Publications by authors named "Ladan Abbasian"

25 Publications

  • Page 1 of 1

Safety and effectiveness of high-dose vitamin C in patients with COVID-19: a randomized open-label clinical trial.

Eur J Med Res 2021 Feb 11;26(1):20. Epub 2021 Feb 11.

Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, Iran.

Background: Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease.

Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen.

Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups.

Conclusions: We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020.
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http://dx.doi.org/10.1186/s40001-021-00490-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877333PMC
February 2021

Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir.

Daru 2020 Dec 28;28(2):625-634. Epub 2020 Aug 28.

Department of Epidemiology and Biostatistics, School of Public health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The role of the antiviral therapy in treatment of COVID-19 is still a matter to be investigated. Also efficacy and safety of antiviral regimens were not compared according severity of the disease. In this study the efficacy and safety of hydroxychloroquine plus atazanavir/ritonavir was compared in patients with moderate and severe COVID-19.

Methods: We prospectively evaluated the clinical outcomes of 213 patients with COVID-19 during the hospitalization course and up to 56 days after the hospital discharge. The disease was categorized to moderate and severe based on the severity of pneumonia and peripheral oxygen saturation (SpO2). The patients received the national treatment protocol containing hydroxychloroquine (400 mg BD in first day and then 200 mg BD) plus atazanavir/ritonavir (300/100 mg daily) for 7 days. Main outcomes included discharge rates at day 7, 14 and 28, 28-day mortality, rate of intensive care unit (ICU) admission and intubation, length of hospital and ICU stay and incidence of adverse events.

Results: The mean (SD) age of patients was 60(14) years and 53% were male. According to WHO definition, 51.64% and 48.36% of the patients had moderate (SpO2 ≥ 90%) and severe disease (SpO2 < 90%) at baseline, respectively. The discharge rate of the moderate group was significantly higher than the severe group at day 7, 14 and 28 (HR = 0.49; 95% CI: 0.35-0.69, p = < 0.001 at day 7, HR = 0.48; 95% CI: 0.35-0.66, p = < 0.001 at day 14 and HR = 0.49; 95% CI: 0.36-0.67, p = < 0.001at day 28). The 28-day mortality of the severe group was six times higher than the moderate group (HR = 6.00; 95% CI: 2.50-14.44), p = < 0.001). The need of admission in ICU for the severe group and the moderate group was 37.86% and 18.18% of the patients. Length of hospital stay was significantly shorter in the moderate group in comparison with the severe group (5 ± 4 vs. 8 ± 6 days, p < 0.001). Patients in the moderate group experienced the serious adverse events and complications less than the severe group. The discharged patients were followed up to 56 days after discharge. Some of the patients complained of symptoms such as exertional dyspnea, weakness and new-onset hair loss.

Conclusion: Our study did not support the use of hydroxychloroquine plus atazanavir/ritonavir in patients who had SpO < 90% at the time of hospital admission. SpO2 was the only predictor of clinical outcomes (duration of hospital stay, discharge from the hospital and mortality) in patients treated with hydroxychloroquine plus atazanavir/ritonavir.
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http://dx.doi.org/10.1007/s40199-020-00369-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453126PMC
December 2020

CT-scan Findings of COVID-19 Pneumonia Based on the Time Elapsed from the Beginning of Symptoms to the CT Imaging Evaluation: A Descriptive Study in Iran.

Rom J Intern Med 2020 Jul 27. Epub 2020 Jul 27.

Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.

Methods: Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.

Results: The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%), and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.

Conclusions: Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.
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http://dx.doi.org/10.2478/rjim-2020-0019DOI Listing
July 2020

A Randomized Clinical Trial of the Efficacy and Safety of Interferon β-1a in Treatment of Severe COVID-19.

Antimicrob Agents Chemother 2020 08 20;64(9). Epub 2020 Aug 20.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

To the best of our knowledge, there is no published study on the use of interferon β-1a (IFN β-1a) in the treatment of severe COVID-19. In this randomized clinical trial, the efficacy and safety of IFN β-1a were evaluated in patients with severe COVID-19. Forty-two patients in the interferon group received IFN β-1a in addition to the national protocol medications (hydroxychloroquine plus lopinavir-ritonavir or atazanavir-ritonavir). Each 44-μg/ml (12 million IU/ml) dose of interferon β-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group consisted of 39 patients who received only the national protocol medications. The primary outcome of the study was time to reach clinical response. Secondary outcomes were duration of hospital stay, length of intensive care unit stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects, and complications during the hospitalization. Between 29 February and 3 April 2020, 92 patients were recruited, and a total of 42 patients in the IFN group and 39 patients in the control group completed the study. As the primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 ± 5.8 versus 8.3 ± 4.9 days, respectively,  = 0.95). On day 14, 66.7% versus 43.6% of patients in the IFN group and the control group, respectively, were discharged (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.05 to 6.37). The 28-day overall mortality was significantly lower in the IFN than the control group (19% versus 43.6%, respectively, = 0.015). Early administration significantly reduced mortality (OR, 13.5; 95% CI, 1.5 to 118). Although IFN did not change the time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality. (This study is in the Iranian Registry of Clinical Trials under identifier IRCT20100228003449N28.).
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http://dx.doi.org/10.1128/AAC.01061-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449227PMC
August 2020

Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment.

Curr HIV Res 2020 ;18(5):373-380

Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

Background: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection.

Objective: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran.

Design: Cross-sectional study.

Methods: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers.

Results: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments.

Conclusion: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.
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http://dx.doi.org/10.2174/1570162X18666200712175535DOI Listing
October 2020

Correction to: Psychometric properties of the scale for non-adherence to antiretroviral medication (NAME) among HIV-infected patients.

Arch Public Health 2019;77:57. Epub 2019 Dec 30.

6Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran.

[This corrects the article DOI: 10.1186/s13690-019-0382-9.].
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http://dx.doi.org/10.1186/s13690-019-0386-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937778PMC
December 2019

Psychometric properties of the scale for non-adherence to antiretroviral medication (NAME) among HIV-infected patients.

Arch Public Health 2019 6;77:54. Epub 2019 Dec 6.

School of Nursing and Allied Medical Sciences Maragheh Faculty of Medical Sciences, Maragheh, Iran.

Background: Adherence to HIV medication is necessary for long-term HIV disease management. The objective of this study was to develop and examine the psychometric properties of a scale for measuring the barriers of antiretroviral medication adherence among Iranian Patients.

Method: This was a sequential, exploratory mixed methods investigation composed of two phases. In the qualitative phase, item pool generation and questionnaire designing was carried out through in-depth individual interviews and group discussions; in the quantitative phase, psychometric properties of the questionnaire were assessed. In both phases, the participants were people who were living with HIV/AIDS and were taking antiretroviral medications.

Results: In the first phase, an item pool containing 181 statements related to barriers of adherence to antiretroviral medication was generated. In the second phase, item reduction was applied, and a questionnaire containing 30 items was developed. The psychometric properties of the questionnaire were assessed, which indicated good validity and reliability of the instrument. In exploratory factor analysis, the items were loaded on six factors that altogether explain for 61.98 of the variance. The Cronbach's alpha and the intra class correlation coefficient of the questionnaire was 0.91 and 0.80, respectively.

Conclusion: This study provided a reliable and valid instrument to identify the barriers of adherence to antiretroviral medication in patients with HIV/AIDS. Identify these barriers and design of interventions to eliminate or reduce of barriers can be an effective means of enhancing adherence to antiretroviral medication among these patients.
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http://dx.doi.org/10.1186/s13690-019-0382-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896284PMC
December 2019

HIV drug resistance among naïve HIV-infected patients in Iran.

J Res Med Sci 2019 26;24:31. Epub 2019 Apr 26.

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.

Background: Antiretroviral (ARV) therapy extends life for persons living with HIV. Antiretroviral treatment (ART) has been rapidly expanding coverage around the world, including in Iran. However, ART drug resistance also rapidly develops with expanding use and limits effectiveness and treatment options. The aim of this study was to monitor the appearance of new mutations conferring HIV pretreatment drug resistance in the treatment of naïve patients with HIV in Iran.

Materials And Methods: Blood samples were obtained from ARV treatment-naïve patients from 8 different provinces in Iran in 2016 for genotyping for drug resistance mutations.

Results: Sequences were successfully obtained from 90 specimens. Of these, 2 (2%) mutations conferring resistance to protease inhibitors, 2 (3%) conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), and 9 (13%) conferring resistance to non-NRTI (NNRTI) were detected. Any ARV-resistant drug mutation was found in 11 patients (12%).

Conclusion: Nearly one in 8 ARV-naïve patients had mutations associated with NNRTI resistance in diverse areas of Iran in 2016. Iranian ARV therapy guideline for HIV could consider non-NNRTI-based first-line therapies and expand routine drug resistance testing before treatment initiation as according to HIV drug resistance recommendations of the World Health Organization.
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http://dx.doi.org/10.4103/jrms.JRMS_689_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521612PMC
April 2019

Comparison of Static and Dynamic Balance in Male Football and Basketball Players.

Foot Ankle Spec 2020 Jun 23;13(3):228-235. Epub 2019 May 23.

Sports Medicine Research Center, Neuroscience Institute (FH, LA, MHPS), Tehran University of Medical Sciences, Tehran, Iran.

The aim of the present study was to compare static and dynamic balance among professional athletes in football and basketball. In this cross-sectional study, 47 professional, male football and basketball players from Pro League in Iran participated. They were divided into 3 groups. Group 1 included 16 participants with history of grade 1 or 2 single ankle sprain within the past 6 months. Group 2 included 17 participants with recurrent ankle sprain. Group 3 included 14 participants without history of ankle sprain. Static and dynamic balance were measured by the Balance Error Scoring System (BESS) and modified Star Excursion Balance Test (SEBT), respectively. For the single-leg stance on a firm surface, group 2 scored errors with a high mean value of 3.94 compared with the other 2 groups, and the difference was statistically significant (P = .03). Significant differences in BESS scores are observed on both surfaces across the tandem limb between groups 2 and 3. The measures from the SEBTs may not reflect the balance performance especially in well-trained athletes who have a better balance when performing sport-related skills. However, BESS includes static postures, and it may reflect postural deficits better than dynamic tests in the more experienced athlete. Diagnostic, Level IV.
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http://dx.doi.org/10.1177/1938640019850618DOI Listing
June 2020

Prevalence of cryptococcal antigen positivity among HIV infected patient with CD4 cell count less than 100 of Imam Khomeini Hospital, Tehran, Iran.

Iran J Microbiol 2017 Apr;9(2):119-121

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Cryptococcal meningitis is one of the main opportunistic infections associated with human immunodeficiency virus (HIV) infection. Despite the present and increasingly availability of specific treatment for cryptococcosis, the mortality rate of this infection is still high, particularly in patients with advanced immunsupression and advanced cryptococcal diseases.

Materials And Methods: This Prospective Cohort study was conducted at Imam Khomeini hospital in Tehran, Iran. Serum cryptococcal antigen was detected using the Lateral Flow Assay (LFA) There were 86 HIV-infected patients included in this study.

Results: There were 86 HIV-infected patients in this study. The prevalence of positive serum cryptococcal antigen was 0% (0 of 86).

Conclusion: The prevalence of cryptococcal infection among patients with advanced acquired immunodeficiency syndrome (AIDS) in the Iran is very low (<3%) thus the screening test for cryptococcal antigenemia dose not save lives and is not cost-effective in Iranian population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715277PMC
April 2017

Antiretroviral Drug Resistance Mutations among HIV Treatment Failure Patients in Tehran, Iran.

Iran J Public Health 2017 Sep;46(9):1256-1264

Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study aimed to determine drug resistance mutations in patients with virological failure and find correlation between HIV drug resistance test and viral load.

Methods: Blood sample was collected from 51 patients who suspicious treatment failure in the center of Imam Khomeini Hospital, Tehran, Iran in 2015. Viral voluntary counseling and testing load test was done and the patients with viral load above 1000 copies choose for detection of drug resistance mutations by genotyping method (29 patients).

Results: The majority of patients (82.75) harbored the HIV subtype CRF 35 A-D. The 86.2% patients compromised at least one resistance mutation. The analysis of reverse transcriptase showed M184V (68.9%), T215YISF (44.8%), K103N (27.6%) and the analysis results of protease revealed G73SC (13.8%) and I47VA (6.9%). Eventually, the significant correlation between viral load and drug resistance was found.

Conclusion: The result of our research stress the significance of recognizing drug resistant on time that prohibits the accumulation of drug resistance mutation and circulates the resistance strain of HIV-1 virus and the importance of national study according to the reliable findings for treatment guidelines.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5632328PMC
September 2017

Assessing the Efficacy of Second-Line Antiretroviral Treatment for HIV Patients Failing First-Line Antiretroviral Therapy in Iran: A Cohort Study.

Acta Med Iran 2017 Apr;55(4):233-240

Academic Member of Academic Center for Education, Culture and Research, Tehran, Iran.

There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.
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April 2017

Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial.

Ann Pharmacother 2017 Jun 1;51(6):457-464. Epub 2017 Feb 1.

1 Tehran University of Medical Sciences, Tehran, Iran.

Background: Several neuropsychiatric adverse effects of efavirenz are known. Preventing these adverse effects may improve patients' adherence to antiretroviral therapy (ART).

Objectives: To evaluate the efficacy and safety of valerian in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.

Method: In this pilot randomized, double-blinded, placebo-controlled, clinical trial, 51 HIV-positive patients who were receiving efavirenz were recruited into the valerian (n = 25) or placebo (n = 26) group. Patients received valerian (530 mg) or placebo nightly 1 hour before sleep for 4 weeks. The neuropsychiatric status (sleep, anxiety, depression, suicidal thought, and psychosis) of patients was assessed at baseline and week 4 using validated questionnaires.

Results: Sleep ( P ≤ 0.001) and anxiety ( P = 0.001) significantly improved in the valerian group compared with the placebo group. Dizziness was the most common complaint of patients in first days of the intervention. In the valerian and placebo groups, 92% and 84.6% of patients experienced dizziness, respectively ( P = 0.35). Nausea was the second common adverse effect that 84% and 76.9% of patients in the valerian and placebo groups experienced ( P = 0.39).

Conclusion: In the first 4 weeks of ART including efavirenz, valerian significantly improved sleep and anxiety in HIV-positive patients. Valerian may be considered as a potential option in preventing neuropsychiatric adverse effects of efavirenz in HIV-positive patients.
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http://dx.doi.org/10.1177/1060028017696105DOI Listing
June 2017

Tuberculin Skin Test Conversion among Individuals with Human Immunodeficiency Virus Infection on Antiretroviral Therapy in a Referral Teaching Hospital, Tehran, Iran.

Tanaffos 2017 ;16(3):201-206

Internal Medicine Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Background: The risk of tuberculosis (TB) is greater for individuals with human immunodeficiency virus (HIV) who are on combined antiretroviral therapy (c-ART) than for the normal population. Therefore, the detection and treatment of latent tuberculosis infections is recommended for all HIV-positive persons with positive tuberculin skin tests (TSTs).

Materials And Methods: This retrospective cohort study included all HIV-positive individuals with CD4 lymphocyte counts greater than 200 cells/μL and negative TST results, who were taking antiretroviral drugs and had been referred to Imam Khomeini Teaching Hospital Consultation Centre for Clients with Risky Behaviors in Tehran, Iran, from 2008 to 2013. TST conversion to positivity is defined as an induration increase of at least 5 mm compared with a previously negative TST result within a 1-year period. Conversion rates are expressed in person-years of observation.

Results: A total of 113 patients were included in our study. At 1 year, 9 of the 113 TST-negative patients taking c-ART became TST-positive (8%; 8 males and 1 female). The TST conversion incidence rate was 10.09/100 person-years. TST conversion was only found to be associated with sex (odds ratio: 8.64; 95% confidence interval: 1.04-7.56, p = 0.032).

Conclusion: Our results suggest that TSTs should be administered to all HIV-positive patients before beginning isoniazid preventive therapy in Iran.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960224PMC
January 2017

HBsAg mutations related to occult hepatitis B virus infection in HIV-positive patients result in a reduced secretion and conformational changes of HBsAg.

J Med Virol 2017 02 1;89(2):246-256. Epub 2016 Aug 1.

Hepatitis B Molecular Laboratory, Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Occult hepatitis B infection (OBI) is a frequent finding in human immunodeficiency virus (HIV)-infected patients. While several related mutations in the hepatitis B virus (HBV) genome have been reported, their distinct impact on HBsAg synthesis is largely obscure.

Methods: Thirty-one (18%) out of 172 HIV-infected patients, who were selected from HBsAg-negative patients, were positive for HBV-DNA assigned as being OBI-positive. We generated a series of expression constructs of variant HBsAg with "a" determinant amino acid substitutions including P127L, P127T, S136Y, and P127T + S136Y using site-directed mutagenesis. The expression of variant HBsAg was examined by transient transfection in hepatoma cells, followed by HBsAg immunoassay and immunofluorescence stained with specific anti-HBs antibodies. The potential impact of amino acid substitutions at different positions for conformational changes in the HBsAg was investigated using bioinformatics.

Results: All variants comprising either single or combined mutations resulted in significantly reduced HBsAg detection in supernatants and in cell lysates of hepatoma cells transfected with the constructs. Moreover, intracellular immunofluorescence staining of cytoblocks showed perinuclear and cytoplasmic fluorescence of HBsAg constructs with significantly diminished fluorescent intensity in comparison to the wild type. Altered protein conformations by predictive models, indicating an impaired detection by the host's immune response as well as by commercial antibody-based test assays.

Conclusion: Mutations in the "a" determinant region of HBV as often found in OBI remarkably impair the detection of HBsAg from serum and infected cells, emphasizing the relevance of alternative methods such as HBV-DNA quantification for high-risk groups like HIV-infected individuals. J. Med. Virol. 89:246-256, 2017. © 2016 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/jmv.24623DOI Listing
February 2017

Effect of Omega-3 Fatty Acids on Depressive Symptoms in HIV-Positive Individuals: A Randomized, Placebo-Controlled Clinical Trial.

Ann Pharmacother 2016 10 20;50(10):797-807. Epub 2016 Jun 20.

Tehran University of Medical Sciences, Tehran, Iran.

Background: The antidepressant effect of omega-3 fatty acids has been described in the non-HIV population. The effect of omega-3 fatty acid supplementation on the mood status of HIV-positive patients has not been evaluated yet.

Objective: In this study, the effect of omega-3 fatty acids on depressive symptoms was evaluated in HIV-positive individuals.

Method: A total of 100 HIV-positive patients with Beck Depression Score ≥16, were assigned to receive either omega-3 fatty acids or placebo twice daily for 8 weeks. Depressive symptoms of each participant were evaluated at baseline (month 0) and at the end of months 1 and 2 of the study. Beck Depression Inventory Second Edition, depression subscale of the Hospital Anxiety and Depression Scale, and Patient Health Questionnaire were used for assessment of depressive symptoms.

Results: Reduction in mean ± SD of all depression scores during the study period was statistically significant within the omega-3 group and when compared with the placebo group (for both comparisons, P < 0.001). Also, the mean differences of all depression scores were decreased significantly during the intervals: months 0, 1, and 2 (P < 0.001 for all comparisons). Among the participants, 7 (7%) and 4 (4%) patients in the omega-3 and the placebo group, respectively, experienced mild gastrointestinal problems, but the incidence of adverse drug reactions related to the interventions was not statistically different between the groups (P = 0.09).

Conclusion: Omega-3 fatty acids improved depressive symptoms in HIV-positive individuals without any significant adverse reaction.
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http://dx.doi.org/10.1177/1060028016656017DOI Listing
October 2016

Adherence to HIV/AIDS antiretroviral therapy among drug users: A qualitative study in Iran.

Iran J Nurs Midwifery Res 2016 Jan-Feb;21(1):29-37

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The introduction of antiretroviral therapy has caused a remarkable decrease in the occurrence of diseases and mortality among HIV-positive patients, while this success has not been achieved among injection addicts due to a low adherence to antiretroviral medicine. This study aims at clarifying the important factors affecting adherence to treatment in addicts suffering from HIV.

Materials And Methods: In this qualitative research, data were gathered through in-depth interviews and field notes, and were interpreted through content analysis in the form of constant comparison. The participants were 16 drug addicts living with HIV/AIDS. Most of them had records of imprisonment and were receiving Highly Active Antiretroviral Therapy (HAART) drug treatments in the AIDS center of Imam Khomeini Hospital complex, affiliated to Tehran University of Medical Sciences. Sampling was started in a purposive method and was continued until data were saturated.

Results: Four main categories including psychological reactions, contradictory beliefs, perceived support, and individual and environmental barriers were extracted from the data, each having some sub-categories.

Conclusions: The obtained results indicated that adherence to the treatment of HIV is not constant and mono-dimensional, but is a function of different factors. Hence, an individual having feeble adherence in a specific time and under specific circumstances may show desirable adherence under a different circumstance. Thus, treatment of addicts living with HIV/AIDS requires physical, psychological, and social attention along with drug treatments.
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http://dx.doi.org/10.4103/1735-9066.174757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776558PMC
March 2016

Adherence to HIV/AIDS antiretroviral therapy among drug users: A qualitative study in Iran.

Iran J Nurs Midwifery Res 2016 Jan-Feb;21(1):29-37

Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The introduction of antiretroviral therapy has caused a remarkable decrease in the occurrence of diseases and mortality among HIV-positive patients, while this success has not been achieved among injection addicts due to a low adherence to antiretroviral medicine. This study aims at clarifying the important factors affecting adherence to treatment in addicts suffering from HIV.

Materials And Methods: In this qualitative research, data were gathered through in-depth interviews and field notes, and were interpreted through content analysis in the form of constant comparison. The participants were 16 drug addicts living with HIV/AIDS. Most of them had records of imprisonment and were receiving Highly Active Antiretroviral Therapy (HAART) drug treatments in the AIDS center of Imam Khomeini Hospital complex, affiliated to Tehran University of Medical Sciences. Sampling was started in a purposive method and was continued until data were saturated.

Results: Four main categories including psychological reactions, contradictory beliefs, perceived support, and individual and environmental barriers were extracted from the data, each having some sub-categories.

Conclusions: The obtained results indicated that adherence to the treatment of HIV is not constant and mono-dimensional, but is a function of different factors. Hence, an individual having feeble adherence in a specific time and under specific circumstances may show desirable adherence under a different circumstance. Thus, treatment of addicts living with HIV/AIDS requires physical, psychological, and social attention along with drug treatments.
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http://dx.doi.org/10.4103/1735-9066.174757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776558PMC
March 2016

Assessing the prevalence distribution of abnormal laboratory tests in patients with simple febrile seizure.

J Pediatr Neurosci 2015 Apr-Jun;10(2):93-7

Department of Pediatric, Arak University of Medical Sciences, Arak, Iran.

Introduction: Febrile seizure is an important issue in pediatric practice. Even some pediatricians do not have a proper approach to febrile seizure, making the sick child undergo complex laboratory tests or invasive procedures or even long-term treatment with anticonvulsant drugs. In spite of multiple studies, many controversies have still remained about the significance of febrile seizure. The goal of this study is to assess the prevalence distribution of routinely requested laboratory tests results in simple febrile seizure.

Materials And Methods: In a descriptive study, 549 patients with simple febrile seizure were studied. The routine lab tests including complete blood count, electrolyte, urine analysis, and cerebrospinal fluid (CSF) analysis had already been performed for all patients and the results had been recorded in their medical data. These results were collected and statistically analyzed through SPSS software.

Results: About 58.7% of our cases were male. Most of the cases were 12-24 months old and the mean body temperature of them was 38.2°C. 99.3% of blood sugar tests, 98% of blood calcium tests, 100% and 99.5% of sodium, and potassium tests, respectively, 100% of blood creatinine, 96.9% of blood urea nitrogen, and 99.1% of urine analysis tests were normal. CSF analysis was done in only 49 cases and the results were normal in all of them.

Conclusion: The percentage of abnormal laboratory test results was not statistically significant in febrile seizure and shows that performing all these tests in all patients with simple febrile seizure as routine is not necessary.
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http://dx.doi.org/10.4103/1817-1745.159180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489076PMC
July 2015

Psychometric Properties of the Coping Self-Efficacy Scale Among HIV-Infected Iranian Patients.

Iran Red Crescent Med J 2015 Feb 10;17(2):e25074. Epub 2015 Feb 10.

Department of Clinical Psychology, Islamic Azad University, Saveh Branch, Saveh, IR Iran.

Background: Self-efficacy is an important predicator of coping with stress.

Objectives: This study aimed to determine the psychometric characteristics of the coping self-efficacy (CSE) scale among HIV-infected Iranian patients.

Patients And Methods: Psychometric properties of the CSE scale were examined by using a cross-sectional study design. One hundred and twenty HIV-infected Iranian patients that had been referred to the Counseling of Behavioral Diseases Center at Imam Khomeini Hospital in Tehran, Iran in 2014 were selected through simple random sampling method. To determine the Content Validity Index (CVI) and the content validity ratio (CVR), a panel of experts (n = 20) reviewed items of CSE scale. Reliability was estimated through the internal consistency (n = 30) and the conformity factor analysis was performed.

Results: Iranian version of the CSE scale contained 16 items, including 7 items on the "use of problem-focused coping" method, 5 items on "stopping unpleasant emotions and thoughts", and 4 items on "getting support from friends and family". CVI and CVR scores were 0.79, 0.42 and more, respectively. Internal consistencies (range, 0.64 to 0.84) of 3 subscales were acceptable. Confirmatory factor analysis showed that comparative indices of the model, including CFI, IFI, GFI, RMSEA, and Chi-square (χ2/df) were 0.96, 0.95, 0.84, 0.83, and 1.82, respectively, which indicated a good fit for the data.

Conclusions: The Iranian version of the CSE scale is a valid instrument to measure the coping self-efficacy among people living with HIV in research and community settings in Iran.
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http://dx.doi.org/10.5812/ircmj.25074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353189PMC
February 2015

Coping With Stress Strategies in HIV-infected Iranian Patients.

J Assoc Nurses AIDS Care 2015 Jul-Aug;26(4):464-71. Epub 2015 Jan 13.

Stress has significant adverse impacts on health outcomes of HIV-infected patients. Our study explored coping with stress strategies by HIV-infected Iranian patients. A qualitative content analysis study was conducted at the Consultation Clinic of HIV at the Imam Khomeini Hospital in Tehran, Iran in 2012. Twenty-six semi-structured in-depth interviews were done. Participants were asked about coping strategies for stress. After the first interview, continuous analysis of data was started and continued up to data saturation. Results showed that participants used two categories of strategies (emotion-based coping and problem-based coping) to cope with stress. Emotion-based coping had two sub-themes: adaptive and maladaptive. The problem-based coping category had three sub-themes: participation in education sessions, adherence to medication, and efforts to maintain a healthy lifestyle. Explanations of different strategies available to HIV-infected patients to cope with stress may help develop tailored interventions to improve the psychological conditions of people living with HIV.
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http://dx.doi.org/10.1016/j.jana.2015.01.001DOI Listing
March 2016

Associated factors of drug-drug interactions of highly active antiretroviral therapy: report from a referral center.

Expert Opin Drug Metab Toxicol 2015 Apr 5;11(4):471-9. Epub 2015 Jan 5.

International Campus, Tehran University of Medical Sciences , Tehran , Iran.

Objective: To assess different aspects of potential drug-drug interactions (DDIs) including incidence, severity, level of evidence and probable associated factors in Iranian HIV-infected individuals receiving antiretroviral therapy.

Methods: All adult HIV-infected patients under highly active antiretroviral therapy regimen attending a referral HIV clinic during 1 year were screened retrospectively for potential moderate or severe DDIs by the Lexi-Interact On-Desktop software.

Results: Near seventy percent (69.89%) of detected DDIs in our population were major. The three most common detected potential DDIs were efavirenz + methadone (11 cases), lopinavir-ritonavir + sulfamethoxazole-trimethoprim, (10 cases) and lamivudine + ribavirin (7 cases). Lopinavir-ritonavir (27.96%) and citalopram (23.66%) were the most common offending antiretroviral and non-antiretroviral agents, respectively.

Conclusion: Performing multicenter and prospective studies is warranted to assess the real clinical as well as economic impacts of DDIs on HIV-infected patients receiving antiretroviral agents in our population and also to develop efficient preventive strategies.
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http://dx.doi.org/10.1517/17425255.2014.993606DOI Listing
April 2015

Ginger for prevention of antiretroviral-induced nausea and vomiting: a randomized clinical trial.

Expert Opin Drug Saf 2014 Jul 12;13(7):859-66. Epub 2014 May 12.

Kerman University of Medical Sciences, Department of Clinical Pharmacy, Faculty of Pharmacy , Kerman , Iran.

Objective: In this randomized clinical trial ginger efficacy for prevention of antiretroviral-induced nausea and vomiting (N/V) was investigated.

Methods: From July 2011 until the end of June 2013, 102 HIV positive patients attending the HIV clinic of Imam Khomeini Hospital participated in the study. In a double blinded manner, participants randomly received either 500 mg ginger or placebo two times per day, 30 min before each dose of antiretroviral regimen for 14 days. The severity of nausea was assessed based on the visual analogue scale. The number of vomiting episodes were also recorded during the study period.

Results: A total of 46 (90.2%) and 29 (56.4%) of the patients in placebo and ginger groups experienced some degree of nausea during the first 2 weeks of antiretroviral therapy (ART), respectively (p = 0.001). Frequency of mild, moderate and severe nausea were significantly lower in the ginger than placebo group (p = 0. 001). Also, 24 (47.1%) and 5 (9.8%) of the patients in the placebo and ginger groups reported at least one episode of vomiting during their time on ART, respectively (p = 0.01).

Conclusion: Ginger was effective in ameliorating of antiretroviral-induced N/V.
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http://dx.doi.org/10.1517/14740338.2014.914170DOI Listing
July 2014

Pediatric flexible flatfoot; clinical aspects and algorithmic approach.

Iran J Pediatr 2013 Jun;23(3):247-60

Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran ; Department of Sports & Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Flatfoot constitutes the major cause of clinic visits for pediatric foot problems. The reported prevalence of flatfoot varies widely due to numerous factors. It can be divided into flexible and rigid flatfoot. Diagnosis and management of pediatric flatfoot has long been the matter of controversy. Common assessment tools include visual inspection, anthropometric values, footprint parameters and radiographic evaluation. Most flexible flatfeet are physiologic, asymptomatic, and require no treatment. Otherwise, the physician should treat symptomatic flexible flatfeet. Initial treatment options include activity modification, proper shoe and orthoses, exercises and medication. Furthermore, comorbidities such as obesity and ligamenous laxity should be identified and managed, if applicable. When all nonsurgical treatment options faile, surgery can be considered. Our purpose in this article is to present a clinical algorithmic approach to pediatric flatfoot.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684468PMC
June 2013

Validity and Reliability of the Iranian Version of the HIV/AIDS Stigma Instrument-PLWHA (HASI-P).

Health Promot Perspect 2013 31;3(2):194-205. Epub 2013 Dec 31.

Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran.

Background: HIV/AIDS disease has remained highly stigmatized all over the world even though the increasing accessibility of its treatment. This study was designed to adapt the HIV/AIDS Stigma Instrument (HASI) to the Iranian People Living with HIV/AIDS (PLWHA).

Methods: Translation -back translation of the scale into Persian was done. Then, the validity and reliability of the instrument were evaluated. The validity of the translated scale was assessed in three ways: evaluating its linguistic validity, assessing its content validity by a panel of nine experts, and exploring its construct validity by factor analysis. The internal con-sistency of the translated scale was evaluated by Cronbach's Alpha.

Results: HASI showed a good Content Validity Index (CVI value >0.75) and Content Validity Ratio (CVR >0.78). The internal consistency of the instrument regarding the total score was α=0.89. The three stigma sub-scales that were dis-tancing and blaming (8 items, α=0.87), fear (3 items, α=0.82), and discrimination (5 items, α=0.83).

Conclusion: This article reports the development and validation of a new measure of stigma, i.e. HIV/AIDS Stigma Instrument in PLWHA (HASI-P), and pro-vides evidence to support its content validity and internal consistency.
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http://dx.doi.org/10.5681/hpp.2013.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963664PMC
April 2014