2019 Impact Factor: 1.291
2019 CiteScore: 0.9
Chairman & Editor-in-Chief:
Dariush D. Farhud, MD, Ph.D., MG.
Vol 48 No 10 (2019)
Background: Interests in nanotechnology and its application in medical research, diagnosis, and treatment of diseases continuously grow. The study identified the theoretical and practical principles of ethics in developed countries’ nanomedical research to be used as the first step of development of a national nanoethics standard or guideline in Iran and developing countries.
Methods: The present study was done between 2012-2016 in Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran, which comprised a literature review and a comparative study to describe and compare the nanoethics situation and considerations of nanoethics in Australia, Canada, and USA.
Results: The main ethical considerations in the three countries contain two major categories, including firstly, the nature of nanoparticles such as its diversity, rapid development of new and not well-defined nanoproducts and particles and unpredictable side effects of such nanoparticles; and secondly, the application of developed nanoparticles in areas such as justice, privacy protection, patient-physician relations, etc.
Conclusion: It is controversial to develop an independent nanoethics standard or codes; however, national priorities and concerns, as well as specific nanoethics considerations, should be investigated before deciding to create such standards in each country. Overall, careful considerations have to take into account the justice, privacy protection, the inherent risks of nanomaterials and their possible side effects on patients and other study subjects, as well as considering characteristics of new developed nanoproducts and particles.
Background: Asymmetry in repeated motion may lead to dyskinesia through imbalance in the involved musculoskeletal structures. The dominance sides are also involved greater movement involvement over the non-dominant sides. The upper limbs with multiple joints and largest range of motion are prone for unsynchronized coordination. Natural movement analysis is required for application to everyday activities.
Methods: Thirty participants were first recruited from Inha University, Incheon, Korea in 2019. Twenty subjects were assessed for comparisons of asymmetrical motion between the dominant and non-dominant arms during the abduction and adduction lateral raises after excluding ten subjects for shoulder pain and left-handedness.
Results: The abduction and adduction motions of the bilateral arms were compared for the angular locations, velocity, and acceleration for every 10 degrees. The angular locations of the dominant side occurred significant earlier in the initial (10°, 20°, 30°) phase and later in the last (10°, 20°) phase of abduction and adduction in comparison to the non-dominant side (P<.05). The angular accelerations of the dominant side were also significantly greater during the initial phase (0°, 10°, 30°) and last phase (0°, 10°, 30°) (P <.05). The angular velocities were significantly greater during the later phase (40, 50, 60°) of abduction (P <.04).
Conclusion: Comparative dominant side indicated more controlled movements through the range of motion with greater stability in angular acceleration and deceleration especially during the initial and last phase of abduction and adduction, respectively. Training for control of the specific angular points should be considered during abduction and adduction motions to prevent asymmetry of the bilateral arms.
Background: To explore the application effects of whole course high-quality nursing on patients with liver cancer during radiotherapy.
Methods: One hundred and five patients with liver cancer who received radiotherapy in Liaocheng People’s Hospital, Liaocheng, China from March 2010 to February 2012 were selected and divided into a control group (42 cases with routine nursing) and an experimental group (63 cases with whole course high-quality nursing). The two groups of patients were observed and compared in terms of clinical data and the Activity of Daily Living (ADL) score before and after nursing (1 course of treatment/6 week). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) were used to evaluate and compare the patients’ anxiety and depression before and after nursing. Adverse reactions during radiotherapy and nursing satisfactory of patients were observed and compared between the two groups.
Results: After nursing, the ADL score and the nursing satisfaction in the experimental group was significantly higher than that in the control group (P<0.05). The SDS and SAS scores in the 2 groups before nursing were significantly higher than those after nursing (P<0.05). The total incidence of adverse reactions in the control group was significantly higher than that in the experimental group (P<0.05).
Conclusion: Whole course high-quality nursing can improve the negative emotions, quality of life and nursing satisfaction, and reduce adverse reactions of patients with liver cancer during radiotherapy.
Background: The prevalence of bleeding and perforation against the diabetes mellitus, obesity and metabolic syndrome (MetS) is studied not sufficiently.
Methods: The period of collecting the material was 15 years (2003-2017). The observation analysis was conducted for the patients at polyclinics observations, by the doctors of first-aid, in the surgical departments of the Astana City, Kazakhstan. The number of first-aid visits to patients, the medical cards of the patients with gastroduodenal perforation (GDP) and gastroduodenal bleeding (GDB) were analyzed.
Results: The rate of annual growth of indices of overall morbidity Rgm=1.0%, obesity in combination with diabetes was Ro=1.7%; and morbidity with metabolic syndrome was Rm=3.1%. The diagnosis of GDP was revealed in 0.63 men with MetS for every 100000 urban people. The diagnosis of GDB was registered in 2.12 men for 100000 urban people. The index of the annual growth in patients with MetS had the tendency to the growth (Rms=3.1%).
Conclusion: The high medical and social significance of diseases of the digestive system among the adult population in Kazakhstan is determined by the annual increase in the incidence rate and a clear decrease in the quality of life of such patients, which necessitates the search for scientifically based ways to improve medical care for this population.
Background: Physical activeness is one of the main elements of lifestyle in terms of preventing civilization diseases. The main purpose of this study was to assess the selected health behaviors of men practicing combat sports and martial arts and to find out what features or variables may have an influence one’s lifestyle.
Methods: Overall, 561 men aged 17-35 yr were enrolled and divided into three groups. Studies were conducted from March 2011 to June 2015 in Warsaw, Poland. The main research tool was Juczyński’s Health Behaviour Inventory. The questionnaire includes 24 statements – descriptions of various health-related attitudes and behaviours – divided into four categories: proper eating habits, preventive behaviours, positive psychical attitude, and health practices.
Results: The persons practicing combat sports and martial arts presented the highest level of health behaviours. The result of Group 1 was significantly higher than the result of Group 2 (P=0.05) and Group 3 (P<0.001). The sportsmen from Group 1 obtained the highest result in the category of psychical attitude (3.5), which was similar to the result of the non-active group (3.29). The men belonging to Group 2 rated highest their eating habits (3.37). All groups obtained the lowest results in the category of preventive behaviours.
Conclusion: The men practicing combat sports and martial arts showed high general level of health behaviours. It may give evidence to the intellectualization of sport and health training process, as well as to the fact of adopting the desired behaviours in everyday life.
Background: We aimed to explore the clinical efficacy of vitamin D combined with metformin and clomiphene in the treatment of patients with polycystic ovary syndrome combined with infertility.
Methods: Overall, 396 cases of polycystic ovarian syndrome combined with infertility in Yantai Yuhuangding Hospital, Yantai, China were prospectively analyzed. Among them, 204 cases treated with vitamin D combined with metformin and clomiphene were set as the study group; 192 cases treated with only metformin and clomiphene were set as the control group. The ovarian volume and thickness of uterine wall before and after treatment were recorded. Levels of fasting insulin (FINS), luteinizing hormone (LH), testosterone (T), follicle-stimulating hormone (FSH), and estradiol (E2) before and after treatment were recorded.
Results: There was no difference in body weight, BMI, ovarian volume, thickness of ovarian wall, FINS, LH, T, FSH and E2 between the study group and the control group; there was no significant difference in FSH, E2 and the thickness of uterine wall between the two groups. After treatment, the BMI, FINS, LH, and T in the study group were significantly lower than those in the control group (P<0.05); the incidence rates of oligomenorrhea, facial acne and hairy symptoms in the study group were significantly lower than those in the control group (P<0.05); after treatment, the ovulation rate and pregnancy rate in 36 cycles in the observation group were significantly higher than those of the control group (P<0.05).
Conclusion: Our challenge could significantly improve clinical symptoms and endocrine conditions, and greatly enhance the ovulation rate and pregnancy rate.
Background: Although oral health improves in several countries, global problems are still present. Predictably, the disadvantaged and poor population groups in both developing and developed countries have high rate of malign disease. The aim of this study was to evaluate the prevalence of head and neck cancers (HNCs) and to compare them between Syrian and Turkish population.
Methods: A total of 4570 patients confirmed to have HNC histopathologically from Hatay Mustafa Kemal University Hospital Pathology report archive were retrospectively evaluated. Among them, 452 were Syrian patients while 4118 were Turkish patients. Data were collected from 2010 to 2017. Gender and age information were taken from medical records. According to the pathological results, HNCs were classified.
Results: In 474 patients, HNCs were inscriptived, of which 317 were in males and 157 in females aged 23–80 years with histologically approved cancer of head and neck area. Overall, 100 were Syrian patients while 374 were Turkish patients. In both Syrian and Turkish patients, the most observed HNC was squamous cell carcinoma (SCC).
Conclusion: Nowadays, the prevalence of cancer is higher because of the excessive consumption of alcohol, tobacco, chewing, and smoking. For the higher cancer incidence in Syrian refugees, we thought that the impact of war such as stress may have been effective as well as the known several etiologic factors of cancer. For the increased risk of cancer, the early diagnosis of this become more important.
Background: To explore the expression level of miR-664-3p in osteosarcoma and its effects on the proliferation and apoptosis of osteosarcoma cells.
Methods: Specimens of osteosarcoma tissues were collected from 41 cases undergoing surgical treatment in the Orthopedics Department of Wuhan Puai Hospital, Wuhan, China from January 2015 to February 2018. Another 40 cases of normal bone tissue were collected. The expression of miR-664-3p were detected using quantificational real-time polymerase chain reaction. miR-664-3p mimics, miR-664-3p inhibitor and miR-664-3p negative control (NC) were used to transfect U2-OS, which were named as mimics group, inhibitor group and NC group, respectively. MTT assay was adopted to detect the effects of microRNA-664-3p on the proliferation of U2-OS after 24, 48, 72, 96 and 120 hours of transfection. Flow cytometry was applied to measure the apoptosis rate of U2-OS after miR-664-3p transfection. Finally, Western Blot was employed to detect the expression of proteolipid protein 2 (PLP2).
Results: The total apoptosis rate of cells in the inhibitor group was obviously higher than those in the mimics group and the NC group (P<0.001). The relative expression level of PLP2 in the inhibitor group was significantly lower than those in the mimics group and the NC group (P<0.001).
Conclusion: MiR-664-3p may be involved in the occurrence and development of osteosarcoma, and can regulate the proliferation and apoptosis of U2-OS cells, and the expression of PLP2. Besides, miR-664-3p may become a novel molecular biological indicator for the diagnosis, targeted treatment and prognosis assessment of osteosarcoma.
Background: Pseudoexfoliation syndrome (XFS) is pathogenetically related to exfoliative glaucoma (XFG), which is the most common type of secondary glaucoma. We aimed to investigate the relationship between LOXL1 SNPs (rs1048661, rs3825942) and XFS and/or XFG in a cohort of Iranian subjects.
Methods: This cross-sectional study investigated possible association between LOXL1 gene polymorphisms and exfoliative glaucoma in Northeastern part of Iran between May 2014 and May 2015. Sixty unrelated XFS/XFG patients, as well as 40 control subjects, were studied by direct sequencing. In fifteen senile cataract patients without glaucoma and fifteen patients with coexisting XFG and cataract, capsulorhexis specimen of the anterior lens capsule was used to evaluate LOXL1 gene transcripts by Real-Time PCR technique. We analyzed the results for allele frequencies and haplotype association and investigated the relative gene expression.
Results: Significant associations between the rs382594 SNP and XFG and between rs1048661 SNP and XFG were observed (P<0.05 for both). The frequency of the G allele in the exonic SNP (rs1048661) appeared to be higher in XFS or XFG patients compared to control subjects (P= 0.0497). Moreover, in the rs3825942 SNP, the G allele was more frequent in XFS/XFG patients compared to control subjects (P=0.0016). The highest cumulative frequency was for the GG haplotype. GG haplotype was associated with increased risk of XFG compared to the rs1048661 G/T and rs3825942 G/A haplotypes. LOXL1 mRNA expression was not statistically significantly different between XFS/XFG and control subjects.
Conclusion: We reported the LOXL1 gene polymorphism in an Iranian XFS/XFG cohort. Similar to many other ethnic groups and geographic regions, our results confirmed an association between LOXL1 gene variants and XFG in Iran.
Background: Nonmelanoma skin cancers are the most frequently occurring skin cancers. Vitamin A is involved in epithelial cell differentiation and may control skin tumor development. Vitamin E is a powerful lipophilic antioxidant that can quench and scavenge reactive oxygen species. However, there is little consistent evidence considering micronutrients and the development of basal cell carcinoma (BCC). Therefore, we aimed to investigate the possible difference between retinol and α-tocopherol in BCC patients and controls in Iranian population.
Methods: This case-control study was conducted on adults with newly diagnosed BCC referred to Razi Hospital, Tehran, Iran in 2015. Serum and subcutaneous fat tissue retinol and α-tochopherol were measured by HPLC method.
Results: Overall, serum retinol level was lower significantly in BCC patients (0.237±0.01 µg/ml) in comparison with control group (0.27±0.02 µg/ml, P-value: 0.038). However serum ɑ-tocopherol level was not significantly different between BCC patients (4.41±0.33 µg/ml) and control subjects (4.06±0.35 µg/ml, P-value=0.18). Subcutaneous adipose tissue retinol was lower significantly in BCC patients (38.60±3.30 ng/mg) compared with control group (54.78±3.49 ng/mg, P-value=0.002). Furthermore, results revealed lower subcutaneous adipose tissue ɑ-tocopherol in BCC patients (4.41±0.33 µg/ml) in comparison with control group (4.06±0.35 µg/ml, P-value=0.18).
Conclusion: Skin tissue concentration of retinol and ɑ-tocopherol and serum retinol level was lower in BCC patients in comparison with control group but serum ɑ-tocopherol was not different between groups.
Background: Substance use is a growing problem in many countries especially among teenagers. We aimed to estimate the prevalence and complications of substance use in teenagers referring to a tertiary hospital following intoxication.
Methods: In a cross-sectional study between 2012 and 2013 in Loghman Hakim Hospital, Tehran, Iran, sixteen substances were checked in teenagers referring due to poisoning. They divided into two groups of young (13 to <16 yr; group 1) and old-teenagers (16 to 19 yr; group 2). History of lifetime substance use and drug use within the week prior to admission were recorded.
Results: Mean (range) age of young teenagers was 14.5±0.6 [13, 15] and 17.7±1.1 [16, 19] in old-teenagers with female predominance. Of 264 teenagers, four in group 1 and 27 in group 2 were admitted due to drug overdose. Six and 69 patients in groups 1 and 2 claimed that they had used some kind of substance in the week prior to admission. Twenty (37%) and 106 (50.5%) patients in the young and old-teenager groups were defined as drug users and rates of unreported substance use were 27.8% (15 cases) and 23.8% (50 cases) respectively. Ninety-six substance users (36.4%) had referred due to poisonings other than recreational intoxication (P<.001). Screening toxicological lab data showed significant opioid and sedative exposure in old-teenagers.
Conclusion: It seems young adolescents hide their drug abuse more than old teenagers. Using illicit drugs screening tests may help us to provide hidden rate of abuse in teenagers.
Background: The tumor protein p73 (TP73) is a homolog of TP53 family. Ectopic p73 overexpression largely mimics p53 activities as a tumor suppressor and activates the transcription of p53-responsive genes and as a result induce apoptosis. This study aimed to investigate the association between p73 G4A polymorphism and the risk of breast cancer in a northeastern Iranian population.
Methods: This case-control study was performed on 105 patients who admitted in educational hospitals of Mashhad University of Medical Sciences, Iran during 2013-2015, with breast cancer as case group and 120 healthy women as the control group. PCR-CTPP method was used to investigate the relationship between the p73 G4A polymorphism and the risk of breast cancer.
Results: There was no significant association between the AA genotype of the p73 G4A polymorphism and breast cancer in case and control groups. Although G allele frequency was higher in the case group, the abundance of this allele between case and control groups was not statistically meaningful and, as a result, not associated with the risk of breast cancer in this study group.
Conclusion: There was no association between G4A p73 polymorphism and the risk of breast cancer in a northeastern Iranian population.
Background: Health reform in Iran began in 2014, aimed at improving financing pattern of health services. We assessed the reform by changes in variables representing distribution of health payments and catastrophic expenditures.
Methods: Using data from households’ income-expenditure survey, this study computed the financial variables, representing poverty line and households at poor state, household’s catastrophic health expenditure, fairness in financial contribution (FFC) index, and household’s impoverishment state, in the years 2010-2016, in urban and rural areas. The variables were computed by special software designed for this study, based on C-Sharp(C#) programming language, with yearly data on more than 38000 households, each with 1072 information sources.
Results: The food share-based poverty line after sharp rise in 2010-2013, in 2014-2016 raised slowly, and the average percent of households facing catastrophic health expenditure, after sharp rise in 2011-2013, left at 3.25 in 2014-2015 and raised to 3.45 in 2016. The average FFC index remained at 0.839 to 0.837 in 2013-2016. However, interestingly, the average percent of households impoverished after out-of-pocket payments improved from 1.36 to 0.912 in 2013-2016.
Conclusion: In three years of health reform, the major impact of reform was considerable improvements in the rate of the impoverished after out-of-pocket payments. The reform had limited impacts on the rates of households facing catastrophic health expenditure, and on FFC indexes, for the rural and urban residents.
Background: Food safety and food security are interrelated concepts with a profound impact on the quality of human life. The current study, for the first time, was set to identify associations between home food safety practice and household food insecurity a structural equation modeling approach.
Methods: In this cross-sectional study, urban households were selected from among 10 health centers of five districts of Tehran, Iran (2015). The following questionnaires were completed: socioeconomic status (SES), food security and food safety. Structural Equation Modeling (SEM) was applied for predicting the relationships between SES, food insecurity, and food safety in households.
Results: Food security was observed in 56% of households. Mild, moderate and severe food-insecure households were determined to be 29%, 12%, and 3%, respectively. In addition, the scores of home food safety practice in 37.5%, 33% and 29.5% of the households were classified as desirable, acceptable and weak, respectively. Low-educated mothers having husbands with low educational and occupational level had a weaker food safety practice compared to high-educated ones. Based on the SEM results, an inverse association between food safety practice and food insecurity score was observed (t= -2.89, ɣ= 0.16).
Conclusion: Food insecurity and undesirable food safety practice were relatively prevalent among households. In addition, the economic and social factors could inversely affect both food insecurity and food safety practices.
Background: Klebsiella pneumonia is one of the common causes of pneumonia and bacteremia in intensive care patients. The present study was aimed to determine the capability of (GTG) 5-PCR assay for molecular typing of K. pneumonia strains isolated from patients with urinary tract infections.
Methods: In this descriptive-sectional study, K. pneumoniae strains were collected from hospitalized patients with urinary tract infection in Baqiyatallah Hospital, Tehran, Iran during 2017-2018. Isolates were identified by conventional microbiological tests. Bacterial DNA was extracted using boiling method and (GTG) 5-PCR assay was used for subtyping of the isolates. For clustering of isolates, dendrogram was generated according to the unweighted pair group method with arithmetic (UPGMA).
Results: Overall, 88 K. pneumoniae isolates were isolated and subjected to the molecular typing study. The (GTG) 5–PCR assay was able to differentiate the K. pneumoniae strains into 9 clusters including G1-G9. Genotype clusters G4 and G9 consist of highest (26) and lowest (1) number isolate, respectively.
Conclusion: The K. pneumonia strains isolated under the study belonged to various clones and the (GTG) 5-PCR assay as simple and rapid method can be a powerful tool for molecular typing of K. pneumoniae strains.
Background: Nowadays, geographic information system (GIS) is one of the most useful epidemiological tools for identifying high-risk areas of cutaneous leishmaniasis. The aim of this study was to determine the spatial distribution of cutaneous leishmaniasis in northeastern Iran.
Methods: In this cross-sectional study, information on positive cases of cutaneous leishmaniasis in the three provinces located in northeastern Iran during Jul 2011 to Jul 2017 was obtained from the Iranian Ministry of Health. Based on the postal address of each case, the geographical coordinates of each patient were determined for spatial analysis of cutaneous leishmaniasis. For spatial analysis, Moran’s index autocorrelation and Kriging interpolation method were used in GIS software.
Results: Moran’s index autocorrelation showed that spatial distribution of disease incidence in the study area was cluster pattern (Z-score > 1). In addition, Kriging interpolation method revealed that 90% of southern parts of North Khorasan province and northern parts of Razavi Khorasan Province formed hot spots.
Conclusion: The CL incidence is a function of spatial and geographical trends. In addition, spatial trends in the disease incidence distribution indicate that it is not greatly increased or decreased from one area to another. It appears as hot spots areas. Spatial analysis by showing high risk areas can be useful tools for controlling and preventing CL incidence.
Background: Measurement of pesticides in biological matrices is become a serious challenge for researches because of their very low concentration in different matrices. The aim of this study was to develop a new sam-ple preparation method with high accuracy and validity, simplicity and short retention time for determination of malathion.
Methods: Dispersive liquid-liquid micro-extraction (DLLME) technique coupled with high-performance liq-uid chromatography equipped with ultraviolet detector (HPLC-UV) developed for trace extraction and deter-mination of malathion pesticide in human urine samples. This study was done in 2017 at Tehran University of Medical Sciences, Tehran, Iran. One variable at a time (OVAT) method was used to optimize parameters af-fecting the malathion extraction. Different parameters such as extraction solvent, disperser solvent, and vol-ume of the extraction solvent, volume of the disperser solvent, centrifugation time and speed, salt addition, and sample pH were studied and optimized.
Results: Under the optimized conditions, the limit of detection and enrichment factor of the method were 0.5 μg L-1 and 200, respectively. The calibration curve was linear in the concentration range of 2-250 μg L-1. The relative standard deviation for six replicate experiments at 200 μg L-1 concentration was less than 3%. The rela-tive recoveries of spiked urine samples were 96.3%, 101.7% and 97.3% at three different concentration levels of 50, 200 and 1000 μg L-1, respectively.
Conclusion: DLLME procedure was successfully developed for the extraction of malathion from human urine samples. Compared to other extraction techniques, the proposed procedure had some advantages such as shorter extraction time, better reproducibility, and higher enrichment factor.
Background: HIV infection remains of major public health importance in all world and in Romania. In Romania there are a large number of long-term survivors coming from the 1987-1990 generation, the circumstances are due to the fact that an increased number of HIV-infected persons receive a specific therapy.
Methods: The study was conducted using sociological analysis methods such as comparative analysis, statistical analysis, and with the help of the method of regression analysis, to capture the dynamics of the HIV / AIDS phenomenon in Romania, as well as forecasting the dynamics of the phenomenon over the next decade.
Results: This longitudinal analysis of the statistical data provided by the Matei Bals Institute of Romania during the period 2004-2016, shows a progressive increase 1.4 times higher in 2016 compared to 2004, the prediction of the extension of the HIV / AIDS phenomenon for the period 2017-2027, in Romania being almost constant. Regarding the prognosis of the number of persons affected by HIV / AIDS in Romania, for the next 10 years an upward dynamic is predicted with an increasing annual rate of 506 new persons taken into evidence. As the prediction function shows, the trend the access to treatment is increasing for the next decade. After 2006 in Romania, the deaths dynamics is an exponential decreasing one, keeping the same rate of decrease, until 2015.
Conclusion: The HIV/AIDS pandemic has changed considerably in the past 27 years. AIDS incidence and mortality in industrialised countries have fallen, and paediatric HIV disease has almost been eliminated as a public health issue, largely through antiretroviral drugs.
Background: Diagnosis of hereditary hearing loss (HHL) as a heterogeneous disorder is very important espe-cially in countries with high rates of consanguinity where the autosomal recessive pattern of inheritance is preva-lent. Techniques such as next-generation sequencing, a comprehensive genetic test using targeted genomic en-richment and massively parallel sequencing (TGE + MPS), have made the diagnosis more cost-effective. The aim of this study was to determine HHL variants with comprehensive genetic testing in our country.
Methods: Fifty GJB2 negative individuals with HHL were referred to the Kariminejad-Najmabadi Pathology and Genetics Center, Tehran, one of the reference diagnostic genetic laboratories in Iran, during a 3-year period between 2014 and 2017. They were screened with the OtoSCOPE test, the targeted genomic enrichment and massively parallel sequencing (TGE + MPS) platform after a detailed history had been taken along with clinical evaluation.
Results: Among 32 out of 50 GJB2 negative patients (64%), 34 known pathogenic and novel variants were de-tected of which 16 (47%) were novel, identified in 10 genes of which the most prevalent were CDH23, MYO7A and MYO15A.
Conclusion: These results provide a foundation from which to make appropriate recommendations for the use of comprehensive genetic testing in the evaluation of Iranian patients with hereditary hearing loss.
Here we report the consumption of traditional cottage cheese (Koupé) in western Iran, as a new way of transmission of botulism. All the patients (a nine member family) had at least two specific symptoms of botulism. Given the clinical symptoms and contact history, anti-toxins were injected in the early hours of hospital admission. On Jan 27, 2017, three patients clinically suspected of foodborne botulism were referred to the hospital in Sanandaj, western Iran from their local hospital in Baneh, western, Iran. Because of the worsening of clinical conditions, a 34-yr-old man with both gastrointestinal and neurological symptoms was admitted to the ICU, while other family members were treated in the infectious diseases ward of the hospital. The disease was diagnosed through isolating toxin A from the cheese and testing the serum sample of one of the patients. This case of botulism showed that traditional Koupé cheese could cause foodborne botulism. Hence, it is necessary to train and inform people about how to process and keep the cheese to prevent similar cases.
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