence of PJP and the patient's gender (p= 0.557) and age (p= 0.681). Fever and dyspnea (n=7, 87.5%), nonproductive cough and abnormal auscultation sound (n=5, 62.5%), and also chills and weight loss (n=2, 25%) were the documented clinical symptoms of PJP. Also, the results showed that none of the samples had positive results for P. jiroveci with microscopic tests while using the nested-PCR method 8 samples had positive results. Conclusion: Since PJP often causes symptoms that are similar to other illnesses, such as the flu or tuberculosis, clinical and laboratory findings should be used simultaneously for making the final decision on drug administration.

Background Virulence factors intensify the pathogenicity of Candida species in candidemia. Limited knowledge exists regarding the azole-resistant mechanism and virulence factors of Candida tropicalis. Consequently, we aimed to evaluate the virulence factors and the molecular mechanisms of azole resistance among C. tropicalis isolated from bloodstream infection. Materials and methods Forty-five C. tropicalis isolates recovered from candidemia patients were evaluated for virulence factors, including extracellular enzymatic activities, cell surface hydrophobicity (CHS), and biofilm formation. Antifungal susceptibility pattern and expression level of ERG11, UPC2, MDR1, and CDR1 genes of eight azole resistance C. tropicalis isolates were assessed. Results The isolates expressed different frequencies of virulence determinants as follows: coagulase 4 (8.9%), phospholipase 4 (8.9 %), proteinase 31 (68.9 %), CSH 43 (95.6 %), esterase 43 (95.6 %), hemolysin 44 (97.8%), and biofilm formation 45 (100%). All the isolates were susceptible to amphotericin B and showed the highest resistance to voriconazole. The high expression of ERG11 and UPC2 genes in fluconazole-resistant C. tropicalis isolates were observed. Conclusion C. tropicalis isolated from candidemia patients extensively displayed capacities for biofilm formation, hemolysis, esterase activity, and hydrophobicity. In addition, the overexpression of ERG11 and UPC2 genes can be considered as one of the possible mechanisms of azole resistance.

Biofilm formation by Candida species is an influential virulence factor in candidemia pathogenesis. We investigated the relationship between biofilm formation of Candida tropicalis isolates with the clinical characteristics and mortality outcomes in patients with candidemia.Thirty-nine C. tropicalis isolates were recovered from patients with candidemia admitted to two university hospitals in Tehran, Iran. Biofilm mass and metabolic activity of C. tropicalis biofilms were assessed in vitro with two colorimetric methods. The sessile minimum inhibitory concentrations (SMICs) were evaluated in vitro by treating preformed biofilms with diluted concentrations of azoles according to CLSI-M27 A3/S4 protocol, followed by metabolic activity quantification. The expressions of ERG11, UPC2, MDR1, and CDR1 genes were also evaluated.All C. tropicalis isolates produced biofilm. Respectively, higher7-day and ≥7-day mortality rates were found among cases with high metabolic activity (46.7% vs. 13%, P = 0.03) and high biofilm mass (31.8% vs. 0, P = 0.029). Sessile cells had high resistance to fluconazole, voriconazole, and itraconazole. The azole minimum inhibitory concentrations (MICs) of C. tropicalis sessile were significantly greater than the planktonic minimum inhibitory concentrations (PMICs). In fluconazole-treated biofilms, the expression of ERG11 and UPC2 genes was increased.Our findings highlight the importance of C. tropicalis biofilm formation as an important factor in candidemia pathogenesis and the clinical outcome of patients with candidemia.

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection. Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole. Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients

Candida tropicalis is one of the major candidaemia agents, associated with the highest mortality rates among Candida species, and developing resistance to azoles. Little is known about the molecular mechanisms of azole resistance, genotypic diversity, and the clinical background of C. tropicalis infections. Consequently, this study was designed to address those questions. Sixty-four C. tropicalis bloodstream isolates from 62 patients from three cities in Iran (2014-2019) were analyzed. Strain identification, antifungal susceptibility testing, and genotypic diversity analysis were performed by MALDI-TOF MS, CLSI-M27 A3/S4 protocol, and amplified fragment length polymorphism (AFLP) fingerprinting, respectively. Genes related to drug resistance (ERG11, MRR1, TAC1, UPC2, and FKS1 hotspot9s) were sequenced. The overall mortality rate was 59.6% (37/62). Strains were resistant to micafungin [minimum inhibitory concentration (MIC) ≥1 μg/ml, 2/64], itraconazole (MIC > 0.5 μg/ml, 2/64), fluconazole (FLZ; MIC ≥ 8 μg/ml, 4/64), and voriconazole (MIC ≥ 1 μg/ml, 7/64). Pan-azole and FLZ + VRZ resistance were observed in one and two isolates, respectively, while none of the patients were exposed to azoles. MRR1 (T255P, 647S), TAC1 (N164I, R47Q), and UPC2 (T241A, Q340H, T381S) mutations were exclusively identified in FLZ-resistant isolates. AFLP fingerprinting revealed five major and seven minor genotypes; genotype G4 was predominant in all centers. The increasing number of FLZ-R C. tropicalis blood isolates and acquiring FLZ-R in FLZ-naive patients limit the efficiency of FLZ, especially in developing countries. The high mortality rate warrants reaching a consensus regarding the nosocomial mode of C. tropicalis transmission.

Agricultural commodities contaminated by molds and mycotoxins can be considered as public health problems in less developed countries, particularly in Iran. Hence the main purpose of this study was to identify mold fungi and molecular analysis of the most important species of aflatoxin-B1-producingTwo hundred fifty samples of wheat, rice, corn, pistachios, and peanuts were collected from the five different locations of Tehran between January 2018 and January 2019. The samples were analyzed by using direct seed inoculation method and grain crushing method. Fungal strains were identified asOne-handed forty-eight aflatoxigenicAccording to the contamination of dried nuts and grains by some aflatoxigenic fungi, an extensive surveillance is necessary to provide a wider view on these products. Moreover, effective and efficient aflatoxin control program requires identifying and managing key elements that are effective in reducing mycotoxin production at farm level or in storage conditions.

Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract diseases. This infection affects 75% of women on at least one occasion over a lifetime. The present systematic review and meta-analysis is the first to determine the prevalence of vulvovaginal candidiasis in Iranian women. We searched national (SID, IranDoc, Iranmedex, and Magiran) and international (PubMed, Scopus, Google Scholar, and web of science) databases for studies published between May 2000 until May 2020 reporting the epidemiologic features of vulvovaginal candidiasis in Iranian women. Inclusion and exclusion criteria were defined to select eligible studies. Data were extracted and presented according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results of the meta-analysis were visualized as a forest plot representing the prevalence estimates of each study. Heterogeneity was also analyzed using the I2, and Chi2 statistics. The literature search revealed 1929 studies, of which 39 studies met the eligibility criteria, consisting of 10536 women with vulvovaginal symptoms from 24 different cities covering all parts of Iran. The city with the highest number of studies was Tehran (5/39). The overall prevalence of vulvovaginal candidiasis among Iranian women was 47% (95% CI, 0/38–0/55%) and Candida albicans was the most prevalent etiologic agent. The use of oral contraceptive pills (OCPs) was the predominant risk factor for developing vulvovaginal candidiasis and vaginal cheese-like discharges were the predominant clinical manifestation in Iranian women suffering from vulvovaginal candidiasis. The 25-34-year-old age group has the highest prevalence. A high level of I2 (I2 = 98.7%, P = 0.000) and Chi2 (Chi2 = 2993.57, P

Background: Learning is a phenomenon that has interested humans for a long time. Research on the factors influencing learning has always interested psychologists and all those dealing with education, particularly sports coaches. Objectives: This study aimed to investigate the impact of goal setting on learning a skill targeting 10-year-old boys. Patients and Methods: For this purpose, forty 10-year-old male children were selected as the study sample and were assigned to one of two groups: goal-setting (n = 20) and non-goal setting (n = 20) groups. In the acquisition phase, each group participated in 8 sessions for 8 continuous days, and then participants in each group conducted 40 (4 blocks of 10 attempts per session) attempts separately. Finally, after 24 hours, the groups performed a retention test. The scores of each group at each phase were obtained and compared using ANOVAs and independent t-tests. Results: The results of the statistical analysis did not show differences in the acquisition phase between the two groups (P > 0.05). In the retention phase, there was a significant difference between the two groups, and this advantage was in favor of the goal-setting group (P < 0.05). Conclusions: In general, it is recommended that teachers and sports coaches use goal setting when teaching skills to children.