Formulation and evaluation of atovaquone-loaded macrophage-derived exosomes against Toxoplasma gondii: in vitro and in vivo assessment.

IMPORTANCE: This study is the first of its kind that suggests exosomes as a nano-carrier loaded with atovaquone (ATQ), which could be considered as a new strategy for improving the effectiveness of ATQ against acute and chronic phases of Toxoplasma gondii.

Parasitological and histopathological features of appendectomy specimens in Fars Province, southern Iran: a retrospective study.

Although the appendix is the most commonly resected and examined intra-abdominal organ, the pathogenesis and etiology of acute nonspecific appendicitis remain enigmatic. This retrospective study aimed to assess the prevalence of parasitic infection in surgically removed appendices and to evaluate the probable associations between the presence of parasites and the occurrence of appendicitis through parasitological and histopathological examinations of the appendectomy specimens. Materials and methods: This retrospective study was carried out from April 2016 to March 2021 among all patients referred to hospitals affiliated with Shiraz University of Medical Sciences, Fars Province, Iran, for appendectomy. Patient information, including age, sex, year of appendectomy, and type of appendicitis, was collected from the available data in the hospital information system database. In positive cases, all pathology reports were retrospectively evaluated for the presence of the parasite and its type, and analytical and descriptive statistics were carried out using SPSS software version 22. Results: A total of 7628 appendectomy materials were evaluated in the present study. Of the total participants, 4528 (59.4%, 95% CI: 58.2-60.5) were males, and 3100 (40.6%, 95% CI: 39.5-41.8) were females. The mean age of participants was 23.87±14.28 years. Overall, Enterobius vermicularis was observed in 20 appendectomy specimens. Fourteen of these patients (70%) were less than 20 years old. Conclusion: This study indicated that E. vermicularis is one of the common infectious agents that could be found in the appendix and may increase the risk of appendicitis. Therefore, in terms of appendicitis, clinicians, and pathologists must be aware of the possible presence of parasitic agents, especially E. vermicularis, to treat and manage the patients sufficiently.

Barriers to the participation of men in reproductive health care: a systematic review and meta-synthesis.

BACKGROUND: Despite emphasizing the importance and benefits of men's active engagement in reproductive health programs, their engagement in reproductive health care is low. Researchers have identified different barriers to men's avoidance of participation in various aspects of reproductive health in different parts of the world. This study provided an in-depth review of the hindrances to men's non-participation in reproductive health. METHODS: This meta-synthesis was conducted using keyword searches in databases including PubMed, Scopus, Web of Science, Cochrane, and ProQuest until January 2023. Qualitative English-language studies that investigated barriers to men's participation in reproductive health were included in the study. The critical appraisal skills program (CASP) checklist was used to assess the articles' quality. Data synthesis and thematic analysis were done using the standard method. RESULT: This synthesis led to the emergence of four main themes such as failure to access all inclusive and integrated quality services, economic issues, couples' personal preferences and attitudes, and sociocultural considerations to seek reproductive healthcare services. CONCLUSION: Healthcare system programs and policies, economic and sociocultural issues, and men's attitudes, knowledge, and preferences, influence men's participation in reproductive healthcare. Reproductive health initiatives should focus on eliminating challenges to men's supportive activities to increase practical men's involvement in reproductive healthcare.

Women's interdependence after hysterectomy: a qualitative study based on Roy adaptation model.

BACKGROUND: Hysterectomy is a difficult process that some women encounter that can affect their interdependence, but its impact on women's Interdependence has received less attention. Therefore, this study aimed to explain women's Interdependence after hysterectomy. METHODS: This qualitative study was performed using a directed content analysis approach in Mashhad (Iran). Thirty women with a history of hysterectomy were included in the study by purposive sampling method. Data were collected from August 2018 to November 2019 using semi-structured interviews based on the interdependence mod of the Roy adaptation model until data saturation. Data analysis was performed using MAXQDA software and the deductive approach of Elo and Kingas (J Adv Nurs 62(1):107-115, 2008. https://doi.org/10.1111/j.1365-2648.2007.04569.x ). RESULTS: Data analysis led to the production of 537 initial codes from participants' experiences. By merging and categorizing them, the theme of "increasing interdependence" emerged, which consists of 2 categories: "Evolution independence and interaction with important people in life" and "Reinforced support system", that include six subcategories. CONCLUSION: After hysterectomy, women not only feel a strong need for support from family members, especially their husbands, they are also seeking support from health care providers and their colleagues. Before the hysterectomy, it is recommended that family members be consulted to ensure the emotional support and care of women after the hysterectomy. It can help the adaptation to hysterectomy.

Toxoplasma gondii Infection in Immunocompromised Patients in Iran (2013-2022): A Systematic Review and Meta-Analysis.

Background: Toxoplasma gondii infection (toxoplasmosis) has the potential to cause a serious disease in immunocompromised patients and can be fatal in this population. We conducted a systematic review and meta-analysis to assess comprehensively the pooled seroprevalence of toxoplasmosis among immunocompromised patients including HIV/AIDS patients, cancer patients, and transplant recipients in Iran. Methods: PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and Scientific Information Database (SID), Magiran, IranMedex, and IranDoc databases (national) were systematically searched for all reports that possibly contained data for T. gondii prevalence in different immunocompromised populations in Iran between 2013 and 2022. Results: Overall, IgG seroprevalence rate of toxoplasmosis in Iranian immunocompromised patients was 45.1% (95% confidence interval (CI), 37.4-52.9). IgG seroprevalence rate of toxoplasmosis in 12 studies that included 2279 cancer patients, 19 studies that included 2565 HIV/AIDS patients and in 3 studies that included 200 transplant recipients was 43.6% (95% CI, 30.2-57.0), 45.9% (95% CI, 34.8-57.1) and 45.8% (95% CI, 32.5-59.0), respectively. Moreover, IgM seroprevalence rate in the 26 studies was 2.6% (95% CI, 1.4-3.7). Conclusion: Our findings represent a high seroprevalence rate of Toxoplasma IgG among immunocompromised patients. Health improvement and education toward prevention of toxoplasmosis is of great importance for these susceptible populations.

Iranian Women's Self-concept after Hysterectomy: A Qualitative Study.

BACKGROUND: The loss of female organs leads to profound changes in one's perception of oneself. There is limited information about the impact of hysterectomy on women's self-concept and culture. Therefore, this study was conducted with the aim to deepen our understanding of the self-concept of Iranian women after hysterectomy. MATERIALS AND METHODS: This qualitative study was conducted using directed content analysis approach. The participants included 30 women with a history of hysterectomy who were selected through purposive sampling method. Data were collected from August 2018 to November 2019 using in-depth and semi-structured interviews based on the self-concept mode of the Roy Adaptation Model (RAM) in Mashhad, Iran. Data analysis was performed using the deductive approach of Elo and Kyngäs in MAXQDA software. RESULTS: As a result of the analysis of the interviews, the main category of "incoherent cognition of self-concept" emerged, which included the two generic categories of "heterogeneous feelings toward and imaginations of the body" and "changed self-perception", and five subcategories. CONCLUSIONS: Women's self-concept changed after hysterectomy in both its physical and psychological aspects. Therefore, counseling before and after hysterectomy is recommended to improve women's self-concept after hysterectomy.

Intestinal parasites among food handlers in Iran: A systematic review and meta-analysis.

Regarding preparing and serving foods, food handlers have an influential role in the spreading of foodborne infections. Due to the great potential to cause foodborne infections, intestinal parasites (IPs) are considered a significant public health problem in today's societies. In Iran, despite several regional reports, national data on IPs prevalence in food handlers are lacking. The aim of the present study, therefore, is to estimate the pooled prevalence of IPs infections and associated pooled odds ratio of educational level among food handlers in Iran. PubMed, Web of Science, Scopus, Embase, and Google Scholar databases (international) and SID and Magiran databases (national) were systematically searched for studies that reporting the prevalence of IPs in food handlers in Iran, published between 2000 and 2020. Pooled prevalence was estimated using a random-effects model with a 95% confidence interval (CI) and depicted as a forest plot, while heterogeneity was evaluated using Cochran's Q-test. The overall pooled prevalence estimate for IPs was 19.3% (95% CI = 14.9-23.7%). Prevalence of the protozoan parasites (20%, 95% CI = 13.7-26.3%) was significantly higher than that of the helminthic parasites (1.6%, 95% CI = 1.1-2.0%). Giardia lamblia (5.2%), Entamoeba coli (5.0%), and Blastocystis spp. (4.4%), as protozoan parasites, and Ascaris lumbricoides (1.4%), Enterobius vermicularis (0.9%), and Hymenolepis nana (0.5%), as helminthic parasites, were the most commonly reported species. Food handlers with low educational levels were 20% more exposed to IPs infection, compared to those with high educational levels (OR = 1.21, 95% CI = 0.88 to 1.65). The prevalence of IPs infections among food handlers in Iran is significant. Besides taking into account this epidemiologic information, a holistic approach, including periodic stool screening, health education, and treatment of infected food handlers, will help in the control of these infections in Iran.

Clinical and Epidemiological Characteristics of Coronavirus Disease 2019 in Iran: a Hospital-Based Observational Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been pandemic and has caused a great burden on almost all countries across the world. Different perspectives of this novel disease are poorly understood. This study sought to investigate the clinical and epidemiological characteristics of COVID-19 to efficiently assist the health system of Iran to conquer the outbreak. MATERIALS AND METHODS: This retrospective observational study was performed on 394 patients with a diagnosis of COVID-19. The patients should have a history of hospitalization at Loghman-Hakim hospital, Tehran, Iran, for 10 weeks, beginning from the first official report of the disease in Iran. In the subsequent step, the baseline demographic and clinical and paraclinical information of the patients was documented. Finally, the patients were assessed if they had exhibited any morbidity or mortality. RESULTS: The epidemiological examination of the COVID-19 population suggested a bell diagram pattern for the hospitalization rate, in which the 4th week of the study was the peak. The highest rate of secondary adverse events due to the virus was observed at the 6th and 7th weeks of the study course. On another note, clinical evaluations resulted in identifying specific abnormalities, such as bilateral opacity in chest computed tomography scans or low oxygen saturation in laboratory data. CONCLUSION: This study provides evidence concerning the clinical and epidemiological characteristics of COVID-19 in the first phase of the virus outbreak in Iran. Further studies comparing the disease features in the subsequent phases with findings of this study can pave the way for additional information in this regard.

A systematic review and meta-analysis of Hymenolepis nana in human and rodent hosts in Iran: A remaining public health concern.

Hymenolepis nana, as a neglected zoonotic helminth, naturally occurs in both humans and rodents. Herein, a systematic review and meta-analysis was carried out to estimate pooled prevalence of H. nana infection among human and rodent hosts for the first time in Iran. PubMed, Web of Science, Scopus, and Embase databases (English articles) and SID and Magiran databases (Persian articles) were systematically searched for relevant studies published from inception till May 24, 2020. Chi2 and I2 index were used to assess the heterogeneity of the included studies. Publication bias was assessed using Egger's intercept and visual inspection of the funnel plot. Pooled prevalence was estimated using random-effects model with 95 % confidence interval (CI) and depicted as a forest plot. STATA software was used for analysis. The overall pooled prevalence estimate of H. nana in humans included 1.2 % (95 % CI = 1.0-1.4%). Subgroup analysis revealed 2.2 % (95 % CI = 1.8-2.6%) and 0.5 % (95 % CI = 0.3 to 0.8 %) of H. nana infection among school children and food handlers, respectively. In terms of rodent hosts, the overall pooled prevalence of H. nana infection included 13 % (95 % CI = 9.3-16.6%). Subgroup analysis revealed the highest rate of the infection was in Rattus spp. (19.6 %; 95 % CI = 10.6-28.6%), a genus with synanthropic behavior. It seems, despite the advancement in sanitation infrastructure and hygiene status, the H. nana infection compares to other helminthic diseases remains a challenging public health problem in Iran.

Glucantime-loaded electrospun core-shell nanofibers composed of poly(ethylene oxide)/gelatin-poly(vinyl alcohol)/chitosan as dressing for cutaneous leishmaniasis.

Leishmaniasis, one of the main concerns of the World Health Organization, is a parasitic disease caused by Leishmania species. The main objective of this study was to prepare a topical drug delivery system that can deliver glucantime to the site of cutaneous Leishmania wounds. Using the electrospinning method, a core-shell nanofibrous mat composed of macromolecules including polyethylene oxide, gelatin, poly (vinyl alcohol) and chitosan was prepared. The prepared nanofibers were characterized by scanning electron microscopy (SEM), transmission electron microscopy, Fourier transform infrared spectroscopy (FT-IR), tensile test and in vitro drug release test. The anti-Leishmania activities of drug-loaded nanofibers against Leishmania promastigotes and its cytotoxicity on fibroblasts were determined respectively by flow-cytometry and indirect MTT methods. Results of morphological studies showed that uniform nanofibers were prepared without any bead with average diameter of 404 nm. The TEM investigation confirmed the core-shell structure of the fibers. The in-vitro drug release assay was executed using Franz diffusion cell, which indicted 84% of glucantime was released during the first 9 h. The results indicated that 4 and 6 cm2 of nanofibers mat were significantly killed promatigotes up to 78%. Moreover, the MTT assay also showed that the fabricated nanofibers do not possess any cytotoxicity towards fibroblast cells.

Comparison of camel, dog and the laboratory animals' sera with the fetal calf serum (FCS) for cultivation of Leishmania major.

The best-known serum for Leishmania spp. cultivation is the fetal calf serum (FCS), which is very expensive with ethical concerns. This study was conducted to compare various laboratory (BALB/c mice, rat, rabbit, hamster and guinea pig) and non-laboratory (dog and camel) animals' sera as a substitute for FCS in L. major culture. L. major, MRHO/IR/75/ER strain, was cultivated in RPMI-1640 medium enriched with different percentages of mentioned animal's sera. Parasite growth was checked constantly. The rate of growth and survival of parasites were compared with a control medium enriched with FCS. As well, biochemical (albumin, globulin AST, ALT, ALP, Bil, BUN, Crea, Ca, P, Na, K, Fe, TIBC, Mg, zinc, Chol, HDL, LDL, TG, BS, uric acid, LDH, CPK) analysis of all sera was performed and compared with FCS. The most promastigote growth rate is considered in 10% BALB/c, guinea pig and hamster sera on the 6th day of cultivation. Also, on the 8th day, parasites showed viability in all animal sera. The promastigote growth in culture media enriched with the camel and the dog sera in comparison with laboratory animals was considered very low. Differences between 10% FCS and 10% cocktail serum were not significant (p > 0.05) but with other sera were significant (p < 0.05). Also, differences between BALB/c with hamster and guinea pig sera were not significant, respectively (p = 0.07 and p = 0.09). According to the biochemical analysis of all sera, the higher content of iron was detected in the hamster, guinea pig, BALB/c and fetal calf sera. The magnesium and zinc content of guinea pig and BALB/c serum was found to be more than the others and comparable with FCS. The promastigote growth decreased by camel, dog and rat sera orderly. In this study, a rapid increase in parasite growth in media supplemented with hamster, BALB/c and guinea pig sera was considered. It could be suggested to use these sera as a suitable alternative for FCS in molecular biology researches.

Seroprevalence and associated risk factors of toxocariasis among nomads in Boyer-Ahmad County, southwest Iran.

BACKGROUND: Human toxocariasis is caused by the larval stage of Toxocara canis and Toxocara cati. This cross-sectional study was conducted to evaluate the seroprevalence and the risk factors associated with Toxocara infection in nomads of Boyer-Ahmad County in the southwest of Iran. METHODS: A total of 968 blood samples were collected from nomads. A structured questionnaire, containing sociodemographic data, was completed for each participant. Sera were evaluated for anti-Toxocara antibodies, using the T. canis excretory-secretory antigens prepared from the second stage larvae, in an ELISA system. RESULTS: Among the 968 participants, 220 (22.7%) were males and 748 (77.3%) were females; the mean age was 40.71 y. Anti-Toxocara IgG antibodies were detected in 14 (1.4%) of the 968 nomads. The association between Toxocara infection and gender, age, contact with dogs, residential area and level of education were not statistically significant (p>0.05). CONCLUSIONS: The findings of the study revealed a low prevalence rate of toxocariasis in nomadic communities in southwest Iran. Geographic location and climatic conditions as well as the lifestyle and sociodemographic features of the participants may contribute to the low prevalence rate of Toxocara infection.