An unusual imaging presentation of pediatric bacterial meningoencephalitis: a case-report study

Background

Bacterial meningoencephalitis is a serious infection affecting the brain and its surrounding membranes. While imaging studies play a crucial role in diagnosing this condition, the typical radiological findings are well-documented. However, this case report describes an unusual imaging presentation that deviates from the expected patterns, emphasizing the need for awareness of such variations.

Case presentation

A 7-year-old female with no prior medical history was referred to our hospital with fever, seizure, and loss of Consciousness. She had mild flu a week before admission. The duration of seizure episodes were 2-3 min, with tonic-clonic uncontrollable jerky movements. Brudzinski and Kernig signs were positive and plantar reflex was upward bilaterally in the physical examination. The computed tomography (CT) scan showed brain ventriculomegaly/hydrocephalus, and MRI findings indicated multiple foci located at cerebellum, basal ganglia, and thalamus alongside intensely restricted diffusion of the layering debris, suggesting pyogenic ventriculitis. Cerebrospinal fluid (CSF) analysis showed severe hypoglycorrhachia, despite non-significant increase of protein. The patient was undergone antibiotic therapy with ceftriaxone, vancomycin and rifampin, resulting in normalization of CSF values.

Conclusion

This case report highlights the importance of recognizing and interpreting unusual imaging presentations of bacterial meningoencephalitis in paediatric patients. It emphasizes the need for a comprehensive diagnostic approach, including clinical evaluation, laboratory tests, and imaging studies, to ensure accurate diagnosis and appropriate management of this potentially life-threatening condition. Further research and awareness of atypical imaging findings are warranted to enhance our understanding and improve patient outcomes.

Moyamoya Disease in a Child With Fanconi Anemia: An Anomaly or a Complication

Fanconi anemia (FA) is an inherited bone marrow failure syndrome associated with congenital anomalies and a predisposition to cancer. We report the case of a 9-year-old boy with FA who developed an abrupt onset of hemiplegia and dysarthria. The diagnosis of moyamoya disease (MMD) was suggested by magnetic resonance angiography (MRA) which demonstrated severe stenosis in the right internal carotid artery along with collateral vessel formation in the right basal ganglia. It is questioned whether the moyamoya pattern in this case is part of congenital malformations associated with FA or is the result of recurrent bleedings around the carotid siphon.

Extraskeletal conventional chondrosarcoma of genitalia in a child- An unusual pathology for a rare tumor

INTRODUCTION AND IMPORTANCE

Chondrosarcoma is a rare malignant tumor considered as the second common sarcoma of bone following osteosarcoma. Less than 5 % of chondrosarcomas occur in children. Conventional chondrosarcoma is the most common type observed as skeletal tumors. Extraskeletal chondrosarcomas account for about 1 % of chondrosarcomas. They are almost always of myxoid or mesenchymal subtypes.

CASE PRESENTATION

A 4-year-old girl was referred with pain and palpable mass in the labia majora since 2 years of age for which she had undergone twice biopsies, reported as soft tissue enchondroma. At this time, complete excision of the lesion with negative margins was carried out. The pathology was in favor of extraskeletal chondrosarcoma of conventional type without any evidence of bone involvement.

CLINICAL DISCUSSION

Our case was a very young child with extraskeletal conventional chondrosarcoma, not reported yet in the literature. The vast majority of extraskeletal myxoid chondrosarcomas arise in the soft tissues of the extremities. The lesion in this case was located within the subcutaneous tissue of the labia majora; however, the tumor was not compatible with myxoid chondrosarcoma. Mesenchymal chondrosarcoma is another type of extraskeletal chondrosarcoma but the histopathologic patterns observed in our patient were not compatible even with the mesenchymal chondrosarcoma.

CONCLUSION

We present a unique case of extraskeletal chondrosarcoma in a child with conventional subtype which has not been reported in the literature. In addition, the lesion was assumed to arise from a previous soft tissue enchondroma of the labia majora since infancy which makes the case distinctive.

Local injection of infliximab into calcinosis lesions in patients with juvenile dermatomyositis (JDM): a clinical trial

BACKGROUND

Juvenile Dermatomyositis (JDM) is a rare autoimmune disorder that primarily affects muscles and skin. One of the severe complications associated with JDM is calcinosis, and treating this condition presents significant challenges. This study aimed to evaluate the efficacy and safety of local injection of infliximab into calcinosis lesions in patients with JDM.

METHODS

In this clinical trial, five patients diagnosed with JDM and calcinosis lesions were enrolled. The primary treatment consisted of weekly infliximab injections for 16 weeks, targeting all four sides of each lesion. Lesion dimensions, including length and width, were documented and monitored weekly. Before the intervention, patients underwent radiographic imaging. After the final injection in week 16, a follow-up radiographic assessment was performed. Data were analyzed using the Generalized Estimating Equation (GEE) method.

RESULTS

The lesions' size significantly decreased in both length and width during each visit. On average, the lesion length reduced by 2.66%, and the width shrank by 3.32% per visit. Based on radiographic findings, the average length and width of lesions at the initial visit were 12.09 ± 5.05 mm (range: 6.00-25.50 mm) and 6.35 ± 3.00 mm (range: 2.00-16.00 mm), respectively. The average length and width at the last visit were 5.59 ± 7.05 mm (range: 0-23.00 mm) and 3.41 ± 4.05 mm (range: 0-13.00 mm), respectively. No specific side effects related to the treatment were reported.

CONCLUSIONS

The results suggest that the direct administration of infliximab into the calcinosis lesions of patients with JDM could be a safe and effective treatment approach.

TRIAL REGISTRATION

Name of the registry: The effect of infliximab injection into calcinosis lesions on patients with juvenile dermatomyositis (JDM), Trial registration number: IRCT20210808052107N1, Registration date: 2022-07-22, URL of trial registry record: https://en.irct.ir/trial/58329 .

The Radiological Manifestations of Phagocytic Primary Immunodeficiencies in Children

Primary immunodeficiencies are a diverse group of rare genetic disorders, among which phagocytic dysfunction impairs neutrophil function in a wide range of inherited disorders. Due to the heterogeneity of the disorders a multidisciplinary approach is often required for early diagnosis and initiation of appropriate treatments. The aim of this study was to evaluate the imaging findings in children admitted with phagocytic primary immunodeficiencies. Thirty-five children who fulfilled the inclusion criteria for phagocytic dysfunction were enrolled in this study. The patients were under close observation and monitoring from January 2011 until data locking in December 2017. The diagnosis of phagocytic immunodeficiency was confirmed by the patient's clinical course, presentation features, and laboratory data.  Among the 35 patients studied, the most frequent condition was chronic granulomatous disease (CGD) (23 patients), followed by different types of neutropenia (8 patients) and Job's syndrome (4 patients). Mediastinal and hilar lymphadenopathies and consolidation were the most frequent presentations. There was a significant relationship between mediastinal/hilar lymphadenopathies and fungal infections. A meaningful relationship was also found between pulmonary nodules without halo signs in patients with concomitant tuberculosis and fungal infections. A significant correlation was found between CGD, pulmonary fibrotic changes, and mediastinal lymphadenopathies. The most frequent radiological manifestations in children included mediastinal and hilar consolidations. Physicians' awareness of the radiological and clinical manifestations of these inherited diseases may be helpful in the early diagnosis and timely initiation of specific prophylaxis measures to prevent infections and also to initiate hematopoietic stem cell transplantation as the curative management modality.

Arterial tortuosity syndrome presented as nonvisualization of thoracic aorta in preoperative transthoracic echocardiogram: A case report

Arterial tortuosity syndrome is a rare genetic disorder characterized by dilation, elongation, and significant tortuosity of major arteries. Approximately 100 cases of this disorder have been reported worldwide, including 3 reports in Iran. We describe a case of arterial tortuosity syndrome suspected during the preoperative evaluation for hypertrophic pyloric stenosis, where the thoracic aorta was not visualized appropriately in transthoracic echocardiography. Our report focuses on identifying the disease through diagnostic imaging.

Relapse of nephrotic syndrome with unusual thromboembolic event: A case report

Key Clinical Message

Most children with nephrotic syndrome heal without any sequelae. However, rare life-threatening complications such as thromboembolism may occur in pediatric nephrotic syndrome and should be considered in those with a new-onset neurologic deficit.

Abstract

The thromboembolism (TE) as a complication of nephrotic syndrome (NS) is rare and serious, and may involve renal, cerebral, pulmonary, or peripheral venous and/or arterial thrombosis. Here, we describe a 4.5-year-old male with a history of nephrotic syndrome, who developed hemorrhagic stroke in the territory of middle cerebral artery (MCA).

Acute Kidney Injury in Pediatric Patients with COVID-19; Clinical Features and Outcome

INTRODUCTION

Renal disorders have been reported as the underlying cause as well as complications of critical COVID-19 in pediatric patients. The purpose of this study was to investigate the pattern of kidney involvement, particularly acute kidney injury (AKI), among pediatric patients with COVID-19.

METHODS

In this prospective study, hospitalized pediatric patients with a clinical diagnosis of COVID-19 were enrolled. Demographic, clinical, and laboratory findings were collected and analyzed using a mixed method of qualitative and quantitative approaches and descriptive statistics.

RESULTS

One hundred and eighty-seven patients, including 120 (64.2%) males and 67 (35.8%) females with COVID-19 with a median age (interquartile range) of 60 (24 to 114) months were enrolled in this study. Most patients (n = 108, 58.1%) had one or two underlying comorbidities, mainly malnutrition (77.4%), neurologic/learning disorders (21.4%), and malignancy (10.2%). According to the Kidney Disease Improving Global Outcomes (KDIGO) classification, AKI was detected in 38.5% of patients (stage 1: 55.6%, stage 2: 36.1%, and stage 3: 8.3%) at presentation or during hospitalization. Nine patients (4.8%) required hemodialysis and 16 (8.6%) eventually died. There was no significant association between AKI and admission to the pediatric intensive care unit (PICU) (P > .05), a multisystem inflammatory syndrome in children (MIS-C) (P > .05), comorbidities (P > .05), and mortality rate (P > .05).

CONCLUSION

Kidneys are among the major organs affected by COVID-19. Although kidney abnormalities resolve in the majority of pediatric COVID-19 infections, particular attention should be paid to serum creatinine and electrolyte levels in patients affected by COVID-19, particularly children with a history of malnutrition and kidney disorders.  DOI: 10.52547/ijkd.7151.

Congenital Skin Rashes in an IVF Baby Progressed to Multisystem Langerhans Cell Histiocytosis with Lung and Bone Involvement: A Case Report and Literature Review

Langerhans cell histiocytosis is an uncommon proliferative disorder that may influence many organs; so, the clinical presentations vary. Here we describe an 85-day-old female who was born with In vitro fertilization after 10 years of infertility. She referred to us due to severe pulmonary insufficiency and congenital progressive maculopapular rash with desquamation. There were significant cystic changes in chest imaging studies. Further evaluation demonstrated lytic lesions in cranial, femoral, and humorous bones. The skin biopsy verified the diagnosis of LCH. A combination of Vinblastine, VP16, and Dexamethasone regimen was applied for the patient. In the course of the disease, she encountered multiple bilateral pneumothoraxes but didn't respond to tube thoracostomy and chemotherapy management. The patient died due to respiratory failure raised from complications of lung involvement as a multisystem LCH, 29 days later. Pediatricians should pay much more attention to the cutaneous lesions in the neonatal period especially if there is any risk factor for presenting LCH such as IVF. The lesions should be monitored closely owing to a high correlation between skin lesions and MS LCH.

Effects of omega-3 supplementation on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus: A randomized clinical trial

Background

Vascular dysfunction is a major complication of diabetes mellitus that leads to cardiovascular disease (CVD). This study aimed to examine the effects of omega-3 consumption on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes mellitus (T1DM).

Methods

In this randomized, double-blind, placebo-controlled clinical trial, 51 adolescents (10–18 years) with T1DM completed the study. Patients received 600 mg/day [containing 180 mg eicosapentaenoic acid (EPA) and 120 mg docosahexaenoic acid (DHA)] of omega-3 or placebo for 12 weeks. Flow-mediated dilation (FMD), carotid intima-media thickness (CIMT), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, blood urea nitrogen (BUN), creatinine, fasting blood sugar (FBS), hemoglobin A1C (HbA1c), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), serum insulin (SI), urine albumin-creatinine ratio (uACR), blood pressure, and anthropometric indices were assessed at the baseline and after the intervention.

Results

Following supplementation, omega-3 significantly increased FMD (3.1 ± 4.2 vs. −0.6 ± 4%, p = 0.006) and decreased TG (−7.4 ± 10.7 vs. −0.1 ± 13.1 mg/dl, p = 0.022) in comparison with the placebo group. However, no significant difference was observed regarding CIMT (-0.005 ± 0.036 vs. 0.003 ± 0.021 mm, p = 0.33). Although hs-CRP was significantly decreased within the omega-3 group (p = 0.031); however, no significant change was observed compared to placebo group (p = 0.221). Omega-3 supplementation had no significant effect on other variables.

Conclusion

Given the elevation in FMD and reduction in TG, omega-3 supplementation can improve vascular function and may reduce the risk of cardiovascular disease in adolescents with T1DM patients.

Incidence and prediction of HBsAg seroclearance in a prospective multi-ethnic HBeAg-negative chronic hepatitis B cohort

BACKGROUND AND AIMS

Achieving HBsAg loss is an important landmark in the natural history of chronic hepatitis B (CHB). A more personalized approach to prediction of HBsAg loss is relevant in counseling patients. This study sought to develop and validate a prediction model for HBsAg loss based on quantitative HBsAg levels (qHBsAg) and other baseline characteristics.

METHODS

The Hepatitis B Research Network (HBRN) is a prospective cohort including 1240 untreated HBeAg-negative patients (1150 adults, 90 children) with median follow-up of 5.5 years. Incidence rates of HBsAg loss and hepatitis B surface antibody (anti-HBs) acquisition were determined, and a predictor score of HBsAg loss using readily available variables was developed and externally validated.

RESULTS

Crude incidence rates of HBsAg loss and anti-HBs acquisition were 1.6 and 1.1 per 100 person-years (PY); 67 achieved sustained HBsAg loss for an incidence rate of 1.2 per 100 PY. Increased HBsAg loss was significantly associated with older age, non-Asian race, HBV phenotype (inactive CHB vs. others), HBV genotype A, lower HBV-DNA levels, and lower and greater change in qHBsAg. The HBRN-SQuARe (sex,∆quantHBsAg, age, race) score predicted HBsAg loss over time with area under the receiver operating characteristic curve (AUROC) (95% CIs) at 1 and 3 years of 0.99 (95% CI: 0.987-1.00) and 0.95 (95% CI 0.91-1.00), respectively. In validation in another cohort of 1253 HBeAg-negative patients with median follow-up of 3.1 years, HBRN SQuARe predicted HBsAg loss at 1 and 3 years with AUROC values of 0.99 (0.98-1.00) and 0.88 (0.77-0.99), respectively.

CONCLUSION

HBsAg loss in predominantly untreated patients with HBeAg-negative CHB can be accurately predicted over a 3-year horizon using a simple validated score (HBRN SQuARe). This prognostication tool can be used to support patient care and counseling.

A multicenter retrospective study of clinical features, laboratory characteristics, and outcomes of 166 hospitalized children with coronavirus disease 2019 (COVID-19): A preliminary report from Iranian Network for Research in Viral Diseases (INRVD)

BACKGROUND

The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

METHODS

One hundred and sixty-six coronavirus disease 2019 (COVID-19) Iranian pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files.

RESULTS

Of 166 patients, 102 (61%) and 64 (39%) were males and females, respectively. Ninety-six (57.8%) and 70 (42.2%), had moderate and severe conditions, respectively. Thirty (18%) of patients died. The common symptoms were fever (73%), cough (54%), and shortness of breath, headache decrease in neutrophil and platelet counts; increase values in lactate dehydrogenase, decrease in the blood pH and HCO₃ were significantly associated with the disease severity. 54% and 56% of patients showed abnormal radiographic appearance in Chest X-ray and in chest computed tomography scan, respectively. Sixty-one (36.7%) of patients were referred to intensive care unit (ICU). The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome, acute cardiac injury, and death.

CONCLUSIONS

We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as the relatively high case fatality rate in the country and the presence of underlying diseases were the main factors for the high death rate.

Detection of Ehrlichia spp. in ticks collected from stray dogs in Central and Southeastern Iran

Ehrlichia is an etiologic agent of ehrlichiosis in humans and some animals. Rhipicephalus sanguineus is the main vector of the Ehrlichia canis and dogs, red foxes and yellow jackals are reservoirs of the bacterium. This tick has a worldwide distribution and is regarded as one of the commonest species of ticks in Iran. This research aimed to detect Ehrlichia spp. in R. sanguineus isolated from stray dogs in Central and Southeast Iran (Isfahan and Zabol), by using polymerase chain reaction (PCR) and to evaluate the prevalence of the microorganism in these two areas. Tick samples were collected from stray dogs in Isfahan and Zabol between April and June of 2018. The DNA extraction was performed with commercial kits. PCR was done to determine the 336 bp fragment related to Ehrlichia spp. Overall, 15.21% of pools in both areas were positive for Ehrlichia, 21.42% and 10% of pools were from Isfahan and Zabol respectively. The results confirmed the presence of Ehrlichia spp. in R. sanguineus in stray dogs revealing that dogs and their ticks may have a significant role in the epidemiology of the disease.

Study protocol of a randomized controlled clinical trial investigating the effects of omega-3 supplementation on endothelial function, vascular structure, and metabolic parameters in adolescents with type 1 diabetes

Background

Type 1 diabetes is a main health burden with several related comorbidities. It has been shown that endothelial function, vascular structure, and metabolic parameters are considerably disrupted in patients with type 1 diabetes. Omega-3 as an adjuvant therapy may exert profitable effects on type 1 diabetes and its complications by improving inflammation, oxidative stress, immune responses, and metabolic status. Because no randomized clinical trial has examined the effects of omega-3 consumption in children and adolescents with type 1 diabetes; the present study aims to close this gap.

Methods

This investigation is a randomized clinical trial, in which sixty adolescents with type 1 diabetes will be randomly assigned to receive either omega-3 (600 mg/day) or placebo capsules for 12 weeks. Evaluation of anthropometric parameters, flow-mediated dilation (FMD) as an endothelial function marker, carotid intima-media thickness (CIMT) as a vascular structure marker, proteinuria, biochemical factors including glycemic and lipid profile, blood urea nitrogen (BUN), creatinine, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR), as well as blood pressure will be done at the baseline and end of the trial. Also, dietary intake and physical activity will be assessed throughout the study. Statistical analysis will be performed using the SPSS software (Version 24), and P < 0.05 will be considered statistically meaningful.

Discussion

It is hypothesized that omega-3 supplementation may be beneficial for the management of type 1 diabetes and its complications by reducing inflammation and oxidative stress and also modulating immune responses and glucose and lipid metabolism through various mechanisms. The present study aims to investigate any effect of omega-3 on patients with type 1 diabetes.

Ethical aspects

This trial received approval from Medical Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.070).

Trial registration

Iranian Registry of Clinical Trials IRCT20210419051010N1. Registered on 29 April 2021

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05930-1.

Pulmonary Radiological Manifestations of Humoral and Combined Immunodeficiencies in a Tertiary Pediatric Center

Respiratory diseases are considered as significant causes of morbidity and mortality in primary immunodeficiencies. This study aimed to reveal the radiologic patterns of thoracic involvement in these disorders. A total of 58 patients, including 38 cases with combined cellular-humoral and 20 cases with humoral immunodeficiencies, were enrolled in this study. The "combined" group consisted of 12 cases with severe combined immunodeficiency (SCID) and 26 cases with combined immunodeficiency. The "humoral" group included seven patients with Hyper IgM syndrome (HIGMs), seven cases with common variable immunodeficiency (CVID), three patients with X-linked agammaglobulinemia, and three patients with other types of humoral primary immunodeficiencies (PIDs). The mean age of patients at the time of evaluation was 3.3±3.8 and 5.3±3.9 years in combined and humoral groups, respectively. The findings of chest X-rays and CT scans were interpreted and compared. There was a significant difference for alveolar opacification between combined and humoral immunodeficiencies (58% vs. 30%). The bronchopneumonia-like pattern was detected as a significant finding in patients with SCID (42%) and HIGMs (43%). Atrophy of the thymus was detected significantly often in cases of SCID (67%). Two patients with CVID and lipopolysaccharide-responsive and beige-like anchor protein deficiency showed parenchymal changes of granulomatous lymphocytic interstitial lung disease. No significant difference was detected for bronchiectasis, bronchitis/bronchiolitis patterns, pleural effusion, and thoracic lymphadenopathy. Distinct subtypes of primary immunodeficiency may provoke differing and comparable radiological patterns of thoracic involvement; which can clue the clinician and radiologist to the diagnosis of the disease.

A Comparison Between Conventional and Terrain-Specific Adaptive Pushrim-Activated Power-Assisted Wheelchairs

Pushrim-activated power-assisted wheels (PAPAWs) are assistive technologies that provide on-demand propulsion assistance to wheelchair users. In this study, we aimed to develop an adaptive PAPAW controller that responds effectively to changes in environmental conditions (e.g., type of surface or terrain). Experiments were conducted to collect kinematics of wheelchair motion using a frame-mounted inertial measurement unit (IMU) while performing a variety of wheelchair activities on different indoor/outdoor terrains. Statistical characteristics of velocity and acceleration measurements were extracted and used to develop a terrain classification framework to identify certain indoor and outdoor terrains. The terrain classification framework, based on random forest classification algorithms and kinematic features, was implemented and tested in our laboratory-developed PAPAW. This computationally efficient terrain classification framework was successfully implemented and tested in real-time. The power-assist ratio of each wheel was adjusted based on the type of terrain (e.g., more assistance was provided on outdoor terrains). Our findings revealed that propulsion effort (e.g., peak input torque) on asphalt was significantly reduced when using adaptive controllers compared to conventional PAPAW controllers. In addition, subjective views of participants regarding the workload of wheelchair propulsion (e.g., physical/cognitive effort) supported the positive effects of adaptive PAPAW controllers. We believe that the adoption of terrain-specific adaptive controllers has the potential to improve the accessibility of outdoor terrains and to prevent or delay upper extremity joint degeneration or pain.

A case of diffuse leptomeningeal glioneuronal tumor in a 10-year-old boy: First report from Iran

A 10-year-old boy who was referred due to acute hydrocephalus symptoms was diagnosed as the first case of pediatric DLGNT in Iran. The results suggested that using shunting for hydrocephaly and anti-seizure medicines, as well as chemotherapeutic agents, can be an effective treatment strategy for DLGNT. Although the patient was stable without a tumor recurrence for a limited follow-up period of 22 months, further studies are expected.

A Comparison Between Conventional and User-Intention-Based Adaptive Pushrim-Activated Power-Assisted Wheelchairs

Pushrim-activated power-assisted wheel (PAPAW) users ideally require different levels of assistance depending on activity and preference. Therefore, it is important to design and develop adaptive PAPAW controllers to account for these differences. The main objective of this work was to integrate a user intention estimation framework into a PAPAW and develop personalized adaptive controllers. We performed experiments to gather kinetics of wheelchair propulsion for a variety of daily life wheelchair activities. The propulsion characteristics (i.e., pushrim forces) were used to train intention estimation models and characterize implicit user intentions when performing daily life wheelchair maneuvers. These intentions included moving straight forward, performing a right/left turn, and braking. The intention estimation framework, based on random forest classification algorithms and kinetic features, was implemented and tested in our laboratory-developed PAPAW. This computationally efficient framework was successfully implemented and tested for each participant in real-time. Our results revealed that the real-time user intention predictions were similar to the offline models. The power-assist ratio of each wheel was adjusted based on which user intention was identified. Data collected from four participants provided evidence regarding the effectiveness of using adaptive intention-based controllers. For instance, the propulsion effort was significantly reduced when using an adaptive PAPAW controller. Subjective views of participants regarding the workload of wheelchair propulsion (e.g., physical/cognitive effort) were also gathered. Our findings suggest that rankings of different controllers varied among different participants and across different wheelchair maneuvers, indicating the need for customized adaptive controllers to fit different users' activities and preferences.

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions.

The effect of spiritual care on quality of life of patients with amputation caused by diabetes type 2: a clinical trial

OBJECTIVES

This study aimed to investigate effect of a spiritual care on quality of life of patients with amputation caused by diabetes type 2.

METHODS

The current study was a clinical trial. Fifty four patients with amputation caused by diabetes type 2 referred to Al-Zahra hospital at Isfahan was allocated to two case and control groups. Spiritual care training including transcendental meditation (T.M) technique was established for case group. Participants in case group performed four weeks of meditation technique following participating in sessions of meditation technique training. Data gathering was done using a standard tool to assess quality of life in patients with diabetes (diabetes quality of life: DQOL). Data was analyzed using SPSS software.

RESULTS

Mean score of quality of life in the four areas of quality of life was not significantly different among case and control groups at baseline, however, mean score of quality of life in case group (2.25 ± 0.56) was significantly better than control group (2.52 ± 0.38) after intervention (p<0.001).

CONCLUSIONS

Given findings of the study, it seems that spiritual care can improve quality of life of patients with amputation caused by diabetes type 2.

Protein losing enteropathy and pneumatosis intestinalis in a child with COVID 19 infection

BACKGROUND

Severe acute respiratory syndrome corona virus 2 (SARS- CoV-2) is known as COVID 19 seems to be one of the most contagious and dangerous infection in children and adults. According to first adult studies association of gastrointestinal (GI) symptoms with COVID 19 infection was as high as 79% (1).But later study showed lower association around 18% (2).As the pandemic of COVID 19 is going on, different clinical presentation of disease especially in children are well appeared. In addition atypical presentations may confuse and mislead physician to do different diagnostic procedures and interventions. We report a 6 years and half old boy with diarrhea, abdominal pain with first diagnosis acute abdomen due to acute appendicitis. At last diagnosis of pneumatosis intestinalis due to enterocolitis was confirmed.

CASE PRESENTATION

A 6 years and half old boy with severe abdominal pain admitted in emergency ward. He had history of fever, nine days of diarrhea and recurrent vomiting. The abdominal pain was severe with moderate tenderness in right lower quadrant. He admitted in pediatric surgery ward after surgical consultation for rolling out acute appendicitis. The results of first lab studies were shown leucopenia, lymphopenia and COVID 19 PCR was positive. During admission the cough has increased and abdominal distention has evolved. Vomiting was intractable and feeding was impossible. Pneumatosis intestinalis in ascending colon and dilatation in colon caliber were detected abdominal. Miliary like pattern in lung has reported in chest CT. Stool exam results revealed loss of protein in high amount in spite of normal pancreatic and enterocyte function. The calprotectin was high and implied high inflammation in large intestine. With all above data necrotizing enterocolitis management was started. After 14 days patients had good appetite and feeding slowly introduced. All symptoms resolved with exception of cough. Albumin and other electrolytes remained stable. The patient discharged without morbidity.

CONCLUSION

COVID 19 infection has many different and mysterious presentations. GI manifestations are among important, common presentations. The acute abdomen like presentation with different complications like pneumatosis intestinalis, protein losing enteropathy are not common but knowledge about these presentations assist physician to be aware and make decision accurately.

Does the BCG vaccine have different effects on strains of tuberculosis?

Several explanations have been suggested concerning the variety in bacille Calmette-Guerin (BCG) vaccine efficacy on strains of Mycobacterium tuberculosis (Mtb). This study aimed to compare the effect of BCG vaccination history in the prevention of the occurrence of Mtb-Beijing and non-Beijing strains. In this cross-sectional study, 64 patients with pulmonary tuberculosis (TB) were recruited from the Iranian border provinces (North West and West). Isolates were subjected to restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 as a probe (IS6110 RFLP) and drug susceptibility testing using the proportion method. Samples were analyzed with Gel Compare II 6.6 and spss version 18. The mean age [standard deviation (SD)] of the patients was 54·4 (SD = 17·0). Overall, 49 cases (76·56%) had no BCG vaccination scar. The prevalence of Beijing strains was 9·38% and drug resistance proportion among the isolates was 14·1% (nine cases). There was a significant relationship between Beijing strains and tuberculosis (TB)-drug resistance in isolates (χ²  = 26·29, P < 0·001). There was also a strong association between vaccination history and Beijing strains (χ²  = 13·23, P = 0·002). Also, a statistical relationship was observed between Beijing strains and drug-resistant TB among patients with a history of vaccination (χ²  = 7·47, P = 0·002). This association was not maintained in the unvaccinated group (P = 0·102). These findings confirm the claim that the vaccine has different effects on different subspecies of tuberculosis. The cause of the high probability of drug resistance in patients with Beijing-TB and vaccination history requires further investigation with a higher sample size.

Protein losing enteropathy and pneumatosis intestinalis in a child with COVID 19 infection

Background

Severe acute respiratory syndrome corona virus 2 (SARS- CoV-2) is known as COVID 19 seems to be one of the most contagious and dangerous infection in children and adults. According to first adult studies association of gastrointestinal (GI) symptoms with COVID 19 infection was as high as 79% (1).But later study showed lower association around 18% (2).As the pandemic of COVID 19 is going on, different clinical presentation of disease especially in children are well appeared. In addition atypical presentations may confuse and mislead physician to do different diagnostic procedures and interventions. We report a 6 years and half old boy with diarrhea, abdominal pain with first diagnosis acute abdomen due to acute appendicitis. At last diagnosis of pneumatosis intestinalis due to enterocolitis was confirmed.

Case presentation

A 6 years and half old boy with severe abdominal pain admitted in emergency ward. He had history of fever, nine days of diarrhea and recurrent vomiting. The abdominal pain was severe with moderate tenderness in right lower quadrant. He admitted in pediatric surgery ward after surgical consultation for rolling out acute appendicitis. The results of first lab studies were shown leucopenia, lymphopenia and COVID 19 PCR was positive. During admission the cough has increased and abdominal distention has evolved. Vomiting was intractable and feeding was impossible. Pneumatosis intestinalis in ascending colon and dilatation in colon caliber were detected abdominal. Miliary like pattern in lung has reported in chest CT. Stool exam results revealed loss of protein in high amount in spite of normal pancreatic and enterocyte function. The calprotectin was high and implied high inflammation in large intestine. With all above data necrotizing enterocolitis management was started. After 14 days patients had good appetite and feeding slowly introduced. All symptoms resolved with exception of cough. Albumin and other electrolytes remained stable. The patient discharged without morbidity.

Conclusion

COVID 19 infection has many different and mysterious presentations. GI manifestations are among important, common presentations. The acute abdomen like presentation with different complications like pneumatosis intestinalis, protein losing enteropathy are not common but knowledge about these presentations assist physician to be aware and make decision accurately.

Molecular detection of Coxiella burnetii in horse sera in Iran

Coxiella burnetii is a zoonotic bacterium that can infect a wide range of animals including horses. However, its circulation dynamics in and through horses are still unclear. The aim of this study was to evaluate prevalence of C. burnetii and its genomic characteristics in horse sera samples in the North of Iran (Golestan Province). The samples were collected in 2018 and the age, sex, and breed of each animal were recorded. Nested-PCR was used to detect C. burnetii based on the presence of the transposable gene IS1111. The results showed that 7.50 % (P < 0.05; 95 % CI: 0.5 %-0.12 %) of the examined sera samples were positive for C. burnetii. Based on the resuls, prevalence of C. burnetii in the age groupof < Years 1-5 (p-value <0.05, 95 % CI: 1 %-8 %) was less than the age group of >6 years old (p-value <0.05, 95 %, CI: 7 %-19.8 %). In previous studies, it was concluded that the horses' population in Golestan Province should be considered as an important factor in the epidemiology of Q fever and consequently in public health. Further studies should be implemented to evaluate if horses may be relevant indicators of zoonotic risk in urban and suburban endemic areas.

Prevalence of C. burnetii DNA in sheep and goats milk in the northwest of Iran

Q fever is a common zoonotic disease with worldwide distribution. The causative agent of Q fever is Coxiella burnetii, a gram-negative and polymorphic rod bacterium. Sheep and goats are the primary reservoirs of this disease, although a variety of animal species can be infected. The main route of Q fever transmission from animals to humans is the inhalation of contaminated aerosols with C. burnetii. The bacterium is excreted in milk of infected animals and therefore; the consumption of unpasteurized milk and dairy products might be a route of coxiella burnetii transmission from animals to humans. The present study was conducted to determine the prevalence of C. burnetii in milk samples collected from sheep and goats in west Azerbaijan province, Iran. During 2018, a total number of 420 milk samples were collected from sheep (n = 210) and goats (n = 210) of different regions of the province. All milk samples were subjected to DNA extraction and examined by a highly and specific nested-PCR method. The results showed that 51 (12.1%) (95% CI: 9.3%-15.6%) examined samples [sheep; n = 16 (7.6%) and goat; n = 35 (16.6%)] were positive for C. burnetii. The prevalence of C. burnetii in goat milk samples was significantly higher than sheep milk samples (P < 0.05). The shedding of C. burnetii in milk was significantly higher in summer (25%) (P < 0.05, 95% CI: 17.7%-34%) than the other seasons. It was concluded that sheep and goat populations in west Azerbaijan play an important role in the epidemiology of Q fever.

Abdominoscrotal hydrocele: A case report

Abdomino scrotal hydrocele (ASH) is a very rare condition in which the hydrocele sac extends beyond the scrotum to the abdomen via the inguinal canal. Although various ideas have been proposed regarding this disease, there is still controversy over its etiology. We report a case of abdominoscrotal hydrocele in a one year old boy (Mofid Children's hospital, Tehran, Iran) with history of right sided herniorrhaphy one month ago in other center. Slow growing mass in lower abdomen was noted by parents. For better diagnose, ultrasound and CT scan was performed. In operation missed large abdominalscrotal hydrocele was confirmed.

Comparing IS6110-RFLP, PGRS-RFLP and IS6110-Mtb1/Mtb2 PCR methods for genotyping of Mycobacterium tuberculosis isolates

AIMS

Tuberculosis (TB) is still an important disease in the world, especially in developing countries. Applying efficient and suitable methods for genotyping Mycobacterium tuberculosis (MTB) isolates is a crucial step for identifying the MTB transmission mode and controlling its subsequent outcomes. Considering the complexity of IS6110-RFLP and PGRS-RFLP methods for MTB classification, suggesting other simple but reliable techniques could be helpful in the MTB studies, especially in low-income countries.

METHODS AND RESULTS

This study aimed to evaluate the capabilities of three methods for genotyping MTB isolates collected from Iran through comparing our previously published results for IS6110-RFLP and PGRS-RFLP methods and current results obtained from IS6110-Mtb1/Mtb2 PCR technique. A strong concordance was observed between the results of clustering by three techniques. Calculated Kendall's Tau concordance value for correlation of IS6110-RFLP and IS6110-Mtb1/Mtb2 PCR, for IS6110-RFLP and PGRS-RFLP, and for IS6110-Mtb1/Mtb2 PCR and PGRS-RFLP techniques was equal to 0·943, 0·898 and 0·85 respectively.

CONCLUSIONS

A strong correlation between IS6110-Mtb1/Mtb2 PCR, and IS6110-RFLP and PGRS-RFLP methods was observed and therefore IS6110-Mtb1/Mtb2 PCR discriminates MTBs capably.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study showed that IS6110-Mtb1/Mtb2 PCR, which is a simple and economical MTB genotyping approach, could be a more appropriate method to be applied in the low-budget research programmes.

Loss of Kat2a enhances transcriptional noise and depletes acute myeloid leukemia stem-like cells

Acute Myeloid Leukemia (AML) is an aggressive hematological malignancy with abnormal progenitor self-renewal and defective white blood cell differentiation. Its pathogenesis comprises subversion of transcriptional regulation, through mutation and by hijacking normal chromatin regulation. Kat2a is a histone acetyltransferase central to promoter activity, that we recently associated with stability of pluripotency networks, and identified as a genetic vulnerability in AML. Through combined chromatin profiling and single-cell transcriptomics of a conditional knockout mouse, we demonstrate that Kat2a contributes to leukemia propagation through preservation of leukemia stem-like cells. Kat2a loss impacts transcription factor binding and reduces transcriptional burst frequency in a subset of gene promoters, generating enhanced variability of transcript levels. Destabilization of target programs shifts leukemia cell fate out of self-renewal into differentiation. We propose that control of transcriptional variability is central to leukemia stem-like cell propagation, and establish a paradigm exploitable in different tumors and distinct stages of cancer evolution.

Expression Level of Circulating Cell Free miR-155 Gene in Serum of Patients with Diabetic Nephropathy

BACKGROUND

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Several factors are known to contribute to the development and progression of diabetic nephropathy. Different microRNAs have been shown to contribute in the pathogenesis of DN. This study, aimed to evaluate the expression level of circulating miR-155 in patients with diabetic nephropathy.

METHODS

In this case-control study, 83 diabetic patients and normal subjects were evaluated in four groups of normal healthy subjects without diabetes and nephropathy, diabetes without nephropathy, diabetes with microalbuminuria, and diabetes with macroalbuminuria. After RNA extraction from serum and cDNA synthesis, the expression of circulating miR-155 was evaluated by quantitative polymerase chain reaction (qPCR).

RESULTS

Expression level of cell-free miR-155 was significantly lower in diabetics compared to the normal healthy controls (p < 0.05). However, no significant difference was found in miR-155 expression level between different diabetes groups with different conditions of kidney function. Furthermore, we detected a significant negative correlation between cell-free miR-155 expression and GFR only in patients with microalbuminuria (r = -0.70, p = 0.001).

CONCLUSIONS

It seems that miR-155 can discriminate diabetic and nondiabetic status, but is not an appropriate biomarker for tracking of macroalbuminuria.

Characterization of Glycoproteins of Native 19kDa C-Terminal Merozoite Surface Protein-1 from Native Antigen of Plasmodium falciparum

Background: Plasmodium falciparum is the protozoan parasite which causes malignant malaria of medical concern. Prime candidates for recombinant vaccine development are asexual stage antigens of P. falciparum, for example, merozoite surface proteins (MSP1 and MSP2) not given satisfactory results to date. In this study, the 19kDa C-terminal of MSP1, a vaccine candidate was purified in its native form in the ring stage, and its glycoproteins studied. Methods: The study was carried out at the Biochemistry Department of Pasteur Institute of Iran in the years 2015–2016. Large scale culture of P. falciparum was performed in vitro with 80% ring stage parasitemia. Isopycnic ultracentrifuga­tion with 36% sucrose and analytical SDS-PAGE on the supernatant and precipitate performed, and the 19kDa antigen was obtained by cutting it from strips of preparative SDS gels. Purified protein was concentrated and analyzed by SDS-PAGE and immunoblotting, using antibodies raised to recombinant C-terminal MSP1. Results: The purified protein gave a single band of 19kDa antigen as shown by silver staining of SDS-PAGE and a sin­gle bond in immunoblotting. Bioinformatics also confirmed the likelihood of the presence of glycans on the antigen. Conclusion: The presence of N and O-glycoproteins were detected by Q proteome kit. This work was done on the ring stage, and earlier workers confirmed the presence of glycoproteins on MSP1 in the other stages. This glycosylation is present in all stages, and maybe incomplete protection elicited by recombinant MSP1 antigens is due to lack of N and O-glycoproteins.

Characterization of Glycoproteins of Native 19kDa C-Terminal Merozoite Surface Protein-1 from Native Antigen of Plasmodium falciparum

BACKGROUND

Plasmodium falciparum is the protozoan parasite which causes malignant malaria of medical concern. Prime candidates for recombinant vaccine development are asexual stage antigens of P. falciparum, for example, merozoite surface proteins (MSP1 and MSP2) not given satisfactory results to date. In this study, the 19kDa C-terminal of MSP1, a vaccine candidate was purified in its native form in the ring stage, and its glycoproteins studied.

METHODS

The study was carried out at the Biochemistry Department of Pasteur Institute of Iran in the years 2015-2016. Large scale culture of P. falciparum was performed in vitro with 80% ring stage parasitemia. Isopycnic ultracentrifugation with 36% sucrose and analytical SDS-PAGE on the supernatant and precipitate performed, and the 19kDa antigen was obtained by cutting it from strips of preparative SDS gels. Purified protein was concentrated and analyzed by SDS-PAGE and immunoblotting, using antibodies raised to recombinant C-terminal MSP1.

RESULTS

The purified protein gave a single band of 19kDa antigen as shown by silver staining of SDS-PAGE and a single bond in immunoblotting. Bioinformatics also confirmed the likelihood of the presence of glycans on the antigen.

CONCLUSION

The presence of N and O-glycoproteins were detected by Q proteome kit. This work was done on the ring stage, and earlier workers confirmed the presence of glycoproteins on MSP1 in the other stages. This glycosylation is present in all stages, and maybe incomplete protection elicited by recombinant MSP1 antigens is due to lack of N and O-glycoproteins.

Differential expression of long non-coding RNA SOX2OT in gastric adenocarcinoma

BACKGROUND

Gastric cancer (GC) is the third leading cause of cancer-related death in the world. Dysfunction of long noncoding RNAs (lncRNAs) in cancers, especially those with role in pluripotency, are approved by increasing evidence.

OBJECTIVE

SOX2 overlapping transcript (SOX2OT) lncRNA, is aberrantly expressed in different cancers; however its role in gastric cancer is still controversial.

MATERIALS AND METHODS

In this study, the expression of SOX2OT was evaluated in 33 matched pair tumor and non-tumor gastric samples and AGS and MKN45 gastric and NTERA2 embryonic carcinoma cell lines by real time PCR.

RESULTS

Our finding revealed a significant decrease in the expression of SOX2OT in gastric tumor samples compared to their matched non-tumor samples (P= 0.05) and also a lower expression in high grade compared to low grade of gastric malignancy. As we expected SOX2OT expression showed higher expression in NT2 compared to AGS and MKN45 cell lines.

CONCLUSION

Simultaneous expression of SOX2 and SOX2OT was reported in some cancers. Regarding to the decreased expression of SOX2OT in the present study in concurrent with downregulation of SOX2 in our previous study, it seems that SOX2OT plays a tumor suppressor role in GC and may be useful biomarker for diagnosis of GC.

Isolation and biotyping of Brucella spp. from sheep and goats raw milk in southeastern Iran

Brucellosis is known as an important public health problem for humans around the world and is one of the most prevalent zoonotic disease as well. Brucella spp. is a Gram negative rod, facultative intracellular pathogenic and non motile bacteria. The aim of this study were to determine the frequency and biotyping of Brucella spp. isolated from sheep and goats from south eastern part of Iran. 700 samples (raw milk) from sheep and goats (90) flocks were collected randomly, from January to July 2015, samples were transferred packed in ice to microbiology lab in Kerman University, immediately. Samples were inoculated on Brucella agar which contains antibiotic and inactivated horse serum and incubate for 5 days. Gram smears were prepared from suspected colonies followed by oxidize and biochemical tests. Polymerase Chain Reaction (PCR) were used for confirmation. All positive samples were biotyped by phage typing. Nine milk samples out of 700 (1.28%) collected were positive by bacteriological method and all of them were Brucella melitensis Biotype 1 and one out of 700 samples was Brucella ovis. In relation to the National vaccination program in these areas the most contaminated region was Rabor, Rayen, Bardsir and Baft, respectively.

Abstract 3505: The expression of two key long non coding RNAs involved in reprogramming, linc-ROR and lin-P21, in gastric cancer

Introduction: Gastric cancer (GC) is the second leading cause of cancer-related death in the world and the most common cancer in southeast of Caspian Sea (Golestan province) and northwest of Iran (Ardabil). Based on cancer stem cell (CSC) hypothesis, there are similarities between process of somatic cell reprogramming, embryogenesis and tumorigenesis. Malfunction of signaling pathways that are essential for normal development also involved in the tumor initiation and CSC formation. In recent years long noncoding RNAs (lncRNAs), more than 200 nt in length, have been highly regarded as promising biomarkers for early diagnosis and prognosis of cancers. Reprogramming-Related Long Intergenic Noncoding RNA (lincRNA-ROR) plays as modulator in the reprogramming of human induced pluripotent stem cells (iPSCs) and also maintenance of embryonic stem cells (ESCs). On the other hand, lincRNA-P21 induced by P53 and prevents the somatic cell reprogramming by silencing of pluripotency gene promoters. In this project, motivate to CSCs, we evaluated the expression level of lincRNA-ROR and linc-P21 in samples of patients with gastric cancer and also in human gastric cancer cell lines (AGS and MKN45) and human embryonal carcinoma cell line (NT2).

Methods: Thirty pairs of gastric samples, including gastric adenocarcinoma and their matched non-tumor tissue samples, were collected from the Iran National Tumor Bank (INTB). Cell lines were cultured in the RPMI1640. Total RNA of samples and cell lines was extracted using TRIZOL reagent (invitrogene). cDNA synthesis was performed by PrimeScript™ 1st strand cDNA Synthesis Kit (TAKARA) and real time PCR was performed by using TaqMan master mix (TAKARA) on Step one Plus™ instrument (ABI). Gene expression analysis performed by GenEx software program.

Results: Despite of reports indicating the high expression of linc-ROR in some cancers, our results showed no expression for linc-ROR in gastric samples (both tumor and non tumor) and also gastric cancer cell lines. But NT2 embryonal carcinoma cell line revealed high expression of linc-ROR compared to AGS and MKN45cell lines. According to our expectation, linc-P21 represents a significant decrease in tumor versus non tumor samples (p&lt;0.01) in different grads of malignancy and also in AGS and MKN45 versus to NT2 cell line.

Conclusion: Dysfunction of linc-ROR and lincRNA-P21 has reported in some cancers. According to our results, it seems that the expression of linc-ROR is limited to embryonic stem cells and hasn’t remarkable expression in gastric samples and cell lines. Based on the low expression of linc-P21 in tumor samples, it seems that linc-P21 functions as a tumor suppressor.

Citation Format: Mitra Khalili, Pourandokht Farhangiyan, Somayeh Jahandoost, Fatemeh Kamali. The expression of two key long non coding RNAs involved in reprogramming, linc-ROR and lin-P21, in gastric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3505. doi:10.1158/1538-7445.AM2017-3505

Tick diversity and detection of Coxiella burnetii in tick of small ruminants using nested Trans PCR in Southeast Iran

Ticks are obligatory bloodsucking arthropods, and probably the most harmful ectoparasites that may cause some tick born diseases. The main objective of this study was to determine the prevalence, diversity and seasonal distribution of ticks and using a nested Trans PCR to identify Coxiella burnetii in ticks collected from small ruminants in Sistan and Balouchestan province, southeast Iran. A total 1305 ticks were collected from 272 Sheep and 253 Goats during May 2014 to April 2015. Prevalence of ixodid tick infestation in small ruminants was 58.4%. Of all examined ticks, nine tick species were identified as follow: Hyalomma anatolicum anatolicum (30.3%), Rhipicephalus sanguineus (21%), Hyalomma anatolicum excavatum (19%), Rhipicephalus turanicus (9%), Rhipicephalus bursa (6.7%), Hyalomma detritum (4.7%), Hyalomma dromedarii (4.4%), Hyalomma asiaticum asiaticum (4.4%) and Hyalomma marginatum (0.5%). The nested Trans PCR examination of ixodid ticks revealed that Hyalomma anatolicum anatolicum and Rhipicephalus sanguineus were infected with C. burnetii. The results of the present study revealed that ixodid ticks infestation was widespread and shows their role as putative vectors and reservoirs for this pathogenic agent in southeast Iran. Hence; Q fever should be considered a significant public health threat in this region.

Comparing the quality of life in insulin recipient and refusal patients with type 2 diabetes

Background:

Better control of blood sugar and reduction of diabetes complications through insulin therapy could convince people to choose this method. However, patients might refuse insulin therapy due to its painful injection, limitations in daily activities, and hypoglycemia. Thus, insulin therapy could have both positive and negative effects on patients’ quality of life (QOL). Therefore, the aim of this study was to compare the QOL of insulin recipient and insulin refusal patients with type 2 diabetes.

Materials and Methods:

This study was a descriptive and comparative research conducted on 126 patients; 63 were insulin recipients and 63 had refused insulin therapy. Participants were under the care of the Endocrine and Metabolism Research Center of Isfahan, Iran. Data were gathered using the Diabetes Quality of Life (DQOL) questionnaire. In this tool, higher scores indicated lower QOL in patients. Data were analyzed using independent t-test, analysis of covariance, Mann-Whitney, Chi-square, and Pearson and Spearman's correlation.

Results:

There was a significant difference (P < 0.001) between insulin recipient patients (mean = 2.02, SD = 0.31) and insulin refusal patients (mean = 1.74, SD = 0.41) in terms of mean QOL score. In addition, men and participants with higher educational levels reported a better QOL (P < 0.001).

Conclusions:

Results showed that insulin refusal patients had a better QOL. It seems that QOL is associated with the acceptance or refusal of insulin therapy. Therefore, enhancement of QOL could be related to all aspects of the disease, especially its treatment method and solving the therapeutic problems.

Downregulation of the Genes Involved in Reprogramming (SOX2, c-MYC, miR-302, miR-145, and P21) in Gastric Adenocarcinoma

PURPOSE

Many cell signaling pathways essential for normal stem cell development are involved in cancer initiation and progression. In the present study, motivated by a possible contribution of reprogramming process in induction of cancer, we compared the expression level of main genes involved in iPS generation, i.e., miR-302, miR-145, SOX2, c-MYC, and P21, in a series of tumor and non-tumor tissues of stomach.

METHODS

A total number of 34 tumors and their matched non-tumor (as control) gastric surgical specimens were obtained. The expression of the candidate genes was evaluated by using real-time PCR and immunohistochemistry (IHC) techniques.

RESULTS

Our data revealed a significant downregulation of miR-302b, P21, and miR-145 genes in intestinal and SOX2 gene in diffuse type of tumor samples. SOX2, but not the other genes, showed a significant downregulation in both proximal (cardia and fundus) and distal (body and antrum) sites of stomach. Based on receiver-operating characteristic (ROC) analyses, the highest total area under the curve (AUC) was found for SOX2 (AUC = 82 %, P < 0.001). Interestingly, all tumor samples revealed a negative signal for c-MYC expression, while non-tumor samples represented an intense cytoplasmic staining.

CONCLUSIONS

Despite the fact that some hESC-specific genes are upregulated in tumors, our data revealed a significant downregulation of all candidate genes, except for c-MYC, in tumor samples of stomach. Moreover, ROC data demonstrated that SOX2 gene expression index is a better potential biomarker of gastric cancer, compared to other tested genes. SOX2 expression has a good sensitivity and specificity to discriminate correctly between tumor/non-tumor and also high/low grades of tumor malignancy. It seems downregulation of miR-302b, miR-145, and P21 could contribute to gastric tumor initiation and progression.

Impact of gender and menopausal status on metabolic parameters in chronic hepatitis C infection

Hepatitis C infection (HCV) and menopause are associated with insulin resistance (IR), and IR accelerates HCV-induced liver disease. The relationship between menopause and IR has not been studied in this population. This study aimed to assess the impact of menopause on IR and metabolic syndrome in HCV. One hundred and three (69 men, 16 premenopausal, 18 postmenopausal women) noncirrhotic, nondiabetic HCV-infected adults underwent IR measurement via steady-state plasma glucose during a 240-min insulin suppression test. Metabolic syndrome was defined by at least three of five standard laboratory/clinical criteria. The patient characteristics were as follows: mean age 48 years, waist circumference 94.4 ± 12.4 cm and 37.9% Caucasian. SSPG was higher in postmenopausal than premenopausal women or men (mean difference 18, 95% CI -41 to 76 and 35, 95% CI -3 to 72 mg/dL; respectively). After adjusting for waist circumference, female gender, nonwhite race and triglycerides were positively associated and high-density lipoprotein negatively associated with steady-state plasma glucose. Compared to men, both pre- (Coef 48, 95% CI 12-84) and postmenopausal women (Coef 49, 95% CI 17-82) had higher steady-state plasma glucose. Compared to premenopausal women, men (OR 2.0, 95% CI 0.38-10.2) and postmenopausal women (OR 2.9, 95% CI 0.46-18.8) had higher odds of metabolic syndrome, but this was statistically nonsignificant. Both liver inflammation (OR 7.9) and nonwhite race (OR 6.9) were associated with metabolic syndrome. We conclude that women are at inc-reased risk for IR in HCV. There may also be an increased risk of metabolic syndrome postmenopause. Along with lifestyle modification and weight loss, women with metabolic abnormalities represent an especially at-risk group warranting HCV treatment to prevent adverse metabolic outcomes.

Evaluating the miR-302b and miR-145 expression in formalin-fixed paraffin-embedded samples of esophageal squamous cell carcinoma

BACKGROUND

MicroRNAs are involved in key cellular processes regulating, and their misregulation is linked to cancer. The miR-302-367 cluster is exclusively expressed in embryonic stem and carcinoma cells. This cluster also promotes cell reprogramming and stemness process. In contrast, miR-145 is mostly regarded as a tumor suppressor, where it regulates cellular functions such as cell division, differentiation, and apoptosis. By suppressing the main pluripotency factors (OCT4, SOX2, MYC and KLF4), miR-145 silences the self-renewal program in ESCs. Therefore, the main aim of this study is to find a potential link between the expression level of hsa-miR-302b and hsa-miR-145 with tumor vs. non-tumor as well as high-grade vs. low-grade states of the esophageal tissue samples.

METHODS

A total number of 40 formalin-fixed, paraffin-embedded (FFPE) samples of esophageal squamous-cell carcinoma (ESCC) were obtained, and the tumor and marginal non-tumor areas delineated and punched off by an expert pathologist. Total RNA was extracted with Trizol, and cDNA synthesized using the miRCURY LNA™ Universal RT microRNA PCR Kit. Real-time reverse transcription polymerase chain reaction (RT-PCR) assays were performed using specific LNA-primers and SYBR Green master mix.

RESULTS

The expression level of miR-302b failed to show any significant difference, neither between tumor and their non-tumor counterparts, nor among tumors with different grades of malignancies (p > 0.05). In contrast, miR-145 was significantly down regulated in all grades of tumor samples (p < 0.001). However, its expression level could not discriminate between different grades of malignancy (p > 0.05).

CONCLUSION

Our data revealed a significant down-regulation of miR-145 in ESCC tissue samples. Based on our ROC curve analysis data (AUC = 0.74, p < 0.001) miR-145 could be regarded as a potential tumor marker for diagnosis of esophageal cancer.