Association between waterpipe smoking and lung cancer: a multicentre case-control study in Iran

OBJECTIVES

This study investigated the association between lung cancer and waterpipe smoking, which is an emerging global public health concern.

STUDY DESIGN

Multicentre case-control study.

METHODS

This study included 627 cases and 3477 controls from the Iranian Study of Opium and Cancer (IROPICAN) study, which was conducted between 2017 and 2020. One frequency-matched control for each lung cancer patient was selected by age, gender and residential place; however, this study used controls of four cancer types in the analyses. The multivariable logistic regression model estimated the odds ratio (OR) and 95% confidence intervals (CIs). Additional analyses were performed among 181 lung cancer cases and 2141 controls who were not cigarette smokers or opium or nass/pipe users.

RESULTS

The odds of lung cancer were higher among waterpipe smokers than never-smokers (OR = 1.3, 95% CI: 1.0-1.7). Results showed a higher OR of lung cancer for those who smoked the waterpipe daily (OR = 2.1, 95% CI: 1.4-3.0), smoked more than two heads per day (OR = 2.7, 95% CI: 1.8-4.0), had smoked for >20 years (OR = 1.9, 95% CI: 1.3-2.7), smoked more than 20 head-years (OR = 2.8, 95% CI: 1.9-4.1) and initiated smoking before the age of 30 years (OR = 1.7, 95% CI: 1.1-2.5). The association was only statistically significant for squamous cell carcinomas (OR = 1.8, 95% CI 1.2-2.7). Furthermore, this study observed a higher OR of lung cancer among exclusive waterpipe smokers (OR = 2.3, 95% CI: 1.6, 3.5).

CONCLUSIONS

Waterpipe smoking was associated with an increased risk of lung cancer. The association was stronger with higher frequency, duration and intensity of exposure to waterpipe smoking. The association increases in exclusive waterpipe smokers, which is likely due to controlling for residual confounding by cigarette smoking and opium consumption, and higher exposure levels in this subpopulation.

Comparison of prognosis between hyperbilirubinemic infants with and without hypernatremia

OBJECTIVES

Hypernatremia may facilitate the diffusion of bilirubin through the blood-brain barrier and increase the risk of bilirubin encephalopathy. This study was conducted to compare the prognosis of jaundice infants with those with jaundice and hypernatremia.

METHODS

A total of 615 term infants with idiopathic jaundice with or without hypernatremia were enrolled in this cohort study with 24-months follow-up at Ghaem Hospital, Mashhad, Iran, between 2010 and 2022. An in-house questionnaire including the laboratory evaluation and neonatal characteristics was used as the data collection tool. The follow-up of neonatal development status was performed using the Denver test II at 6, 12, 18, and 24 months after discharging from hospital.

RESULTS

Normal outcomes were seen in 555 (90.2%) out of 615 studied infants, while 60 cases (9.8%) showed abnormal outcomes. Serum levels of sodium (P = 0.017), bilirubin (P = 0.001), urea (P = 0.024), and creatinine (P = 0.011) as well as hyperthermia (P = 0.046) and unconsciousness (P = 0.005) showed significant differences between the two groups. Approximately 16% of the newborns with both jaundice and hypernatremia, and 9% of those with only jaundice had unfavorable prognoses. Also, bilirubin level had the most predictive power (91.3%).

CONCLUSIONS

Our results suggest that hypernatremia or jaundice alone, may affect the prognosis of infants aged 2 years; but jaundice and hypernatremia together, will intensify the developmental problems in jaundice infants. However, the role of hyperbilirubinemia in the incidence of complications is more than hypernatremia.

Bac to Bac System Efficiency for Preparing HPV Type 16 Virus-Like Particle Vaccine

Today, the human papillomavirus (HPV) L1 protein is the main target in the construction of prophylactic HPV vaccines. The production of virus-like particles (VLPs) that closely resemble the natural structure of the HPV16 virus and induce high levels of virus-neutralizing antibodies in animals and humans is facilitated by the expression of HPV16-L1 protein in eukaryotic cells. The Bac-to-Bac system has been previously used to produce high levels of recombinant proteins. In this study, we utilized this expression system to generate HPV16-L1 VLPs in Spodoptra frugipedra (Sf9) insect cells. The wild-type L1 gene of papillomavirus type 16 was selected from Gene Bank and placed in bacmid structure after codon optimization using pFast Bac vector. The recombinant baculovirus containing HPV-16/L1 gene was then provided using the Bac-to-Bac system. It should be mentioned that the vector was transfected into the Sf9 cell. The cells were then lysed and the expression of L1 protein was revealed by SDS-PAGE and confirmed by Western Blot. The L1 purification was performed through Ni-NTA chromatography. The VLP formation of papillomavirus L1 protein was visualized by transmission electron microscopy. The expressed recombinant L1 was ~60 KD on SDS-PAGE which was identified in western blot by a specific anti-L1 monoclonal antibody. The electron microscopy confirmed the assembly of VLPs. Results of this study showed that the production of this protein at the industrial level can be optimized using a baculovirus/Sf9 system. The characteristics and advantages of this system are promising and it is a suitable candidate for protein synthesis.

Evaluating Cognitive Performance of Executive Control Based on Evidence from Attention Network Test and Event-Related Potential in Individuals with Mild Depressive Disorder and Burnout

Introduction: One of the secondary consequences of burnout is a significant reduction in cognitive functions, the most obvious and important of which is the cognitive function of attention and control, which can play a vital role in efficiency and prevention of errors at work in many occupations. On the other hand, a neurological examination is needed to understand better the relationship between burnout and its consequent depressive disorder regarding the cognitive function of the attention network of these individuals. Depressed people usually have neuropsychological disorders. Therefore, the present study aimed to investigate the cognitive performance of executive control of healthcare workers with shift jobs on the verge of burnout using the Attention Network Test (ANT) Event-Related Potential (ERP). Materials and Methods: The sample included 26 health care providers on the verge of burnout in Rasoul Akram Hospital in Tehran (15 without depression and 11 with mild to moderate depression) selected by purposive sampling. The rate of burnout was assessed by the Maslach Scales (1981); depression was evaluated by the Depression, Anxiety and Stress Scale-21 (DASS-21); attention was assessed by the Network Attention Test (ANT) and simultaneously with the behavioral test. We investigated the event-related potential (ERP) indicators of attention processing. Independent t-test and paired t-test were used for data analysis. Results: The results of behavioral performance revealed no significant difference between the two groups in the three attention networks; however, Significant differences can be seen in ERP brain waves related to the executive function of attention, especially by increasing the SP wave and N2 wave component compared to normal individuals without depression Conclusion: : Significant differences can be seen in ERP brain waves related to the executive function of attention, especially by increasing the SP wave and N2 wave component compared to normal individuals without depression. According to the study results, it can be stated that to improve cognitive performance in people's work environments, measures should be taken to reduce burnout and depression, and employees should perform their activities with better performance and help the quality growth of the work environment.

Knowledge, perceptions and prevention of malaria among women in Sistan va Baluchestan, Islamic Republic of Iran

A questionnaire about malaria knowledge, beliefs and practices was given to a random sample of 2168 married women from rural and urban areas of Sistan va Baluchestan, Islamic Republic of Iran. The mean knowledge score of subjects was low at 5.5 [maximum 15.0]. Few respondents [37.6%] knew that malaria was an important disease in the area and only 58.4% knew that malaria was transmitted by mosquitoes. Most subjects [69.4%] never used a mosquito net. Only 49.9% of rural and 73.8% of urban residents would seek care for fever and chills from the local health centre. Community health workers [behvarz] were the main source of information [29.5%] for rural women; the role of physicians in education was minimal. Subsequent health education must be tailored to the educational needs of the target population in this area

Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences

As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino (n = 4), non-Hispanic/Latino Black (n = 8), or non-Hispanic/Latino White (n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient-provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.

International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2012 to December 2017 in 523 intensive care units (ICUs) in 45 countries from Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, prospective data from 532,483 ICU patients hospitalized in 242 hospitals, for an aggregate of 2,197,304 patient days, were collected through the INICC Surveillance Online System (ISOS). The Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI) were applied.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the medical-surgical ICUs, the pooled central line-associated bloodstream infection rate was higher (5.05 vs 0.8 per 1,000 central line-days); the ventilator-associated pneumonia rate was also higher (14.1 vs 0.9 per 1,000 ventilator-days,), as well as the rate of catheter-associated urinary tract infection (5.1 vs 1.7 per 1,000 catheter-days). From blood cultures samples, frequencies of resistance, such as of Pseudomonas aeruginosa to piperacillin-tazobactam (33.0% vs 18.3%), were also higher.

CONCLUSIONS

Despite a significant trend toward the reduction in INICC ICUs, DA-HAI rates are still much higher compared with CDC-NHSN's ICUs representing the developed world. It is INICC's main goal to provide basic and cost-effective resources, through the INICC Surveillance Online System to tackle the burden of DA-HAIs effectively.

Effect of crude oil-induced water repellency on transport of Escherichia coli and bromide through repacked and physically-weathered soil columns

Knowledge of the transport and fate of pathogenic Escherichia coli, especially in the areas contaminated with crude oil, is required to assess contamination of shallow groundwater resources. The present study aims to investigate the effect of crude oil-mediated water repellency on the movement of nalidixic acid-resistant Escherichia coli strain (E. coli NAR) and bromide (Br) as an inert tracer in two soil types. The soils were contaminated at three levels of 0, 0.5 and 1% w/w of total petroleum hydrocarbons (TPHs) using crude oil. Steady-state saturated flow in the soil columns was controlled using a tension infiltrometer. Leaching experiments were conducted through the columns of repacked (un-weathered) and physically-weathered clay loam (CL) and sandy loam (SL) soils. The columns leachate was sampled at specific times for 4 pore volumes. The shape of breakthrough curves for the E. coli NAR and Br depended on soil texture and structure and the TPHs level. Preferential flow in the crude oil-mediated water-repellent soils facilitated the transport of contaminants especially E. coli NAR. Filtration coefficient and relative adsorption index of bacteria were greatest in the repacked CL soils and were lowest in the weathered SL soils. Discontinuity of soil pores and lower flow velocity resulted in greater filtration of E. coli NAR in the repacked CL soil than other treatments. Physical weathering induced the formation of aggregates which reduced soil particle surfaces available for retention of water-repellent oil and contaminants. Movement of both bacteria and Br tracer in the weathered SL soil with 1% TPHs was higher than other treatments. This finding was attributed to low specific surface area, continuity of the pores and water repellency-mediated preferential pathways in the weathered SL soil columns. Our findings implied that shallow groundwater resources could be very sensitive to microbial contamination particularly in the oil-mediated water-repellent soils.

A systematic review and meta-analysis on the epidemiology, casual agents and demographic characteristics of onychomycosis in Iran

Onychomycosis or fungal nail infection is one of the most common fungal infections. Nearly 50% of all nail disorders are caused by fungi. This systematic review and meta-analysis was conducted to determine the prevalence of onychomycosis across Iran. We searched English and Persian databases for studies reporting the epidemiologic features of onychomycosis in Iranian people from January 2000 to December 2018. Literature search revealed 307 studies, of which 24 studies met the eligibility criteria. In order to identifying the existence of publication bias among studies, funnel plots were used. The results of the meta-analysis were visualized as a forest plot representing the prevalence estimates of each study. Heterogeneity was also analyzed using the I², Chi², and Tau² statistics. A high level of I² and Chi² was obtained among studies, which provides evidence of notable heterogeneity between studies. The results of current study revealed that the highest prevalence of onychomycosis was related to Mazandaran and Tehran provinces, respectively. As in the literature hypothesized shift in etiologic agents from yeasts to dermatophytes or molds could not be confirmed. Females were affected more frequently than males and in both sexes the highest incidence of infection occurrence was at the ages of >50 years. It seems the highest prevalence of onychomycosis in Mazandaran and Tehran provinces is due to the concentration of specialist doctors and research centers in these two provinces compared with others which leads to more detection and more care of the disease. Therefore, further educational strategies in order to accurate diagnosis in other provinces is necessary to reduce the risk of onychomycosis in Iran.

National Study of Opium and Cancer in Iran (IROPICAN): Study Protocol and Results of the Pilot Phase

Background: Several epidemiologic studies have reported that opium consumption is associated with higher risk of cancer and may indeed cause cancer. However, most of these studies were not primarily designed to study the effect of opium on cancer. Therefore, control selection and data collections methods were not optimized for this purpose. Aim: We designed a large multicenter case-control study to specifically investigate the association between opium use and risk of 4 cancer types (i.e., lung, bladder, head and neck and colorectal cancers). We will recruit 800 cases and 800 controls for each cancer in this project. Methods: So far we have collected 70% of the cases and controls. We report here the study protocol and results of the pilot phase. Results: During the pilot phase, we determined that hospital visitors are the most appropriate type of controls; 185 cases and 176 controls were enrolled. Controls are matched to cases for sex, age and place of residence. Collection of data using a comprehensive questionnaire, focused on measuring use of opium and its derivatives, was feasible. Underreporting of opium was estimated to be 30% among controls. Collection of other data, including data tobacco and alcohol use, and nutritional data using a food frequency questionnaire, was feasible. Biologic samples including blood and saliva sample were collected from cancer cases and controls. Results of the pilot phase and validation study were used to optimize the full study protocol and questionnaires. Conclusion: The pilot phase of the study showed that the study is feasible, the best method of control selection is from hospital visitors, and both questionnaire and biologic samples can be collected. In addition of the results from pilot phase, preliminary results from the main phase of this study will be presented.

Correction to: Effects of dust on forest tree health in Zagros oak forests

The original version of this article unfortunately contained an error in the affiliation section.

The Prevalence of Methamphetamine Dependence among Iranian Women in Methadone Maintenance Therapy in Tehran, Iran

Objective: To date, there has been no specific survey of the prevalence of methamphetamine (MA) dependence among Iranian women in methadone maintenance therapy (MMT). The current study aimed at addressing this critical gap in the literature. Method: This study was part of a larger cross-sectional survey, which was conducted in 36 MMT clinics in Tehran during 2015 and 2016. A researcher-designed questionnaire was devised to collect data on demographics and drug and treatment characteristics. Data were analyzed using SPSS Version 19. Results: Overall, 307 women were in the study sites. Of them, 275 were MA dependent (89.5%) while in MMT. The mean age of the participants, who were MA-dependent, was 38 years. Age of MA dependence was 30 years, and duration of MA dependence was 7years. However, only 24.3% of the participants were currently in MA treatment (i.e. Matrix Model). This was accompanied with high rates of psychiatric hospitalization (29.4%), anxiety (33.4%), and depression (50.9%) because of long years of untreated MA dependence. Conclusion: The study revealed a high prevalence of untreated MA dependence and its adverse health impacts among the participants. However, no considerable treatment for MA dependence had been received by the participants. Psychosocial treatments should address MA dependence in MMT in Iran.

Pattern of mandibular third molar impaction: A cross-sectional study in northeast of Iran

OBJECTIVES

Impacted teeth, if left untreated, have a potential to induce various complications. The aim of the current study was to determine the prevalence and pattern of impacted mandibular third molar in the Iranian population.

STUDY DESIGN

This cross-sectional study was performed in patients who were referred to the Department of Oral Radiology between July 2009 and October 2010 to obtain an orthopantomogram (OPG). Data were collected regarding age and gender, prevalence of impacted mandibular third molars, angulation of impacted teeth (Winter's classification), level of impaction (Pell and Gregory classification), and relationship of the mandibular third molar with the ramus (Pell and Gregory classification). The collected data were analyzed using SPSS software version 11.0 with a confidence interval of 95%.

RESULTS

Among the 1433 patients included in the study, 489 (34.12%) patients were male and 944 (65.88%) were female. Of the total OPGs performed, 871 (60.78%) OPGs demonstrated at least one impacted mandibular third molar. In addition, of the 2866 mandibular third molars investigated, 1397 (48.74%) were found to be impacted. A significant association was observed between gender and the number of impacted teeth or the presence of impaction of any mandibular tooth (or teeth) (P < 0.05). The most common type of tooth angulation was mesioangular (48.67%). In addition, the most prevalent type of impaction level and ramus relationship was level B (63.85%) and Class II (48.46%), respectively. There were no significant differences between the two sides of the mandible for the prevalence of impacted third molar (P > 0.05).

CONCLUSION

The pattern of mandibular third molars in the Northeast region of Iran revealed a high prevalence of impaction, which was mostly mesioangular, level B, and Class II with a gender predilection for females.

Effects of dust on forest tree health in Zagros oak forests

Dust is one of the most devastating factors for the environment threatening all animal and plant species. In many regions, the ecological and economic impact of microdust on scarce species is critical. In the western region of Iran, the Zagros forests have been exposed to dust storms for many years. In this study, the effect of dust on oak trees, the most important trees of Zagros forests, is investigated. For this purpose, 3-year-old seedlings of three species of oak trees under natural conditions were exposed to dust during spring and summer months. Seedlings were divided into two groups; one group was assigned as dust treatment and the other as control that the control group washed regularly to remove dust. Anatomical characteristics of leaves and dust deposits on leaves during the study period were examined by scanning electron microscope (SEM). The rate of photosynthesis and gas exchange in control and treated plants was examined by IRGA, LCI. SEM images showed that stomata structure, trichome density, and epicuticular waxes of leaves are different in all three species. This difference in micromorphology of species influences the effects of dust deposited on the leaves. A comparison of leaf species images in control and dust treatment showed that in dust treatment the percentage of stomata blocked by dust in three species (per unit area) of Quercus infectoria, Q. libni, and Q. brantii were 61/6, 48/4, and 38/1%, respectively. The results of leaf gas exchange investigation indicated that stomatal occlusion by dust had a negative impact on the examined parameters of three oak species (P ≤ 0.01). Thus, gas exchange and photosynthetic rates of the treated species were significantly reduced. The results of both parts of the study showed the vulnerability of the three species to dust as Q. infectoria > Q. libni > Q. brantii. Therefore, based on these findings, dust can disrupt the physiological activities of the studied species and the continuation of the exposure to dust will accelerate the process of destruction of these forests.

The evaluation of the effect of metformin on breast fibrocystic disease

BACKGROUND

Fibrocystic changes (FCC) is the most common benign breast disease. The main pathophysiologic mechanism of FCC, excessive cell proliferation in response to monthly estrogen and progesterone changes. Regarding to antiproliferative of metformin, the aim of this study is the evaluation of the effect of metformin on FCC in women who were referred to gynecology clinics of ArakMETHODS:This study is a double blind placebo control randomized clinical trial. At the first among women who were referred to gynecology of Arak, 186 women with FCC between 18-40 years were selected. The women were randomly classified into three groups. The first group took metformin and the second group as placebo group took vitamin E and the third group did not take any drug during six months. All groups were compared in clinical symptoms based on visual analogue scale (VAS) and the sonographic data also were recorded and compared. Data analysis was performed by unilateral variance, student t and Chi-square.

RESULTS

The three groups were not different in aspect of mean of the cysts number, cyst size, tenderness and discharge from breast before the intervention, but after the intervention, there was a significant decrease in metformin group (p value < 0.001) based on variance analysis test. There was not a meaningful difference of pain and the location of cysts between the groups after the intervention.

CONCLUSIONS

The present study showed that metformin is effective in treatment of FCC and decreasing of clinical symptoms and imaging items.

Factors associated with subluxation in mallet fracture

Radiographs and medical record of all adult patients with a mallet fracture in three hospitals between 2004 and 2014 were reviewed. International Classification of Diseases, Ninth Revision (ICD-9) codes and text search in radiographic reports were used to identify all acute patients with potential mallet fractures in our institutional database. Manually checking, 392 true mallet fractures were identified among them, 78 had subluxation at the time of diagnosis and 19 had subluxation at a later time point during treatment. Fragment size, fragment displacement, and interval between injury and treatment were associated with initial and late subluxation. Subluxation was not observed when the fracture size was less than 39% of the total articular surface. For each 1% increase in total articular surface involvement in fractures with more than 39% involvement, the risk of subluxation increased by 4% and for each 1% of displacement, the risk of subluxation increased by 4%.

LEVEL OF EVIDENCE

IV.

Barriers to Hepatitis C Treatment among Women in Methadone Treatment: A Study from Iran, the Most Populous Persian Gulf Country

BACKGROUND

Untreated Hepatitis C Virus (HCV) has been reported among many Iranian female methadone patients. However, few of them report receiving HCV treatment. The present study is the first research from western Asia that explored the barriers to receiving HCV treatment among a group of Iranian female HCV-infected methadone patients.

METHODS

This qualitative study was conducted in four main methadone treatment clinics in Tehran, Iran, in November 2016. Overall, fifty-six untreated HCV-infected women and eight clinicians from HCV and methadone treatment services were interviewed. Women either had not received HCV treatment or received HCV treatment but left it. Data were analyzed using NVivo software. This was based on the grounded theory of Strauss and Corbin.

FINDINGS

Barriers to receiving HCV treatment included factors related to individuals and factors related to the system. Individual factors included the perception that untreated HCV infection was not a serious health concern, family responsibilities, and self-perceived discrimination against HCV-infected women. System-related factors included the lack of referral from methadone treatment staff, and a long distance between HCV treatment centers and methadone treatment centers. Interviews with the health professionals also confirmed the women' self-reports.

CONCLUSION

The results of this research confirm the necessity of providing HCV education and the delivery of comprehensive care for this group in methadone treatment clinics. Other services such as staff education and HCV treatment services at methadone treatment centers are suggested.

A novel signaling role for miR-451 in esophageal tumor microenvironment and its contribution to tumor progression

OBJECTIVE

We evaluated miR-451 expression in serum and tissue samples of esophageal squamous cell carcinoma (ESCC) patients. Then, we examined a secretory role of miR-451 in esophageal tumor microenvironment.

METHODS

miR-451 expression was evaluated in 39 serum samples from esophageal SCC patients compared to 39 normal individuals as well as 26 pairs of fresh-frozen tumor and adjacent normal tissues from patients with ESCC, using qRT-PCR. In a co-culture system of human normal fibroblasts (HFSF-PI3) and esophageal cancer cell line (KYSE-30), we evaluated exosomal miR-451 secretion into the conditioned medium (CM) of both cell lines. Then, we analyzed the effect of primiR-451-transfected fibroblasts on the migration potency of their neighboring KYSE-30 cells.

RESULTS

We detected miR-451 over-expression in serum samples of esophageal cancer patients compared to the normal group (P = 0.005). Interestingly, fresh-frozen tumor tissues from the same patients showed miR-451 down-regulation compared to their adjacent normal counterparts (P = 0.043). Co-culturing the KYSE-30 cell line with normal fibroblasts significantly induced miR-451 exosomal secretion into the CM. Moreover, co-culture of KYSE-30 cell line with miR-451-over-expressing fibroblasts significantly induced migration tendency in KYSE-30 cell line compared to the mock-transfected fibroblasts (P < 0.0001). In this system, MIF expression (a validated target of miR-451) in the KYSE-30 cell line was increased although this alteration was not statistically significant (fold change = 4.44).

CONCLUSIONS

Our data suggest that cancer-associated fibroblasts use exosomal miR-451 as a signaling molecule to provide a favorable niche for tumor cell migration and cancer progression. Our findings provide new insights into the stromal role of miR-451 in the esophageal tumor microenvironment as a communicatory molecule and suggest a signaling role for miR-451 in extracellular matrix cross-talks.

HIV Responses in Arab States on the Southern Persian Gulf Border: The First Review

Context

There is no review of HIV responses in Arab states on the southern Persian Gulf border. This narrative review aimed to describe and synthesize HIV responses in Kuwait, Qatar, Bahrain and the United Arab Emirates (UAE).

Evidence Acquisition

A review of scientific databases and grey literature was conducted based on an international guide. Overall, 16 original studies and reports were found.

Results

The review indicates that HIV has been found present in each Arab state based on sporadic case finding. The prevalence of HIV is the result of heterosexual relationship and/or drug injection. Mandatory testing of the nationals and expatriate workers is the main route of HIV detection. In general, HIV knowledge and education are poor. Only Bahrain has some non-governmental organizations that provide HIV education. Lack of identifying key populations and high risk behaviors has been reported in all of the states. HIV responses are mainly for Arab and Arabic-speaking nationals. Effective strategic plans for HIV have not been developed in all of the states. The provision of antiretroviral therapy for the nationals is the main HIV response. Only Qatar has paid for the treatment of Qatari and non-Qatari HIV-infected patients. As a HIV response, drug treatment is based on short-term inpatient rehabilitation. Only Qatar has voluntary HIV counseling and testing. Lack of needle and syringe programs has been reported for people who inject drugs with HIV problem in all of the states.

Conclusions

To conclude, HIV problem needs a comprehensive policy response in each state. Providing effective strategic plans for HIV and sero-surveillance data systems is required. Empowering human resources and infrastructural development are suggested.

Persian At-Risk Women and Barriers to Receiving HIV Services in Drug Treatment: First Report From Iran

BACKGROUND

As the most populated Persian Gulf country, in Iran, engagement with drug injection and unsafe sex are the main routes of HIV transmission among some drug-dependent women.

OBJECTIVES

The current study explored the barriers that a group of drug-dependent women reported in accessing and adhering to HIV services in drug use treatment.

PATIENTS AND METHODS

Qualitative interviews were conducted with 47 Persian women at five outpatient drug treatment centers between January and December 2011. Five focus group interviews were conducted with ten key informants (KI). The interviews made use of a semi-structured interview guide, which facilitated discussion regarding the barriers. The interview transcripts were analyzed thematically using Atlas-ti software.

RESULTS

The interview accounts highlighted a number of barriers, including stigmatization, a considerable lack of knowledge about free HIV centers in the community, previous traumatic events, misconceptions about the quality of HIV services, and a poor supportive referral system among drug treatment and HIV centers.

CONCLUSIONS

The findings highlight a need for removing stigma and providing high quality women-only HIV services. Increasing trust and knowledge of available HIV services are needed for this group of women. Increasing staff knowledge is a priority. An integrated supportive network among drug treatment and HIV centers is suggested in Iran.

HIV Programs in Iran (Persia), Iraq and Saudi Arabia: A Brief Review of Current Evidence in West and Southwest Asia

BACKGROUND

In Western and Southwest Asia, literature is not documented on human immunodeficiency virus (HIV) programs in Iran, Iraq and Saudi Arabia. The present study is the first brief review that describes HIV programs in these three neighboring countries.

METHODS

Data regarding the evidence of HIV programs were gathered through a systematic literature searching. English publications were retrieved through searching online scientific databases. Grey literature was also searched online. The review was based on the studies related to the last decade.

FINDINGS

Systematic searching resulted in retrieving 21,948 studies but only 21 studies were relevant to the study aim. The review findings indicated that Iran has provided a nationwide sero-surveillance data system and has identified its key populations. Detecting HIV prevalence has been limited to case-finding in Iraq and Saudi Arabia. However, strategic plans for HIV have been provided in the three countries. HIV education, knowledge and support have been provided but still needs consideration in the three countries especially in Iraq. The low coverage of antiretroviral therapy (ART) has remained a critical gap in the provision of comprehensive HIV programs in these three countries. This issue has been followed by the lack of opiate substitution therapies for drug dependents and injecting drug users in Iraq and Saudi Arabia. Condom promotion and voluntary HIV counselling and testing have been provided for at-risk groups in the three countries but need more nationwide coverages. However, needle and syringe programs (NSPs) have been only provided in Iran.

CONCLUSION

The review concluded that the provision of effective HIV programs should address training human resources and infrastructural development. This issue should be facilitated by international collaborations and governmental supports.

Synthesis, characterization and biological evaluation of novel α, β unsaturated amides

Three derivatives of α,β unsaturated amides have been successfully synthesized via Ugi-four component (U-4CR) reaction. The interactions of the amides with calf thymus deoxyribonucleic acid (ct-DNA) have been investigated in the Tris-HCl buffer (pH=7.4) using viscometric, spectroscopic, thermal denaturation studies, and also molecular docking. By UV-Vis absorption spectroscopy studies, adding CT-DNA to the compound solution caused the hypochromism indicates that there are interactions between the compounds and DNA base pairs. In competitive fluorescence with methylene blue as an intercalator probe, adding compounds to DNA-MB solution caused an increase in emission spectra of the complex. This could be because of compound replacing, with similar binding mode of MB, between the DNA base pairs due to release of bonded MB molecules from DNA-MB complex. Thermal denaturation studies and viscometric experiments also indicated that all three investigated compounds bind to CT-DNA by non-classical intercalation mode. Additionally, molecular docking technique predicted partial intercalation binding mode for the compounds. Also, the highest binding energy was obtained for compound 5a. These results are in agreement with results obtained by empirical methods.

Carbon-Nanohorn Based Nanofluids for a Direct Absorption Solar Collector for Civil Application

Direct solar absorption has been often considered in the past as a possible solution for solar thermal collectors for residential and small commercial applications. A direct absorption could indeed improve the performance of solar collectors by skipping one step of the heat transfer mechanism in standard devices and having a more convenient temperature distribution inside the collector. Classical solar thermal collectors have a metal sheet as absorber, designed such that water has the minimum temperature in each transversal section, in order to collect as much solar thermal energy as possible. On the other hand, in a direct configuration, the hottest part of the system is the operating fluid and this allows to have a more efficient conversion. Nanofluids, i.e., fluids with a suspension of nanoparticles, such as carbon nanohorns, could be a good and innovative family of absorbing fluids owing to their higher absorption coefficient compared to the base fluid and stability under moderate temperature gradients. Moreover, carbon nanohorns offer the remarkable advantage of a reduced toxicity over other carbon nanoparticles. In this work, a three-dimensional model of the absorption phenomena in nanofluids within a cylindrical tube is coupled with a computational fluid dynamics (CFD) analysis of the flow and temperature field. Measured optical properties of nanofluids at different concentrations have been implemented in the model. Heat losses due to conduction, convection and radiation at the boundaries are considered as well.

Association of retinal vessel calibre and visual outcome in eyes with diabetic macular oedema treated with ranibizumab

PURPOSE

The study aims to identify the association between the baseline retinal vascular calibre and visual outcome of patients with diabetic macular oedema (DMO) treated with intravitreal ranibizumab.

METHODS

The 1-M field (as defined in the ETDRS study) of the digital colour fundus photographs of DMO patients who had been treated primarily with ranibizumab in a clinical trial was assessed. Of the 84 patients, 25 had gradable retinal photographs that could be subjected to analyses by the Interactive Vessel Analysis (IVAN) software at baseline. The average retinal vascular calibre of the six largest venules (CRVE) and the six largest arterioles (CRAE) in the peripapillary area (0.5 and 1 disc diameter from the optic disc margin) was measured. The relationship between CRVE and CRAE at baseline and the change in visual acuity at month 12 was assessed using the Mann-Whitney U test.

RESULTS

Ten eyes from 10 patients who had shown an improvement of ≥2 lines of best corrected visual acuity (BCVA) at month 12 had a wider baseline CRVE (248.3±24.5 μm) compared with the 15 eyes from 15 patients who did not show the improvement of ≥2 lines (226.6±44.8 μm, P<0.05). The baseline CRAE did not differ significantly in these patients (156.1±22.7 vs 142±17.5 μm, P=0.17).

CONCLUSIONS

A wider baseline retinal venular calibre may be a predictor of better visual outcome in DMO eyes treated with ranibizumab. Further prospective studies with a larger sample size and a broader range of disease severity and visual acuity are needed to confirm this finding.

Longitudinal comparison of visual acuity as measured by the ETDRS chart and by the potential acuity meter in eyes with macular edema, and its relationship with retinal thickness and sensitivity

PURPOSE

To evaluate the relationship between visual acuity as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and by the potential acuity meter (PAM) with retinal thickness and sensitivity measured by a combined microperimetry/optical coherence tomography system (OCT).

METHODS

Forty-four patients with macular edema (ME) were included in a prospective observational study. Visual acuity (VA) was assessed using the ETDRS chart (with best correction) as well as by the PAM. Retinal thickness and sensitivity was measured by an automatic fundus perimetry/tomography system.

RESULTS

Best-corrected VA using the ETDRS chart ranged from 20/20 to 20/400 (median: 20/50). VA measured by the PAM without correction ranged from 20/20 to 20/400 (median: 20/40). The mean retinal thickness was 369.57 μm (s.d.: 140.28 μm) on spectral domain-OCT and the mean retinal sensitivity was 8.12 decibels (dB) (s.d.: 5.78 dB). The mean LogMAR value using the ETDRS chart was 0.43, whereas it was 0.38 using the PAM (P-value: 0.009).

CONCLUSIONS

VA values measured by the PAM were statistically significantly better than those measured by the ETDRS chart in eyes with ME secondary to various retinal vascular and uveitic diseases. VA measured by the PAM may be a more sensitive predictor of macular function than that obtained by ETDRS testing in eyes with ME.

A novel and rapid loop-mediated isothermal amplification assay for the specific detection of Verticillium dahliae

AIMS

In this study, a loop-mediated isothermal amplification (LAMP) assay has been developed and evaluated for the rapid and sensitive detection of Verticillium dahliae Kleb., the causal agent of vascular wilts in many economically important crops.

METHODS AND RESULTS

LAMP primers were designed based on a previously described RAPD marker, and the LAMP assay was applied for direct detection of V. dahliae grown on medium and from soil samples without DNA purification steps (direct-LAMP). Thirty-two agricultural soil samples from various olive orchards were collected, and the presence of pathogen was detected by LAMP, direct-LAMP and nested-PCR methods. The LAMP methodology could successfully detect V. dahliae with high specificity, and cross-reaction was not observed with different pathogenic and nonpathogenic fungi and bacteria. The LAMP assay was capable of detecting a minimum of 500 and 50 fg of purified target DNA per reaction of V. dahliae ND and D pathotypes, respectively. In contrast, nested-PCR could only detect 5 pg reaction(-1) for both pathotypes. In artificially infested soil samples, the LAMP method detected 5 microsclerotia per gram of soil. Conversely, nested-PCR assay detected 50 microsclerotia g(-1) soil. The detection ratios of LAMP and direct-LAMP protocols were better (26 and 24 positive samples out of 32 agricultural soils analysed, respectively) than that obtained for nested-PCR method (22 positive results). Moreover, direct-LAMP yielded positive detection of V. dahliae in agricultural soil samples within 60-80 min.

CONCLUSIONS

The newly developed LAMP method was proved to be an effective, simple and rapid method to detect V. dahliae without the need for either expensive equipment or DNA purification.

SIGNIFICANCE AND IMPACT OF STUDY

This technique can be considered as an excellent standard alternative to plating and nested-PCR assays for the early, sensitive and low-cost detection of V. dahliae as well as other soilborne pathogens in the field.

Influencing factors on the functional level of haemophilic patients assessed by FISH

Joint destruction in early adulthood brings the patients to the orthopaedic clinics. If a haemophilic patient becomes disabled, it shows a number of factors such as timely diagnosis, availability of appropriate treatment depending on the country, access and affordability to treatments and equally importantly the responsibility of the patient in managing self care by remaining compliant by prescribed treatment regimen. We assessed the functional level by functional independence score in haemophilia (FISH). Overall, 104 patients with haemophilia A and 29 with haemophilia B were evaluated. We assessed the function of the patients by FISH. We divided the sum scores into weak (FISH score 8-16), moderate (17-24), and good (25-32). For evaluating the level of functional deficit in a 2 × 2 table, we categorized the weak and moderate levels into Disordered Group and the good level into Not-Disordered Group. The average age was 26.9 ± 14.24. Each 1 year increase in age can increase 1.07 fold the possibility of being placed in Disordered Function Group. Severe haemophilia can increase 7.34 fold, presence of inhibitor can increase 9.75 fold and home self-care increases 3.89 fold the possibility of being placed in Disordered Function Group. To decrease the burden of the cost on patient, family and the government, education plays the most important role. We suggest that we send a trained team of physician and nurses to the deprived villages and cities instead of waiting for the patient to refer to our Care Center.

Treatment outcome, mortality and their predictors among HIV-associated tuberculosis patients

The risk of death is significantly higher in HIV-infected patients with tuberculosis (TB). This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a tertiary TB centre in Iran. In total, 111 patients were recruited from 2004 to 2007. Mycobacteriological studies and demographic, clinical, and laboratory data from all patients were analysed and predictors of unsuccessful outcomes as well as mortality were determined. The mean age for all 111 TB-HIV patients was 38 ± 9 years (range 22-70) and 107 (96.3%) were men; 104 (93.7%) had a history of drug abuse and 96 (86.4%) had a history of imprisonment. The method of HIV transmission was intravenous drug use in 88 (79.3%). Twenty-three (20.7%) had a history of Category 1 (CAT I) TB treatment and six (5.4%) Category 2 (CAT II) treatment. Combination antiretroviral therapy (cART) was given to 48 (43.2%). No significant associations were found between treatment outcomes or mortality and gender, smoking, drug and alcohol abuse, imprisonment, method of transmission, history of CAT I and CAT II treatments, CD4 counts or adverse effects (P > 0.05). Administration of cART led to significantly better outcomes (P < 0.001). Lower serum albumin levels and low body weight were significantly associated with mortality.

Prevalence of HPV Infection and High Risk HPV Genotypes (16, 18), among Monogamous and Polygamous Women, In Zabol, Iran

BACKGROUND

This study was performed to compare the prevalence of HPV infection and high risk HPV genotypes [16, 18] between monogamous and polygamous women, in Zabol, Iran.

METHODS

This cross sectional study was conducted in Zabol in 2006 - 2007. Two hundred sixty five married women attending the Gynecology Clinic for Cervical Disease Screening entered to this study. One hundred sixty two cases had monogamous, and 103 had polygamous husbands. HPV PCR samples were obtained from scrape of papsmear specimens. The biotinylated primers MY09/MY11, GP5+/GP6+, were utilized to enable amplification and detection of positive PCR products. Confirmation of HPV-16 and -18 were done by type-specific PCR primers HPV-16/F, HPV-16/R and HPV-18/F, HPV-18/R.

RESULTS

Prevalence of HPV infection in monogamous and polygamous groups was 29% and 37.9%, respectively. The most HPV infection was found in 15-25 years group. The most prevalence of infection in monogamous group was HPV-18 and HPV-non16, 18 in 15-25 years, and HPV-16 in 26-35 years group. In polygamous group the most prevalent type was HPV-16, 18 in 15-25 years group. The most prevalent HPV-16 was seen in sever inflammation and dysplasia cytology in both groups.

CONCLUSION

Prevalence of HPV infection in Zabol is high, and in women with polygamous husbands group is slightly more than monogamous. Screening for this infection must be recommended in this region of Iran.

Standardised second-line treatment of multidrug-resistant tuberculosis during pregnancy

We describe the efficacy and outcome of standardised second-line anti-tuberculosis (TB) medications during pregnancy. Treatment outcomes of five pregnant women with documented multidrug-resistant TB (MDR-TB) referred to the National Research Institute of Tuberculosis and Lung Diseases from 2003 to 2009 were analysed in two categories, maternal and neonatal. Patients became pregnant during treatment for MDR-TB without any changes in their anti-tuberculosis regimen. None of them had any adverse effects during pregnancy and delivery. No adverse effects were observed in mothers or neonates. The treatment of MDR-TB during pregnancy with a standardised second-line regimen in this study population was safe, with an acceptable rate of treatment success.

Concurrent infections of hepatitis C and HIV in hepatitis B patients in the north-east of Iran

Co-infection of HBV, HCV and HIV is common because of shared routes of viral transmission with increased risk of morbidity and mortality. Anti-HCV and HIV antibodies of 168 HBV patients were assayed. Co-infection of HCV in HBV patients was seen in four cases (2.4%). Simultaneous infection of HIV in HBV patents was seen in three cases (1.8%). There was no simultaneous co-infection of HCV, HIV and HBV. It is recommended that all patients are screened for possible co-infections before initiating treatment.

Saffron in the treatment of patients with mild to moderate Alzheimer's disease: a 16-week, randomized and placebo-controlled trial

WHAT IS KNOWN

Herbal medicines have been used in the treatment of behavioural and psychological symptoms of dementia but with variable response. Crocus sativus (saffron) may inhibit the aggregation and deposition of amyloid β in the human brain and may therefore be useful in Alzheimer's disease (AD).

OBJECTIVE

The goal of this study was to assess the efficacy of saffron in the treatment of mild to moderate AD.

METHODS

Forty-six patients with probable AD were screened for a 16-week, double-blind study of parallel groups of patients with mild to moderate AD. The psychometric measures, which included AD assessment scale-cognitive subscale (ADAS-cog), and clinical dementia rating scale-sums of boxes, were performed to monitor the global cognitive and clinical profiles of the patients. Patients were randomly assigned to receive capsule saffron 30 mg/day (15 mg twice per day) (Group A) or capsule placebo (two capsules per day) for a 16-week study.

RESULTS

After 16 weeks, saffron produced a significantly better outcome on cognitive function than placebo (ADAS-cog: F=4·12, d.f.=1, P=0·04; CDR: F=4·12, d.f.=1, P=0·04). There were no significant differences in the two groups in terms of observed adverse events.

WHAT IS NEW AND CONCLUSION

This double-blind, placebo-controlled study suggests that at least in the short-term, saffron is both safe and effective in mild to moderate AD. Larger confirmatory randomized controlled trials are called for.

Nonlinear solution for radiation boundary condition of heat transfer process in human eye

In this paper we propose a new method based on finite element method for solving radiation boundary condition of heat equation inside the human eye and other applications. Using this method, we can solve heat equation inside human eye without need to model radiation boundary condition to a robin boundary condition. Using finite element method we can obtain a nonlinear equation, and finally we use nonlinear algorithm to solve it. The human eye is modeled as a composition of several homogeneous regions. The Ritz method in the finite element method is used for solving heat differential equation. Applying the boundary conditions, the heat radiation condition and the robin condition on the cornea surface of the eye and on the outer part of sclera are used, respectively. Simulation results of solving nonlinear boundary condition show the accuracy of the proposed method.

Molecular Epidemiology of High-Risk Types of Human Papillomaviruses (16, 18) in Pap-Smear, the North East of Iran

BACKGROUND

Cervical Cancer is one of the most important and commonly diagnosed types of cancer in females. There are different causes of cervical cancer, amongst which recurrent and persistent infection with HPV types 16 and 18 are the most renowned ones. These genotypes are the main factors in 99 % of cases in developed countries and 70 % in developing ones. Due to the importance of these viruses in cervical cancer, molecular detection of HPV and its high risk genotypes in Gorgan was designed.

METHODS

Pap smears and swabs specimens were taken from 308 women. Papanicola staining method and cytology were used. Nucleic acid was extracted by proteinase K phenol-chloroform standard method and then assessed by using beta-globin primer. Polymerase Chain Reaction (PCR) was then performed for papilomaviruses on all patients and positive cases from both types, including HPV 16 and 18 genotypes, were detected.

RESULTS

Three hundred and eight women (15-75 years old) with mean age of 37.54±10.6 were recruited. Seventy six cases (20.1%) of whom were infected with HPV and 48.6% with HPV16 or 18 positive. Normal cytology was seen in 226 cases and 41 patients (18.1%) were HPV positive. Amongst those 152 cases with inflammation or abnormal cytology, 35 cases (23%) were HPV positive. No significant relation was reported between different variables and HPV infections.

CONCLUSIONS

Due to high rate of HPV infection, as well as its high risk genotypes in different studies, more careful screening of women by Pap smear is recommended.