Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

BACKGROUND

Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.

METHODS

We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.

FINDINGS

Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier.

INTERPRETATION

Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress.

FUNDING

Bill & Melinda Gates Foundation.

The Neglected Role of Trichomonas tenax in Oral Diseases: A Systematic Review and Meta-analysis

PURPOSE

Trichomonas tenax (T. tenax) is a commensal flagellated protozoan found in periodontal microenvironment of the oral cavity, with a possible role in periodontal diseases. The purpose of the present systematic review and meta-analysis was to determine the worldwide prevalence of T. tenax infection and to show the neglected association of this parasitic infection with oral diseases.

METHODS

To find literatures published until August 2020, five English databases (PubMed, Scopus, Science Direct, Web of Science and Google Scholar) were explored. Finally, 65 papers were qualified to be included in the current study.

RESULTS

Our results revealed a global pooled prevalence of 17% (95% CI 14-22%) for T. tenax infection. The highest prevalence was estimated at 56% (42-69%) in Chile, while the lowest prevalence was related to Kenya with 3% (1-6%). The age-based analysis found that the infection was most common in 46-55 mean age group with 15% (0-100%). The overall prevalence regarding culture method, molecular method and direct method was 21% (12-32%), 19% (8-35%) and 17% (12-23%), respectively. Moreover, the subgroup analysis showed the pooled prevalence in patient with candidiasis [22% (3-52%)], gingivitis [21% (9-36%)] and periodontitis [27% (10-48%)].

CONCLUSION

Our study specified a connection between T. tenax protozoa and periodontitis disease. However, more epidemiological studies as well as clinical trials are needed to precisely identify this relation.

Environmental Surface Contamination with SARS-CoV-2: Toilets as the Most Contaminated Surfaces in COVID-19 Referral Hospital

INTRODUCTION

The possibility of surface transmission in hospitals with high density of COVID- 19 patients is unneglectable. The aim of this study is to determine the extent of surface contamination in coronavirus central hospital of Ilam province in western Iran.

MATERIALS AND METHODS

In this experimental study, 205 samples were taken from environmental surfaces in hospital. SARS-CoV-2 RNA detected by Real-time RT-PCR.

RESULTS

121 out of 205 (50.02%) samples were positive. The most contaminated objects were toilet sites (5/5,100% ICU; 5/5, 100% isolation wards).

CONCLUSION

High surface contamination with SARS-CoV-2 proposes the surface as a potential route of transmission.

Use of multidimensional item response theory methods for dementia prevalence prediction: an example using the Health and Retirement Survey and the Aging, Demographics, and Memory Study

BACKGROUND

Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation samples from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally.

METHODS

Using cognitive testing data and data on functional limitations from Wave A (2001-2003) of the ADAMS study (n = 744) and the 2000 wave of the HRS study (n = 6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all individuals over 70. Based on diagnostic information from the formal clinical adjudication in ADAMS, we fit a logistic regression model for the classification of dementia status using cognition and function scores and applied this algorithm to the full HRS sample to calculate dementia prevalence by age and sex.

RESULTS

Our algorithm had a cross-validated predictive accuracy of 88% (86-90), and an area under the curve of 0.97 (0.97-0.98) in ADAMS. Prevalence was higher in females than males and increased over age, with a prevalence of 4% (3-4) in individuals 70-79, 11% (9-12) in individuals 80-89 years old, and 28% (22-35) in those 90 and older.

CONCLUSIONS

Our model had similar or better accuracy as compared to previously reviewed algorithms for the prediction of dementia prevalence in HRS, while utilizing more flexible methods. These methods could be more easily generalized and utilized to estimate dementia prevalence in other national surveys.

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019: a systematic analysis for the Global Burden of Disease Study 2020, Release 1

BACKGROUND

Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time.

METHODS

For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development.

FINDINGS

By 2019, global coverage of third-dose DTP (DTP3; 81·6% [95% uncertainty interval 80·4-82·7]) more than doubled from levels estimated in 1980 (39·9% [37·5-42·1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38·5% [35·4-41·3] in 1980 to 83·6% [82·3-84·8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42·6% (41·4-44·1) in 1980 to 79·8% (78·4-81·1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56·8 million (52·6-60·9) to 14·5 million (13·4-15·9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019.

INTERPRETATION

After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines.

FUNDING

Bill & Melinda Gates Foundation.

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

BACKGROUND

Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control.

METHODS

We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period.

FINDINGS

In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period.

INTERPRETATION

Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence.

FUNDING

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Global prevalence of Trichomonas vaginalis among female sex workers: a systematic review and meta-analysis

Trichomoniasis is a sexually transmitted infection (STI), caused by the protozoan parasite, Trichomonas vaginalis. Female sex workers are intensely affected by the infection, since they have frequent direct physical contact. The current systematic review and meta-analysis represents the global prevalence of T. vaginalis in female sex workers. Five databases (Science Direct, Scopus, PubMed, Web of Science, and Google Scholar) were explored for literatures that published from July 1985 to June 2020. Totally, 85 studies (54,515 participants) from 46 countries met the inclusion criteria. The global pooled prevalence of T. vaginalis was 16% (95% CI 13-19%). The estimated pooled prevalence based on methods including wet mount, culture, and molecular techniques was 15% (95% CI 12-19%), 16% (95% CI 10-24%), and 22% (95% CI 13-32%), respectively. Moreover, the infection was most prevalent at the mean age of 30-36 (20%, 95% CI 11-30%). Regarding the World Health Organization (WHO) regions, the highest pooled prevalence was estimated to be in the African region (23%, 95% CI 7-46%). In addition, we indicated that countries with low-income level have the highest pooled prevalence (23%, 95% CI 14-34%). Our results revealed that the worldwide prevalence of T. vaginalis was significant in female sex workers. Therefore, considering a precise strategy such as a health education program with regard to safe intercourse is needed to increase knowledge and prevent T. vaginalis infection in sex workers.

Global prevalence of intestinal parasitic infections and associated risk factors in pregnant women: a systematic review and meta-analysis

BACKGROUND

Intestinal parasitic infections (IPIs) during pregnancy, if left untreated, can cause adverse effects for the mothers, foetuses and newborns. However, limited information is available about the global status of IPIs in pregnant women. Here we undertook a meta-analysis to estimate the global prevalence of IPIs and associated risk factors in pregnant women.

METHODS

We searched the PubMed, Science Direct, Scopus, Web of Science and Google Scholar databases for relevant studies that were published between 1 January 1987 and 30 December 2019. A random effects meta-analysis model was used to estimate the pooled prevalence, odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

A total of 114 studies comprising 98 342 pregnant women across 35 countries were included in the systematic review and meta-analysis. Among IPIs identified from pregnant women, three helminth infections (hookworm 19% [95% CI 15 to 23], Ascaris lumbricoides 17% [95% CI 13 to 21] and Trichuris trichiura 11% [95% CI 7 to 16]) and three protozoan infections (Blastocystis sp. 21% [95% CI 4 to 46], Entamoeba histolytica/dispar 9% [95% CI 3 to 19] and Giardia sp. 8% [95% CI 4 to 13]) were identified as the most prevalent intestinal parasites. Moreover, we found that there was a significant association between IPIs with increased risk of anaemia in pregnant women (OR 2.65 [95% CI 2.08 to 3.37]). The prevalence of IPIs was slightly higher in geophagic pregnant women compared with controls, but this was not significant (OR 1.22 [95% CI 0.87 to 1.71]). According to species, the pooled OR of A. lumbricoides infection had a significantly higher risk in geophagic pregnant women compared with controls (OR 2.66 [95% CI 1.37 to 5.16]). There was a positive relationship between the high prevalence of IPIs in pregnant women living in rural areas compared with urban residents (OR 3.36 [95% CI 1.57 to 7.19]).

CONCLUSIONS

The current review revealed a relatively high prevalence of IPIs in pregnant women, especially in some low- and middle-income countries. These results suggest a need for improved prevention and control efforts to reduce the health risks to pregnant women.

Toxoplasma oocysts in the soil of public places worldwide: a systematic review and meta-analysis

Toxoplasmosis is a zoonotic and cosmopolitan infection. Although a few studies have evaluated the prevalence of Toxoplasma oocysts in the soil of public places, the present study was conducted to provide insights into environmental contamination levels and its potential transmission to humans on a global scale. A systematic search was conducted using bibliographic databases through 30 August 2020. A random effects model was utilized to estimate pooled prevalence with 95% confidence intervals (CIs). Subgroup analysis and meta-regressions were also performed on the geographical and environmental parameters. Finally, 22 articles, wherein 15 420 soil samples were examined, met the systematic review and meta-analysis requirements. The mean pooled prevalence of Toxoplasma oocysts was estimated at 16% (95% CI 10 to 26) in public places. The estimated prevalences in Europe, South America, Asia and North America were 23% (95% CI 4 to 65), 22% (95% CI 18 to 26), 15% (95% CI 0.06 to 33) and 8% (95% CI 0.00 to 97), respectively. An increasing trend was observed in the prevalence of Toxoplasma oocysts with increasing latitude (41-56°), decreasing longitude (0-40°) and increasing relative humidity (≥76%). Loop-mediated isothermal amplification and polymerase chain reaction methods revealed the highest and lowest prevalence rates, respectively, in the detection of Toxoplasma oocysts. Awareness of the health authorities and people about Toxoplasma prevalence in the soil of public places and its risk factors is of great importance to developing effective strategies to prevent infection.

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019

BACKGROUND

Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.

METHODS

We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.

FINDINGS

Globally in 2019, 1·14 billion (95% uncertainty interval 1·13-1·16) individuals were current smokers, who consumed 7·41 trillion (7·11-7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5-28·5] reduction) and females (37·7% [35·4-39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98-1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16-8·20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3-21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.

INTERPRETATION

In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens.

FUNDING

Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Prevalence and clinical presentation of COVID-19 infection in hemodialysis patients

Introduction: Hemodialysis (HD) patients are at increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives: The aim of this study was to evaluate the prevalence and clinical symptoms of SARS-CoV-2 infection in HD patients. Patients and Methods: This is a single-center study conducted at HD center, in Ilam, Iran. The study was included 87 HD patients to be tested. SARS-CoV-2 infection was diagnosed with confirmed test by rRT-PCR (real-time reverse transcription polymerase chain reaction) assay. Results: Around 35.63% of HD patients were diagnosed as COVID-19 infection; most of them were male (74.4%). Dyspnea (58.1%) and cough (45.2%) were the most common symptoms among HD cases with SARS-CoV-2 infection. Diabetes (16.1%) and hypertension (19.4%) were the most coexisting medical illnesses. About 12.9% of patients needed ICU care. Additionally, 16.1% of our patients died, which all of them were male. Conclusion: This study showed a high prevalence of COVID-19 among our HD group, accompanied by mild symptoms. The HD population is probably among the most sensitive and high-risk groups for COVID-19 because of advanced age, comorbidities disease, low-immune function and frequent required visits, and patient overload in HD centers. Preventive measures should be taken in order to minimize the virus transmission in dialysis centers.

Claims and reasons about mild COVID-19 in children

The elderly form the main risk group in the coronavirus disease 2019 (COVID-19) pandemic, and age is recognized as a major risk factor for the severity of infection and mortality of COVID-19. The severity of the infection in children is milder than in adults. Although the pathophysiology of COVID-19 is not fully understood, several possible factors and mechanisms have been suggested for the lower severity of infection in children.

Keys to Unlock the Enigma of Ocular Toxocariasis: A Systematic Review and Meta-analysis

Purpose: Ocular toxocariasis (OT) is a zoonotic infection caused by larval stages of Toxocara canis and T. cati. The current review and meta-analysis aimed to evaluate the global prevalence of OT.Methods: Five English (PubMed, Scopus, Science Direct, Web of Science, and Google Scholar) databases were explored and 101 articles met the inclusion criteria.Results: The pooled prevalence (95% confidence interval) of OT was higher in immunological studies (9%. 6-12%) than in studies that applied ophthalmic examination (1%. 1-2%). The lower middle-income level countries had the highest prevalence (6%. 2-12%) as well as the African region (10%. 7-13%). The highest infection rate (4%. 2-7%) was detected in the 1-25 mean age group.Conclusion: Regular anthelminthic treatment of cats and dogs, and removal of animal feces from public places must be considered.

A dietary pattern rich in fruits and dairy products is inversely associated to gestational diabetes: a case-control study in Iran

BACKGROUND

Gestational diabetes mellitus (GDM) causes many problems for mother and her neonate. A healthy diet plays an important role in preventing GDM. This study aimed to investigate the relationship between major dietary patterns and the GDM.

METHODS

386 healthy and 306 GDM pregnant women (total 693) completed this case-control study. Basic information and anthropometric indices were recorded, and a food frequency questionnaire was completed. For extracting major dietary patterns, the principal component analysis was performed. Multivariable logistic regression models were used to examine whether specific dietary patterns are associated to the GDM.

RESULTS

Four dietary patterns were identified: "fruits and dairy products", "red meat and plant-based foods", "snacks and high-fat foods" and "carbohydrate-rich foods". Among these major extracted dietary patterns, "fruits and dairy products" showed an inverse association to the GDM (odds ratio adjusted for confounders: 0.50, confidence interval: 0.284-0.882, p-trend = 0.019, for highest vs. lowest quartile).

CONCLUSIONS

It seems using a healthy dietary pattern such as "fruits and dairy products" may decrease GDM risk.

Infections, inflammation, and risk of neuropsychiatric disorders: the neglected role of "co-infection"

Neuropsychiatric disorders (NPDs) have multiple etiological factors, mainly genetic background, environmental conditions and immunological factors. The host immune responses play a pivotal role in various physiological and pathophysiological process. In NPDs, inflammatory immune responses have shown to be involved in diseases severity and treatment outcome. Inflammatory cytokines and chemokines are involved in various neurobiological pathways, such as GABAergic signaling and neurotransmitter synthesis. Infectious agents are among the major amplifier of inflammatory reactions, hence, have an indirect role in the pathogenesis of NPDs. As such, some infections directly affect the central nervous system (CNS) and alter the genes that involved in neurobiological pathways and NPDs. Interestingly, the most of infectious agents that involved in NPDs (e.g., Toxoplasma gondii, cytomegalovirus and herpes simplex virus) is latent (asymptomatic) and co-or-multiple infection of them are common. Nonetheless, the role of co-or-multiple infection in the pathogenesis of NPDs has not deeply investigated. Evidences indicate that co-or-multiple infection synergically augment the level of inflammatory reactions and have more severe outcomes than single infection. Hence, it is plausible that co-or-multiple infections can increase the risk and/or pathogenesis of NPDs. Further understanding about the role of co-or-multiple infections can offer new insights about the etiology, treatment and prevention of NPDs. Likewise, therapy based on anti-infective and anti-inflammatory agents could be a promising therapeutic option as an adjuvant for treatment of NPDs.

Iran, sanctions, and the COVID-19 crisis

With an over 80 million population, Iran is the second-largest country in the Middle East. The coronavirus disease 2019 (COVID-19) has spread over all 31 provinces of Iran, leading to the most cases and death among the Eastern Mediterranean countries. At the same time, Iran is under the United States political and economic sanctions that compromised Iran's health system. Although medicines and basic medical equipment exempted from the economic sanctions, direct and indirect effects of sanctions have restricted Iran's banking system, and consequently has led to a wide range of limitation on trade, manufacturing sector, insurance and ventures. All these circumstances have meant that Iran is restricted to provide the essential basic medical equipment for diagnosis, treatment and prevention of the COVID-19. Although sanctions are not the sole reason for this high rate of mortality and morbidity in a short time period, the chronic and long-term effects of sanctions may be more tangible than their acute impact. In conclusion, providing health services is one of the major problems of Iran's health system during this pandemic that potentially influence on morbidity and mortality of the COVID-19. Iran needs to be free from sanctions for battling against this crisis.Key messagesIran is one of the countries that significantly impacted by the COVID-19 pandemic.Iran is under political and economic sanctions that consequently influence on their health system during the COVID-19 crisis.The chronic and long-term effects of sanctions may be more tangible than their acute impact.

The COVID-19 stress may influence on the sex ratio at birth

The ratio of boys to girls (sex ratio) at birth (SRB) is about 1.01-1.05 in most populations and is influenced by various factors, such as maternal stress, maternal inflammation, and endocrine disruption. Male fetus is biologically weaker and more vulnerable to prenatal events than female fetuses. Hence, premature death (and consequently decline the SRB) is higher in boys than girls. The recent coronavirus disease 2019 (COVID-19) has been known to have a variety of stressful and psychological impacts. This stress may consequently enhance maternal inflammation, pregnancy complication, and fetal loss. Also, male fetuses have more adverse outcomes than female fetuses among asymptomatic pregnant women with SARS-Cov-2 infection. Inasmuch as the male fetus are more vulnerable to prenatal events and premature death, it is proposed that the SRB can decline in pregnant women following the COVID-19 stress. However, future studies are needed to define the impact of the COVID-19 on SRB rate.

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017

BACKGROUND

Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

METHODS

We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

FINDINGS

In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

INTERPRETATION

Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

Helminths and COVID-19 Co-Infections: A Neglected Critical Challenge

Helminth infections are among the most common infectious diseases in underdeveloped countries. Helminths suppress the host immune responses and consequently mitigate vaccine efficacy and increase severity of other infectious diseases. Helminth co-infections might suppress the efficient immune response against SARS-CoV-2 at the early stage of the infection and may increase morbidity and mortality of COVID-19.

The prevalence of human bocavirus in <2-year-old children with acute bronchiolitis

Acute bronchiolitis is one of the most common lower respiratory tract infections in children with less than 2 years of age. Nowadays, molecular methods provide an opportunity to better understand the etiology of bronchiolitis. Several viral agents including Respiratory syncytial virus (RSV), Rhinovirus, Parainfluenza and Human bocavirus (HBoV) are responsible for acute bronchiolitis. There are growing studies on the prevalence of HBoV in patients with bronchiolitis. The present systematic review and meta-analysis were conducted to determine the pooled prevalence of HBoV in the respiratory samples of children with acute bronchiolitis. A literature search was conducted in the databases of PubMed, Scopus and Web of Science to recruit studies reporting the frequency of HBoV in <2-year-old children with acute bronchiolitis from 2005 to 2019. Only studies that used polymerase chain reaction (PCR)-based methods to detect the virus in nasopharyngeal samples were included. A total of 22 studies assessing 6751 cases were analyzed. According to the meta-analysis based on the random-effects model, the overall prevalence of HBoV in children with <2 years old was obtained 13% (95% CI: 0.09-0.17). Additionally, the rates of single (as the sole organism) and mixed (in combination with other viruses) HBoV infections were 4% and 9%, respectively. This study showed a high rate of HBoV detection in children with acute bronchiolitis. This should be considered as part of a diagnostic test panel for respiratory infections in children with bronchiolitis.

Blastocystis, urticaria, and skin disorders: review of the current evidences

Blastocystis is one of the most common intestinal protozoan parasites worldwide, which is linked to cutaneous lesions and urticaria. In a setting of systematic review, the data on the association of Blastocystis infection with cutaneous lesions were searched in order to summarize the main clinical symptoms, diagnostic methods, treatment, and outcome of the patients. The search identified 28 eligible articles, including 12 cross-sectional studies and 16 case reports/case series (including 23 cases). A diverse spectrum of skin symptoms, mainly urticaria, rash, and itching, was reported from the studies. Of the 23 infected cases with the skin symptoms, gastrointestinal symptoms were reported from the 16 cases, whereas 7 cases with urticaria had asymptomatic infection. The most frequent subtypes were ST1, ST2, and ST3, respectively. Metronidazole, paromomycin, and tinidazole were the most prescribed drugs in patients with single Blastocystis infection. Notably, urticaria and other cutaneous symptoms of all treated patients were resolved after treatment. In conclusion, this study indicates that Blastocystis infection can be a neglected cause of urticaria and skin disorders. Since the treatment of Blastocystis infection is simple, screening and treatment of this infection should be considered in patients with urticaria and other skin disorders.

The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories.

METHODS

We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries.

FINDINGS

In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8-38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8-10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3-4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4-133·4] per 100 000 in 2017). There were 10·6 million (10·3-10·9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI.

INTERPRETATION

Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.

METHODS

The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.

FINDINGS

Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, -1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, -1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function.

INTERPRETATION

Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI.

FUNDING

Bill & Melinda Gates Foundation.

Helminth infections and immunosenescence: The friend of my enemy

Age-associated alterations of the immune system, which known as "immunosenescence", is characterized by a decline in innate and adaptive immunity, which leading to increased susceptibility to age-associated diseases, such as infectious diseases, rheumatic disease and malignancies. On the other hand, helminth infections are among the most prevalent infections in older individuals, especially in the nursing homes. Most of helminth infections have minor clinical symptoms and usually causing chronic infections without treatment. Nevertheless, chronic helminthiasis alters immune responses somewhat similar to the immunosenescence. Some similarities also exist between helminth infections and immunosenescence: 1) both of them led to declining the immune responses; 2) undernutrition is a consequence of immunosenescence and helminthiasis; 3) vaccine efficacy declines in aging and individuals with helminth infections; 4) increase incidence and prevalence of infectious diseases in the elder individuals and patients with helminth infections; and 5) both of them promote tumorigenesis. Hence, it is probable that helminth infections in the elderly population can intensify the immunosenescence outcomes due to the synergistic immunoregulatory effects of each of them. It would be suggested that, diagnosis, treatment and prevention of helminth infections should be more considered in older individuals. Also, it would be suggested that helminths or their antigens can be used for investigation of immunosenescence because both of them possess some similarities in immune alterations. Taken together, this review offers new insights into the immunology of aging and helminth infections.

Potential application of helminth therapy for resolution of neuroinflammation in neuropsychiatric disorders

Neuropsychiatric disorders (NPDs) are among the major debilitating disorders worldwide with multiple etiological factors. However, in recent years, psychoneuroimmunology uncovered the role of inflammatory condition and autoimmune disorders in the etiopathogenesis of different NPDs. Hence, resolution of inflammation is a new therapeutic target of NPDs. On the other hand, Helminth infections are among the most prevalent infectious diseases in underdeveloped countries, which usually caused chronic infections with minor clinical symptoms. Remarkably, helminths are among the master regulator of inflammatory reactions and epidemiological studies have shown an inverse association between prevalence of autoimmune disorders with these infections. As such, changes of intestinal microbiota are known to be associated with inflammatory conditions in various NPDs. Conversely, helminth colonization alters the intestinal microbiota composition that leads to suppression of intestinal inflammation. In animal models and human studies, helminths or their antigens have shown to be protected against severe autoimmune and allergic disorders, decline the intensity of inflammatory reactions and improved clinical symptoms of the patients. Therefore, "helminthic therapy" have been used for modulation of immune disturbances in different autoimmunity illnesses, such as Multiple Sclerosis (MS) and Inflammatory Bowel Disease (IBD). Here, it is proposed that "helminthic therapy" is able to ameliorate neuroinflammation of NPDs through immunomodulation of inflammatory reactions and alteration of microbiota composition. This review discusses the potential application of "helminthic therapy" for resolution of neuroinflammation in NPDs.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study

Importance

Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective

To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review

We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings

In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions and Relevance

The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

Microfluidic Brain-on-a-Chip: Perspectives for Mimicking Neural System Disorders

Neurodegenerative diseases (NDDs) include more than 600 types of nervous system disorders in humans that impact tens of millions of people worldwide. Estimates by the World Health Organization (WHO) suggest NDDs will increase by nearly 50% by 2030. Hence, development of advanced models for research on NDDs is needed to explore new therapeutic strategies and explore the pathogenesis of these disorders. Different approaches have been deployed in order to investigate nervous system disorders, including two-and three-dimensional (2D and 3D) cell cultures and animal models. However, these models have limitations, such as lacking cellular tension, fluid shear stress, and compression analysis; thus, studying the biochemical effects of therapeutic molecules on the biophysiological interactions of cells, tissues, and organs is problematic. The microfluidic "organ-on-a-chip" is an inexpensive and rapid analytical technology to create an effective tool for manipulation, monitoring, and assessment of cells, and investigating drug discovery, which enables the culture of various cells in a small amount of fluid (10-9 to 10-18 L). Thus, these chips have the ability to overcome the mentioned restrictions of 2D and 3D cell cultures, as well as animal models. Stem cells (SCs), particularly neural stem cells (NSCs), induced pluripotent stem cells (iPSCs), and embryonic stem cells (ESCs) have the capability to give rise to various neural system cells. Hence, microfluidic organ-on-a-chip and SCs can be used as potential research tools to study the treatment of central nervous system (CNS) and peripheral nervous system (PNS) disorders. Accordingly, in the present review, we discuss the latest progress in microfluidic brain-on-a-chip as a powerful and advanced technology that can be used in basic studies to investigate normal and abnormal functions of the nervous system.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Highlights of human ectopic fascioliasis: a systematic review

Fascioliasis is a tropical zoonotic disease caused by the Fasciola parasite. The adult parasite usually resides in the liver and biliary ducts; however, several cases of ectopic fascioliasis (EF) have been reported. This study is a highlight on EF according to the confirmed case reports. In a setting of systematic review, we found 25 eligible articles containing 26 confirmed cases of EF (any date until 30 November 2018), including abdominal and intestinal EF in six cases, skin and subcutaneous tissues in five cases, eye in four cases, brain and pancreas in three cases, neck and lymph node in two cases, and lung, dorsal spine, and peritoneal cavity in one case, respectively. The result indicates that fascioliasis can have diverse ectopic forms and should be more attended in the endemic regions of fascioliasis in order to distinguish from other endemic diseases.

Therapeutic Potential of Helminths and Helminth-Derived Antigens for Resolution of Inflammation in Inflammatory Bowel Disease

Inflammation plays a pivotal role in the pathogenesis of inflammatory bowel disease (IBD), and treatment of IBD mainly targets on inhibition of pro-inflammatory mediators. Helminth-based therapy is a novel strategy for resolution of inflammation in IBD, because helminths have great immunomodulatory properties. Helminth-based therapy may be efficacious as a vaccine for patients with IBD. This article is a highlight on the therapeutic potential of helminths in IBD.

Screening of toxoplasmosis in cancer patients: a concern

Toxoplasmosis is an opportunistic infectious disease in immunocompromised patients, including cancer patients, whose detection is by molecular and serological methods. A total of 106 blood samples from patients with different types of cancer were evaluated for anti- Toxoplasma gondii IgG and IgM antibodies by the enzyme-linked immunosorbent assay (ELISA) and the parasite DNA by nested polymerase chain reaction (PCR). These were detected in 41.51% (44/106) and 0.94% (1/106), respectively, but T. gondii IgM antibody was not detected at all. These results suggest that the screening of toxoplasmosis should be considered more routinely in cancer patients.

Intestinal parasitic infections in different groups of immunocompromised patients in Kashan and Qom cities, central Iran

INTRODUCTION

Intestinal parasitic infections (IPIs) are important causes of morbidity and mortality in patients with immunocompromising conditions.

OBJECTIVE

The aim of this study was to determine the prevalence of IPIs in different groups of immunocompromised patients, including hemodialysis patients (HD), renal transplant recipients (RTR), cancer and HIV/AIDS patients in comparison with healthy individuals in two central cities of Iran (Kashan and Qom).

METHODS

In this case-control study, the stool samples of 135 HD, 50 RTR, 60 cancer patients, 20 HIV/AIDS patients and 120 healthy subjects were tested using direct-smear, formol-ether concentration, Ziehl-Neelsen staining and Agar plate method.

RESULTS

The overall infection rate was 11.7% (31/265) in patient groups and 0% (0/120) in the control group. The frequency of parasites was 25% in HIV/AIDS patients, 11.9% (16/135) in HD, 12.0% (6/50) in RTR and 6.7% (4/60) in cancer patients. Blastocystis hominis (4.2%) and Giardia lamblia (3.0%) were the most prevalent parasites in patient groups. The infection rate was significantly higher in male (17.6%) than female (5.4%) patients (p = .002), but no statistically significant association was observed according to the age and educational levels.

CONCLUSIONS

This study showed a high prevalence of IPIs in immunocompromised patients. The results of this study suggest that periodic stool examinations for screening of IPIs should be included as a part of routine medical care in these patients.

Molecular detection of Neospora caninum in house sparrows (Passer domesticus) in Iran

Neospora caninum is an intracellular protozoan parasite with a wide range of intermediate bird hosts. There is little information describing the prevalence and genetic characterization of N. caninum in bird hosts worldwide and in Iran. In this study, a total of 217 brain samples of house sparrow (Passer domesticus) were examined for N. caninum presence by nested polymerase chain reaction targeting the Nc-5 gene. N. caninum DNA was detected in 3.68% (8/217) of sparrows. Sequencing of the Nc5 genomic DNA revealed 97-99% of similarity with N. caninum sequences deposited in Genbank. To our knowledge, this study is the first molecular evidence of N. caninum DNA in bird hosts in Iran. The results of this study highlight the role of the house sparrow (Passer domesticus) in maintaining and spreading N. caninum infection to canines in the feral and domestic environment.

Molecular Detection and Genotypic Characterization of Toxoplasma gondii in Paraffin-Embedded Fetoplacental Tissues of Women with Recurrent Spontaneous Abortion

Background

Congenital toxoplasmosis is an important cause of spontaneous abortion worldwide. However, there is limited information on detection and genotypic characterization of Toxoplasma gondii (T. gondii) in women with recurrent spontaneous abortion (RSA). The aim of this study is the molecular detection and genotypic characterization of T. gondii in formalin-fixed, paraffin-embedded fetoplacental tissues (FFPTs) of women with RSA that have referred to the Avicenna Research Institute in Tehran, Iran.

Materials and Methods

This experimental research was undertaken on 210 FFPTs of women with RSA. The information of the patients was collected from the archives of Avicenna Research Institute in Tehran, Iran. After DNA extraction, the presence of T. gondii was examined by nested polymerase chain reaction targeting the GRA6 gene. Genotyping was performed on positive samples using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) that targeted the GRA6 and SAG3 genes. Sequencing was conducted on two GRA6 positive samples.

Results

T. gondii DNA was detected in 3.8% (8/210) of the samples. Genotyping showed that all positive samples belonged to type III of the T. gondii genotype. Sequencing two genomic DNAs of the GRA6 gene revealed 99% similarity with each other and 99-100% similarity with T. gondii sequences deposited in GenBank. There were six patients with histories of more than three abortions; one patient had a healthy girl and another patient had two previous abortions. Abortions occurred in the first trimester of pregnancy in seven patients and in the second trimester of pregnancy in one patient.

Conclusion

The results of this study have indicated that genotype III is the predominant type of T. gondii in women with RSA in Tehran, Iran. Also, our findings suggest that toxoplasmosis may play a role in the pathogenesis of RSA. However, further studies are needed to elucidate a clear relationship between T. gondii infection and RSA.

Pro- and anti-inflammatory cytokines in cutaneous leishmaniasis: a review

Cutaneous leishmaniasis (CL) is caused by different species of the genus Leishmania. Pro- and anti-inflammatory cytokines play different roles in resistance/susceptibility and the immunopathogenesis of Leishmania infection. The balance and dynamic changes in cytokines may control or predict clinical outcome. T helper 1 (Th1) inflammatory cytokines (especially interferon-γ, tumor necrosis factor-α and interleukin-12) are the crucial factors in the initiation of protective immunity against L. major infection, whereas T helper 2 cytokines including IL-5, IL-4, and IL-13 facilitate the persistence of parasites by downregulating the Th1 immune response. On the other hand, aggravation of inflammatory reactions leads to collateral tissue damage and formation of ulcer. For this reason, immunity system such as T regulatory cells produce regulatory cytokines such as transforming growth factor-β and IL-10 to inhibit possible injures caused by increased inflammatory responses in infection site. In this article, we review the role of pro- and anti-inflammatory cytokines in the immunoprotection and immunopathology of CL.

Identification of latent neosporosis in sheep in Tehran, Iran by polymerase chain reaction using primers specific for the <i>Nc-5</i> gene

Little is known about latent infection and molecular characterisation of Neospora caninum in sheep (Ovis aries). In this study, 330 sheep samples (180 hearts and 150 brains) were analysed for N. caninum DNA by nested polymerase chain reaction (PCR) targeting the Nc-5 gene. Neospora caninum DNA was detected in 3.9% (13/330) of sheep samples. The parasite's DNA was detected in 6.7% of heart samples (12/180) and 0.7% (1/150) of brain samples. No clinical signs were recorded from infected or uninfected animals. Sequencing of the genomic DNA revealed 96% - 99% similarity with each other and 95.15% - 100% similarity with N. caninum sequences deposited in GenBank. To our knowledge, this is the first report on the use of PCR to identify latent neosporosis in sheep in Iran. The results of this study have the potential to contribute to our understanding of the role of N. caninum-infected sheep in the epidemiology of neosporosis.