Echinococcus granulosus sheep strain (G1) as the predominant genotype in definitive host (dogs) isolates in northeastern Iran.

Echinococcus granulosus sensu lato (E. granulosus s.l.) is a zoonotic parasite, causing cystic echinococcosis in humans. In the present study, prevalence and genotypes of E. granulosus s.l. was assessed in stools collected from 244 dogs including 138 stray and 106 domestic animals using high resolution melting curve (HRM) method. Initially, to detect taeniid eggs in feces, all samples were examined using the formalin-ether techniques. Genomic DNA was extracted from the positive samples and E. granulosus s.l. was differentiated from other Taeniidae parasites using SSU-rDNA gene and E. granulosus s.l. was analyzed for genotyping using HRM based on the cox1 gene. In total, 12.7% (31/244) of the samples were positive for Taeniidae eggs. In addition, among the positive samples, 77.4% (24/31) were positive for E. granulosus s.l.. In details, 11.3% (12/106) of the domestic dogs and 8.7% (12/138) of the stray dogs were positive for E. granulosus s.l.. The results of HRM analysis showed that all E. granulosus s.l. isolates were G1 strain. Findings of the present study indicated a considerable prevalence of E. granulosus G1 among dogs in the northeast of Iran and imply a serious risk of transmitting to humans and livestock.

Topical Tranexamic Acid in Primary Breast Augmentation Surgery: Short- and Long-term Outcomes.

BACKGROUND: Breast augmentation mammaplasty (BAM) remains the most popular cosmetic procedure done worldwide. Bleeding in this procedure increases the chance of capsular contracture. Tranexamic acid (TXA), an antifibrinolytic, has been widely used by other surgical specialties to reduce bleeding. OBJECTIVES: We aimed to evaluate the use of TXA in BAM surgery. METHODS: This was a single-surgeon case series of all patients who underwent primary BAM from March 2017 to March 2018 and received topical TXA spray to the implant pocket before implant insertion. Early postoperative complications and long-term outcomes, such as capsular contracture and revisional surgery, were recorded and described. RESULTS: Two hundred and eighty-eight patients were included in the study with an overall complication rate of 2.8% over 5 years. No patients had postoperative bleeding or hematoma formation. One patient had a seroma, managed with ultrasound drainage. Complications requiring reoperation included rippling (3, 1.0%), pocket revision (2, 0.7%), capsule contracture (1, 0.3%) and rupture (1, 0.3%). CONCLUSIONS: This study highlights the safety and potential benefits of the use of topical TXA in breast augmentation, with low bleeding and capsular contracture rates.

Evaluation of scolicidal potential of salicylate coated zinc nanoparticles against Echinococcus granulosus protoscoleces.

Echinococcosis is a zoonotic disease caused by larval stages of the Echinococcus genus (metastasis). In this study, salicylate-coated Zinc oxide nanoparticles (SA-ZnO-NPs) were fabricated and characterized by SEM, FTIR and XRD analytical techniques. After that, different doses of SA-ZnO-NPs, SA and ZnO-NPs were taken to assess scolicidal potency. Scanning electron microscopy (SEM) micrographs were also used to evaluate the morphological deformities of treated protoscoleces. Furthermore, Caspase-3&7 inductions were examined in protoscoleces cysts treated with all formulations. Based on SEM and DLS analyses, the size of SA-ZnO-NPs was between 30 and 40 nm, with a spherical shape. The FTIR spectrum verified the presence of SA functional groups on the ZnO coating. At 20 min, SA-ZnO-NPs at 2000 µg/ml exhibited the greatest activity on protoscolices with 100% mortality, followed by ZnO-NPs at 1500 µg/ml at 10 min and SA alone at 2000 µg/ml at 30 min. The activation of Caspase-3&7 apoptotic enzyme was determined for 2000 µg/ml of SA-ZnO-NPs, ZnO-NPs and SA to be 16.4, 31.4, and 35.7%, respectively. The SEM image revealed apoptogenic alterations and the induction of tegument surface wrinkles, as well as abnormalities in rostellum protoscolices. According to the current study, SA-ZnO-NPs have a high mortality rate against hydatid cyst protoscolices. As a result, further studies on the qualitative assessment of these nanoformulations in vivo and preclinical animal trials seem to be required. Furthermore, the adoption of nano-drugs potentially offers alternative therapeutic approaches to combat hydatid cysts.

Identification and differentiation of Fasciola hepatica and F. gigantica using multiplex PCR technique.

We aimed to present an alternate method instead of PCR-RFLP and also develop an optimized method for rapid, time-saving and affordable molecular-based approach to discriminate species of liver fluke, Fasciola hepatica and F. gigantica. Seventy-six samples of F. hepatica and 28 F. gigantica were collected from the slaughterhouses of endemic regions in Iran. Following a comprehensive analysis of the mitochondrial complete sequences of both F. hepatica and F. gigantica, the extracted DNAs from all samples were used as templates in multiplex PCR reactions containing two sets of primers specific for cytochrome c oxidase I (cox I) gene of both species. In a parallel experiment, PCR-RFLP was performed for each sample using internal transcribed spacer (ITS1) sequence. Furthermore, following a PCR amplification for cox I gene, the amplicons were purified for sequencing. To assess the validity of the multiplex PCR approach, the obtained data from the multiplex PCR and PCR-RFLP experiments were compared with each other. By sequence analysis of 104 samples, 76 and 28 samples were identified as F. hepatica and F. gigantica, respectively. Results revealed 100% and 92% of accuracy as for multiplex PCR and PCR-RFLP. The designed multiplex PCR strategy offers a valid alternative approach to the conventional methods with distinctive features including convenience, cost-effectiveness, time-saving (3 hours from sampling to obtain final results) and high efficacy.

Are there predictors of flexible ureteroscopic aptitude among novice trainees? objective assessment using simulation-based trainer.

PURPOSE: Non-surgical skills involving hand-eye coordination and bimanual dexterity may have a transferable impact on the acquisition of ureteroscopy skills. In this study, we aim to investigate the predictors of initial flexible ureteroscopy skills among novice trainees. METHODS: This was a prospective study involving students with no prior ureteroscopy exposure. Non-surgical parameters were assessed with a detailed survey, including demographics, video game, and musical history. Musical ability was objectively evaluated with the mini-Profile of Music Perception Skills test. Ureteroscopic performance was evaluated using a Boston Scientific© flexible ureteroscope on a bench model. Each participant completed diagnostic ureteroscopy and stone extraction. Outcomes included both speed and quality of performance, based on an Objective Structured Assessment of Technical Skills rubric. RESULTS: A total of 28 pre-clerkship medical students and 10 urology residents were included. Age and musical background were not associated with ureteroscopic aptitude. Those with video game history tended to perform ureteroscopy tasks faster with a higher OSATS score, although no statistical significance was reached. Male gender was associated with faster task completion with statistically higher OSATS score independent of video game activities (p = 0.011), however, the absolute score difference was small. CONCLUSIONS: Among novice trainees, musical and video game experience was not predictive of ureteroscopy skills. Male gender was associated with slightly faster and higher ureteroscopy technique scores, however, the differences are small and unlikely to represent clinical significance. Nevertheless, the use of ureteroscopy trainer provides useful insights and should be adopted in training programs as a marker of skills progression.

Screening and molecular characterization of Trichomonas vaginalis genotypes isolated from married women in northern Iran.

Trichomonas vaginalis is an anaerobic protozoan parasite that causes trichomonosis in human. It is one of the most common non-viral sexually transmitted infections. It has been found to be most prevalent in patients referred to sexually transmitted disease clinics. In recent years, molecular methods have been used to identify genotypes of this parasite in different parts of the world and so far 6 types of T. vaginalis have identified. The aim of this study was to investigate the prevalence and genotype identification of T. vaginalis from married women in northern Iran. A total of 450 vaginal specimens were taken from married women, referring to health centers in northern Iran. Demographic information of women was collected through a questionnaire. The samples were first examined microscopically and then monitored in Dorsch culture medium for up to 10 days. Actin genes of positive samples were amplified by PCR. Finally, PCR products were used to determine the sequence and genotype of the parasite. Overall, 0.7% (3/450) samples were positive for T. vaginalis. All of the three infected women were housewives. After sequencing, the genotype of these parasites were type H (66.7%) (Accession no; MW414672-MW414673) and type E (33.3%) (Accession no: MW414671). Low prevalence of T. vaginalis in north of Iran indicate high level of hygiene in sexual intercourse and avoiding from high risk sexual behaviors, and also it seems that genotype H is dominant type of the parasite in the study area.

Data on the prevalence and distribution of carbapenemase genes in Enterobacterales species isolated from clinical specimens in the center of Irans.

Carbapenem resistance in Enterobacterales is a major and persistent public health problem worldwide. In current research, we present data of 96 Enterobacterales species collected from a clinical hospital in Isfahan, Iran. The bacterial identification was performed by standard biochemical tests and API 20E methods. Agar disk diffusion assay was performed to determine the phenotypic antibiotic resistance of strains. Polymerase chain reaction (PCR) was carried out to detect carbapenemase genes. In this manuscript, multiple antimicrobial resistance phenotype such as multiple carbapenem resistance determinants were detected. The data would provide important information on distribution of carbapenemase genes of those pathogenic bacteria in Iran.

Seroprevalence of toxoplasmosis in Kermanshah City, west of Iran.

It is estimated that one-third of the world's population is infected with Toxoplasma gondii. The purpose of this study was to evaluate the latest status of toxoplasmosis seroprevalence in the general population and pregnant women in the west of Iran. This retrospective cross-sectional study was conducted in 2018. Accordingly, data associated with serodiagnosis of toxoplasmosis, age, sex, anti-toxoplasmosis IgG and IgM, and pregnancy status in women were collected from 6 health centers of Kermanshah City, the west of Iran, during 2016-2017. In total, 1228 people referred to the health centers in Kermanshah City. Of 1228 people, 359 (29.23%) individuals were seropositive for toxoplasmosis, of them 294 (81.89%) individuals were seropositive only for IgG, and 65 (18.11%) individuals were both IgG and IgM seropositive. The seropositivity in men was 29.3% (n = 63), in women was 29.2% (n = 296), and in pregnant women was 25.9% (n = 44). All individuals were examined using ELISA kit. This study showed that the prevalence of this disease in the west of Iran has been decreased in comparison with the previous studies. Therefore, regular epidemiological studies of in different regions seem to be necessary in order to conclude on the decrease or increase trend of this disease in an area.

Genetic diversity of Leishmania major strains isolated from Phlebotomus papatasi and Phlebotomus alexandri in western Iran based on minicircle kDNA.

This study aimed to screen the natural infection rate of Leishmania major in Phlebotomus papatasi and Phlebotomus alexandri in two counties (Mehran and Dehloran) of Ilam province as cutaneous leishmaniasis endemic areas in the west of Iran. Furthermore, the genetic diversity of parasite species that are isolated from vectors, was investigated. Sandflies were collected by sticky traps from May 2018 to October 2018. Afterward, specimens were prepared for species identification by morphological features. DNA was extracted from female sandflies, and minicircle kDNA was used to identify Leishmania isolates through nested-PCR, followed by genetic diversity between Leishmania isolates was investigated by sequence analysis of the amplified minicircle kDNA. Natural infection of the L. major was shown in all positive specimens using nested-PCR. Analysis of data from 14 isolates displayed a high level of genetic diversity in L. major. In the phylogenetic trees, all of the L. major isolates occurred in six clusters. Clusters I, II, III, and VI contained isolated strains from P. papatasi. While clusters IV and V contained isolated strains from P. alexandri. Genetic diversity of L. major isolated from vectors was investigated in western Iran for the first time. According to the results of this study, probably "various clones of L. major populations are distributed in the study area.

A comparison of the efficiency of molecular and conventional methods in the diagnosis of cutaneous leishmaniosis.

Leishmaniosis is one of the most important vector borne diseases. Among different forms of the disease, cutaneous leishmaniosis (CL) is the most common. Determining the method of definitive diagnosis for the disease has been the aim of various studies. Therefore this study afforded an opportunity to investigate this subject. To diagnose CL in 150 suspected patients referred to Mehran and Dehloran health centers during June 2018 to November 2019, two polymerase chain reaction (PCR) methods were performed and compared with the in vitro culture and microscopic evaluation of stained slides. The smears were stained with Giemsa for microscopy and cultured in Novy-Nicolle-McNeal (NNN) blood agar for promastigote growth. For semi-nested PCR and PCR-RFLP, the tissue and serosity from the lesions were used for DNA extraction. The semi-nested PCR technique using minicircle kDNA gene showed the highest positivity rates among all diagnostic assays with 114/150 (76%) of the samples and was used as reference standard, followed by the PCR-RFLP test using ITS1 gene with 112/150, (74.7%) positivity rates, microscopy with 101/150 (67.3%) and then culture 72/150 (48%). microscopy and culture methods together improved overall positivity rates to 68.7% (103/150). The all positive samples using molecular technique were identified as Leishmania major. The highest sensitivity (98.3%), specificity (100%), accuracy (98.8%), negative predictive value (94.7%) and κ coefficient (0.96=almost perfect) was observed by comparing PCR-RFLP and semi-nested PCR. kDNA-semi-nested PCR and ITS1-PCR-RFLP presented an interesting alternative to conventional methods for the identification of CL and improved its diagnostic value significantly in suspected patients with negative direct smears.

Study of fauna, activity patterns and Leishmania infection rate of phlebotomine sand flies in Western Iran.

Cutaneous leishmaniasis is a crucial vector-borne disease caused by various species of Leishmania and is transmitted by several species of sandflies. The present study was conducted to describe sand fly fauna on vectors of leishmaniasis and performing molecular identification of Leishmania isolates from them on the Iran-Iraq border. Entomological surveys were done from May to October 2016-2018 in 2 counties (Mehran and Dehloran) of Ilam province, west of Iran. Sandflies were collected by 40 Sticky Traps at each station. Samples were mounted for species identification using morphological characters of the head and abdominal terminalia. DNA was extracted from Phlebotomus papatasi females, and Leishmania isolates were identified through PCR on minicircle kDNA, followed by sequencing. A total of 5592 sandflies including 2 genera of Phlebotomus and Sergentomyia comprising 8 species of sand flies were detected. Leishmania major infection was detected in 3.33% of 300 tested female sandflies. Phlebotomus papatasi was predominant in outdoor and indoor resting places. Phlebotomus papatasi was determined as dominant vector of Leishmania major infection in Mehran and Dehloran counties, West of Iran. It seems the composition of sandfly species in the study area is almost similar to the other parts of Iran. A detailed description of the epidemiology and ecology of Phlebotomine sand flies needs to be established to accomplish effective vector control programs.

High contamination of soil with Toxocara spp. eggs in the north of Iran.

Toxocarosis is an important emerging zoonotic disease, which is caused by larvae of Toxocara canis and Toxocara cati, the most widely distributed nematode parasites of dogs and cats. The soil, where Toxocara eggs become infective, is the natural source of infection. The aim of this work was to determine the levels of soil contamination with Toxocara spp. eggs in Sari district, north of Iran, in order to estimate the risk of infection of the population living in this region. A total of 141 soil samples were collected from 12 parks, 12 primary schools and 45 backyards from three regions. Soil samples were investigated for the presence of Toxocara eggs by flotation technique using sucrose solution and examined under light microscope using 10× and 40× objective. Out of 141 soil samples, 67 (47.5%) were found to contain Toxocara spp. eggs. The contamination rate in public parks, primary schools and backyards were observed 50%, 58.3% and 33.3%, respectively. The comparison of soil contamination rate from different areas, public parks, primary schools and backyards, was statistically significant (χ2=6.00, d.f.=2 and P=0.049). The public parks, backyards and primary schools, which are main places that children play, are suitable for defecation of dogs and cats. The knowledge of the soil contamination with Toxocara eggs indicates the need to take an appropriate and effective measures to prevent the infection.

Investigating the prevalence of intestinal parasites with an emphasis on Strongyloides stercoralis infection in hospitalized patients: a regional report from Iran.

Intestinal parasitic infections such as strongyloidosis are more common among individuals with immune deficiency and sometimes accompanied by severe symptoms. The purpose of this cross-sectional study was to evaluate the prevalence of intestinal parasites with focus on strongyloidosis in hospitalized patients. A total number of 566 faecal samples were obtained from different wards and assessed by the use of direct smear, formalin-ether concentration, and agar plate culture procedures in order to find parasitic protozoa and helminthes. The findings revealed that 10.1% (n=57) of the examined samples were positive for intestinal parasites. The highest prevalence rate was related to Entamoeba coli (4.6%, n=26) and the lowest one was related to Strongyloides stercoralis (0.5%, n=3). In addition, Giardia lamblia prevalence rate was 3.2% (n=18) and the prevalence rate of Blastocystis hominis was 1.8% (n=10). The sensitivity of S. stercoralis diagnosis was equal for agar plate culture and formalin-ether concentration methods. This study demonstrated the significance of focus on intestinal parasites in hospitalized patients and highlighted the necessity of improving the insight in health care providers about the occurrence of parasitic infections especially strongyloidiasis in these patients.

Frequency and Molecular Identification of Cryptosporidium Species among Immunocompromised Patients Referred to Hospitals, Central Iran, 2015-16.

BACKGROUND: The purpose of this study was to determine the prevalence and genotype of Cryptosporidium spp. in different groups of immunocompromised patients admitted to the referral hospitals in center of Iran during 2015-2016. METHODS: This cross-sectional study was conducted on 346 immunocompromised patients (HIV+/AIDS, Lymphoma, Leukemia and organ transplants) in referred hospitals from central parts of Iran including Isfahan, Markazi, Yazd and Chaharmahale Bakhtiari provinces. Stool samples were analyzed for Cryptosporidium species, modified Ziehl-Neelsen staining techniques followed by the semi-nested PCR and DNA sequencing methods. RESULTS: The total rate of Cryptosporidium spp. was 3.46% (12/346) in the patients, however, the prevalence of the parasite, was 4.6% (4/87) in HIV+/AIDS patients, 3.6% (6/168) in patients with blood malignancy and 2.1% (2/91) in organ transplant recipients. The SSU rRNA gene of Cryptosporidium spp. in all microscopic-positive samples was effectively amplified by the semi-nested PCR and DNA sequences, exposed the existence of two Cryptosporidium species, including C. hominis 91.6% (11/12) and C. parvum 8.3% (1/12). CONCLUSION: The predominance of C. hominis in the present study may be certifies the importance of anthroponotic transmission of cryptosporidiosis in center of Iran.

A Case of an Adult Wilms Tumour in a Patient With Velocardiofacial Syndrome.

Adult Wilms tumors (nephroblastomas) are exceedingly rare with less than 500 cases reported in the literature. To our knowledge, ours is the first reported case of a patient with velocardiofacial syndrome (Shprintzen syndrome) acquiring an adult Wilms tumor. The case highlights the possible role of chromosome 22q aberrations toward the pathogenesis of a subset of Wilms tumors.

Does patient education improve compliance to routine diabetic retinopathy screening?

Introduction: Diabetic retinopathy (DR) screening relies on adherence to follow-up eye care. This article assesses if a model of patient education and tele-retina screening among high-risk patients with DR can achieve increased rates of compliance within a one-year follow-up. Methods: Between May 2014 and May 2016, DR screening was conducted in a cohort of 101 patients with diabetes in Southern Ontario. Optical coherence tomography and fundus photography images were used to visualize the retina remotely. Enrolled patients participated in an educational seminar at the screening site with the expressed purpose of enhancing patient understanding of DR. A chi-squared test was used to assess patient compliance to follow-up examinations within 6­12 months, while pre-to post-screening HbA1c levels were compared using a dependent t-test. Results: Of 101 patients who completed the study, 33 patients (32.6%) have never previously been screened for DR. Baseline compliance to annual screening increased from 36 patients (35.6%) to 51 patients (50.5%) after the tele-retina programme (p = 0.03). Eighty-nine patients (88%) were referred to an optometrist for ongoing care compared with 12 patients (11.9%) to an ophthalmologist for management of DR. Overall, 100 patients (99.0%) were satisfied with the tele-retina screening. There was no significant change in pre- to-post screening HbA1c levels (p = 0.91). Discussion: Patient education-focused tele-retina screening for DR significantly increased compliance to follow-up in a high-risk, non-compliant patient population. Management of diabetes as captured by HbA1c levels remain unchanged in the cohort indicating a need for ongoing inter-professional collaboration in education and vision screening.

The role of Bax in the apoptosis of Leishmania-infected macrophages.

BACKGROUND: Leishmania is a protozoan parasite that nests in macrophages and is responsible for the Leishmaniasis disease. In spite of different defense pathways, last strategy of macrophage for killing parasite is apoptosis process. By permeableizing the mitochondrial outer membrane (MOM). As breaching MOM releases apoptogenic factors like cytochrome-c which activate caspases that result in the destruction of the cell. In this review, we summarized the appropriate manuscripts regarding the bax includes, its different types and the effect of bax on the apoptosis of Leishmania and parasite-infected macrophages. METHODS: Information about the role of BAX in the apoptosis of parasite-infected macrophage of recent articles were surveyed by searching computerized bibliographic database PubMed and Google Scholar entering the keywords BAX and leishmaniasis. RESULTS: The common studies revealed Leishmania use different survival strategies for inhibiting macrophage apoptosis. As Leishmania by preventing homooligomerization or upregulating the anti-apoptotic molecule Bcl-2 can prohibits proteins of host-cell apoptosis such as Bax that is required for mitochondrial permeabilisation during apoptosis. CONCLUSION: With regard to the supportive role of bax in apoptosis and the preventive role of Leishmania in its function, it seems that expression of bax gene in parasite by technologies like transgenic or down regulating of anti-apoptotic molecule Bcl-2 by miRNA could be prompted the apoptosis process of infected-macrophages and inhibited extensive spread of Leishmania and the resulting lesions.

Correction to: Isolated Human and Livestock Echinococcus granulosus Genotypes Using Real-Time PCR of cox1 Gene in Northeast Iran.

Unfortunately, the affiliation of Majid Fasihi­Harandi needs to be edited.

Isolated Human and Livestock Echinococcus granulosus Genotypes Using Real-Time PCR of cox1 Gene in Northeast Iran.

PURPOSE: Cystic echinococcosis (CE), caused by the metacestode of Echinococcus granulosus, is highly endemic over large parts of Iran. The purpose of this study was to investigate the prevalence rate of hydatidosis and mitochondrial cox1 real-time PCR with high-resolution melting curve (HRM) analysis of E. granulosus isolated from human and livestock. METHODS: In this cross-sectional study, 61 formalin-fixed paraffin-embedded tissue isolates were collected from human CE cases and 83 hydatid cysts from the liver and lung lesions of the livestock in Khorasan Razavi province, Northeast Iran. DNA was extracted from each isolate and amplified by real-time PCR and analyzed using the HRM method. RESULTS: The HRM analysis using the cox1 gene of 40 E. granulosus human isolates showed that 35 (87.5%), 4 (10%), and 1 (2.5%) of the isolates were categorized as G1, G3, and G6 genotypes, respectively. Out of the total 1342 livestock inspected, 39 (4%) goats and 44(12%) cattle were found harboring hydatid cysts all belonging to E. granulosus sensu stricto. CONCLUSION: The results confirmed that the high prevalence of E. granulosus sensu stricto in intermediate hosts is remarkable in northeast of Iran coupled with the high prevalence of infection in livestock, which reinforced the need for hydatidosis control programs in this region.