Rabies in the Middle East, Eastern Europe, Central Asia and North Africa: Building evidence and delivering a regional approach to rabies elimination.

The Middle East, Eastern Europe, Central Asia and North Africa Rabies Control Network (MERACON), is built upon the achievements of the Middle East and Eastern Europe Rabies Expert Bureau (MEEREB). MERACON aims to foster collaboration among Member States (MS) and develop shared regional objectives, building momentum towards dog-mediated rabies control and elimination. Here we assess the epidemiology of rabies and preparedness in twelve participating MS, using case and rabies capacity data for 2017, and compare our findings with previous published reports and a predictive burden model. Across MS, the number of reported cases of dog rabies per 100,000 dog population and the number of reported human deaths per 100,000 population as a result of dog-mediated rabies appeared weakly associated. Compared to 2014 there has been a decrease in the number of reported human cases in five of the twelve MS, three MS reported an increase, two MS continued to report zero cases, and the remaining two MS were not listed in the 2014 study and therefore no comparison could be drawn. Vaccination coverage in dogs has increased since 2014 in half (4/8) of the MS where data are available. Most importantly, it is evident that there is a need for improved data collection, sharing and reporting at both the national and international levels. With the formation of the MERACON network, MS will be able to align with international best practices, while also fostering international support with other MS and international organisations.

Natural Infection with Rabies Virus: A Histopathological and Immunohistochemical Study of Human Brains

OBJECTIVES: Despite all the efforts and increased knowledge of rabies, the exact mechanisms of infection and mortality from the rabies virus are not well understood. To understand the mechanisms underlying the pathogenicity of rabies virus infection, it is crucial to study the tissue that the rabies virus naturally infects in humans. METHODS: Cerebellum brain tissue from 9 human post mortem cases from Iran, who had been infected with rabies virus, were examined histopathologically and immunohistochemically to evaluate the innate immune responses against the rabies virus. RESULTS: Histopathological examination revealed inflammation of the infected cerebellum and immunohistochemical analyses showed an increased immunoreactivity of heat shock protein 70, interleukin-6, interleukin-1, tumor necrosis factor-alpha, caspase-3, caspase-9, toll-like receptor3 and toll-like receptor4 in the infected brain tissue. CONCLUSION: These results indicated the involvement of innate immunity in rabies infected human brain tissue, which may aggravate the progression of this deadly disease.

Anxiety but not depression is associated with metabolic syndrome: The Isfahan Healthy Heart Program.

BACKGROUND: Only a few studies have carried out to evaluate the association of depression and anxiety with metabolic syndrome (MetS). The aim of this study was to investigate whether the depression and anxiety are associated with MetS and its different components. MATERIALS AND METHODS: This cross-sectional study forms part of the prospective Isfahan Cohort Study. A total of 470 participants were chosen. Anxiety and depression symptoms were measured using hospital anxiety and depression scale (HADS). The MetS was diagnosed according to the American Heart Association and National Heart, Lung, and Blood Institute. One-way analysis of variance and binary logistic regression were used. RESULTS: The mean age of participants was 55.7 ± 9.3. The prevalence of MetS in female participants with symptoms of depression (P < 0.0001), concurrent anxiety and depression (P = 0.004), anxiety (P < 0.0001), and asymptomatic individuals (P = 0.001) was significantly different when compared to male participants. Moreover, the analysis showed that having anxiety symptoms is in a negative relationship with MetS (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.12-0.78). In addition, with each 10-year increase in age, the probability of MetS will decrease 40% (OR = 0.59; 95%Cl = 0.53-0.72). Body mass index (OR = 1.29; 95%CI = 1.21-1.37), and gender (higher age for women) (OR = 0.34; 95%CI = 0.11-0.98) had positive relationship with MetS. CONCLUSION: The study findings revealed that the prevalence of MetS in patients with anxiety was lower than the healthy subjects, while no significant association was found between depression, concurrent depression, an anxiety with MetS.

Adverse drug reactions reporting: pharmacists' knowledge, attitude and practice in Shiraz, Iran.

BACKGROUND: While yellow card reporting system has started in 1998 in Iran, the ADR reporting rate is very low. OBJECTIVE: In order to explore whether the Iranian Pharmacovigilance system could be modified, and to determine reasons for under-reporting, a study to investigate the role of pharmacists in ADR reporting was done in Shiraz. METHODS: A cross-sectional study was conducted between January and June 2013 in Shiraz, Iran. After describing the study and its goal for each participant, oral consent was taken. RESULTS: 100 out of 120 pharmacists (83.3%) agreed to participate in the interview. 79 out of 100 respondents were working in private pharmacies, 7% in governmental pharmacies, and 3% in pharmacies located in hospitals. Although level of knowledge regarding ADR was low among pharmacists, all of them admitted that paying attention to ADRs and timely reporting is very important. While 6 (6%) pharmacists thought that they had been taught too much about ADR in the university, 30% believed that it was enough, 41% claimed that it was not satisfactory and 23% admitted that it was little. CONCLUSIONS: Our pharmacists have little knowledge about the process, goal, and importance of ADR spontaneous reporting system. Otherwise, education and training courses will be important in maintaining, improving and enhancing ADR reports by pharmacists.