Seroprevalence of Strongyloides stercoralis among patients with leptospirosis in northern Iran: a descriptive cross-sectional study.

Strongyloidiasis and leptospirosis are neglected tropical diseases that have affected many countries across the world. In this study, we evaluated the seroprevalence of Strongyloides stercoralis among patients with leptospirosis in northern Iran. We evaluated 156 laboratory- or clinically confirmed leptospirosis cases. The overall seroprevalence of S. stercoralis was 32.0% (95% confidence interval (CI): 27.4-36.5%, 50/156). Seropositivity was significantly associated with agricultural activities (odds ratio (OR): 2.84, 95% CI: 1.0-8.77) and gastrointestinal disorders (OR: 2.4, 95% CI: 1.1-4.9). Laboratory findings indicated that seropositivity of S. stercoralis was significantly associated with decreased levels of platelet and elevated levels of creatinine, alanine aminotransferase and aspartate aminotransferase (P < 0.05). Our findings suggested a higher exposure to S. stercoralis larvae among patients with leptospirosis. The public health and medical communities may benefit from this research through preventive measures to improve farmers' knowledge and awareness regarding strongyloidiasis and leptospirosis and the associated risk factors.

Risk factors for mortality of 557 adult patients with COVID 19 in Babol, Northern Iran: a retrospective cohort study.

BACKGROUND: This study was aimed to investigate the risk factors for mortality in patients with COVID-19. METHODS: For this retrospective cohort study, we included 121 deceased and 436 discharged cases with COVID-19 in Babol, Northern Iran. The cases were between March 1 to April 1, 2020. RESULTS: Multivariate Poisson regression analysis revealed that older age (aRR: 1.03, 95% CI: 1.01, 1.05, p < 0.001), hospital length of stay (aRR: 0.94, 95% CI: 0.90, 0.97, p = 0.003), ICU admission (aRR: 4.34, 95% CI: 2.95, 6.37, p < 0.001), cerebrovascular disease (aRR: 1.96, 95% CI: 1.20, 3.19, p = 0.007), ventilator-associated pneumonia (VAP) (aRR: 2.09, 95% CI: 1.22, 3.55, p = 0.006), septic shock (aRR: 2.98, 95% CI: 1.44, 6.19, p = 0.003), acute respiratory distress syndrome (ARDS) (aRR: 3.80, 95% CI: 2.28, 6.31, p < 0.001), acute kidney failure (AKF) (aRR: 1.45, 95% CI: 1.12, 3.76, p = 0.021), acute heart failure (AHF) (aRR: 1.63, 95% CI: 1.01, 2.62, p = 0.043) and lymphocyte count (aRR: 3.01, 95% CI: 1.99, 4.57, p < 0.001) were associated with mortality. CONCLUSION: Findings showed that elderly with comorbidities such as cerebrovascular diseases had an increased risk of death. Some complications such as: pneumonia, septic shock, ARDS, AHF, and AKF played crucial roles as well death (Tab. 2, Ref. 25).

Toxocara eggs in public places worldwide - A systematic review and meta-analysis.

Toxocariasis is a neglected tropical disease of humans. Although many studies have indicated or shown that environmental contamination with Toxocara species eggs is a major risk factor for toxocariasis in humans, there has been no comprehensive analysis of published data or information. Here, we conducted the first systematic review and meta-analysis of current literature to assess the global prevalence of Toxocara eggs in public places (including beaches, parks and playgrounds). We conducted searches of the PubMed, Embase, Scopus and Science Direct databases for relevant studies published until 20 April 2018, and assessed the prevalence rates of Toxocara eggs in public places. We used the random effects model to calculate pooled prevalence estimates, with 95% confidence intervals (CIs), and analysed data in relation to WHO geographical regions. Subgroup analysis and meta-regressions regarding the geographical and environmental variables were also performed. Of 2384 publications identified, 109 studies that tested 42,797 soil samples in 40 countries were included in the meta-analysis. The pooled global prevalence of Toxocara eggs in public places was 21% (95% CI, 16-27%; 13,895/42,797). The estimated prevalence rates in the different WHO regions ranged from 13% to 35%: Western Pacific (35%; 95% CI, 15-58%), Africa (27%; 95% CI, 11-47%), South America (25%; 95% CI, 13-33%), South-East Asia (21%; 95% CI, 3-49%), Middle East and North Africa (18%; 95% CI, 11-24%), Europe (18%; 95% CI, 14-22%), and North and Central Americas (13%; 95% CI, 8-23%). A high prevalence was significantly associated with high geographical longitude (P = 0.04), low latitude (P = 0.02) and high relative environmental humidity (P = 0.04). This meta-analysis of data from published records indicates that public places are often heavily contaminated with eggs of Toxocara. This finding calls for measures to reduce the potential risk of infection and disease in humans.

Seroprevalence and molecular detection of Toxoplasma gondii in young healthy blood donors in Northern Iran.

T. gondii is a life-threatening infection in immunocompromised patients which may be transmitted through blood transfusion. The present study aimed to evaluate the seroprevalence and molecular detection of T. gondii infection and the associated risk factors among young healthy blood donors in the central part of Mazandaran province, northern Iran. Blood samples were taken from 500 participants and the serum was separated. All serum samples were tested for the presence of anti-T. gondii antibodies (IgG) and then all positive samples were evaluated for IgM antibodies using commercial ELISA kits. All IgM positive samples and 66 randomly selected IgG positive samples were further tested by PCR of the REP-529 gene. Anti-Toxoplasma antibodies (IgG) avidity test was performed for 142 IgG positive samples which were randomly selected. In the current study, anti-T. gondii antibodies (IgG) and (IgM) were found in 316 (63.2%) and 3 (0.95 %) participants, respectively. Seropositivity rate of Toxoplasma was higher among blood donors living in rural areas (P=0.000) and those with a history of soil and animal contact (P<0.05). PCR of the REP-529 gene showed T. gondii DNA in 21 out of 66 samples. The REP-529 gene was not detected in IgM positive samples. Low avidity antibodies (IgG) was found in 23.2% of the IgG positive samples. In conclusions, this study found that the prevalence of toxoplasmosis among young healthy blood donors in north of Iran was high. To reduce the risk of parasite transmission, leukofilteration method are recommended for donated blood used for immunosuppressed patients.

Seroprevalence and molecular detection of Toxoplasma gondii in young healthy blood donors in Northern Iran

@#T. gondii is a life-threatening infection in immunocompromised patients which may be transmitted through blood transfusion. The present study aimed to evaluate the seroprevalence and molecular detection of T. gondii infection and the associated risk factors among young healthy blood donors in the central part of Mazandaran province, northern Iran. Blood samples were taken from 500 participants and the serum was separated. All serum samples were tested for the presence of anti-T. gondii antibodies (IgG) and then all positive samples were evaluated for IgM antibodies using commercial ELISA kits. All IgM positive samples and 66 randomly selected IgG positive samples were further tested by PCR of the REP-529 gene. Anti-Toxoplasma antibodies (IgG) avidity test was performed for 142 IgG positive samples which were randomly selected. In the current study, anti-T. gondii antibodies (IgG) and (IgM) were found in 316 (63.2%) and 3 (0.95 %) participants, respectively. Seropositivity rate of Toxoplasma was higher among blood donors living in rural areas (P=0.000) and those with a history of soil and animal contact (P<0.05). PCR of the REP-529 gene showed T. gondii DNA in 21 out of 66 samples. The REP-529 gene was not detected in IgM positive samples. Low avidity antibodies (IgG) was found in 23.2% of the IgG positive samples. In conclusions, this study found that the prevalence of toxoplasmosis among young healthy blood donors in north of Iran was high. To reduce the risk of parasite transmission, leukofilteration method are recommended for donated blood used for immunosuppressed patients.

The prevalence of chronic kidney disease and associated factors among patients admitted at princess marina hospital, Gaborone, Botswana.

BACKGROUND: Chronic kidney disease (CKD) has become a major public health problem worldwide. Due to the asymptomatic nature of CKD during earlier stages, patients tend to present late, missing opportunities for prevention. AIMS: This study was conducted to determine the prevalence and assess the risk factors associated with CKD in patients admitted at Princes Marina Hospital. SETTINGS AND DESIGN: Hospital inpatient setting. SUBJECTS AND METHODS: A case-matched comparison study was done involving 86 cases and 86 matches by gender and age (± 5 years) from March 21, 2014, to May 31, 2014. STATISTICAL ANALYSIS USED: SPSS software version 20 (SPSS Inc. Chicago Illinois) was used for data entry, cleaning, and analysis. Frequency, percentage, mean, and standard deviation were used to describe the data. Chi-squared test and odds ratio (OR) with 95% confidence interval (CI) were employed to analyze the associations of categorical variables. Logistic regression analysis was done to control for possible confounding variables. A P < 0.05 was considered statistically significant. RESULTS: In the study period, CKD prevalence was 74/550 (13.5%), and 23/99 (23.2%) of mortality occurred in patients with CKD. Over half of the 86 cases of CKD (53.5%) were not aware of their CKD status and were diagnosed during the index admission. Hypertension (HTN), diabetes mellitus, and HIV-positive status were significantly associated (P < 0.05) with CKD in the bivariate analysis, while HTN (adjusted OR [AOR] [95% CI]: 11.28 [4.56, 27.89]) and HIV-positive status (AOR [95% CI]: 8.68 [3.58, 20.99]) remained significant predictors of CKD in the multivariate analysis. CKD within the HIV-positive patients was significantly associated with duration of <3 years since HIV diagnosis and lower CD4 levels (P < 0.05). CONCLUSIONS: Significant admissions and mortality in medical wards are attributed to renal impairment. There is an urgent need to establish follow-up programs in high-risk populations (hypertensives, diabetes, and HIV) which aims to identify patients at early stages of CKD, and devise prevention mechanisms to reduce burden in terms of cost, morbidity, and mortality.

Evaluation of CD4+ CD25+ FoxP3+ regulatory T cells during treatment of patients with brucellosis.

Cell-mediated immunity (CMI) plays a critical role in the control of brucellosis. Regulatory T cells (Tregs) have a functional character in modulating the balance between host immune response and tolerance, which can eventually lead to chronic infection or relapse. The aim of this study was to assess the alteration of Tregs in cases of brucellosis before and after treatment. Thirty cases of acute brucellosis with the mean age of 41.03±15.15 years (case group) and 30 healthy persons with the mean age of 40.63±13.95 years (control group) were selected and assessed. Peripheral blood mononuclear cells (PBMCs) were isolated from peripheral blood of all individuals. We analyzed the alteration of Treg cell count using flow cytometry for CD4, CD25, and FoxP3 markers. The level of CD4+ CD25+ FoxP3+ Treg cells was increased in active patients compared with controls (2.5±0.99% vs 1.6±0.84%, p= 0.0004), but it had declined in the treated cases (1.83±0.73%, p=0.02). The level of Tregs was elevated in three relapsed cases. The frequency of Tregs and Treg/Teff (effector T cell) ratio was correlated with inverse serum agglutination test (SAT) and, 2-mercaptoethanol (2-ME) titers as markers of treatment in brucellosis. Based on our findings, we suggest that regulatory cells, such as CD4+ CD25+ FoxP3+ Treg cells, may contribute to the development of infection processes involving immune responses in brucellosis, and evaluation of regulatory T-cell levels may be a potential diagnostic strategy for the treatment outcome in chronic and relapsed cases of brucellosis.

Pain management during needle insertion with low level laser.

AIM: To date, there is no safe, effective, and rapid method to eliminate the pain associated with needle insertion. It is noticed that using a low-energy laser before intradermal and intramuscular injection would help rapid local anaesthesia with a lidocaine product. However, there is no valuable data on the effect of the concomitant use of laser and benzocaine as a pre-treatment option, compared to local application of benzocaine products alone before needle insertion. MATERIALS AND METHODS: A prospective single-blind clinical trial was designed to assess pain perception during needle insertion into mucosa in 66 healthy volunteer dental students. They received a topical anaesthetic agent on one side (control) applied for one minute and a topical anaesthetic agent plus low-power laser on the other side (experimental) prior to needle insertion. The first pre-treatment method was chosen based on block randomisation table. A dentist recorded the subjects' reaction based on the visual analogue scale (VAS) during insertion of needle in the two groups. SPSS version 15 was used for data analysis. The statistical significant level was defined at P-value< 0.01. RESULTS: The mean scores of VAS for the experimental and control groups was 21± and 19± 2.70 respectively, with a statistically significant higher VAS score in the experimental group, although it was not clinically significant. CONCLUSION: Simultaneous application of laser with local anaesthetic products containing benzocaine in the buccal mucosa before dental needle insertion does not reduce pain perception.

The effect of nasal midazolam premedication on parents-child separation and recovery time in dental procedures under general anaesthesia.

AIM: For many children medical and dental procedures, unfamiliar dental staff and treatment places are disturbing and stressful. Stress in children often makes them uncooperative. General anaesthesia is indicated for anxious uncooperative children or those who are disabled, immature or too young to undergo dental treatment by other means. Moreover parents' separation while entering the operative room is a traumatic experience for children. Thus premedication such as midazolam is recommended to decrease child's stress. In these situations the increased recovery time was considered as one of the midazolam side effects. There is no study that evaluated the effect of midazolam both in parents-child separation and recovery time in long dental procedure. The purpose of this study was to evaluate the effect of nasal midazolam premedication with placebo on parents-child separation and recovery times in uncooperative paediatric patients undergoing long-lasting general anaesthesia for dental procedures. STUDY DESIGN: This randomised, double-blind study was done on 60 uncooperative patients (ASA physical status I or II) aged 2-4 years who were scheduled for general anaesthesia for dental treatment. Group A received 0.2 mg/kg intranasal midazolam as premedication, and group B received the same volume of intranasal placebo 20 minutes before entering the operating room for general anaesthesia. General anaesthesia was done with the same method for all patients, then parent-child separation and recovery times were compared between the two groups. STATISTICAL ANALYSIS: Statical significance was set at P≤0.05. Statically analysis was performed using SPSS version17.Chi-squared and student t-tests were applied to analyse the data. RESULTS: We found significant differences in parents- child separation assessment between two groups. Nasal midazolam premedication had a positive effect on parents-child separation; but there was no significant difference between the two groups in terms of recovery time. CONCLUSION: Premedication of nasal midazolam before induction of general anaesthesia did not prolong recovery time but made the separation of children from their parents easier by showing a better behaviour.

Plasmodium falciparum: Adhesion Phenotype of Infected Erythrocytes Using Classical and Mini-Column Cytoadherence Techniques.

BACKGROUND: Cytoadherence of Plasmodium falciparum- infected erythrocytes to host cells is an important trait for parasite survival and has a major role in pathology of malaria disease. Infections with P. falciparum usually consist of several subpopulations of parasites with different adhesive properties. This study aimed to compare relative sizes of various binding subpopulations of different P. falciparum isolates. It also investigated the adhesive phenotype of a laboratory P. falciparum line, A4, using different binding techniques. METHODS: Seven different P. falciparum isolates (ITG, A4, 3D7 and four field isolates) were cultivated to late trophozoite and schizont and then cytoadherence to cell differentiation 36 (CD36), intercellular cell adhesion molecule-1 (ICAM-1), and vascular cell adhesion molecule (V-CAM) and E-selectin were examined. The relative binding sizes of parasite subpopulations to human receptors were measured by mini-column cytoadherence method. The adhesion phenotype of P. falciparum-A4 line was evaluated by in vitro static, flow-based and mini-column binding assays. RESULTS: The relative binding size of ITG, A4 and 3D7 clones to a column made with CHO/ICAM-1 was 68%, 54% and 0%, respectively. The relative binding sizes of these lines to CHO/CD36 were 59.7%, 28.7% and 0%, respectively. Different field isolates had variable sizes of respective CD36 and ICAM1-binding subpopulations. A4 line had five different subpopulations each with different binding sizes. CONCLUSION: This study provided further evidence that P. falciparum isolates have different binding subpopulations sizes in an infection. Furthermore, measurement of ICAM-1 or CD36 binding subpopulations may practical to study the cytoadherence phenotypes of P. falciparum field isolates at the molecular level.

Malaria in mazandaran, northern iran: passive case finding during 1997-2012.

BACKGROUND: Malaria is one of the most important parasitic diseases in tropical and temperate regions. The aim of this study was to determine the trend of malaria in Mazandaran Province, northern Iran during 1997-2012. METHODS: This retrospective study was conducted from 1997 to 2012. The population's study was individuals who registered at health centers of Mazandaran Province. Peripheral blood smear were prepared for each case, stained with Giemsa and examined by light microscope. In addition to demographic data, other parameters including Slide Positive Rate (SPR), Annual Parasite Incidence (API) and Annual Blood Examination Rate (ABER) were analyzed. RESULTS: In total, 844 cases of malaria were reported. Plasmodium vivax was predominant species with 821 cases (97.4%). The number of malaria cases increased from 1997 to 2005 and then decreased to 3 cases in 2011. Some cities had not reported any cases during last three years. The highest infection rate, 163(20.07%), was seen in 2001-02. The SPR had the highest value (0.54%) in 2004-05. The maximum API and ABER were observed in 2001-02 and 1997-98. 641(75.9%) of cases were imported from hyperendemic areas such as Afghanistan and South-eastern Iran and 94 (11.1%) malaria patients were recorded as introduced cases. The highest infection rate of malaria (21.3%) was seen in Babolsar. CONCLUSION: Extensive malaria control should be continued to Mazandaran to become malaria-free region and in prevention of re-introduction stage.