Publications by authors named "Mahboubeh Hajiabdolbaghi"

20 Publications

  • Page 1 of 1

Pulmonary Valve Endocarditis: A Case Report.

Infect Disord Drug Targets 2020 Dec 3. Epub 2020 Dec 3.

Department of Infectious Diseases, Tehran University of Medical Sciences, Tehran,. Iran.

Isolated pulmonary valve endocarditis (PVE) is an extremely uncommon clinical finding comprising less than 1.5-2% of cases for infective endocarditis. It is a challenging condition to diagnose mainly because of nonspecific signs and symptoms at presentation. A 58-year-old married and retired man was admitted to a community hospital for evaluation of chest pain. Transesophageal echocardiography (TEE), 2 days after, revealed semi-mobile vegetation on the pulmonary valve and pulmonary artery wall. Moreover, occlude devices at the root of the aorta, and the pulmonary artery was seen. Left ventricular ejection fraction (LVEF) with systolic dysfunction, mild aortic insufficiency (AI), mild tricuspid regurgitation (pulmonary artery pressure of 50 mmHg) without pericardial effusion, was also reported in Echocardiography. Blood cultures, viral markers, and Brucella IgG and IgM titration were negative during the admission. The patient received a 4-week course of intravenous antibiotic therapy included Ceftriaxone and Teicoplanin (Targocid).
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http://dx.doi.org/10.2174/1871526520999201203212135DOI Listing
December 2020

Does an antimicrobial stewardship program for Carbapenem use reduce Costs? An observation in Tehran, Iran.

Caspian J Intern Med 2020 May;11(3):329-332

Department of Infectious Diseases, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background: Inappropriate administering of antimicrobials has led to increased antibiotic resistance as well as burden of infectious diseases. Antibiotic stewardship programs (ASPs) help prevent resistance through improved utilization of antimicrobial agents while potentially decrease costs of treatment.

Methods: We reviewed 186 infectious disease (ID) consultations from two internal disease wards in a tertiary center where ID specialists were asked to confirm carbapenem use in patients within 48 hours of initiation. The records were reviewed in terms of age, gender, and final decision about carbapenem use. The crude mortality rates during the 5-month period of the study (May to September 2016) as well as hospital spendings were compared with the same time of the year before the implementation of the ASP.

Results: Of the 186 consultations conducted by the ID specialists, 28 (15%) consultations led to antibiotic change, 46 (25%) led to discontinuation, while 112 (60%) carbapenems were continued. An estimate of 14,000 € was saved based on the annual hospital costs during the 5-month period of the study. Although antimicrobial resistance patterns could not be evaluated, the crude mortality rate in the two IM wards was calculated to be 2.6% with no significant change compared to previous year (CMR: 2.9%).

Conclusion: Based on findings of the present study, ASPs for carbapenems (as wide-spectrum agents) can lower costs with no increased mortality rates in a tertiary center located in a middle-income country.
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http://dx.doi.org/10.22088/cjim.11.3.329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442459PMC
May 2020

Safety and effectiveness of azithromycin in patients with COVID-19: An open-label randomised trial.

Int J Antimicrob Agents 2020 Oct 25;56(4):106143. Epub 2020 Aug 25.

Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Keshavarz Boulevard, Tehran University of Medical Sciences, Tehran 14197-33141, Iran. Electronic address:

As no specific pharmacological treatment has been validated for use in coronavirus disease 2019 (COVID-19), we aimed to assess the effectiveness of azithromycin (AZM) in these patients at a referral centre in Iran. An open-label, randomised controlled trial was conducted on patients with laboratory-confirmed COVID-19. A total of 55 patients in the control group receiving hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) were compared with 56 patients in the case group who in addition to the same regimen also received AZM. Patients with prior cardiac disease were excluded from the study. Furthermore, patients from the case group were assessed for cardiac arrythmia risk based on the American College of Cardiology (ACC) risk assessment for use of AZM and HCQ. The main outcome measures were vital signs, SpO levels, duration of hospitalisation, need for and length of intensive care unit admission, mortality rate and results of 30-day follow-up after discharge. Initially, there was no significant difference between the general conditions and vital signs of the two groups. The SpO levels at discharge were significantly higher, the respiratory rate was lower and the duration of admission was shorter in the case group. There was no significant difference in the mortality rate between the two groups. Patients who received AZM in addition to HCQ and LPV/r had a better general condition. HCQ+AZM combination may be beneficial for individuals who are known to have a very low underlying risk for cardiac arrhythmia based on the ACC criteria.
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http://dx.doi.org/10.1016/j.ijantimicag.2020.106143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445147PMC
October 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

Bone Marrow Aspiration/Biopsy in the Evaluation of Fever of Unknown Origin in Patients with AIDS.

Infect Disord Drug Targets 2020 Jul 5. Epub 2020 Jul 5.

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

Background: HIV can interrupt the normal development of bone marrow cell lines. Bone marrow aspiration/biopsy (BMA/B) has been described as a diagnostic tool in AIDS patients with fever of unknown origin (FUO). In this study, we aimed to study patients with AIDS who had undergone a BMA/B to investigate FUO and describe the pathologies diagnosed in the biopsy.

Methods: Thirty-four BMA/B samples were collected from AIDS patients admitted for workup of FUO to the infectious disease ward of a tertiary referral HIV center in Tehran, Iran, between September 2014 and September 2015. Data including age, sex, duration of disease, CD4 cell counts, hepatitis B (HBV) and C (HCV) coinfection, the primary presentation of AIDS, and the treatment history were retrieved and analyzed. Patients underwent BMA/B. An expert pathologist reviewed the BMA/B specimens.

Results: The mean age of the patients was 37.5 years (range, 26-56), and 27 (79%) were men. Twenty-seven (79%) patients contracted HIV from injection drug use, and 7 (21%) via sexual transmission. Only 3 (9%) of the BMA/B examinations were normal. Hypocellular bone marrow was diagnosed in 22 (65%) patients. Other pathologies included granulomas in 6 (18%), hematologic malignancies in 2 (6%), and leishmaniasis Aspergillosis, each in 1 (3%) patient. Six (17%) of the specimens were found to have tuberculosis infections.

Conclusion: Hypocellular bone marrow was the most common pathology on BMA/B examinations, followed by the presence of granulomas. Tuberculosis, Aspergillosis, and Leishmaniasis were the opportunistic infections diagnosed on BMA/B specimens. Our results support BMA/B as an appropriate diagnostic tool for early diagnosis of opportunistic infections and malignancies in AIDS. BMA/B is indispensable in the armament of diagnostic tools of the physicians managing AIDS patients.
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http://dx.doi.org/10.2174/1871526520666200705212903DOI Listing
July 2020

Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran.

East Mediterr Health J 2019 Mar 19;25(2):90-97. Epub 2019 Mar 19.

Department of Nursing, Sina Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Background: Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs). Device-associated infections (DAIs) are a major threat to patient safety.

Aim: To measure DAI rates in ICUs.

Methods: Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter- associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran.

Results: The incidence rate of CLABSI, VAP and CAUTI was 10.20, 21.08 and 7.42 per 1000 device-days, respectively. The utilization ratio for central lines, ventilators and urinary catheters was 0.62, 0.47, and 0.84, respectively. The most common organisms were Acinetobacter (33.5 %) and Klebsiella (19.0 %). Sixty to eighty percent of Enterobacteriaceae were extended- spectrum beta-lactamase producing. About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem. Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 70-80 %. The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 84.6 % and 83.3 %, respectively.

Conclusions: This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates.
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http://dx.doi.org/10.26719/emhj.18.015DOI Listing
March 2019

Evaluation of the association between Addiction Severity Index and depression with adherence to anti-retroviral therapy among HIV infected patients.

Infect Disord Drug Targets 2015 ;15(3):177-83

Iranian Research Center for HIV/AIDS (IRCHA), Imam Khomeini Hospital, Keshavarz Blvd, Tehran, Iran.

Adequate adherence to anti-retroviral therapy is required to achieve viral suppression and desirable treatment outcomes among HIV patients. The aim of this study was to examine the associations between adherence and severity of substance use as well as adherence and severity of depressive symptoms among Iranian HIV patients. In a prospective study, HIV patients with current substance use were assessed for adherence level via self report and pill count methods, severity of depressive symptoms (Beck Depression Inventory- II) and substance use (Addiction Severity Index) during a three months follow up after initiating antiretroviral therapy. The adherence level, severity of depressive symptoms and substance use were assessed one month, two months and three months after initiation of anti-retroviral therapy. Addiction Severity Index (ASI) composite scores were calculated for each domain and the associations between ASI domains and adherence as well as severity of depressive symptoms and adherence were assessed. Twenty six HIV patients with current substance use disorder completed the study. At the end of the first month, adherence to therapy via pill count and self-report were 80%±31.9% and 85.12%±32%, respectively. At the end of the second month, adherence to therapy via pill count and self report were 87%±32% and 93.94%±23% respectively. At the end of the third month, the measured adherence via pill count and self report were 85%±33.7% and 90.1%±25.7% respectively. Adherence was higher among married patients and those who used reminder systems. Composite scores of the medical status and psychiatric status were related to higher adherence after first month. Substance use was inversely associated with adherence at the second follow up (r=-0.4, p=0.04). Also, severity of depressive symptoms was not related to adherence level. The repeated measurement analysis showed a significant decrease in psychiatric status domain of the ASI composite score after three months of initiating therapy (p=0.02). Preventive measures should aim treatment of substance use among HIV patients in order to increase adherence level. Also, conducting psychological evaluations is necessary considering the high prevalence of depression among Iranian HIV patients.
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http://dx.doi.org/10.2174/1871526515666150928115103DOI Listing
August 2016

Diabetic foot: infections and outcomes in Iranian admitted patients.

Jundishapur J Microbiol 2014 Jul 1;7(7):e11680. Epub 2014 Jul 1.

Research Development Center, Sina hospital, Tehran University of Medical Sciences, Tehran, IR Iran.

Background: Diabetes mellitus (along with its complications) has become a global problem. Diabetic foot infection, among the most common complications, is responsible for 40 to 50% of foot amputations. Antibiotic-resistant microorganisms, however, have compromised empiric therapy in the infected patients.

Objectives: The current study aimed to determine the most common microorganisms involved in diabetic foot infection in order to minimize the failure of antibiotic therapy and the risk of developing complications.

Patients And Methods: All patients with diabetic foot infection admitted to the infectious diseases, surgery and endocrinology wards of two teaching hospitals from 2007 to 2010 (n = 196) were recruited. In this retrospective study, demographic characteristics, type of lesions, history of hospitalization/antibiotic therapy, isolated microorganisms, clinical complications, administered treatment (medical or surgical) and outcome were recorded.

Results: Patients' mean age was 60.84 (± 10.30) years. Totally, 113 (57.65%) of the patients were male and 83 (42.35%) were female. According to Wagner's grading, deep ulcers with/without osteomyelitis accounted for the majority of lesions. A single microorganism was isolated (most common: Escherichia coli, Staphylococcus aureus and Klebsiella spp.) from 81 of the patients (80.20%); while for the remaining polymicrobial infection was reported. Isolated pathogens showed no significant correlation with duration of diabetes, type of the lesions (P = 0.13) and history of hospitalization (P = 0.61). The majority of patients (n = 118, 60.20%) were treated surgically; however 11 patients expired due to sepsis. Amputation (most common at toes and below the knee) was performed for 89 patients (45.40%). The response rate to medical treatment was 31.6% for single-pathogen and 10% for polymicrobial infection (with a 30% mortality rate).

Conclusions: Physicians are recommended to take microbiological cultures before starting empirical therapy recommended to cover Gram-negative microorganisms in order to lower the risk of antibiotic resistance.
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http://dx.doi.org/10.5812/jjm.11680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4216583PMC
July 2014

Invasive candidiasis in intensive care unit; consensus statement from an Iranian panel of experts, July 2013.

JRSM Open 2014 Mar 26;5(3):2042533313517689. Epub 2014 Feb 26.

Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran ; Behphar Scientific Committee, Behphar Group, Tehran, Iran.

Invasive candidiasis (IC) is associated with high mortality in intensive care unit (ICU) patients. Timely diagnosis of this potentially fatal condition remains a challenge; on the other hand, the criteria for initiating empirical antifungal therapy in critically ill patients are not well defined in different patient population and ICU settings. Alongside the international guidelines, reaching regional and local consensus on diagnosis and management of IC in ICU setting is essential. This report summarizes our present status of IC management in ICU, considered by a group of Iranian experts in the fields of intensive care and infectious diseases. A round table of 17 experts was held to review the available data and discuss the optimal treatment strategies for IC in critical care setting. Comparative published data on the management of IC were analytically reviewed and the commonly asked questions about the management of IC in ICU were isolated. These questions were interactively discussed by the panel and audience responses were taken to consolidate point-to-point agreement with the panel arriving at consensus in many instances. The responses indicated that patients' risk stratification, clinical discretion, fungal diagnostic techniques and the empirical therapy for IC are likely to save more patients. Treatment options were recommended to be based on the disease severity, prior azole exposure, and the presence of suspected azole-resistant Candida species. This report was reviewed, edited and discussed by all participants to include further evidence-based insights. The panel expects such endorsed recommendations to be soon formulated for implementation across the country.
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http://dx.doi.org/10.1177/2042533313517689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4012669PMC
March 2014

Sequences type analysis of Candida albicans isolates from Iranian human immunodeficiency virus infected patients with oral candidiasis.

Acta Med Iran 2014 ;52(3):187-91

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran.

The growing number of immunocompromised individuals has increased the incidence of infections caused by Candida species during the recent decades. Typing of C. albicans on the basis of DNA sequences at multiple loci has greatly advanced our knowledge about the epidemiology and phylogeny of candidiasis. The aim of this study was to evaluate the diversity, and genetic relationships among C. albicans isolates obtained from HIV patients in Iran. using multilocus sequence typing (MLST) method. We analyzed 25 C. albicans isolates obtained from HIV positive patients referred to Iranian Research Center for HIV/AIDS. After diagnostic test and DNA extraction C. albicans isolates were typed using the original MLST scheme explained previously include of six loci: ACC1, VPS13, GLN4, ADP1, RPN2, and SYA1. Fifty one (2.17%) nucleotide sites were found to be polymorphic; all were found to be heterozygous in at least one isolate. For the 25 clinical isolates, 22 diploid sequence types were defined by the genotypes identified from the six loci. The MLST data suggest a relatively high level of divergence in the population structure of C. albicans isolated from HIV infected patients. These findings indicate that in these patients there is a favorable context for the growth of potential pathogenic C. albicans. We found no association between fluconazole resistance, highly active antiretroviral therapy (HAART) receiving and either sequence type or group.
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September 2014

Effect of an educational course at an Iranian dental school on students' knowledge of and attitudes about HIV/AIDS.

J Dent Educ 2012 Jun;76(6):792-9

Department of Community Oral Health, Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.

This study investigated the effects of an educational program designed to improve the knowledge and attitudes of senior dental students in an Iranian dental school about caring for patients with HIV/AIDS. As part of an extramural program in community dentistry, a new educational program about HIV/AIDS was developed at Tehran University of Medical Sciences in 2009. The program consisted of two days' observation at the Consultation Center for Behavioral Diseases and a one-day workshop on infection control. A control group was selected from dental students at Shahid Beheshti University of Medical Sciences. Before and after the intervention, students in both the intervention and control groups completed a questionnaire concerning their knowledge of and attitudes about HIV/AIDS. Students in the intervention group also expressed their opinions in a post-test questionnaire. An independent sample t-test was used for statistical analysis. In the control group, the means of students' knowledge and attitude scores did not differ significantly from pre-test to post-test. In the intervention group, however, the means of both knowledge and attitude scores on the post-test were significantly higher than on the pre-test (p=0.001 and p=0.009, respectively). In the intervention group, more than 96 percent of the students reported that they would completely follow infection control principles in future practice. This study concludes that the educational program improved the students' knowledge of and attitudes about HIV/AIDS and will have a positive effect on their future practice.
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June 2012

Brucella infection in HIV infected patients.

Acta Med Iran 2011 ;49(12):801-5

Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Iran.

The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6%) subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU) men and one was a rural woman. Considering both prevalence rates of Brucella infection (3%) and symptomatic brucellosis (0.1%) in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors.
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April 2012

Seroprevalence of toxoplasmosis in HIV(+)/AIDS patients in Iran.

Acta Med Iran 2011 ;49(4):213-8

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran.

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male (male to female ratio: 5 to 1) with the mean age of 36 ± 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 ± 22.4 cells/µl. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 ± 15.5 cells/µl and there was a significant association between CD4 count and rate of toxoplasma encephalitis (P<0.001). Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran.
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October 2011

Respiratory Complications in Iranian Hospitalized Patients with HIV/AIDS.

Tanaffos 2011 ;10(3):49-54

CAPS and the Institute for Global Health, University of California, San Francisco, USA.

Background: The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran.

Materials And Methods: This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients.

Results: All patients were males. The mean age was 35 years (age range: 15 to 63 years). Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm(3). Nearly half the patients (47.7%) had respiratory symptoms. The most common pulmonary complications were cough (86.3%), sputum (71.6%), dyspnea (54.7%), and hemoptysis (10.5%). The most common diagnosis was pulmonary tuberculosis (27.1%), followed by other bacterial pneumonias (16.6%) and pneumocystis carinii pneumonia (4.5%). Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection (59%), and other bacterial pneumonias (52%).

Conclusion: Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153161PMC
September 2014

CD4+ cell counts in patients with different clinical manifestations of tuberculosis.

Braz J Infect Dis 2008 Dec;12(6):483-6

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

Tuberculosis is the prototype of infections that require a cellular immune response for their control. It has been shown that CD4+ T-lymphocytes are most important in the protective response against Mycobacterium tuberculosis. CD8+ T-lymphocytes are also important for effective T-cell immune response. This study compares CD4+ and CD8+ baseline values in patients with different manifestations of tuberculosis. CD4+ and CD8+ in three groups of patients with tuberculosis (pulmonary, lymphadenitis, meningitis/milliary involvement) and a group of healthy volunteers were enumerated using flowcytometry. Twenty-six patients with pulmonary tuberculosis, 10 with adenitis, 16 with meningitis or milliary tuberculosis and 16 healthy volunteers entered the study. Mean CD4 in meningitis/milliary group was significantly lower than all other groups (p<0.05). Mean CD4 counts of patients with pulmonary tuberculosis was also significantly lower than control group (p=0.01). Mean CD8 in meningitis/milliary group was significantly lower than control group (p=0.02). No relation was found between results of TSTs and CD4 values in three groups. CD4 depletion is an expectable phenomenon in patients with tuberculosis. This study shows that patients with more severe form of disease had the lowest number of both CD4 and CD8 cells which can be a sign of suppressed cellular immunity in these patients.
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http://dx.doi.org/10.1590/s1413-86702008000600008DOI Listing
December 2008

Insights from a survey of sexual behavior among a group of at-risk women in Tehran, Iran, 2006.

AIDS Educ Prev 2007 Dec;19(6):519-30

Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Department of Infectious Diseases, Emam Khomeini Hospital, Tehran, Iran.

Despite high rates of HIV among male injection drug users, the sexual behaviors of at-risk women in Iran remain unknown. A questionnaire on HIV knowledge and risk behavior was administered in a Tehran nongovernmental organization targeting runaways and other women seeking safe haven. Half (total N = 50) were less than 24 years old; baseline HIV knowledge was high. The few who acknowledged using illicit substances said they used "frequently." Nonresponse rates to questions regarding sexual behavior were high (12 of 50). Half admitted a history of sexual activity; 40% of those reported their first sexual contact with someone other than their husband; three people had multiple partners. Three women reported a history of rape. Zero (97.5% one-sided confidence interval [CI] = 0, 0.17) of 35 women tested positive for HIV or syphilis. This study documents the existence of sexual behavior in a population of Iranian women, represents one of the first attempts at sexual research in the Iranian context, and highlights challenges in surveying this vulnerable group.
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http://dx.doi.org/10.1521/aeap.2007.19.6.519DOI Listing
December 2007

Subphrenic abscess and recurring focal lesions due to tuberculosis in a patient with IgA deficiency.

J Infect 2007 Jan 3;54(1):e9-12. Epub 2006 May 3.

Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Boulevard, 14114 Tehran, Iran.

Subdiaphragmatic abscess has not yet been reported as a manifestation of tuberculosis. We report an IgA deficient patient with recurrent episodes of unusual extrapulmonary manifestations of tuberculosis including subdiaphragmatic abscesses and metacarpophalangeal osteomyelitis that was improved each time with antituberculosis drugs. There was not any resistance to the drugs used against mycobacterium despite repeated courses of antituberculosis regimens. In such recurrent cases, one should rule out any immunodeficiency states.
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http://dx.doi.org/10.1016/j.jinf.2006.03.019DOI Listing
January 2007

Evaluation of anti-tuberculosis induced adverse reactions in hospitalized patients.

Pharm Pract (Granada) 2006 ;4(3):134-8

MPH, Iranian Adverse Drug Reaction Monitoring Center Undersecretary of Food and Drug Affairs.Ministry of Health. Tehran, Iran.

Background: Tuberculosis has been one of the common diseases of human communities. Besides of disease-related complications, there are serious adverse reactions due to Anti-tuberculosis (Anti-TB) drug therapy.

Objectives: To assess the rate of Adverse Drug Reactions (ADRs) induced by Anti-TB drugs in the infectious disease department for a period of one year. To detect serious and preventable recognized ADRs.

Methods: All patients admitted to the infectious disease department at Imam tertiary teaching hospital in Iran who received Anti-TB drugs from July 2001 to July 2002 entered the study. These patients were monitored for ADRs during hospital stay. The ADRs were then classified based on patients and reactions factors. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.

Results: During the study period, 83 patients received Anti-TB drugs; of them 44 developed at least one ADR. Total number of 81 ADRs was detected in this study. ADRs were recognized as the major cause of hospital admission in 11 (13.3%) patients. The most frequent system-organ class affected by ADRs was Liver and biliary system (37%). Hepatitis was observed in 21 (25.3%) patients leading to death in two patients.

Conclusion: Anti-TB drugs could cause significant adverse effects both in quantity and severity leading to hospitalization, prolonged hospital stay and even death. More attention is needed to prevent these reactions.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156846PMC
September 2014