Invasive Fungal Sinusitis in Immunocompromised Patients: A Multicenter, University Hospital Experience in Shiraz

Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Hospitals. Thirty-six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis. Results: Thirty-five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of parasinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients were considered as proven, from these, 17 samples had positive growth. The culture aetiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were matched with histopathology findings. Significant associations were considered for radiologic finding and histopathology and culture (p 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: DM is the most common predisposing factor for IFS followed by ALL and AML. The most common aetiology of IFS was found to be Aspergillus fumigant followed by Mucormycosis and Candida. None of antifungal agents could successfully cover all the species.

Risk factors of gastroesophageal reflux disease in Shiraz,southern Iran

AIM: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic,lifestyle and health-seeking behaviors in Shiraz,southern Iran. METHODS: A total of 1978 subjects aged > 35 years who referred to Gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic,lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined. RESULTS: The prevalence of GERD was 15.4%,which was higher in females (17.3%),in rural areas (19.8%),and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%),and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%),taking aspirin (21%) and in subjects with psychological distresses (27.2%) and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%),dyspepsia (30.6%),anxiety (19.5%),nightmares (23.9%) and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%),consumption of herbal medicine (19%),using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%).CONCLUSION: GERD is more common in females,rural and illiterate subjects and correlated with consumption of pickles,occurrence of headache,psychological distress,dyspepsia,halitosis,anxiety,nightmare and restlessness,and a family history of GERD and aspirin intake,but the correlation was negative with consumption of fat and fiber intake.

Discernment scheme for paraquat poisoning: A five-year experience in Shiraz, Iran

AIM To evaluate various schemes for paraquat poisoning and different variables that influence the outcome of acute paraquat poisoning.METHODS In a cross-sectional study, the information about all cases of acute paraquat poisoning who were admitted to teaching hospitals affiliated to Shiraz University of Medical Sciences, in a five year period(September 2010 to September 2015) were evaluated. The variables included: Demographic data, medical assessment, therapeutic options, laboratory findings, and the outcomes. Data were analyzed using SPSS, version 22. Significant difference between groups was tested using t-test for continues outcomes and χ~2 test for categorical. The significance level was considered to be P < 0.05. RESULTS A total of 104 patients(66.3% male) were evaluated. The mean age of the female patients was 22.81 ± 9.87 years and the male patients' was 27.21 ± 11.06 years. Ninety seven(93.3%) of all the cases were suicide attempts with mortality rate of 43.2%. Despite the necessity for emergency hemodialysis during the first 6 h of intoxication, none of the patients had dialysis during this time. Immunosuppressive and corticosteroid medications were not administrated in adequate dosage in 31.1% and 60% of the patients, respectively. Ingestion of more than22.5 cc of paraquat and increase in creatinine level were the most important predictors of mortality.CONCLUSION Treatment should start immediately for these patients.Moreover, creating a clinical guideline according to the findings can have an impact on the treatment procedure which seems to be necessary.

Antimicrobial susceptibility of Helicobacter pylori strains isolated from patients in Shiraz, Southern Iran

AIM: To improve our understanding of Iranian regional variation in Helicobacter pylori (H. pylori ) antibiotic resistance rates to find the best antibiotic therapy for eradication of H. pylori infections.METHODS: A total of 266 patients undergoing endoscopy in Shiraz, Southern Iran, were included in this study. H. pylori strains were isolated from antral biopsies by culture and confirmed by the rapid urease-test and gram staining. Antibiotic susceptibility of H. pylori isolates was determined by E-test.RESULTS: A total of 121 H. pylori strains were isolated, 50 from male and 71 from female patients. Data showed that 44% (n = 53), 20% (n = 24), 5% (n = 6), and 3% (n = 4) of all strains were resistant to the antibiotics metronidazole, amoxicillin, clarithromycin, and tetracycline, respectively. When the antibiotics were considered together we found 11 sensitivity patterns for the strains. Resistance to metronidazole was significantly higher in female than in male patients (P < 0.05). In about 71% of the metronidazole-resistant isolates, the minimum inhibitory concentrations (MICs) exceeded 256 μg/mL.CONCLUSION: We found a moderate rate of primary resistance to metronidazole. However, a high MIC (> 256 mg/L) which was found in 71% of the isolates is considerable. In the case of amoxicillin, an increased resistance rate of 20% is worrying. Resistance to clarithromycin and tetracycline is also emerging among the H. pylori strains in our region.

Conduction system disorders and electro-cardiographic findings in COVID-19 deceased patients in 2021,Shiraz,Iran

BACKGROUND Cardiac conduction disorders and electrocardiographic(ECG)changes may occur as a manifestation of coronavirus disease 2019(COVID-19),especially in severe cases.AIM To describe conduction system disorders and their association with other electrocardiographic parameters in patients who died of COVID-19.METHODS In this cross-sectional study,electrocardiographic and clinical data of 432 patients who expired from COVID-19 between August 1st,2021,and December 1st,2021,in a tertiary hospital were reviewed.RESULTS Among 432 patients who died from COVID-19,atrioventricular block(AVB)was found in 40(9.3%).Among these 40 patients,28(6.5%)suffered from 1st degree AVB,and 12(2.8%)suffered from complete heart block(CHB).Changes in ST-T wave,compatible with myocardial infarction or localized myocarditis,appeared in 189(59.0%).Findings compatible with myocardial injury,such as fragmented QRS and prolonged QTc,were found in 91 patients(21.1%)and 28 patients(6.5%),respectively.In patients who died of COVID-19,conduction disorder was unrelated to any underlying medical condition.Fragmented QRS,axis deviation,and ST-T changes were significantly related to conduction system disorder in patients who died of COVID-19(P value<0.05).CONCLUSION Conduction system disorders are associated with several other ECG abnormalities,especially those indicative of myocardial ischemia or inflammation.Most patients(73.14%)who died of COVID-19 demonstrated at least one ECG abnormality parameter.Since a COVID-19 patient's ECG gives important information regarding their cardiac health,our findings can help develop a risk stratification method for at-risk COVID-19 patients in future studies.

Assessment of geochemical and sedimentological characteristics of atmospheric dust in Shiraz,southwest Iran

Geogenic dust is commonly believed to be one of the most important environmental problems in the Middle East.The present study investigated the geochemical characteristics of atmospheric dust particles in Shiraz City(south of Iran).Atmospheric dust samples were collected through a dry collector method by using glass trays at 10 location sites in May 2018.Elemental composition was analysed through inductively coupled plasma optical emission spectrometry.Meteorological data showed that the dustiest days were usually in spring and summer,particularly in April.X-ray diffraction analysis of atmospheric dust samples indicated that the mineralogical composition of atmospheric dust was calcite+dolomite(24%)>palygorskite(18%)>quartz(14%)>muscovite(13%)>albite(11%)>kaolinite(7%)>gypsum(7%)>zircon=anatase(3%).The high occurrence of palygorskite(16%-23%) could serve as a tracer of the source areas of dust storms from the desert of Iraq and Saudi Arabia to the South of Iran.Scanning electron microscopy indicated that the sizes of the collected dust varied from 50 μm to0.8 μm,but 10 μm was the predominant size.The atmospheric dust collected had prismatic trigonal-rhombohedral crystals and semi-rounded irregular shapes.Moreover,diatoms were detected in several samples,suggesting that emissions from dry-bed lakes,such as Hoor Al-Azim Wetland(located in the southwest of Iran),also contributed to the dust load.Backward trajectory simulations were performed at the date of sampling by using the NOAA HYSPLIT model.Results showed that the sources of atmospheric dust in the study area were the eastern area of Iraq,eastern desert of Saudi Arabia,Kuwait and Khuzestan Province.The Ca/Al ratio of the collected samples(1.14) was different from the upper continental crust(UCC) value(UCC=0.37),whereas Mg/A1(0.29),K/Al(0.22) and Ti/Al(0.07) ratios were close to the UCC value(0.04).This condition favours desert calcisols as the main mineral dust sources.Analysis of the crustal enrichment factor(EF_(crustal)) revealed geogenic sources for V,Mo,Pb,Sr,Cu and Zn(<2),whereas anthropogenic sources affected As,Cd,Cr and Ni.

Prediction of the impact of air pollution on rates of hospitalization for asthma in Shiraz based on air pollution indices in 2007-2012

Objectives: This study was designed to determine the effects of air pollutants on emergency admissions for asthma, and to forecast the disease burden in Shiraz, Iran. Methods: The average daily concentrations of fine particles (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO) and ozone (O3) were calculated from data reported by two air quality monitoring stations in Shiraz from the beginning of 2007 to mid-2012. Results: The numbers of patients admitted with asthma attack during this period were collected from four main university-affiliated hospitals. Admissions correlated strongly with the levels of PM10, SO2, CO and O3 during warm seasons (P<0.001), and with NO2 level during cold seasons (P<0.001). We forecast increasing trends in air pollutants and patient admissions in the year 2015. Conclusion: Our findings are further evidence of the effects of air pollutants on asthma exacerbations.

A simple multiplex PCR for assessing prevalence of extended-spectrumβ-lactamases producing Klebsiella pneumoniae in Intensive Care Units of a referral hospital in Shiraz,Iran

Objective:To identify three common genes(bla_(TEM),bla_(SHV)and bla_(CTX-M)responsible for ESBL production in Klebsiella pneumnniae(K.pneumnniae)isolated from Intensive Care Units of Namazi Hospital,Shiraz,Iran.Methods:A total of 60 non-repetitive nosocomial isolates from 60patients were selected during 2009-2010.The phenotypic identification of ESBL production was confirmed by Double Disk Synergy Test(DDST)according to CLSI guidelines.The ESBL's genotype was then analyzed by multiplex PCR of bla_(TEM),bla_(SHV)and bla_(CTX-M)genes and DNA sequencing.Results:The primary susceptibility tests of K.pneumoniae showed that among 10 examined antibiotics,the most resistant and susceptible antibiotics identified in this study were ampicillin and imipenem,respectively.The phenotypic determination of ESBL by DDST showed that 60%(n=36)of isolates produced ESBL.Multiplex PCR of genes among K.pneuunoniae isolates showed that 39%(n=18)of them have TEM,39%in=18)of then have both CTX-M and TEM and 13%(n=8)of them have TEM,SHV,CTX-M.Conclusions:Our findings reveal the high prevalence(60%)of ESBL prcxducing K.pneumnniae from ICL patients along with a new pattern of bla_(TEM)distribution differ from other countries.

Prevalence and genotype distribution of Enterobius vermicularis among kindergarteners in Shiraz and Khorramabad cities, Iran

Objective: To study the prevalence and genotype of Enterobius(E.)vermicularis from adhesive tape samples in the cities of Shiraz and Khorramabad, Iran. Methods: A total of 1 000 adhesive tape samples from kindergartens in Shiraz(500 samples) and Khorramabad(500 samples) were collected and tested using a microscope to find E. vermicularis egg/s. A questionnaire was filled out for each sample. In order to characterize the genotype of E. vermicularis, the PCR-sequencing method of the mitochondrial cytochrome C oxidase subunit 1(cox1) gene was used. Genomic DNA was extracted from the positive scotch tape samples of E. vermicularis. The cox1 gene was amplified by the polymerase chain reaction and sequenced. The sequence data were aligned using the BioEdit software and compared with the published sequences in GenBank. Phylogenetic analysis was performed using the maximum likelihood method. Results: The parasitological method showed that 15 out of the 500 samples from Shiraz(3.00%) and 12 out of the 500 samples from Khorramabad(2.40%) were infected with E. vermicularis eggs. BLAST analysis indicated that the sequenced isolates belonged to E. vermicularis genotype B while three different haplotypes were also identified. Conclusions: This is the first study on genotyping E. vermicularis in the cities of Shiraz and Khorramabad. Considering the public health importance of the disease, further studies are necessary to characterize the genotype of E. vermicularis in human populations from other regions of Iran.

Common psychological disorders in elderly and their correlations with social support, Shiraz, Iran, 2018

Objective: To recognize and screen common mental disorders in elderlies and determine their relationship with social support in Shiraz, Iran. Methods: In this cross-sectional analytical study, 400 elderlies aged >60 years from Shiraz were selected through stratified random sampling. Data collection was done by 3 demographic data, Medical Outcome Study (MOS), social support, and standardization of mental disorders symptoms checklist 90 (SCL-90) questionnaires. The collected data were analyzed with SPSS 22, using descriptive statistics, Pearson correlation coefficient, and univariate and multivariate linear regression analyses. A P value <0.05 was regarded as statistically significant. Results: A total of 400 elderlies (mean age = 67.39 ± 6.89), among whom 204 individuals were female (51%), participated in the study. Somatization and phobic anxiety were the most (68.9%) and least (14.2%) prevalent disorders, respectively. The average total score of social support was 85.59 + 3.5. Social support and its 5 subscales showed statistically significant negative correlation with SCL-90 total scores and its 9 domains (P < 0.05). A 1-point increase in social support score results in reduction in the psychological disorders score by 0.35 point (P < 0.001). Conclusions: It seems necessary to plan and make policies by the authorities to increase social support and reduce the burden of common mental disorders in the elderly.

Evaluation of Human Papillomavirus Infection among Women Using Pap Smear and PCR in Shiraz, Iran

Human papillomaviruses （HPVs） infect mucosal and cutaneous epithelia and cause malignancy and neoplastic lesions. These viruses cause 25,000 deaths per year from cervical cancer most often in developing countries. This major public health problem makes them important targets in the researches of papillomavirus detection methods. Since the early diagnosis of this virus infection would prevent neoplasia and cervical cancer, therefore in this study the combination of molecular and cytological methods were used to show the occurrence of the infection in women referred to Baghiatollah clinic of Shiraz. The results showed out of 110 cases, two samples were positive by PCR using GP5/6 primers but Pap smears showed only one sample of abnormal cytology. The rest 108 samples were negative by PCR and had normal cytology. The samples （1.82%） in evaluated women. present study showed a low occurrence of HPV infection in cervical

Paleogeography and Sequence Stratigraphy in Dariyan Carbonate Reservoir, NE Shiraz

Zagros Basin is a very important hydrocarbon region in the Iran and World. One of the major reservoirs in this basin is the Lower Cretaceous Dariyan Formation. Based on petrographic studies, 9 microfacies were determined and interpreted as related to lagoon, barrier island and open marine environments. Facies associations show deposition in a carbonate ramp. Sequence stratigraphy studies show two sequences, each one with a transgressive system tract, marked by open marine microfacies, and then a retrogradational highstand, marked by barrier and lagoonal facies. Paleogeography and sequence stratigraphy studies of this formation and correlation of it with other sections may provide useful information about reservoir characterizations.

Frilled Lizard Optimization: A Novel Bio-Inspired Optimizer for Solving Engineering Applications

This research presents a novel nature-inspired metaheuristic algorithm called Frilled Lizard Optimization(FLO),which emulates the unique hunting behavior of frilled lizards in their natural habitat.FLO draws its inspiration from the sit-and-wait hunting strategy of these lizards.The algorithm’s core principles are meticulously detailed and mathematically structured into two distinct phases:(i)an exploration phase,which mimics the lizard’s sudden attack on its prey,and(ii)an exploitation phase,which simulates the lizard’s retreat to the treetops after feeding.To assess FLO’s efficacy in addressing optimization problems,its performance is rigorously tested on fifty-two standard benchmark functions.These functions include unimodal,high-dimensional multimodal,and fixed-dimensional multimodal functions,as well as the challenging CEC 2017 test suite.FLO’s performance is benchmarked against twelve established metaheuristic algorithms,providing a comprehensive comparative analysis.The simulation results demonstrate that FLO excels in both exploration and exploitation,effectively balancing these two critical aspects throughout the search process.This balanced approach enables FLO to outperform several competing algorithms in numerous test cases.Additionally,FLO is applied to twenty-two constrained optimization problems from the CEC 2011 test suite and four complex engineering design problems,further validating its robustness and versatility in solving real-world optimization challenges.Overall,the study highlights FLO’s superior performance and its potential as a powerful tool for tackling a wide range of optimization problems.

Nonlinear wave dispersion in monoatomic chains with lumped and distributed masses:discrete and continuum models

The main objective of this paper is to investigate the influence of inertia of nonlinear springs on the dispersion behavior of discrete monoatomic chains with lumped and distributed masses.The developed model can represent the wave propagation problem in a non-homogeneous material consisting of heavy inclusions embedded in a matrix.The inclusions are idealized by lumped masses,and the matrix between adjacent inclusions is modeled by a nonlinear spring with distributed masses.Additionally,the model is capable of depicting the wave propagation in bi-material bars,wherein the first material is represented by a rigid particle and the second one is represented by a nonlinear spring with distributed masses.The discrete model of the nonlinear monoatomic chain with lumped and distributed masses is first considered,and a closed-form expression of the dispersion relation is obtained by the second-order Lindstedt-Poincare method(LPM).Next,a continuum model for the nonlinear monoatomic chain is derived directly from its discrete lattice model by a suitable continualization technique.The subsequent use of the second-order method of multiple scales(MMS)facilitates the derivation of the corresponding nonlinear dispersion relation in a closed form.The novelties of the present study consist of(i)considering the inertia of nonlinear springs on the dispersion behavior of the discrete mass-spring chains;(ii)developing the second-order LPM for the wave propagation in the discrete chains;and(iii)deriving a continuum model for the nonlinear monoatomic chains with lumped and distributed masses.Finally,a parametric study is conducted to examine the effects of the design parameters and the distributed spring mass on the nonlinear dispersion relations and phase velocities obtained from both the discrete and continuum models.These parameters include the ratio of the spring mass to the lumped mass,the nonlinear stiffness coefficient of the spring,and the wave amplitude.

Hepatoprotective effect of Holothuria leucospilota methanolic extract on dimethyl nitrosamine-induced hepatotoxicity in rats

Background:Complementary medicine is an interesting field for extracting bio-active compounds from various plant and animal sources.The hepatoprotective effect of the methanolic extract of a species of sea cucumber called Holothuria leu-cospilota in an animal model of liver cancer caused by dimethyl nitrosamine(DMN)was studied.Methods:Wistar female rats were randomly divided into five groups(n=12):control(intact),positive control(received 1%DMN[10 mg/kg/week,intraperitoneally]for 12 weeks),and three treatment groups(received 50,100,and 200 mg/kg/day H.leu-cospilota extract orally for 12 weeks along with intraperitoneal administration of 1%DMN[10 mg/kg/week]).In all groups,ultrasound was performed on the liver every week to check its density.Blood sampling and liver isolation were performed on three occasions,at 4,8,and 12 weeks,to check liver enzymes and the histopathological condition of the liver tissue(every week,four animals from each group were randomly selected).Results:Liver density changes were evident from the eighth week onward in the positive control group.Histopathological results indicated pathologic changes in the positive control group after 4 weeks.The increase in liver enzymes in the posi-tive control group was significantly different from that in the treatment and control groups.Conclusions:We demonstrated the hepatoprotective effect of H.leucospilota on DMN-induced liver damage in rats using biochemical and histological parameters and ultrasonography.More additional research(in silico or in vitro)is needed to find the exact mechanism and the main biological compound in H.leucospilota.

Protective effect of co-enzyme Q10 on testicular tissue and sperm parameters in adult male rats treated with Sunset Yellow FCF

Objective:To determine the protective effect of co-enzyme Q10(CoQ10)on testicular tissue and sperm parameters in male rats treated with SunsetYellow FCF.Methods:Sixty male Sprague-Dawley rats were randomly divided into 6 groups of the control,CoQ10(10 mg/kg/day),low dose of Sunset Yellow(2.5 mg/kg),high dose of Sunset Yellow(70 mg/kg),low dose of Sunset Yellow(2.5 mg/kg)plus CoQ10,and high dose of Sunset Yellow(70 mg/kg)plus CoQ10.The drugs were administered via daily oral gavages for 6 weeks.At the end of the experiment,sperm analysis,stereological and histological assessments of the testis were carried out.Results:The normal morphology(by 41.1%)and progressive spermatozoa(by 74.8%),testicle volume(by 33.4%),lumen volume(by 38.3%),interstitial tissue volume(by 44.7%),seminiferous tubule volume(by 40.7%),and number of spermatogonia(by 53.9%)and Leydig cells(by 70.7%)reduced in the rats that received high doses of Sunset Yellow in comparison to the control group.Nonetheless,all these alterations were recovered by CoQ10 treatment in the CoQ10 plus high dose of Sunset Yellow group.Furthermore,low doses of Sunset Yellow did not affect different parameters of the testis and sperm.Conclusions:CoQ10 could,to some extent,prevent structural changes of the testis induced by the high dose of SunsetYellow.

Efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19:A randomized placebo-controlled trial

Objective: According to the high prevalence of COVID-19 and the subsequent risk of men's sexual health, we decided to investigate the efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19.Methods: In this study, 70 outpatients who were recovered from COVID-19 without acute respiratory distress syndrome with negative polymerase chain reaction test and a complaint of erectile dysfunction were divided into two groups: 35 patients who received tadalafil 5 mg daily and 35 who received placebo. For each patient, basic assessment of sexual function was performed using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Then, treatment was started from 2 months after complete recovery of COVID-19 with negative polymerase chain reaction test for 3 months. At the end of the treatments, the patients were re-evaluated for sexual function using the complete version of IIEF questionnaire. Finally, the results before and after treatment in the intervention group were compared with those of the control group.Results: Treatment with both tadalafil and placebo improved the patients' sexual function criteria compared to the baseline. However, this improvement was significantly higher in the intervention group with tadalafil than the control group with placebo (p<0.05).Conclusion: Daily administration of tadalafil 5 mg seems to be effective and safe for improvement of erectile dysfunction caused by COVID-19.