Detection of SARS-CoV-2 in the indoor air and surfaces of subway trains in Mashhad, Iran

INTRODUCTION

Millions of passengers around the world are concerned with the possibility of SARS-CoV-2 contamination on public transportation. Therefore, this study aimed to investigate the presence of SARS-CoV-2 virus in indoor air and subway surfaces in Mashhad.

METHODS

In this study, air and surface sampling were done at two times in the morning (7-8:30 a.m.) and evening (3:30-5 p.m.), simultaneously in two wagons for men and women in line 1 of Mashhad Metro in March 2021 to detect the virus and measure the concentration of particulate matter. Totally, 30 air and 30 metro samples were collected and examined by reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTS

The results showed that three and two cases in the air and surface samples were infected with the SARS-CoV-2 virus, respectively. There was a significant relationship between the mean concentration of suspended particles PM1 (particulate matter smaller than 1 μm) with PM2.5 (particulate matter smaller than 2.5 μm) and PM10 (particulate matter smaller than 10 μm) (p < 0. 05). There was also a significant relationship between the mean concentration of suspended particles PM2.5 and PM10. The results showed that the mean PM2.5 measured in the indoor air of the Mashhad metro wagon had a significant relationship with WHO and US EPA and national standards, and its value was higher than the standards (p < 0.05). The average particle concentrations of PM1, PM2.5, and PM10 were equal to 40.46, 42.61, and 48.31 μg/m3.

CONCLUSION

According to the results of the pollution detected in this study, COVID-19 may be transmitted by air and environmental surfaces. Our study emphasizes the need for continuous assessment of the presence of the virus in public transportation. Detection of viral RNA in subways indicates the necessity of adequate disinfection in public settings, strictness in disinfection methods, strengthening of educational activities for sanitary measures, physical spacing plan, and increasing ventilation of wagons.

Periapical lymphoma: Review of reported cases in the literature

Oral lymphoma can resemble clinically to other pathologic entities such as periapical radiolucencies, or dental abscess. The aim of this study was to review the literature related to misdiagnosed periapical lymphomas and discuss their characteristics. In this review study, authenticated search engines and databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus were surfed to find articles related to the topic by using related keywords. Out of more than 100 articles approximately, 50 were closely relevant to the title, and ultimately 43 well-documented English articles were chosen. Out of 45 reported cases, 63% were male and 37% were female with mean age of 41.22 years. The majority of such lesions have been detected in the mandible (61%) with a mandibular to maxillary involvement ratio of 1.58:1. The most frequent type of lymphoma was diffuse large B cell lymphoma (DLBCL) (53%). Noteworthy, 49% of periapical lymphoma has been misdiagnosed as pulpal pathology and treated through root canal therapy. The mean time lapse before making the correct diagnosis was 4.3 months. Although rare, periapical lymphoma should be ranked in the differential diagnosis of a periapical lesion especially when vitality pulp tests are positive.

Evaluation of Th17 associated antigen in Old World Cutaneous Leishmaniasis: A comparative study in acute versus chronic human cutaneous Leishmaniasis using immunohistochemistry

There are little information about Th17 cells and cutaneous Leishmaniasis (CL), due to an important effect of Th17 cells on immune response, it is worth to explore the role of Th17 on CL. The purpose of this study was to assess Th17 population in patients with acute vs. chronic CL lesions in comparison with skin samples collected from healthy volunteers in an endemic region of Old World CL. A total of 49 patients with clinical manifestations of chronic (n=16) and acute (n=33) CL lesions were recruited. The clinical diagnosis of CL was confirmed by direct smear or PCR. Biopsy specimens from prelesional skin of non-infectious lesions of 30 healthy individuals were used as control. Tissue sections of 3µm thickness were prepared and used for immunohistochemistry (IHC) analysis with primary antibody specific for Th17 associated antigen (CD161). For IHC, Envision+ (DakoCytomation) system was used and developed by using diaminobenzidine (DakoCytomation). The mean age of 33 patients with acute CL and the mean age of 16 patients with chronic CL were accordingly 45.24±16.43 and 33.56±15.87. In acute and chronic CL the mean (±standard deviation) and median (±interquartile range) were accordingly 2.92±2.21, 2.56±2.9 and 2.1±1.99, 1.54±2.81. In healthy controls the mean (±standard deviation) and median (±interquartile range) were 0.72±0.41 and 0.61±0.58 respectively. With pairwise comparison of acute, chronic and control groups, there were significant difference between acute and control (P value < 0.001), chronic and control (P value = 0.043). The results showed that there was an increasing cellular response of Th17 in both acute and chronic CL patients. Th17 was significantly higher in patients with acute and chronic CL lesions in comparison with healthy control group. However, there was no significant difference between acute and chronic infection concerning to Th17 cells.

Mycosis fungoides two decades after exposure to sulphur mustard: a follow-up of 1100 victims

BACKGROUND

Sulphur mustard (SM) is an alkylating chemical warfare agent which causes acute and chronic injuries to the eyes, skin, lung and respiratory tract.

OBJECTIVE

We aimed to investigate the relationship between SM poisoning and Mycosis fungoides (MF) as a late consequence.

MATERIAL AND METHODS

In this retrospective study, the medical files of 1100 Iranian veterans confirmed to have exposure to SM agent during the Iraq-Iran war of the 1980s were reviewed.

RESULTS

All 10 cases with MF were confirmed by clinical and histopathological examinations. The mean age of the studied subjects was 43.3 ± 9.8 (years). In comparison to MF incidence rate in Iranian general population (0.39/100 000 person-years), we found an incidence rate of 0.799/100 000 person-years for MF among those who had short-term exposure to SM. The most common sites for SM lesions were flexural and thin skin areas. The main limitation was the retrospective design.

CONCLUSION

This study indicates that the risk of MF in those exposed to SM may increase over time. Therefore, their follow-up is recommended.

Comparing acute and chronic human cutaneous leishmaniasis caused by Leishmania major and Leishmania tropica focusing on arginase activity

BACKGROUND

Cutaneous leishmaniasis (CL) in Iran is mainly caused by Leishmania major (L. major) and L. tropica. Arginase mediated L-arginine metabolism is an important issue in Leishmania parasite propagation. Arginase activity in human CL due to L. major and L. tropica have not been studied up to now.

OBJECTIVES

We aimed to compare the clinical and laboratory aspects of acute and chronic CL, focussing on arginase activity.

METHODS

In this case-control study, 30 patients with acute CL (duration ≤ 1 year), 13 patients with chronic CL (duration ≥ 2 year) and 11 healthy controls were recruited. Arginase activity was measured in skin biopsies of lesions, peripheral blood polymorphonuclear cells (PMNs), peripheral blood mononuclear cells (PBMCs) and plasma by standard methods.

RESULTS

The median of arginase activity in the acute lesions was higher than in chronic samples and significantly higher than in healthy controls (P = 0.008). PMNs of both acute and chronic patients showed higher levels of arginase activity as compared to the levels in PBMCs and plasma. The median of arginase activity in the PMNs of patients with chronic CL was higher than that of patients with acute CL and significantly higher than that of the healthy controls (P = 0.010).

CONCLUSION

The level of arginase activity in lesions of patients with acute and chronic CL was higher than the skin of healthy controls. The highest level of arginase activity was observed in PMNs from patients with chronic CL. This suggests that the high level of arginase activity in PMNs of patients with chronic CL may contribute to the chronicity.

Diagnostic accuracy of BP180 NC16a and BP230-C3 ELISA in serum and saliva of patients with bullous pemphigoid

BACKGROUND

Bullous pemphigoid (BP) is a subepidermal blistering disease, characterized by autoantibodies directed against BP180 and BP230. Collecting saliva is an easy and painless way of obtaining biological samples, and can be used for diagnosis of autoimmune diseases.

AIM

To compare the diagnostic accuracy of serum and salivary BP180-NC16a and BP230-C3 in the initial diagnosis of BP.

METHODS

We assessed 50 patients newly diagnosed with BP and 50 healthy controls. The diagnosis of BP was confirmed based on clinical, histopathological and immunofluorescence findings. Serum and saliva samples were collected from both groups, and BP180 and BP230 titres were assessed using commercially available ELISA kits.

RESULTS

Using serum, the sensitivity of the serum BP180 and BP230 ELISA assays was 88% and 48%, respectively, and the specificity of both was 96%. Using saliva with the cutoff value proposed by the manufacturer, sensitivity was 56.2% and 14.6%, and specificity was 98% and 100%, respectively. Using the best calculated cutoff for saliva, sensitivity increased to 87.5% and 77.1%, and specificity to 96% and 62%, respectively. There was a significant correlation between serum and saliva BP180 levels and the severity of skin disease. Both serum and saliva BP230 levels were significantly higher in patients with mucosal involvement.

CONCLUSION

Serum BP180 NC16a ELISA is a sensitive and specific test for the initial diagnosis of BP, whereas serum BP230-C3 ELISA is highly specific, but less sensitive. Saliva may be a noninvasive and convenient alternative for use in the BP180 NC16a ELISA to diagnose BP.

Re-evaluation of the first phenytoin paste healing effects on oral biopsy ulcers

BACKGROUND

Until now, several formulations of topical phenytoin have been used to promote wound healing.

AIM

This study was aimed at re-evaluating the effects of a newly formulated phenytoin mucoadhesive paste on wound healing after oral biopsy.

SUBJECTS AND METHODS

In a double-blind clinical trial, 35 consecutive patients with oral lichenoid or lichen planus lesions were randomized into two groups. After incisional biopsy, patients applied simple, or 1% phenytoin paste at least three times a day (after each meal), for 4 days. They were evaluated every other day for size of wound closure, severity of pain, and diameter of the inflammatory halo. This study was approved by Medical Ethics committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Statistical analysis was performed using Mann-Whitney U test and Ordinal Logistic Regression.

RESULTS

Of 35 patients, 17 (10 [10/17, 59%]) men, 7 (7/17, 41%) women, mean age: 40 (4.11) were in phenytoin group, and 18 (9 [9/9, 50%]) men, 9 (9/9, 50%) women, mean age: 43.1 (5.15) were in placebo group. There were no significant differences between both study groups in terms of age and sex (male/female ratio) (P = 0.76, P = 0.88). As all biopsies were done by means of punch number 8, the incisions were of 10 mm length. After second and third appointments, it was observed that patients in the treatment group showed quicker wound closure and less pain compared to control group significantly (P < 0.05). Although not significant, patients treated with phenytoin paste had smaller inflammatory halo than controls.

CONCLUSION

Applying 1% phenytoin mucoadhesive paste on oral biopsy incisions resulted in accelerated wound healing and decrease in pain.

Investigation of underlying primary immunodeficiencies in patients with severe atopic dermatitis

BACKGROUND

Primary immunodeficiency diseases (PIDs) are a group of heterogeneous inherited disorders, characterised by recurrent infections, autoimmunity and malignancy. Some PIDs such as hyper IgE syndrome (HIES) and Wiskott-Aldrich syndrome (WAS) may be initially presented as atopic dermatitis (AD), especially in its severe form, resulting in diagnostic delay and poor prognosis of patients.

OBJECTIVE

The aim of this study was to evaluate the frequency of PIDs among patients with severe AD and to determine factors that can help to raise suspicion towards these disorders.

METHODS

Seventy-five patients with a well-established diagnosis of severe AD were enrolled in this study. Initial immunological evaluations, including humoral and cellular investigation, were performed in all individuals. Patients underwent further investigations in a case of suspicion of a probable PID.

RESULTS

Among all patients with severe AD, five (6.6%) were diagnosed with HIES and one (1.3%) with WAS. Family history of PIDs, family history of death in early infancy, positive history of recurrent infections such as skin and respiratory infections, otitis media and sinusitis were observed significantly higher in patients with a diagnosis of PID.

CONCLUSIONS

The presence of an underlying PID could explain the poor prognosis and refraction to the treatment of some patients with severe AD. Several clinical and laboratory findings can help the physicians to focus towards PIDs which are more serious. Delay in diagnosis of PID cases with skin manifestation of AD without proper management may result in lower quality of life and higher morbidity and mortality rates.

Xerostomia due to systemic disease: a review of 20 conditions and mechanisms

Xerostomia is a common complaint of nearly half of the elderly population and about one-fifth of younger adults. It causes several signs and symptoms, and compromise oral functions and health-related quality-of-life. Multiple reasons are proposed to describe the etiology of xerostomia such as local factors, psychogenic factors, and systemic diseases. In order to manage xerostomia effectively, identification of the main causality is mandatory. The aim of this review was to present systemic diseases leading to xerostomia with their mechanisms of action. We used various general search engines and specialized databases such as Google, Google Scholar, Yahoo, PubMed, PubMed Central, MedLine Plus, Medknow, EBSCO, ScienceDirect, Scopus, WebMD, EMBASE, and authorized textbooks to find relevant topics by means of Medical Subject Headings keywords such as "xerostomia," "hyposalivations," "mouth dryness," "disease," and "systemic." We appraised 97 English-language articles published over the last 40 years in both medical and dental journals including reviews, meta-analysis, original papers, and case reports. Upon compilation of relevant data, it was concluded that autoimmune diseases most frequently involve salivary glands and cause xerostomia followed by diabetes mellitus, renal failure, and graft-versus-host disease. Moreover, the underlying mechanisms of systemic disease-related xerostomia are: autoimmunity, infiltration of immunocompetent cells, granuloma formation, fibrosis and dehydration, deposition of proteinaceous substances, bacterial infection, and side-effects of medications.

Randomized double blind trial of prednisolone and azathioprine, vs. prednisolone and placebo, in the treatment of pemphigus vulgaris

BACKGROUND

The classic treatment for pemphigus vulgaris is prednisolone. Immunosuppressive drugs can be used in association.

OBJECTIVE

To compare the efficacy of Azathioprine in reducing the Disease Activity Index (DAI).

PATIENTS AND METHODS

A double blind randomized controlled study was conducted on 56 new patients, assigned to two therapeutic groups: (i) prednisolone plus placebo; (ii) prednisolone plus Azathioprine. Patients were checked regularly for 1 year. 'Complete remission' was defined as healing of all lesions after 12 months, and prednisolone <7.5 mg daily, (DAI ≤ 1). Analysis was done by 'Intention To Treat' (ITT) and 'Treatment Completed Analysis' (TCA).

RESULTS

Both groups were similar in age, gender, disease duration, and DAI. Primary endpoint: By ITT and TCA, the mean DAI improved in both groups with no significant difference between them. The difference became significant for the last trimester (3 months; ITT: P = 0.033, TCA: P = 0.045). Secondary endpoint: The total steroid dose decreased significantly in both groups, with no significant difference between them, except for the last trimester (ITT: P = 0.011, TCA: P = 0.035). The mean daily steroid dose decreased gradually in both groups becoming statistically significant in favour of azathioprine, in the last trimester, especially at 12th months (ITT: P = 0.002, TCA: P = 0.005). Complete remission was significant at 12 months only for TCA (AZA/Control: 53.6%/39.9%, P = 0.043).

LIMITATIONS

Sample size was rather small to demonstrate all differences. Other limitations include the choice of primary and secondary endpoints and the unavailability to measure thiopurine methyltransferase activity.

CONCLUSION

Azathioprine helps to reduce prednisolone dose in long-run.

Antibacterial and antifungal activities of punica granatum peel extracts against oral pathogens

OBJECTIVE

Punica granatum has been used for many years in folk medicine due to several purposes. The aim of the present study was to evaluate the effect of methanolic extract of Punica granatum peel (MEPGP) against Streptococcus mutans, Staphylococcus aureus, Streptococcus salivarius, Streptococcus sanguinis, Staphylococcus epidermidis, Actynomyces viscosus, Lactobacillus acidophilus and Candida albicans.

MATERIALS AND METHODS

In this in vitro study, the mentioned oral organisms were cultured in blood agar and mueller-hinton media and then paper disks containing MEPGP at concentrations of 4 mg/ml, 8 mg/ml and 12 mg/ml were inserted on medias. The antimicrobial activity was evaluated by agar disk diffusion method. The effects of three different concentrations of MEPGP against microorganisms were compared using one-way ANOVA and Tukey tests.

RESULTS

All concentrations of MEPGP had antibacterial activity against S. aureus and S. epidermidis. Only at concentration of 8 mg/ml and 12 mg/ml MEPGP was effective against L. acidophilus, S. mutans and S. salivarius. Furthermore; no concentrations of MEPGP inhibited A. viscosus and C. albicans.

CONCLUSION

This study suggests that MEPGP might be used as an antibacterial agent in controlling oral infections.

Evaluation of salivary glucose, IgA and flow rate in diabetic patients: a case-control study

OBJECTIVE

An association between diabetes mellitus and alterations in the oral cavity has been noted. In this study, we evaluated differences between salivary IgA, glucose and flow rate in diabetic patients compared with healthy controls.

MATERIALS AND METHODS

Forty patients with type 1 diabetes, 40 patients with type 2 diabetes and 40 healthy controls were selected. Whole unstimulated saliva samples were collected by the standard method and the salivary flow rate was determined. Nephelometric and Pars method were used to measure salivary IgA and salivary glucose concentrations, respectively. Statistical analysis was performed by Chi-square and t test.

RESULTS

There were no significant differences in salivary IgA and glucose concentrations between type 1 and type 2 diabetic patients and their matched control subjects (P>0.05). Salivary flow rate was significantly lower in diabetic patients (P<0.05). In addition, DMFT was higher in diabetic patients than the controls.

CONCLUSION

Determination of salivary constituents may be useful in the description and management of oral findings in diabetic patients.

Blood Mercury Level and Its Determinants among Dental Practitioners in Hamadan, Iran

OBJECTIVE

Exposure to mercury can occur in occupational and environmental settings. During clinical work with dental amalgam, the dental personnel are exposed to both metallic mercury and mercury vapor. The aim of the present study was to investigate blood mercury level (BML) and its determinants among dentists practicing in Hamadan city, Iran.

MATERIALS AND METHODS

This cross sectional study was done on all dental practitioners of Hamadan (n=43). Dentists were asked to complete a questionnaire, and then 5 ml blood samples were obtained from them. After preparation, mercury concentration of each sample was measured by cold vapor atomic absorption device. Pearson correlation test and regression models served for statistical analysis.

RESULTS

The mean blood concentration of mercury was 6.3 μg/l (SD=1.31 range 4.15-8.93). BML was positively associated with age, years in practice, working hours per day, number of amalgam restorations per day, number of amalgam removal per week, sea food consumption, working years in present office, using amalgam powder, using diamond bur for amalgam removal, dry sterilization of amalgam contaminated instruments, and deficient air ventilation.

CONCLUSION

BML of dentists in Hamadan was higher than standards. Working hours and number of amalgam restorations per day were significantly correlated with blood mercury.

CD26 expression on CD4+T cells in patients with cutaneous leishmaniasis

Surrogate marker(s) of protection in human leishmaniasis is not well defined. In this study, T helper 1 (Th1) and Th2 cytokine profiles and CD26 expression on CD4(+) T cells in peripheral blood mononuclear cells of patients with healing or non-healing forms of cutaneous leishmaniasis (CL) stimulated with Leishmania antigens were assessed. The level of interferon (IFN)-gamma production was significantly higher in patients with healing or non-healing forms of CL than in healthy controls, but it was not significantly different between the two patient groups. The level of interleukin-5 production was significantly higher in patients with the non-healing form of CL than in the two other groups. There was a significant increase in the level of CD26 expression on CD4(+) T cells in patients with healing (P < 0.001) or non-healing (P = 0.025) forms of CL compared with the control group, but no significant difference was seen between the two patient groups. A weak positive correlation was seen between IFN-gamma production and CD26 expression on CD4(+) T cells of patients with the healing form of lesion (r = 0.54, P = 0.008), but this correlation was not observed in patients with the non-healing form of CL (r = 0.53, P = 0.078). Surface CD26 is not correlated with the clinical manifestation of CL or IFN-gamma production. Therefore, CD26 is not a surrogate marker for IFN-gamma production in CL.

The Presence and Clearance of Immune Complexes in the Untreated Generalised Psoriasis

Psoriasis is a hyperproliferative inflammatory disease and 70% of patients develop a chronic plaque form of the disease. The pathogenesis of psoriasis is not known but evidence exists that changes in micro vascular occur. There are micro vascular abnormalities in the capillaries which display a multilayer basement membrane with fenestration. Study of involved synovium in psoriatic arthritis reveals endothelial cell swelling, thickening of the vessel walls and inflammatory cell infiltration. Investigation on expression of CD35 molecules that clear the immune complexes were carried out in this study. CD35 is single chain glycoprotein (MW160–240 kD) and is located on the long arm of the chromosome 1. FACScan was used as laser flow cytometer. Initially 40 blood samples from normal individuals, 35 untreated Lupus Erythematosus Systemic and 35 Rheumatoid arthritis patients were studied as controls for reference values of CD35, Circulating immune Complexes (CIC), Complement C3 & C4. Next 34 patients suffering from psoriasis were studied for, Circulating immune Complexes (CIC), Complement C3 & C4. Comparison of these results with those of reference values normal ranges showed significant increase of CIC (P<0.05) and decrease of CD35 (P<0.001). Where as, the complement component levels C3 (P>0.05) and C4(P>0.05) indicates werenot significantly altered. This study shows that the decrease in expression of CD35 on Red blood cells in psoriasis patients is more crucial than C3 and C4 levels. Thus decrease of CD35 molecule in psoriasis may cause increased levels of CIC in patients' sera and promotion of inflammatory responses.

[Hemorrhagic hypertrophic gastropathy in a child. A 15 year follow-up]

A 7 year-old boy with hypertrophic gastropathy and anemia is described. He was given a substitutive therapy and was under regular control. Upper G.I. bleeding disappeared when he was 15 but hypochlorhydria, radiologic changes and hyperplasia of mucus-secreting cells persisted up to the 22nd year of life. Transient intestinal metaplasia of fundic mucosa was found at 16. Several of these findings are similar to those in Menetrier's disease in adults.

[Bone scan in the diagnosis of infectious osteoarthritis (author's transl)]

Bone scan with Technetium 99m is harmless method of evaluation of skeletal lesions. It is safe in pediatrics age group and it can be used in early diagnosis of infectious osteoarthritis. Bone scan differentiate osteomyelitis from cellulitis, and also it may help in diagnosis of subclinical involvement of rheumatoid arthritis, benign and malignant bone tumors, stress fractures and periositis. We report results of bone scan in 30 pediatric patients as follows: osteomyelitis 9 cases, cellulitis 4 cases, infectious arthritis 4 cases, tuberculous osteoarthritis 2 cases, rheumatoid arthritis 2 cases, and other different diseases 9 cases.