Publications by authors named "Farzin Khorvash"

66 Publications

Molecular Typing of Community-acquired Methicillin-Resistant Isolated from 2- to 6-year old Children by Staphylococcal Protein A and Typing in Isfahan, Iran.

Adv Biomed Res 2021 27;10. Epub 2021 Jan 27.

Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Methicillin-resistant (MRSA) has become a considerable public health concern in the entire world due to the rapid spread of this bacterium in human community; also the epidemiology of MRSA has changed, as the isolation of MRSA strains from healthy and non-healthy patients. Therefore, the objective of this study is to determine the genetic diversity and antibiotic resistance profile of community-acquired (CA)-MRSA nasal carriage in the Iranian samples.

Materials And Methods: A total of 25 CA-MRSA were isolated from the anterior nares of 410 healthy preschool children. All MRSA isolates were characterized by the detection of the toxic shock syndrome toxin-1 (TSST-1) and typed by γ-hemolysin genes, groups, and staphylococcal protein A () typing. Kirby-Buyer antibiotic susceptibility testing was performed and interpreted as per the standard guidelines.

Results: A total of 25 (6.1%) MRSA isolates were recovered from the anterior nares of 410 preschool children. Sixteen isolates (64%) were positive for the TSST-1 gene. Three specificity groups were determined, as follows: eight (32%) isolates belonged to Group I, five (20%) isolates belonged to Group II, and 12 (48%) isolates belonged to Group III. The repeated profiles of these types of 25 isolates were organized into eight different lineages groups. Five of lineages contained a single strain, three of lineages contained two strains, and three of lineages consisted of more than three strains.

Conclusions: The results of our study show that the rate of MRSA in our region is significantly high. Additionally, type t037 was the predominant type among CA .
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http://dx.doi.org/10.4103/abr.abr_139_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8095255PMC
January 2021

Rhabdomyolysis plus Hypocalcemia and Diabetic Ketoacidosis as Concurrent Rare COVID-19 Manifestations.

Case Rep Med 2021 8;2021:6625086. Epub 2021 Mar 8.

Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Common manifestations of coronavirus disease 2019 (COVID-19) from its initial official introduction are mostly related to the respiratory system. However, other rarer presentations are reported nowadays. . We reported three cases of COVID-19-infected patients with rhabdomyolysis as well as two other rarer simultaneous signs, including hypocalcemia (Case 1) and diabetic ketoacidosis (DKA) (Case 2).

Conclusion: Despite the fact that rhabdomyolysis is an infrequent manifestation of COVID-19, high clinical suspicion is required for proper diagnosis and management of this disease as well as other concurrent rarer presentations, including hypocalcemia and DKA for the prevention of further complications.
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http://dx.doi.org/10.1155/2021/6625086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7945673PMC
March 2021

The effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19): A structured summary of a study protocol for a randomised controlled trial.

Trials 2020 Dec 3;21(1):996. Epub 2020 Dec 3.

Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objectives: This study aims to assess the effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19).

Trial Design: This is a Double-Blind, Placebo-Controlled, Parallel Arm, Randomized Phase ΙΙ Clinical Trial.

Participants: Patients with the confirmed COVID-19 based on the PCR test are eligible to participate in the trial if they are 18 to 75 years of age and have no history of the current use of warfarin or propolis supplement and presence of sensitivity to bee products. Patients will be recruited from the Al-Zahra hospital in Isfahan city, Isfahan, Iran.

Intervention And Comparator: Participants (N=40) in the intervention group will receive an identical propolis tablet (containing 300 mg Iranian green propolis extract) three times a day for a period of 2 weeks. Participants (N=40) in the control group will receive an identical placebo tablet (containing 300 mg microcrystalline cellulose) three times a day for 2 weeks. All tablets are prepared by the Reyhan Naghsh Jahan Pharmaceutical Co., Isfahan, Iran.

Main Outcomes: The main outcomes are changes in the coronavirus disease's clinical symptoms including duration and severity from baseline to the end of 2 weeks.

Randomization: Eligible patients will be randomly allocated in a 1:1 ratio to the intervention or control group. Randomization will be performed on the basis of permuted block sizes of 4 and will be stratified according to sex categories. Randomization sequences will be prepared by the trial's pharmacist with the use of random-number tables.

Blinding (masking): The trial-group assignment will be concealed from all participants, clinicians, and investigators throughout the trial. To ensure blinding, randomization sequences will be kept in identical, opaque, sealed, sequentially numbered envelopes. Only the trial's pharmacist has access to the randomization list. Also, the placebo tablet will be similar to the propolis tablet in terms of texture, taste, color, odor, and weight. Both tablets will be provided in containers that are completely identical in weight, shape, labelling, and packaging.

Numbers To Be Randomized (sample Size): The calculated total sample size is 80 patients, with 40 patients in each group.

Trial Status: The protocol is Version 1.0, October 10, 2020. Recruitment began August 22, 2020, and is anticipated to be completed by March 21, 2021.

Trial Registration: The name of the trial register: The effect of propolis supplementation on clinical symptoms in patients with coronavirus (COVID-19): A randomized, double-blind, placebo-controlled clinical trial. IRCT registration number: IRCT20200802048267N1 . Date of trial registration: 20 October 2020, retrospectively registered.

Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.
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http://dx.doi.org/10.1186/s13063-020-04934-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713667PMC
December 2020

Subcutaneous tocilizumab in adults with severe and critical COVID-19: A prospective open-label uncontrolled multicenter trial.

Int Immunopharmacol 2020 Dec 13;89(Pt B):107102. Epub 2020 Oct 13.

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Potential therapeutic approaches in coronavirus disease 2019 (COVID-19) comprise antiviral and immunomodulatory agents; however, no immunomodulator drug has been approved. This multicenter, prospective, open-label, uncontrolled study aimed to assess the use of subcutaneous tocilizumab in adult patients with severe and critical COVID-19. Tocilizumab was added to the standard care of therapy at a dose of 324 mg (<100 kg bodyweight) or 486 mg (≥100 kg bodyweight). The study endpoints were all-cause mortality rate, changes in oxygen-support level, oxygen saturation, body temperature, respiratory rate, and laboratory variables during the study, and drug safety. Of 126 patients enrolled, 86 had severe and 40 had critical disease. Most patients were male (63.49%) and aged below 65 (78.57%). By day 14 of the study, 4.65% (4/86) of severe patients and 50.00% (20/40) of critical patients died. By the end, 6.98% (6/86) of severe patients and 60.00% (24/40) of critical patients died.Outcomes concerning three additional endpoints (oral temperature, oxygen saturation, and respiratory rate)were significantly improved as early as three days after tocilizumab administration in both groups of subjects, more considerably in severe patients. Significant improvement in the required level of oxygenation was reported in severe patients seven days after tocilizumab administration. No tocilizumab-related serious adverse event occurred in this study. Subcutaneous tocilizumab might improve some clinical parameters and reduce the risk of death in COVID-19 patients, particularly if used in the early stages of respiratory failure.
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http://dx.doi.org/10.1016/j.intimp.2020.107102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553010PMC
December 2020

Vitamin E in the prevention of vancomycin-induced nephrotoxicity.

Res Pharm Sci 2020 Apr 11;15(2):137-143. Epub 2020 May 11.

Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, I.R. Iran.

Background And Purpose: The use of vancomycin, as a key therapeutic choice for treatment of hazardous infections, may be associated with nephrotoxicity. The proposed mechanism is the indirect production of reactive oxygen species and oxidative stress. The purpose of this study was to investigate the effect of vitamin E as an antioxidant agent in the prevention of vancomycin-induced nephrotoxicity.

Experimental Approach: In a matched-groups interventional study, patients who received vancomycin for any indication were assigned to vitamin E ( = 30) and control ( = 60) groups. The patients in experimental group received 400 units of oral vitamin E per day for 10 days started concurrently with vancomycin, while the patients in control group received vancomycin alone. Serum level of creatinine, blood urea nitrogen (BUN), creatinine clearance (CrCl), and 24-h urine output were determined and recorded before the start of interventions, every other day during therapy, and 12 h after the last dose of vancomycin in 10 day of therapy for all patients. Also, the rate of acute kidney injury (AKI) in the two groups was recorded. Finally, the mean values of the measured parameters were compared between the groups.

Findings / Results: Treatment with vitamin E for 10 days resulted in a significant reduction of BUN (from 17.5 ± 7.8 mg/dL at baseline to 11.4 ± 4.8 mg/dL at the end; < 0.001) along with slightly non-significant increase of CrCl (from 84.7 ± 18.9 mL/min at baseline to 91.3 ± 19.5 mL/min at the end; = 0.301) in comparison to the control group. However, CrCl decreased significantly in the control group. Vitamin E had no significant effect on 24-h urine output. Regarding vancomycin-induced AKI, 12 cases were observed in the control group, while no case was reported in experimental group ( = 0.041).

Conclusion And Implications: This study showed the beneficial effect of add-on therapy of vitamin E besides vancomycin in reducing AKI, which could be considered as a new potential prophylactic therapy for vancomycin-induced nephrotoxicity.
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http://dx.doi.org/10.4103/1735-5362.283813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306246PMC
April 2020

Effect of N-acetylcysteine against Vancomycin-Induced Nephrotoxicity: A Randomized Controlled Clinical Trial.

Arch Iran Med 2020 06 1;23(6):397-402. Epub 2020 Jun 1.

Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The proposed mechanism of vancomycin-induced nephrotoxicity (VIN) is indirect production of reactive oxygen species in the kidney tissue. This study aimed to investigate the effectiveness of N-acetylcysteine (NAC), an anti-oxidant agent, in the prevention of VIN.

Methods: Patients who received vancomycin for any indication were randomly divided to drug (NAC) and control groups. The patients in the drug group received oral NAC 600 mg every 12 hours for 10 days, starting concurrently with vancomycin. Serum creatinine (SCr) levels and blood urea nitrogen (BUN) as well as creatinine clearance (CrCl) and 12-hour urine volume were recorded at baseline, every other day during the study, and 12 hours after the last dose of vancomycin on the 10th day. Furthermore, the cases of acute kidney injury (AKI; ≥ 0.5 mg/dL or at least 50% increase in serum creatinine from baseline) were recorded in the two groups.

Results: Over the study period, 84 and 95 patients completed the study in drug and control groups, respectively. SCr and CrCl were significantly lower and higher, respectively, at all-time points (except for baseline) in the NAC compared to the control group. Furthermore, although not statistically significant, 12 cases of vancomycin-induced AKI were observed in the control group (12.63%), while 4 cases (4.76%) were reported from drug group (P = 0.066; relative risk [RR] = 0.377, 95% CI: 0.126-1.124).

Conclusion: NAC has the potential for reduction of VIN. However, more studies are necessary to confirm this effect.
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http://dx.doi.org/10.34172/aim.2020.33DOI Listing
June 2020

COVID-19 infection in a patient with multiple sclerosis treated with fingolimod.

Neurol Neuroimmunol Neuroinflamm 2020 07 5;7(4). Epub 2020 May 5.

From the Department of Neurology (M.B., O.M., R.S., V.S.), School of Medicine, Isfahan University of Medical Sciences; Isfahan Neurosciences Research Center (M.B., O.M., N.N., V.S.), Isfahan University of Medical Sciences; Acquired Immunodeficiency Research Center (F.K.), Isfahan University of Medical Sciences, Iran; and Ann Romney Center for Neurologic Diseases (A.-H.M.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

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http://dx.doi.org/10.1212/NXI.0000000000000753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7217655PMC
July 2020

Association Between BMI and Inflammation Among Diabetic Polyneuropathy Patients.

Int J Prev Med 2019 10;10:212. Epub 2019 Dec 10.

Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Inflammation is defined as body tissues response to harmful stimuli. Obesity-related inflammation leads to increased risk chronic diseases including diabetic polyneuropathy (DPN). The present study was performed to determine association between body mass index (BMI) and inflammatory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in DPN patients.

Methods: In this cross-sectional study, 200 DPN patients with a mean (SD) of age 58.76 (9.53) years were selected. All patients completed the questionnaire including demographic data and chronic disease history. In addition, anthropometric measures and clinical laboratory tests were taken. Multivariate linear regression was used to detect the association between BMI, CRP, and ESR levels.

Results: BMI was associated with increase in ESR and CRP levels (β-ESR = 4.67, < 0.001 and β-CRP = 0.71, < 0.001). Also, this association remained after adjustment for other different variables.

Conclusions: These findings indicate that higher BMI is related to increase inflammatory markers including CRP and ESR in DPN patients. Therapies for DPN and reducing inflammation should target the weight loss among obese patients.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_48_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6941393PMC
December 2019

Comparison of two therapeutic approaches for the management of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter: a randomized clinical trial study.

J Immunoassay Immunochem 2020 28;41(1):97-105. Epub 2019 Nov 28.

Department of infectious disease, School of medicine, Isfahan University of medical sciences, Isfahan, Iran.

Management of ventilator-associated pneumonia (VAP) is a puzzling issue for infectious disease specialist. The present clinical trial study was aimed to comparing the effects of injectable colistin plus nebulized colistin and injectable colistin plus nebulized tobramycin on management of patients with VAP due to multidrug-resistant Acinetobacter. VAP patients were randomly divided into two groups ( = 30/each): Group 1 - patients that received intravenous (IV) meropenem, injectable colistin plus nebulized colistin, as a routine treatment, and Group 2 - patients that received IV meropenem, injectable colistin plus nebulized tobramycin. A total of 14 days of therapeutic intervention are required for every case. Follow-up for subjects was performed at five time-points: days 1, 3, 5, 7, and 14 after intervention. Also, a mean of creatinine levels of patients was determined in five times. In the present study, the clinical pulmonary infection score (CPIS) was determined on the basis of points assigned for various clinically manifestations of VAP. Based on our statistical analysis, there was no significant difference between CPIS and creatinine level in both Groups 1 and 2 ( > .05). CPIS and other clinical investigation appeared effectiveness of the treatment with injected colistin plus nebulized tobramycin; on the other hand, the results of present clinical trial showed that aforementioned therapeutic approach can be used as an alternative treatment for the management of infection in VAP patients.
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http://dx.doi.org/10.1080/15321819.2019.1696818DOI Listing
February 2020

Trimethoprim-sulfamethoxazole Induced Hyponatremia and Hyperkalemia, The Necessity of Electrolyte Follow-up in Every Patient.

Iran J Kidney Dis 2019 07;13(4):277-280

Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Trimethoprim-sulfamethoxazole (TMP/SMX) is a bactericidalantibiotic. The most common adverse effect of TMP/SMX is skinrashes and gastrointestinal symptoms. Although hyperkalemia canoccur with TMP/SMX component but hyponatremia is uncommon. A55- year old woman, known case of rheumatoid arthritis, presentedwith fever and mild dyspnea. According to diagnostic work upthe infection with pneumocystis jirovecii was confirmed. TMP/SMX was started but after 10 days the patient acutely representedwith nausea and became lethargic. The laboratory studies showedmoderate hyperkalemia and severe hyponatremia. TMP/SMX wasstopped and alternative treatment started. Upon discontinuation ofthe drug, serum sodium and potassium levels were both changed tonormal. Hyponatremia as a life threatening adverse effect appearsto be rare with TMP-SMX therapy, but clinicians should be awareof electrolyte disturbances developed with this drug and electrolytemonitoring should always be considered.
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July 2019

Naturally occurring NS5A and NS5B resistant associated substitutions in HCV and HCV/HIV patients in iranian population.

Clin Res Hepatol Gastroenterol 2019 10 10;43(5):594-602. Epub 2019 May 10.

Clinical Research Dept, Pasteur Institute of Iran, Tehran, Iran. Electronic address:

Background: The introduction of direct acting antivirals (DAAs) for hepatitis C virus (HCV) treatment promises shorter treatment duration, higher cure rates and fewer side effects. Naturally, occurring Resistance Associated Substitutions (RASs) are major challenge to the success of the HCV antiviral therapy.

Aim: To determine the naturally occurring NS5A and NS5B RASs in Iranian HCV and HCV/human immunodeficiency virus (HIV) patients.

Methods: A total of 209 DAA-naïve chronic HCV patients including 104 HCV mono-infected and 105 HCV/HIV co-infected cases were enrolled. Amplification and Sanger population sequencing of NS5A and NS5B regions of HCV genome were carried out. The amino acid sequence diversity of the NS5A and NS5B regions were analyzed using geno2pheno HCV.

Results: NS5A RASs were detected in 25.5% of HCV and 16.9% of HCV/HIV subjects. In HCV cases, clinically relevant RASs were L28M followed by M28Vand Q30H and Y93H/N. In HCV/HIV subjects, clinically relevant RASs were Y93H/N followed by L28M and P58T and M28V/T and Q30R. NS5B RASs were observed in 11.8% of HCV and 5.9% of HCV/HIV subjects. Clinically relevant substitutions were included V321A/I, C316Y, S282R and L159F. The major S282T mutation was not observed.

Conclusion: The emergence of RASs is a growing issue in the setting of current treatment with DAAs. Although currently, screening of RASs is recommended before specific DAA regimens, it should be consider in patients with therapeutic failure and in the cases of retreatment.
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http://dx.doi.org/10.1016/j.clinre.2019.01.011DOI Listing
October 2019

Clostridium difficile isolated from faecal samples in patients with ulcerative colitis.

BMC Infect Dis 2019 Apr 30;19(1):361. Epub 2019 Apr 30.

Department of Pathobiology and Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, Guelph, Canada.

Background: Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that is widely identified worldwide. This study aimed to investigate the phenotypic characterization and molecular typing of Clostridium difficile isolates among patients with UC at an inflammatory bowel disease clinic in Iran.

Methods: In this cross-sectional study, conducted from April 2015 to December 2015, 85 UC patients were assessed for C.difficile infection (CDI). C. difficile isolates were characterized based on their toxin profile and antimicrobial resistance pattern. Multi-locus sequence typing analysis (MLST) and PCR ribotyping were performed to define the genetic relationships between different lineages of toxigenic strains.

Results: The prevalence of C. difficile isolates was 31.8% (27/85) in patients, of those 15 patients (17.6%) had CDI. Three different sequence types (STs) identified based on MLST among the toxigenic isolates, that is ST54 (33.3%), ST2 (53.3%), and ST37 (13.6%). C. difficile strains were divided into four different PCR-ribotypes (012, 014, 017 and IR1). The most common ribotype was 014 accounting for 48.3% (7/15) of all strains. The strains isolated during the first episode and recurrence of CDI usually belonged to PCR ribotype 014 (ST2). A high rate of CDI recurrence (14.1%, 12/85) experienced in UC patients. Colonization of the gastrointestinal tract with non-toxigenic C. difficile strains was frequent among patients with mild disease. All C. difficile isolates were susceptible to metronidazole, and vancomycin, 86 and 67% of isolates were resistant to clindamycin and erythromycin respectively. There was no correlation between the toxin type and antibiotic resistance (p > 0.05).

Conclusion: Overall CDI is rather prevalent in UC patients. All patients with CDI experienced moderate to severe disease and exposed to different antimicrobial and anti-inflammatory agents. Close monitoring and appropriate management including early detection and fast treatment of CDI will improve UC outcomes.
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http://dx.doi.org/10.1186/s12879-019-3965-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492486PMC
April 2019

Prevalence of herpes simplex virus-1 in hospitalized adult patients with clinical diagnosis of meningoencephalitis using real-time polymerase chain reaction: A single-center, cross-sectional study.

J Res Med Sci 2019 31;24. Epub 2019 Jan 31.

Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Early diagnosis of herpes simplex virus-1 (HSV-1) meningoencephalitis is very important because antiviral therapy significantly decreases mortality and morbidity. Polymerase chain reaction (PCR) is a reliable method with high sensitivity and specificity in detection of HSV-1. The aim of this study is to determine the prevalence of HSV-1 in patients with diagnosis of meningoencephalitis using real-time PCR.

Materials And Methods: The cerebrospinal fluid samples were collected from 126 patients with clinical diagnosis of HSV-1 meningoencephalitis in Alzahra Referral Hospital in Isfahan, Iran. After deoxyribonucleic acid (DNA) extraction, real-time PCR was performed by fluorescence resonance energy transfer assay and participants underwent brain magnetic resonance imaging, as well.

Results: Among 126 patients, 68.3% were male and 31.7% were female. The mean age of the participants was 41.96 ± 22.36 years. Most of the participants were in the age group of 20-29 years. Three patients (2.4%) had positive and 123 patients (97.6%) had negative HSV-1 DNA test. Among three positive cases, two were in the age group of 20-29 years and one in the age group of ≥80 years. No HSV-2 DNA was detected.

Conclusion: According to the estimated prevalence of HSV-1 meningoencephalitis in the current study, it seems that the prevalence of HSV-1 meningoencephalitis is not too high in our community; therefore, initial empiric acyclovir therapy is frequently overused.
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http://dx.doi.org/10.4103/jrms.JRMS_370_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383335PMC
January 2019

Molecular epidemiology of infection in Iranian hospitals.

Antimicrob Resist Infect Control 2019 14;8:12. Epub 2019 Jan 14.

8Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Canada.

Background: infection (CDI) is known as one of the most important causes of nosocomial infections. The main objective of this study was to evaluate the presence of in the stool of hospitalized patients with diarrhea as well as in their environments.

Methods: isolates were characterized according to the presence of toxin genes and antibiotic resistance. Multilocus Sequence Typing Analysis (MLST) was applied for finding the genetic polymorphism and relationship among strain lineages.

Results: A total of 821 samples (574 stools and 247 swabs) were collected between April 2015 and May 2017. The prevalence of isolates was 28.6% (164/574) in patients and 19% (47/247) in swabs taken from medical devices, hands of healthcare workers and skin patient sites. Finally, 11.5% (66/574) toxigenic strains isolated from stool samples of inpatients and 4.4% (11/247) from hands of healthcare workers and skin patient sites. All the toxigenic isolates were inhibited by a low concentration of vancomycin (MIC < 0.5 μg/ml). About 43% (33/77) and 39% of isolates were resistant to Clindamycin and moxifloxacin respectively. All isolates were susceptible to metronidazole. Toxigenic strains were analyzed by MLST and were divided into 4 different STs. The detected types were ST-54 (57.9%), followed by ST-2 (31.6. %), ST-15 (5.3%) and ST-37 (5.3%), while none of the isolates were identified as ST-1 or ST-11. Significant risk factors for CDI appear to be advanced age, undergoing chemotherapy, previous surgery, and residence in the nursing home.

Conclusions: CDI is common in Iran and further studies are recommended to monitor its epidemiological variations. Moreover, greater attempts must be made to encourage antibiotic stewardship by healthcare workers and the public.
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http://dx.doi.org/10.1186/s13756-018-0454-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6332892PMC
March 2020

Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing.

Diabetes Metab Syndr 2019 Jan - Feb;13(1):822-825. Epub 2018 Dec 1.

Health Research Center, Baitullah University of Medical Sciences, Tehran, Iran.

Background: Diabetic foot ulcer is one of the common complications of diabetes disease that is costly and difficult to treat. This problem can lead to morbidity and even mortality. Ozone is a gas that can optimize cellular metabolism and, because of its antioxidant and antibacterial effects, can help the better healing of diabetic foot ulcer.

Method: Two hundred patients, aged 18-85 with diabetic foot ulcers ranging from grade 1 to 4 according to Wagner classification in two groups were studied. Group 1 was treated by full ozone therapy besides the standard regular DFU treatment while group two just was received routine diabetic foot care. Wound size, wound grade, healing time, Fasting blood sugar and inflammatory biomarker before and after treatment were checked.

Results: All patients have had complete wound closure in the ozone group. The mean age of the patients included in the results was 59.03 ± 12.593 and 53.5 ± 10.212 for ozone group and control group. The baseline average surface area of ulcers was 13.41 ± 14.092 cm (range 1-70 cm) in ozone group and 12.72 ± 0.911 (range 1_64 cm) in the control group. Average healing time was 69.44 ± 36.055 days (range 15-180 days), which is significantly lower than the median healing time measured in the control group and some previous studies.

Conclusion: Our study results support the efficacy of ozone therapy especially in its comprehensive use in DFU healing and reduction in the chances of infection and amputation.
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http://dx.doi.org/10.1016/j.dsx.2018.11.060DOI Listing
April 2019

Oropharyngeal Irrigation to Prevent Ventilator-Associated-Pneumonia: Comparing Potassium Permangenate with Chlorhexidine.

Int J Prev Med 2018 12;9:93. Epub 2018 Oct 12.

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Pneumonia is one of the most common hospital-acquired infections among bedridden patients in Intensive Care Units (ICUs). Colonization of mouth and pharynx by pathogenic bacteria and their aspiration into the lower respiratory tract is an important step in pathogenesis of hospital-acquired pneumonia. The purpose of this study was to compare the effects of chlorhexidine and potassium permanganate mouthwashes in preventing incidence of hospital-acquired pneumonia in hospitalized patients in the ICU.

Methods: This study is a clinical trial, conducted on 150 patients on ventilator in ICU. Patients were divided into three groups: Chlorhexidine group, potassium permanganate group, and control group. Mouthwashing three times a day, each time 5 min for 1 week by sterile gas with 10 cc solution of chlorhexidine, potassium permanganate, or placebo, was performed. Finally, pneumonia incidence was recorded, according to the Center for Disease Control and Prevention criteria. The data were analyzed by SPSS software version 20.

Results: In the present study, 28 cases of pneumonia among 150 patients on ventilator were investigated. There were 15 (30%), 6 (12%), and 7 (14%) incidences of pneumonia in control, chlorhexidine, and permanganate group, respectively. Pneumonia incidence in these groups differed significantly ( = 0.041).

Conclusions: The use of common mouthwashes, especially chlorhexidine solution, for washing oropharynx of ICU patients, can decrease pneumonia incidence, especially in patients under ventilation. Thus, washing and sterilizing mouth of patients with mouthwashes is recommended due to the high risk of hospital-acquired pneumonia in these patients.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_370_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6202778PMC
October 2018

Meropenem Utilization Evaluation in a Referral Teaching Hospital in Iran.

J Res Pharm Pract 2018 Apr-Jun;7(2):83-87

Pharmacy Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Inappropriate use of antibiotics is associated with detrimental effects including emergence of antibiotic resistance. This study aimed to evaluate the use of meropenem, an extended-spectrum antibiotic, in a referral teaching hospital to detect different types of errors in its prescription.

Methods: In a cross-sectional study performed over a 6-month period (2014-2015), hospitalized adult patients who received meropenem for any indication were randomly selected. The collected data included the indication for prescription and its correctness, the basis of prescription (empirical or culture based), administered dose, duration of treatment, the status of demanding sample culture in the case of empirical prescription, the status of dose adjustment in the case of renal impairment, and the treatment outcome.

Findings: Over the study period, 123 patients were evaluated. The most frequent indication for prescription of meropenem was pneumonia (31.7%) and soft-tissue infections (18.7%). Out of these prescriptions, 62.6% (77 prescriptions) were incorrect. All meropenem prescriptions were initially empirical. Furthermore, sample culture and antibiotic susceptibility test were requested for only 52% of patients ( = 66). Treatment duration was correct for 53.7% of patients. Seventeen patients (13.8%) received an inappropriate dose of the antibiotic. Furthermore, of 51 patients who needed meropenem dose adjustment because of renal impairment, 17 patients (33.33%) received unadjusted dose.

Conclusion: High rate of errors exists in the utilization of meropenem in our hospital, especially in the rank order of selection for treatment (indication), dose adjustment, and treatment duration. Therefore, modification strategies are necessary to promote the rational use of meropenem in this center.
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http://dx.doi.org/10.4103/jrpp.JRPP_17_86DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036873PMC
July 2018

Prevalence of Fungemia in Pediatric Patients with Febrile Neutropenia.

Adv Biomed Res 2018 29;7:88. Epub 2018 May 29.

Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Increasing use of different chemotherapy regimens, organ transplants, etc., has led to the increasing number of neutropenic patients. Overall, 10% of patients affected by cancer who are under treatment with anticancer drugs, regardless of the tumor type, are susceptible to febrile neutropenia. The study was performed to evaluate the frequency of bloodstream fungal infections in pediatric patients with febrile neutropenia in Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010-2012.

Materials And Methods: This cross-sectional study was performed on pediatric patients with febrile neutropenia who were referred to Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010-2012. Blood samples were obtained from all the patients and were loaded into Bactec 9050 blood culture instruments (Bectone Dickinson, Baltimore, Md., USA), and organisms responsible for causing fever were detected.

Results: Sixty-seven patients (51.3 males, 48.7 females) with a mean age of 12.3 ± 15.8 years were included. The blood cultures of 48 patients (71.6%) were negative. Seven samples of the isolates (10.4%) were fungi, and twelve of them (18%) were bacteria. Thus, the prevalence of fungal infection was 10.4%.

Conclusion: Due to the high relative prevalence of fungal infections in our study, it is necessary to take precautions for fungal infection prevention and choose the best way management to obtain optimal results in these patients.
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http://dx.doi.org/10.4103/abr.abr_154_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991268PMC
May 2018

-producing Metallo-β-lactamases (VIM, IMP, SME, and AIM) in the Clinical Isolates of Intensive Care Units, a University Hospital in Isfahan, Iran.

Adv Biomed Res 2017 30;6:147. Epub 2017 Nov 30.

Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: is a severe challenge for antimicrobial therapy, due to the chromosomal mutations or exhibition of intrinsic resistance to various antimicrobial agents such as most β-lactams. We undertook this study to evaluate the existence of SME, IMP, AIM, and VIM metallo-β-lactamases (MBL) encoding genes among strains isolated from Intensive Care Unit (ICU) patients in Al-Zahra Hospital in Isfahan, Iran.

Materials And Methods: In a retrospective cross-sectional study that was conducted between March 2012 and April 2013, a total of 48 strains of were collected from clinical specimens of bedridden patients in ICU wards. Susceptibility test was performed by disc diffusion method. All of the meropenem-resistant strains were subjected to modified Hodge test for detection of carbapenemases. Multiplex polymerase chain reaction was performed for detection of blaVIM, blaIMP, blaAIM, and blaSME genes.

Results: In disk diffusion method, imipenem and meropenem showed the most and colistin the least resistant antimicrobial agents against strains. Of the 48 isolates, 36 (75%) were multidrug resistant (MDR). Amplification of β-lactamase genes showed the presence of blaVIM genes in 7 (%14.6) strains and blaIMP genes in 15 (31.3%) strains. All of the isolates were negative for blaSME and blaAIM genes. We could not find any statistically significant difference among the presence of this gene and MDR positive, age, or source of the specimen.

Conclusion: As patients with infections caused by MBL-producing bacteria are at an intensified risk of treatment failure, fast determination of these organisms is necessary. Our findings may provide useful insights in replace of the appropriate antibiotics and may also prevent MBLs mediated resistance problem.
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http://dx.doi.org/10.4103/2277-9175.219412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5735557PMC
November 2017

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Persian Gulf region: A case and review.

Mycoses 2018 Apr 3;61(4):261-265. Epub 2018 Jan 3.

Department of Medical Mycology and Parasitology/Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Cerebral phaeohyphomycosis is frequently a fatal disease caused by truly neurotropic dematiaceous fungi. Although rare, this infection occurs especially among immunocompetent patients, and the clinical symptoms are often misdiagnosed as a cerebral tumour or bacterial brain abscess. The appropriate diagnosis and therapy of cerebral infections by melanized fungi are very challenging if they are caused by mysterious fungi with unknown ecological niche. We reported the second case of cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran and the first culture-confirmed case. In this report, the differential diagnosis and histopathological findings are discussed and a review of the literature is provided.
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http://dx.doi.org/10.1111/myc.12734DOI Listing
April 2018

Changing Beliefs and Behaviors Related to Sexually Transmitted Diseases in Vulnerable Women: A Qualitative Study.

Iran J Nurs Midwifery Res 2017 Jul-Aug;22(4):303-307

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The first step in health education is awareness of the people and their acceptance to change their behavior. Therefore, the aim of this study was to investigate the effects of empowerment program towards the concept of self-care and prevention of sexually transmitted diseases (STDs) in women at risk of STDs.

Materials And Methods: The present study was conducted as a qualitative approach (step of action and observation of an action) by using conventional content analysis method. An empowerment program regarding STDs (Action) was performed among 32 (with convenient sample) drug user women with addicted husbands referring to the counseling center for vulnerable women (drop in enter) in Isfahan in 2015. The knowledge of quiddity, transmission, and prevention of STDs, as well as some items of life skills such as self-awareness, interpersonal communication, and assertive behavior were taught in an educational program. Teaching methods were lectures, group, and individual training and role play. The impact of the program on modified belief and behavior change regarding STDs was evaluated with structured interviews.

Results: Analysis of the obtained results yielded three categories. The categories were awareness of STD, believing in being at risk, and decision and change.

Conclusions: Promoting self-care and prevention through education programs based on action research can make a significant reduction in the incidence of problems and cause a behavior change in women with the disease or those at risk for STDs.
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http://dx.doi.org/10.4103/ijnmr.IJNMR_117_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5590361PMC
September 2017

Distribution of Elements and Presence of Panton-Valentine Leukocidin in Methicillin-Resistant Isolated from Clinical Samples in a University Hospital of Isfahan City, Iran.

J Clin Diagn Res 2017 Jul 1;11(7):DC27-DC31. Epub 2017 Jul 1.

Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: Coagulase Negative (CoNS) is considered as a major pathogen of nosocomial infections among immunosuppressed patients.

Aim: The aim of this study was to identify the types of () and Panton-Valentine Leukocidin () gene among clinical Methicillin-Resistant isolates collected from Isfahan.

Materials And Methods: This cross-sectional study was performed from March 2014 to January 2015 at a tertiary care hospital of Isfahan, Iran. Antimicrobial susceptibility tests of isolates were performed by the disc diffusion method. All the strains were screened for methicillin resistance based on resistance to cefoxitin (30 μg) disc and presence of gene. Determination of typing and toxin gene were performed by PCR method. For categorical variables different groups were compared using the Chi-square test or Fisher exact test. A p-value of <0.05 was considered significant for all statistical tests.

Results: The frequency of MRSE was 53.8% according to the presence of gene. The overall resistance rate was high with ciprofloxacin (81.4%). PCR analysis showed that 17% (12/70) of MRSE isolate carried the PVL gene and 43% (30/70) were type I; 11.4% (8/70) were type II; and 34.2% (24/70) were type IV, whereas, 11.4% (8/70) of the MRSE isolates could not be typed.

Conclusion: type I was the major type of , which indicates an emergence of this type in the studied medical centers. Increased prevalence of types in community is cause of an increase in antibiotic resistance among microorganisms.
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http://dx.doi.org/10.7860/JCDR/2017/25518.10258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583865PMC
July 2017

The Immune Response of Vaccination Against Hepatitis B virus in Iranian Patients Undergoing Chemotherapy.

Adv Biomed Res 2017 25;6:88. Epub 2017 Jul 25.

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Introduction: Hepatitis B virus (HBV) infection and its complications are major public health problems. As it is hard to treat and control the chronic state, control of disease depends on the prevention especially by vaccination. There is an impaired immune response to vaccinations including HBV in patients with some malignancies. The aim of this study is to assess the response rate of patients undergoing chemotherapy to HBV vaccination.

Materials And Methods: All patients from two hematology/oncology clinics in Isfahan, Iran with the history of at least 1 month chemotherapy who had the inclusion criteria were enrolled in a case control study. Also a sex- and age-matched control group from healthy population was selected. They were vaccinated in a schedule of 0, 1, and 6 months and were examined for antibody titers 1 month after the last dose. The titers more than 10 mIU/ml were determined as positive response to vaccination.

Results: In this study, 50 patients and 50 healthy subjects were enrolled. The two groups were age and sex matched ( > 0.05). Frequency of negative responses to HBV vaccination in case and control groups were 9 (18%) and 1 (2%), respectively (OR = 10.75, CI = 1.30-88.47, = 0.027). Of 50 patients, 54%, 12%, 22%, and 12% had breast cancer, lymphoma, gastrointestinal, and genitourinary cancers, respectively, and frequency of negative responses were 3 (11%), 1 (16%), 4 (36.4%), and 1 (16%), respectively ( = 0.167).

Conclusion: According to our results, malignancy and chemotherapy will have an important effect on the immune system and cause negative response to HBV vaccination. Our results revealed the importance of passive immunity and screening for HBV infection in patients undergoing chemotherapy. Also more studies for better vaccination schedules in this group of patients are recommended.
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http://dx.doi.org/10.4103/abr.abr_330_13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5549552PMC
July 2017

Prevalence of Acquired Carbapenemase Genes in by Multiplex PCR in Isfahan.

Adv Biomed Res 2017 17;6:41. Epub 2017 Apr 17.

Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Multi-drug resistant has been considered as a serious global threat. This study was done to investigate carbapenemase producing genomes among isolates in Isfahan, Central Iran.

Materials And Methods: In a cross-sectional study from 2011 to 2012, 29 carbapenem resistant (according to disc diffusion method) carbapenemase producing (according to modified Hodge test) strains were collected from Intensive Care Unit (ICUs) of Al-Zahra referral Hospital. In the strains with the lack of sensitivity to one or several carbapenems, beta-lactams, or beta-lactamases, there has been performed modified Hodge test to investigate carbapenmase and then only strains producing carbapenmases were selected for molecular methods.

Results: In this study, there have been 29 cases of isolated from hospitalized patients in the (ICU). Three cases (10.3%) contained blaVIM, 1 case (3.4%) contained blaIMP, and 1 case (3.4%) contained blaOXA. The genes blaNDM and blaKPC were not detected. Then, 16 cases (55.2%) from positive cases of were related to the chip, 4 cases (13.8%) to catheter, 6 cases (20.7%) to urine, and 3 cases (10.3%) to wound.

Conclusion: It is necessary to monitor the epidemiologic changes of these carbapenemase genes in in our Hospital. More attention should be paid to nosocomial infection control measures. Other carbapenemase producing genes should be investigated.
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http://dx.doi.org/10.4103/2277-9175.204594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414410PMC
April 2017

Isolated pulmonary candidiasis in a patient with diabetes mellitus: A rare case report.

Adv Biomed Res 2016 30;5:146. Epub 2016 Aug 30.

Department of Hematology, Isfahan University of Medical Sciences, Isfahan, Iran.

Fungal infections are as a cause of morbidity and mortality in immunocompromise patients. Because the respiratory tract is colonized with Candida, the presence of this agent in respiratory specimens makes the diagnosis of Candida pneumonia problematic. Candida pneumonia is a rare infection, and the majority of cases are secondary to hematogenous dissemination. Furthermore isolated Candida pneumonia originating from endotracheal inoculation is an extremely rare entity. We describe a case of isolated pulmonary candidiasis in the form multiple nodular lesions in a patient with long-term history of diabetes mellitus without evidence of fungemia or systemic involvement who responded to antifungal therapy.
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http://dx.doi.org/10.4103/2277-9175.187377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025916PMC
September 2016

Nasal carriage screening of community-associated methicillin resistant Staphylococcus aureus in healthy children of a developing country.

Adv Biomed Res 2016 30;5:144. Epub 2016 Aug 30.

Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The rapid emergence and spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has raised considerable public health concern in both developed and developing countries. The current study aimed to address the extent of this phenomenon in healthy preschool children of a developing country.

Materials And Methods: We conducted a prospective study from April 2013 to March 2014 on 410 healthy 2-6 years old preschool children in Isfahan, Iran. Demographic medical data and nasal samples were collected from the participating children. Isolates were identified as S. aureus and MRSA based on microbiological and molecular tests, including the presence of eap and mecA genes.

Results: The overall prevalence of S. aureus and CA-MRSA nasal carriage was 28% (115/410) and 6.1% (25/410), respectively. The identity of isolates was confirmed by molecular assay. The factors that were independently associated with nasal carriage of S. aureus were: Children crowding in day-care nurseries and income level of families. A total of 20/90 (22.2%) of methicillin-susceptible S. aureus and all 25 CA-MRSA displayed multiple drug resistance to 3-8 antibiotics.

Conclusions: The current report reflects issues and concerns that the high rate of colonization by CA-MRSA in Iranian healthy children provides obliging evidence that MRSA have established a foothold in the community and are emerging as important health threatening pathogens. It is suggested that we need more effective infection control measures to prevent transmission of nasal CA-MRSA in healthy preschool children.
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http://dx.doi.org/10.4103/2277-9175.187400DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025912PMC
September 2016

Association Between Acute Infectious Mononucleosis and Vitamin D Deficiency.

Viral Immunol 2016 09 9;29(7):398-400. Epub 2016 Aug 9.

5 Department of Neurology, Cedars-Sinai Medical Center , Los Angeles, California.

Epstein-Barr virus and vitamin D both have been implicated in the pathogenesis of autoimmune diseases, especially multiple sclerosis (MS). Vitamin D influences both innate and adaptive immune responses and has been linked to increased susceptibility to other viral infections such as influenza. Here we aimed to examine the association between vitamin D and acute infectious mononucleosis (IM).This study is a case-control study that was conducted on IM patients and a control group of healthy individuals at infectious disease clinics of Isfahan University of Medical Sciences. Patients were recruited from January to December 2014. The viral capsid antigen (VCA) IgM titer and vitamin D levels were measured at the time of acute infection in IM patients. We also measured vitamin D levels in healthy controls recruited during the same period of time. A total number of 60 IM patients with the mean age of 23.26 ± 7.59 and a healthy control group with the mean age of 25.13 ± 6.72 were enrolled. In the IM patients, there was no significant association between 25(OH) D3 levels and VCA IgM titers (r = 0.190, p = 0.146). Mean 25(OH) D3 levels in IM patients were significantly lower than in the control group (15.61 ± 9.72 vs. 21.41 ± 12.64, p = 0.006). Our findings showed significantly lower vitamin D levels in IM patients at the time of infection than in the control group, providing some evidence that the two major risk factors for autoimmune diseases (e.g., MS) might not be independent risk factors.
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http://dx.doi.org/10.1089/vim.2016.0038DOI Listing
September 2016

Validity and Reliability of Knowledge, Attitude and Behavior Assessment Tool Among Vulnerable Women Concerning Sexually Transmitted Diseases.

J Family Reprod Health 2016 Mar;10(1):9-14

Department of Epidemiology and Biostatistics, School of Health, and Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: The study aimed to design and evaluate the content and face validity, and reliability of knowledge, attitude, and behavior questionnaire on preventive behaviors among vulnerable women concerning sexually transmitted diseases (STDs).

Materials And Methods: This cross-sectional study was carried out in two phases of an action research. In the first phase, to explain STDs preventive domains, 20 semi- structured interviews were conducted with the vulnerable women, residing at women prison and women referred to counseling centers. After analyzing content of interviews, three domains were identified: improve their knowledge, modify their attitude and change their behaviors. In the second phase, the questionnaire was designed and tested in a pilot study. Then, its content validity was evaluated. Face validity and reliability of the questionnaire were assessed by test re- test method and Cronbach alpha respectively.

Results: Index of content validity in each three domain of the questionnaire (knowledge, attitude and behavior concerning STDs) was obtained over 0.6. Overall content validity index was 0.86 in all three domains of the questionnaire. The Cronbach's alpha as reliability of questionnaire was 0.80 for knowledge, 0.79 for attitude and 0.85 for behavior.

Conclusion: The results showed that the designed questionnaire was a valid and reliable tool to measure knowledge, attitude and behavior of vulnerable women, predisposed to risk of STDs.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930455PMC
March 2016

Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients.

Adv Biomed Res 2016 8;5:108. Epub 2016 Jun 8.

Department of Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Urinary tract infection (UTI) as an important infection in the setting of renal transplantation carries the high mortality and morbidity rate. Thus, the prevention of this infection should receive higher priority. However, bacterial resistance to antibiotics is on the rise, with limited data to guide prophylaxis. The purpose of this study was to compare the effect of sulfamethoxazole-trimethoprim (SMZ/TMP) and SMZ/TMP plus ciprofloxacin for prophylaxis of UTI in renal transplant recipients.

Materials And Methods: In a clinical trial study, 50 patients were included and divided into two groups of 25 using block randomization. Patients in Group I received prophylactic SMZ/TMP and those in Group II received ciprofloxacin plus SMZ/TMP. The incidence of UTI in the two groups at 1, 3, and 6 months after transplantation was evaluated. This study was registered in Iranian Registry of Clinical Trial (IRCT number: IRCT 2015120823743N1).

Results: Of the 61 patients older than 18 years at the time of transplantation, 50 were included. UTI was documented in 8 patients (32%) in Group I and 3 (12%) in Group II (P = 0.026). The average time for the development of the first case of infection was the same for both groups (P = 0.241), and it was at its maximum in the 1(st) month. Urinary infections caused by Escherichia coli, the dominant strain, were the same in both groups (P = 0.673).

Conclusions: Our study shows that the addition of 1 month course of ciprofloxacin lowered the incidence of UTI. More studies are needed to confirm the efficacy of this approach.
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http://dx.doi.org/10.4103/2277-9175.183669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918205PMC
July 2016

Hepatitis G virus exposure in dialysis patients and blood donors in Isfahan-Iran.

Int J Prev Med 2014 Dec;5(Suppl 3):S219-22

The Research committee of Medical Students, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hepatitis G virus (HGV) is transmitted mainly by parenteral route and patients on maintenance hemodialysis (HD) are at risk for this infection. This study was conducted to estimate prevalence of infection through the presence of anti-HGV and to evaluate the clinical significance of HGV envelope protein E2 (anti-E2) in HD patients in compare with volunteer blood donors in Isfahan-Iran.

Methods: In a cross-sectional study, a total of 40 HD patients as cases and 40 healthy volunteer blood donors as negative controls were selected randomly in summer 2008. The epidemiological data were obtained in all subjects, and duration of HD was obtained in HD patients as well. All samples were tested for anti-E2 antibodies, hepatitis C virus (HCV)-antibody and hepatitis B virus surface antigen (HBs-Ag) by an enzyme-linked immunosorbent assay and a recombinant immunoblot assay was employed to confirm anti-HCV reactivity. Student's t-test, Chi-square test or Fisher exact test was used for data analysis and P < 0.05 was considered as statistically significant.

Results: Ten of the 40 HD patients tested positive for anti-E2 (25%) and of 40 voluntary blood donors, 10 (5%) were positive for anti-E2 (P = 0.012). Anti-HCV antibodies and HBs-Ag were found in 4 and 1 HD patients, respectively. In anti-E2-positive patients, co-infection with HCV or hepatitis B virus was not significant. Furthermore, the mean duration of hemodialysis in anti-E2 positive and anti-E2 negative patients did not have significant differences.

Conclusions: HD patients are at increased risk of HGV infection in Isfahan-Iran. Since hepatitis G is a good predictor for parenteral transmission, it is suggested to test all of the blood for transfusion for HGV infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635412PMC
December 2014