Human papillomaviruses and bladder cancer risk: first report in south of Iran.

Information regarding the possible carcinogenicity of human papillomaviruses (HPVs) in bladder tissue might pave the way for the prevention of bladder cancer through improving HPV vaccination of the at-risk population. To address this, this study was conducted to detect HPVs in bladder cancer tissues in the South of Iran. Bladder biopsy samples of 181 patients with bladder cancer were included in this study. The detection of HPVs was performed by nested PCR assay, targeting the L1 region of the genome, and sequencing. HPV was detected in 0.55% of the bladder cancer samples, while the non-cancerous bladder samples were negative for HPV. HPV genotype 6 was detected in this study. The HPV-positive patient was a 55-year-old man with papillary urothelial neoplasms of low malignant in stage Ta-T1. This patient was resident of Dayer city. Overall, HPV prevalence among patients with bladder cancer was not statistically associated with place of residency, gender, age, stage, and grade of the tumor (P value > 0.05). The presence of HPV is extremely rare in bladder cancer biopsy specimens in the south of Iran. Therefore, the results of our study rule out the possible role of HPVs in the etiology of bladder cancer. Due to the increasing air pollution in this region and high-risk jobs, and habits such as cigarette smoking and hookah smoking, the role of these factors alongside genetic factors seems more prominent than the role of HPVs in causing bladder cancer in the south of Iran. Supplementary Information: The online version contains supplementary material available at 10.1007/s13337-023-00819-w.

Prevalence and Genotypes of Hepatitis C Infection Among Hemodialysis Patients in Bushehr, Iran.

Objectives: To investigate the prevalence, genotype distribution, and risk factors of hepatitis C virus (HCV) infection among patients undergoing regular hemodialysis in Bushehr province in southern Iran. Methods: All chronic hemodialysis patients from the cities of Dashtestan, Genaveh, and Bushehr participated in this study. Enzyme-linked immunosorbent assay was used to detect anti-HCV antibodies. Molecular detection of HCV infection was performed by semi-nested reverse transcription polymerase chain reaction assay, targeting 5' untranslated region and core region of the genome, and sequencing. Results: Of 279 hemodialysis patients, 15 (5.4%) were positive for anti-HCV antibodies, and two (0.7%) patients had HCV viremia with genotype 3a. The hemodialysis patients had a significantly higher seroprevalence of HCV than the control group (p =0.007). Patients with Arab ethnicity had significantly higher anti-HCV seroprevalence compared to those with Fars ethnicity (p =0.026). Anti-HCV seropositivity was not statistically associated with the patients' sex, age group, place of residence, level of education, duration of hemodialysis, or history of blood transfusion. Conclusions: Considering the high seroprevalence of HCV in hemodialysis patients, regular screening of these patients for HCV infection and prompt treatment of those found infected are recommended.

High Prevalence of Occult Hepatitis B Virus Infection among Iranian Hemodialysis Patients.

Considering the potential risks associated with occult hepatitis B virus (HBV) infection, this study was designed to investigate the magnitude and genotypic pattern of occult HBV infection among hemodialysis patients. All patients on regular hemodialysis attending the dialysis centers located in southern Iran and 277 nonhemodialysis controls were invited to participate in this study. Serum samples were tested for detection of hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg) by competitive enzyme immunoassay and sandwich ELISA, respectively. The molecular evaluation of HBV infection was conducted by two nested polymerase chain reaction (PCR) assays, targeting S, X, and precore regions of HBV genome, and sequencing by Sanger dideoxy sequencing technology. Moreover, HBV viremic samples were tested for hepatitis C virus (HCV) coinfection by HCV Ab ELISA and seminested reverse transcriptase PCR. Of 279 hemodialysis patients, five (1.8%) were positive for HBsAg, 66 (23.7%) were positive for HBcAb, and 32 (11.5%) had HBV viremia with HBV genotype D, sub-genotype D3 and subtype ayw2. Moreover, 90.6% of the hemodialysis patients with HBV viremia had occult HBV infection. Hemodialysis patients (11.5%) had significantly higher prevalence of HBV viremia than nonhemodialysis controls (1.08%; P = 0.0001). The prevalence of HBV viremia among hemodialysis patients was not statistically associated with duration of hemodialysis, age and gender distribution. In contrast, HBV viremia was significantly associated with place of residency and ethnicity, with residents of Dashtestan and Arab having had significantly higher prevalence of HBV viremia compared with the residents of other cities and Fars patients. Notably, 27.6% and 6.9% of hemodialysis patients infected with occult HBV infection were also positive for anti-HCV antibodies and HCV viremia, respectively. High prevalence of occult HBV infection was detected in hemodialysis patients, whereas 62% of patients with occult HBV infection were negative for HBcAb. Therefore, screening of all hemodialysis patients by sensitive molecular tests, regardless of the pattern of HBV serological markers, is recommended to increase the diagnosis rate of HBV infection.

Hepatitis B infection among ß-thalassemia major patients in Bushehr province of southern Iran.

This study was performed to determine the prevalence, genotype distribution and risk factors of hepatitis B virus (HBV) infection among ß-thalassemia patients. ELISA was used to detect HBsAg and HBcAb. Molecular evaluation of HBV infection was performed by nested PCR, targeting S, X and pre-C regions of the genome, and sequencing. Of 126 thalassemia patients, 4 cases (3.17%) were positive for HBsAg, 23 cases (18.25%) were positive for HBcAb, and 6 cases (4.76%) had HBV viremia with genotype D, sub-genotype D3 and subtype ayw2. HBV prevalence among thalassemia patients was not statistically associated with gender distribution, place of residency, marital status and frequency of blood transfusion. HBsAg seroprevalence was significantly higher in Afghan immigrants and patients with ALT levels of 41-80 IU/L. The prevalence of HBV viremia was significantly higher among thalassemia patients aged >20 years compared to the patients aged <20 years. Moreover, 1.59% of thalassemia patients had seropositive occult HBV infection, which was positive for HBV-DNA and HBcAb but negative for HBsAg. Considering the relatively high prevalence of occult HBV infection among thalassemia patients, there is a possibility of their contamination through donated blood. Therefore, screening of donated blood based on detection of HBsAg cannot abolish HBV transmission through blood transfusion.

Prevalence and Molecular Evaluation of Hepatitis C Virus Infection among Multi-transfused Thalassemia Patients in South of Iran.

Objectives: Information regarding the magnitude of hepatitis C virus (HCV) infection among thalassemia patients is of great importance for health care providers to assess blood safety and improve the quality of screening systems. Therefore, this study evaluated the prevalence, risk factors, and genotypic pattern of HCV infection among ß-thalassemia patients in South Iran. Methods: This descriptive-analytical cross-sectional study was conducted from March to June 2019. All patients with ß-thalassemia major from Borazjan, Bushehr, Delvar, Kangan, and Ahram cities participated in the study and attended the transfusion center of the Bushehr University of Medical Sciences located in southern Iran. Serum samples were tested for the presence of anti-HCV antibodies by an enzyme-linked immunosorbent assay. The seropositive serum samples were tested for detection of HCV viremia and genotypes by semi-nested reverse transcriptase-polymerase chain reaction and sequencing. Results: Of 125 thalassemia patients, 22 (17.6%) were positive for anti-HCV antibodies and two (1.6%) had HCV viremia with genotype 3a. HCV seroprevalence increased with age, so anti-HCV seropositive thalassemia patients had significantly higher mean age than anti-HCV seronegative patients. HCV seroprevalence was higher among female patients, residents of Kangan, patients with blood transfusion every two weeks, Fars patients, and thalassemia patients with alanine aminotransferase levels of < 20 IU/L and aspartate aminotransferase levels of > 80 IU/L. Nevertheless, anti-HCV seroprevalence among thalassemia patients was not statistically associated with these variables. Conclusions: These results indicate ongoing HCV incidence among the thalassemia population in this region. Transfusion of HCV-seronegative viremic blood units donated during the infectious window period contributes to HCV infection in thalassemia patients. These findings highlight the need to include sensitive molecular assays in the screening process of donated blood for HCV infection in Iran.

BK and JC polyomaviruses and risk of urothelial bladder carcinoma: a preliminary study in the northern shores of Persian Gulf, Iran.

BACKGROUND: Bladder cancer is a challenging public health concern in South of Iran because of its high prevalence and the related medical expenses. Although the exact etiology of bladder cancer remains unknown, given the cell transforming ability and oncogenic potential of the members of Polyomaviridae families, this study was conducted to evaluate the magnitude of BK polyomavirus (BKPyV) and John Cunningham polyomavirus (JCPyV) among patients with bladder cancer residents in the northern shores of the Persian Gulf, South of Iran. METHODS: Totally 211 patients with bladder cancer were enrolled in this study. Bladder biopsy samples of these patients and patients with interstitial cystitis as well as autoptic samples of healthy bladder were tested for detection of BKPyV and JCPyV by semi-nested PCR-RFLP followed by sequencing. RESULTS: BKPyV and JCPyV were detected in 1.7% and 6.1% of bladder cancer samples, respectively. These samples were infected with JCPyV genotypes 2, 3 and 6 and BKPyV genotypes I and IV. BKPyV and JCPyV coinfection was detected in 2 samples. Moreover, one of the healthy bladder samples was positive for BKPyV, and one of the interstitial cystitis samples was positive for JCPyV. Although the majority of infected patients were in the age group 70-79 years, male, residents in Tangestan, stage Ta-T1, and low-grade and high-grade papillary urothelial carcinoma, the prevalence of BKPyV and JCPyV among patients with bladder cancer was not statistically associated with age, gender, place of residency, and stage and grade of the tumor. CONCLUSION: Despite identifying BKPyV and JCPyV in a number of bladder cancer biopsy specimens and the high prevalence of bladder cancer among people resident in South of Iran, it is suggested that these viruses are unlikely to be effective causative factors in bladder carcinogenesis in this region. Therefore, environmental risk factors and genetic backgrounds may have a more prominent role than human polyomaviruses in the development of bladder cancer in South of Iran.

Molecular evaluation of hepatitis B virus infection and predominant mutations of pre-core, basal core promoter and S regions in an Iranian population with type 2 diabetes mellitus: a case-control study.

BACKGROUND: This study was designed to evaluate the prevalence, genotypic patterns, and predominant mutations of hepatitis B virus (HBV) infection among diabetic patients. METHODS: Serum samples were obtained from 733 patients with type 2 diabetes mellitus and 782 non-diabetic controls. The presence of HBsAg and HBcAb was determined by ELISA. Nested PCR, targeting S and pre-core regions of the HBV genome, followed by sequencing was carried out to determine HBV genotypes and predominant mutations in the S, basal core promoter (BCP), and pre-core regions of the HBV genome. RESULTS: Of 733 diabetic patients, 94 cases (12.82%) were positive for HBcAb, 28 cases (3.82%) were positive for HBsAg, and 19 cases (2.59%) had HBV-DNA with genotype D, sub-genotype D1/D3 and subtype ayw2. An occult HBV infection was found in one of the HBV DNA-positive samples, which was positive for HBcAb but negative for HBsAg. P120T/G145R, G1896A/G1899A, and A1762T/G1764T were the most frequent point substitution mutations detected in the S, pre-core, and BCP regions of the HBV genome, respectively. P120T and G145R mutations were associated with low levels or undetectable levels of HBsAg in serum. Therefore, routine tests based on HBsAg detection cannot detect HBsAg-negative infected patients. CONCLUSIONS: Relatively high prevalence of HBV infection was found in diabetic patients, while all of the HBV-infected patients were unaware of their infection. Therefore, screening for HBV infection should be included in the management program of diabetes for timely diagnosis and treatment of infected but asymptomatic patients.

Molecular Evaluation of Human Parvovirus B19 Infection and Associated Risk Factors among Pregnant Women in Bushehr Province, Southern Iran.

Given the importance of human parvovirus B19 infection during pregnancy and the potential risks to the fetus, this study was designed to determine the prevalence, genotypic pattern, and risk factors of parvovirus B19 infection among a population-based sample of pregnant women in Bushehr Province, southern Iran. A total of 824 pregnant women were enrolled in this study. Serum samples were screened for the detection of anti-parvovirus B19 IgM and IgG by ELISA. The molecular evaluation was performed by nested polymerase chain reaction, targeting the non-structural protein 1-viral protein 1 unique region of the genome, and sequencing. Of 824 pregnant women, 330 (40.1%) were positive for anti-parvovirus B19 IgG and 50 women (6.1%) had anti-parvovirus B19 IgM. A greater rate of anti-parvovirus B19 IgG seroprevalence was observed in women older than 39 years, in Afghan immigrants, and in those women with more parities. Anti-parvovirus B19 IgM seroprevalence decreased with increasing gestational age and was significantly greater among women in the first trimester of pregnancy and among residents of the city of Borazjan. Moreover, 0.73% of the pregnant women had parvovirus B19 viremia with genotype 1 and subtype 1a. Parvovirus B19 DNA was detected in the samples collected in late autumn and winter, which is a rainy season associated with temperate climes in southern Iran. According to the results of this study, approximately 60% of pregnant women in this region are serologically negative and susceptible to parvovirus B19 infection. Therefore, assessment for maternal parvovirus B19 infection is important and should be considered as part of the fetal-maternal health policy in Iran.

Prevalence, genotype distribution and mutations of hepatitis B virus and the associated risk factors among pregnant women residing in the northern shores of Persian Gulf, Iran.

BACKGROUND: Considering perinatal transmission and the high rate of chronic hepatitis B virus (HBV) infection in infants, diagnosis of HBV infection during pregnancy and timely interventions are of great importance. Therefore, this study was performed to investigate the prevalence and genotype distribution of HBV infection and the associated risk factors among pregnant women in the northern shores of the Persian Gulf, South of Iran. METHODS: Serum samples of 1425 pregnant women were tested for the presence of HBsAg and HBcAb by ELISA (HBsAg one-Version ULTRA and HBc Ab ELISA kits, DIA.PRO, Milan, Italy). The seropositive samples were tested for the presence of HBV DNA by nested PCR, targeting S, X, pre-core (pre-C), and basal core promoter (BCP) regions of the HBV genome. The amplified fragments were sequenced by Sanger dideoxy sequencing technology to evaluate the genotype distribution and mutations of HBV infection by using the MEGA 7 software. The HBV seropositive pregnant women were tested for HCV and HIV coinfections by ELISA (HCV Ab and HIV Ab/Ag ELISA kits, DIA.PRO, Milan, Italy). RESULTS: Of 1425 participants, 15 pregnant women (1.05%, 95% CI: 0.64%-1.73%) were positive for HBsAg, 41 women (2.88%, 95% CI: 2.10%-3.88%) were positive for HBcAb, and 5 women (0.35%, 95% CI: 0.15% -0.82%) had HBV viremia with genotype D, sub-genotype D3 and subtype ayw2. One of the viremic samples was positive for HBcAb but negative for HBsAg, which is indicative of an occult HBV infection. HBsAg seroprevalence was higher among pregnant women aged 20 to 29 years, women in the third trimester of pregnancy, residents of Khormuj city, Afghan immigrants, illiterate women, and pregnant women with a history of tattoo and HBV vaccination. The highest rate of HBcAb seroprevalence was observed in residents of Borazjan city, Turk ethnicity, the age group >39 years, and those women with more parities and a history of abortion. Nevertheless, HBV seroprevalence among pregnant women was not statistically associated with these variables. In contrast, HBcAb seropositivity was significantly associated with the history of tattoo (P = 0.018). According to mutations analyses, seven amino acid substitutions in the HBsAg, one point mutation in the pre-C region, and five points mutations in the BCP region were detected. Besides, the BCP mutations caused amino acid substitutions in the X protein. Of note, the conversion of Ala → Val at amino acid 168 (A168V) and Thr → Pro at amino acid 127 (T127P) were detected in HBsAg of the occult HBV strain. CONCLUSION: These results indicate a relatively low prevalence of HBV infection among pregnant women in the South of Iran, while tattooing is a risk factor for exposure to HBV infection. Moreover, all of the HBV-positive pregnant women were asymptomatic and unaware of their infection. Therefore, routine screening for HBV markers during pregnancy, appropriate treatment of HBV-infected women, and HBV vaccination are recommended to decrease mother-to-child transmission of HBV.

Prevalence and risk factors of hepatitis E virus infection among patients with ß-thalassemia major in South of Iran.

This study was performed to determine the prevalence and risk factors of hepatitis E virus (HEV) infection among thalassemia patients. All ß-thalassemia major patients on regular blood transfusion attending the blood transfusion centers located in southern Iran were invited to participate in this study. ELISA was used to detect anti-HEV IgM and anti-HEV IgG antibodies. The molecular detection of HEV infection was performed by nested RT-PCR assay, targeting the ORF2 region of HEV genome, and sequencing. In this study, 16.67% of thalassemia patients were positive for anti-HEV IgG compared to 12.1% of the controls. Thalassemia patients were negative for anti-HEV IgM and HEV viremia. Patients with blood transfusion every two weeks had significantly higher anti-HEV IgG seroprevalence compared to the patients with blood transfusions at longer intervals (OR: 12.50; 95% CI: 1.76-88.74; P = .012). Anti-HEV IgG seroprevalence was not statistically associated with age, gender distribution, ethnicity, place of residency, education level, and serum levels of liver enzymes. This study reports a high seroprevalence of HEV among thalassemia patients, while frequency of blood transfusion was significantly associated with anti-HEV IgG seropositivity. This suggests that frequent blood transfusion may be a risk factor for exposure to HEV infection among thalassemia patients.

Molecular identification and clinical characteristics of mumps virus and human herpesviruses associated with aseptic meningitis in South of Iran.

Viral infections are the major etiological agent of aseptic meningitis; though, limited data exist on the prevalence and molecular epidemiology of viral pathogens responsible for the occurrence of aseptic meningitis in Iran. Therefore, this study aimed to elucidate the prevalence and clinical features of mumps virus and human herpesviruses associated with aseptic meningitis in the South of Iran. A total of 73 patients with aseptic meningitis were enrolled in this study. Cerebral spinal fluid (CSF) samples were tested for detection of HSV, CMV, VZV and mumps virus using nested PCR assay. Mumps virus, HSV-1 and VZV were found in 4 (5.5%), 4 (5.5%) and 3 (4.1%) of the CSF samples, respectively. The highest rates of mumps virus and HSV infections were observed in infants less than one year, and VZV was more prevalent in patients under 5 years of age. The majority of mumps virus and VZV infections were found among male patients, while HSV was more prevalent among female patients. The highest incidence of aseptic meningitis associated with mumps virus was observed in summer, while HSV and VZV were more prevalent during spring. Headache was the most common symptom in mumps meningitis. About HSV and VZV, the most predominant clinical symptom was fever. The results of this study indicate the importance of molecular assay in the diagnosis of etiological agents of aseptic meningitis. Prompt detection of viral pathogens provides a better chance of managing viral meningitis in health care settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13337-021-00718-y.

Pediatric case with vaccine-related poliovirus infection: A case report.

BACKGROUND: As long as oral poliovirus vaccine (OPV) is used, the potential risk for the emergence of vaccine-related polioviruses remains. CASE SUMMARY: We report a case of Sabin-like type 1 poliovirus infection in an immunocompetent 17-mo-old child after receiving four scheduled doses of OPV. Somehow, the four doses did not confer full protection, possibly because of interference created by other enteroviruses. CONCLUSION: The surveillance of vaccine-related polioviruses has important implications for improving health policies and vaccination strategies. Missed cases of vaccine-related poliovirus infection might pose a potential risk to global poliovirus eradication. Therefore, the global withdrawal of OPV and a shift to the inclusion of only inactivated poliovirus vaccine in the vaccination schedule is the main objective of the polio eradication program.

Prevalence and Predominant Genotype of Hepatitis C Virus Infection and Associated Risk Factors among Pregnant Women in Iran.

OBJECTIVE: Knowledge regarding the prevalence and risk factors of hepatitis C virus (HCV) infection among pregnant women can give clue to health care providers regarding the appropriate management of HCV infection. Therefore, this study was conducted to determine the prevalence, genotypic pattern, and risk factors of HCV infection among pregnant women in the northern shores of the Persian Gulf, south of Iran. METHODS: From January 2018 to June 2019, serum samples were obtained from 1425 pregnant women, ages ranging from 14 to 46 years (28.1 ± 5.99). Serum samples were tested for detection of anti-HCV antibodies using an enzyme-linked immunosorbent assay (ELISA) (HCV Ab ELISA kit, Dia.Pro, Milan, Italy). Following the extraction of nucleic acid, the molecular evaluation of HCV infection was performed by seminested reverse transcriptase-polymerase chain reaction assay (RT-PCR), targeting the 5' untranslated region (5'UTR) and core of HCV genome and sequencing. RESULTS: Of the 1425 pregnant women, 19 women (1.33%, 95% CI: 0.85%-2.07%) were positive for anti-HCV antibodies. The majority of HCV-seropositive women were in the third trimester of pregnancy, educated, and had a history of blood transfusion, abortion, surgery, or dentistry. Moreover, Arab and Fars pregnant women and those aged >39 years had the highest rate of HCV seroprevalence. Nevertheless, none of these variables were significantly associated with HCV seropositivity. In contrast, HCV seropositivity was associated with place of residency, so that residents of Khormuj city had significantly higher HCV seroprevalence compared to the residents of other cities (OR: 7.05; 95% CI: 1.75-28.39; P = 0.006). According to the molecular evaluation, 9 of the 19 HCV-seropositive pregnant women (47.37%) had HCV viremia with genotype 3a. CONCLUSION: This study reports the HCV prevalence of 1.33% for anti-HCV antibodies and 0.63% for HCV RNA among pregnant women in the south of Iran. Considering the asymptomatic nature of chronic HCV infection and the fact that vertical transmission is possible in women with detectable viremia, therefore, screening of women before pregnancy is recommended to reduce the risk of HCV infection and its complications during pregnancy.

Dynamics of host immune responses to SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the most recent global health threat, is spreading throughout the world with worrisome speed, and the current wave of coronavirus disease 2019 (COVID-19) seems to have no mercy. While this mysterious virus challenges our ability to control viral infections, our opportunities to control the COVID-19 pandemic are gradually fading. Currently, pandemic management relies on preventive interventions. Although prevention is a good strategy to mitigate SARS-CoV-2 transmission, it still cannot be considered an absolute solution to eliminate this pandemic. Currently, developing a potent immunity against this viral infection seems to be the most promising strategy to drive down this ongoing global tragedy. However, with the emergence of new challenges in the context of immune responses to COVID-19, the road to control this devastating pandemic seems bumpier; thus, it is pivotal to characterize the dynamics of host immune responses to COVID-19, in order to develop efficient prophylactic and therapeutic tools. This begs the question of whether the effector mechanisms of the immune system are indeed potent or a possible contributing factor to developing more severe and lethal forms of COVID-19. In this review, the possible role of the immunopathologic phenomena including antibody-dependent enhancement, cytokine storm, and original antigenic sin in severity and mortality of COVID-19 will be discussed.

High prevalence of hepatitis E among regular hemodialysis patients in South of Iran.

OBJECTIVE: Hepatitis E virus (HEV) is one of the prevalent nosocomially transmitted agents among patients on maintenance hemodialysis due to parenteral transmission of HEV and immunocompromised condition of chronic hemodialysis patients. Therefore, this study aimed to investigate prevalence, risk factors, and genotypic pattern of HEV infection among hemodialysis patients in South of Iran. METHODS: All patients on maintenance hemodialysis attending the hemodialysis centers of Bushehr, Borazjan, and Genaveh cities for regular hemodialysis were enrolled in this study. Serum samples were tested for the presence of anti-HEV antibodies using ELISA kit. The serum samples were further tested for detection of HEV RNA using nested RT-PCR. RESULTS: Of 226 hemodialysis patients, 155 patients (68.6%, 95% CI: 62.3%-74.3%) were positive for anti-HEV IgG antibody, of which 33 patients (14.6%, 95% CI: 10.6%-19.8%) had anti-HEV IgM antibody. The prevalence of anti-HEV IgG and anti-IgM antibodies in non-hemodialysis controls were 65.1% and 9.6%, respectively. Although the hemodialysis patients had higher prevalence of HEV than the controls, the difference was not significant. All samples were negative for HEV RNA. HEV seroprevalence among hemodialysis patients was not significantly associated with place of residency, ethnicity, level of education, gender distribution, hemodialysis duration, and levels of liver enzymes. HEV seropositive patients had significantly higher mean age compared to seronegative patients. CONCLUSION: This study reports the highest seroprevalence of HEV among hemodialysis patients in Iran. Inapparent HEV infection in the dialysis setting calls for regular screening of hemodialysis patients regardless of the hemodialysis duration, clinical symptoms, and liver function parameters.

Antibody-Dependent Enhancement and the Critical Pattern of COVID-19: Possibilities and Considerations.

Coronavirus disease 2019 (COVID-19), a pandemic infection with profound effects on human society, has challenged our ability to control viral infections. Although at the beginning of the COVID-19 outbreak, the epidemic seemed controllable in Southern Iran, the disease presented a critical pattern as of May 2020. After a few months of the emergence of COVID-19, its severity and mortality increased dramatically. It has been proposed that antibodies produced during previous exposure to local circulating human coronaviruses or possibly severe acute respiratory syndrome coronavirus 2 might contribute to the development of more severe and lethal presentations of COVID-19 possibly by triggering antibody-dependent enhancement. The binding of virions complexed with antibodies to Fcγ receptors on the target cells initiates receptor-mediated signaling events, leading to enhanced expression of inflammatory cytokines and suppression of intracellular antiviral responses at the transcriptome level, followed by endocytosis of the virus and subsequent activation of immune cells. The activated immune cells might accumulate in the lung and promote cytokine storm and lymphopenia. Furthermore, the formation of immune complexes can promote complement activation and subsequent tissue damage. Although there are currently no clinical data to support this hypothesis, a better understanding of these immunopathologic phenomena and their relation to the disease course and severity might give insights into the development of the most efficient prophylactic and therapeutic approaches. This review demonstrates the critical pattern of COVID-19 in Southern Iran and highlights the possible interplay of factors leading to this condition.

Molecular epidemiology of enteroviruses and predominance of echovirus 30 in an Iranian population with aseptic meningitis.

Human enteroviruses are the most prevalent causes of aseptic meningitis worldwide. However, despite such predominancy, defining the enteroviral etiology of aseptic meningitis remains a diagnostic dilemma for the clinician in Iran. Therefore, this study was conducted to characterize the prevalence and clinical significance of enteroviral aseptic meningitis as well as the predominant enterovirus serotypes among patients with aseptic meningitis in the South of Iran.Cerebrospinal fluid (CSF) specimens were obtained from 73 patients with aseptic meningitis (52.1% males and 47.9% females), ages ranging from 1 month to 88 years. Following the extraction of nucleic acid, the detection of enteroviruses was performed by RT-PCR, targeting the 5' untranslated region of the genome, and sequencing. Enteroviruses were found in 46.6% of samples (34/73). The most predominant serotype was echovirus 30, followed by coxsackievirus B5 and poliovirus type 1 Sabin strain. The enterovirus infections were more prevalent among female patients (58.8%) and those below 5 years of age (52.9%). Although enterovirus infections were observed throughout the year, the infections were more prevalent during autumn with fever as the predominant clinical symptom. The outcomes revealed that enteroviruses are significant causes of aseptic meningitis in the South of Iran, while suspected cases of aseptic meningitis are usually monitored by bacterial culture and biochemical testing of CSF samples. Therefore, the etiology remains unknown in most cases. Molecular detection of viral pathogens should be included as a common approach in the screening of patients with aseptic meningitis to prevent unnecessary treatment and to improve clinical management.

Barriers to Leaving a Relationship From the Perspective of Married Abused Iranian Women: Secondary Analysis of the Interviews With Abused Women.

Violence has a heavy impact on the physical and mental health of women in developed and developing countries; however, most of the violence victims would suffer in silence and never leave their relationship. The aim of the present study was to identify the barriers to leaving a relationship from the perspective of married abused Iranian women. The present study was a secondary analysis of the interviews conducted in a primary study. The primary study that was conducted using the grounded theory approach has assessed the coping process with domestic violence in 24 married abused Iranian women. These women were selected from local parks, health centers, and universities of Tehran city using a purposive sampling method. Qualitative secondary analysis of the interviews was conducted, in accordance with the goal of this study, using content analysis. Four categories emerged through the analysis of the data including "fear," "lack of resources," "beliefs and attitudes," and "dependence" and the common theme between these categories was "deterrents to leaving an abusive relationship." Results indicated that contextual factors such as fear, lack of resources, attitudes and beliefs, and dependence were the reason for not leaving a relationship. Interventions for enriching women's resources (improving the condition of education and employment, and improvement of the formal and informal support systems), education about domestic violence and its management methods, and modification of the existing attitudes and beliefs in this regard could keep abused women from experiencing more violence.

Complexity on modulation of NF-κB pathways by hepatitis B and C: A double-edged sword in hepatocarcinogenesis.

Nuclear factor-κB (NF-κB), a family of master regulated dimeric transcription factors, signaling transduction pathways are active players in the cell signaling that control vital cellular processes, including cell growth, proliferation, differentiation, apoptosis, morphogenesis, angiogenesis, and immune responses. Nevertheless, aberrant regulation of the NF-κB signaling pathways has been associated with a significant number of human cancers. In fact, NF-κB acts as a double-edged sword in the vital cellular processes and carcinogenesis. This review provides an overview on the modulation of the NF-κB signaling pathways by proteins of hepatitis B and C viruses. One of the major NF-κB events that are modulated by these viruses is the induction of hepatocellular carcinoma. Given the central function of NF-κB in carcinogenesis, it has turned out to be a considerable therapeutic target for cancer therapy.

Hepatitis C virus core protein modulates several signaling pathways involved in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer, and hepatitis C virus (HCV) infection plays a major role in HCC development. The molecular mechanisms by which HCV infection leads to HCC are varied. HCV core protein is an important risk factor in HCV-associated liver pathogenesis and can modulate several signaling pathways involved in cell cycle regulation, cell growth promotion, cell proliferation, apoptosis, oxidative stress and lipid metabolism. The dysregulation of signaling pathways such as transforming growth factor ß (TGF-ß), vascular endothelial growth factor (VEGF), Wnt/ß-catenin (WNT), cyclooxygenase-2 (COX-2) and peroxisome proliferator-activated receptor α (PPARα) by HCV core protein is implicated in the development of HCC. Therefore, it has been suggested that this protein be considered a favorable target for further studies in the development of HCC. In addition, considering the axial role of these signaling pathways in HCC, they are considered druggable targets for cancer therapy. Therefore, using strategies to limit the dysregulation effects of core protein on these signaling pathways seems necessary to prevent HCV-related HCC.