Challenges and strategies for the internationalization of higher education in low-income East African countries.

As it becomes more crucial to push the boundaries of science to develop new technologies and important global initiatives, internationalization can be instrumental in helping underdeveloped countries overcome challenges such as poverty, climate change, and educational inequalities. Higher education institutions have always faced challenges in the process of internationalization, which have occupied scholarly attention in recent decades, but little research has been conducted on the internationalization of higher education in less developed African countries. This qualitative study aims to shed light on the challenges of internationalization of higher education in low-income countries in East Africa. After reviewing the literature and interviewing academics, the obtained data were thematically analyzed. The results suggested 12 main challenges, which were classified into four major categories. The challenges include a lack of clear policies and guidelines; the inefficiency of the organizational structure of internationalization; financial, infrastructure, and equipment problems; weaknesses in scientific, skill, and language competences; cultural differences; non-reciprocal relationships; and a brain drain. Finally, strategies for responding to these challenges with regard to the internal and external environments of higher education institutions were proposed. Among the internal strategies of higher education institutions are the development of clear policies and visions, planning for the development of human resources, and sustainable budgeting for internationalization programs. External strategies emphasize the development of national policies and laws based on contextual and environmental conditions, as well as interaction and participation in international meetings to expand communication and use the scientific and economic capacities of international agencies and institutions.

Genomic Detection of Mycobacterium avium subspecies paratuberculosis in Blood Samples of Patients with Inflammatory Bowel Disease in Southern Iran.

BACKGROUND: Inflammatory bowel disease (IBD), of which Crohn's disease (CD) and ulcerative colitis (UC) are the two main clinicopathological subtypes, is a group of digestive system diseases of unknown etiology. Risk factors for IBD are environmental factors, genetics, and immune system agents. Mycobacterium avium subspecies paratuberculosis (MAP) is one of the most important infectious factors and a suspected cause of IBD. The present study aimed to determine the prevalence of MAP in both IBD patients and non-IBD people as well as to investigate the relationship between the presence of this bacterium and IBD. METHODS: A cross-sectional study was conducted during May-December 2017 among 146 IBD patients (32 with CD and 114 with UC) at the Motahari Clinic affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. For comparison, the blood samples of 146 non-IBD volunteers (the control group) were tested for the presence of MAP using the polymerase chain reaction method (specific IS900 fragment). The data were analyzed using the SPSS software (version 19.0). The Kolmogorov-Smirnov test was used to evaluate the normal distribution of variables. The χ2 test was used to compare the qualitative variables between the groups. RESULTS: MAP was present in 104 (71.2%) IBD patients out of which 24 (75%) had CD and 80 (70.2%) had UC. In the control group, MAP was present in 63 (43.2%) non-IBD volunteers. There was a significant association between the presence of IBD and MAP (P<0.001). CONCLUSION: A high prevalence of MAP was observed in the South of Iran. MAP DNA was detected in the blood samples of CD and UC patients as well as non-IBD volunteers. The high prevalence of MAP indicated a possible role of MAP in stimulating IBD.

Association Between Non-Alcoholic Fatty Liver Disease and Metabolic Syndrome with Gallstone Disease, South Iran: A Population-Based Study.

AIM: Gallstone disease (GSD), non-alcoholic fatty liver disease (NAFLD), and metabolic syndrome (MetS) are common problems. The aim of this study was to investigate the association between NAFLD, MetS and its components with GSD. MATERIALS AND METHODS: This cross-sectional study was conducted as a part of the Kavar Cohort Study (KCS) affiliated to Shiraz University of Medical Sciences, Shiraz, Iran between January 2012 and January 2018. A total of 2239 participants of the general population of the KCS were selected randomly. Ultrasonography for GSD and NAFLD diagnosis and clinical and laboratory assaying for MetS evaluation were performed for the participants. The National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) and Criteria for Clinical Diagnosis of MetS in Iranian Adults (CCDMIA) were used for diagnosis of MetS. RESULTS: Overall, 59 patients with GSD and 177 age- and sex- matched participants without gallstones as a comparison group were enrolled. According to GSD groups, NAFLD was observed in 42.4% and 22.6% of patients with and without GSD, respectively, and the difference between the two groups was statistically significant (P = 0.003). MetS was present in 33.9% and 39.0% of GSD subjects, compared with 32.8% and 33.3% of the non-GSD group, based on NCEP/ATPIII and CCDMIA, respectively. Although the mean of all components of MetS except HDL-cholesterol were higher in the GSD group than in the non-GSD group,  the difference was only significant in waist circumference (P = 0.041). CONCLUSION: The present study found an obvious association between NAFLD and GSD. This study also showed a significant association between increasing waist circumference and risk of GSD. We recommend that patients with GSD should be evaluated for the likelihood of NAFLD and its treatment in addition to lifestyle changes to gain proper weight. However, further researches are needed to clarify the relationship between the nature of GSD, NAFLD, and obesity.

Effects of Self-Management Education on Self-Efficacy and Quality of Life in Patients with Ulcerative Colitis: A Randomized Controlled Clinical Trial.

BACKGROUND: Self-management (SM) as a dynamic process enables Ulcerative colitis (UC) patients to live with this chronic illness. The present study aimed to investigate the effect of SM education on self-efficacy (SE) and quality of life (QoL) in patients with UC. METHODS: This randomized controlled clinical trial study was conducted on 64 patients with UC from December 2016 to February 2017 at Motahari clinic, Shiraz. Patients were randomly divided into two groups of intervention and control. The education program included six 90-minute sessions in 3 weeks and one month telephone follow-up. Before, immediately and one month after the intervention, the participants filled out the Strategies Used by People to Promote Health (SUPPH) for SE, and the Inflammatory Bowel Disease Questionnaire-9 (IBDQ-9) for Qol. Then, data were entered into SPSS 18.0 and analyzed using independent samples t-test, Chi-square, repeated measures ANOVA and Pearson's correlation coefficient. RESULTS: A significant increase was observed in terms of the overall mean score for SE and its dimensions in the intervention group (P<0.001). These scores were significantly higher than those of the control group (P<0.001), except for positive attitude (P=0.15). The scores for overall Qol and its dimensions significantly increased in the intervention group immediately and one month after the intervention (P<0.001), and the difference between the two groups was significant (P<0.001). There was a significant positive correlation between SE and Qol (r=0.32, P=0.01). CONCLUSION: SM improved the SE and Qol in patients with UC. SM educatoin is recommended in nursing care of patients with UC. Trial Registration Number: IRCT2016092429823N1.

Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective?

INTRODUCTION: Patients with drug addiction have high risk for hepatitis C virus (HCV). Effective treatment response is essential to optimize treatment for drug abusers infected by hepatitis C virus. AIM: The aim of this present study was to show that hepatitis C treatment in patients with drug addiction is effective like patients without drug addiction. MATERIAL AND METHODS: Total amount of 57 patients with hepatitis C (25 drug abuser and 32 non-drug abuser) that referred to Shahid Motahari clinic of Shiraz were selected. All patients infected with HCV treated by combination regimens of ribavirin, sofosbuvir and interferon. Patients received sofosbuvir (400mg once a day) in combination with peg-IFN-alpha (92a180m/w>92b1/5m/kg/w) and RBV (under 75 kg 1000mg, over 75 kg 12000kg) for 12 weeks. The Kolmogorov-Smirnov test was used for testing normality. Associations between variables were analyzed using a Chi-square, Fisher exact, T student and Mann-Whitney U test. RESULTS: Out of 25 HCV patients (43.9%) were drug addicts and 32 patients (56.1%) were non-drug addicts. Insomnia (61.4%), fatigue (63.1%) and debility (49.1%) were more common adverse effects of therapy in drug abusers and non-drug abusers. Alanine transaminase (ALT) and HCV RNA was normal in the end of therapy (EOT). White blood cell (WBC) count decreased in during two-week after starting of the treatment and then increased to normal levels at the end of treatment. Reduction of WBC count was considerable in during two-week. Hematologic result was not considerable. Reduction of hemoglobin was <10 g/dL in 9.37% of non-injecting drug addicts and <8.5 g/dL in 6.25% of injecting drug addicts. The results of this study did not demonstrated a significant relationship about sustained virologic response (SVR) between the drug abusers and non-drug abusers (P = 0.99). CONCLUSIONS: In conclusion, patients with drug addiction can receive hepatitis C treatment on the history of their past or current drug use status. Combination therapy with sofosbuvir plus peginterferon and ribavirin can lead to high treatment response in HCV patients were drug abuser. In addition, this treatment combination was with low discontinuation rates and low adverse effects. Effective intervention in HCV patients with drug addiction to reduce injection- related risk.

Use of endoanal ultrasound as complimentary evaluation for detection of anal sphincter injury after vaginal birth / Uso da ultrassonografia endoanal como avaliação complementar para a detecção de lesão do esfíncter anal após parto vaginal

Abstract Purpose Anal sphincter injury after delivery is the main factor in the pathogenesis of fecal incontinence. Clinical obvious and specific injury to anal canal sphincter is seen in 3% of vaginal deliveries. There are many women who do not have a clear and specific laceration but they are damaged by sphincter muscles of anal canal. The purpose of the present study is to investigate the frequency of occult anal sphincter injury after vaginal delivery by Endo-anal sonography. Methods Fifty women with first pregnancy were assessed at 27-33 weeks of pregnancy, and at 6 weeks and 6 months after vaginal delivery by questionnaire, examination and Endo-anal sonography. Women age, duration of delivery, the effect of epidural anesthesia, episiotomy and birth weight were studied and Endo-anal sonography results were recorded. Anal manometry was performed for all mothers before delivery and 5 ones with sphincter injury at 6 months and 3 years after delivery. Results Five (10%) patients, with mean age 29.4 ± 6.5 years, mean neonatal weight of 3874 ± 287, and mean duration of delivery 11.6 ± 1.51 h, had signs of sphincter injury in Endo-anal sonography. The injury was persisted at six months after delivery. Also, significant differences were seen between anal manometry before delivery and 6 months and 3 years after delivery (p = 0.006 for mean squeezing pressure) in the five mothers. Conclusion Endo-anal sonography might be a good screening tool for early detection of postpartum anal sphincter damages. However, further prospective cost benefit studies should be performed to propose it as a standard of care.

Resumo Finalidade A lesão de esfíncter anal após o parto é o fator principal na patogênese da incontinência fecal. Observa-se uma lesão clínica óbvia e específica ao esfíncter no canal anal em 3% dos partos vaginais. Em muitas mulheres não se percebe uma laceração nítida e específica, mas houve lesão nos músculos esfinctéricos do canal anal. A finalidade desse estudo é investigar a frequência de lesão oculta de esfíncter no canal anal em seguida ao parto vaginal por meio da ultrassonografia endoanal. Métodos Cinquenta mulheres primíparas foram avaliadas no período de 27-33 semanas de gestação e também a 6 semanas e 6 meses após o parto vaginal por meio de questionário, exame e ultrassonografia endoanal. Foram anotados a idade das pacientes, a duração do parto, o efeito da anestesia epidural, episiotomias e peso do bebê ao nascer; também foram registrados os resultados da ultrassonografia endoanal. Antes do parto, todas as gestantes foram submetidas a um exame de manometria; e 5 mães com lesão esfinctérica também passaram por esse procedimento a 6 meses e 3 anos após o parto. Resultados Cinco (10%) pacientes, com média de idade = 29,4 ± 6,5 anos, peso médio do bebê ao nascer = 3874 ± 287 gramas e duração média do parto = 11,6 ± 1,51 horas, apresentavam sinais de lesão esfinctérica ao exame por ultrassonografia endoanal. Seis meses após o parto, as lesões persistiam. Também foram observadas diferenças significativas entre a manometria anal antes do parto e a 6 meses e 3 anos após o parto (p = 0,006 para média de pressão de contração) nas cinco mães. Conclusão A ultrassonografia endoanal pode ser um bom instrumento de triagem para a detecção precoce de lesões do esfíncter anal no pós-parto. Contudo, é importante que sejam realizados novos estudos prospectivos e de custo-benefício, para que essa técnica possa ser proposta como padrão terapêutico.

Stereological comparison of intraprostatic injection of alcohol and bleomycin with finasteride gavages in rats.

INTRODUCTION: Resection of the prostate is one of the standard surgical treatments for symptomatic Benign Prostatic Hyperplasia (BPH). To evaluate minimally invasive treatments, intraprostatic injections of ethanol and bleomycin were compared with oral finasteride administration in rats with BPH. MATERIAL AND METHODS: The rats were divided into six groups. The control rats received no BPH/no treatment. BPH was induced using injections of testosterone (2 mg/day/rat for 4 weeks) in groups II-VI. After 4 weeks, Group II received no treatment while Group III received oral finasteride (10 mg/kg/day). Moreover, Groups IV-VI received a single injection of ethanol (95%), bleomycin (5 mg/kg) and normal saline 25 mm3 in each ventral lobe of the prostate respectively. Two weeks after the injections, the ventral lobes underwent a quantitative stereological study. RESULTS: The volume of the ventral lobes, glandular epithelium, fibromuscular tissue and microvessles increased by 1.7, 3.1, 2.4 and 1.6 times in BPH rats respectively (P <0.01). Alcohol or bleomycin injection in PBH rats induced drastic recession of the increased volume of the ventral lobe, glandular epithelium and fibromuscular tissue (P <0.01). Regarding the BPH+alcohol group, the glandular epithelium volume restored to the normal values of the control rats (P <0.01). BPH+finasteride also incited an atrophic change in the volume of the whole prostate and glandular epithelium, but not the fibromuscular tissue and microvessels (P <0.01). CONCLUSIONS: Injection of alcohol and bleomycin (approximately 10% of the volume of ventral prostatic) as well as consuming finasteride can induce a reduction of 1/3, 1/4 and 1/5 in the hypertrophied gland respectively.

Association Study of Glutathione S-transferases Gene Polymorphisms (GSTM1 and GSTT1) with Ulcerative Colitis and Crohn's Disease in the South of Iran.

BACKGROUND: Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic inflammatory disorders of the gastrointestinal tract. A combination of environmental factors and interactions with a genetic predisposition are suggested to play an important role in the etiology and pathogenesis of the IBD. Glutathione S-transferases (GSTs) are multifunctional enzymes involved in the cellular oxidative stress handling. Possible associations between GSTs gene polymorphisms and susceptibility to UC and CD have been reported in different population. The relationship between GSTM1 and GSTT1 deletion polymorphisms and susceptibility to UC and CD were investigated in the Iranian population. MATERIALS AND METHODS: The study was performed in 106 IBD patients and 243 age- and sex-matched healthy Iranian controls consulting the IBD registry center of the Motahari Clinic, Shiraz University of Medical Sciences, Shiraz, Iran, between 2011 and 2013. GSTM1 and GSTT1 genotyping were performed using multiplex polymerase chain reaction and differences in the distribution of gene polymorphisms were analyzed statistically between the studied groups. RESULTS: Statistically significant higher frequency of GSTM1 null genotype was observed in IBD patients (P = 0.01) and in the subgroup of patients with UC (P = 0.04) compared to healthy controls, whereas this was not true for CD patients. No significant association was found between GSTT1 gene polymorphism and UC or CD. CONCLUSIONS: Absence of GSTT1 functional gene does not play an important role in the pathophysiology and development of IBD, UC, and CD in Iranian population whereas GSTM1 null genotype could be considered as a possible genetic predisposing factor for more susceptibility to IBD and UC.

Evaluation of Caspase 3 Enzyme and TNF-alpha as Biomarkers in Ureteropelvic Junction Obstruction in Children- a preliminary report.

OBJECTIVE: To determine the applicability of urinary caspase 3 enzyme and TNF-α as biomarkers in children with ureteropelvic junction obstruction (UPJO). METHODS: In this study, 31 unilateral UPJO patients and 33 age- and sex-matched healthy childrens were enrolled. The patients with UPJO consisted of 11 female and 20 male children between the ages of 2 to 62 months old. All participants were evaluated regarding anterior-posterior(AP) diameter and cortical thickness of affected kidney by ultrasonography. Technetium DTPA renal scan and voiding cystourethrogram(to assess vesicoureteral reflux) were performed, pre-operatively. Also, urinary levels of TNF-α and caspase 3 enzyme were checked. Follow-ups included measurement of aforementioned indices in patients: AP diameter and cortical thickness of the affected kidney, as well as TNF-α and caspase 3 levels in urine, three and six months after pyeloplasty. RESULTS: The results showed highly significant decrease in urinary TNF-α and caspase 3 enzyme (P values < 0.01), approaching the level measured in children without UPJO after six months. Significant decrease in AP diameter and increase in cortical thickness were also noticed (P values < 0.01). CONCLUSION: The results of this study strongly support that TNF-α and caspase 3 levels in urine can be used for improvement monitoring in follow-up of UPJO patients after pyeloplasty and can also be potentially used as determining indices for surgical plan but more studies, especially in patients who are not surgical candidates are needed to confirm our observaitons.

The Prevalence of Metabolic Syndrome In Non-alcoholic Fatty Liver Disease; A Population-Based Study.

BACKGROUND Some evidence, not in large study populations, suggests that nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS) share common interactions. We aimed to determine the prevalence of NAFLD and MetS in a large population registered to Kavar Cohort Study center. We also assessed the role of each component of MetS in NAFLD existence. METHODS Data were obtained from 3415 volunteers who called and refereed to our center. Complete anthropometric and laboratory measurement and abdominal ultrasonography was done for these individuals to screen NAFLD and its grade. A questionnaire was also used to obtain information on demographical and medical history and alcohol consumption. MetS was defined in all participants based on the National Cholesterol Education Program Adult Treatment Panel III (2001) (NCEP/ATP-III) and criteria for clinical diagnosis of metabolic syndrome in Iranian adults (CCDMIA). RESULTS Among the refereed individuals, 2980 peoples were aged ≥18 years with male to women ratio of 1:2.45. NAFLD was diagnosed by ultrasound in 32.9% and 27.4% of men and women, respectively. MetS was detected in 65.9 and 64.6 of the patients with NAFLD (based on NCEP/ATP-III) and in 30.1% and 73.7% (based on CCDMIA) of men and women, respectively. There were no significant differences between two gender in none of the components (p>0.05). Although, OR for hyperglycemia and abdominal obesity were approximately high in CCDMIA criteria (0.9613 and 1.2082, respectively), the differences were not statistically significant. CONCLUSION NAFLD was associated with MetS. However, it was not possible to determine whether NAFLD predating the development of MetS.

Self-medication of irritable bowel syndrome and dyspepsia: How appropriate is it?

OBJECTIVE: Self-medication is common among patients with gastrointestinal (GI) symptoms. This study was performed to evaluate self-medication among patients who fulfilled irritable bowel syndrome (IBS) and dyspepsia diagnostic criteria and to investigate the appropriateness of self-medication with chemical and herbal drugs. METHODS: A prospective, descriptive cross-sectional study was conducted in outpatient's GI clinics at Shiraz from November 2011 to May 2012. A GI specialist visited the patients and recruited those who had IBS (base on Rome III adapted criteria) or functional dyspepsia. We surveyed self-medication among these patients, using a questionnaire containing specific questions about self-medication. FINDINGS: One thousand four hundred and forty-seven patients visited by the GI specialist during the study period. Seven hundred and forty-seven patients had the inclusion criteria, 337 of them fulfilled criteria for IBS, with IBS-mixed (52%) being the most prevalent subtype, and 410 patients had dyspepsia. Overall, 78.8% of the total participants had recently sought medical attention for their GI complaint. Twenty-eight percent of patients selected inappropriate medication for their GI complaints. The H2-blockers class were most common medicines reportedly used. We did not find any significant relationship between age, gender, level of education, marital status, and self-medication frequency. CONCLUSION: Patients who fulfilled criteria for IBS had a high tendency to self-treat their GI symptoms, use of acid-suppressive agents was common among patients. Around one-third of patients self-treated GI symptoms inappropriately. Consequently, the concept of self-medication among patients has to be revised. We recommend conduction of educational programs to improve self-medications selection and attitude among patients to reduce the burden on other health care resources.

Using amniotic membrane for anal sphincter repair in animal model / Uso de membrana amniótica para reparo de esfíncter anal em modelo animal

Purpose: Sphincter repair is the primary management for fecal incontinence especially in traumatic causes. Regardless of progression in the method and material of sphincter repair, the results are still disappointing. This study evaluates the efficacy of using amniotic membrane during sphincteroplasty regarding its effects in healing of various tissues. Methods: Rabbits undergone sphincterotomy and after three weeks end to end sphincteroplasty was done. Animals divided to three groups: classic sphincteroplasty, sphincteroplasty with fresh amniotic membrane and sphincteroplasty with decellularized amniotic membrane. Three weeks after sphincteroplasty animals were sacrificed and sphincter complex was sent for histopathologic evaluation. Sphincter muscle diameter and composition of sphincter was evaluated. Before sphincterotomy, before and after sphincteroplasty electromyography of sphincter at the site of repair were recorded. Results: No statistical significant difference was seen between groups even in histopathology or electromyography. Conclusion: Although amniotic showed promising effects in the healing of different tissue in animal and human studies it was not effective in healing of injured sphincter.

Objetivo: Reparo do esfíncter é o tratamento primário para casos de incontinência fecal, especialmente em causas traumáticas. Independentemente da progressão no método e do material de reparo do esfíncter, os resultados são ainda desapontadores. Esse estudo avalia a eficácia do uso da membrana amniótica durante a esfincteroplastia, com relação aos seus efeitos na cura de diversos tecidos. Métodos: Coelhos foram submetidos a um procedimento de esfincterotomia e, depois de transcorridas três semanas, foi realizada uma esfincteroplastia término-terminal. Os animais foram divididos em três grupos: esfincteroplastia clássica, esfincteroplastia com membrana amniótica fresca, e esfincteroplastia com membrana amniótica descelularizada. Três semanas após a realização da esfincteroplastia, os animais foram sacrificados e o complexo esfinctérico foi encaminhado para avaliação histopatológica. O diâmetro do músculo esfinctérico e a composição do esfíncter foram avaliados. Antes da esfincterotomia, e antes e depois da esfincteroplastia, foi registrada a eletromiografia do esfíncter no local do reparo. Resultados: Não foi observada diferença estatisticamente significativa entre os grupos, mesmo na histopatologia, ou na eletromiografia. Conclusão: Embora a membrana amniótica tenha demonstrado efeitos promissores em termos da cicatrização dos diferentes tecidos em estudos com animais e em humanos, não foi observada eficácia na cura do esfíncter lesionado.

YMDD Motif Mutation Profile Among Patients Receiving Liver Transplant Due to Hepatitis B Virus Infection With Long Term Lamivudine/Immunoglobulin Therapy.

BACKGROUND: Recurrence of Hepatitis B Virus infection in patients undergoing liver transplanted (LT) is a serious and often fatal problem. Lamivudine (LAM) and Hepatitis B Immunoglobulin (HBIG) are widely used to manage hepatitis B recurrence after liver transplantation. However, the outcomes in patients are less elucidated. OBJECTIVES: The current study aimed to evaluate the YMDD motif mutations profile among the patients undergoing LT infected with HBV and treated with LAM/HBIG at least for one year. PATIENTS AND METHODS: Thirty patients with liver transplantation due to HBV were enrolled, while DNA level remained under detection limit of 50 IU/mL before transplantation and abnormal higher levels of liver enzymes after LT. The HBV genome detection was performed by two different Polymerase Chain Reaction methods following viral quantification by commercial Real-Time PCR. HbsAg detection, besides liver function tests were conducted as complementary assays. To assess nucleotide analogue mutations, the major part of polymerase gene (aa 80 - 240) was amplified by Nested-PCR, introduced to sequencing and subjected to phylogenetic analysis. RESULTS: Totally, according to the laboratory criteria there were 13 cases with detectable HBV genome, while the mean liver enzyme levels were higher in recurrent patients and HBsAg was detected only in four out of the 13 cases. Phylogenetic analysis demonstrated that all isolated genomes belonged to genotype D. Critical M204I mutation, as a proof for resistance to LAM, was detected among 46% of the subjects and natural entecavir resistance (S202I) was also distinguished in one subject. Viral quantification showed higher titer in LAM resistant group in comparison to the group with undetectable drug resistance mutant (P > 0.05). CONCLUSIONS: Although the patients carrying M204I mutation were more likely to show lack of responses to LAM therapy, LAM replacing by other nucleoside/tide analogs plus HBIG maybe still effective in decreasing hepatitis B recurrence after liver transplantation. However, it is suggested that drug resistance test should be considered by clinicians during therapeutic management to avoid the following viral breakthrough.

The prevalence of hepatitis C virus infection and its related risk factors among the rural population of fars province, southern iran.

BACKGROUND: Hepatitis C virus (HCV) infection is a major blood-borne infection with silent epidemic, major global public health problem and diverse prevalence worldwide. OBJECTIVES: This study aimed to evaluate the prevalence of HCV infection and related risk factors in the general population of two villages, Farmashkan and Akbarabad, of the Kavar City in Fars Province, Iran. PATIENTS AND METHODS: A 34-month cross-sectional study was performed on all people of the villages aged ≥ 7 years from July 2007 to April 2010. Demographic information and history of HCV-related risk factors were extracted from their medical records. For each participant, the serum anti-HCV IgG was assessed by the commercial enzyme-linked immunosorbent assay (ELISA) kits. RESULTS: A total of 6095 participants (36.4% male and 65.6% female) with the mean age of 92 (7-95) and mean ± SD of 34.6 ± 17.3 years were included in this study. Fifteen persons (0.24%) were detected as HCV-positive and the highest prevalence was seen in age ≤ 12 years old (1%). A significant association was only detected between blood transfusion and HCV infection; therefore, those persons with history of blood transfusion had 15-fold higher risk for HCV seropositivity (odds ratio 15.54, 95% CI = 4.89-49.41). CONCLUSIONS: Our reported rate of HCV seropositivity is similar to the previous Iranian reports. However, future evaluations should be focused on the Polymerase Chain Reaction method for the detection of HCV and determining and evaluating of other related risk factors. Moreover, more attention should be paid to blood donors as a reservoir population of HCV.

Clinical significance of serum vascular endothelial growth factor and complement 3a levels in patients with colorectal cancer in southern Iran.

BACKGROUND: Colon cancer (CRC) is perhaps the second most common cause of cancer mortality. This study determined the clinical significance of serum vascular endothelial growth factor (VEGF) and serum complement 3a (C3a) levels in patients with CRC in Fars province, southern Iran. MATERIALS AND METHODS: Between June 2010 and June 2012, 110 patients with CRC of both genders and different age groups were divided into 3 groups. Group A included patients who had just undergone surgery; Group B had undergone chemotherapy after surgery; and Group C had undergone chemotherapy and radiotherapy after surgery. Twenty one healthy subjects with normal colonoscopy were considered as a control group. ELISA was undertaken to determine VEGF and C3a levels before and after treatment measures. RESULTS: The mean age of patients was 53.9±14.1 years. Considering VEGF level, a significant decrease was visible after treatment measures in groups A and B, but not Group C. For VEGF level, the difference was not statistically significant between two genders and various age groups before and after treatment. No significant difference was found for VEGF level between patients and normal group before any treatment. Regarding C3a levels in 101 subjects, they significantly decreased after treatment measures. Before and after treatment, the difference was statistically significant between two genders, but was not statistically significant among various age groups. CONCLUSIONS: As VEGF and C3a levels were significantly lower in patients after treatment, these may be beneficial markers in assessment of CRC therapy especially in early stages.

The characteristics of rare codon clusters in the genome and proteins of hepatitis C virus; a bioinformatics look.

BACKGROUND Recent studies suggest that rare codon clusters are functionally important for protein activity. METHODS Here, for the first time we analyzed and reported rare codon clusters in Hepatitis C Virus (HCV) genome and then identified the location of these rare codon clusters in the structure of HCV protein. This analysis was performed using the Sherlocc program that detects statistically relevant conserved rare codon clusters. RESULTS By this program, we identified the rare codon cluster in three regions of HCV genome; NS2, NS3, and NS5A coding sequence of HCV genome. For further understanding of the role of these rare codon clusters, we studied the location of these rare codon clusters and critical residues in the structure of NS2, NS3 and NS5A proteins. We identified some critical residues near or within rare codon clusters. It should be mentioned that characteristics of these critical residues such as location and situation of side chains are important in assurance of the HCV life cycle. CONCLUSION The characteristics of these residues and their relative status showed that these rare codon clusters play an important role in proper folding of these proteins. Thus, it is likely that these rare codon clusters may have an important role in the function of HCV proteins. This information is helpful in development of new avenues for vaccine and treatment protocols.

Role of Physical Examination in Decision Making for Selective Exploration in Patients with Penetrating Zone II Neck Injury.

OBJECTIVE: To evaluate the role of physical examination in decision making for exploring patients with penetrating zone II neck injury. METHODS: This was a cross-sectional study being performed in a level I trauma center between 2006 and 2010. The present study reviewed the records of 150 patients with penetrating neck injuries. Of 46 cases with zone II deep platysma neck injuries, 3 patients died before taking any significant medical measure. RESULTS: Thirty of 43 patients (70%) presented with hard sings while 13 (30%) did not show these sings. All patients underwent neck exploration. Two patients (4.6%) without hard sings exhibited positive findings, whereas 29 cases (67%) with hard sings reported positive on exploration. CONCLUSION: Briefly, we hold the view that it seems reasonable to follow an algorithmic approach by using physical examination of the patients with zone II penetrating neck injuries. This prevents unnecessary exploration for management of such patients.