Why the COVID-19 Is Not Significantly Reduced in Iran?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was transported from China to Iran via passengers. The virus is transmitted through droplets from coughing, sneezing, talking and contact with infected surfaces. Due to high transmissibility in places such as clinics, medical offices, buses and offices where there are large crowds, it spread rapidly in Iran and caused the mortality of a significant number of people, especially the elderly with underlying disease. Preventing travel and gatherings, as well as applying house quarantine in Apr 2020, reduced COVID-19 somewhat but then due to lack of attention to social distancing, reducing the use of masks by the people and inappropriate decisions by the national committee on combating coronavirus (NCCC), including reducing the working hours of public offices and shops, reducing the staff of government offices, monopoly on the distribution of essential materials and supplies, the presence of overcrowding in clinics of medical centers, hospitals, and private clinics caused the decline of the disease in the country to decrease. Measures can be taken to prevent the spread of the virus as much as possible, including: rapid detection of infected people, their isolation, contact tracing, quarantine of people over 65 and under 15, protection of the elderly, prevention of gatherings, forcing the use of protective equipment in possible gatherings, and electronicizing public services.

IFN-γ and TNF-α Gene Polymorphisms in Multiple Sclerosis Patients in Northwest Iran.

BACKGROUND: Cytokines are polypeptides that play critical roles in immune responses. Gene polymorphisms occurring in the inflammatory cytokines are taking a role in autoimmune diseases, including multiple sclerosis (MS), which may induce inappropriate immune responses. OBJECTIVE: The aim of this study was to investigate the allelic and genotypic frequencies of interferon gamma gene (IFN-γ) at +874A/T locus and tumor necrosis factor (TNF-α) at+308A/G locus in MS patients of Azeri population. METHODS: At first, a questionnaire was prepared for each of 240 healthy, non-relative, and 152 Azeri MS patients before obtaining the blood sample from all subjects. After DNA extraction, the frequency of alleles and genotypes of the IFN-γ and TNF-α genes at +874A/T and -308G/A loci, respectively, were determined by allele-specific PCR method. Finally, the frequencies were compared between control and MS patients by chi-square test (x2-test) and p<0.05 was considered significant. RESULTS: In the IFN-γ +874A/T gene single nucleotide polymorphism (SNP), the most allelic and genotypic frequencies in MS patients were the A allele, 55.26% (p=0.04) and the AT genotype, 52.63% (p=0.048). In healthy individuals, it was 65.42% for the A allele and 45.42% for the AA genotype. For the TNF-α 308 G/A SNP, the highest allelic and genotypic frequencies in MS patients were the G allele with 55.92% (p<0.001) and AG genotype with 61.84%, and in healthy subjects, the allelic and genotypic frequencies were 84.2% and 70.8% for the G allele and GG genotype, respectively. CONCLUSION: Head trauma, the infection with the herpes virus and Mycoplasma pneumonia, frequent colds and high consumption of canned foods provide grounds for MS. The T allele in the IFN-γ gene (+874) and the genotypes of AA and AG at the TNF-α gene (-308) at the position-308 were considered as potential risk factors for MS. Therefore, the polymorphisms in cytokine genes and following changes in their expression levels can be effective in susceptibility to MS.

Vitamin D Receptor Gene Polymorphism and the Risk of Multiple Sclerosis in the Azeri Population of Iran.

BACKGROUND: Multiple sclerosis (MS), a disease of the central nervous system (CNS), is associated with damage to the myelin sheath of neurons. It is demonstrated that vitamin D deficiency plays an important role in the development of the disease. Binding of vitamin D to its specific nuclear receptors is a way to exert its function. OBJECTIVE: Possible correlation between the vitamin D receptor (VDR) gene and MS was evaluated in the Azeri population of Iran. METHODS: Different genotypes of the Bsml site were determined by using the PCR-RFLP method in 148 MS patients and 220 non-relative healthy controls. RESULTS: In MS patients, genotype bb was significantly higher than the healthy controls (p<0.05). Additionally, most subjects of the MS group had been insufficiently exposed to sunlight before the age of 15 (p<0.001). Our findings indicated that the red meat intake in MS patients was significantly higher than the healthy controls (p<0.001). In addition, the healthy controls had appropriate dieting behaviors in comparison to MS patients (excessive intake of some foods) (p=0.0001). CONCLUSION: In conclusion, genotype BB and sufficient exposure to sunlight before the age of 15 were the protective factors against MS. Although, excessive consumption of red meat and inappropriate dieting behaviors were predisposing factors to MS disease.

Risk Factors for COVID-19.

SARS-CoV-2 in bats was transmitted to humans at a live and wet animal market in China through the intermediate host, creating COVID-19. Viral, environmental and host factors play roles in virus infection and disease. The virus has high transmissibility and is rapidly transmitted to people through close contact and droplets from coughing, sneezing and talking loudly, as well as through contact with contaminated objects. As crowding is an environmental risk factor for contamination, its transmission is high among patients and staff in hospital and also in elderly-care centers. It is more common in the elderly, in men, and subjects with diabetes mellitus, hypertension, cardiovascular disease, and malignancy.

Role of Immigration in Tuberculosis Transmission to Iran: A Systematic Review.

BACKGROUND: Today, because of increasing immigration and the prevalence of drug-resistant tuberculosis in Iran, identifying intra-community cases is necessary in the country. It will be possible through the use of molecular epidemiologic methods. In this inquiry, in order to determine the role of immigrants in the transmission of specific strains to Iran, the studies have been examined which had been conducted based on molecular epidemiologic methods among Iranians and non-Iranians people. METHODS: All studies from 1997 to the end of March 2017 were examined in three databases of PubMed, Scopus, and Google Scholar and finally, 16 studies were selected. RESULTS: The common clustering rate between Iranians and non-Iranians was determined to be 19.8, and the intra-community recent transmission rate was from 0% to 49% with average of 18.1%. The rate of multidrug-resistant tuberculosis (MDR-TB) was 12.5%, which was higher among immigrants, especially Afghans, and a significant number of the strains were Beijing. CONCLUSIONS: The studies have shown that migrants, especially Afghans, are more effective in transmitting specific strains of tuberculosis to migratory areas. To control tuberculosis, it is necessary to register of immigrant's health information, while enter to the country, so that, by doing appropriate diagnostic tests, the curing the patients, the transmission of tuberculosis to the country would be prevented.

Stopping of the Downtrend of Tuberculosis in Iran, a Systematic Review of Associated Risk Factors.

Tuberculosis (TB) is a public health problem in developing countries. In recent decades, the incidence of the disease has been gradually reducing in Iran. However, the reducing incidence of the disease has stopped in the country during recent years. It could be due to an increase in immigration, diabetes, HIV/AIDS, and the prevalence of drug-resistant strains. In order to prevent the spread of TB cases and control this disease, it is essential to identify the predisposing factors, which may be related to bacteria, host and environment. The objective of the present systematic review was to investigate the role of potentially effective factors in the increase in TB cases in the country. The epidemiological studies that had considered the risk factors for the development of TB in populations from different regions of Iran were reviewed systematically from the beginning of 2007 to the end of June 2017 in electronic databases. Upon evaluation of the literature, these 7 major risk factors were identified in twenty-five eligible studies, including poor living conditions, drug abuse, HIV/AIDS, multidrug-resistant tuberculosis (MDR-TB), diabetes, migration, and smoking. In conclusion, the increase in predisposing risk factors for catching TB, especially the migration and Beijing strain, shows that in the absence of accurate monitoring, TB cases will increase in the near future in Iran.

Relationship between the use of electronic devices and susceptibility to multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune condition influenced by both genetic and environmental factors. Dirty electricity generated by electronic equipment is one of the environmental factors that may directly or indirectly impact MS susceptibility. The current Study aimed to evaluate the relationship between the usage time of electronic equipment and susceptibility to MS in North-West Iranian people. This approach was carried out upon 471 MS-diagnosed patients and 453 healthy participants as control group in East Province of Azerbaijan. By utilizing structured questionnaires, the information of all participants about usage status of some electronic devices was obtained. Data were analyzed by IBM SPSS Statistics version 18.0 and the quantitative variables were analyzed by Chi Square and Independent sample t tests. P values below or equal to 0.05 were considered as significant. Among the evaluated items in this approach, the utilization of cell phones and satellite television dishes were significantly higher in MS patients (p < 0.001, p = 0.07). Furthermore, a correlation was observed between sleeping with cell phone and/or laptop under the pillow (p = 0.011) and MS disease; however, there was no significant differences between MS patients and controls in computer using and television watching. Our study reinforces the concept that the utilization of some electronic devices and the continuous exposure to dirty electricity would increase the risk of MS disease thereupon by enhancing the cognizance of adverse effects of dirty electricity and reducing the time spent over electronic devices during adolescence and adulthood the occurrence probability of MS could be declined.

Laboratory Cross-Contamination of Mycobacterium tuberculosis: A Systematic Review and Meta-analysis.

BACKGROUND: Microbiological cultures are the mainstay of the diagnosis of tuberculosis (TB). False-positive TB results lead to significant unnecessary therapeutic and economic burden and are frequently caused by laboratory cross-contamination. The aim of this meta-analysis was to quantify the prevalence of laboratory cross-contamination. METHODS: Through a systematic review of five electronic databases, we identified studies reporting rates of laboratory cross-contamination, confirmed by molecular techniques in TB cultures. We evaluated the quality of the identified studies using the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and conducted a meta-analysis using standard methodology recommended by the Cochrane Collaboration. RESULTS: Based on 31 eligible studies evaluating 29,839 TB cultures, we found that 2% (95% confidence intervals [CI] 1-2%) of all positive TB cultures represent false-positive results secondary to laboratory cross-contamination. More importantly, we evaluated the rate of laboratory cross-contamination in cases where a single-positive TB culture was available in addition to at least one negative TB culture, and we found a rate of 15% (95% CI 6-33%). Moreover, 9.2% (91/990) of all patients with a preliminary diagnosis of TB had false-positive results and received unnecessary and potentially harmful treatments. CONCLUSIONS: Our results highlight a remarkably high prevalence of false-positive TB results as a result of laboratory cross-contamination, especially in single-positive TB cultures, leading to the administration of unnecessary, harmful treatments. The need for the adoption of strict technical standards for mycobacterial cultures cannot be overstated.

Frequency of Smear-Negative Tuberculosis in Northwest Iran.

BACKGROUND: Microscopic smear examination is the most common test in tuberculosis (TB) detection. It is, however, not strong enough to identify TB in the majority of afflicted individuals; thus, a significant number of TB patients are smear negative and capable of transmitting the infection. The aim of this study was to evaluate the rate of smear-negative TB in northwest Iran. METHODS: In this cross-sectional study, 329 TB-confirmed patients were evaluated through culture up to March 1, 2015, in northwest Iran. The demographic and clinical features of the smear-negative and smear-positive TB patients were compared. The χ2 test was used to compare the frequency of the variables. All the statistical analyses were conducted using SPSS, version 16 (Chicago, IL, USA). RESULTS: Seventy-five cases were smear negative and 254 were smear positive. Smokers, asthmatics, and extra-pulmonary TB patients were primarily among the smear-negative cases. The rate of mortality was also relatively higher among the smear-negative TB patients. CONCLUSION: Totally, 22.8% of the TB cases in northwest Iran were smear negative, with a relatively higher rate of mortality than those with positive smears. A delay in these patients' return to TB diagnosis and treatment centers increases the chance of transmission to others. This is a very sensitive issue in centers where there is no equipment for TB cultivation. Thus, it is essential to equip centers without TB cultivation facilities and to use appropriate diagnostic techniques in centers with those facilities to help rapidly detect smear-negative cases.

Role of Molecular Epidemiology on Tuberculosis Control in the Middle East Countries: a Systematic Review and Meta-Analysis.

BACKGROUND: Tuberculosis (TB) is a public health problem in developing countries and yet the numbers of people with the disease are abundant. Early detection of transmission sources and effective treatment of the cases is essential to control the disease which will be possible by application of molecular epidemiology approaches. Studies conducted based on Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) method in Muslim Middle East countries were evaluated to determine their role in TB control. MATERIALS AND METHODS: All studies from January 2005 to April 2016 were systematically reviewed in four electronic databases and finally 16 articles were found eligible to be included in this study. The mean clustering rate was determined as 44% and the recent transmission rate was 12.3 to 78.8% with average of 33%. RESULTS: The results showed that both reactivation and recent transmission were important in developing new cases of TB in Middle East countries; but, reactivation plays a more critical role. CONCLUSION: Regarding to ongoing war and immigration in the region along with the increasing of drug-resistant TB, in the case of improper supervision in the future, the disease, especially drug- resistant TB, will be problematic.

Tuberculosis Control and Role of Molecular Epidemiology Studies in Iran: A Systematic Review.

BACKGROUND: Today because of immigration, HIV pandemic and spread of drug resistant tuberculosis, mortality caused by tuberculosis (TB) has increased. To control the disease it is essential to identify the sources of the infection and patterns of transmission. This becomes possible through using molecular epidemiology methods. MATERIALS AND METHODS: This research reviewed studies based on IS6110-restriction fragment length polymorphism (IS6110-RFLP) as a primary method to recognize the role of molecular epidemiology researches in managing TB in Iran. Within 1995-2015 all human population based studies which had use IS6110-RFLP as the primary method systematically reviewed. RESULTS: At the end, 11 articles were selected. The mean clustering rate obtained was 28.1%. The rate of recent transmission was variable from 2% to 49% and the mean value was determined 17%. CONCLUSION: The studies revealed that in Iran both reactivation and recent transmission were significant in developing new cases of TB. Yet, reactivation plays greater role. If the matter is supervised insufficiently and carelessly, because of increasing rate of drug resistant TB, immigration of HIV infected individuals, TB especially drug resistant TB will be problematic in the near future.

Molecular Diversity of Mycobacterium tuberculosis Strains in Northwestern Iran.

BACKGROUND: Years after the development of antituberculosis (TB) drugs, many people continue to suffer from this disease. To control the spread of TB, strains of the Mycobacterium tuberculosis complex need to be determined, and sources of infection must be identified. Such steps should help to prevent transmission of the infection. OBJECTIVES: The aim of this study was to perform molecular genotyping of isolates of the M. tuberculosis complex obtained from patients in northwestern Iran. METHODS: One hundred ninety-four culture-positive M. tuberculosis isolates obtained from patients in northwestern Iran were analyzed using the mycobacterial interspersed repetitive unit-exact tandem repeats (MIRU-ETR) method. RESULTS: The MIRU-ETR method distinguished 162 different patterns in the 194 isolates, comprising 23 clusters and 139 unique patterns. Its discriminatory power according to the Hunter-Gaston discriminatory index (HGDI) was 0.9978. The largest cluster contained six isolates. CONCLUSIONS: This research indicated that various strains of M. tuberculosis were responsible for TB and that the majority of cases were due to reactivation.

Association of Promoter Polymorphisms of Interleukin-10 and Interferon-Gamma Genes with Tuberculosis in Azeri Population of Iran.

Promoter polymorphism of cytokine genes may lead to inter-individual differences in cytokine levels, therefore, polymorphisms may associate with susceptibility to infectious diseases. In this study, we investigated a possible association between interleukin-10 (IL-10) -1082A/G (rs1800896) and interferon (IFN)-gamma +874T/A (rs2430561) promoter polymorphisms and tuberculosis (TB) in the Azeri population of Iran. IL-10 -1082G/A and IFN-gamma +874T/A single nucleotide polymorphisms (SNPs) were genotyped by amplification refractory mutation system (ARMS)-PCR in 200 healthy controls and 124 tuberculosis patients. IL-10 -1082 A allele was more frequent in the control group than in the patient group (p=0.001, odds ratio [OR]=2.183). On the other hand, the AA genotype was significantly more frequent in the control group (p=0.0001). The frequency of IFN-gamma +874 T allele was significantly higher in the controls (p=0.013, OR=1.56). There was no significant association between IFN-gamma +874 T/A genotypes and susceptibility to tuberculosis (p=0.078), but TT genotype was more frequent in the control group. Our findings suggest that interleukin-10 -1082G/A polymorphism may play an important role in susceptibility to tuberculosis in our population. On the other hand, the +874T allele, which has been suggested to be associated with high IFN-gamma levels, was significantly higher in the controls and TT genotype was also more frequent in the control group. Thus, +874 T allele may be associated with resistance to tuberculosis in this Azeri population of Iran.