Publications by authors named "Mitra Ranjbar"

25 Publications

  • Page 1 of 1

Efficacy and safety of chloroquine and hydroxychloroquine for COVID-19: A comprehensive evidence synthesis of clinical, animal, and in vitro studies.

Med J Islam Repub Iran 2020 17;34:171. Epub 2020 Dec 17.

Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.

The world is facing a pandemic of COVID-19, a respiratory disease caused by a novel coronavirus which is now called SARS-CoV-2. Current treatment recommendations for the infection are mainly repurposed drugs based on experience with other clinically similar conditions and are not backed by direct evidence. Chloroquine (CQ) and its derivative Hydroxychloroquine (HCQ) are among the candidates. We aimed to synthesize current evidence systematically for in vitro, animal, and human studies on the efficacy and safety of chloroquine in patients with COVID-19. The Cochrane Library, Google Scholar, PubMed (via Medline), Embase, Scopus, and Web of Science, MedRxiv, clinical trial registries including clinicaltrials.gov, ChiCTR (Chinese Clinical Trial Registry), IRCT (Iranian Registry of Clinical Trials), and the EU Clinical Trials Register. We used the Cochrane tool for risk of bias assessment in randomized studies, the ROBINS tool for non-randomized studies, and the GRADE methodology to summarize the evidence and certainty in effect estimates. The initial database searching retrieved 24,752 studies. Of these, 15,435 abstracts were screened and 115 were selected for full-text review. Finally, 20 human studies, 3 animal studies, and 4 in vitro studies were included in this systematic review. The risk of bias within studies was unclear to high and the overall certainty in evidence-based on GRADES- was very low. HCQ may be effective in clinical improvement in a subset of patients with COVID-19. However, the frequency of adverse events was higher in patients taking HCQ compared to standard of care alone. In contrast, animal studies, did not report any adverse effects. Furthermore, clear benefit of the drug in the survival of the animals has been reported. Most in vitro studies indicated a high selectivity index for the drug and one study that used a human coronavirus reported blockage of virus replication. Current evidence background is limited to six poorly conducted clinical studies with inconsistent findings which fail to show significant efficacy for HCQ. Safety data is also limited but the drug may increase adverse outcomes. Routine use of the drug is not recommended based on limited efficacy and concerns about the drug safety especially in high-risk populations.
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http://dx.doi.org/10.47176/mjiri.34.171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004577PMC
December 2020

Infliximab and Intravenous Gammaglobulin in Hospitalized Severe COVID-19 Patients in Intensive Care Unit.

Arch Iran Med 2021 Feb 1;24(2):139-143. Epub 2021 Feb 1.

Department of Internal Medicine, Firoozgar Medical and Educational Hospital, Iran University of Medical Sciences, Tehran, Iran.

Background: Severe coronavirus disease 2019 (COVID-19) may lead to the cytokine storm syndrome which may cause acute respiratory failure syndrome and death. Our aim was to investigate the therapeutic effects of infliximab, intravenous gammaglobulin (IVIg) or combination therapy in patients with severe COVID-19 disease admitted to the intensive care unit (ICU).

Methods: In this observational research, we studied 104 intubated adult patients with severe COVID-19 infection (based on clinical symptoms, and radiographic or CT scan parameters) who were admitted to the ICU of a multispecialty hospital during March 2020 in Tehran, Iran. All cases received standard treatment regimens as local protocol (Oseltamivir + hydroxychloroquine + lopinavir/ritonavir or sofosbuvir or atazanavir ± ribavirin). The cases were grouped as controls (n = 43), infliximab (n = 27), IVIg (n = 23) and combination (n = 11).

Results: There was no significant difference between controls and treatment groups in terms of underlying diseases or the number of underlying diseases. The mean age (SD) of cases was 72.42 (16.06) in the control group, 64.52 (12.965) in IVIg, 63.40 (17.57) in infliximab and 64.00 (11.679) in combination therapy; ( = 0.047, 0.031 and 0.11, respectively). Also, 37% in the infliximab group, 26.1% in IVIg, 45.5% in combination therapy, and 62.8% in the control group expired (all < 0.05). Hazard ratios were 0.31 in IVIg (95% CI: 0.12-0.76, = 0.01), 0.30 in infliximab (95% CI: 0.13-0.67, = 0.004), 0.39 in combination therapy (95% CI: 0.12-1.09, = 0.071).

Conclusion: According to the findings of this study, it seems that infliximab and IVIg, alone or together, in patients with severe COVID-19 disease can be considered an effective treatment.
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http://dx.doi.org/10.34172/aim.2021.22DOI Listing
February 2021

Effect of Arbidol (Umifenovir) on COVID-19: a randomized controlled trial.

BMC Infect Dis 2020 Dec 14;20(1):954. Epub 2020 Dec 14.

Department of Infectious Disease, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Background: Treatment of patients with COVID-19 has included supportive care to mainly relief symptoms of the disease. Although World Health Organization (WHO) has not recommended any effective treatments for COVID-19, there are some reports about use of antiviral drugs. The aim of this study is to determine the effect of Arbidol (ARB) on COVID-19 disease.

Methods: Using an open-label randomized controlled trial, we examined the efficacy of ARB in patients with COVID-19 in a teaching hospital. One hundred eligible patients with diagnosis of COVID-19 were recruited in the study and assigned randomly to two groups of either hydroxychloroquine followed by KALETRA (Lopinavir/ritonavir) or hydroxychloroquine followed by ARB. The primary outcome was hospitalization duration and clinical improvement 7 days after admission. The criteria of improvement were relief of cough, dyspnea, and fever. Time to relief from fever was also assessed across the two groups. Without any dropouts, 100 patients were entered into the study for the final analysis at significance level of 0.05.

Results: The mean age of patients was 56.6 (17.8) years and 56.2 (14.8) years in ARB and KALETRA groups, respectively. Majority of patients were male across two groups (66 and 54%). The duration of hospitalization in ARB group was significantly less than KALETRA arm (7.2 versus 9.6 days; P = 0.02). Time to relief fever was almost similar across two groups (2.7 versus 3.1 days in ARB and KALETRA arms, respectively). Peripheral oxygen saturation rate was significantly different after 7 days of admission across two groups (94% versus 92% in ARB and KALETRA groups respectively) (P = 0.02). Based on multiple linear regression analysis, IHD, Na level, and oxygen saturation at the time of admission and type of therapy were the independent adjusted variables that determined the duration of hospitalization in patients with COVID-19.

Conclusion: Our findings showed that Arbidol, compared to KALETRA, significantly contributes to clinical and laboratory improvements, including peripheral oxygen saturation, requiring ICU admissions, duration of hospitalization, chest CT involvements, WBC, and ESR. We suggest further studies on ARB against COVID-19 using larger sample size and multicenter design.

Trial Registration: IRCT20180725040596N2 on 18 April 2020.
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http://dx.doi.org/10.1186/s12879-020-05698-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734453PMC
December 2020

Angiotensin Converting Enzyme Inhibitors, A Risk Factor of Poor Outcome in Diabetic Patients with COVID-19 Infection.

Iran J Kidney Dis 2020 12 5;14(6):482-487. Epub 2020 Dec 5.

Firoozgar Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Introduction: Diabetes mellitus and hypertension are described as the most common comorbidities among COVID-19 patients. We investigated the adverse effect of ACEIs in diabetic and nondiabetic patients with COVID-19.

Methods: This prospective study consisted of 617 RT-PCR-confirmed COVID-19 inpatients. Demographic and baseline characteristics, underlying comorbid diseases, and antihypertensive drugs were evaluated. Study outcome (in-hospital death) was evaluated with the Kaplan-Meyer method and Cox regression model. Statistical analyses were performed with SPSS software for Windows. P values < .05 were considered significant.

Results: Mean ± SD age was 58.49 ± 15.80 (range: 18 to 94) years old. Cox regression analysis revealed that age (adjusted hazard ratio [HR] = 1.04, 95% CI: 1.03 to 1.06), diabetes mellitus (adjusted HR = 2.07, 95% CI: 1.32 to 3.26), immunocompromised patients (adjusted HR = 2.33, 95% CI: 1.29 to 4.21), acute kidney injury (AKI) (adjusted HR = 3.23, 95% CI: 2.01 to 5.19), ICU admission (adjusted HR = 2.48, 95% CI: 1.46 to 4.21), Asthma and COPD (adjusted HR = 2.13, CI:1.6 to 4.28) and ACEI (adjusted HR = 3.08, 95% CI: 1.56 to 6.06), respectively were associated with in-hospital death. Among diabetic patients, ACEI (adjusted HR = 3.51, 95% CI: 1.59 to 7.75), AKI (adjusted HR = 3.32, 95% CI: 1.76 to 6.45) and ICU admission (adjusted HR = 3.64, 95% CI: 1.530 to 8.65) were associated with increased mortality. The Kaplan-Meier survival curve showed a lower survival rate in diabetic patients with ACE inhibitor (adjusted HR = 3.36, 95% CI: 2.25 to 7.71).

Conclusion: ACEIs may harm the diabetic patient's outcome with COVID-19. Further studies can confirm if ACE inhibitors have an adverse effect on COVID-19 diabetic patient's mortality.
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December 2020

Occult Hepatitis C Infection Among Hemodialysis Patients: A Prevalence Study.

Ann Hepatol 2017 Jul-Aug;16(4):510-513

Department of Gastroenterology and Liver Diseases, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Introduction And Aim: Occult hepatitis C infection (OHCI) is the presence of HCV-RNA in the liver or peripheral blood mononuclear cells (PBMC) accompanying with negative serologic results. The aim of this study was to evaluate the prevalence of OHCI among Iranian chronic hemodialysis (HD) patients.

Material And Methods: In this cross sectional study 200 chronic HD patients with negative HCV antibody enrolled the study. Blood sample of patients were obtained, followed by Polymerase Chain reaction (PCR) testing for detection of HCV RNA. Patients with positive serum HCV RNA were considered as manifest hepatitis C infection (MHCI). However, patients with negative serum HCV RNA underwent further tests on PBMCs for detection of OHCI.

Results: Serum HCV RNA was positive in 2 (1%) patients whom considered as MHCI, and 6 (3.03%) patients had positive PBMC HCV RNA.

Conclusion: In conclusion, chronic HD patients have been considered as a high risk group for hepatitis C infection. The results of this study suggest that these patients are also at risk for OHCI. Furthermore, evaluating PBMCs to detect HCV RNA would be a sensitive diagnostic method to find OHCI patients.
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http://dx.doi.org/10.5604/01.3001.0010.0277DOI Listing
April 2018

Interferon-gamma release assay agreement with tuberculin skin test in pretransplant screening for latent tuberculosis in a high-prevalence country.

Iran J Kidney Dis 2014 Jul;8(4):329-32

Department of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Tuberculosis reactivation is one of significant complications after transplantation. Tuberculin skin test (TST) has been the major available screening test in end-stage renal disease patients, but it is associated with a low accuracy. Recently, an interferon-gamma release assay (IGRA) has been approved as a substitution test in diagnosis of Mycobacterium tuberculosis infection. This study aimed to compare the ability of the TST and IGRA in the diagnosis of latent tuberculosis in hemodialysis patients and investigate risk factors of having positive test results.

Materials And Methods: Forty-seven hemodialysis patients underwent the IGRA and TST tests. Demographic data and blood samples were collected and chest radiography was done for all participants.

Result: Abnormal chest radiography was reported in 24% of the study group. The IGRA and TST were positive in 11 (23.4%) and 20 patients (43.5%), respectively. The agreement coefficient (kappa) between the IGRA and TST was 0.31. Positive TSTs were significantly associated with male sex and abnormal chest radiography. Diabetes mellitus was a risk factor for a positive IGRA result (P = .01).

Conclusions: The IGRA test is not a sensitive test for detection of latent tuberculosisin hemodialysis patients residing in high-prevalence areas. We suggest that assessment of cellular immunity response in end-stage renal disease patient be a priority before reliance on the IGRA test result.
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July 2014

Intrafamilial seropositivity of hepatitis in patients with hepatitis B and C virus in hepatitis clinic in Hamadan, Iran.

Ann Hepatol 2012 Jan-Feb;11(1):32-6

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

Objective: To determine intrafamilial seropositivity of HBV and HCV and to compare them in families of infected persons with HBV and HCV in Hamadan clinic of hepatitis.

Material And Methods: In this analytic cross-sectional study, 651 family members of 200 HBV and HCV infection index cases were entered into the study and after signing an informed consent, they were referred to Blood Transfusion Center. With completion of laboratory tests, interviewers filled the questionnaires.

Results: One hundred and eighteen (20.5%) and 107 (18.6%) family members were HBsAg and HBcAb positive respectively. 21 (3.6%) were isolated HBcAb positive. Only one person (1.3%) was HCVAb positive. The general rate of infection in family members of HBV infected people (atleast one case) (49.4%) was significantly higher than that of HCV infected people (3.3%), p < 0.001. Interspouses transmission was evaluated and prevalence of interspouses HBV and HCV infection were 32.3 and 8%, respectively.

Conclusion: Intrafamilial and interspousal seropositivity of HBV is obviously more than those of HCV. More attention should be paid to screening and risk lowering activities particularly about HBV infected people and their families.
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June 2012

Seroprevalence of hepatitis D virus and its risk factors in the west of Iran.

J Microbiol Immunol Infect 2010 Dec;43(6):519-23

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Despite the decreasing trend in hepatitis D virus (HDV) infection worldwide, the importance of this disease cannot be underestimated. The aim of this study was to evaluate patients positive for HBsAg with respect to HDV infection and related factors. Patients with chronic hepatitis B who presented at Hamedan Province Hepatitis Community Center in 2002-2007 were included. A questionnaire covering demographic variables and history of hepatic disease was completed for each patient. Necessary tests were performed and antibodies to HDV were measured using an enzyme-linked immunosorbent assay. Of 81 HBsAg positive patients, 14 (17.3%) contained anti-HDV IgG. Only one of the patients with anti-HDV IgM was positive for HBsAg. Of the anti-HDV IgG positive patients, two (14.3%) were women. Among the women examined in this study, 24 (35.8%) were anti-HDV IgG negative (p = 0.21), and of these, six (42.8%) were HBeAg positive while 17 (25.4%) of the anti-HDV IgG negative women were positive for HBeAg (p = 0.16). The prevalence of chronic hepatitis B among anti-HDV IgG positive and negative patients was 28.6% and 39.2% respectively (p = 0.31). Because of the relatively high rate of hepatitis B virus (HBV) and HDV co-infection in our study subjects, it is vital that healthcare providers and policy makers to recognize the risk factors associated with this HBV and HDV co-infection as well as the reasons for this increased anti-HDV serology in HBV carriers.
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http://dx.doi.org/10.1016/S1684-1182(10)60080-1DOI Listing
December 2010

High prevalence of multidrug-resistant strains of Vibrio cholerae, in a cholera outbreak in Tehran-Iran, during June-September 2008.

Trop Doct 2010 Oct 13;40(4):214-6. Epub 2010 Aug 13.

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

Following the occurrence of suspected cases of Vibrio cholerae in Karaj in 2008, this study was conducted in order to determine whether or not the cases were infected with cholera and, if so, to describe the prevalence of serotypes, route of transmission and the antimicrobial resistance profile. In this cross-sectional study, 6505 rectal swabs were collected from patients with acute gastroenteritis. Serotypes and biotypes of the isolates were determined by standard procedures. The antimicrobial susceptibility of 45 Inaba and 30 non-agglutinating (NAG) strains was determined. From 6505 specimens, 110 (1.69%) were defined as V. cholerae, including 70 (63.3%) V. cholerae O1 serotype Inaba biotype El Tor and 40 (36.4%) NAG Vibrios. The case fatality rate was 0.9%. Inaba strains were 100% resistant to nalidixic acid and amoxicillin, 95.7% resistant to trimethoprim-sulfamethoxazole, 91.3% resistant to furazolidone while the highest frequency of resistance in NAG Vibrios was 77.4% to erythromycin. The lowest resistance rate belonged to ciprofloxacin to which just one NAG strain was resistant. Results suggests an increase in resistance of V. cholerae to several antibiotics. Ciprofloxacin can still be used as first-line treatment of cholera in this region.
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http://dx.doi.org/10.1258/td.2010.100015DOI Listing
October 2010

Clinical features of patients with typhoid fever and drug resistance of the causative isolates in western Iran.

Trop Doct 2009 Oct;39(4):223-4

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

Typhoid fever is an important infectious disease in developing countries, including Iran. In this survey, all patients hospitalized in teaching hospitals of Hamedan during 1995-2005 were investigated. A total of 162 patients with typhoid fever were studied. Of all patients, 106 were male (65.4%). The most prevalent symptoms were fever (93.2%), chills (76.5%), anorexia (72.2%) and headache (71%). Splenomegaly and hepatomegaly were present in 43.8% and 13.6%, respectively. Salmonella typhi strains were identified in 144 patients (88.9%) and S. paratyphi A strains were found in 12 (7.4%). In others, S. paratyphi B and C were detected. Serum glutamic oxalo-acetic transaminase values were higher than normal in 77.5% of cases and serum glutamic pyruvic transaminase values were higher than normal in 62.5%. The highest sensitivity rate was for ceftizoxime, 91.4% and the lowest rate was for ampicillin, 16.3%.
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http://dx.doi.org/10.1258/td.2009.090046DOI Listing
October 2009

A comparative trial of three therapeutic regimens: ciprofloxacin-rifampin, ciprofloxacin-doxycycline and doxycycline-rifampin in the treatment of brucellosis.

Trop Doct 2009 Oct;39(4):207-10

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

This study was designed to compare the efficacy of ciprofloxacin plus rifampin (CR) and ciprofloxacin plus doxycycline (CD) versus doxycycline plus rifampin (DR) in the treatment of brucellosis. A total of 178 patients with brucellosis who were referred to the Sina Hospital, Hamedan, Iran, were included. The responses to therapy were observed in 166 cases (93.7%) - 59 were in the DR group, 59 in the CR group and 48 in the CD group. No significant differences in the therapeutic responses were observed (P = 0.09). Relapse was observed in 11.7% (DR 7.7%, CR 8.3% and CD 17.5%) after a six-month follow-up. No significant differences were also observed in relapse rates among the three groups (P = 0.35). We concluded that DR is still the first choice regimen and CR or CD may be used as alternatives for treatment of brucellosis in adults.
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http://dx.doi.org/10.1258/td.2009.090030DOI Listing
October 2009

Seroprevalence of Immunoglobulin G antibodies against pertussis toxin among asymptomatic medical students in the west of Iran: a cross sectional study.

BMC Infect Dis 2009 May 9;9:58. Epub 2009 May 9.

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

Background: Pertussis is a highly communicable, vaccine-preventable respiratory infection. Immune response against this disease can be induced by infection or vaccination. Protection after childhood vaccination is minimal after ten years. Our aim was to assess pertussis immunity state in a population of healthy young medical students.

Methods: In this seroepidemiological survey, blood samples were obtained from 163 first-year medical students in Hamedan University, Iran. Serum level of IgG against pertussis toxin (IgG-PT) was measured by Enzyme-Linked Immunosorbent Assay (ELISA) method. For qualitative assessment, IgG-PT levels more than 24 unit (U)/ml were considered positive. Data was analysed qualitatively and quantitatively considering gender and age groups.

Results: There were 83 males and 80 females, with a mean age of 19.48 years, Prevalence of IgG-PT was 47.6% with mean level of 71.7 u/ml (95% confidence interval: 68.1-75.3). No statistically significant difference was observed with respect to sero-positivity of IgG-PT between males and females (45 cases (54%) vs. 34 cases (42%); P = 0.06). Mean IgG-PT levels in males and females were 84 U/ml and 58.8 U/ml, respectively (P = 0.91).

Conclusion: A considerable proportion of our study population with a positive history of childhood vaccination for pertussis was not serologically immune to pertussis. A booster dose of acellular pertussis vaccine may be indicated in Iranian, medical students regarding their serologic conditions and outstanding role in health care systems.
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http://dx.doi.org/10.1186/1471-2334-9-58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684070PMC
May 2009

Health-related quality of life in patients with HIV/AIDS.

Arch Iran Med 2008 Nov;11(6):608-12

Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Background: The present study was conducted to determine the health-related quality of life in patients living with human immunodeficiency virus or suffering from acquired immune deficiency syndrome (HIV/AIDS), referred to Behavioral Diseases Consultation Center in west of Tehran, Iran.

Methods: This cross-sectional study was conducted using a convenience sampling method on 139 patients living with HIV or suffering from AIDS at the first half of the year 2006. The method of data collection was summarized questionnaire of World Health Organization (WHO-QOL-Brief). The main measured outcome in this study was quality of life and some related demographic and clinical variables.

Results: The majority of the patients were males (88.5%) with secondary education (45.3%) and married (27.3%); the majority of them were unemployed (65.4%). The mean+/-SD age of the patients was 35.4+/-6.4 years. Gender, marital status, level of education, CD4+ count, and clinical stage of the disease, had a significant effect on the quality of life of the patients. In multivariate analysis, the most important predictor of the quality of life was clinical stage of the disease.

Conclusion: The most important factors, association with decreased quality of life of the patients in this study, were being female, separated or divorced, having less CD4+ count, and being at severe stage of the disease.
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November 2008

Osteoarticular complications of brucellosis in Hamedan, an endemic area in the west of Iran.

Int J Infect Dis 2007 Nov 6;11(6):496-500. Epub 2007 Mar 6.

Department of Infectious Diseases, Hamedan University of Medical Sciences, Sina Hospital, Mirzadeh-eshghi Street, Hamedan 65168, Iran.

Objective: To determine the frequency and clinical characteristics of osteoarticular complications of brucellosis in an endemic region in Iran.

Methods: In a prospective study we evaluated 245 patients with brucellosis diagnosed between January 2004 and December 2005. Patients included were those older than 8 years of age and who had clinical features suggestive of brucellosis and specific antibodies at significant titers, and/or positive blood or body fluid culture for Brucella species. A bone scan was performed in those with a clinical suspicion of osteoarticular involvement.

Results: Seventy patients (28.6%) had osteoarticular complications. Sacroiliitis was the most common complication (75.7%), followed by spondylitis (21.4%) and peripheral arthritis (8.6%). Spondylitis was the most common osteoarticular complication in the elderly. Relapses occurred in five (2%) patients, three of them with spondylitis.

Conclusions: Osteoarticular disease is the most common complication of brucellosis in Western Iran. Sacroiliitis is the most common form of osteoarticular complication. With the use of a proper treatment regimen, the prospect for recovery is good.
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http://dx.doi.org/10.1016/j.ijid.2007.01.008DOI Listing
November 2007

Distribution frequency of hepatitis C virus genotypes in 2231 patients in Iran.

Hepatol Res 2007 Feb;37(2):101-3

Iran University of Medicine, Tehran, Iran.

Aim: Given the importance of frequency distribution of HCV genotypes, we studied genotypic distribution of HCV in Iran. In this cross-sectional study, 2231 patients with hepatitis C who presented in hepatitis clinics in Tehran were investigated for HCV genotypes.

Methods: Genotyping was performed by genotype specific primers.

Results: The highest frequency was for genotype 1a, with 886 (39.7%) of subjects. Genotype 3a and 1b were the other frequent genotypes, with 613 (27.5%) and 271 (12.1%) subjects, respectively. Of the samples, 401 (18%) had an undetermined genotype. Mixed genotypes were also found in 33 samples (1.6%). Genotype 1b frequency in patients under 20 years old was 10.2%, while its frequency in patients over 60 years old was 18.5%. Genotype 1b frequency significantly increased by age (P = 0.02).

Conclusion: This study indicates that the dominant HCV genotype among patients living in Tehran was 1a.
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http://dx.doi.org/10.1111/j.1872-034X.2007.00015.xDOI Listing
February 2007

Insulin resistance in chronic hepatitis B and C.

Indian J Gastroenterol 2006 Nov-Dec;25(6):286-9

Research Center of Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: To determine whether insulin resistance occurs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC) and its relationship with the presence of liver fibrosis and steatosis.

Methods: Untreated patients with CHC (n=60) or CHB (n=40), similar in age, gender, body mass index and waist-hip ratio, were studied. Relationship between anthropometric, biochemical (fasting serum insulin, C-peptide, ferritin, iron, TNF-alpha, cholesterol, triglyceride, bilirubin, hemoglobin and platelet concentrations) and liver biopsy (43 CHC and 20 CHB patients) findings was investigated by insulin resistance determined via the homeostasis model assessment (HOMA-IR).

Results: The mean fasting serum insulin was 14.9 (11.9) mU/mL in CHC and 21.4 (17.4) in the CHB group (normal range 0.7-9; p=0.049) and mean HOMA-IR was 3.1 (2.6) in CHC versus 4.7 (4.1) in the CHB group (normal range 0.12-4.61; p=0.036). HOMA-IR was significantly associated with fibrosis stage in the CHC group (p=0.015), but not in the CHB group.

Conclusion: Hyperinsulinemia occurs in chronic viral hepatitis B and hepatitis C; insulin resistance is associated with stage of fibrosis in hepatitis C.
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March 2007

Association of promoter polymorphism of the CD14 C (-159) T endotoxin receptor gene with chronic hepatitis B.

World J Gastroenterol 2006 Sep;12(35):5717-20

Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, 7th floor, Taleghani Hospital, Yaman Str., Evin, Tehran 19857, Iran.

Aim: To investigate whether single-nucleotide polymorphisms in the promoter regions of endotoxin-responsive genes CD14 C (-159) T is associated with chronic hepatitis B.

Methods: We obtained genomic DNA from 80 patients with established diagnosis of chronic hepatitis B and 126 healthy subjects served as a control population. The CD 14 C (-159) T polymorphism was investigated using an allele specific PCR method.

Results: Twenty seven percent of chronic hepatitis B patients and 75% of controls were heterozygous for CT genotype. The difference between the chronic hepatitis B and control groups was statistically significant [P < 0.0001; Odds ratio (OR) = 2.887; 95% CI: 1.609-5.178]. Twenty four point six percent of chronic hepatitis B and patients 12.3% of the control group were heterozygous for TT genotype. The difference between groups was not statistically significant (P = 0.256; OR = 0.658; 95% CI: 0.319-1.358). Forty eight point four percent of chronic hepatitis B patients and 12.7% of control were homozygote for CC genotype (P < 0.004; OR = 0.416; 95% CI: 0.229-0.755). The frequency of allele C was 61.9% and allele T was 38.1% in hepatitis B patients group. The frequency of allele C was 55.2% and allele T was 44.8% for the control group (P = 0.179; OR = 1.319; 95% CI: 0.881-1.977).

Conclusion: The TT heterozygous genotype was not a risk factor for chronic hepatitis B. CC homozygote genotype is protective for hepatitis B. Lack of heterozygosis of genotype CT is a risk factor for chronic hepatitis B. Alleles C or T were not risk factors for chronic hepatitis B. These findings show the role of a single-nucleotide polymorphism at CD14/-159 on the development of chronic hepatitis B. Endotoxin susceptibility may play a role in the pathogenesis of chronic hepatitis B.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4088176PMC
http://dx.doi.org/10.3748/wjg.v12.i35.5717DOI Listing
September 2006

Polymorphisms of interleukin-1R receptor antagonist genes in patients with chronic hepatitis B in Iran.

World J Gastroenterol 2006 Aug;12(31):5044-7

Hamedan University of Medical Sciences and Health Services, Sina Hospital, Hamedan, Iran.

Aim: To investigate the relationships between polymorphisms of interleukin-1R receptor antagonist genes and susceptibility to chronic hepatitis B in Iran population.

Methods: Genomic DNA was extracted from the peripheral blood of 80 patients with chronic hepatitis B (57 males, 23 females) aged 12-77 years (mean 36.1 +/- 13.8 years) and 147 normal controls (96 males, 51 females) aged 6-75 years (mean 41 +/- 18.7 years) who referred to a liver clinic of Tehran and then subjected to polymerase chain reaction (PCR) amplification. PCR products were resolved on a 3% agarose gel and stained with ethidium bromide.

Results: Only three of the five kinds of polymorphism (2/2, 2/4, and 4/4) were found in this study. The frequencies of 2/2, 2/4, and 4/4 were 12.5%, 17.5%, 70% respectively in chronic hepatitis B patients and 6.8%, 24.5%, and 68.7% respectively in controls. IL-1 R allele 2 was detected in 30% of chronic hepatitis B patients and in 31.3% of controls, while IL-1 R allele 4 was detected in 87.5% of chronic hepatitis B patients and in 93.2% of controls. The frequency of IL-1R alleles 2 and 4 was detected in 21.25% and 78.75% of the patients and 19.04% and 80.96% of the controls, respectively.

Conclusion: Our results suggest that the carriage of IL-1R receptor antagonist alleles 2, 4, 6 may not play any role in the development of HBV infection. Large population-based studies are needed to investigate the role of IL-1 polymorphisms in the pathogenesis of developing chronic hepatitis B.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4087410PMC
http://dx.doi.org/10.3748/wjg.v12.i31.5044DOI Listing
August 2006

Biochemical response to lamivudine treatment in HBeAg negative chronic hepatitis B patients in Iran.

World J Gastroenterol 2006 Jul;12(26):4203-5

Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, Tehran 19857, Iran.

Aim: To study the effect of a one-year lamivudine regimen in patients with chronic hepatitis B.

Methods: Medical records of HBeAg negative hepatitis B patients who attended a hepatitis clinic in Tehran between March 2002-March 2004 were evaluated. The patients received 100 mg lamivudine tablets once daily for at least 12 mo. Liver enzymes and complete blood count were checked at baseline and the end of treatment (12th mo) and 6 mo after discontinuation of treatment.

Results: Of all patients, 24 were excluded. Of 71 patients left, 58 (81.7%) were men. Mean age of the patients was 38 +/- 14 years. Mean level of ALT in serum was 1437 +/- 205 nkat/L at baseline with a significant reduction at the end of treatment to a mean level of 723 +/- 92 nkat/L (P = 0.002). In 38 patients (53.5%), the ALT level was normal after one-year treatment. Five patients (7.3%) relapsed (biochemically) within 6 mo after discontinuing lamivudine therapy (the patients with good end of treatment response). Mean level of AST in serum was 1060 +/- 105 nkat/L at baseline which decreased significantly to 652 +/- 75 nkat/L at the end of treatment (P = 0.002).

Conclusion: Over half (53.5%) of chronic hepatitis B patients with HBeAg negative have normal liver enzyme level at 12-mo lamivudine therapy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4087374PMC
http://dx.doi.org/10.3748/wjg.v12.i26.4203DOI Listing
July 2006

Comparison between doxycycline-rifampin-amikacin and doxycycline-rifampin regimens in the treatment of brucellosis.

Int J Infect Dis 2007 Mar 22;11(2):152-6. Epub 2006 Jun 22.

Department of Infectious Diseases, Sina Hospital, Hamedan, Iran.

Background: Combination drug therapy of brucellosis leads to recovery of symptoms, shortening of symptomatic interval, and decrease in morbidity rate, but single drug therapy is associated with more relapse episodes and a higher rate of drug resistance. Different drug combinations have been evaluated in the treatment of brucellosis. Considering the failure of treatment and relatively high rate of relapse of the disease with the World Health Organization's (WHO) recommended therapeutic regimen, we evaluated a new regimen that we assumed would increase the success of treatment and decrease the rate of relapse. In this study we compare the standard regimen of the WHO, doxycycline-rifampin (DR), to triple therapy with doxycycline-rifampin-amikacin (ADR).

Methods: Two hundred and twenty-eight consecutive patients with brucellosis, who attended Hamedan Sina Hospital between 1999 and 2001, whether seen as outpatients or as inpatients, were enrolled in the study. The participants were randomly allocated to the DR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks) or the ADR group (receiving doxycycline 100 mg twice a day and rifampin 10 mg/kg body weight/day every morning, both taken orally for eight weeks, plus 7.5 mg/kg amikacin intramuscularly twice a day for seven days). The patients were checked for the relief of symptoms, drug side-effects, and relapse of disease during the treatment and follow-up.

Results: Of the 228 patients enrolled, eight were withdrawn - four patients from the DR group and four from the ADR group. Of the remaining 220 participants (110 in the ADR group and 110 in the DR group), 107 were male (48.6%) and 113 were female (51.4%). Mean age was 35.7+/-17 years in the ADR group and 37+/-18.4 years in the DR group (p=0.5). In the DR group, 97 (88.2%) and in the ADR group, 106 (96.4%) of the patients had relief of symptoms (a significant difference by Chi-square test (p=0.04)). After completion of treatment, and at the sixth month follow-up, nine (9.3%) patients in the DR group and six (5.7%) in the ADR group experienced a relapse of the disease, with no significant difference (p=0.4). Mild side-effects were found in only 10 patients, and none required discontinuation of the therapeutic regimen. Of these patients, four were from DR group and six from ADR group; no significant difference was observed (p=0.7).

Conclusions: Given the fact that the ADR regimen had a higher efficacy and more rapid action in terms of relief of symptoms compared to the DR regimen, and that no significant difference in drug side-effects and disease relapse existed in the patients of either group, adding amikacin to the DR standard treatment regimen seems beneficial.
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http://dx.doi.org/10.1016/j.ijid.2005.11.007DOI Listing
March 2007

Cytotoxic T-lymphocyte antigen 4 gene polymorphisms and susceptibility to chronic hepatitis B.

World J Gastroenterol 2006 Jan;12(4):630-5

Research Center for Gastroenterology and Liver disease, 7th Floor of Taleghani Hospital, Parvaneh Avenue, Tabnak Str., Evin, Tehran 19857, Iran.

Aim: To assess the three polymorphism regions within cytotoxic T-lymphocyte antigen 4 (CTLA-4) gene, a C/T base exchange in the promoter region -318 (CTLA-4 -318C/T), an A/G substitution in the exon 1 position 49 (CTLA-4 49A/G), a T/C substitution in 1172 (CTLA-4 -1172T/C) in patients with chronic hepatitis B.

Methods: Fifty-one patients with chronic hepatitis B virus infection and 150 healthy subjects were recruited sequentially as they presented to the hepatic clinic. Classification of chronic hepatitis B virus (HBV)-infected patients was as asymptomatic carrier state (26 patients) and chronic hepatitis B (25 patients). Genomic DNA was isolated from anti-coagulated peripheral blood Buffy coat using Milleros salting-out method. The presence of the CTLA-4 gene polymorphisms was determined using polymerase chain reaction amplification refractory mutation system (ARMS).

Results: We observed a significant association between -318 genotypes frequency (T+C-, T+C+, T-C+) and susceptibility to chronic hepatitis B (P=0.012, OR=0.49, 95%CI: 0.206-1.162). However, we did not observe a significant association for +49 genotype frequency (T+C+, T+C- T-C+) and -1172 genotype frequency (C+T+, T+C- C+T-) and state of disease.

Conclusion: Our results suggest that CTLA-4 gene polymorphisms may partially be involved in the susceptibility to chronic hepatitis B.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066100PMC
http://dx.doi.org/10.3748/wjg.v12.i4.630DOI Listing
January 2006

Intra-familial prevalence of hepatitis B virologic markers in HBsAg positive family members in Nahavand, Iran.

World J Gastroenterol 2005 Aug;11(31):4857-60

Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, 7th Floor, Taleghani Hospital, Yaman Street, Evin, Tehran 19857, Iran.

Aim: To determine the prevalence of hepatitis B in Nahavand and evaluate the HBsAg positive prevalence in families with a member who was confirmed to have HBV infection.

Methods: This study was performed in two phases. In the first phase, 1 824 subjects in Nahavand city were selected. The interviewers visited the houses of chosen families to fill the questionnaire and take the blood samples. All subjects signed an informed consent before interviews and blood sampling. The samples were evaluated for HBV virologic markers. In the second phase, 115 HBsAg-positive cases were enrolled and evaluated for HBV virologic markers.

Results: The prevalence of positive HBsAg in Nahavand was 2.3%. The most frequent relatives of index cases were sons and daughters (32.2% and 23.5% respectively). Twelve (11%) of all family members were HBsAg positive. Fifty (56.2%) were isolated HBsAb positive and only one person (2.5%) was isolated HBcAb positive. The higher rates of HBsAg marker were detected in the brothers (1-25%) and fathers (1-12.5%). The infection rate in husbands and wives of index cases was 10%. Only two (16.7%) of all HBsAg-positive participants reported previous HBV vaccination.

Conclusion: The prevalence of intra-familial HBV infection is lower in Nahavand of Iran compared to other studies. More attention should be paid to HBV vaccination and risk-lowering activities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398736PMC
http://dx.doi.org/10.3748/wjg.v11.i31.4857DOI Listing
August 2005

Effectiveness of hepatitis B vaccination in children of chronic hepatitis B mothers.

Saudi Med J 2004 Oct;25(10):1414-8

Research Center for Gastroenterology and Liver Diseases, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained.

Methods: The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen (HBsAg) and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993.

Results: Chronic infection (HBsAg positivity) was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group (relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02). Previous infection of hepatitis B (HBcAb positivity) was found in 29 (29.9%) children in the exposed group, but only one (1.2%) in the unexposed group (RR=26.01, 95% CI: 3.61-186.95). Immunity (HBsAb positivity) in the exposed group measured 48 (49.5%) and unexposed group measured 56 (64.4%) (R.R=0.76, 95% CI: 0.59-0.99).

Conclusion: Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth.
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October 2004