Gluten-free Nan-e-Fasaee: Formulation optimization on the basis of quinoa flour and inulin.

Diversification of gluten-free (GF) bakery products is considerably important, as those who suffer from gluten intolerance should follow a GF diet their whole life. Regarding this study, it was aimed at optimizing the formulation of a quinoa-based GF traditional bakery product, i.e. Nan-e-Fasaee using inulin as a bifunctional agent (both a prebiotic compound and a structure-forming agent). Otherwise, its potential role as a fat and sugar replacer was also assessed. For this purpose, short (S)- and long (L)-chain inulin were used as sugar and fat replacers, respectively, at 0%-50% w/w in quinoa flour (QF)-based GF Nan-e-Fasaee and optimization was done based on rheological, textural, and sensory analysis. Results indicated that QF diet provided the batter with the dominance of elastic modulus and increased hardness (i.e. 5170.0 ± 22.50 g in the presence of QF compared to 1477.0 ± 20.81 g in wheat-based ones). Inulin inclusion reduced the hardness, as the lowest was observed at S-inulin substitution levels of 40% and 50% w/w, with values equal to 2422.0 ± 20.81 and 2431.0 ± 35.57 g, respectively (the most similar ones to control sample). The interference of S-inulin with the non-gelatinized starch structure is supposed to decrease the hardness. The highest score in texture was also perceived at F6 and F13, with values equal to 8.00 ± 0.10 and 7.97 ± 0.05, respectively. Using S- and L-inulin in combination is found to improve the textural characteristics due to preventing the competitive role of sugar in water absorption in formulations containing L-inulin. Regarding optimization of quinoa-based GF Nan-e-Fasaee with reduced sugar and fat levels using inulin, it is found to be feasible.

Measurement of polychlorinated biphenyls in different high consumption canned foods, using the QuEChERS/GC-MS method.

Polychlorinated biphenyls (PCBs) are organic pollutants containing chlorine, which can be carcinogenic to humans. The current research focused on the heart risk and determination of PCBs levels in canned foods using the modified QuEChERS (fast, easy, cheap, effective, resistant and safe) method and gas chromatograph/mass spectrometer (GC-MS) technique. In this study, LOD (limit of detection), LOQ (limit of quantification), and recovery ranged from 0.06 to 0.32, 0.18 to 1.07 ng/g, and 97.05 to 102.5 %, respectively. In canned foods, the highest median of PCBs was PCB 52 (0.27 ± 0.20 ng/g fat) and the lowest median were PCB 28 and 138 (not detected in samples). Also, the maximum median of PCB 28, 52, 101, 138, 153, and 180 were detected in eggplant samples (0.06 ng/g), haricot samples (0.49 ng/g), eggplant samples (0.36 ng/g), eggplant samples (0.19 ng/g), eggplant samples (0.11 ng/g) and lentiform samples (0.66 ng/g), respectively. The median PCBs levels of oral exposure were estimated to be in the range of 9.80E-07to 4.30E-05 ng/g.d for all population groups, which were meaningfully lesser than the Tolerable daily intake value. The Monte Carlo simulation (MCS) outcomes indicated that the rank order of PCBs in adults based on incremental lifetime cancer risk (ILCR) was Lentiform (7.05E-8) > canned fish (5.73E-8) > Eggplant (5.38E-8) > Haricot (4.33E-8) > pasta source (2.06E-8); and in children was Lentiform (3.40E-7) > canned fish (2.72E-7) > Eggplant (2.44E-7) > Haricot (2.06E-7) > pasta source (9.83E-8). The median values of the ILCR induced oral exposure for all groups were within safe limits (lower than 10-6). The heat map and multivariate principal component analysis (PCA) showed significantly different contributions of PCBs profile in samples as the PCA axis scores were correlated with the type of cans. Based on the obtained outcomes, it can be concluded that the PCBs of canned food do not potential health risks to Iranian consumers.

Drug-use disorders in the Eastern Mediterranean Region: a glance at GBD 2019 findings.

PURPOSE: The aim of this study is to investigate drug use disorders which are a major cause of Disability Adjusted Life Years (DALYs) in the Eastern Mediterranean Region (EMR). METHODS: This article is a part of the global burden of diseases (GBD), injuries, and risk factors 2019 study. The GBD modeling approach was used to estimate population-level prevalence of drug use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990-2019. RESULTS: It is estimated that in 2019 in EMR around 3.4 million people have drug use disorder which has increased by 137% compared to 1990. Also, in 2019, DALY number for drug use disorders was 1217.9 (95% UI: 940.4, 1528.9) thousand years and 7645 (95% UI: 6793.7, 8567.9) deaths occurred. The DALY rate increased 39.6% in the region since1990, whereas the global rate increased by 24.4%. United Arab Emirates, Libya, and Iran were most affected by drug use disorders with the highest rates of age-standardized DALY in EMR in 2019. The most prevalent drug use disorder in the region is opioid use which is accountable for 80% of all drug use disorders DALYs. CONCLUSION: Despite many interventions, drug use disorders are still responsible for high rates of DALY in the region which has increased since 1990 in both males and females; more comprehensive policies, better control measures and proper education could reduce the adverse effects.

Protective effect of early immunomodulatory treatment on ocular involvement in Behcet's disease: Historical cohort of 1166 patients.

Objectives: Eye involvement is a main presentation of Behcet's disease. This study was performed to evaluate possible determinants affecting the occurrence of eye involvement, especially the role of early systemic treatment with immunomodulatory drugs on the incidence of ocular involvement. Methods: This is a retrospective cohort study performed on 1166 Behcet's patients in the Behcet's Clinic of Rheumatology Research Center. All patients were followed up for at least 10 years and a maximum of 15 years. Data analysis was performed using survival analysis models including Kaplan-Meier Survival analysis, Logrank test, and Cox's proportional hazards regression. Results: 1166 Behcet's patients were evaluated. 80 patients who had eye involvement as the first manifestation of the disease were excluded and 1086 participants entered the analysis. Among them, 647 patients (59.6%) developed ocular involvement 7.8 ± 6.7 years after the first symptom. Immunomodulatory treatment before ocular involvement reduced the risk by 3 times (P-value <0.001). Conclusion: This study demonstrated that the initiation of immunomodulatory treatment prior to eye involvement can reduce the risk of eye involvement in Behcet's patients. Therefore, reducing the onset time of disease symptoms and providing appropriate treatment can reduce Behcet's disease ocular complications.

Milk thistle nano-micelle formulation promotes cell cycle arrest and apoptosis in hepatocellular carcinoma cells through modulating miR-155-3p /SOCS2 /PHLDA1 signaling axis.

BACKGROUND: Hepatocellular Carcinoma (HCC) is a prevalent form of liver cancer that causes significant mortality in numerous individuals worldwide. This study compared the effects of milk thistle (MT) and nano-milk thistle (N-MT) on the expression of the genes that participate in apoptosis and cell cycle pathways in Huh-7 and HepG2 cells. METHODS: IC50 values of MT and N-MT were determined using the MTT assay. Huh-7 and HepG2 cell lines (containing mutant and wild-type TP53 gene, respectively) were incubated with MT and N-MT for 24h and 48h and the impact of MT and N-MT on the proliferation of these cell lines was evaluated through a comparative analysis. Cell cycle and apoptosis were assessed by flow cytometry after 24h and 48h treatment in the cell lines mentioned. Real-time PCR was used to analyze miR-155-3p, PHLDA1, SOCS2, TP53, P21, BAX, and BCL-2 expression in the cell lines that were being treated. RESULTS: N-MT reduces cancer cell growth in a time and concentration-dependent manner, which is more toxic compared to MT. Huh-7 was observed to have IC50 values of 2.35 and 1.7 µg/ml at 24h and 48h, and HepG2 was observed to have IC50 values of 3.4 and 2.6 µg/ml at 24 and 48h, respectively. N-MT arrested Huh-7 and HepG2 cells in the Sub-G1 phase and induced apoptosis. N-MT led to a marked reduction in the expression of miR-155-3p and BCL-2 after 24h and 48h treatments. Conversely, PHLDA1, SOCS2, BAX, and P21 were upregulated in the treated cells compared to untreated cells, which suggests that milk thistle has the potential to regulate these genes. N-MT reduced the expression of TP53 in Huh-7 cells after mentioned time points, while there was a significant increase in the expression of the TP53 gene in HepG2 cells. No gene expression changes were observed in MT-treated cells after 24h and 48h. CONCLUSION: N-MT can regulate cancer cell death by arresting cell cycle and inducing apoptosis. This occurs through the alteration of apoptotic genes expression. A reduction in the expression of miR-155-3p and increase in the expression of SOCS2 and PHLDA1 after N-MT treatment showed the correlation between miR-155-3p and PHLDA1/SOCS2 found in bioinformatics analysis. While N-MT increased TP53 expression in HepG2, reduced it in Huh-7. The findings indicate that N-MT can function intelligently in cancer cells and can be a helpful complement to cancer treatment.

Genotyping tool for salmonid gill pox virus (SGPV) obtained from farmed and wild Atlantic salmon (Salmo salar).

Poxviruses are common viruses found in vertebrate species. In 2006, the first poxvirus associated with salmon, salmonid gill poxvirus (SGPV), was identified during an outbreak of gill disease at a smolt production site in northern Norway and at two marine farms in western Norway. Poxviruses had previously been detected in ayu (Plecoglossus altivelis) and koi carp (Cyprinus carpio). In all three fish species, poxviruses are associated with gill disease. It has not been possible to culture SGPV from Norway, and little is known about its virulence. However, the association between SGPV and gill disease in salmon has shown the need for molecular tools to identify reservoirs and transmission routes. Sequencing the genome of a second isolate of SGPV has made it possible to compare variable regions between two strains of the virus, showing the presence of a large number of variable regions that exhibit both variable numbers of tandem repeats and intra-ORF variation. We present eight regions that are suitable for distinguishing strains of SGPV and determining their phylogenetic relationship, and these were used to compare SGPV isolates obtained from both farmed and wild salmon in fresh and sea water. The prevalence of the virus was found to be higher in wild salmon in rivers than in returning wild salmon collected from traps in Norwegian fjords. Genotyping based on the eight selected variable regions, suggests the presence of geographically distinct isolates in freshwater among both farmed and wild salmon, while SGPV from marine farms shows high local diversity and a wide geographical distribution of similar strains of the virus.

Effect of Lipid Profile Parameters on Noise Induced Hearing Loss.

Background: Noise induced hearing loss (NIHL) is an irreversible occupational disease among industrial workers. Recent studies have reported that changes in some metabolic factors such as the serum level of sugar and lipids might have a role in suffering from NIHL among workers exposed to noise. We designed this study to assess the association between lipid profile changes and NIHL occurrence among noise-exposed workers. Methods: This case-control study has been conducted according to noise-exposed workers registry data in one of the Iranian automobile factories between 2007 and 2017. We classified study workers into the NIHL and control groups. We assessed the impact of lipid profile parameters across the study groups using the independent samples t-test, chi-square, and regression. Results: The mean serum level of cholesterol was significantly higher in the NIHL group than in workers of the control group (215.27 ± 60.30 vs 204.49 ± 63.69 mg/dL; P = 0.041). Moreover, the serum level of HDL was significantly lower in workers in the NIHL group compared with the control group (35.21 ± 6.87 vs 37.43 ± 7.28 mg/dL; P < 0.001). Although other lipid profile parameters (LDL, TG, LDL/HDL ratio) were higher among workers of the NIHL group, their differences were not significant. Conclusion: A cholesterol level lower than 200 mg/dL is known as a protective factor and an HDL level lower than 40 mg/dL is an NIHL risk factor. More attention should be paid to controlling serum levels of cholesterol and HDL.

The Effects of Covid-19 on Financial-Economic and Performance Efficiency of Hospitals.

Background: During the pandemic of COVID-19, the function and performance of hospitals have been affected by various economic-financial and management aspects. The aim of the current study was to assess the process of therapeutic care delivery and also the economic-financial functions of the selected hospitals before and after COVID-19. Methods: This research is a descriptive-analytical study and a cross-sectional-comparative study in terms of time, and it was conducted in several selected teaching hospitals of Iran University of Medical Sciences. A purposeful and convenient sampling method was used. The data has been collected using the standard research tool (standard checklist of the Ministry of Health) in the two areas of financial-economic and healthcare performance (such as Data of financial and economic indicators such as direct and indirect costs, liquidity ratio and profitability index as well as key performance indicators of hospitals such as bed occupancy ratio (BOR; %), average length of stay (ALOS), bed turnover rate (BTR), bed turnover distance rate (BTIR) and hospital mortality rate (HMR), physician-to-bed ratio and nurse-to-bed ratio) of hospitals in two times before and after the outbreak of COVID-19 (time period 2018 to 2021). The data was collected from 2018 to 2021. Pearson/Spearman regression was used for the evaluation of the relationship between variables using SPSS 22. Results: This research showed the admission of COVID-19 patients caused a change in the indicators we evaluated. ALOS (-6.6%), BTIR (-40.7%), and discharge against medical advice (-7.0%) decreased from 2018 to 2021. BOR; % (+5.0%), occupy bed days (+6.6%), BTR (+27.5%, HMR (+50%), number of inpatients (+18.8%), number of discharges (+13.1%), number of surgeries (+27.4%), nurse-per-bed ratio (+35.9%), doctor-per-bed ratio (+31.0%) increased in the same period of time. The profitability index was correlated to all of the performance indicators except for the net death rate. Higher length of stay and turnover interval had a negative effect on the profitability index while higher bed turnover rate, bed occupancy ratio, bed day, number of inpatient admission, and number of surgery had a positive effect on the profitability index. Conclusion: It has been shown from the beginning of the COVID-19 pandemic, the performance indicators of the studied hospitals were negatively affected. As a consequence of the COVID-19 epidemic, many hospitals were not able to deal with the negative financial and medical outcomes of this crisis due to a significant decrease in income and a double increase in expenses.

Isolation of Sphingomonas paucimobilis from an ocular infection and identification using ribosomal RNA gene: First case report from Iran.

Key Clinical Message: Sphingomonas paucimobilis can cause infection in healthy people. As this bacterium is slow-growing, special attention should be paid to the timely diagnosis and control of its antibiotic resistance to prevent the spread of resistant strains. Abstract: This study reports a case of ocular infection caused by Sphingomonas paucimobilis and its treatment with various antibiotics. A middle-aged woman with prolonged purulent eye discharge was admitted to an ophthalmology clinic in Qazvin, Iran. A strain of S. paucimobilis was isolated from the patient. The sample was identified by Sanger sequencing of the 16s rRNA gene, and an antibiogram test was performed to determine its resistance profile. The patient was treated with ceftazidime and levofloxacin eye drops. The bacterial culture was negative 18 days after starting ceftazidime and levofloxacin treatment. The antibiogram results showed that the isolated bacterium was resistant to aminoglycosides and colistin. This study highlights that S. paucimobilis can cause disease even in immunocompetent individuals. Due to the different resistance profiles of this bacterium, treatment should be based on antibiogram results.

Retention rate in methadone maintenance treatment and factors associated among referred patients from the compulsory residential centers compared to voluntary patients.

Introduction: Compulsory treatment has decades of history in Iran; both before and after the Islamic Revolution, but there are many debates regarding its efficacy and effectiveness. Retention Rate is one of the best indices to estimate the efficacy of treatment. This study will compare Retention Rate among people referred from compulsory treatment centers and volunteer participants. Methods: This was a retrospective (historical) cohort study that has been conducted among people who were taking methadone maintenance treatment (MMT). The study sample was selected from the MMT centers that admit both referral patients from compulsory centers and voluntary patients. All newly admitted patients from March 2017 to March 2018 were enrolled and followed up until March 2019. Results: A total of 105 participants were recruited for the study. All were males with a mean age of 36.6 ± 7.9 years. Fifty-six percent of individuals were referred from compulsory residential centers. The total one-year retention rate of participants in this study was 15.84%. The one-year retention rate for the patients referred from compulsory residential centers and the non-referred patients was 12.28 and 20.45%, respectively (value of p = 0.128). Among the other studied factors, only marital status was significantly associated with MMT retention (p = 0.023). Conclusion: Although the average treatment adherence time for non-referred patients was about 60 days higher than those referred from compulsory residential centers, this study found no significant differences in retention days and a one-year retention rate. Further studies with larger sample sizes and longer follow-ups are needed to explore the efficacy of compulsory treatment methods in Iran.

Phenotypic and genotypic characterization of virulence markers and antifungal susceptibility of oral Candida species from diabetic and non-diabetic hemodialysis patients.

BACKGROUND: Patients with chronic kidney disease undergoing hemodialysis are often colonized by Candida species with high possibility of fungal infections. The purposes of this study were to determine the prevalence of Candida species, evaluate antifungal susceptibility profile, biofilm formation, proteinase and phospholipase activities, and the frequency of virulence genes in the Candida species isolated from the oral mucosa of hemodialysis diabetic (DM) and non-diabetic (non-DM) patients. METHODS: This study identified several species of Candida isolated from 69 DM and 58 non-DM patients on hemodialysis using phenotypic methods and PCR-RFLP technique. The identification of C. albicans and C. glabrata complex was performed by HWP1 gene and four oligonucleotides (UNI-5.8S, GLA-f, BRA-f, and NIV-f), respectively. Antifungal susceptibility to amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin was assessed according to CLSI M27-A3/S4. The biomass, metabolic activity of biofilm, proteinase (Prz), phospholipase (Pz), and molecular study for virulence genes were assessed using crystal violet, XTT assay, agar-based hydrolytic enzyme, and PCR technique, respectively. RESULTS: Candida prevalence was 44.9% with 47.8% and 41.4% among DM and non-DM patients, respectively (P = .045). The species identified were C. albicans (49.5%), C. glabrata (16.5%), C. tropicalis (12%), C. kefyr (8.8%), C. parapsilosis (6.6%), C. dubliniensis (3.3%), and C. lusitaniae (3.3%). The antifungal susceptibility profile showed that all Candida isolates were sensitive to amphotericin B, itraconazole, voriconazole, and caspofungin whereas fluconazole resistance was observed in 6.3% (MIC ≥ 64 µg/mL) of C. albicans and 6.6% of C. glabrata (MIC ≥ 64 µg/mL). The susceptible- dose-dependent rate was found in 10.5% of C. albicans. The Prz values of C. albicans ranged from 0.37 to 0.66 for the DM and 0.44-0.73 for the non-DM group (P < 0.05). The non-albicans Candida (NAC) species produced higher degree of biomass and metabolic activity compared to C. albicans (P < 0.05). Furthermore, significant (p < 0.05) correlations were detected between the biofilm formation with Prz values and fluconazole MICs. The most detected virulence factors were ALS3 and Sap5. CONCLUSIONS: These results showed the importance of prevalence of NAC species in hemodialysis patients. Investigating antifungal susceptibility profile made a better understanding of the role of virulence markers in the pathogenesis of Candida strains.

In vitro anti-Toxoplasma gondii activity of Ganoderma lucidum extracts.

OBJECTIVE: Ganoderma extracts have the potential to be used as anti-cancer, anti-inflammatory, immunomodulator, and antimicrobial agents, as evaluated in numerous studies. This study was aimed to determine the lethal and inhibitory effects of aqueous, hydroalcoholic, and alcoholic extracts of Ganoderma lucidum on Toxoplasma gondii RH strain tachyzoites, in vitro. RESULTS: All three types of extracts showed toxoplasmacidal effects. The highest percentage of mortality was related to hydroalcoholic extract. The EC50 of Ganoderma extracts for tachyzoites were 76.32, 3.274, and 40.18 for aqueous, hydroalcoholic and alcoholic extracts, respectively. The selectivity index obtained for hydroalcoholic extract was 71.22, showing the highest activity compared to other extracts. According to our findings, the hydroalcoholic part was the most effective substance among the extracts. This basic study showed obvious anti-toxoplasma effect of Ganoderma lucidum extracts. These extracts can be used as candidates for further in-depth and comprehensive studies especially In vivo experiments to prevent toxoplasmosis.

Investigating machine learning models in predicting lake water quality parameters as a 3-year moving average.

Lake water quality plays a vital role in the lake ecosystem, including biotic (for living creatures, such as plants, animals, and micro-organisms) and abiotic interactions. In this research, various types of machine learning (ML) methodologies, such as classification and regression tree (CART), chi-squared automatic interaction detector (CHAID), C5 tree, quick, unbiased, and efficient statistical tree (QUEST), along with multilayer perceptron (MLP) neural network, and radial basis function (RBF) neural network, are employed to predict the concentration of water quality parameters (P, EC, TDS, pH, DO, NH3, SO4, and θ). Lake Erie is situated at the international border of the USA and Canada. The C5 tree and QUEST tree are used to classify data and predict the number of groups, while the other methods are used to predict the concentration of water quality parameters in the form of a 3-year moving average. The greater matching between the observed and predicted data of dissolved oxygen (NSE = 0.978, bias = 0.126) shows that the CART decision tree has higher accuracy in correctly detecting the concentration of this parameter. The C5 tree could identify 33 groups correctly out of 36 total groups, which shows better accuracy for the C5 tree in classifying the data for this parameter.

Application of inulin in bread: A review of technological properties and factors affecting its stability.

Due to its dual function, inulin is an important prebiotic compound in the cereal industry, especially in bread production. In other words, improving technological features and creating health properties (such as reducing the risk of type 2 diabetes, heart disease, metabolic syndrome, and osteoporosis) have led to the widespread use of this compound. Inulin has many important technological functions in bread, including its ability to interact with water, create structure, and influence rheological properties, texture, and overall acceptability of the final product. Nevertheless, bread processing conditions can influence the structural integrity of inulin and thus affect its technological efficiency. Therefore, this review article aims to investigate the technological properties and factors affecting the stability of inulin during bread processing conditions. Generally, the addition of inulin could considerably improve the technical performance of bread. However, the stability of inulin depends on the formulation components, type of fermentation, and baking process.

Fampridine in multiple sclerosis patients with acute phase of cervical transverse myelitis: a double-blind, randomized placebo-controlled trial.

BACKGROUND: Fampridine is a potassium channel blocker drug used to improve walking ability in patients with multiple sclerosis (MS). We evaluated the effect of fampridine in patients with MS in the acute phase of transverse myelitis. METHODS: In a randomized, placebo-controlled trial, 30 patients who had their first episode of cervical myelitis with quadriparesis presentation, with the final diagnosis of MS, were randomly divided into two equal groups. The intervention group received intravenous methylprednisolone (IVMP) for 7 days plus fampridine. The placebo group received IVMP for 7 days plus placebo. To compare the treatment results, we compared the Barthel index (BI) scores of the groups at the start of the trial and the 21st day after the start of treatment. RESULTS: There was no significant difference in baseline characteristics between the intervention and placebo groups in terms of mean age, sex, and mean admission BI (p > 0.05). Mean (SD) admission BI in placebo and intervention groups was 27.20 (7.341) and 27.87(5.78), respectively (p = 0.784). The measured mean (SD) BI after treatment was 48.73 (15.54) in the placebo and 64.93 (11.81) in the intervention group (p = 0.003) after 3 weeks. CONCLUSION: Using fampridine plus IVMP in the acute phase of transverse myelitis in MS patients improved the disease's symptoms and increased the daily activity ability of patients.

Iranian older adults women: The Impact of COVID-19 and Coping Strategies.

In the field of epidemics, some vulnerable groups, such as older adults, are at greater risk. Many psychological, social, economic and physical hazards have threatened older adults during the COVID-19 pandemic. Some threats can be managed with medical system interventions. However, social and psychological challenges cannot be controlled quickly. People will have a better quality of life if they can take appropriate action in critical situations. There is a strong theoretical and empirical background that a sense of control and self-efficacy can promote psychological well-being. The main questions of this study included the following: What were the main problems experienced by older Iranian women during the outbreak of COVID-19? What coping methods did they use to control the situation? What were their views on the future? This research was conducted in Kerman city, the capital of Kerman Province. A phenomenological method was used. We interviewed 15 women over 65 years old. We extracted five main themes from the interviews. These themes were health issues, persistent anxiety, economic and social pressures, identifying unique solutions to the current situation, and optimism versus pessimism: what is the future? From the participants' point of view, psychological, social and physical problems have disturbed them during the pandemic, especially at the beginning. However, they controlled their problems by using selective coping strategies. In Iran, planners can use the potential of the two institutions of family and religion to reduce the problems of older adults.

The Uncomplicated Course of COVID-19 in Primary Immunodeficiency Patients: A Report of 14 Common Variable Immunodeficiency Patients.

Coronavirus disease 2019 (COVID-19) affects millions of people worldwide. Clinical manifestations range from asymptomatic to severe viral pneumonia. CVID patients with COVID-19 infection are not adequately studied. In some studies, CVID patients had higher mortality rates, although other studies showed that CVID patients might have an uncomplicated COVID-19 infection. We describe 14 cases of COVID-19 infection in Iranian CVID patients in this study, including clinical manifestations, laboratory findings, and treatment strategies. There were 29% of patients with mild disease, 43% with moderate disease, and 29% with severe disease in this study. A critical case and a death occurred in none of our patients. There were six cases of infection more than two weeks after receiving the second dose of Sinopharm BIBP COVID-19 vaccine; all had mild to moderate disease. Among these patients, Remdesivir was the most frequently prescribed medication. According to this study, most of our patients presented with an uncomplicated disease course.

Novel hybrid neuro-fuzzy model to anticipate the heat transfer in a heat exchanger equipped with a new type of self-rotating tube insert.

In this investigation, a combination of the wingsuit flying search (WFS) and teaching-learning-based optimization (TLBO) algorithms is developed as a new combinatorial optimization algorithm. The proposed combinatorial algorithm is tested over some well-known benchmark functions and then integrated with the artificial neural network (ANN) to construct a novel hybrid model. After that, the obtained hybrid model is employed to anticipate the experimentally obtained values of the average Nusselt number (Nu), average friction coefficient (f) as well as thermal-hydraulic performance ratio (η), in a heat exchanger equipped with a new type of self-rotating tube insert, against governing parameters. The insert is placed in the tube side of the water heater to heat natural gas. The proposed insert consists of various numbers of self-rotating modules. Indeed, the rotating insert is introduced to create effective secondary sweeping flow on the inner side of the tube. Since this type of tube insert simultaneously provides heat transfer enhancement and undesired pressure drop, a thermal-hydraulic performance ratio is defined to consider both of them. The governing parameters are the number of inserts (0 ≤ N ≤ 30), reservoir's temperature (40 °C  ≤  TR ≤ 50 °C) as well as Reynolds number (6 × 103 ≤ Re ≤ 18 × 103). It was found that the WFS-TLBO enhances the effectiveness of the main ANN in anticipating the Nusselt number (Nu), average friction coefficient (f) as well as performance ratio (η). Moreover, introducing the WFS-TLBO algorithm into the neural network provides an enhancement in the effectiveness of the hybrid models based on the single WFS and TLBO algorithms in anticipating the same parameters.

Vascular Endothelial Growth Factor as a Predictive and Prognostic Biomarker for Multiple Sclerosis.

BACKGROUND: Growing bodies of evidence suggest that angiogenesis plays a crucial role in the development and progression of multiple sclerosis (MS). Vascular endothelial growth factor (VEGF) is one of the key factors involved in angiogenesis. Because of this importance, we investigated the serum levels of VEGF in MS patients according to their clinical phase and subtype of MS in this study. MATERIAL AND METHODS: This case-control study was done on 47 definite MS patients with the first clinical attack and 47 randomly selected individuals without any underlying inflammatory and autoimmune disease as the control group. The total serum VEGF level was measured from the subject's peripheral blood sample by ELISA during the first and second attacks of MS and 6 months after the first attack in the remission phase as well as the control group. In addition, the correlation between these variables and the influence of gender, age, and duration of the remission phase on such associations was evaluated by using the independent t test and Pearson's correlation coefficient. RESULTS: There was an increase in the serum level of VEGF in all phases of MS compared with non-MS individuals (p value <0.0001) and a significant correlation between the serum level of VEGF and the interval between first and second attacks (r = -720, p < 0.0001). A higher serum level of VEGF in the first attack leads to higher VEGF levels in the second and sixth mount of remission phases. CONCLUSION: Rise in the serum VEGF level may be involved in MS's relapsing phases and a shorter remission phase. Therefore, it could be used as a prognostic and predictive biomarker for MS disease.

A case report of rhino-facial mucormycosis in a non-diabetic patient with COVID-19: a systematic review of literature and current update.

BACKGROUND: COVID-19 disease may be associated with a wide range of bacterial and fungal infections. We report a patient with COVID-19 infection who developed rhino-facial mucormycosis during treatment with corticosteroids. CASE PRESENTATION: A 59-year-old non-diabetic male patient was admitted with a diagnosis of COVID-19 based on positive RT-PCR and CT of the lungs. Due to sever lung involvement, he was treated with methylprednisolone. The patient was re-admitted to hospital, due to nasal obstruction and left side facial and orbital swelling, several days after discharge. In sinus endoscopic surgery, debridement was performed and the specimens were sent to pathology and mycology laboratories. A nasal biopsy showed wide hyphae without septa. The sequenced PCR product revealed Rhizopus oryzae. Despite all medical and surgical treatment, the patient died. In addition, the characteristics of patients with COVID-19-associated mucormycosis were reviewed in 44 available literatures. In most studies, diabetes mellitus was the most common predisposing factor for mucormycosis. CONCLUSION: Our report highlights the need for assessing the presence of mucormycosis in patients with COVID-19 and also it shows that physicians should consider the potential for secondary invasive fungal infections in COVID-19 cases.