Publications by authors named "Ehsan Chitsaz"

25 Publications

  • Page 1 of 1

What Does a Positive Multi-target Stool DNA Test With a Negative Colonoscopy Can AND Cannot Tell Us About Risk of Aerodigestive Cancers Incidence.

Authors:
Ehsan Chitsaz

Clin Gastroenterol Hepatol 2021 Apr 26;19(4):853-854. Epub 2020 Nov 26.

Case Western Reserve School of Medicine, Cleveland, Ohio.

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http://dx.doi.org/10.1016/j.cgh.2020.05.033DOI Listing
April 2021

Competition Shadow: Anchoring to Fear Versus Hope in Estimating Rivals in Competition.

Adv Cogn Psychol 2020 3;16(3):186-201. Epub 2020 Sep 3.

School of Economy and Management, Harbin Institute of Technology, Heilongjiang, China4.

We studied the effect of two inconsistent emotions, fear and hope, in strategic decision-making during a competition. We sought to examine which emotion will be more related to whether decision-makers accurately and objectively estimate their rival We developed a nuanced perspective on the effects of trait anxiety on rival estimation by integrating it with the competition shadow. Using a competition simulation and basing on data from 221 individuals across two countries, we found support for a predicted effect of trait anxiety on rival estimation. Several theoretical implications are discussed.
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http://dx.doi.org/10.5709/acp-0296-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509682PMC
September 2020

APECED-Associated Hepatitis: Clinical, Biochemical, Histological and Treatment Data From a Large, Predominantly American Cohort.

Hepatology 2021 Mar;73(3):1088-1104

Translational, Hepatology Section, Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.

Background And Aims: Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), caused by autoimmune regulator (AIRE) mutations, manifests with chronic mucocutaneous candidiasis (CMC) and multisystem autoimmunity, most often hypoparathyroidism (HP) and adrenal insufficiency (AI). European cohorts previously reported a ~10% prevalence of APECED-associated hepatitis (APAH) with presentations ranging from asymptomatic laboratory derangements to fatal fulminant hepatic failure. Herein, we characterized APAH in a large APECED cohort from the Americas.

Approach And Results: Forty-five consecutive patients with APECED were evaluated (2013-2015) at the National Institutes of Health (NIH; NCT01386437). Hepatology consultation assessed hepatic and autoimmune biomarkers and liver ultrasound in all patients. Liver biopsies evaluated autoimmune features and fibrosis. The 16S ribosomal RNA (rRNA) sequencing was performed in 35 patients' stools (12 with and 23 without APAH). Among 43 evaluable patients, 18 (42%) had APAH; in 33.3% of those with APAH, APAH occurred before developing classic APECED diagnostic criteria. At APAH diagnosis, the median age was 7.8 years, and patients manifested with aminotransferase elevation and/or hyperbilirubinemia. All patients with APAH were in clinical remission during their NIH evaluation while receiving immunomodulatory treatment. We found no difference in age, sex, or prevalence of CMC, AI, or HP between patients with or without APAH. Autoantibody positivity against aromatic L-amino acid decarboxylase, cytochrome P450 family 1 subfamily A member 2, histidine decarboxylase (HDC), bactericidal/permeability-increasing fold-containing B1, tryptophan hydroxlase, and 21-hydroxylase (21-OH), and the homozygous c.967_979del13 AIRE mutation were associated with APAH development. Classical serological biomarkers of autoimmune hepatitis (AIH) were only sporadically positive. AIH-like lymphoplasmacytic inflammation with mild fibrosis was the predominant histological feature. Stool microbiome analysis found Slackia and Acidaminococcus in greater abundance in patients with APAH.

Conclusions: APAH is more common than previously described, may present early before classic APECED manifestations, and most often manifests with milder, treatment-responsive disease. Several APECED-associated autoantibodies, but not standard AIH-associated biomarkers, correlate with APAH.
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http://dx.doi.org/10.1002/hep.31421DOI Listing
March 2021

"Dwarfing" White Strands on Screening Colonoscopy!

Gastroenterology 2018 Sep 24;155(3):e22-e23. Epub 2018 Apr 24.

Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Maryland.

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http://dx.doi.org/10.1053/j.gastro.2018.04.022DOI Listing
September 2018

Coffee consumption and decreased all-cause mortality - What is the true estimate of effect?

J Hepatol 2018 05 7;68(5):1105. Epub 2018 Feb 7.

Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD 20892, USA.

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http://dx.doi.org/10.1016/j.jhep.2018.01.028DOI Listing
May 2018

Black Smoke Arising in the Duodenum After Liver Biopsy: What Does the Smoke Signal Mean?

Gastroenterology 2018 Sep 4;155(3):e1-e2. Epub 2018 Aug 4.

Digestive Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

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http://dx.doi.org/10.1053/j.gastro.2018.01.058DOI Listing
September 2018

Role of proton pump inhibitors in the occurrence of spontaneous bacterial peritonitis.

Authors:
Ehsan Chitsaz

Liver Int 2014 Apr 23;34(4):645. Epub 2013 Dec 23.

Department of Internal Medicine, Boston University Medical Center, Boston, MA, USA.

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http://dx.doi.org/10.1111/liv.12425DOI Listing
April 2014

Concomitant, sequential, and hybrid therapy for Helicobacter pylori: which one is the correct answer?

Authors:
Ehsan Chitsaz

Clin Res Hepatol Gastroenterol 2013 Dec 24;37(6):e125-6. Epub 2013 Aug 24.

Boston University Medical Center Place, Internal Medicine Department, Boston, MA 02118, USA. Electronic address:

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http://dx.doi.org/10.1016/j.clinre.2013.07.007DOI Listing
December 2013

Contribution of substance use disorders on HIV treatment outcomes and antiretroviral medication adherence among HIV-infected persons entering jail.

AIDS Behav 2013 Oct;17 Suppl 2:S118-27

Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA.

HIV and substance use are inextricably intertwined. One-sixth of people living with HIV/AIDS (PLWHA) transition through the correctional system annually. There is paucity of evidence on the impact of substance use disorders on HIV treatment engagement among jail detainees. We examined correlates of HIV treatment in the largest sample of PLWHA transitioning through jail in 10 US sites from 2007 to 2011. Cocaine, alcohol, cannabis, and heroin were the most commonly used substances. Drug use severity was negatively and independently correlated with three outcomes just before incarceration: (1) having an HIV care provider (AOR = 0.28; 95 % CI 0.09-0.89); (2) being prescribed antiretroviral therapy (AOR = 0.12; 95 % CI 0.04-0.35) and (3) high levels (>95 %) of antiretroviral medication adherence (AOR = 0.18; 95 % CI 0.05-0.62). Demographic, medical and psychiatric comorbidity, and social factors also contributed to poor outcomes. Evidence-based drug treatments that include multi-faceted interventions, including medication-assisted therapies, are urgently needed to effectively engage this vulnerable population.
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http://dx.doi.org/10.1007/s10461-013-0506-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3818019PMC
October 2013

Post-release substance abuse outcomes among HIV-infected jail detainees: results from a multisite study.

AIDS Behav 2013 Oct;17 Suppl 2:S171-80

Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College St., Suite 323, New Haven, CT, 06510-2283, USA,

HIV-infected individuals with substance use disorders have a high prevalence of medical and psychiatric morbidities that complicate treatment. Incarceration further disrupts healthcare access and utilization. Without appropriate diagnosis and treatment, drug relapse upon release exceeds 85 %, which contributes to poor health outcomes. A prospective cohort of 1,032 HIV-infected jail detainees were surveyed in a ten-site demonstration project during incarceration and six-months post-release, in order to examine the effect of predisposing factors, enabling resources and need factors on their subsequent drug use. Homelessness, pre-incarceration cocaine and opioid use, and high drug and alcohol severity were significantly associated with cocaine and opioid relapse. Substance abuse treatment, though poorly defined, did not influence post-release cocaine and opioid use. An approach that integrates multiple services, simultaneously using evidence-based substance abuse, psychiatric care, and social services is needed to improve healthcare outcomes for HIV-infected persons transitioning from jails to the community.
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http://dx.doi.org/10.1007/s10461-012-0362-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600070PMC
October 2013

Sequential antiretroviral adherence: things to consider.

Authors:
Ehsan Chitsaz

J Int Assoc Physicians AIDS Care (Chic) 2012 Jul-Aug;11(4):217-8; author reply 219

1Yale University School of Medicine, Section of Infectious Diseases, Yale AIDS Program, New Haven, CT, USA.

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http://dx.doi.org/10.1177/1545109712444465DOI Listing
February 2014

Wells' prediction rules for pulmonary embolism: valid in all clinical subgroups?

Blood Coagul Fibrinolysis 2012 Oct;23(7):614-8

Cardiovascular Department, Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran.

Pulmonary embolism is major cause of hospital death. Clinical prediction rules such as Wells' prediction rules can help in selection of at-risk patients who need further testing for pulmonary embolism. We evaluated the usefulness of such criteria for detection of patients with diagnosed pulmonary embolism. Patients enrolled in National Research Institute of Tuberculosis and Lung Disease (NRITLD) deep venous thrombosis (DVT) registry were evaluated and those with objective data about presence or absence of pulmonary embolism were selected for this study. Diagnosis of pulmonary embolism was based on computed tomography pulmonary angiography (CTPA). We calculated the embolic burden in those with CTPA-confirmed pulmonary embolism. Eighty-six patients entered the study (58 males, 28 females, mean age = 54.39 ± 1.74 years). Fifty-four cases had coexisting pulmonary embolism (embolic burden score: 10.77 ± 1.181). Embolic burden score was correlated to presence of massive pulmonary embolism (Pearson rho: 0.43, P = 0.002). There was no association between Wells' pulmonary embolism score and the occurrence of pulmonary embolism (Spearman's rho: 0.085, P = 0.51). Dividing the patients into two, or three, risk groups according to Wells' model did not reveal an association with occurrence of pulmonary embolism either (P = 0.99 and P = 0.261, respectively). Tachycardia and hemoptysis were the only parameters from the Wells' pulmonary embolism score correlated to presence of pulmonary embolism (Spearman's rho: 0.373, P < 0.000 and Spearman's rho: 0.297, P = 0.005, correspondingly). Wells' pulmonary embolism score could not predict the occurrence of pulmonary embolism in DVT patients suspected of having coexisting pulmonary embolism. Until further studies shed light on this patient subset, overreliance on Wells' prediction rules as the solo decision making tool should be cautioned.
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http://dx.doi.org/10.1097/MBC.0b013e328356926eDOI Listing
October 2012

Treatment outcome and mortality: Their predictors among HIV/TB co-infected patients from Iran.

Int J Mycobacteriol 2012 Jun 21;1(2):82-6. Epub 2012 Jun 21.

Clinical TB and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The risk of death is significantly higher in TB/HIV-infected patients than in those patients with just one disease or the other. This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a TB tertiary center in Iran.

Materials And Methods: The study was conducted at Iran's National Referral Center for Tuberculosis. In total, 111 patients were recruited between 2004 and 2007. Mycobacteriology studies were performed for all patients. Demographic, clinical, and lab data of all patients were analyzed, and predictors of unsuccessful outcomes, as well as mortality, were determined.

Results: The mean age for all 111 TB/HIV patients was 38±9years (range 22-70) and 107 patients (96.3%) were male; 104 patients (93.7%) had a history of drug abuse, and 96 patients (86.4%) had a history of imprisonment. The route of transmission of HIV was intravenous drug use in 88 of the patients (79.3%); 23 patients (20.7%) had a history of Category 1 (CAT-1) (5.4%) and CAT-2 treatment. Highly Active Antiretroviral Therapy (HAART) was given to 48 patients (43.2%). There was no significant association found between treatment outcome or mortality with sex, smoking, drug and alcohol abuse, imprisonment, route of transmission, history of CAT-1 and CAT-2, cluster of differentiation 4 (CD4), and adverse effects (p>0.05). Administration of HAART led to a significantly higher rate of good outcome (p<0.001). Lower Albumin levels and body weight were significantly associated with mortality.

Conclusion: Albumin levels and weight can be predictors of mortality and an unsuccessful outcome. Administration of HAART led to a better outcome.
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http://dx.doi.org/10.1016/j.ijmyco.2012.05.002DOI Listing
June 2012

Utility of Gastric Lavage for Diagnosis of Tuberculosis in Patients who are Unable to Expectorate Sputum.

J Glob Infect Dis 2011 Oct;3(4):339-43

Clinical Tuberculosis and Epidemiology Research Center, N. R. I. T. L. D, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Science and Health Services, Tehran, Iran.

Background: There are number of patients who are unable to expectorate sputum specimens. In this study, we used gastric lavage (GL) test for diagnosis of tuberculosis (TB) in patients who were unable to produce sputum.

Materials And Methods: Patients who were unable to produce sputum specimens were included in the study to confirm TB disease. Gastric lavage sampling was performed and sent for acid fast bacillus smear and culture under special laboratory conditions and sterilized methods. Further bronchoscopy for broncho-alveolar lavage was done on patients with negative GL smear results. Drug susceptibility tests were performed on 48 GL culture positive cases.

Results: Eighty-five patients were included in the study; who were hospitalized at our referral center for suspected TB. GL smears were reported to be positive in 37 cases (66.07%) and culture in 85.7%. The total number of smear and culture-positive cases in this study was 48 (85.7%). Forty cases (87%) of drug-sensitive, 1 case (2.2%) of isoniazid and rifampin-resistant TB (multi-drug resistant; MDR), and 5 cases of resistant to one drug were detected. There have not been observed any complications after the GL method.

Conclusion: It seems that regarding the high number of positive GL cultures (85.7%), GL can be effective for diagnosis of patients who have suspicious tuberculosis symptoms and are unable to produce sputum especially in resource limited areas.
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http://dx.doi.org/10.4103/0974-777X.91054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249987PMC
October 2011

Dexter versus sinister deep vein thrombosis: which is the more sinister? Findings from the NRITLD DVT registry.

Semin Thromb Hemost 2011 Apr 31;37(3):298-304. Epub 2011 Mar 31.

Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University MC, Tehran, Iran.

Deep vein thrombosis (DVT) is a major health problem. Despite the wealth of studies on its epidemiology, few have described the thrombus sidedness and particularly the association of thrombus sidedness with clinical presentation and subsequent complications. This article reviews current knowledge regarding this topic and in light of recent data from a large prospective study. This is the first report from the prospective National Research Institute of Tuberculosis and Lung Disease DVT registry. Patients with ultrasound-confirmed symptomatic DVT were enrolled, and thrombus sidedness was investigated in each case. Computed tomography pulmonary angiography was used to diagnose coexisting pulmonary embolism (PE) in DVT patients with suggestive symptoms. Embolic burden score was calculated for those with PE. From the total of 100 patients, 45 had left-sided DVT, 41 had right-sided DVT, and 14 had bilateral DVT. Presenting symptoms and comorbidities were comparable, except for cancer, which was more common in those with right-sided involvement (either right-sided or bilateral DVT; P = 0.004). Compared with those with left-sided DVT, PE happened more frequently in right-sided DVT patients. Right-sided DVT patients also had a higher rate of massive PE ( P = 0.03) and a greater mean embolic burden (13.32 ± 1.63 versus 6.05 ± 1.06; P = 0.001). These findings support raised awareness for global reconsideration of the assumption of complete identicalness of right-sided and left-sided DVT. Although future studies are needed to better elucidate epidemiological and prognostic differences based on the thrombus sidedness, our preliminary findings suggest that the two are not completely identical and right-sided DVT might be more ominous.
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http://dx.doi.org/10.1055/s-0031-1273093DOI Listing
April 2011

Revised Category II regimen as an alternative strategy for retreatment of Category I regimen failure and irregular treatment cases.

Am J Ther 2011 Sep;18(5):343-9

Mycobacteriology Research Center, NRITLD, Sheheed, Beheshti University of Medical Science, Tehran, Iran.

Currently, the Category (CAT) II regimen is recommended for patients who have failed the CAT I regimen. We have determined before that prevalence of multidrug-resistant tuberculosis (MDR TB) is relatively high among these patients. On the other hand, the retreatment success rate with CAT II in CAT I treatment failures and defaults is nearly 50%. Therefore, we tried to find another strategy with a higher success rate. From January 2004 to November 2007, 105 patients with pulmonary TB, who failed a prior CAT I regimen or with more than one course of irregular anti-TB treatment, were included in this study, whereas five cases with nontuberculous mycobacteria were excluded. Drug susceptibility testing (DST), for first line anti-TB drugs, and polymerase chain reaction were performed. By the time of availability of DST that took 3 to 4 months, a pilot protocol consisted of isoniazid, rifampin, ethambutol, ofloxacin, cycloserine, and amikacin was started. Then therapeutic regimen was adjusted based on four categories of DST pattern: sensitive, non-MDR pattern, MDR pattern, and culture-negative. Sensitive patients received the standard CAT I regimen, non-MDR patients an individualized regimen based on DST, MDR patients a standard second-line regimen, and culture-negatives a standard CAT I plus a 6-month injectable agent. Treatment outcomes were categorized and analyzed. Forty-eight patients with prior CAT I treatment failure and 52 with more than one irregular treatment courses were included in the analysis. Six percent of subjects had confirmed HIV infection. Seventy-two percent of subjects were assigned to a good outcome and 28% were assigned to a poor outcome group. Seventeen percent were culture-negative. Regarding DST pattern, 13% isolated strains were completely sensitive to first-line drugs. 53% strains were MDR, 10% monodrug-resistant, and 7% polydrug-resistant. There was no significant association between DST pattern and outcome (P = 0.13). The irregular regimen was associated with MDR TB as twice as CAT I regimen failure (69.2% versus 35.4%, P = 0.004). Patients with MDR TB significantly experienced more side effects than non-MDR-TBs (47% versus 27%, P = 0.102). Of 100 patients, 72% were cured, 5% abandoned treatment, 12% died, 6% were classified as treatment failures, 1% relapsed, and 5% were transferred out. Of 53 patients with MDR TB, 33 subjects were cured and seven died. All together, successful outcome was achieved in 62.2%, 76%, and 76% of MDR TB, non-MDR TB, and completely sensitive cases, respectively. A retreatment strategy based on DST and replacing the Category II regimen with an intermediate regimen called revised CAT II may improve clinical outcomes among Category I treatment failures and defaults who found to have active, infectious MDR TB. This strategy significantly reduces delays to MDR TB diagnosis and to the initiation of MDR TB therapy. Success rate of this strategy is 62.2% and 72% in MDR TB and overall CAT I failure cases and defaulters, respectively.
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http://dx.doi.org/10.1097/MJT.0b013e3181dd60ecDOI Listing
September 2011

Performance of QuantiFERON-TB Gold test compared to tuberculin skin test in detecting latent tuberculosis infection in HIV- positive individuals in Iran.

Ann Thorac Med 2010 Jan;5(1):43-6

Iranian Infectious Disease Research Center, Shaheed Beheshti Medical University, Tehran, Iran.

Background: There is limited data about the performance of QuantiFERON-TB Gold (QFT-G) test in detecting latent tuberculosis infection (LTBI) in our region. We intended to determine the performance of QFT-G compared to conventional tuberculin skin test (TST) in detecting LTBI in HIV-positive individuals in Iran.

Methods: This study was conducted in a HIV clinic in Tehran, Iran in April 2007. A total of 50 consecutive HIV-positive patients, not currently affected with active tuberculosis (TB), were recruited; 43 (86%) were male. The mean age was 38 ± 7.2 years (21-53). All had history of Bacillus Calmette Guerin (BCG) vaccination. A TST with purified protein derivative (PPD) and whole-blood interferon-gamma release assay (IGRA) in reaction to ESAT-6 and CFP-10 antigens was performed and measured by enzyme-linked immuno-sorbent assay (ELISA). The agreement between TST and QFT-G results were analyzed using Kappa test.

Results: A total of 36 (72%) patients had negative and 14 (28%) revealed positive TST. For QFT-G, 20 (40%) tested positive, 19 (38%) tested negative, and the results in 11 cases (22%) were indeterminate. A total of 14 (28%) patients had a CD4 count of <200. Of the 14, TST + group, 12 had QFT-G +, only one case TST+/QFT-G-, and QFT-G was indeterminate in one TST positive case. Of the 36 patients with negative TST tests, 8 (22%) had positive GFT-G and 10 (28%) yielded indeterminate results. There was no association between a positive TST and receiving highly active anti-retroviral therapy (HAART) or absolute CD4 counts. Similarly, the association between QFT-G results and receiving HAART or CD4 counts was not significant (P = 0.06). Although TST results were not significantly different in patients with CD4 < 200 vs. CD4 >200 (P = 0.295), association between QFT-G results and CD4 cutoff of 200 reached statistical significance (P = 0.027). Agreement Kappa coefficient between TST and QFT-G was 0.54 (Kappa = 0.54, 95% CI = 38.4-69.6,P < 0.001).

Conclusion: Detecting LTBI in HIV-positive individuals showed moderate agreement between QFT-G and LTBI in our study. Interestingly, our findings revealed that nontuberculous mycobacteria and prior BCG vaccination have minimal influence on TST results in HIV patients in Iran.
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http://dx.doi.org/10.4103/1817-1737.58959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841808PMC
January 2010

Biliary atresia: the timing needs a changin'.

Can J Public Health 2009 Nov-Dec;100(6):475-7

Division of Gastroenterology, BC Children's Hospital, Rm K4-200, 4480 Oak Street, Vancouver, BC V6H 3V4.

Biliary atresia (BA), a uniquely pediatric liver disease, is the leading cause of liver-related death in children and the most frequent indication for liver transplantation in the pediatric population. Early intervention with a Kasai procedure (KP) is the current standard of care for this condition. The single most important and well-established prognostic factor for the KP outcome is the patient's age at the time of the KP. The older the infant, the less successful the operation and the less favourable is the post-KP survival with native liver. There remains in Canada, and throughout the world, a problem of late referral, delayed diagnosis and older age at surgery. Early disease detection and intervention has been hampered by the lack of an effective screening strategy for BA. Recently, however, novel programs for the early identification of BA in the first month of life, but after two weeks of age, have been successfully implemented and evaluated in some countries, with significantly improved outcomes for affected infants. Whether any of these programs should be adopted to improve the timing of referral and treatment for Canadian infants affected with this devastating liver disease deserves consideration and study.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973595PMC
March 2010

Impact of extensively drug-resistant tuberculosis on treatment outcome of multidrug-resistant tuberculosis patients with standardized regimen: report from Iran.

Microb Drug Resist 2010 Mar;16(1):81-6

Mycobacteriology Research Center, NRITLD, Shaheed Beheshti University of Medical Science, Tehran, Iran.

The limited experience in treating patients with extensively drug-resistant tuberculosis (XDR-TB) shows a therapeutic success rate under 50-60% and there are no publications regarding the outcome of these patients treated with standardized regimens. All multidrug-resistant tuberculosis (MDR-TB) patients hospitalized at the Masih Daneshvari Hospital in Tehran, Iran, during 2004-2007 were recruited. Drug susceptibility testing to 14 drugs (including eight second-line drugs) was performed and a standardized regimen with ofloxacin, cycloserine, prothionamide, and amikacin was administered for all patients. Outcome of the patients was studied, comparing between the MDR-TB non-XDR-TB and the XDR-TB. Fifty-one patients were included, 12 with XDR-TB criteria. Of 51, 48 were HIV negative and HIV status was unknown in three cases. All 12 were HIV negative. XDR-TB infection was significantly associated only with age (p = 0.039). The success rates for the total 51 MDR-TB, the 39 MDR-TB non-XDR-TB, and the 12 XDR-TB patients were 76.5% (39 patients), 87.2% (34 patients), and 41.7% (5 patients), respectively. Resistance to ofloxacin, ciprofloxacin, and amikacin were found to be significantly associated with unsuccessful outcome. In this setting, a standardized second-line drugs regimen produces high treatment success rates in MDR-TB patients unless XDR-TB is present.
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http://dx.doi.org/10.1089/mdr.2009.0073DOI Listing
March 2010

Extensively drug-resistant tuberculosis treatment outcome in Iran: a case series of seven patients.

Int J Infect Dis 2010 May 8;14(5):e399-402. Epub 2009 Oct 8.

Department of TB and Respiratory Infection, National Research Institute of TB and Lung Disease, Masih Daneshvari Hospital, Niavaran-Darabad, Tehran, Iran.

Background: Extensively drug-resistant tuberculosis (XDR-TB) has recently been identified as a major threat to global health. XDR-TB poses a risk of higher failure rates and death during TB treatment. We report herein the outcomes of XDR-TB in patients treated with the standardized regimen in Iran.

Patients And Methods: Between 2002 and 2006, seven patients were diagnosed with XDR-TB. All patients were treated with the standardized second-line regimen containing cycloserine, prothionamide, amikacin, and ofloxacin. First-line drugs, such as ethambutol and pyrazinamide, were added to the regimen if drug susceptibility testing showed sensitivity to these drugs.

Results: Four (57.1%) patients were male. All seven patients were HIV-negative. The patient age range was 22-79 years. Of the seven cases, the final outcome was 'cure' in two (28.6%), 'relapse' in one, 'treatment failure' in one, and 'death' in two; the outcome for one patient was unknown.

Conclusion: Our study shows a poor prognosis in patients with XDR-TB. This indicates the necessity of detecting XDR-TB cases earlier, as well as the need to gain access to more second-line agents. This is particularly important in resource-limited settings in order to administer individualized regimens.
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http://dx.doi.org/10.1016/j.ijid.2009.07.002DOI Listing
May 2010

Incidence, clinical and epidemiological risk factors, and outcome of drug-induced hepatitis due to antituberculous agents in new tuberculosis cases.

Am J Ther 2010 Jan-Feb;17(1):17-22

Tuberculosis Department, Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Drug-induced hepatitis (DIH) is an important issue in tuberculosis (TB) treatment. We intend to assess the incidence, risk factors, and outcome of hepatitis due to anti-TB drugs. The study is carried out at the national TB referral center 2006-2008 including all documented new cases of TB. All patients received standard anti-TB treatment. If DIH occurred, all drugs were discontinued and reinitiated after liver function tests (LFT) normalization in a stepwise way. Of total 761 patients, 99 (13.0%) patients developed DIH during anti-TB treatment. There was no difference in sex, nationality, smoking, or opium use history between the hepatitis group and the control group (P > 0.05). DIH was significantly higher in patients older than 65 years (P = 0.019). The mean duration of DIH from the beginning of treatment was 17.53 +/- 19.42 days (median = 12; 1-125 days). Also, the mean of the time elapsed from DIH till the (LFT) normalization was 10.26 +/- 5.95 (median = 9; 0-32 days). Anorexia, nausea, vomiting, abdominal pain, jaundice, diarrhea, decreased level of consciousness, and fever were significantly higher in patients with DIH. In DIH group, 13 patients (13.4%) died, whereas in the control group, death occurred just in 21 cases (3.2%) (P < 0.001, 95% confidence interval = 2.26-9.70, odds ratio = 4.7). After adjusting with logistic regression, all the anticipated factors retained the statistical significance. Our study indicated that DIH most often occurs during the first 2 weeks of anti-TB treatment. DIH development is associated with old age, certain clinical manifestations, and higher death rates.
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http://dx.doi.org/10.1097/MJT.0b013e31818f9eaeDOI Listing
March 2010

Nontuberculous mycobacteria among patients who are suspected for multidrug-resistant tuberculosis-need for earlier identification of nontuberculosis mycobacteria.

Am J Med Sci 2009 Mar;337(3):182-4

Masih Daneshvari Hospital, Darabad, Tehran, Iran.

Background: In this study, we intended to find the prevalence of nontuberculosis mycobacteria (NTM) among patients who are referred as suspected multidrug-resistant tuberculosis (MDR-TB) cases to the only referral center in Iran.

Methods: All patients referred to our center in 2002-2006 as MDR-TB with histories of treatment with standard and CAT II World Health Organization regimens were included in the study. Sputum smear and culture for acid-fast bacilli were performed for all patients 3 times. Sputum polymerase chain reaction was also performed for all patients. Mycobacterial identification was performed via polymerase chain reaction and routine identification tests for all culture-positive cases.

Results: Of the 105 patients in the study, 12 (11.43%) were identified to have NTM infection. The identified mycobacteria were classified in order of prevalence as Chelonae (8 cases), Simiae (2 cases), Aloei (1 case), and Farcinogen (1 case). Based on radiologic findings, most of the cases demonstrated bilateral nodularity (83.3%) and also multifocal bronchiectasis (75%). Notably, cavitary lesions were present in 41.7% of the cases.

Conclusion: Based on the findings of this study, it is essential that such cases be identified before commencing MDR-TB treatment.
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http://dx.doi.org/10.1097/maj.0b013e318185d32fDOI Listing
March 2009

First-line anti-tuberculosis drug resistance patterns and trends at the national TB referral center in Iran--eight years of surveillance.

Int J Infect Dis 2009 Sep 13;13(5):e236-40. Epub 2009 Mar 13.

Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari University Hospital, Shahid Beheshti University of Medical Sciences, Darabad, Niavaran Sq, Tehran, 1955841452, Iran.

Objective: Resistance to anti-tuberculosis (anti-TB) drugs is becoming a major and alarming threat in most regions worldwide.

Methods: This was a descriptive cross-sectional study at a tertiary hospital in Iran, using patient medical records for 2000-2003. The findings were analyzed following the same framework as that used for previous reports from this center.

Results: Among 1556 TB patients, drug susceptibility testing (DST) was performed for 548 culture-positive cases. Anti-TB drug resistance to both isoniazid and rifampin was identified in 10 (2.8%) of the new TB cases (multidrug-resistant TB; MDR-TB). Any resistance was detected in 228 (41.6%), showing an increasing trend in both new and retreatment cases. The data analysis revealed that drug-resistant TB had a statistically significant association with Afghan ethnicity, age>65 years, and the type of disease (retreatment vs. new TB case) (p<0.05). Also, assessment of the drug resistance trends showed a significant increase in resistance to any anti-TB agent, to isoniazid, and to streptomycin in new cases, and to all of the first-line anti-TB drugs in retreatment patients.

Conclusions: There has been an increasing trend in drug resistance in recent years, particularly in retreatment cases. Hence, revision of the national TB control program, reevaluation of the role of the World Health Organization category II (CAT II) regimen, as well as the conducting of a nationwide drug resistance survey, are recommended.
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http://dx.doi.org/10.1016/j.ijid.2008.11.027DOI Listing
September 2009

Is standardized treatment appropriate for non-XDR multiple drug resistant tuberculosis cases? A clinical descriptive study.

Scand J Infect Dis 2009 ;41(1):10-3

Mycobacteriology Research Centre, N.R.I.T.L.D, Shaheed Beheshti Medical University, Tehran, Iran.

The clinical relevance of second-line drug susceptibility test (DST) results with respect to treatment outcome is unknown in non-XDR MDR patients. This study was carried out in the sole national referral centre for TB in Iran between 2002 and 2006. Multidrug-resistant tuberculosis (MDR-TB) patients who had DST to second-line drugs were included. For all MDR-TB patients the standard second-line regimen was initiated. Outcome of treatment based on DST to second-line drugs was analysed. 53 patients were included. DST for second-line drugs was available for 40 patients. Seven patients returned to Afghanistan during treatment. Among the remainder, 13 (30.4%) cases were Iranian. Mean age was 40.8 + 19.7 y. The relatively small sample size imposes some limitations on this study. However, in this study, there was no difference in resistance to second-line drugs by nationality. No significant correlation was seen between resistance to second-line drugs and outcome of treatment. In conclusion, the treatment outcome according to WHO definitions was appropriate in the study population by the use of standardized treatment regimens. Follow-up studies on a long-term basis are however needed in order to detect possible relapses.
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http://dx.doi.org/10.1080/00365540802298079DOI Listing
March 2009