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The COVID-19 pandemic has had a devastating impact worldwide, with Iran being one of the hardest-hit countries in the Middle East. Understanding the factors that influence the spread of the virus is crucial for developing effective mitigation strategies. This study aims to investigate the geographical and climatic risk factors associated with COVID-19 incidence in the Kohgiluyeh and Boyer-Ahmad Province of southwest Iran during the 2020−2021 epidemic period. The study involved mapping the residential addresses of 15,585 patients with COVID-19 during 2020–2021. Geographical Information System (GIS) evaluated the effects of geographical and climatic determinants, including temperature, rainfall, humidity, evaporation, elevation, slope, and land cover, on COVID-19 occurrence. The data were analyzed using univariate and multivariate binary logistic regression. In the univariate model, significant climatic factors affecting COVID-19 susceptibility included elevation (p < 0.001, OR=0.617), evaporation (p < 0.001, OR=0.635), dusty days (p < 0.001, OR=1.050), humidity (p = 0.005, OR=1.013), and rainfall (p = 0.032, OR=0.998). Additionally, urban areas (p < 0.001, OR=65), irrigated farms (p < 0.001, OR=5.723), dry farms (p < 0.001, OR=3.101), thin forests (p = 0.009, OR=2.975), and thin rangeland (p = 0.030, OR=2.571) demonstrated the highest impact on the disease distribution. In the multivariate analysis, urban areas (p < 0.001 and OR=47.123), irrigated farms (p < 0.001, OR=4.510), dry farms (p = 0.006, OR=3.002), evaporation (p < 0.001, OR=0.999), and elevation (p < 0.001, OR=0.999) were found to be the main factors related to COVID-19 occurrence. Based on the study results, individuals living in urban areas, irrigated and dry farms, as well as in regions with lower elevation and lower evaporation, have a higher risk of contracting COVID-19.

Iran is one of the six countries with the most cutaneous leishmaniasis (CL) patients. Understanding better the genotypes of the parasite population in relation to geography and climate is critical to achieving better CL control. We aimed to characterise the population structure of Leishmania tropica, the cause of anthroponotic cutaneous leishmaniasis (ACL), from important foci in southeast (Bam and Kerman) and southwest (Shiraz) Iran. A total of 39 L. tropica isolates from ACL patients from southeast (Bam 14, Kerman 12) and southwest (Shiraz 13) Iran were analysed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) of the kinetoplast DNA (kDNA) using restriction enzymes MspI (HpaII) and ClaI. 37 genotypes were identified among south Iran L. tropica isolates. The unweighted pair group method with arithmetic mean (UPGMA) tree obtained from the banding patterns of ClaI digested kDNA RFLP distinguished southeast from and southwest L. tropica isolates with some subclustering but the MspI derived tree showed greater discrimination with greater subclustering and divergence of the two foci of southeast region but with some overlapping. Although a monophyletic structure has been defined for southeast L. tropica, isolates from two foci of southeast Iran were partly discriminated in the current study.

Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease associated with some environmental factors. In this study, we evaluated the effect of geo-climatic factors on CRS in a region of southwest Iran. The study mapped the residency addresses of 232 patients with CRS who lived in Kohgiluyeh and Boyer-Ahmad province and had undergone sinus surgery from 2014 to 2019. The effects of Mean Annual Humidity (MAH), Mean Annual Rainfall (MAR), Mean Annual Temperature (MAT), maximum MAT (maxMAT), minimum MAT (minMAT), Mean Annual Evaporation (MAE), wind, elevation, slope, and land cover were assessed on the occurrence of CRS using Geographical Information System (GIS). Statistical analysis was performed using univariate and multivariate binary logistic regression. Patients came from 55 points including villages, towns, and cities. In univariate analysis, climatic factors including MAT (OR = 0.537), minMAT (OR = 0.764), maxMAT (OR = 0.63), MAR (OR = 0.994), and MAH (OR = 0.626) were significantly related to CRS occurrence. Elevation (OR = 0.999), slope (OR = 0.9), and urban setting (OR = 24.667) were the significant determinants among geographical factors when analyzed independently. The multivariate analysis found maxMAT (OR = 0.5), MAR (OR = 0.994), elevation (OR = 0.998), and urban (OR = 16.8) as significant factors affecting CRS occurrence. The urban setting is the most critical factor affecting CRS disease. Cold and dry areas and low attitude are the other risk factors for CRS in Kohgiluyeh and Boyer-Ahmad province, southwest Iran.

Background Congenital hypothyroidism (CH) is one of the most prevalent preventable cause of mental retardation and intellectual disability in newborns. Genetic and environmental factors have been related to congenital hypothyroidism. Hence, this study was conducted to illustrate the incidence and spatial distribution of the CH using the dataset from the national newborn CH screening information system during 2011-2020in counties affiliated to the Kohgiluyeh and Boyer Ahmad University of Medical Sciences. Methods This was a cross-sectional study. All newborns that were screened for CH in 3–5 days of age in the health centers of Yasuj University of Medical Sciences were enrolled the study since 2011–2020. Meteorological data including information on temperature, humidity, precipitation in a 10-year period (2011–2020) was taken from the Meteorological Organization. The required information layers include slope, slope direction, height, vegetation and political divisions of the province, were purchased from the organizations that made the layers. The data related to the incidence of congenital hypothyroidism was collected from the 10-year reports of the provincial health center. Addresses of patients were transferred to Arc GIS 10.5 software and entered in urban and rural point ’ s layer to prepare and draw disease distribution maps in the province’s newborns. The influence of geographical factors on the occurrence of disease was done by SPSS 23 software using multivariate binary logistic regression. P -value < 0.05 was assumed as significant level. Results Out of 142,674 screened newborns for CH, 827 had positive screening, including 441 boys (53.3%) and 386 girls (46.7%). Total incidence per 1000 live birth was 5.79. Based on multivariate logistic regression, slope (sig = 0.0001, Exp(B) = 0.91, CI 95% Exp(B) = 0.87–0.95), thin forest (sig = 0.001, Exp(B) = 0.2, CI 95% Exp(B) = 0.07–0.53), water area (sig = 0.0001, Exp(B) = 8.91, CI 95% Exp(B) = 3.35–23.69), were predicting factors of CH. Conclusion Given that, the incidence of CH in the Kohgiluyeh and Boyar Ahmad province is higher than the average of country (Iran), and the geographical factors of land slope and type of vegetation were related to it that cannot be changed, it is very important to carry out necessary nutritional interventions during pregnancy to prevent newborns from contracting this disease.

Background Cystic echinococcosis (CE), a worldwide zoonotic disease, is affected by various biological and environmental factors. We investigated dog/livestock populations, climatic and environmental factors influencing the distribution of human CE cases in Fars province, southwest Iran. Methods We mapped the addresses of 266 hospitalised CE patients (2004–2014) and studied the effects of different temperature models, mean annual rainfall and humidity, number of frosty days, slope, latitude, land covers, close proximity to nomads travel routes, livestock and dog densities on the occurrence of CE using geographical information systems approach. Data were analyzed by logistic regression. Results In the multivariate model predicting CE, living in an urban setting and densities of cattle and dogs were the most important CE predictors, sequentially. Dry (rained) farm, density of camel and sheep, close proximity to nomads travel routes, humidity, and slope also were considered as the determinants of CE distribution, when analyzed independently. Slope had a negative correlation with CE while temperature, frost days and latitude were not associated with CE. Conclusions In our study, an urban setting was the most important risk factor and likely due to a combination of the high density of key life cycle hosts, dogs and livestock, a large human susceptible population and the high number of abattoirs. Farmland and humidity were highly suggestive risk factors and these conditions support the increased survival of Echinococcus granulosus eggs in the soil. These findings support the development of strategies for control of disease. More research is needed test optimal interventions.

Visceral Leishmaniasis (VL) is an endemic parasitic disease and remains as a major health concern in southwestern Iran. The current study describes clinico-hematological, epidemiological and therapeutic features of VL cases, admitted to university-affiliated hospitals, during 1999-2014 in Fars province, southwestern Iran. A total of 380 VL cases were recorded during a 16 years period, giving an average annual admission of 23.75 cases/year in which 217 (57.1%) were male and 163 (42.9%) were female. Mean age of the patients was 3.7 years. The majority of the cases (91.5%) were ≤ 5 years old. Bone-marrow aspiration detected Leishmania amastigotes only in 26.6% of cases. Fever (98.1%), abdominal protrusion (65.1%) and hepatosplenomegaly (63.7%) were the most common clinical presentations of the patients. Pancytopenia was noted in 43.1, anemia in 87.3 and thrombocytopenia in 64% of cases. Increase in the level of AST (aspartate aminotransferase), ALT (alanine aminotransferase), alkaline phosphatase, LDH (lactate dehydrogenase) and CRP (C-Reactive Proteins) were seen in 84.9, 53.6, 44.4, 72.5 and 83.1% of cases, respectively. Mortality was noted in 5.3% of cases. Deranged haemato-biochemical parameters including total and direct bilirubin, PLT (platelet) and pancytopenia were significantly contributed to mortality from VL. Moreover, clinical features such as severe splenomegaly as well as bacterial infections were meaningfully contributed to death from VL. The majority of patients (74.9%) were treated with meglumine antimoniate. Amphotericin B was administrated in 59 of cases, 11 of them were initially treated with meglumine antimoniate with a shift to amphotericin B, because of treatment failure. Findings of the current study demonstrated that VL is present in southwest of Iran with a fairly continual rate during the last 16 years period. Deranged haemato-biochemical parameters along with severe splenomegaly contributed to mortality from VL.

Background Snails of the Lymnaeidae family are the intermediate hosts of Fasciola species, the causative agents of fascioliasis. The purpose of this study was to determine the prevalence of Fasciola species in lymnaeid snails and to investigate the association of geoclimatic factors and Fasciola species distribution in northwestern provinces of Iran using geographical information system (GIS) data. Methods A total of 2000 lymnaeid snails were collected from 33 permanent and seasonal habitats in northwestern Iran during the period from June to November 2021. After identification by standard morphological keys, they were subjected to shedding and crushing methods. Different stages of Fasciola obtained from these snails were subjected to the ITS1 polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method for species identification. The associations of weather temperature, rainfall, humidity, evaporation, air pressure, wind speed, elevation, and land cover with the distribution of Fasciola species were investigated. Geographical and statistical analysis was performed using ArcMap and SPSS software, respectively, to determine factors related to Fasciola species distribution. Results Of the 2000 snails collected, 19 were infected with Fasciola hepatica (0.09%), six with F. gigantica (0.03%), and 13 with other trematodes. Among geoclimatic and environmental factors, mean humidity, maximum humidity, and wind speed were significantly higher in areas where F. hepatica was more common than F. gigantica . The altitude of F. hepatica -prevalent areas was generally lower than F. gigantica areas. No significant relationship was observed between other investigated geoclimatic factors and the distribution of infected snails. Conclusions The present study showed the relationship of humidity and wind speed with the distribution of snails infected with F. hepatica or F. gigantica in the northwestern regions of Iran. In contrast to F. gigantica , F. hepatica was more prevalent in low-altitude areas. Further research is recommended to elucidate the relationship between geoclimatic factors and the presence of intermediate hosts of the two Fasciola species. Graphical Abstract

Background This study investigates the prevalence of hypervirulent Klebsiella pneumoniae (hvKp) in clinical isolates, emphasizing hypermucoviscosity, virulence-related genes, capsular serotype, and extended-spectrum β-lactamase (ESBL) genes. Methods During a 12-month surveillance study, a total of 144 K. pneumoniae isolates were obtained from various clinical specimens of patients referred to teaching hospitals in Yasuj, Iran. Antimicrobial susceptibility testing was performed for various classes of antibiotics using the disk diffusion method. Detection of virulence genes ( rmpA , rmpA2 , iucA , peg-344 ), capsular serotype ( K1 , K2 ), and ESBLs ( bla SHV , bla TEM , bla CTX-M ) was conducted using polymerase chain reaction (PCR). Results A total of 31 isolates (21.5%) were identified as hvKp, while 113 (78.5%) were classified as cKp. Among hvKp, iucA (100%) and rmpA2 (77.4%) were the most prevalent virulence genes, while among all K. pneumoniae isolates, rmpA , rmpA2 , and iucA were detected in 11.1%, 16.7% and 21.5%, respectively. Capsular serotype K2 was found in 21.5% of isolates and 9.7% of hvKp, while serotype K1 was not detected in any isolate. ESBL production was observed in 22.2% of isolates and 22.6% of hvKp. Genotypically, bla SHV , bla CTX-M , and bla TEM were identified in 88.9%, 69.4%, and 58.3% of isolates and in 90.3%, 100%, and 74.2% of hvKp, respectively. The highest resistance to third-generation cephalosporins, including cefotaxime, ceftazidime, and ceftriaxone, was observed among all 144 K. pneumoniae isolates as well as hypervirulent strains, whereas gentamicin showed the highest susceptibility. Multidrug-resistant (MDR), extensively drug-resistant (XDR), and carbapenem-resistant K. pneumoniae (CRKP) were identified in 72.9%, 59.7%, and 79.2% of isolates, respectively. In comparison, all these resistance phenotypes were observed in 90.3% of hvKp strains. Conclusions These findings demonstrate strong coexistence of virulence and resistance in K. pneumoniae , particularly among hvKp. The high prevalence of virulence factors such as iucA (100%) and rmpA2 (77.4%), with MDR, XDR, and CRKP phenotypes detected in 90.3% of hvKp isolates, indicates a critical situation and emphasizes the need for accurate molecular diagnosis, continuous monitoring, and rational antibiotic use.

Pediatric respiratory allergic diseases, including asthma and allergic rhinitis, are increasingly recognized as significant global health concerns, with rising prevalence rates linked to environmental changes driven by urbanization and climate change. This review explores the impact of climatic factors such as temperature fluctuations, shifting precipitation patterns, and dust storms on air pollution and its consequences on respiratory allergic diseases in children. Evidence suggests these environmental exposures increase allergen loads and profoundly influence immune system function. Air pollutants and airborne allergens promote Type 2 helper T‐cell (Th2)‐skewed responses, leading to elevated IgE production, eosinophilic inflammation, and airway hyperreactivity. Additionally, epithelial barrier dysfunction caused by oxidative stress triggers the release of alarmins such as thymic stromal lymphopoietin, interleukin‐33 (IL‐33), and IL‐25, that activate innate lymphoid cells, and amplify allergic sensitization. Long‐term exposure to pollutants also disrupts immune tolerance by impairing regulatory T‐cell (Treg) activity and promoting persistent airway inflammation. This review highlights how these immunological pathways contribute to the severity and chronicity of allergic diseases in pediatric populations, with special attention to studies conducted in regions prone to dust storms. Understanding these mechanisms is critical for developing targeted public health strategies, improving air quality, and mitigating the health impacts of climate change on children.

Visceral leishmaniasis (VL) is endemic in Iran and is caused predominantly by Leishmania infantum, but L. tropica is emerging as an important cause. We studied the intra-species population structure of Leishmania spp. causing VL in southwest Iran by sequence analysis of the internal transcribed spacer (ITS) 1 of DNA samples from 29 bone marrow aspiration smears. L. infantum (n = 25) and L. tropica (n = 4) were identified, consisting of 10 and three ITS1 sequence types (STs), respectively. Compared to GenBank ITS1 STs, our L. infantum parasites displayed high heterogeneity but less heterogeneity compared than northwest Iranian isolates. VL affects mostly nomadic populations in southwest Iran, and their mobility may explain partly the L. infantum heterogeneity. The VL causing L. tropica was also genetically heterogeneous but genetically indistinguishable from L. tropica strains causing anthroponotic cutaneous leishmaniasis from southwest Iran.