Publications by authors named "Maryam Foroughi"

27 Publications

  • Page 1 of 1

Bilateral pleural masses in an immunocompromised patient.

BMJ Case Rep 2020 Nov 4;13(11). Epub 2020 Nov 4.

Office of Faculty and Academic Affairs, University of Central Florida College of Medicine, Orlando, Florida, USA.

We present a case of persistent pleural masses with mediastinal adenopathy in an immunocompromised patient initially biopsied, diagnosed and treated for pneumonia, ultimately requiring surgical thoracoscopy to diagnose pulmonary histoplasmosis. We discuss the diagnostic approach for pleural masses in immunocompromised patients, the limitations of tissue sampling, interpretation and methodology, and pitfalls of testing in making a pathogen-specific diagnosis.
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http://dx.doi.org/10.1136/bcr-2020-237696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643469PMC
November 2020

Hospitalization period of COVID-19 for future plans in hospital.

Br J Surg 2020 Sep 5;107(10):e427-e428. Epub 2020 Aug 5.

Department of Emergency Medicine, Neyshabur University of Medical Sciences, Neyshabur, Iran.

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http://dx.doi.org/10.1002/bjs.11871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436404PMC
September 2020

Efficient technologies for carwash wastewater treatment: a systematic review.

Environ Sci Pollut Res Int 2020 Oct 7;27(28):34823-34839. Epub 2020 Jul 7.

Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Carwash wastewater (CWW) is considered as an important source of either water pollution or water consumption. Therefore, its treatment is critical not only from the prevention of environmental contamination but also from the recycling of such high-volume water source. Unfortunately, the effective treatment of CWW is almost unknown, complex, and expensive. To overcome the former challenge, this study aimed to systematically review different technologies for CWW treatment. For this, a comprehensive literature survey was conducted and 48 research articles were found suitable to be included in the investigation. The included studies were of coagulation and adsorption (n = 5), membrane-based technologies (n = 15), and electrochemical (n = 11) and combined (n = 17) systems. This comprehensive review showed that the treatment methods of advanced filtration membrane techniques, electrical and chemical coagulation, and advanced oxidation processes can be effective in the removal of pollutants from carwash wastewater (CWW). The mining of different studies, however, showed that the combined methods are the most promising option in the remediation of such wastewater.
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http://dx.doi.org/10.1007/s11356-020-09741-wDOI Listing
October 2020

Capture of I from medical-based wastewater using the highly effective and recyclable adsorbent of g-CN assembled with Mg-Co-Al-layered double hydroxide.

J Hazard Mater 2020 05 22;389:122151. Epub 2020 Jan 22.

Applied Chemistry Department, Faculty of Gas and Petroleum (Gachsaran), Yasouj University, Gachsaran, 75813-56001, Iran. Electronic address:

This paper reports a very high capacity and recyclable Mg-Co-Al-layered double hydroxide@ g-CN nanocomposite as the new adsorbent for remediation of radioisotope-containing medical-based solutions. In this work, a convenient solvothermal method was employed to synthesize a new nano-adsorbent, whose features were determined by energy dispersive X-ray (EDS/EDX), XRD, FESEM, TEM, TGA, BET, and FT-IR spectroscopy. The as-prepared nano-adsorbent was applied to capture the radioisotope iodine-131 mainly from the medical-based wastewater under different conditions of main influential parameters, (i.e. adsorbent dose, initial I concentration, sonication time, and temperature). The process was evaluated by three models of RSM, CCD-ANFIS, and CCD-GRNN. Furthermore, comprehensive kinetic, isotherm, thermodynamic, reusability cycles and optimization (by GA and DF) studies were conducted to evaluate the behavior and adsorption mechanism of I on the surface of Mg-Co-Al-LDH@ g-CN nanocomposite. High removal efficiency (95.25%) of I in only 30 min (i.e. during 1/384 its half-life), along with an excellent capacity that has ever been reported (2200.70 mg/g) and recyclability (seven times without breakthrough in the efficiency), turns the nanocomposite to a very promising option in remediation of I-containing solutions. Besides, from the models studied, ANFIS described the process with the highest accuracy and reliability with R > 0.999.
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http://dx.doi.org/10.1016/j.jhazmat.2020.122151DOI Listing
May 2020

Woman's Sexual Health Knowledge and Needs Assessment in Behavioral Clinics and Shelters in Tehran.

J Family Reprod Health 2019 Mar;13(1):26-34

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

The aim of this study was to assess the sexual health knowledge among females seeking consultation in behavioral clinics or shelters with emphasis on sexual routs of HIV transmission. In this study 250 women who have attended behavioral clinics or shelters in Tehran were recruited and a standardized questionnaire which asked about demographics, sexual partner and knowledge about HIV/STDs was used. The median age of our cases was 40.82% and among them 16% were married but lived alone. Among the total 250 cases, 56% (140) were sexually active in the last 30 days, 19.2% (48) had a history of a one-night stand and 2.4% had more than 1 sexual partner. 212 cases answered questions about condom use, 60% (127) of them did not use condoms at all. For knowledge about signs and symptoms related to STDs, 63% believed that abdominal pain has no relation to STDs. Also 44%, 43%, 37%,and 40% believed that dyspareunia, dysuria, malodorous vaginal discharge and change in color of vaginal discharge, respectively had no relation to STDs and 13% of whom presented with these symptoms in the past 30 days had not seek medical evaluation. It is a necessity to emphasize the use of condoms among the male population however in this study it was a challenge to do so because it goes against the government's campaign of pro-natalism. Improving the knowledge of protected sex should start from the teenage years and at school to have maximum STD prevention planning. Most women in our study did not know about healthy sexual lifestyle and this shows the need of sexual health education before marriage or even at school.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911147PMC
March 2019

Bio-inspired, high, and fast adsorption of tetracycline from aqueous media using FeO-g-CN@PEI-β-CD nanocomposite: Modeling by response surface methodology (RSM), boosted regression tree (BRT), and general regression neural network (GRNN).

J Hazard Mater 2020 04 6;388:121769. Epub 2019 Dec 6.

Department of Environmental Health Engineering, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran; Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.

Because antibiotic-containing wastewaters are able to contaminate all environmental matrices (e.g. water bodies, soil, etc.), a special attention should be paid on developing appropriate materials for their remediation. Herein, the novel nanocomposite (NC) of FeO-g-CN@PEI-β-CD was synthesized and employed effectively for the adsorptive removal of tetracycline (TC), the second most produced and employed antibiotic around the world. The successful fabrication of the nanocomposite with a high specific surface area (57.12 m/g) was confirmed using XRD, SEM, TEM, FTIR, TGA, EDX, and BET analyses. The FeO-g-CN@PEI-β-CD NC exhibited fast adsorption rates towards TC and maximum adsorption capacity on the basis of the Langmuir model reached 833.33 mg g, much higher than that reported by different carbon- and/or nano-based materials. The adsorption process was modeled using the approaches of central composite design (CCD), boosted regression tree (BRT), and general regression neural network (GRNN) under various operational conditions of initial TC concentration, pH, adsorbent dose, tempreature, and time. The comparison of the models indicated good predictions of all, however, the BRT model was more accurate compared to the others, with R = 0.9992, RMSE = 0.0026, MAE = 0.0014, and AAD = 0.0028, proving that it is a powerful approach for modeling TC adsorption by FeO-g-CN@PEI-β-CD nanocomposite. The results showed that the order of the variables' effectiveness is as follow: pH > dose > TC concentration. The high adsorption capacity along with high efficiency (98 % in the optimized conditions by GA) ensures the potential of the as-prepared nanocomposite for in situ remediation of antibiotic-containing wastewaters.
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http://dx.doi.org/10.1016/j.jhazmat.2019.121769DOI Listing
April 2020

A highly effective, recyclable, and novel host-guest nanocomposite for Triclosan removal: A comprehensive modeling and optimization-based adsorption study.

J Colloid Interface Sci 2019 Sep 3;551:195-207. Epub 2019 May 3.

Applied Chemistry Department, Faculty of Gas and Petroleum (Gachsaran), Yasouj University, Gachsaran 75813-56001, Iran.

In this research paper, response surface methodology (RSM), generalized regression neural network (GRNN), and Adaptive Neuro-Fuzzy Inference System (ANFIS) were employed to develop prediction models for Triclosan (TCS) removal by a novel inclusion complex (host-guest complex). Hence, β-cyclodextrin (β-CD) and poly(ethylene glycol) (PEG) host-guest complex loaded on the multi walled carbon nanotube (MWCNT/PEG/β-CD) was prepared and characterized by Raman, NMR, TGA, XRD, SEM, TEM, and point of zero charge (pH) technique. The effects of MWCNT/PEG/β-CD dose (g), temperature (°C), antibiotic concentration (mg L), and sonication time (min), each at five levels were investigated as independent factors. Central composite design (CCD) of RSM setup was applied in combination with ANFIS and GRNN training dataset for evaluation purposes. Moreover, the kinetic, isotherm equilibrium, and thermodynamic parameters of adsorption of TCS on MWNT-PEG/β-CD nanocomposite was examined. To assess the accuracy of results, several statistics such as R, RMSE (root mean square error), mean squared error (MSE), MAE (mean absolute error), sum of the absolute error (SAE), %AAD (absolute average deviation), average relative error (ARE), hybrid fractional error function (HYBRID), Marquart's percentage standard deviation (MPSD), and Pearson's Chi-square measure (χ) were checked. The results of ANFIS approach were found to be more trustworthy than GRNN model since better statistical analysis were attained. However, it was known that the GRNN is easier and take a little time for modeling than the ANFIS approach.
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http://dx.doi.org/10.1016/j.jcis.2019.05.007DOI Listing
September 2019

Severe aortic regurgitation masked as sepsis-induced ARDS in a patient with endocarditis.

BMJ Case Rep 2018 Dec 4;11(1). Epub 2018 Dec 4.

Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA.

Septic shock is the most common type of shock in the intensive care unit with an associated mortality close to 50%. Infective endocarditis (IE) is a rare cause of septic shock but carries significant morbidity and mortality. Group B IE (GBS-IE) is an invasive infection with an incidence of approximately 1.7%. It affects immunocompromised patients such as intravenous drug users, alcoholics, those with HIV and elderly among others. IE with severe acute valvular heart disease challenges physicians when assessing fluid status during the early resuscitation in patients with septic shock. We present a case of GBS-IE complicated by severe acute aortic regurgitation with rapidly progressive acute respiratory failure in the setting of septic shock management.
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http://dx.doi.org/10.1136/bcr-2018-226681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301507PMC
December 2018

Prevalence of HIV, HBV and HCV among street and labour children in Tehran, Iran.

Sex Transm Infect 2017 09 6;93(6):421-423. Epub 2016 Sep 6.

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

Objectives: The existence of street and working children in Iran is undeniable. The precarious conditions of these children (including disrupted family, poverty, high prevalence of crime among relatives, family members and peers) cause social harm and high-risk behaviours, including drug addiction, selling sex or having sex with adolescents or peers. Here we explore the HIV, hepatitis B and hepatitis C status of street and working children in Tehran.

Methods: One thousand street and labour children, aged 10-18 years, were recruited by using the time-location sampling method, and semistructured questionnaires were used to find demographic information and information on HIV/AIDS-related high-risk sexual behaviours. Blood samples were collected from children, with use of the dried blood sampling method.

Results: 4.5% of children were HIV infected, 1.7% were infected with hepatitis B virus and 2.6% were infected with hepatitis C virus (HCV). Having parents who used drug, infected with HCV and having experience in trading sex significantly increased the likelihood of getting HIV among the street children of Tehran.

Conclusion: HIV prevalence among street children is much higher than general population (<0.1%), and in fact ,the rate of positivity comes close to that among female sex workers in Iran. These findings must be an alarm for HIV policymakers to consider immediate and special interventions for this at-risk group.
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http://dx.doi.org/10.1136/sextrans-2016-052557DOI Listing
September 2017

Occult hepatitis B virus infection and S gene escape mutants in HIV-infected patients after hepatitis B virus vaccination.

Int J STD AIDS 2016 10 18;27(11):967-72. Epub 2015 Sep 18.

Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran

Hepatitis B virus (HBV) vaccination is recommended for HIV patients. Despite the relative success of HBV vaccination, breakthrough infections can occur infrequently in patients, and it can be due to occult HBV infection, vaccine unresponsiveness and/or emergence of escape mutants. This study assessed the presence of occult HBV infection and S gene escape mutants in HIV-positive patients after HBV vaccination. Ninety-two HIV-positive patients were enrolled in this study, including 52 responders to HBV vaccine and 40 non-responders. All of the cases received HBV vaccine according to routine HBV vaccination protocols. The presence of HBV-DNA was determined by real-time polymerase chain reaction (PCR). In HBV-DNA positive samples, the most conserved regions of S gene sequences were amplified by nested PCR and PCR products were sequenced. Occult HBV infection was detected in two cases. Glycine to arginine mutation at residue 145 (G145R) within the 'a' region of the S gene was detected in one of the occult HBV infection cases who was in the non-responder group. This study showed that the prevalence of occult HBV infection and vaccine escape mutants was low in our HBV-vaccinated HIV-positive patients in both responder and non-responder groups, so there was no alarming evidence indicating breakthrough HBV infection in our vaccinated HIV-positive cases.
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http://dx.doi.org/10.1177/0956462415602419DOI Listing
October 2016

Lack of Association between Interleukin-10 Gene Promoter Polymorphisms with HIV Susceptibility and Progression to AIDS.

Iran J Pathol 2015 ;10(2):141-8

Iranian Research Center for HIV/AIDS, Tehran, Iran.

Background: Interleukin (IL)-10 is an important anti-inflammatory and immunomodulatory cytokine. Some authors believe that single nucleotide polymorphisms (SNP) in the promoter region of the IL-10 gene have been associated with susceptibility to HIV infection and progression to AIDS, but its role is not clearly defined yet. The present study was undertaken to evaluate the association between HIV infection susceptibility and progression with SNP in the promoter region of the IL-10 gene.

Methods: This study was carried out in 70 HIV infected patients (39 treatment naïve and 31 under treatment) and 31 matched healthy controls. The biallelic polymorphisms in the IL-10 gene promoter (-592 ,-1082) were analyzed by polymerase chain reaction and direct sequencing.

Results: At position -1082, G/A was the most common genotype and A was the most prevalent allele and at position -592, A/C was the most prevalent genotype and -592 C was the most common allele in HIV positive patients; although there was not any significant difference between cases and controls regarding genotypes and alleles of these regions.

Conclusion: Our study showed that genetic polymorphisms of IL-10 promoter region may not associate with HIV infection outcome and the lack of this association suggests that other genes may influence on HIV infection course.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539764PMC
September 2015

Defluoridation of water using activated alumina in presence of natural organic matter via response surface methodology.

Environ Sci Pollut Res Int 2016 Jan 8;23(1):887-97. Epub 2015 Sep 8.

Department of Environmental Health Engineering, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Adsorption by activated alumina is considered to be one of the most practiced methods for defluoridation of freshwater. This study was conducted, therefore, to investigate the effect of natural organic matters (NOMs) on the removal of fluoride by activated alumina using response surface methodology. To the authors' knowledge, this has not been previously investigated. Physico-chemical characterization of the alumina was determined by scanning electron microscope (SEM), Brunauer-Emmett-Teller (BET), Fourier transform infrared spectroscopy (FTIR), X-ray fluorescence (XRF), and X-ray diffractometer (XRD). Response surface methodology (RSM) was applied to evaluate the effect of single and combined parameters on the independent variables such as the initial concentration of fluoride, NOMs, and pH on the process. The results revealed that while presence of NOM and increase of pH enhance fluoride adsorption on the activated alumina, initial concentration of fluoride has an adverse effect on the efficiency. The experimental data were analyzed and found to be accurately and reliably fitted to a second-order polynomial model. Under optimum removal condition (fluoride concentration 20 mg/L, NOM concentration 20 mg/L, and pH 7) with a desirability value of 0.93 and fluoride removal efficiency of 80.6%, no significant difference was noticed with the previously reported sequence of the co-exiting ion affinity to activated alumina for fluoride removal. Moreover, aluminum residual was found to be below the recommended value by the guideline for drinking water. Also, the increase of fluoride adsorption on the activated alumina, as NOM concentrations increase, could be due to the complexation between fluoride and adsorbed NOM. Graphical abstract ᅟ.
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http://dx.doi.org/10.1007/s11356-015-5293-xDOI Listing
January 2016

Frequency and genotype of human parvovirus B19 among Iranian patients infected with HIV.

J Med Virol 2015 Jul 13;87(7):1124-9. Epub 2015 Mar 13.

Department of Virology, Pasteur Institute of Iran, Tehran, Iran.

The human parvovirus B19 (B19) usually causes a subclinical infection in immunocompetent individuals. Whereas immunocompromised individuals such as patients infected with HIV are at risk of persistent anemia due to B19 infection. Only few studies have been carried out on distribution and molecular epidemiology of B19 in Iran. We aimed to determine the frequency and genotype of B19 among Iranian patients infected with HIV. We conducted a survey on 99 HIV patients and 64 healthy controls. IgG and IgM antibodies against B19 were detected by ELISA and B19 DNA was assessed by nested PCR. PCR products were subjected to direct sequencing and classified after phylogenetic analysis. The prevalence of B19 immunoglobulin was 11.1% for IgG and 1% for IgM. B19 DNA was detected in 13.1% of cases. The prevalence of B19 IgG, IgM, and DNA in control group was 25%, 1.6%, and 9.4%, respectively. B19 IgG was significantly lower in HIV group than in normal controls. There was no significant difference regarding anemia between cases and controls. All sequenced B19 isolates belonged to genotype 1A with low genetic diversity. Our findings indicated that in the HAART era, the importance of B19 infections in HIV patients may be limited whereas persistent B19 viremia in the circulation of healthy controls raises a potential concern in blood donations.
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http://dx.doi.org/10.1002/jmv.24169DOI Listing
July 2015

Echocardiographic assessment of systolic pulmonary arterial pressure in HIV-positive patients.

Acta Med Iran 2014 ;52(11):827-30

Department of Public Health, School of Public Health, Flinders University, Flinders, South Australia.

Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP) by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort) in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5%) and 62 females (46.5%). The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4%) of them had SPAP ≤ 30 mmHg (normal), six (3.6%) had SPAP: 31-35 mmHg (borderline) and five (3%) had SPAP > 35 mmHg (pulmonary hypertension). Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.
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July 2015

Urban runoff treatment using nano-sized iron oxide coated sand with and without magnetic field applying.

J Environ Health Sci Eng 2013 Dec 20;11(1):43. Epub 2013 Dec 20.

Department of Environmental Health Engineering, School of Health, Hamedan University of Medical Sciences, Hamedan, Iran.

Increase of impervious surfaces in urban area followed with increases in runoff volume and peak flow, leads to increase in urban storm water pollution. The polluted runoff has many adverse impacts on human life and environment. For that reason, the aim of this study was to investigate the efficiency of nano iron oxide coated sand with and without magnetic field in treatment of urban runoff. In present work, synthetic urban runoff was treated in continuous separate columns system which was filled with nano iron oxide coated sand with and without magnetic field. Several experimental parameters such as heavy metals, turbidity, pH, nitrate and phosphate were controlled for investigate of system efficiency. The prepared column materials were characterized with Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray analysis (EDXA) instruments. SEM and EDXA analyses proved that the sand has been coated with nano iron oxide (Fe3O4) successfully. The results of SEM and EDXA instruments well demonstrate the formation of nano iron oxide (Fe3O4) on sand particle. Removal efficiency without magnetic field for turbidity; Pb, Zn, Cd and PO4 were observed to be 90.8%, 73.3%, 75.8%, 85.6% and 67.5%, respectively. When magnetic field was applied, the removal efficiency for turbidity, Pb, Zn, Cd and PO4 was increased to 95.7%, 89.5%, 79.9%, 91.5% and 75.6% respectively. In addition, it was observed that coated sand and magnetic field was not able to remove NO3 ions. Statistical analyses of data indicated that there was a significant difference between removals of pollutants in two tested columns. Results of this study well demonstrate the efficiency of nanosized iron oxide-coated sand in treatment of urban runoff quality; upon 75% of pollutants could be removed. In addition, in the case of magnetic field system efficiency can be improved significantly.
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http://dx.doi.org/10.1186/2052-336X-11-43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3892038PMC
December 2013

Hepatitis E virus infection in patients infected with human immunodeficiency virus in an endemic area in Iran.

Int J STD AIDS 2013 Oct 10;24(10):769-74. Epub 2013 Jul 10.

Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran.

Some studies have suggested that hepatitis E virus is more frequent in human immunodeficiency virus (HIV) patients and can progress to chronic infection. We aimed to determine the prevalence of hepatitis E virus antibodies and RNA in a series of 100 HIV-infected patients in Tehran, Iran, with comparison to 52 healthy HIV, hepatitis B and C-negative blood donors as controls. HIV-infected patients were also tested for hepatitis E virus-RNA. Among the HIV-infected patients, 10% had antibodies to hepatitis E virus - a finding not significantly different from the uninfected controls (11.5%). No HIV-infected patients had hepatitis E virus IgM antibodies nor did any have detectable hepatitis E virus-RNA. We found no associations between anti-hepatitis E virus IgG-seropositivity and age, sex, route of HIV acquisition, aminotransferases levels, CD4, antiretroviral therapy, hepatitis B virus and hepatitis C virus co-infection. Hepatitis E virus is relatively prevalent in our HIV-infected patients, although without evidence of chronic infection and no more common than among HIV-negative controls or the general population. For the present, we do not recommend routine screening for hepatitis E virus infection in HIV-infected patients in our moderately endemic region.
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http://dx.doi.org/10.1177/0956462413484457DOI Listing
October 2013

Frequency and Genotype of Hepatitis D Virus Infection in Patients Infected with HIV and Those Undergoing Hemodialysis.

Hepat Mon 2013 May 11;13(5):e7481. Epub 2013 May 11.

Department of Hepatitis and AIDS, Pasteur Institute, Tehran, IR Iran.

Background: Hepatitis D virus (HDV) is a defective virus dependent on hepatitis B virus (HBV) for its replication. Due to HDV transmission routes, patients undergoing hemodialysis and those with HIV infection are at risk of acquiring HDV.

Objectives: This study was aimed to determine the frequency and genotype of HDV infection among patients with HIV infection and those undergoing hemodialysis.

Patients And Methods: 720 cases including 120 patients undergoing hemodialysis, and 600 patients with HIV infection were studied. All cases with positive results for HBsAg were evaluated for the presence of anti-HDV antibodies. Samples with Anti-HDV positive results were subjected to nested PCR for HDV-RNA confirmation, and sequenced for HDV genotype determination.

Results: HBsAg was found in 9 (7.5%) of 120 patients undergoing hemodialysis, and 9 (1.5%) of 600 patients with HIV infection. 3 (33.3%) of patients undergoing hemodialysis with positive results for HBsAg, and 5 (55.5%) of cases with HIV infection and positive results for HBsAg, had positive findings for anti-HDV which were then subjected to nested PCR. The amplification results confirmed that in 3 (37.5%) samples HDV-RNA was detected. Overall 2.5% of patients undergoing hemodialysis, and 0.8% of cases infected with HIV had positive results for anti-HDV and 1.7% and 0.2% of cases undergoing hemodialysis and patients infected with HIV had positive findings for HDV-RNA respectively. All of the HDV isolates were clustered in clade 1.

Conclusions: The survey showed that overall HDV frequency was not high in our high risk cases. Therefore, practitioners and health care managers should become aware of the risk of dual infection with HBV and HDV especially in high risk patients.
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http://dx.doi.org/10.5812/hepatmon.7481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728973PMC
May 2013

Antibody responses to trivalent influenza vaccine in Iranian adults infected with human immunodeficiency virus.

Acta Med Iran 2013 Apr 6;51(3):148-52. Epub 2013 Apr 6.

Department of Infectious Disease, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus (HIV), highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A (H1N1), A (H3N2), and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A (H1N1), A (H3N2), and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annual influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus.
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April 2013

Randomized controlled trial of mindfulness-based stress reduction delivered to human immunodeficiency virus-positive patients in Iran: effects on CD4⁺ T lymphocyte count and medical and psychological symptoms.

Psychosom Med 2012 Jul-Aug;74(6):620-7. Epub 2012 Jun 28.

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

Objective: To evaluate the immediate and long-term effectiveness of mindfulness-based stress reduction (MBSR) on biological and symptomatological markers of health among human immunodeficiency virus-positive (HIV+) patients in Tehran, Iran.

Methods: Using a randomized controlled trial design, data from 173 HIV+ patients (CD4 count > 250) not yet receiving antiretroviral therapy, who participated in either an 8-week MBSR (n = 87) or a brief education and support condition (n = 86) at the Imam Khomeini Hospital, were analyzed. Assessments included CD4 count, Symptom Checklist-90-Revised (SCL-90R), and Medical Symptom Checklist (MSCL) at baseline, immediate post-treatment, and at the 3-, 6-, 9-, and 12-month follow-up periods.

Results: The treatment-adherent sample had a mean (standard deviation) age of 35.1 (6.5) years and 69% were male. Linear mixed-model estimates indicated that, in the MBSR condition, the mean CD4 count increased from baseline up to 9 months after treatment and then returned to baseline level at 12 months. Improvements in mean SCL-90R (up to 6 months) and MSCL (up to 12 months) scores were observed for the MBSR condition, whereas education and support condition scores remained the same over time; however, only MSCL improvements significantly differed between groups and these changes lasted up to the final assessment.

Conclusions: Findings suggest that among treatment-adherent Iranian HIV+ patients not yet receiving antiretroviral drug treatment, MBSR seems to have the strongest potential to improve self-reported medical symptoms.

Trial Registration: Iranian Registry of Clinical Trials: IRCT201106084076N2.
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http://dx.doi.org/10.1097/PSY.0b013e31825abfaaDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392542PMC
November 2012

Incidence of isolation of Mycobacterium tuberculosis from blood samples in tuberculosis patients in Imam Khomeini Hospital, Tehran, Iran.

Acta Med Iran 2011 ;49(8):556-9

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

It is estimated that one third of the world's population is latently infected with tuberculosis (TB). The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS (Systemic Inflammatory Response Syndrome) status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB.
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March 2012

Evaluation of bone mineral density in Iranian HIV/AIDS patients.

Acta Med Iran 2011 ;49(7):460-7

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

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (naïve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive naïve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.
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January 2012

Persistence of antibody to hepatitis B surface antigen among vaccinated children in a low hepatitis B virus endemic area.

World J Pediatr 2011 Nov 27;7(4):358-60. Epub 2011 Aug 27.

Clinical Research Dept., Pasteur Institute of Iran, Tehran, Iran.

Background: A potential problem of hepatitis B immunization is that vaccine-induced antibody to hepatitis B surface antigen (anti-HBs) declines to low levels with age. This study investigated the persistence of anti-HBs in vaccinated children in a low hepatitis B virus (HBV) endemic area.

Methods: Plasma samples of 938 children between ages of 8 months and 15 years were tested for the presence of anti-HBs.

Results: The seroprotection rate was 60%. Protective antibody level was detected in 65% of children one year after vaccination, and in 30%, 29% and 24% 5, 10 and 15 years after vaccination, respectively. The mean anti-HBs titer declined with post-vaccination time (to 66 mIU/mL in 1 year, 60 mIU/mL in 5 years, 40 mIU/mL in 10 years to 37 mIU/mL in 15 years after vaccination).

Conclusions: Children vaccinated against HBV during infancy may show low levels of antibody during adolescence. Our data suggest that a booster dose of vaccine may be required in low HBV endemic areas.
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http://dx.doi.org/10.1007/s12519-011-0286-4DOI Listing
November 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

Prevalence of hepatitis A virus infection in a HIV positive community.

Acta Med Iran 2010 May-Jun;48(3):192-5

Department of Infectious and Tropical Diseases, Iranian Research Center for HIV/AIDS, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Hepatitis A is acute and usually self-limiting disease, but sometimes it can be dangerous such as in immunosuppressed patients. Purpose of this study is to investigate the prevalence of hepatitis A serology in HIV/AIDS Patients. 247 HIV positive patients from March 2005 to September 2006 were entered in this study. Participants completed questionnaires to elicit demographic, drug and sex risk information, and were (tested for hepatitis A. They were all referred to Counseling center for behavioral diseases in Imam Khomeini Hospital. Cases were chosen from volunteers with no history of jaundice or acute hepatitis. Data were analyzed by SPSS version 13 and results were compared between seropositive and seronegative groups using T test and chi square. Statistical significance was accepted at a level of P < 0.05.200 (80.98%) were male and 47 (19.02) were female. The mean age was 36 +/- 9.3. 238 (96.3%) of patients were seropositive. One hundred percent and 96% who were born in rural and urban areas were seropositive, respectively. Also, 85.7% and 96.6% who reside in rural and urban areas were seropositive, respectively. Iran is an endemic country for hepatitis A in which most people has asymptomatic infectious during childhood. According to high prevalence of hepatitis A positive serology in HIV/AIDS patients, routine vaccination seems to be unnecessary. But special sub populations like HIV infected infants should be evaluated more precisely and different approaches may be needed for them.
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January 2011

The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study.

Acta Med Iran 2010 Mar-Apr;48(2):101-6

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

Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study, we examined the effects of MBSR upon psychological, physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study, we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3, 6, 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 +/- 7.7 yrs. There was no significant difference in MSCL scores after MBSR and in 3, 6, 9 and 12 months compared to those before MBSR (P>0.05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0.05). Nevertheless, in 3, 6, 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0.05). The means of CD4 count, before and after MBSR, and in 3, 6, 9 and 12 months were 549 +/- 173.6, 640.2 +/- 189.4, 655.3 +/- 183.4, 638 +/- 167.4, 619.3 +/- 163.2, and 595.2 +/- 165.6, respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0.05). In our study, MBSR had positive effects on psychological status and CD4 count. However, more studies with large sample size are necessary.
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January 2011

Characterization of immune responses induced by combined clade-A HIV-1 recombinant adenovectors in mice.

Iran J Immunol 2010 Sep;7(3):162-76

Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran, e-mail:

Background: Numerous evidences indicate that in some HIV-1 positive patients, the humoral and cellular immune responses are induced against HIV-1 proteins and this is inversely related to the progress of infection.

Objective: The aim of this study was the evaluation of the Adenovectors containing HIV genes in induction of immune responses in mice.

Methods: The HIV-1 genes including gag p24, rev, nef and exon-1 of tat were amplified from HIV-1 RNA (clade-A). The cDNA of each gene was cloned into a transfer vector. The transfer vector was then co-transformed into E. coli strain BJ5183 together with pAdenovector ∆E1/E3. The recombinant adenoviral construct was transfected into QBI-293A cells. Recombinant viruses were purified and titrated on 293 cell plates. Expression of transgenes was evaluated using western blotting. Then 10(12) viral particles were injected into 15 groups of 5 mice and all patterns of combination of these 4 HIV-1 genes were evaluated. After 2 weeks, humoral and cellular immune responses were evaluated using ELISA, cell proliferation and ELISpot (IL-2, IL-4 and IFN-γ) assays, consecutively.

Results: It was demonstrated that each gene was expressed. The response targets were mostly toward Th1, though several Th2 responses were also observed. Single injection in our study induced a good cellular response but the humoral responses were not as strong as the cellular ones.

Conclusion: Considering and comparing all results and evaluating the various possible interactions revealed that simultaneous injection of tat and gag has enhanced the humoral and cellular responses.
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http://dx.doi.org/IJIv7i3A4DOI Listing
September 2010

Assessing subtype and drug-resistance-associated mutations among antiretroviral-treated HIV-infected patients.

AIDS 2010 Jul;24 Suppl 2:S85-91

Tehran University of Medical Sciences, Tehran, Iran.

Background: Several studies have reported an increasing number of therapeutic failures with antiretroviral drugs in HIV-infected patients. The emergence of viral-resistant strains is a major problem for the medical management of infected individuals. The aim of this study is to determine viral subtypes and drug-resistance mutations among antiretroviral-treated HIV-infected patients.

Methods: A total of 42 antiretroviral-treated but still viremic HIV-infected patients were enrolled. The HIV pol regions were amplified and sequenced to determine subtypes and antiretroviral-resistant mutations.

Results: The subtype distribution was 48% A/D recombinants, 43% subtype B, 5% subtype A and 5% CRF01-AE recombinants. Drug-resistant mutations were most common in subtype B (53%) and A/D recombinant strains (44%). Virus samples from 19% of participants had no drug-resistant mutations; 2, 2 and 76% of samples carried one, two and at least three drug-resistant mutations, respectively. The prevalence of nucleoside transcriptase inhibitor mutations was 76%, with M184V and L74V present in 60 and 38% of samples, respectively. The prevalence of nonnucleoside transcriptase inhibitor mutations was 74%, with P225H present in 55% of study specimens. The prevalence of protease inhibitor mutations was 45%, with major mutation L90M seen in 33% and minor mutation A71V in 36% of samples. Of note, the P225H and A71V are 'minor' drug-resistance mutations conferring only minimal drug-resistance phenotypes in the absence of major mutations.

Conclusion: Our study found a high prevalence of drug-resistant mutations in Iranian HIV-infected patients. Our data support the need for continued surveillance of resistance patterns to help guide therapeutic approaches and limit transmission of these variants.
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http://dx.doi.org/10.1097/01.aids.0000386738.32919.67DOI Listing
July 2010