Efficacy of tenofovir disoproxil fumarate therapy in nucleoside-analogue naive Iranian patients treated for chronic hepatitis B

Background: Tenofovir disoproxil fumarate (TDF) is a new effective treatment option for patients with chronic hepatitis B (CHB). Objectives: To evaluate TDF efficacy in nucleos(t)ide analogues (NAs)-naive Iranian patients with CHB. Patients and Methods: The NA-naive patients received TDF for at least six months. The primary endpoint was the proportion of patients achieving a complete virological response (CVR) during the treatment. Multivariate Cox regression analysis determined predictive factors independently associated with the time to CVR. The secondary endpoints were biochemical and serological responses, frequency of virological breakthrough, genotypic resistance development, safety and tolerability. Results: In all, 93 patients (64.5 hepatitis B e antigen HBeAg-negative) were eligible. Of these, 70 patients completed 24 months of treatment. The cumulative CVR rates in HBeAg-negative and HBeAg-positive patients were 87% versus 53% at 24 months, respectively. The multivariate Cox regression model showed only HBeAg positivity at baseline and a high baseline HBV DNA level were independent factors predicting a CVR. No patient achieved hepatitis B surface antigen (HBsAg) and HBeAg loss or seroconversion and no virologic breakthrough occurred. A new amino acid substitution (rtD263E) was observed to develop in 60% of patients with viremia. Conclusions: The cumulative CVR rates showed that patients with HBeAg-negative have better virologic respond than those with HBeAg-positive during the same period. The rtD263E mutation might be associated with partial resistance to TDF. © 2015, Kowsar Corp

Scorpion fauna (Arachnida: Scorpiones) in Darmian county, Iran (2015-2016)

Background and purpose: Venomous bite and specific morphological features of scorpions are the most important reasons for paying attention to scorpions. Anxiety and stress caused by scorpions and their stings are amongst the important health issues in many countries especially in Iran. This study was conducted on scorpions’ fauna in Darmian County, South Khorasan province, Iran. Materials and methods: In this study, 21 districts in Darmian were sampled including plains, mountains, residential, non-residential, rural and urban areas. Sampling effort was conducted monthly in 2015-16. Scorpions were collected by actively searching in day and night using pitfall trap. The specimens were identified by appropriate identification keys. Results: Totally 685 specimens were collected. Five species including Mesobuthus eupeus, M. caucasicus Androctonus crassicauda, Orthochirus scrobiculosus, and Compsobuthus matthiesseni were identified from Butidae family. The most frequent species was M. eupeus (n= 373, 54.5%), while A. crassicauda (n= 22, 3.2%) was recognized as the least frequency species. Conclusion: Androctonus crassicauda (black scorpion) was found as the most dangerous species in Iran, so, alongside care programs for scorpionism in Darmian, prescription of anti-scorpion serum in cases stung by scorpion should be done by considering the coloring of scorpion and residential area of injured person. © 2016, Mazandaran University of Medical Sciences. All rights reserved

Diagnostic accuracy of dual-source computerized tomography coronary angiography in symptomatic patients presenting to a referral cardiovascular center during daily clinical practice

Background: There are numerous studies that address the diagnostic value of dual-source computed tomography (DSCT) as an alternative to conventional coronary angiography (CCA). However, the benefit of application of DSCT in a real world clinical setting should be evaluated. Objectives: To determine the diagnostic accuracy of DSCT technique compared with CCA as the gold standard method in detection of coronary artery stenosis among symptomatic patients who are presented to a referral cardiovascular center during daily clinical practice. Patients and Methods: Evaluating the medical records of a tertiary care referral cardiovascular center, 47 patients who had undergone DSCT and CCA, and also met the inclusion and exclusion criteria of the study were selected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LRs) of the DSCT imaging technique were calculated. Results: In total, 97.8 of the segments (628/642) could be visualized with diagnostic image quality via DSCT coronary angiography. The mean heart rate during DSCT was 69.2±12.2 bpm (range: 39 - 83 bpm), and the mean Agatston score was 507.7±590.5 (range: 0 - 2328). Per segment analysis of the findings revealed that the sensitivity, specificity, PPV, NPV, positive LR (PLR) and negative LR (NLR) of DSCT technique for evaluation of patients with coronary artery disease were 93.7, 96.8, 92.7, 97.2, 29.4, and 0.066, respectively. Also per vessel, analysis of the findings showed a sensitivity of 97.1, a specificity of 94.0, PPV of 95.3, NPV of 96.3, PLR of 16.1, and NLR of 0.030. Conclusion: Our results indicate that DSCT coronary angiography provides high diagnostic accuracy for the evaluation of CAD patients during daily routine practice of a referral cardiovascular setting. © 2016, Tehran University of Medical Sciences and Iranian Society of Radiology

Suprasternal innominate artery cannulation for reoperative aortic surgery: A technical note

Suprasternal cannulation of the innominate artery in aortic reoperations may be useful in specific situations. Over a period of 3.5 years, 9 patients (6 males, average age = 49.2 ± 16.1 years) underwent suprasternal cannulation prior to resternotomy. Cannulation was performed using a side graft. All operations were successfully completed. Two patients died after surgery because of coagulopathy and multiorgan failure. There were no complications related to access or technique, and no site complications were detected during follow-up. Suprasternal cannulation of the innominate artery may play a role in selected reoperations. © 2016 The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved

Evaluation of right ventricular function and various models of delayed enhancement with cardiac magnetic resonance imaging in patients with repaired tetralogy of fallot

Background: Tetralogy of Fallot (TOF) is considered as the most frequent cyanotic congenital heart disorder. Right ventricular (RV) dysfunction is possible to be observed in patients with repaired TOF. Delayed enhancement (DE) is one of the recommended findings for RV dysfunction. Objectives: This study aimed at investigating the DE and its probable relationship with RV function through cardiac magnetic resonance (CMR). Patients and Methods: In this cross-sectional study, the values of cardiovascular magnetic resonance of 110 symptomatic patients, who had repaired TOF for 35 years, were gathered. We compared cardiac function indices (CFI) in patients with and without DE. Results: The patients had an average age of 21.93 ± 6.94 years (59.12 were male and 40.94 were female). 93.66 of the subjects showed DE and 6.44 of them did not have DE. 78.61 of the samples had DE of the right ventricular outflow tract (RVOT); whereas, 21.39 showed DE of the other sites. The differences between mean regurgitation fraction, average RV end-diastolic volume (RVEDV), average RV end systolic volume (ESV), and average RV ejection fraction in DE positive and negative patients were statistically significant (P values = 0.01, 0.04, 0.04, and 0.01, respectively.) Conclusion: DE commonly occurs as a complication of surgery to repair TOF and could be used as a factor for impaired RV function and other complications. Using CMR imaging for follow up of these patients could lead to diagnosis of these complications. © 2020, Iranian Journal of Radiology. T

Designing & producing polytope DNA vaccine containing HBsAg gene for the induction of protective immunity against hepatitis C

Background: Considering the immunosuppressive effects and prevalent mutations in some HCV antigens, induction of CD8+ T cell responses is focused on conserved and critical epitopes which as a multi-epitope vaccine can prevent the chronic nature of the disease. Materials and Methods: Two immunodominant HLA-A2-restricted human epitopes (E2614-622 and NS31406-1415) and two H-2d-restricted mouse epitopes (core132-142 and E2405-414) were designed in a sequential tandem, predicted by immunoinformatic analyses. Following the synthesis, related nucleotide sequence was cloned into the pcDNA3.1 vector with and without the fusion of hepatitis B surface antigen (HBsAg). Two constructed plasmids (pcDNA3.1.HPOL and pcDNA3.1.POL, respectively) were evaluated for the protein expression and secretion in Cos-7 cell line. After the vaccination of BALB/c mice (n=6 in each group) with different DNA and peptide immunization regimens, CD8+ T cell activity as well as the type and protective potency of the induced responses were evaluated. Results: Despite the induction of epitope-specific responses in pcDNA3.1.POL injected mice, the group immunized with pcDNA3.1.HPOL indicated a significant increase in the number and activity of CD8+ T cells (P<0.05). Peptide boosting of this group (formulated in two human-compatible adjuvant) still led to the more activation of CD8+ cells, induction of Th1 response and the inhibition of tumor model growth (P<0.05). Conclusion: Fusion of HBsAg as a particle-forming sequence and the source of helper epitopes along the DNA-prime/peptide-boosting immunization regimen are proposed as two promising strategies to improve the CTL multi-epitope vaccines against HCV