ACTA MEDICA IRANICA

Azole Resistance and CYP51A/B Mutations in Aspergillus Clinical Isolates Before and During the COVID-19 Pandemic: A Molecular Surveillance Study

Mohammadrafi Khorgami — 2026-01-04

We conducted a cross-sectional study to (I) determine the relative frequency of antifungal-resistant Aspergillus clinical isolates, (II) address changes in susceptibility to available antifungals in patients infected with Aspergillus spp. with COVID-19, and (III) determine mutations in the CYP51A and CYP51B genes of Aspergillus spp. Isolated from the clinical specimens. A total of 30 fungal species were enrolled in the study. The antifungal activities of itraconazole and voriconazole were assessed using azole-containing agar media in Petri dishes. After identifying resistance in the isolates, the CYP51A and CYP51B gene regions were sequenced using the designed primers, and mutations were identified. To amplify CYP51A and CYP51B, primers with the specified sequences were used. Genomic DNA from 22 azole-resistant Aspergillus isolates was amplified using the CYP51-A and CYP51-B gene primers. 12/22 (54.54%) azole-resistant A. flavus isolates with the Tandem Repeat (TR34)/L98H (leucine-to-histidine substitution) mutation, MICs above the CLSI Epidemiological Cutoff Value. One carried the F46Y /TR34. 5/22 azole non-WT A. fumigatus isolates, CYP51-A analysis revealed that M220I, S297T/ TR34/L98H mutations, 4 A.orezea isolates had C498T/TR34 at a CYP51-B gene. Antifungal susceptibility testing should be performed when possible, and efficient systems must be implemented to monitor the evolution of newly introduced azole-resistant Aspergillus spp. In addition, these data are useful for clinicians to understand the incidence of azole resistance, enabling optimal management of affected patients and helping choose the right solution for infection management.

Unraveling the Anemia Nexus: Bioinformatics-Driven Discovery of Key Protein Interactions and Therapeutic Targets

Azar Bahrami — 2026-01-04

Anemia, characterized by a deficiency in red blood cells or their oxygen-carrying capacity, is a prevalent condition with significant health impacts. This study utilizes a bioinformatics approach to identify key proteins involved in anemia, leveraging multiple centrality metrics within the anemia protein interaction network to uncover potential therapeutic targets. By analyzing genomic and proteomic data, we identified critical proteins using centrality metrics, including Degree, Closeness, Betweenness, and Radiality. The study focused on five key proteins: GAPDH, EEF2, TPI1, ACO1, and RPS13. These proteins were assessed for their roles in cellular processes related to anemia. Our findings highlight GAPDH's multifunctional roles in glycolysis and iron homeostasis, EEF2's regulation of protein synthesis under stress, TPI1's crucial function in glycolysis and its link to hemolytic anemia, ACO1's dual role in the TCA cycle and iron regulation, and RPS13's importance in protein synthesis and erythropoiesis. Each protein was identified as a significant node within the network, indicating its potential as a biomarker and therapeutic target. The integration of genomic, proteomic, and clinical data revealed that these proteins play pivotal roles in the molecular mechanisms underlying anemia. GAPDH interacts with iron-regulatory proteins, EEF2 modulates protein synthesis, TPI1 mutations lead to hemolytic anemia, ACO1 regulates iron homeostasis and is linked to sideroblastic anemia, and RPS13 contributes to erythropoiesis. This study explores how specific proteins may contribute to the development and progression of anemia. Rather than reinforcing existing models, it introduces fresh biological clues that could reshape how clinicians interpret and treat this condition. These findings point toward personalized treatment options and offer a more refined lens for evaluating patient needs.

Seroprevalence of Cytomegalovirus and Toxoplasma in People Living With HIV Referred to the Behavioral Diseases Counseling Center in Tehran

Peyman Kouhi Habibi Dehkordi — 2026-01-04

According to data from the WHO and CDC, Toxoplasma gondii is found worldwide, with a higher prevalence in regions with warm, humid climates; the highest reported rates in the general population reach 90%. The prevalence of cytomegalovirus infection among the general population of Iran has been estimated at 5.2%. According to the existence of insufficient data on the seroprevalence of Cytomegalovirus (CMV) infections in Tehran and the Center for Behavioral Diseases of human immunodeficiency virus (HIV)+ and toxoplasmosis among the people of Imam Khomeini Hospital, as well as the grave and fatal complications that threaten these infections, to identification, prevention and timely treatment of People Living with HIV (PLWH), general knowledge of its prevalence in our country is essential. This project was a cross-sectional study of PLWH referred to the Behavioral Diseases Counseling Center of Imam Khomeini Hospital in Tehran in 2018. A number was assigned to each patient who visited this year, and 348 were selected from this group. Anti-Cytomegalovirus Immunoglobulin G (IgG Anti CMV), and Anti-Toxoplasmosis Immunoglobulin G (IgG Anti-Toxoplasmosis) levels in serum were measured alongside demographic information, HIV transmission routes, disease duration, cluster of differentiation 4 (CD4) count, viral load, and Hepatitis B Virus and Hepatitis C Virus status of participants. The collected data were entered into IBM SPSS Statistics software version 25. The data were extracted from the patients' files to support the research aim. The seroprevalence of cytomegalovirus and toxoplasmosis was 99.4% and 41.7%, respectively. Due to cytomegalovirus's high prevalence, it has been impossible to investigate the impact of influential factors, and the efforts have been ineffective. A statistically significant relationship was seen between factors of hepatitis B serum level and marital status with the prevalence of toxoplasmosis; more than half of participants who were married were infected with Toxoplasma in comparison with the unaffected 28.2% (P<0.001). A larger portion of participants with positive HBV test results were infected with Toxoplasma, in contrast to 39% in the HBV-negative group (P=0.017). But no relationship with gender was observed (42.8% vs 39%). In this study, a significant association was observed between serum levels of positive hepatitis B (Hepatitis B Surface Antigen or Hepatitis B Core Antibody) and anti-toxoplasmosis antibody. Given the 99% prevalence of CMV in the population, it is recommended to conduct further research on demographic factors, such as residence and income level, or on the reliability and accuracy of the laboratory testing kits at this facility.

Exploring the Relationship Between Migraine and Blood Pressure in Pediatric Patients: A Case-Control Study

Saba Rezazadeh — 2026-01-04

Migraine headaches are a significant concern for both parents and primary care providers due to their frequency and impact on the child's quality of life. Studies in the adult population have shown that migraines are linked to cardiovascular disease. This study aimed to compare blood pressure in children with and without Migraine. In this case-control study, we evaluated blood pressure in patients with Migraine and a control group. Blood pressure was evaluated during three clinic visits. Systolic, diastolic, pulse, and mean arterial blood pressure were compared between the two groups, and the association between blood pressure and Migraine was evaluated using the odds ratio. The mean systolic and diastolic pressures, pulse pressure, and mean arterial pressure were not significantly different between the two groups (P>0.05). Twenty-three children with Migraine had abnormal blood pressure, and the adjusted odds ratio was 1.32 (95% CI: 0.68-2.57). There was no significant relationship between prehypertension, stage 1 hypertension, and stage 2 hypertension and Migraine in children (P>0.05). The prevalence of prehypertension in children with bilateral Migraine was higher compared to unilateral Migraine, although this difference was not statistically significant (P>0.05). Our results did not confirm blood pressure as an etiological factor in children with Migraine. These findings suggest that further research is needed to explore the relationship between Migraine and blood pressure in pediatric populations.

Gender Determination Using the Hyoid Bone: A Discriminant Function Analysis

Atie Safaee — 2026-01-04

The hyoid bone, with its unique morphology, offers a valuable alternative for gender determination in cases where traditional indicators like the pelvis and skull are compromised. This study aimed to investigate the relationship between gender and hyoid bone dimensions using CT scan images. This retrospective study analyzed 120 neck CT scans to investigate the relationship between gender and hyoid bone dimensions. RadiAnt DICOM Viewer software was used for evaluation. Measurements included width, length, and proximal and distal widths of the greater horns of the hyoid bones on both sides. Statistical analysis employed a range of techniques, including independent t-tests, paired t-tests, Spearman's rank correlation, and discriminant analysis, with a significance level of 0.05. This retrospective study analyzed 120 neck CT scans from 60 women (mean age 48.92±13.53 years) and 60 men (mean age 53.97±17.05 years). In examining the dimensions of the hyoid bone, all variables except the distal width of the greater horn on both sides (RDD, LDD) were found to have statistically significant differences between the two sexes. The classification of individuals by sex was correctly determined in 85% of cases using discriminant function analysis. Stepwise analysis identified hyoid body length and width as the most significant predictors, demonstrating 81.7% and 85% accuracy in classifying men and women, respectively. In our study population, measurements of body length and width at the hyoid bone proved highly reliable indicators of sex differentiation.

A Comparative Study of Apgar Score and Neonatal Dysrhythmia in Painless Delivery and Natural Childbirth

Mohammad Reza Golbadinejad — 2026-01-04

Effective pain relief supports both the mother and fetus against many stressors associated with labor pain, which can have adverse effects on both. This study was conducted to determine Apgar scores and neonatal dysrhythmia in painless delivery compared with natural childbirth. The current study was conducted as a cross-sectional investigation of 213 hospital records of pregnant women (2020-2022) who underwent natural childbirth and painless delivery using a combination of two drugs: 25 µg of fentanyl and 25 mg of pethidine. Data were extracted from both groups using a checklist that included maternal age, infant sex, gravidity, parity, gestational age, birth weight, duration of labor, number of previous cesarean sections, mode of delivery, neonatal Apgar score, and dysrhythmia. In this study, 49.3% delivered painlessly, whereas 50.7% experienced natural childbirth. The mean Apgar score for infants born to mothers who underwent natural childbirth was 9.81±0.53, whereas that for infants born to mothers who experienced painless delivery was 9.93±0.53. Despite the higher Apgar scores in infants delivered using painless methods, this increase was not statistically significant. No cases of dysrhythmia were observed in either group. Based on the results of the present study, it can be concluded that there were no significant differences in neonatal outcomes, specifically Apgar scores and dysrhythmia, between the two groups. Therefore, it can be stated that painless delivery may be the preferred method of childbirth for pregnant women who have a fear of labor pain.

Examining the Frequency of Complications of Vaginal Birth After Cesarean Delivery in Postpartum Time: A Retrospective Case-Series

Mahshid Shooshtari — 2026-01-04

This study investigates the complications associated with unplanned vaginal birth after cesarean delivery (VBAC) among women in Sistan-Balochistan province, who often delay hospital visits until labor is imminent due to concerns about clinician acceptance. A retrospective case-series study was conducted at Khash and Baharloo hospitals from September 2021 to October 2022. Data on all VBAC deliveries were collected from hospital records with informed consent. Maternal demographics, delivery profiles, and complications were analyzed using SPSS 22 software. The study investigated the safety and complications associated with vaginal birth after cesarean (VBAC) among 120 women, ultimately analyzing data from 114 participants after excluding those who underwent cesarean delivery due to failed trial of labor after cesarean (TOLAC). Out of 114 women who achieved VBAC, there were no maternal deaths. Complications included 5 (4.3%) uterine ruptures and 2 (1.7%) cases of endometritis. Four neonates had an Apgar score< 7 at five minutes, including one intrauterine fetal death (IUFD). Understanding the complications associated with VBAC is essential for developing localized guidelines tailored to individual patient needs.

Comparing the Efficacy and Safety of Tumor-Infiltrating Lymphocyte Therapy and Pembrolizumab in Advanced Melanoma: A Randomized Controlled Trial

Thaer A. Hussein — 2026-01-04

TIL and pembrolizumab treatments compared for advanced melanoma patient outcomes. The idea was to determine which one was better, the safety of each, and the quality of life of the patients under the treatments. While understanding the safety profile of both drugs, the assumption was that TIL therapy would be a better alternative to pembrolizumab in survival outcomes and quality of life improvements. 120 patients were randomly allocated (TIL n=60; pembrolizumab n=60). Progression-free survival (PFS) and overall survival (OS) were taken as primary endpoints. Secondary endpoints were objective response rate (ORR), quality of life (EORTC QLQ-C15-PAL), and safety (CTCAE v5.0). Median PFS was 8 vs 6 months (HR=0.85, 95% CI: 0.65-1.12; P=0.15). Median OS was 18 vs 17 months (HR=0.92, 95% CI: 0.70-1.21; P=0.21). ORR was similar (36% vs 34%). TIL improved physical functioning, and both arms provided emotional benefit. TIL was associated with higher rates of grade 3-4 toxicities, including neutropenia and cytokine release syndrome. TIL therapy resulted in survival outcomes similar to those with pembrolizumab, with improved quality of life but higher toxicity.