This study aimed to explore the prevalence, antimicrobial resistance levels, and serotype distribution of S. pneumoniae in the Middle East region. We conducted a systematic literature review by searching several databases including PubMed, ISI Web of Science, Scopus, Google scholar through 2000 to 2017 by using the following keywords: “Streptococcus pneumoniae”, “pneumococcus”, “serotype”, “Antibiotic resistance,” and “Middle East “in combination with “OR” and “AND” Boolean Operators within Title/Abstract/Keywords fields. We used a random-effects model to calculate the pooled prevalence and 95% confidence intervals (CIs) for binomial variables. All statistical analyses were done using STATA 12.0 (STATA Corp, College Station, TX). We found 73 articles appropriate, on the word of inclusion and exclusion criteria, for inclusion in this systematic review and meta-analysis. The result revealed that the pooled prevalence of S. pneumoniae carriage was 35% (95% CI: 26-44%). The most frequent pneumococcal serotypes were19, 19F, 6, 23 and 6A/B which were found in 19%,12%, 11%, 10% and 10% of isolates respectively. Pneumococcal resistance reported for azithromycin, cefaclor, clarithromycin, chloramphenicol, erythromycin, and tetracycline were 24%, 37%, 23%, 11%, 26%, and 29% respectively, while vancomycin resistance was not reported. The highest resistant prevalence was reported against co-trimoxazole (Trimethoprim/sulfamethoxazole). For this antibiotic, a pooled resistance prevalence of 43% was identified. The present review demonstrates that the prevalence of S. pneumoniae carriage was high in the Middle East region. Surveillance must be continued in this region to evaluate. The resistance pattern and serotype distribution.

Endothelial cells (EC) have dynamic properties and high plasticity in response to microenvironmental change. A proinflammatory cytokine such as tumor necrotizing factor-α (TNF-α) can induce EC phenotype shift to osteoinduction properties by releasing a potent osteogenic cytokine, namely bone morphogenetic protein 2 (BMP2). Normally BMP2 acts as an osteoblast stimulating factor in bone and cartilage tissue. BMP2 activation in vascular tissue will invite osteoblast recruitment and mineralization and generated pathological vascular stiffening and calcification. Recently, endoplasmic reticulum stress (ERS) has been emerging as a new target therapy in many vascular diseases such as vascular stiffening and calcification. Some short-chain fatty acid like 4-phenyl butyric acid has been shown had anti-ERS properties. However, the role of 4-phenyl butyric acid in BMP2 inhibition in endothelial cells is still poorly understood. Hence, we investigated the role of 4-phenyl butyric acid in inflammation-induced BMP2 expression in human vein derived endothelial cells. Endothelial cells obtained from a baby born umbilical vein were cultured and pre-treated with TNF-α (5 ng/ml) as inflammation precondition. Multiple doses of 4-phenyl butyrate acid (4-PBA) 1 nM/mL, 2 nM/mL, and 3 nM/m were used as ERS inhibitors. The expression of two ERS biomarkers, glucose-related protein-8 (GRP78) and activating transcription factor-6 (ATF6), were measured. Statistical analysis was done using one-way ANOVA and Kruskal Wallis tests, and P<0.01 considered as significant. 4-PBA decrease luminal BMP2 at dose one nM/L, GRP78 at dose 1 nM/L, and translocated ATF6 expression at dose 1 nM/L in endothelial culture dose-dependently. Short-chain fatty acid 4-phenylbutyrate acid decreases luminal ERS marker GRP78 and translocated ATF6 expression in endothelial culture. ERS has a role in osteoinductive phenotype shifting in inflammation endothelial cells, which was the novelty of this research. Further research needs to elucidate ERS inhibition in in vivo experiment

The role of angiogenesis in the development of chronic inflammatory diseases, including oral lichen planus (OLP), is of great concern. The most representative method for the assessment of angiogenesis is the semi-quantification of microvessel density (MVD) using specific markers such as CD105. We aimed to assess the MVD in patients with OLP and find its clinical significance to differentiate the atrophic/erosive forms from reticular ones. This cross-sectional study was conducted on 82 patients with clinically and histopathologically proven cases of OLP, including reticular (n=52) or atrophic/erosive (n=30) lesions. The control group comprised 82 age- and sex-matched subjects without any oral disease. To assess the MVD using CD105, tissue blocks were sliced, and the immunoexpression of CD105 was measured by the standard immunohistochemical staining procedure. The mean value of MVD in OLP patients was significantly higher than that in the controls (14.61±12.48 vs. 8.67±1.76, P<0.0001). Furthermore, there was a significant difference in the mean MVD value between reticular and atrophic/erosive lesions (8.19±7.13 vs. 25.73±12.06, P=0.001). However, no significant difference was observed between the reticular lesions and normal tissues (P=0.58). An increased level of CD105 in OLP patients can improve our knowledge about the causes and mechanisms of the disease. The CD105-MVD assessment might be a useful method for semiquantitative measurement of angiogenesis in OLP patients as well as differentiating its clinical forms; therefore, it can open new vistas for formulating strategies based on antiangiogenic treatments for the management of OLP and other precancerous lesions.

Cataract is a multifactorial ocular disease, resulting in turbidity or opacity of the lens of the eyes, which leads to blindness or reduction of visuality. The different environmental, socio-economical, and lifestyle factors indicate as risk factors of age-related cataracts. The aim of this study was the evaluation of daily activity, dietary regimen, residence location and etc., as risk factors of age-related cataracts. In this census, a cross-sectional study was performed on 353 patients with age-related cataract underwent surgery, who referred to Rouhani Hospital in Babol, Iran from 2018 to 2019, and 343 healthy individuals. The lifestyle-related information was collected from all individuals via the designed questionnaire. Our results showed that there were significant correlations between the birth/residence in the village (comparing to city, P<0.001), abnormal sleeping time (P<0.001), daily activity (and being outdoor, P<0.001), and use of solid oil (P<0.001) with increasing in age-related cataracts. Furthermore, the use of antioxidant-containing fruits significantly reduces the risk of age-related cataracts. Our results established that lifestyle clearly has a golden impact on age-related cataracts. The reduction in daily activity, normal sleeping time, and more use of antioxidant-containing dietary regimen play a preventive role in age-related cataracts.

Abstract-Cardiac abnormalities have been suspected and identified using transthoracic echocardiography in patients with normal electrocardiographic results have been reported. It is however not clear whether these abnormalities are clinically significant or can lead to change in clinical management. The aim of this study was to evaluate the prevalence and clinical significance of cardiac abnormalities found in patients with normal electrocardiographic results. Transthoracic echocardiography was conducted on outpatients on referral despite having normal electrocardiographic results. Clinical symptoms were identified and parameters such as BMI, smoking status, blood pressure, blood glucose levels and hypercholesterolemia status were evaluated. The data obtained from these parameters were compared with findings of cardiac abnormalities in the patients. Out of 552 patients analysed with mean age of 50.53±15.04 years, 412 representing 74% had abnormalities in their transthoracic echocardiographic reports. Significant majority of active smoking patients (82.2%) had cardiac abnormalities. The major findings were valvular heart disease observed in 123 patients, grade I and II diastolic dysfunction in 85 patients, hypertensive heart disease in 76 patients and non-significant valve disease reported in 50 patients.
The common symptoms included atypical chest pain, shortness of breath and epigastric pain. Hypertension, hypercholesterolemia and diabetes mellitus were observed among patients with abnormal transthoracic echocardiographic reports. There is high prevalence of clinically significant cardiac abnormalities evaluated using transthoracic echocardiography in patients with normal electrocardiographic results. These cardiac abnormalities are associated with symptoms and cardio-metabolic disease, hence might warrant change in clinical management.
Keywords: Transthoracic, echocardiography, Cardiac abnormalities, Cardio-metabolic diseases, Structural heart disease.

COVID-19, which quickly became a global problem, in addition to its effects on public health, is very important in terms of the effect on mental health and anxiety in health care providers. Job burnout should be considered during such health crises. The study design is a cross-sectional study. A total of 87 health care providers (nurses and physicians) were included in the study. Their general information such as age, gender, years of experience, and hours working in COVID-19 was asked. They all filled Maslach burnout inventory, a questionnaire measuring job burnout with three dimensions: Emotional exhaustion (EE), Depersonalization (DP), and personal accomplishment (PA). We found that in physicians, EE (r:0.54, P<0.001) and DP were correlated with hours working in the COVID-19 ward, but no such correlation was found in nurses. Physicians had a higher DP score (mean 12.66 vs. 8.28, P<0.001) and lower PA score (mean 22.71 vs. 25.62, P:0.004) both of them represent higher burnout levels in physicians. Comparing our results with previous studies show that during the COVID-19 breakout higher level of job burnout could be found in health care workers, especially in physicians. Hours working in COVID-19 special wards can increase the level of burnout.

Global evidence indicates that transgender people are disproportionately at risk for HIV infection. However, limited data are available characterizing sexual behaviors and HIV infection among transgender people in Iran. This study aims to determine the prevalence of high-risk sexual behaviors and HIV infection among transgender people in Iran. In 2009, we assessed data of 58 transgender individuals (41 female-to-male (FTM) and 17 male-to-female (MTF)). Their demographic characteristics and risky sexual behaviors, and other risky behaviors such as substance use were gathered using a structured questionnaire. Rapid tests were used to confirm HIV seropositivity. Fifty-four participants who provided blood samples, none were positive (exact 95% confidence intervals: 0.0, 0.07). 75.6% of FTM and 64.7% of MTF reported having sex in the past six months, respectively. Of the sample who reported having sex in the past six months (n=42), only 19% reported using condoms. No participants reported a history of injection. In this study of HIV infection among a small sample of transgender people in Iran, no one was HIV positive. Some reasons for these findings can be outlined as a lack of history of intravenous drug use and related behaviors, limited high-risk relationships and behaviors, and the limited number of males among the samples.

Most adnexal masses found in pregnancy are simple benign cysts less than 5 cm in diameter. On the other hand, the majority of persistent adnexal masses 5 cm or greater in diameter are mature teratomas. Malignant transformation occurs in 0.2 to 2 percent of mature teratomas, and squamous cell carcinoma arising from ectoderm is the most common secondary neoplasm. The mucinous cystadenocarcinoma transformation is very rare. We presented a 38-year-old G2Ab1 woman at 32 weeks of gestation with a huge, rapid growth adnexal mass who came to our emergency department due to severe preeclampsia, stage 1 of IUGR, and borderline AFI. After 48 hours of expectant management, a cesarean section associated with unilateral salpingo-oophorectomy was done, and the histopathology of the cyst revealed mature teratoma that was focally involved with mucinous cystadenocarcinoma. The complete surgical staging was done, and due to the stage of disease (1C1), she received adjuvant chemotherapy, and she has remained disease-free in her last follow up after one year.

We describe a 34-year-old woman with isolated tuberculosis (TB) uveitis who had unsuccessful resolution of her ocular surface squamous neoplasia after multiple shave excisions with a positive purified protein derivative (PPD) test and interferon-gamma (IFN-γ) release assays (IGRAs) proven tuberculosis. She was managed with wide local excision of the lesion. Histopathology confirmed conjunctival intraepithelial neoplasia (CIN) grade II. Topical interferon alpha-2b (4 times daily) and anti-tuberculous therapy was planned for her, and there was no sign of recurrence of the lesion at six months follow-up.

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