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SARS-CoV-2 genome surveillance projects provide a good measure of transmission and monitor the circulating SARS-CoV-2 variants at regional and global scales. Iran is one of the most affected countries still involved with the virus circulating in at least five significant disease waves, as of September 2021. Complete genome sequencing of 50 viral isolates in an early phase of outbreak in Iran, shed light on the origins and circulating lineages at that time. As part of a genomic surveillance program, we provided an additional 319 complete genomes from October 2020 onwards. The current study is the report of complete SARS-CoV-2 genome sequences of Iran in the March 2020-May 2021 time interval. We aimed to characterize the genetic diversity of SARS-CoV-2 in Iran over one year. Overall, 35 different lineages and 8 clades were detected. Temporal dynamics of the prominent SARS-CoV-2 clades/lineages circulating in Iran is comparable to the global perspective and introduces the 19A clade (B.4) dominating the first disease wave, followed by 20A (B.1.36), 20B (B.1.1.413), 20I (B.1.1.7) clades, dominating second, third and fourth disease waves, respectively. We observed a mixture of circulating 20A (B.1.36), 20B (B.1.1.413), 20I (B.1.1.7) clades in winter 2021, paralleled in a diminishing manner for 20A/20B and a growing rise for 20I, eventually prompting the 4th outbreak peak. Furthermore, our study provides evidence on the entry of the Delta variant in April 2021, leading to the 5th disease wave in summer 2021. Three lineages are highlighted as hallmarks of SARS-CoV-2 outbreak in Iran; B4, dominating early periods of the epidemic, B.1.1.413 (specific B.1.1 lineage carrying a combination of [D138Y-S477N-D614G] spike mutations) in October 2020-February 2021, and the co-occurrence of [I100T-L699I] spike mutations in half of B.1.1.7 sequences mediating the fourth peak. Continuous monthly monitoring of SARS-CoV-2 genome mutations led to the detection of 1577 distinct nucleotide mutations, in which the top recurrent mutations were D614G, P323L, R203K/G204R, 3037C>T, and 241C>T; the renowned combination of mutations in G and GH clades. The most frequent spike mutation is D614G followed by 13 other frequent mutations based on the prominent circulating lineages; B.1.1.7 (H69_V70del, Y144del, N501Y, A570D, P681H, T716I, S982A, D1118H, I100T, and L699I), B.1.1.413 (D138Y, S477N) and B.1.36 (I210del). In brief, mutation surveillance in this study provided a real-time comprehensive picture of the SARS-CoV-2 mutation profile in Iran, which is beneficial for evaluating the magnitude of the epidemic and assessment of vaccine and therapeutic efficiency in this population.

Background: Sepsis is a significant cause of mortality worldwide. This study aimed to compare clinical and laboratory characteristics of sepsis in patients addicted to illicit drugs versus patients with no illicit drug addiction. Methods: In this cross-sectional study, all patients hospitalized with sepsis diagnosis were recruited within six months from September to March 2019. Sixty patients for each group (illicit drug-addicted and non-addicted individuals) were selected. The data relating to illicit drug consumption, serum indices, the current focus of infection, duration of hospitalization, and disease outcomes were collected. Patients who had an illicit drug addiction were compared with non-addicted patients in terms of clinical and laboratory parameters. The data collected were analyzed using SPSS software (version 19). Results: The bacterial load in the urine culture was statistically significant in both groups and higher in the non-addicted group. The frequency distributions of focus of infection, duration of hospitalization, and outcome were not significantly different between the two groups. The serum sodium and total neutrophils were significantly higher in the addicted group. However, the MCHC level was significantly lower (p Conclusion: Opium may have stimulated the immune system and reduced bacterial infection in septic patient users.

Background: The combination of sofosbuvir (SOF) and daclatasvir (DCV) has shown preliminary efficacy for patients with COVID-19 in five open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir and daclatasvir to standard care improved clinical endpoints in hospitalized patients with moderate or severe COVID-19. Methods: This was a placebo-controlled, randomized clinical trial in adults with moderate or severe COVID-19 admitted to 19 hospitals in Iran. Patients were randomized to SOF/DCV 400/60mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O 2 saturation

Introduction Imbalances of various electrolytes, including calcium, are associated with the prognosis of Covid disease. This study investigated the relationship between serum calcium and clinical outcomes in patients with COVID‐19. Method This study is a systematic review and meta‐analysis by searching PubMed, Scopus, web of sciences until August 2021 using the keywords COVID‐19, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), COVID, coronavirus disease, SARS‐COV‐infection. 2, SARS‐COV‐2, COVID19, calcium, calcium isotopes, calcium radioisotopes, hypercalcemia, and hypocalcemia were performed. Heterogeneity of studies was investigated using I 2 index, data were analyzed using meta‐analysis (random effects model) with Comprehensive Meta‐Analysis Software software. Results Finally, 25 articles were included in the study. Clinical data from 12 articles showed that 59% (95% confidence interval [CI]: 0.49–0.68) of people with COVID‐19 have hypocalcemia. The results of meta‐analysis showed that hypocalcemia was significantly associated with severity of the disease (p = .002), mortality in patients with COVID‐19 (odds ratio [OR] = 6.99, 95% CI: 2.71–17.99), number of hospitalization days (p < .001) and admission to the intensive care unit (OR = 5.09, 95% CI: 2.14–12.10). The results also showed that there is a direct relationship between low serum calcium levels with increasing D‐dimer levels (p = .02) and decreasing lymphocyte counts (p = .007). Conclusion Based on the results of meta‐analysis in people with lower calcium, mortality and complications are higher, therefore, serum calcium is a prognostic factor in determining the severity of the disease. Consequently, it is suggested that serum calcium levels should be considered in initial assessments.

Introduction: Chronic hepatitis B (CHB) is caused by hepatitis B virus infection. It has been shown that vitamin D3 has very important biological effects in the immune system and host response to viral infection. This study aimed to identify potential risk factors of vitamin D deficiency among CHB patients in Birjand, Iran. Materials and Methods: In this case-control study, there were 292 patients with CHB and 304 healthy subjects as a control group in the outpatient clinic of the Infectious Diseases Department from January, 2017 to December, 2018. Of all the subjects, 62.7% of the control and 48.1% of the case groups were male. We quantified the levels of total vitamin D3 in their serum samples. We employed t- and chi-square tests along with logistic regression to determine the association between the variables of interest and vitamin D3 deficiency related to CHB (p0.05). The prevalence of vitamin D3 inadequacy was high in both HBV patients (63%) and in the healthy group (52.9%). The frequency distribution for the vitamin D3 serum level was significantly different in the two groups (p=0.001). Conclusions: According to the results, a high risk of vitamin D3 deficiency related to CHB was not found among CHB patients in Birjand, in contrast to previous literature. Possible reasons for these findings were discussed, although future comprehensive studies are needed to clarify underlying mechanisms and real association.

Introduction: The survival cox analysis is becoming more popular in time-to-event data analysis. When there are unobserved /unmeasured individual factors, then the results of this model may not be dependable. Hence, this study aimed to determine the factors associated with Covid-19 patients’ survival time with considering frailty factor. Methods: This study was conducted at 1 of the hospitals in Iran, so that hospitalized patients with COVID-19 were included. Epidemiological, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. Gamma-frailty Cox model was used to identify the effects of the risk factors. Results: A total of 360 patients with COVID-19 enrolled in the study. The median age was 74 years (IQR 61 – 83), 903 (57·7%) were men, and 661 (42·3%) were women; the mortality rate was 17%. The Cox frailty model showed that there is at least a latent factor in the model (P = 0.005). Age and platelet count were negatively associated with the length of stay, while red blood cell count was positively associated with the length of stay of patients. Conclusion: The Cox frailty model indicates that in addition to age, the frailty factor is a useful predictor of survival in Covid-19 patients.

The SARS‐CoV‐2 virus has been rapidly spreading globally since December 2019, triggering a pandemic, soon after its emergence. While Iran was among the first countries confronted with rapid spread of virus in February 2020, no real‐time SARS‐CoV‐2 whole‐genome tracking in early phase of outbreak was performed in the country. To address this issue, we provided 50 whole‐genome sequences of viral isolates ascertained from different geographical locations in Iran during March–July 2020. The corresponding analysis on origins, transmission dynamics and genetic diversity of SARS‐CoV‐2 virus, represented at least two introductions of the virus into the country, constructing two major clusters defined as B.4 and B.1*. The first entry of the virus might have occurred around very late 2019/early 2020, as suggested by the time to the most recent common ancestor, followed by a rapid community transmission that led to dominancy of B.4 lineage in early epidemic till the end of June. Gradually, reduction in dominancy of B.4 occurred possibly as a result of other entries of the virus, followed by surge of B.1* lineages, as of mid‐May. Remarkably, variation tracking of the virus indicated the increase in frequency of D614G mutation, along with B.1* lineages, which showed continuity till October 2020. The increase in frequency of D614G mutation and B.1* lineages from mid‐May onwards predicts a rapid viral transmission that may push the country into a critical health situation followed by a considerable change in composition of viral lineages circulating in the country.

Background: Blood-borne viruses (BBVs) are one of the most important public health concerns. South Khorasan has a long border with Afghanistan and concern has risen there about blood-borne oncogenic viral infections. The aim of the present study was to evaluate the prevalence and associated risk factors of human T-lymphotropic virus 1 (HTLV-1) and co-infections of BBVs in Birjand, Iran’s eastern border. Methods: In this cross-sectional study, 3441 subjects were tested for sero-prevalence of HTLV-1 by ELISA. The data on demographic features, HTLV-1-related risk factors and other characteristics of the population were analyzed by Pearson chi-square and logistic regression tests. Finally, the co-infection of BBVs was evaluated in the study. Results: The prevalence of HTLV-1 was 0.3% (95% CI: 0.12–0.48). Notably, the sero-prevalence of HIV, hepatitis B virus (HBV), hepatitis D virus (HDV), and hepatitis C virus (HCV) in our previous studies was reported at 0%, 0.2%, 1.2% and 1.6%, respectively. The results indicated that the occurrence of HTLV-1 infection was associated only with the history of hospitalization (odds ratio [OR]: 0.27, 95% CI: 0.07–0.97, with P = 0.04). The co-infection of HBV with HCV was the most common (2.35%), while a co-infection rate of 1.17% was found for both HBV/HTLV-1 and HBV/HDV. Conclusion: Although a higher prevalence of the viruses was expected, it was close to the overall Iranian population. With respect to close relationship with an HTLV-1 endemic area (Mashhad and Neyshabour), the prevalence is very low; however, more attention is needed. Our findings reinforce the importance of increasing knowledge about BBV-related health risk behaviors to prevent the emergence of new cases, especially in low-risk populations.

Background and purposeFatty liver is one of the most common pre-existing illnesses; it can cause liver injury, leading to further complications in coronavirus disease 2019 patients. Our goal is to determine if pre-existing fatty liver is more prevalent in hospitalized COVID-19 patients compared to patients admitted before the SARS-CoV-2 pandemic and determine the disease severity among fatty liver patients.Experimental approachThis retrospective study involves a case and a control group consisting of 1162 patients; the case group contains hospitalized COVID-19 patients with positive PCR tests and available chest CT-scan; the control group contains patients with available chest CT-scan previous to the COVID-19 pandemic. Patients’ data such as liver Hounsfield unit, hospitalization length, number of affected lobes, and total lungs involvement score were extracted and compared between the patients.ResultsThe findings indicate that 37.9% of hospitalized COVID-19 patients have a pre-existing fatty liver, which is significantly higher (P P = 0.02), a higher total lungs involvement score (8.73 ± 5.28P P ConclusionThe statistical analysis shows fatty liver is significantly more prevalent among COVID-19 against non-COVID-19 patients, and they develop more severe disease and tend to be hospitalized for more extended periods.

Background: Hepatitis B Virus (HBV) is a universal health challenge all around the world. Several factors like viral load, genetic characteristics, age, sex, and immune status contribute to variable clinical outcomes of HBV infection. The sequels of HBV infection vary remarkably among persons ranging from the spontaneous deletion of infection to persistent infection. Objective: The present study aimed to evaluate the association of single nucleotide polymorphisms IL10-1082 with HBV clearance. Methods: Sixty subjects with Chronic Hepatitis B (CHB) infection and 60 subjects who spontaneously recovered HBV were enrolled in the study. The IL-10-1082 polymorphisms were determined by Polymerase Chain Reaction with Restriction Fragment Length Polymorphism (PCR–RFLP). Results: The clearance of HBV infection demonstrated a significant association with IL-10-1082 polymorphisms in the GG genotype (P = 0.03), while there was no association with other genotypes. Reduced risk of chronic hepatitis B infection was associated with IL-10-1082 GG (OR: 2.33, 95% CI: 1.07 - 5.09). Besides, IL-10-1082 A/G alleles did not differ clearly between the two study groups (P = 0.07) Conclusions: The IL-10-1082 polymorphisms may be associated with a reduced risk of CHB infection and recovery after HBV infection.

Background Nonalcoholic fatty-liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although NAFLD has been studied extensively, potential risk factors for NAFLD among chronic hepatitis B (CHB) patients and their comparison with healthy individuals have remained understudied in Iran. As such, we examined the association between HBV infection and the development of NAFLD in two groups. Methods A case-control study was done on 376 CHB patients and 447 healthy subjects randomly selected from Birjand, South Khorasan province, Iran. We used logistic regression to estimate adjusted ORs with 95% CIs for incidence of NAFLD. Potential risk factors for NAFLD were evaluated while adjusting for age, sex, marital status, and educational level. Also, χ2 was used to compare demographic characteristics between the two groups. Results A total of 373 CHB patients (mean age 40.1±12.9 years) versus 447 individuals in the control group (mean age 39.8±13.9 years) were included in this study (p=0.337). Liver characteristics were found to be significantly different in CHB and healthy groups (p

Background: Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines. Setting: The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013. Methods: This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen. Results: The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4) and 28 (10.6) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21 and 62 of all patients exhibited complete and partial recovery, respectively. We found that 90 of the cases showed compliance with the HICPAC recommendations. Conclusion: Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug. © 2019 Mahi-Birjand et al.

Ghodsiyeh Azarkar,1 Motahare Mahi Birjand,2 Alireza Ehsanbakhsh,3 Bita Bijari,1 Mohammad Reza Abedini,4 Masood Ziaee1 1Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran; 2Student Research Committee, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 3Department of Radiology, Valiasr Hospital, Birjand University of Medical Sciences, Birjand, Iran; 4Cellular and Molecular Research Center, Department of Pharmacology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran Background: Ceftriaxone (CTX) is widely used for the treatment of bacterial infections; however, side effects such as gallstone and nephrolithiasis have been reported in children. There is limited information about urinary tract calculi as CTX side effects in adults. Therefore, the present study was aimed to evaluate the incidence of gallstone and nephrolithiasis following CTX administration.Methods: The present study was conducted in the Vali-e-Asr Hospital. Eighty-four patients with various infectious diseases with different daily treatment (mean ± SD: 4.19±2.54) were included in this study, consisting of 49 females and 35 males. The mean of total doses used in patients was 10.2143 (SD: 5.8585). To detect possible gallstone, gallbladder sludge, and urolithiasis, patients were evaluated by serial ultrasound before and after CTX treatment. Patients with renal and hepatobiliary dysfunction were excluded from the study and did not receive any nephrotoxic drugs during this study. Demographic parameters including age, sex, body mass index, dosage of CTX, as well as the duration of treatment and hospitalization were determined. Statistical significances were determined using Fisher’s exact test and independent t-test.Results: Results from our study showed that the incidence of gallstone and nephrolithiasis were 8.8% and 1.5% following CTX administration, respectively. Surprisingly, we found a significant correlation in terms of age between patients with and without gallstone (P=0.03).Conclusion: Our findings suggest that the patients’ age might play a role in the development of such a complication. This indicates the need for a close monitoring of CTX-treated patients to assess the possible formation of gallstone and nephrolithiasis. Keywords: ceftriaxone, gallstones, nephrolithiasis, sonography&nbsp

Background: Diabetes and hepatitis are among the most common diseases in the world. Hepatitis C virus leads to extra-liver manifestations, including endocrine disease and diabetes. The prevalence of hepatitis C and B in diabetic patients and the prevalence of diabetes in hepatitis C and B patients are higher than those in normal populations, and if each is added to the other, the complications will be more and the consequences will be worse. Objectives: This study aimed to compare the frequency distribution of diabetes and serum lipid levels in hepatitis B and C patients and other people. Methods: In this retrospective case-control study, 80 patients with hepatitis B and C and 160 patients without hepatitis were included. In both groups, those with two glucose levels above 126 mg/dL were considered as diabetic subjects. Also, the tests for factors such as cholesterol, TG, LDL, HbA1c, HDL, and liver ultrasonography were performed for patients. Data were collected and entered into SPSS 23 software and analyzed using descriptive statistical tests (t test and chi-square or Fisher's exact test) at a significance level of α = 0.05. Results: A total of 240 patients [80 cases (hepatitis B or C positive) and 160 controls] were enrolled. Of them, 46.3% were females and most of them were in the age range of 45-55 years. Besides, 14 (5.8%) subjects had high fasting blood glucose levels of more than 126 mg/dl twice, and were considered to have diabetes. Among them, four (5.0%) cases (all having hepatitis B) and 10 (6.3%) controls were diabetics. Statistical analysis showed no significant difference in the mean serum lipids of cholesterol and LDL between the case and control groups (P < 0.1) but there was a significant association between HDL and TG in both groups (P = 0.02). Conclusions: All patients with hepatitis B and C should be screened for diabetes, and in addition to fasting blood glucose, we suggest that HbA1c be measured to confirm or rule out diabetes.

Background: Many viruses increase their replication by affecting DNA damage response (DDR) signaling and activating and inhibiting DNA damage response factors. to date, few studies have investigated Homologous Recombination (HR) system in the field of hepatitis B patients. The current study set out to investigate HR system by examining the expression of RAD51, BRCA1, and HBx genes in peripheral blood mononuclear cells (PBMCs) of hepatitis B patients. Two groups of subjects were enrolled including healthy controls (n=61) and hepatitis B patients (n=60). The serum levels of HBV DNA, Rad5 1and BRCA1, in the PBMCs were measured using real-time quantitative polymerase chain reaction (PCR.) Moreover, serum levels of liver enzymes (ALT and AST) levels were assessed by automatic biochemical analyzer technique. Results: In HBV-infected patients, the gene expression of Rad51 and BRCA 1 were significantly upregulated compared to healthy controls (P< 0.05). However, There is a statistically significant correlation between Rad51(r= 0.838; P value < 0.001) and BRCA1(r= 0.588; P value < 0.05), genes expression and viral load. Conclusions: These results demonstrated that hepatitis B virus affected the homologous recombination system by increasing the expression of Rad51 and BRCA1 genes, suggesting these genes could be considered as valuable therapeutic targets for treating hepatitis B patients.

Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC). The exact molecular contributors to the development of HBV-related HCC are not yet completely understood. Recent studies demonstrated that the deregulation of the Wnt pathway is highly associated with the development of HCC. Besides, HBV is known to have roles in the deregulation of this pathway. The present study evaluated the molecular aspects of the Wnt pathway in HBV-related HCC in liver tissue samples. Viral characterization was done by identifying the HBx mutations and the assessment of intrahepatic viral load. The expression of Wnt pathway genes was assessed using real-time PCR and methylation-specific PCR. The intrahepatic viral load was significantly higher in tumor samples than in normal tissues (P = 0.0008). Aberrant expression was observed in Wnt-1, Wnt-7a, FZD2, FZD7, β-catenin, URG7, c-Myc, SFRP5, and GSK3β, among which Wnt1, FZD2, SFRP5, Gsk3β, and URG7 were associated with HBV. HBx mutations at positions I88, L116, and I127 + F132 were associated with the decreased expression of GSK3β and overexpression of URG7 and Wnt1. Alterations in the expression level of β-catenin, as well as some mutants of HBx, were correlated with the level of c-Myc. HBV-related HCC seems to be mostly coordinated with epigenetic behaviors of HBx, such a multi-functional peptide with suppressing/trans-activating functions.

Toxoplasma gondii, the etiological agent of toxoplasmosis, can cause serious public health problems. Although Toxoplasma gondii tends more to neurotropic and ocular organs, some existing evidence suggest that this disease might induce serious pathological effects on liver. Hence, this study aimed to evaluate the relationship between chronic liver diseases and toxoplasmosis. Meanwhile, it attempted to assess whether patients with toxoplasmosis are susceptible to chronic liver diseases. To achieve this aim, the published studies related to the subject were systematically searched in five major electronic databases between the January 1, 1950 and October 1, 2019. The meta-analysis was carried out using the StatsDirect statistical software and a p-value less than 0.05 was considered significant for any test. Out of 691 identified studies, 10 studies met our inclusion criteria and entered this systematic review. The pooled prevalence rates of Toxoplasma gondii in patients with liver diseases (35.97%; 95% CI: 28.38–43.93) were higher than those in the control group (18.24%; 95% CI: 13.85–23.09). The meta-analysis indicated that the common Odd Ratio by a random effect model was 2.7 (95% CI: 2.30–3.24), revealing a significant association between chronic liver diseases and anti-Toxoplasma IgG antibody. The results of this systematic review confirmed the positive connection between toxoplasmosis and chronic liver diseases. Nonetheless, more studies are needed to clarify the detailed association between these diseases.

Background: Hemophilia is a rare inherited sex-linked disease caused by the deficiency or lack of some blood coagulation factors. The severity varies depending on the levels of these factors in the blood. Objectives: Therefore, this study aimed at determining the prevalence of metabolic syndrome and risk factors of cardiovascular disease in patients with hemophilia compared to a control group in 2015. Methods: A case-control study was done on all hemophilia patients referring to the Birjand University of Medical Sciences (n = 91). Healthy subjects with no hemophilia were selected using systematic random sampling from healthy individuals in Birjand City, who were matched in terms of age and sex. The data were entered into SPSS19 software. The significance level of less than 0.05 was considered in this study. Results: The mean age was 34.11 ± 14.68 and 33.72 ± 13.46 years in the case and control groups, respectively. The rate of metabolic syndrome was 12.1% in the control group and 4.4% in the hemophilia group. The results of Mann-Whitney U test showed a significant difference between the two groups in terms of TG (P = 0.016) and LDL (P < 0.001), and the waist circumference was significantly higher (P = 0.001) in the control group than in the hemophilia group. Conclusions: In the present study, the prevalence of metabolic syndrome was significantly lower among hemophilia patients than in the control group. The prevalence of diabetes and hypertriglyceridemia was significantly lower in hemophilia patients than in the control group (healthy subjects).

Iran is the country in Western Asia most impacted by the COVID-19 outbreak. A survey was conducted among the general public in Iran aimed at investigating psychobehavioural issues related to the COVID-19 outbreak, namely (a) barriers to preventive measures against SARS-CoV-2 infection; (b) negative emotions towards SARS-CoV-2 infection; and (c) anxiety levels among the general public in Iran. A cross-sectional, web-based survey using an online questionnaire was carried out between 16 March and 1 April 2020. The six-item version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety levels. A total of 1,789 complete responses were received. Nearly 60% reported having difficulty in wearing a face mask to protect against SARS-CoV-2 infection. The mean and standard deviation (SD) for the total prevention barrier score was 35.8 (SD ± 7.1; range 18-68) out of a possible score of 72. Male respondents [odds ratio (OR) = 1.25; 95% confidence interval (CI) 1.03-1.51] and respondents who perceived their health status as poor/fair (OR = 1.49; 95% CI 1.31-1.82) were predictors of high prevention barriers. Negative emotions such as fear (74.6%) followed by depression (43.4%) and stigma (23.0%) associated with SARS-CoV-2 infection were reported. Respondents who perceived their health as poor/fair (OR = 2.19; 95% CI 1.57-3.04) reported a higher likelihood of having higher negative emotions. Findings on anxiety level revealed 68.0% (95% CI 65.8-70.1) reported moderate to severe anxiety. Respondents who perceived their health as poor/fair (OR = 3.46; 95% CI 12.22-5.40) and who were females (OR = 1.91; 95% CI 1.55-2.36) were predictors of moderate to severe anxiety. In conclusion, psychobehavioural interventions are needed to facilitate management and control of the COVID-19 outbreak.

Background: Gum bleeding in the absence of trauma or injury in adults with haemophilia is often reported. So hemophilic patients require special care and attention in various dentistry practices. The purpose of this study was to evaluate the gingival health status in patients with hemophilia in Birjand in 2018-2019. Methods: Sampling was used in this case-control study to recruit cases (89 patients with hemophilia) and 89 individuals as control group recruited randomly from the general population, which were matched with cases based on gender, age and place of residence. Clinical examinations included dental health and salivary assessments. After taking informed consent from cases who had the inclusion criteria for the study, information including demographic characterizes, family history, viral infections, coagulation history, and the time of onset treatment was recorded. Oral examination was done by catheter and dental mirror. MGI (Modified gingival index) and Periodontal Index (PI) were determined for each subject. Results: In this study, 84.3% of the hemophilia patients were males and 76.4% of them had a family history of hemophilia. The results show that difference between the mean of MGI and PI in hemophilic patients and healthy subjects is not statistically significant (P>0.05) while, it is higher in hemophilic patients than healthy subjects, but this difference is not statistically significant (P>0.05). Also, with increasing age, MGI and PI showed a significant increase (P

Background: Patients with chronic kidney failure and those undergoing chronic hemodialysis (CHD) treatment are at high risk of infection with hepatitis C virus (HCV). The incidence of occult HCV infection (OCI) in CHD remains controversial and the real burden of HCV in this population may be affected by the rate of OCI. This study evaluates the molecular assessment of OCI in CHD in an Iranian population. Methods: All subjects on CHD in the South Khorasan province of Iran were invited for participation in the study. Whole blood samples were taken and serological, clinical, and demographic information was recorded. HCV-RNAs were checked in serum and peripheral blood mononuclear cells (PBMCs) using an in-house semi-nested PCR assay. Viral load was determined using a real-time PCR-based quantification kit. Sequencing was performed to determine genotypes. Results: Overall, 120 cases participated in the study; 57.5% were male and the rest were female. In serum samples, no positive case was found for HCV-RNA. In PBMC samples, 2/120 (1.6%) were positive for HCV-RNA (95% CI, 0.002 to 0.059); the mean age of OCI positive cases was 37.5 ± 19.2 years which was significantly lower than OCI negative cases (P = 0.026). Only one case had detectable viral load which was 49 IU/mL. The only HCV genotype identified was 1a. Conclusion: This study showed that there is a risk of OCI among CHD patients; the very low and undetectable viral loads of OCI warrant further follow-up molecular testing for earlier diagnosis and treatment in the era of DAA.

Previous local and national Iranian publications indicate that all Iranian hepatitis B virus (HBV) strains belong to HBV genotype D. The aim of this study was to analyze the evolutionary history of HBV infection in Iran for the first time, based on an intensive phylodynamic study. The evolutionary parameters, time to most recent common ancestor (tMRCA), and the population dynamics of infections were investigated using the Bayesian Monte Carlo Markov chain (BMCMC). The effective sample size (ESS) and sampling convergence were then monitored. After sampling from the posterior distribution of the nucleotide substitution rate and other evolutionary parameters, the point estimations (median) of these parameters were obtained. All Iranian HBV isolates were of genotype D, sub-type ayw2. The origin of HBV is regarded as having evolved first on the eastern border, before moving westward, where Isfahan province then hosted the virus. Afterwards, the virus moved to the south and west of the country. The tMRCA of HBV in Iran was estimated to be around 1894, with a 95% credible interval between the years 1701 and 1957. The effective number of infections increased exponentially from around 1925 to 1960. Conversely, from around 1992 onwards, the effective number of HBV infections has decreased at a very high rate. Phylodynamic inference clearly demonstrates a unique homogenous pattern of HBV genotype D compatible with a steady configuration of the decreased effective number of infections in the population in recent years, possibly due to the implementation of blood donation screening and vaccination programs. Adequate molecular epidemiology databases for HBV are crucial for infection prevention and treatment programs.

Background and Objectives: Regarding the high prevalence of the risk factors for human T-cell leukemia Virus (HTLV) in prison, including the high intravenous drug use and the higher chance of unprotected sexual behaviors, homosexuality, tattoos, and the probability of association between this disease and other sexually transmitted infections such as HTLV, this study compares the prevalence of HTLV-1 and its risk factors in intravenous and non-intravenous drug user prisoners in Birjand. Methods: This descriptive-analytical study was conducted in Birjand Prison during 2014-2015. The research community included all the prisoners of Birjand. Census method was used across intravenous drug users and simple random sampling for non-intravenous drug users’ group where sample size was considered to be 300 individuals (69 individuals in the case group and 231 individuals in the control group). Collected data were analyzed by descriptive statistics, Chi-square and Fisher's exact tests in SPSS software v.21 at siginificance level of 5%. Results: According to the results of the study, there was no case of HTLV-1 in either of the two groups. However, prevalence of smoking and history of common injection, non-sterile injections, suspected sexual contact, alcohol consumption, and tattoo in intravenous drug users were significantly higher than in non-intravenous drug users (P < 0.05). Conclusions: The results of this study suggested that although the prevalence of this disease was zero in the studied community, the prevalence of its risk factors was significant. This requires planning to reduce the risk factors associated with this disease in the target community.

Background Nonalcoholic fatty-liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. Although NAFLD has been studied extensively, potential risk factors for NAFLD among chronic hepatitis B (CHB) patients and their comparison with healthy individuals have remained understudied in Iran. As such, we examined the association between HBV infection and the development of NAFLD in two groups. Methods A case–control study was done on 376 CHB patients and 447 healthy subjects randomly selected from Birjand, South Khorasan province, Iran. We used logistic regression to estimate adjusted ORs with 95% CIs for incidence of NAFLD. Potential risk factors for NAFLD were evaluated while adjusting for age, sex, marital status, and educational level. Also, χ2 was used to compare demographic characteristics between the two groups. Results A total of 373 CHB patients (mean age 40.1±12.9 years) versus 447 individuals in the control group (mean age 39.8±13.9 years) were included in this study (p=0.337). Liver characteristics were found to be significantly different in CHB and healthy groups (p

To estimate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and the associated risk factors among drug-abusing prisoners in Birjand correctional facility.This is a cross-sectional study on 300 drug-abusing prisoners in 2016. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants were determined by HBsAg, HBcAb, and HCVAb blood tests using third-generation enzyme immune assays (ELISA). The chi-square test was used to investigate the associations between risk factors and status of HBV infection and HCV exposure. All data were analyzed with SPSS software and P0.05 was considered as significant difference.The mean age of participants was 37.4 ± 9.4 years with a range of 20-78 years. The prevalence rates of HBV exposure (total HBcAb) and infection (HBsAg) were 20.7 and 3.3% respectively, and the prevalence of HCV exposure (HCV Ab) was 8%. No co-infection was observed. Seroprevalence results for injecting drug users (IDUs) was 13 (18.8%) for total HBcAb, 1 (1.4%) for HBsAg, and 13 (18.8%) for HCVAb. There was no significant difference between the IDUs and non-IDUs in terms of HBsAg and total HBcAb positive rate, but the prevalence of HCV was significantly higher in the IDUs (P0.001). In logistic regression analysis, the main risk factors for HCV exposure in the entire samples was injecting drug use and having tattoos (OR = 4.08, 95% CI: 1.64-10.17, P = 0.003).We found a high rate of HBV and HCV infection in drug-using prison inmates compared to the general population of this area. The main risk factors associated with HCV infection in the prison populations with history of drug abuse were injecting drug use and having tattoo.

BACKGROUND The combination of sofosbuvir and daclatasvir is a potent, pangenotypic regimen suitable for mass-scale hepatitis C treatment, especially in resource-limited countries where newer, expensive combinations are not available. This combination has been widely tested on genotype 4. However, Phase III trials of this combination in other genotypes have been cost prohibitive. With the introduction of generic, low-cost sofosbuvir and daclatasvir, large-scale studies in resource-limited countries are now possible. METHODS Sofosbuvir at 400 mg and daclatasvir at 60 mg were coformulated into a fixed-dose combination (FDC) tablet (Sovodak, Rojan Pharma, Tehran, Iran). Patients from 46 centers were dosed for 12 or 24 weeks with or without ribavirin, in line with existing guidelines. Responses to treatment were evaluated 12 weeks after the end of treatment (for a sustained virological response at Week 12; SVR12). RESULTS There were 1361 patients recruited. Overall, the patients were 21% female, with a mean age of 50 years; 39% were cirrhotic; 22% were treatment-experienced; 47% were genotype 1, 41% were genotype 3, and 2% were other genotypes. The genotype was not known in 10% of the patients. The intention-to-treat and per-protocol SVR12 rates were 94.7% and 98.8%, respectively. The safety profile was unremarkable, treatment was well tolerated, and compliance with the single-tablet regimen was excellent. CONCLUSIONS The treatment with FDC of sofosbuvir and daclatasvir achieved high SVR12 rates, equivalent to those seen in Phase III trials of other pangenotypic options, and has been conducted at a similar scale in a representative, real-world population at a cost of under $100 per patient, which makes this combination suitable for elimination protocols in resource-limited countries. CLINICAL TRIALS REGISTRATION NCT03200184.

Background: The present study aimed to determine the prevalence of bone density reduction and its associated factors in hemophilia patients in South Khorasan Province in 2018. Materials and Methods: This case-control study was conducted on all patients with hemophilia type A with medical records in Hemophilia center in South Khorasan province. A number of 57 eligible subjects who met the criteria were selected based on census method. Thereafter, 60 non-hemophilic individuals who were similar to hemophilic patients in terms of age and body mass index were selected by convenience sampling method. DXA device was used to measure bone mineral density (BMD) in two locations of femoral neck and lumbar vertebrae. Data were analyzed in SPSS software (version 19), using Chi-square, Fisher’s exact test, and independent t-test. A P-value less than 0.05 was considered statistically significant. Results: The prevalence rate of bone density reduction in spine bone in hemophilia patients was measured at 31.6% and 13.3% in non-hemophilia subjects (P=0.02); moreover, this rate in hip bone was reported as 7% and 5%, respectively (P=0.65). Relative frequency of bone density reduction in the spine and hip bone was not significantly different among hemophilia patients based on age, severity of hemophilia, vitamin D, hepatitis and smoking (P>0.05). However, a significant difference was detected in terms of body mass index (P

Background The occult hepatitis B virus infection (OBI) is a health concern among high-risk groups and immunosuppressed individuals. There is still a paucity of data regarding the occult hepatitis B virus infection among hemophilic patients. With this in mind, we aimed to evaluate the molecular prevalence of OBI among clients with hemophilia. Methods Totally, 87 hemophilic patients were selected to be studied. To detect OBI, nested polymerase chain reaction test was used to amplify HBV-S, X, and Core regions. Viral load was determined using an in-house real-time PCR assay. Finally, sequence of S gene was used for genotyping and analysis of mutations. Results The mean age of patients was 28.4 ± 5.3 years old, with 90.7% of whom were men. HBV-DNA was detected in eight subjects (9.3%). The rate of OBI was much higher in anti-HBs seronegative subjects than that in other patients (P = 0.019). All OBI cases had HBV genotype D, subgenotype D1. In addition, five out of eight cases (62.5%) showed detectable viral loads (a mean viral load of 4.5 × 10 2 copies/mL). sR73H, sI110L, sP120A, sP127T, sQ129H, sG130R, and sC137S were shown to be the most determinant escape mutation and OBI-relevant mutants. Conclusion The rate of OBI among the studied population of hemophilia seems to be remarkable. Therefore, screening for OBI must be a routine practice in patients with hemophilia and also patients undergoing immunosuppressive treatments. Amino acid substitutions were observed in the major hydrophilic region. However further investigations are needed for analysis of exact function.

Most recently, silver nanoparticles due to antibacterial properties have been considered in medical science. So the aim of the study was green synthesis of silver nanoparticles using Berberis vulgaris leaf and root aqueous extract and its antibacterial activity. After collection, identification and extraction of Berberis vulgaris was performed production of silver nanoparticles. In the study effect of parameters such as AgNO3 concentration (0.5, 1, 3, 10 mM), aqueous extract (3, 5, 10, 15, 30 mL) and contact time (1, 2, 6, 12, 24 h) were investigated in the synthesis of nanoparticles and also the antibacterial effect of these nanoparticles was studied on Escherichia coli and Staphylococcus aureus bacteria by Disk diffusion test and Minimum Inhibitory Concentration test (MIC). According to XRD results and analysis of TEM, nanoparticles have spherical shapes and size of 30 to 70 nm. On the other hand antibacterial tests showed these nanoparticles have more antibacterial activity more than other extracts. Result showed the biosynthesis of silver nanoparticles using aqueous extract of Berberis vulgaris is a clean, inexpensive and safe method that has not been used any toxic substance and consequently does not side effects and this nanoparticles has a high antibacterial activity.

Background and Objectives: Hepatitis B is associated with different physical and psychological complications. This study sought to evaluate the effects of cognitive behavioral therapy on the quality of life among patients with hepatitis B. Methods: In this quasi-experimental study, 60 patients with hepatitis B were conveniently recruited from a private infectious disease clinic in Birjand, Iran. The patients were randomly allocated to either a control (n = 30) or an intervention (n = 30) group. Patients in the intervention group received cognitive behavioral therapy in eight 45-minute sessions while their counterparts received no cognitive behavioral therapy. All patients completed the 36-item Short Form Survey both before and after the intervention. The SPSS software (v. 15.0) was used to analyze the data by running the paired-sample t, independent-sample t, Wilcoxon signed-rank, and Mann-Whitney U test at a significance level of less than 0.05. Results: In the intervention group, the scores of the social functioning and general health domains of quality of life significantly decreased while the score of the emotional well-being domain significantly increased after the intervention (P 0.05). Moreover, in the control group, the scores of quality of life and its social functioning and general health domains significantly decreased (P 0.05). The groups did not significantly differ from each other respecting the pretest-posttest mean scores of the quality of life and its domains (P > 0.05). Conclusions: This study suggests that cognitive behavioral therapy has no significant effect on the quality of life but significantly improves emotional well-being among patients with hepatitis B.