Clinical insights into nanomedicine and biosafety: advanced therapeutic approaches for common urological cancers.

Urological cancers including those of the prostate, bladder, and kidney, are prevalent and often lethal malignancies besides other less common ones like testicular and penile cancers. Current treatments have major limitations like side effects, recurrence, resistance, high costs, and poor quality of life. Nanotechnology offers promising solutions through enhanced diagnostic accuracy, targeted drug delivery, controlled release, and multimodal imaging. This review reflects clinical challenges and nanomedical advances across major urological cancers. In prostate cancer, nanoparticles improve delineation and radiosensitization in radiation therapy, enable fluorescent guidance in surgery, and enhance chemotherapy penetration in metastatic disease. Nanoparticles also overcome bladder permeability barriers to increase the residence time of intravesical therapy and chemotherapy agents. In renal cancer, nanocarriers potentiate tyrosine kinase inhibitors and immunotherapy while gene vectors and zinc oxide nanoparticles demonstrate antiproliferative effects. Across modalities, urological applications of nanomedicine include polymeric, liposomal, and metal nanoparticles for targeted therapy, prodrug delivery, photodynamic therapy, and thermal ablation. Biosafety assessments reveal favorable profiles but clinical translation remains limited, necessitating further trials. In conclusion, nanotechnology holds significant potential for earlier detection, precise intervention, and tailored treatment of urological malignancies, warranting expanded research to transform patient outcomes.

Prevalence and risk factors of gastroesophageal reflux disease in Iran: A cross-sectional analysis from the PERSIAN cohort.

BACKGROUND: This study assessed the prevalence of gastroesophageal reflux disease (GERD) in a general adult population in Iran. The association between GERD and various factors was also evaluated. METHODS: We performed a cross-sectional study on 163,018 individuals aged over 35 who were enrolled in the PERSIAN cohort. GERD was defined as the occurrence of heartburn and/or regurgitation symptoms at least several days a month. Survey design analysis for pooled data was performed and multiple regression analysis was conducted to determine the independent risk factors for GERD. RESULTS: The prevalence of GERD in our study was estimated at 21.86% (95% confidence interval:17.4%-36.4%). The mean age of the participants was 49.84 years±9.25 (35-70) and 44.75% of the participants were male. Symptoms of heartburn and regurgitation were reported in 18.65% (n: 29,170) and 6.06% (n: 9,717) of participants, respectively. In the multivariate analysis, several factors were found to be associated with a higher prevalence of GERD: female sex, age >50, current smoking, opium use, weekly consumption of fried foods, frequent consumption of hot tea, less than 6 hours of sleep per night, psychiatric disorders, usage of NSAIDs, and poor oral hygiene, were associated with a higher prevalence of GERD. Conversely, higher education levels and average physical activity were found to be less commonly associated with GERD. CONCLUSION: We found a relatively high prevalence of GERD (21.86%) in this population-based study in Iran. By identifying modifiable risk factors, this research offers opportunities for targeted interventions and lifestyle modifications to reduce the burden of GERD.

The Effect of Coronavirus Disease 2019 on the Quality of Associated Care in Patients with Gastric Cancer.

Coronavirus is a new virus that has affected human life on a large scale; it has infected millions of people and killed hundreds of thousands of people. In contrast, among cancers, stomach neoplasia is the most common cancer of the upper gastrointestinal (UGI) tract. COVID-19 disease has disrupted the optimal management of patients with cancer. Metastasis, deterioration of the patient's nutritional status, UGI bleeding, and increased surgical complications are all consequences of delayed treatment of patients with gastric cancer. However, there is still insufficient evidence on the immunogenicity of the vaccine and the protection provided by coronavirus vaccines in patients with cancer, especially those with immunodeficiency or those who are treated for certain types of cancers. Also, as part of the prevention and control of COVID-19 disease, nutritional support for patients with gastrointestinal cancer is particularly important, and the psychological and physiological limitations caused by the disease duration are hurting the well-being of patients. Therefore, the assessment of the impact of the coronavirus on cancer should be treated as an important issue, and healthcare professionals should be prepared to deal with the long-term effects of the coronavirus disease.

Knowledge on Human Papillomavirus Infections, Cancer Biology, Immune Interactions, Vaccination Coverage and Common Treatments: A Comprehensive Review.

Human papillomavirus (HPV) is a circular, double-stranded DNA virus and recognized as the most prevalent sexually transmitted infectious agent worldwide. The HPV life cycle encompasses three primary stages. First, the virus infiltrates the basal cells of the stratified epidermis. Second, there is a low-level expression of viral genes and preservation of the viral genome in the basal layer. Lastly, productive replication of HPV occurs in differentiated cells. An effective immune response, involving various immune cells, including innate immunity, keratinocytes, dendritic cells, and natural killer T cells, is instrumental in clearing HPV infection and thwarting the development of HPV-associated tumors. Vaccines have demonstrated their efficacy in preventing genital warts, high-grade precancerous lesions, and cancers in females. In males, the vaccines can also aid in preventing genital warts, anal precancerous lesions, and cancer. This comprehensive review aims to provide a thorough and detailed exploration of HPV infections, delving into its genetic characteristics, life cycle, pathogenesis, and the role of high-risk and low-risk HPV strains. In addition, this review seeks to elucidate the intricate immune interactions that govern HPV infections, spanning from innate immunity to adaptive immune responses, as well as examining the evasion mechanisms used by the virus. Furthermore, the article discusses the current landscape of HPV vaccines and common treatments, contributing to a holistic understanding of HPV and its associated diseases.

Effectiveness of polypill for primary and secondary prevention of cardiovascular disease: a pragmatic cluster-randomised controlled trial (PolyPars).

BACKGROUND: We aimed to investigate the effectiveness of fixed-dose combination therapy (polypill) for primary and secondary prevention of major cardiovascular diseases in a typical rural setting. METHODS: The PolyPars Study is a two-arm pragmatic cluster-randomised trial nested within the PARS cohort study, including all residents aged over 50 years in the entire district in southern Iran. The 91 villages underwent random allocation into two arms: the control arm, encompassing 45 clusters, was subjected to non-pharmacological intervention (educational training on healthy lifestyle), whereas the intervention arm, comprising 46 clusters, received the non-pharmacological interventions in conjunction with a once-daily polypill tablet. This tablet comprised two antihypertensive agents, a statin and aspirin. The primary outcome was the first occurrence of major cardiovascular events defined as a composite of hospitalisation for acute coronary syndrome (non-fatal myocardial infarction and unstable angina), fatal myocardial infarction, non-fatal and fatal stroke, sudden death and heart failure. The Cox regression model, with shared frailty, was used to account for clustering effect. RESULTS: During December 2015-December 2016, a total of 4415 participants aged 50-75 years were recruited (2200 participants in the intervention arm and 2215 participants in the control arm). The overall median of follow-up duration was 4.6 years (interquartile interval 4.4-4.9). The achieved adherence rate to polypill in intervention arm was 86%. In the control group, 176 (8.0%) of 2215 participants developed primary outcome, compared with 88 (4.0%) of 2200 participants in the polypill group. We found substantial reduction in risk of primary outcome both in relative and absolute scales (HR 0.50, 95% CI 0.38 to 0.65; absolute risk reduction 4.0%, 95% CI 2.5% to 5.3%). No difference in serious adverse events was observed between the two groups. CONCLUSIONS: The fixed-dose combination therapy using polypill can safely halve the risk of major cardiovascular diseases at the population level. TRIAL REGISTRATION NUMBER: NCT03459560.

Outcomes of Different Donor and Recipient Vessel and Ureteral Anastomoses in En Bloc Kidney Transplant From Pediatric Deceased Donors: A Retrospective Cohort.

OBJECTIVES: This study aimed to investigate the possible role of different donor and recipient vessel and ureteral anastomoses on survival and functional outcomes in en bloc kidney transplants. MATERIALS AND METHODS: This retrospective cohort included 99 en bloc kidney transplants performed from December 2005 to March 2022. Recipients were grouped based on donor's vessel (distal [n = 84] or proximal [n = 15] abdominal aorta), recipient's vessel (abdominal aorta [n = 3], external [n = 21], internal [n = 50], or common [n = 25] iliac artery), and ureteral anastomosis (separate [n = 32] or common [n = 67]). Patient and graft survival, complication rates, and estimated glomerular filtration rate trends were compared between groups. RESULTS: Pediatric brain dead donors had a mean age and weight of 37 ± 22 months and 14 ± 4 kg, respectively. Donor and recipient vessel and ureteral anastomoses did not affect overall survival (P = .306, .296, and .225), graft survival (P = .720, .172, and .124), and vascular (P = .347, .689, and .264) and urinary (P = .587, .172, and .385) complication rates. Lymphoceles requiring intervention were significantly more prevalent in the recipient external iliac artery group (P = .008) but were independent of donor vessel and ureteral anastomosis (P = .587 and 1.00). Estimated glomerular filtration rate trend was independentofdonor(P=.921) andrecipient vessel(P=.878 and .536). CONCLUSIONS: We found that different arterial and ureteral anastomoses appear to have comparable outcomes in en bloc kidney transplant with the exception of recipient external iliac artery, which may be slightly inferior because of the relatively higher rate of lymphoceles requiring intervention.

Laparoscopic gastric plication: A long-term follow-up and comparison of outcomes in severe vs. non-severe obesity.

BACKGROUND: LGGCP is a non-gastrectomy, restrictive bariatric technique. This study aims to assess its long-term efficacy. METHODS: This is a retrospective cohort study on LGGCP patients (2010-2019) from a single tertiary center, followed for up to 60 months. RESULTS: Ninety-four patients with obesity were included in the study. The mean five-year postoperative BMI was 32.00. Excess weight loss (EWL): 30%-50% and EWL<30% occurred in 16 and 9 cases, respectively. The mean EWL was higher at 3-, 6-, and 12- months post-operation in patients with a BMI<40. Weight regain was 46.3% at the five-year follow-up. Eighty-seven patients had associated comorbidity, and 76 had improved in at least one of their comorbidities. Sixteen patients (17.0%) experienced complications. CONCLUSION: LGGCP is safe and effective, with benefits in patients with BMI<40. Thus, we suggest the usage of LGGCP, especially in this group of patients, due to its less-invasive nature and acceptable cost-benefit. Further studies with larger sample sizes are required for validation.

Intraoperative use of electrical impedance spectroscopy for adenoid cystic carcinoma of the lacrimal gland: A case report.

Key Clinical Message: Electrical Impedimetric Tumor Detection System is a novel and promising tool for fast intraoperative tumor delineation and accurate safe margin detection in orbital tumors. Abstract: Adenoid cystic carcinoma (ACC) is a rare malignant tumor of epithelial origin, typically arising from the salivary and lacrimal glands. ACC is notorious for recurrence and a high rate of morbidity and mortality despite therapy. We presented a 48-year-old male patient with lacrimal gland ACC of the right orbit who underwent radical tumor resection and adjuvant radiotherapy. We applied a new diagnostic method, the Electrical Impedimetric Tumor Detection System, during surgery and tested its performance to enhance the precision of tumor resection. Two months after surgery, he underwent external radiation of 58 Gy in 29 fractions. He showed no tumor recurrence or metastasis in the 1-year follow-up visits. ITDS showed a precision of tumor and margin detection consistent with histopathology results. This novel ITDS may be a reliable system for fast intraoperative tumor delineation and accurate, safe margin detection in orbital tumors.

Effect of miR-4270 Suppression on Migration in Hepatocellular Carcinoma Cell Line (HepG2)

Background: Liver transplantation and surgical resection are two major strategies for treatment of hepatocellular carcinoma (HCC) patients. One approach to treating HCC is the suppression of metastasis to other tissues. Herein, we aimed to study the effect of miR-4270 inhibitor on migration of HepG2 cells as well as activity of matrix metalloproteinase (MMP) these cells in order to find a strategy to suppress metastasis in future. Methods: HepG2 cells were treated with 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 nM of miR-4270 inhibitor, and then the cell viability was measured by trypan blue staining. Afterwards, cell migration and MMP activity of HepG2 cells were assessed by wound healing assay and zymography, respectively. The MMP gene expression was determined by real-time reverse transcription polymerase chain reaction. Results: Results showed that miR-4270 inhibitor decreased the cell viability of HepG2 cells in a concentration-dependent manner. Also, inhibition of the miR-4270 reduced invasion, MMP activity, and expression of MMP genes in HepG2 cells, respectively. Conclusion: Our findings suggest that miR-4270 inhibitor decreases in vitro migration, which could help find a new approach for HCC therapy patients.

Indirect Spinal Canal Decompression Using Ligamentotaxis Compared With Direct Posterior Canal Decompression in Thoracolumbar Burst Fractures: A Prospective Randomized Study.

Background: There is still no standard of care to manage thoracolumbar burst fractures. With all the recent advances, posterior approaches are still one of the mainstays of treatment. On the other hand, while spinal canal decompression in neurological impaired patients is an important goal of treatment, its technique remains controversial.This study compared the effects of direct laminectomy decompression against ligamentotaxis/indirect canal decompression on neurological and radiographic improvements. Methods: A prospective double-blind randomized clinical trial was conducted on 60 thoracolumbar burst-fracture patients meeting our inclusion and exclusion criteria. They were randomized into 2 treatment arms: (1) direct decompression using laminectomy and (2) indirect decompression using ligamentotaxis/distraction. Each patient was observed for 6 months, and their neurological and radiographical data were collected prospectively. Statistical analysis was done by the Student t test, Friedman test, Mann Whitney-U test, Wilcoxon ranked test, and 1-way analysis of variance. Results: Among 60 patients enrolled in our study, each treatment arm had an improvement in Frankel scores but there was no difference between the groups at any given time. After 6 months of surgery, local sagittal kyphosis improved in both groups (from 32.2 to 7.43 and 29.93 to 8.77 for the indirect and direct groups, respectively), as well as anterior vertebral height ratio (from 57.73 to 70.7 and 62.17 to 66.27 for the indirect and direct group, respectively) and posterior vertebral height ratio (from 61.17 to 74.87 and 64 to 67.5 for the indirect and direct group, respectively). For between-group comparisons after 6 months, there was a significant difference only for posterior vertebral height ratio (P = 0.040). Conclusion: Posterior approaches with ligamentotaxis have shown to be safe and may present the same outcome as direct decompression techniques using wide laminectomy.

The efficacy of intrathecal methyl-prednisolone for acute spinal cord injury: A pilot study.

Study design: Randomized clinical trial. Objectives: To evaluate the safety and effectiveness of intrathecal methyl-prednisolone compared to intravenous methyl-prednisolone in acute spinal cord injuries. Setting: Imam Reza Hospital, Tabriz University of Medical Sciences. Methods: Patients meeting our inclusion and exclusion criteria were enrolled in the study and divided randomly into two treatment arms: intrathecal and intravenous. Standard spinal cord injury care (including surgery) was given to each patient based on our institutional policy. Patients were then assessed for neurological status (based on ASIA scores, Frankel scores) and complications for six months and compared to baseline status after injury. To better understand the biological bases of methyl-prednisolone on spinal cord injuries, we measured two biomarkers for oxidative stress (serum malondialdehyde and total antioxidant capacity) in these patients at arrival and day three after injury. Results: The present study showed no significant difference between the treatment arms in neurological status (sensory scores or motor scores) or complications. However, the within-group analysis showed improvement in neurological status in each treatment arm within six months. Serum malondialdehyde and total antioxidant capacity were analyzed, and no significant difference between the groups was seen. Conclusion: This is the first known clinical trial investigating the effect of intrathecal MP in acute SCI patients. Our finding did not show any significant differences in complication rates and neurological outcomes between the two study arms. Further studies should be conducted to define the positive and negative effects of this somehow novel technique in different populations as well.

Dietary selenium intake in relation to non-alcoholic fatty liver disease assessed by fatty liver index and hepatic steatosis index; a cross-sectional study on the baseline data of prospective PERSIAN Kavar cohort study.

BACKGROUND: There is limited and conflicting evidence on the association between selenium and non-alcoholic fatty liver disease (NAFLD). Therefore, the present population-based cross-sectional study aimed to explore the relationship between dietary selenium intake and the risk of NAFLD. METHODS: A total of 3026 subjects from the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Kavar cohort study were included in the analysis. The daily selenium intake was evaluated using a semi-quantitative food frequency questionnaire, and energy-adjusted quintiles of selenium intake (µg/day) were calculated. NAFLD was defined as the fatty liver index (FLI) ≥ 60 or the hepatic steatosis index (HSI) > 36. The association between dietary selenium intake and NAFLD was evaluated using logistic regression analysis. RESULTS: The prevalence rates of NAFLD were 56.4% and 51.9%, based on the FLI and HSI markers, respectively. The odds ratios (ORs) for FLI-defined NAFLD were 1.31 (95% confidence interval (CI): 1.01-1.70) and 1.50 (95% CI: 1.13-1.99) for the fourth and fifth quintiles of selenium intake, respectively, after adjustment for sociodemographic variables, smoking status, alcohol drinking, physical activity, and dietary factors (P trend = 0.002). There was also a similar association between selenium intakes and HSI-defined NAFLD (OR = 1.34 (95% CI: 1.03-1.75) for the fourth quintile and OR = 1.50 (95% CI: 1.12-2.01) for the fifth quintile of selenium intake) (P trend = 0.006). CONCLUSION: In this large sample study, we observed a weak positive association between dietary selenium intake and NAFLD risk.

Polymorphism Analysis of Interleukin-18 and Interleukin-37 Genes in Hepatitis B Infections with Different Outcomes: A Preliminary Report from an Iranian Population.

OBJECTIVE: Given the vital role of cytokines in influencing the outcomes of hepatitis B virus (HBV) infections, this study aimed to investigate the association between polymorphisms of interleukin (IL)-18 and IL-37 and the outcomes of HBV infection. METHODS: In this study, we enrolled 300 subjects with chronic HBV infection, including those with cirrhosis/hepatocellular carcinoma (C/HCC), chronic active hepatitis B (CAH) infection, or asymptomatic carriers (AC), and 58 individuals whose infection was spontaneously cleared (SC). Genomic DNA was extracted, and IL-18/IL-37 genotyping was performed using PCR-RFLP and ARMS-PCR. RESULTS: The frequency of genotypes and alleles of IL-18 single nucleotide polymorphisms (SNPs) at positions rs1946519, rs1946518, and rs187238 and IL-37 at position rs4241122 were not statistically different among the four studied groups (P>0.05). Furthermore, the frequency of different haplotypes was similar among the studied groups (P>0.05). CONCLUSIONS: Polymorphisms of IL-18 SNPs at positions rs1946519, rs1946518, and rs187238 and variation of IL-37 at position rs4241122 do not appear to influence the outcome of HBV infection.

Metabolic Syndrome and Nephrolithiasis; A Cross Sectional Population-based Study on the Baseline Data of the PERSIAN Kavar Cohort Study.

OBJECTIVE: To explore the relationship between metabolic syndrome and its components with nephrolithiasis. METHODS: In current study, 4,901 individuals from the PERSIAN (Prospective Epidemiological Research Studies in IrAN) Kavar cohort study were included. Metabolic syndrome was defined according to the ATP III criteria (2005 revision). The nephrolithiasis was assessed using a structured questionnaire, and ultrasound findings were reviewed in subjects who reported positive history of nephrolithiasis. We applied logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI). RESULTS: The prevalence of nephrolithiasis and metabolic syndrome was 28.5% and 40.91%, respectively. Almost 31% of the patients with metabolic syndrome had a history of nephrolithiasis. Multivariable logistic regression analysis revealed a positive association between metabolic syndrome and nephrolithiasis (OR= 1.30, 95% CI: 1.14-1.49, P<.001) after adjustment age, sex, ethnicity, physical activity, smoking status, and alcohol intake. Furthermore, the relation was higher for elders aged 50 years or more (P for interaction= .016) and Turk Nomad participants (P for interaction= 0.044) than the others. There was also a positive independent association between hypertension (OR=1.29, 95% CI: 1.12-1.48, P<.001) and hypertriglyceridemia (OR= 1.15, 95% CI: 1.01-1.31, P=.033) with nephrolithiasis. CONCLUSION: In this large sample study, we demonstrate a weak positive association between metabolic syndrome, hypertension, and hypertriglyceridemia with nephrolithiasis.

Estimation of 10-Year Risk of Cardiovascular Diseases Using WHO Risk Prediction Charts: A Population-Based Study in Southern Iran.

Background: An effective strategy for primary prevention of Cardiovascular Disease (CVD) is accurate diagnosis and the subsequent evidence-based treatment for high-risk people. This study aimed to estimate the 10-year risk of CVD and its related factors. Methods: The baseline data of 8138 participants of the Pars cohort study (PCS) in southern Iran were used. Risk scores were calculated using the updated 2019 WHO CVD risk prediction charts. The scores were determined based on age, gender, current smoking status, systolic blood pressure (SBP), diabetes status, and total serum cholesterol. Demographic and socioeconomic variables, physical activity, and anthropometric indices were measured and analyzed. Multivariable logistic regression was applied to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI). Results: The mean (SD) age of the participants was 51.65 (9.06) years, and 53.44% were female. The 10-year CVD risk for 23.89% of participants was ≥10%. The prevalence of hypertension, diabetes, hypercholesterolemia, and smoking was 12.79%, 8.38%, 12.80%, and 14.41%, respectively. Having abdominal obesity, having low or moderate physical activity, being illiterate or having diplomas or lower degrees, and being in the third quartile of the wealth score group were associated with a higher 10-year risk of CVD. Conclusion: About one-fourth of the participants had moderate risk and higher. Due to the relatively high prevalence of CVD risk factors in the middle-aged population, the modifiable risk factors are recommended to be adjusted. Additionally, individual- and community-based educational policies are essential to create a healthy lifestyle.

Metabolic syndrome, hepatic fibrosis, and steatosis diagnosed by liver stiffness measurement and controlled attenuation parameter after liver transplantation: the impact on long-term survival.

BACKGROUND: Liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) are used for diagnosis of liver fibrosis and steatosis. This study aimed to noninvasively evaluate hepatic steatosis and fibrosis in liver transplant recipients using CAP and LSM and the impact on survival of patients. METHODS: In a prospective study, adult liver transplant recipients were included. CAP and LSM obtained during transient elastography (TE) were used for assessment of hepatic steatosis and fibrosis. Patients were followed during 4 years for mortality as the main outcome after liver transplantation. RESULTS: From 296 patients, 24.7% and 25% of liver transplant recipients had liver steatosis and fibrosis in CAP and LSM, respectively. In multivariable Cox regression analysis, etiology of liver disease (NASH versus non-NASH) (HR: 3.125; 95% CI: 1.594-6.134; p = 0.001), and post-transplant diabetes mellitus (PTDM) (HR: 2.617; 95% CI: 1.396-4.926; p = 0.003) were associated with hepatic steatosis after liver transplantation.  In multivariable Cox regression analysis, liver fibrosis was an independent predictor of mortality after liver transplantation (HR: 4.926; 95%CI: 1.779-13.513; p = 0.002). CONCLUSION: CAP and LS measurement during TE are useful methods for diagnosis of hepatic steatosis and fibrosis in liver transplant recipients. LS measurement might predict long-term survival of patients.

Serosurvey of Cystic Echinococcosis and Related Risk Factors for Infection in Fars Province, Southern Iran: A Population-Based Study.

Cystic echinococcosis (CE) is a common zoonotic infection in all provinces of Iran, especially in areas where people live on agriculture and animal husbandry. The current cross-sectional population-based study is aimed at determining the seroprevalence of CE in Kavar County, Fars province, southern Iran. Blood samples were collected from 1500 individuals (749 males and 751 females). Anti-hydatid cyst antibodies were detected, using a recombinant B8/1 antigen of Echinococcus graunlosus in an ELISA system. Multivariate logistic regression analysis was used to find out the independent risk factor for CE seropositivity. Anti-hydatid cyst antibodies were detected in the sera of 131 out of 1500 participants, corresponding to a seroprevalence rate of 8.73%. With a statistically significant difference (p < 0.05), the seroprevalence of hydatid cyst in males and females was 5% and 7%, respectively. Differences in the seropositivity of hydatid cysts were also statistically significant by occupation (p < 0.05). The seroprevalence of hydatid cyst was significantly higher in the age group of 35-45 years than in other age groups (p < 0.05). Multivariate logistic regression showed that only age was associated with seropositivity to CE (OR = 2.23, 95% CI: 1.33-3.72). Moreover, there was a statistically significant association between seropositivity to hydatid cysts and underlying diseases such as hypertension (p = 0.049) and fatty liver (p = 0.048). The findings of this study indicate that the seroprevalence rate of CE is relatively high in the Fars province, southern Iran, and this high rate of infection is mainly linked to people's jobs and lifestyles.

An Epidemiologic Overview of Traumatic Vascular Injures in Emergency Department; a Retrospective Cross-Sectional Study.

Introduction: Vascular system injuries (VSIs) are one of the main causes of preventable mortality and morbidity of trauma patients. This study aimed to evaluate baseline characteristics, presenting signs, managements, and outcomes of patients presenting to emergency department (ED) with traumatic VSIs. Methods: This retrospective cross-sectional study was conducted on patients with traumatic VSIs admitted to the ED of a referral tertiary trauma center, during one year. Using a pre-prepared checklist, demographics, pre-hospital care, type of VSIs, injury severity score (ISS), anatomical location of trauma, associated injuries, method of surgery, complications, and outcome were collected from patients' profiles and reported. Results: One hundred and twelve patients with the mean age of 33.5 ± 14.7 (range = 8 - 80) years were studied (90.2% male). Most of the patients were categorized as mild or moderate in terms of their ISS. 90 (80.4%) patients had at least one soft sign and 99 (88.4%) patients had at least one hard sign. Isolated arterial injury was diagnosed in 90 (80.4%) patients, isolated venous injuries in 12 (10.7%) cases, and combined arteriovenous injuries in 10 (8.7%) patients. The most common associated injury was tendon rupture (63.4%) and nerve injuries were present in 60.7% of patients. 1 (0.9%) patient died, 6 (5.4%) patients went through amputation, and 3 (2.7%) patients were discharged against medical advice. The rest of the patients were discharged in perfect health. There was a significant correlation between trauma type (p = 0.001), upper and lower extremity trauma (p < 0.001), presence of distal ischemia and lack of pulse (p = 0.041), penetrating injury close to a major vessel (p = 0.006), type of injured vessels and arteries (p<0.001), injury to nerve (p = 0.011) and tendon (p = 0.007), presence of open fracture (p = 0.005), multiple trauma (p < 0.001), method of surgery (p < 0.001), and number of postoperative complications (p< 0.001) with poor outcome. Conclusion: The findings showed that the majority of the studied patients were young males, most of whom were discharged in perfect situation. Those who presented with higher ISS, or were affected by blunt trauma or injury to lower limb arteries had worse outcome than the others.

Unusual manifestation of COVID-19-associated pulmonary aspergillosis: A case report.

A young man, a recent coronavirus patient, was readmitted with hypoesthesia and dysarthria following a rapid deterioration of respiratory symptoms. The brain and lung CT scans revealed ischemia and cavitary lung lesions. Clinical suspicion for aspergillus leads to prompt treatment, confirmed by biopsy. Neurologic and pulmonary symptoms resolved ultimately.

Comparison of laboratory-based and non-laboratory-based WHO cardiovascular disease risk charts: a population-based study.

BACKGROUND: Determining the risk of Cardiovascular Disease (CVD) is a necessity for timely preventive interventions in high-risk groups. However, laboratory testing may be impractical in countries with limited resources. This study aimed at comparison and assessment of the agreement between laboratory-based and non-laboratory-based WHO risk charts models. METHODS: This study was performed using the baseline data of 8138 participants in the pars cohort study who had no history of CVD and stroke. The updated 2019 WHO model was used to determine the 10-year fatal and non-fatal CVD risks. In general, there are two types of new WHO risk prediction models for CVD. The scores were determined based on age, sex, smoking status, diabetes, Systolic Blood Pressure (SBP), and total cholesterol for the laboratory-based model and age, sex, smoking status, SBP, and Body Mass Index (BMI) for the non-laboratory-based model. The agreement of these two models was determined via kappa statistics for the classified risk (low: < 10%, moderate: 10-< 20%, high: ≥ 20%). Correlation coefficients (r) and scatter plots was used for correlation between scores. RESULTS: The results revealed very strong correlation coefficients for all sex and age groups (r = 0.84 for males < 60 years old, 0.93 for males ≥ 60 years old, 0.85 for females < 60 years old, and 0.88 for females ≥ 60 years old). In the laboratory-based model, low, moderate, and high risks were 76.10%, 18.17%, and 5.73%, respectively. These measures were respectively obtained as 77.00%, 18.08%, and 4.92% in the non-laboratory-based model. Based on risk classification, the agreement was substantial for males < 60 years old and for both males and females aged ≥ 60 years (kappa values: 0.79 for males < 60 years old, 0.65 for males ≥ 60 years old, and 0.66 for females ≥ 60 years old) and moderate for females < 60 years old (kappa = 0.46). CONCLUSIONS: The non-laboratory-based risk prediction model, which is simple, inexpensive, and non-invasive, classifies individuals almost identically to the laboratory-based model. Therefore, in countries with limited resources, these two models can be used interchangeably.