New-onset or flare-up of bullous pemphigoid associated with COVID-19 vaccines: a systematic review of case report and case series studies.

Background: Numerous cutaneous manifestations have been associated with the Coronavirus Disease 2019 (COVID-19) outbreak and vaccination, but new-onset bullous pemphigoid (BP) or flaring up of pre-existing BP is a rare side effect of COVID-19 vaccines that has been mentioned to a lesser extent in the literature. Therefore, we aimed to conduct a systematic review focused on the association between the new- onset or flare-up of BP and the COVID-19 vaccination. Method: A comprehensive literature search was conducted using PubMed (MEDLINE), Scopus, and the Web of Science databases up to 11 March 2023. The search aimed to identify English-language studies reporting new-onset or flare-ups of BP as a potential side effect of the COVID-19 vaccination. The search terms included bullous pemphigoid and COVID-19 vaccination-related MeSH terms. Results: The systematic review of 40 articles investigating the incidence of BP in individuals who received various COVID-19 vaccines revealed pertinent findings. Among the 54 patients with new-onset BP, the median age was 72.42 years, and most were men (64%). Conversely, the median age of the 17 patients experiencing a flare-up of BP was 73.35 years, with a higher proportion of women (53%). Regarding vaccination types, a significant number of patients (56%) developed new-onset BP after receiving the BNT162b2 vaccine (Pfizer-BioNTech). Conclusion: This study indicates a potential association between COVID-19 vaccinations, particularly mRNA vaccines, and the occurrence of BP. It suggests that this rare autoimmune disorder may be triggered as an adverse event following the COVID-19 vaccination. However, it is important to note that the majority of BP patients in our study were unaffected by the COVID-19 vaccine, and even those who experienced worsening of their conditions were managed without significant consequences. These findings provide additional evidence supporting the safety of COVID-19 vaccines. Physicians should be mindful of this uncommon adverse event and encourage patients to complete their planned vaccination schedules.

Discovering conserved epitopes of Monkeypox: Novel immunoinformatic and machine learning approaches.

The Monkeypox virus, an Orthopoxvirus with zoonotic origins, has been responsible for a growing number of human infections reminiscent of smallpox since May 2022, as reported by the World Health Organization. As of now, there are no established medical treatments for managing Monkeypox infections. In this study, we used machine learning to select conserved epitopes. Proteins were determined using Reverse Vaccinology and Gene Ontology subcellular localization, and their epitopes were predicted. NextClade was used to calculate the number of mutations in each amino acid position using 2433 Monkeypox sequences. The Unsupervised Nearest Neighbor machine learning algorithm and ideal matrix [0 0] were used to calculate the conservancy score of epitopes. Six proteins were determined for epitope prediction. Finally, 47 MHC-I epitopes, 5 MHC-II epitopes, and 10 Linear B cell epitopes were discovered. Our method can select epitopes for vaccine design to prevent viruses with accelerated evolution and high mutation rate.

The association between thyroid dysfunction, autoimmune thyroid disease, and rheumatoid arthritis disease severity.

BACKGROUND: Rheumatoid Arthritis (RA) and autoimmune thyroid disease (AITD) are the two most prevalent coexisting autoimmune diseases due to their similar pathogenesis. Considering the potential effect of AITD on the severity of RA disease, this study aimed to determine the association between thyroid dysfunction, anti-thyroid peroxidase (anti-TPO) positivity, AITD, and RA disease severity in the Iranian population. METHODS: Three hundred and fifty RA patients who presented to Shahid Beheshti tertiary care center, Qom, Iran, were included in this cross-sectional study. The data were collected through the patient's medical records, interviews, physical examinations, and laboratory tests. The RA disease activity score in 28 joints for RA with erythrocyte sedimentation rate (DAS-28-ESR) was used to divide patients into three subgroups, remission (DAS-28-ESR ⩽ 2.6), mild-to-moderate (2.6 < DAS-28-ESR ⩽ 5.1), and severe disease activity (DAS-28-ESR > 5.1). RESULTS: Using the aforementioned method, 111, 96, and 138 patients were put into remission, mild-to-moderate, and severe disease activity groups, respectively. Anti-TPO antibody positivity rate was 2.93 times more prevalent among patients with severe disease compared to the remission subgroup (OR: 2.93; P-value < 0.001). Patients suffering from a more severe disease were almost 2.7 times more probable to have AITD (OR = 2.71; P-value < 0.001) and they were 82% more likely to have thyroid dysfunction compared to patients in remission (OR = 1.82; P-value = 0.006). CONCLUSIONS: It was demonstrated that thyroid dysfunction, anti-TPO antibody positivity, and AITD were significantly more common among RA patients with more severe disease activity.

The effect of interferon in the therapy of severe coronavirus infection.

BACKGROUND: So far, several protocols have been used for the treatment of coronavirus disease-2019 (COVID-19). In this study, we aimed to study the effect of interferon on the treatment of hypoxemia caused by COVID-19. MATERIALS AND METHODS: This was a quasi-experiment with a nonequivalent group design. All participants were admitted to Shahid Beheshti Hospital, Qom province. In total, 60 patients were enrolled in the study, and inclusion criteria were age over 18 years, positive PCR test result, pulmonary involvement in computed tomography (CT) scan, and SpO2 level below 93%. Individuals were divided into two control (hydroxychloroquine + lopinavir/ritonavir [Kaletra]) and intervention (hydroxychloroquine + lopinavir/ritonavir [Kaletra] + interferon-ß 1a [recigen]) groups. The data were analyzed in Stata/SE 14.2 using Chi-square, t-test, and Mann-Whitney U test. RESULTS: The mean ± standard deviation (SD) age of patients was 63 ± 16.12 years and 43.3% were male. In terms of outcome variables, 20% of patients in the intervention group and 53.3% of subjects in the control group died and this difference was significant (P = 0.007). According to the quick sequential organ failure assessment (qSOFA) score, the severe cases were 16.7% in the intervention group and 50% in the control group (P = 0.006). In addition, the median days of hospitalization were 11.5 days-significantly higher than those in the control group (5.5 days) (P < 0.001). CONCLUSION: Based on the results of this study, the use of interferon in the treatment of COVID-19 can improve health and reduce the severity of the disease and mortality.

Latent Toxoplasmosis among Breast Cancer Patients in Jahrom, South of Iran.

Objective: Reactivation of latent toxoplasmosis is the main cause of severe infection among immunocompromised patients, including patients with cancer. Hence, this study is aimed at screening the status of Toxoplasma gondii infection among breast cancer patients by serological and molecular methods and determining their associated risk factors in Jahrom County, Fars Province, south of Iran. Methods: One hundred and seven women with breast cancer (aged 34 to 80 years) were screened for anti-T. gondii antibodies (IgG and IgM) during 2019-2020. A questionnaire regarding demographic factors was filled out by participants. Molecular detection was performed by polymerase chain reaction (PCR) using the primer pair targeting the repetitive element (RE) gene of T. gondii. The risk factors and demographic data were analyzed by SPSS software (ver. 20, Chicago, IL, USA) using the Chi-squared test. Results: Anti-T. gondii IgG was detected in 45.8% (49/107) of the patients, which indicates latent infection, but anti-T. gondii IgM and PCR were negative in all samples. Demographic factors revealed a statistically significant increased T. gondii seropositivity among nonmenopause cancer patients (P < 0.0005), patients without previous breast cancer (P = 0.0001), and human epidermal growth factor receptor 2- (HER2-) negative patients (P = 0.00002). As such, patients with a history of previous abortions and who were at stages II, III, and IIII of cancer had higher seropositivity rates than patients without a history of previous abortions or who were at stage I cancer, but the statistical analysis was not significant. We did not find a statistically significant association between T. gondii seropositivity and other risk factors of toxoplasmosis (e.g., education level, type of water source, washing raw fruits and vegetables, consumption of raw or undercooked meat, and contact with soil, cats, and domestic animal). Conclusion: A high seroprevalence rate of latent T. gondii infection was detected among patients with breast cancer; hence, these patients may be at high risk for reactivation of latent infection. Screening of T. gondii infection is recommended to detect active infection among patients with malignancies.

Application of soft computing techniques to estimate the scouring depth formed by crossing jets.

The scouring depth caused by the water jet outputs from a dam is one of the crucial parameters for design purposes. Due to the importance of the subject, several laboratory studies have been conducted to understand this subject. Nevertheless, using soft computing techniques is a new attitude for modeling and predicting the natural process parameters. Herein, the types of soft computing techniques for estimating the scouring depth of a plunge pool caused by the symmetrical crossing jets have been explored. The parameters involved in the scouring phenomenon are densimetric Froude number, tailwater depth, vertical jet angle, horizontal crossing angles, and the distance between the crossing points of two jets and the water level. The prediction results show that the Multi-Layer Perceptron (MLP) model gives the best performance among the other models tested here. The Pearson correlation coefficient, root mean square error, and normalized root mean square error for the MLP model were 0.9527, 0.9039, and 19.36% for the test phase, respectively. Furthermore, based on the sensitivity analysis, the parameters, for instance, tailwater depth and vertical jet angle have the highest and lowest effects for predicting the scouring depth of a plunge pool, respectively.

Toxoplasma gondii, HBV, and HCV co-infection and their correlation with CD4 cells among Iranian HIV-positive patients.

INTRODUCTION: Human immunodeficiency virus (HIV/AIDS) infected patients have a higher risk of opportunistic infections (OIs) depending on their immunological status, especially CD4 + cell count. Toxoplasma gondii, hepatitis C virus (HCV), and hepatitis B virus (HBV) are important OIs among Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) patients. However, little is known about co-infection of these pathogens among HIV-infected individuals and their correlation with the patient's CD4 + cell count. Hence, this study aimed to investigate the serological and molecular status of T. gondii infection among HIV-infected individuals who had co-infection with HBV and HCV infections. METHODS: A total of 100 HIV/AIDS patients in two cities in the southwest of Iran was tested for T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies as well as DNA detection by polymerase chain reaction (PCR) targeting the RE gene. HBV and HCV were detected by hepatitis B surface antigen (HBsAg) test, hepatitis C antibody (HCV Ab) test, and Real-Time PCR. The number of CD4 + cell counts was determined by Flow cytometry. RESULTS: Anti-T. gondii IgG was positive in 22% of the patients, but anti-T. gondii IgM and PCR were negative in all samples. HBV and HCV were positive in 8% and 33% of the patients, respectively. Co-infections were as followed: HIV + HCV (16%), HIV + HCV + T. gondii (11%), HIV + T. gondii (5%), HIV + HBV (1%), HIV + HBV + T. gondii (1%), HIV + HBV + HCV (1%), and HIV + HBV + HCV + T. gondii (5%). A significant decline in CD4 + cell counts was found in such co-infection groups (HIV + T. gondii, HIV + HCV + T. gondii, and HIV + HBV + HCV + T. gondii) compared with the HIV mono-infection group. CONCLUSIONS: Our study showed that co-infections of T. gondii, HCV, and HBV were common among HIV-infected patients and co-infections had a negative correlation with CD4 + cell counts of the patients.

Considering epitopes conservity in targeting SARS-CoV-2 mutations in variants: a novel immunoinformatics approach to vaccine design.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has gained mutations at an alarming rate in the past years. Developing mutations can increase the virus's pathogenicity and virulence; reduce the efficacy of vaccines, antibodies neutralization, and even challenge adaptive immunity. So, it is essential to identify conserved epitopes (with fewer mutations) in different variants with appropriate antigenicity to target the variants by an appropriate vaccine design. Yet as, 3369 SARS-CoV-2 genomes were collected from global initiative on sharing avian flu data. Then, mutations in the immunodominant regions (IDRs), immune epitope database (IEDB) epitopes, and also predicted epitopes were calculated. In the following, epitopes conservity score against the total number of events (mutations) and the number of mutated sites in each epitope was weighted by Shannon entropy and then calculated by the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Based on the TOPSIS conservity score and antigenicity score, the epitopes were plotted. The result demonstrates that almost all epitopes and IDRs with various lengths have gained different numbers of mutations in dissimilar sites. Herein, our two-step calculation for conservity recommends only 8 IDRs, 14 IEDB epitopes, and 10 predicted epitopes among all epitopes. The selected ones have higher conservity and higher immunogenicity. This method is an open-source multi-criteria decision-making platform, which provides a scientific approach to selecting epitopes with appropriate conservity and immunogenicity; against ever-changing viruses.

Poly-L-lysine/hyaluronan nanocarriers as a novel nanosystem for gene delivery.

The present research comes up with a novel DNA-loaded poly-L-lysine (PLL)/hyaluronan (HA) nanocarrier (DNA-loaded PLL/HA NCs) for gene delivery applications, as a promising candidate for gene delivery into diverse cells. A straightforward approach was employed to prepare such a nanosystem through masking DNA-loaded PLL molecules by HA. Fourier-transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), field emission-scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM) were used to analyse the interaction of the molecules as well as the physicochemical properties of the NCs. The NCs showed a negative charge of -24 ± 3 mV, with an average size of 138 ± 6 nm, in an ellipsoid-shape with smooth surfaces. The DNA loading efficiency (LE) measured by DNA absorbance was around 95 %. The MTT assay showed that the developed NCs are non-toxic to the cells. Furthermore, the uptake of the DNA-loaded PLL/HA NCs by the human embryonic kidney (HEK)-293T cells was evaluated by a flow cytometry method, and demonstrated high potential cellular uptake over 90% for transferring the gene to HEK-293T cells at the optimised conditions. Therefore, the DNA-loaded PLL/HA NCs are the potent strategy for developing nanosystems for gene delivery applications.

Bone characteristics and metabolic phenotypes of obesity in an Iranian Elderly population: Bushehr Elderly Health Program (BEHP).

INTRODUCTION: Obesity and osteoporosis are health problems with high impact on the morbidity and mortality rate. While the association between BMI and bone density is known, the combined effects of obesity and metabolic components on bone health have not yet been revealed. The objectives of this study were to determine the association between bone health and different phenotypes of obesity in an elderly population. METHODS: This cross-sectional study was conducted on the data collected in the Bushehr Elderly Health Program (BEHP). The participants were classified in four groups based on the metabolic phenotypes of obesity (metabolic healthy obese (MHO), metabolic non-healthy non-obese (MNHNO), metabolic non-healthy obese (MNHO), and metabolic healthy non-obese (MHNO)). The association between osteoporosis and TBS and the metabolic phenotypes of obesity were assessed using multiple variable logistic regression models. RESULTS: Totally, 2378 people (1227 women) were considered for analyses. The prevalence of MHNO, MHO, MNHNO, and MNHO were 902 (39.9%), 138 (6.1%), 758 (33.5%), and 464 (20.5%), respectively. In the multivariate logistic regression models, those with MHO (OR 0.22; 95% CI 0.12-0.36), MNHNO (OR 0.52; 95% CI 0.4-0.66), and MNHO phenotypes (OR 0.22; 95% CI 0.16-0.3) had a significantly lower risk of osteoporosis. Likewise, those having MHO (OR 2.38; 95% CI 1.51-3.76), MNHNO (OR 1.49; 95% CI 1.11-2), and MNHO (OR 2.50; 95% CI 1.82-3.42) phenotypes were found to had higher risk of low bone quality as confirmed by TBS. CONCLUSIONS: The obese subjects have lower bone quality, regardless of their obesity phenotype.

Nanotechnology against COVID-19: Immunization, diagnostic and therapeutic studies.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in early 2020 soon led to the global pandemic of Coronavirus Disease 2019 (COVID-19). Since then, the clinical and scientific communities have been closely collaborating to develop effective strategies for controlling the ongoing pandemic. The game-changing fields of recent years, nanotechnology and nanomedicine have the potential to not only design new approaches, but also to improve existing methods for the fight against COVID-19. Nanomaterials can be used in the development of highly efficient, reusable personal protective equipment, and antiviral nano-coatings in public settings could prevent the spread of SARS-CoV-2. Smart nanocarriers have accelerated the design of several therapeutic, prophylactic, or immune-mediated approaches against COVID-19. Some nanovaccines have even entered Phase IΙ/IIΙ clinical trials. Several rapid and cost-effective COVID-19 diagnostic techniques have also been devised based on nanobiosensors, lab-on-a-chip systems, or nanopore technology. Here, we provide an overview of the emerging role of nanotechnology in the prevention, diagnosis, and treatment of COVID-19.

Evaluating the effect of a herb on the control of blood glucose and insulin-resistance in patients with advanced type 2 diabetes (a double-blind clinical trial).

BACKGROUND: Different benefits of various herbal medicines in decreasing blood sugar have been reported in different clinical trials so far. Considering the growing tendency toward these combinations and the booming market, inappropriate advice is growing accordingly. Hence, it is necessary to evaluate the effects and possible complications of such combinations on health status and blood glucose control. METHODS: Two 38-subject groups were formed and a 12-week treatment program was administered for both groups. The inclusion criteria were failure to control blood glucose with two oral medicines, unwillingness to inject insulin. The medicine was prepared in capsules by Booali Company. Each capsule weighed 750 mg and contained nettle leaf 20% (w/w), berry leaf 10% (w/w), onion and garlic 20% (w/w), fenugreek seed 20% (w/w), walnut leaf 20% (w/w), and cinnamon bark 10% (w/w) all in powder. RESULTS: At the beginning of the study, there was no significant difference between the subjects regarding the evaluated parameters, but after the intervention, the level of glucose was significantly lower in fasting (P=0.0001) and 2-hour postprandial (P=0.002) levels. The level of glycated hemoglobin A1c (HbA1c) (P=0.0001) also decreased from 0.33±9.72 % to 0.20±8.39 %. Finally, the level of insulin resistance reduced from 1.9±4.1 to 1.4±2.6 (P=0.001) after consuming herbal medicine. CONCLUSION: According to the results of the current study, the herbal combination was effective in controlling blood sugar, and considering the reduction of HbA1c by 1.31 %, it seems that the herbal combination is an effective medicine to treat diabetes.

Squamous cell carcinoma of the lung and pulmonary metastasis of papillary thyroid carcinoma: a case report.

BACKGROUND: The coexistence of malignancies in a patient may be explained by the tumor-to-tumor metastasis phenomenon or multiple primary malignant tumors, both of which are not common findings. Here, we are going to present a case with coexistent papillary thyroid carcinoma and primary squamous cell carcinoma of the lung. CASE PRESENTATION: A 36-year-old Iranian man presented to our clinic for evaluation of constitutional symptoms. His past medical history was significant for papillary thyroid carcinoma due to which he had undergone total thyroidectomy, cervical lymph node dissection, and radioactive iodine therapy 14 years ago. Six months prior to admission, he received radioactive iodine therapy due to the metastatic involvement of both lungs with papillary thyroid carcinoma in another center with consequent improvement in symptoms. Diffuse nodular lesions in both lungs, a lesion in the lower lobe of his left lung, not present 6 months ago, peritoneal carcinomatosis, and several para-aortic lymphadenopathies were detected by imaging studies. A radioactive iodine uptake scan, positron emission tomography/computed tomography scan, and transbronchial biopsy of the lesion in the lung revealed concurrent squamous cell carcinoma of the lung and pulmonary metastasis of papillary thyroid carcinoma. After consultation with an oncologist, our patient received 6 months of chemotherapy; however, he died 8 months after presentation. CONCLUSIONS: Physicians should be aware of the possibility of the emergence of primary malignancies in patients with a history of papillary thyroid carcinoma, especially lung cancer as it is a common site of papillary thyroid carcinoma metastases. Using appropriate diagnostic evaluations in order to choose the best therapeutic option is of utmost importance.

Effect of diabetes on BMD and TBS values as determinants of bone health in the elderly: Bushehr Elderly Health program.

BACKGROUND: Considering the aging population associated with higher osteoporotic fracture risk, high prevalence of diabetes and its effect on bone health along with lack of information on bone quality using common methods (BMD) the aim of present study was to determine the association between trabecular bone score (TBS) and diabetes in an elderly population participating in Bushehr Elderly Health (BEH) program. MATERIALS AND METHODS: This cross-sectional study was performed on data collected during the BEH Program, stage II. Anthropometric indices were measured based on NHANES III protocol. Diabetes and pre-diabetes were defined according to ADA Guideline 2018. Bone density was measured using DXA method (DXA, Discovery WI, Hologic Inc., USA). A software installed on the same device (TBS iNsight® software) was applied to assess TBS values. Variables related to bone health were compared based on their glycemic status (participants with diabetes, participants with prediabetes, and normoglycemic) using analysis of variance. Univariate and multivariate linear and logistic regression models were used to determine the association between TBS values and bone density in different glycemic states. RESULTS: The data of 2263 participant aged 60 years and over were analyzed. Mean TBS values were significantly different between participants with diabetes, participants with prediabetes, and normoglycemic groups (P = 0.004;, however, P trend was not significant (0.400)). Mean BMD values at femoral neck and lumbar spine were significantly higher in diabetics compared with those diagnosed with pre-diabetes; the latter also had higher bone density compared with normoglycemic individuals (both P ANOVA test and P trends for means were < 0.01]. In univariate linear regression model, TBS values were negatively associated with pre-diabetes (ß = -0.070; P < 0.001) but not with diabetes (ß = -0.002, P = 0.915). This significant relationship disappeared when the results were adjusted for BMI. In fully adjusted multivariate logistic regression models, odds ratio linking pre-diabetes and diabetes with spinal osteoporosis was 0.861 (CI 95% 0.670-1.105) and 0.525 (CI 95% 0.392-0.701), respectively. As for femoral osteoporosis, odds ratio was 0.615 (CI 95% 0.407-0.928) and 0.968 (CI 95% 0.629-1.489), correspondingly. Moreover, for cumulative osteoporosis, the odds were 0.843 (CI 95% 0.676-1.106) and 0.551 (CI 95% 0.415-0.732), respectively. CONCLUSION: Our findings suggest that subjects with pre-diabetes and diabetes have higher bone mineral density than normoglycemic subjects; the quality of bone, however, was not different between them. The discordance between BMD and TBS values in participants with diabetes suggest that although these patients have higher BMD values, their quality of bone microarchitecture may not be better than normoglycemic subjects.

Coexistence of medullary thyroid carcinoma and recurrent non-functional pituitary adenoma: a case report.

BACKGROUND: Medullary thyroid carcinoma and pituitary adenoma are neuroendocrine tumors and their coexistence has not been reported in the literature, previously. Medullary thyroid carcinoma is a neoplasm of the thyroid gland arising from parafollicular c-cells producing calcitonin, and pituitary adenoma is a benign hyperplasia of the cells of the pituitary gland. Coexistence of these neoplasms can be explained by being affected by simultaneous primary neoplasms or tumor-to-tumor metastasis phenomenon. CASE PRESENTATION: We present the case of a 60-year-old Persian man who presented to the clinic with a chief complaint of headache for the last 2 months. His past medical history was significant for non-functional pituitary macroadenoma and medullary thyroid carcinoma and he had received a total thyroidectomy and a transsphenoidal surgery several years ago. Diagnostic evaluations revealed that the pituitary adenoma has recurred. He was well and symptom-free after the second transsphenoidal surgery for resection of the adenoma. Noticeably, investigations were negative for any form of multiple endocrine neoplasia syndromes; however, we could not rule them out definitively. CONCLUSIONS: To the best of our knowledge, it is the first case reported in the literature of a patient who has been affected by recurrent non-functional pituitary adenoma and medullary thyroid carcinoma, concomitantly. Although this association can be accidental, it emphasizes the fact that patients with a history of a neoplasm should be monitored regularly in order to diagnose and treat possible second primary cancers in a timely manner. Of note, this consideration is of great importance in patients whose first neoplasms have better prognosis and survival rates, which provide them more time to develop second primary cancers, for example, pituitary adenoma.

Insulin resistance and coronary artery disease in non-diabetic patients: Is there any correlation?

BACKGROUND: Cardiovascular diseases are the most common causes of death in the world and type 2 diabetes is one of them because it is highly prevalent and doubles heart disease risk. Some studies suggest that insulin resistance is associated with coronary artery disease in non-diabetics. The aim of this study was to evaluate the association of insulin resistance (IR) and coronary artery disease (CAD) in non-diabetic patients. METHODS: In this cross-sectional study, from September 2014 to July 2015, 120 patients referring to Shahid Beheshti Hospital of Qom were evaluated. Their medical history, baseline laboratory studies, BMI and GFR were recorded. After 8 hours of fasting, blood samples were taken from the patients at 8 am, including fasting glucose and insulin level. We estimated insulin resistance using the homeostatic model assessment index of IR (HOMA-IR). Finally, we evaluated the association between IR and CAD. RESULTS: Totally, 120 patients were assigned to participate in this study, among them, 50 patients without CAD and 70 with coronary artery stenosis. Insulin resistance (HOMA-IR> 2.5) was positive in 59 (49.3%) patients and negative in 61 (50.7%) patients. Hence, the correlation between IR and CAD was not statistically significant (P=0.9). CONCLUSIONS: In this study, although the correlation was not found between insulin resistance and coronary heart disease, among men, we found a significant association between coronary heart disease and insulin resistance.

Neurobrucellosis in systemic lupus erythematosus.

BACKGROUND: Brucellosis is a zoonotic infection which is endemic in many countries. It is a multisystem disease which may present with a broad spectrum of clinical manifestations and complications. Neurobrucellosis is an uncommon complication of brucellosis. CASE PRESENTATION: A 25-year-old woman with a history of lupus for 5 months referred to the emergency ward of Shahid Beheshti Hospital of Qom due to vertigo, drop attack and a convulsion episode from the previous day. She was unable to move at initial evaluation, and her upper and lower extremities were spastic. She had blurred vision one day after admission. Based on her past history and suspecting neurological pulmonary presentations, treatment with immunosuppressive drugs was started and brain MRI was performed. According to the MRI mode and endemic area, neurobrucellosis was suspected and 2ME and Wright tests were performed. Wight test was 1.5120 while 2ME test was 1.640 which were strongly positive. So, with neurobrucellosis diagnosis, the patient was treated but unfortunately 4 days later, after respiratory apnea, she was pronounced dead. CONCLUSION: In endemic areas for brucellosis, neurobrucellosis should always be kept in mind in the differential diagnosis of neurological and psychiatric cases that are encountered.

Effect of Helicobacter pylori on metabolic syndrome parameters in diabetic patients.

AIM: The aim of this study is to survey the effect of Helicobacter Pylori on metabolic syndrome parameters in diabetic patients. BACKGROUND: Helicobacter pylori (HP) infection is the most common infection in developing countries. Some studies showed the association between HP infection and insulin resistance. Insulin resistance is a major mechanism in the development of metabolic syndrome (MetS) and it is said that MetS is more prevalent among HP infected subjects. Also, some studies have shown that MetS is common among patients with type 2 diabetes mellitus. In this study, we aimed to investigate the prevalence of MetS in diabetic patients and its association with HP. METHODS: This cross-sectional study was carried out from May to December 2014 on 211 diabetic patients. For each patient, the following data were collected: age, gender, diabetes duration, weight, body mass index (BMI), waist circumference, blood pressure (BP), HDL, cholesterol, triglyceride (TG), total cholesterol, and HbA1c. The lipid profile was performed on fasting samples. Anti- HP IgG antibody was measured and serum titer >30AU/mL was considered positive. MetS was diagnosed by The National Cholesterol Education Program's Adult Treatment Panel III report (NCEP-ATPIII) and IDF criteria. RESULTS: Totally 139 patients (65.9%) were HP+ and 72 patients (34.1%) were HP-. Age, gender and diabetes duration were not significantly different in both groups. BMI was significantly lower in HP+ women (29.05±5.26 vs. 31.45±4.8, p=0.02). Although the waist circumference of men was not different between the two groups but it was significantly lower in HP+ women (102.04±12.37 vs. 97.3±10, p=0.03). Although BP and TG levels were not statistically different in HP+ and HP- patients, but HP+ patients had lower HDL level (p=0.037) which was due to lower HDL in men (58.2±26.6 vs. 72.48±28.1, p=0.012). The prevalence of MetS according to the IDF criteria among HP+ and HP- patients was 76.6% vs. 69.8% (p=0.27). Also, the prevalence of MetS according to NCEP-ATP III criteria among HP+ and HP- patients was 90.4% vs. 87.2% (p=0.5). Duration of diabetes did not affect the prevalence of metabolic syndrome among HP+ and HP- patients. CONCLUSION: It seems that HP infection increases the prevalence of metabolic syndrome through an increase in insulin resistance. According to NCEP-ATPIII criteria, the increase in the prevalence of metabolic syndrome in HP+ patients is almost significant, however more complete studies is recommended to investigate this relationship.

Helicobacter pylori infection prevalence: Is it different in diabetics and nondiabetics?

BACKGROUND: Helicobacter pylori (HP) infection plays a significant role in the development of gastrointestinal complications and has a significant role in systemic inflammation. It has some extragastrointestinal manifestations like endocrine diseases. In this study, we aimed to compare the prevalence of HP infection in diabetic and nondiabetic individuals. MATERIALS AND METHODS: In this cross-sectional study, 218 nondiabetic and 211 diabetic patients referring to Shahid Beheshti Hospital of Qom between March 2013 and 2014 were studied. The patients were divided into two HP(+) and HP(-) groups based on serological immunoglobulin G antibody against HP and the association between diabetes, and HP infection was evaluated. Data were analyzed using independent t-tests, Chi-square, Fisher's exact and Mann-Whitney tests. RESULTS: The prevalence of HP seropositive was 65.9% versus 50.5% in diabetic and nondiabetics, respectively, and the difference was statistically significant (P = 0.001). CONCLUSIONS: This study showed a higher prevalence of HP infection in diabetic patients.