Publications by authors named "Mohsen Meidani"

41 Publications

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

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

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

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

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

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

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

Vitamin E in the prevention of vancomycin-induced nephrotoxicity.

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

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

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

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

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

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

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

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

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

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

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

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

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

Traumatic Mucormycosis of Auricular Cartilage in an Iranian Diabetic Patient.

Int Med Case Rep J 2020 18;13:95-99. Epub 2020 Mar 18.

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

Mucormycosis is an uncommon and acute fungal infection, with high morbidity and mortality. Traumatic mucormycosis mainly occurs in military conflicts, civilian trauma, and vehicle accidents. Hurricanes, tornadoes, floods, and tsunamis also play a major role in causing mucormycosis by inoculation. Herein, we presented a case of trauma-related mucormycosis in a 70-year-old diabetic male. He referred to a specialty clinic due to the auricular swelling after having fallen and having a major trauma in his ear. Pathologic examination of necrotic cartilage revealed broad ribbon like aseptate hyphae. Antifungal therapy with amphotericin B deoxycholate (1.5 mg/kg/day) was administered for 6 weeks as an initial therapy, and the patient was discharged with a regimen of posaconazole oral solution (400 mg PO bid with meals) for 8 weeks. He followed up for one year and there was no recurrence of the infection. In conclusion, traumatic mucormycosis is a rare but potentially life-threatening fungal infection. Early diagnosis and surgical excision are essential regarding the management of this critical condition. Knowing the underlying diseases is preferable to early diagnosis and timely initiation of antifungal therapy in order to improve survival rates.
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http://dx.doi.org/10.2147/IMCRJ.S246072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7090215PMC
March 2020

Cytarabine and Doxorubicin-Induced Palmoplantar Erythrodysesthesia Syndrome: The Possible Role of Voriconazole Interaction.

Eurasian J Med 2019 Oct;51(3):313-315

Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Palmoplantar Erythrodysesthesia Syndrome (PPES) caused by chemotherapeutic agents is rarely life threatening and requires a reduction in dose or discontinuation of chemotherapy. The use of cytarabine and doxorubicin in the treatment of acute myeloid leukemia (AML) along with voriconazole can potentially alter the metabolism of the drugs and cause some interactions. In this study, we presented a case of AML who received cytarabine and doxorubicin as a chemotherapy regimen and voriconazole as a prophylactic anti-fungal. In this combination, voriconazole probably inhibits the P-glycoprotein pump, which leads to an increase in the cytarabine concentration. The emphasis of this report is the awareness of clinicians and pharmacotherapists about these interactions.
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http://dx.doi.org/10.5152/eurasianjmed.2019.18459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812918PMC
October 2019

Serum Cystatin C for Evaluation of Acute Kidney Injury in Adults Treated with Colistin.

J Res Pharm Pract 2018 Oct-Dec;7(4):178-181

Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.

Objective: Recent studies have shown that serum cystatin C (Cys C) is a better marker for measuring the glomerular filtration rate and may rise more quickly with acute kidney injury (AKI). The purpose of this study was to evaluate the clinical application of serum Cys C to predict colistin-induced nephrotoxicity in comparison with serum creatinine (SCr).

Methods: Thirty-two adult patients with no history of acute or chronic kidney injury having been planned to receive intravenous colistin for an anticipated duration of at least 1 week for any indication were recruited. At baseline and 5 days after colistin treatment, serum Cys C as well as creatinine levels were measured. The incidence of colistin-induced acute renal failure was defined according to the AKIN criteria for SCr. Rise in concentration of Cys C by more than 10% from baseline considered as AKI.

Findings: Colistin-induced nephrotoxicity (defined as SCr ≥0.3 mg/dl) occurred in 6 patients (18.8%). A Cys C increase concentration ≥10% after 5 days of colistin treatment was detected in 15 patients (46.9%). There was a poor agreement between the presence and absence of any SCr-AKI and Cys C-AKI (κ = 0.28, = 0.04).

Conclusion: Serum Cys C is a better marker of renal function in early stages of AKI and predictive of persistent AKI on colistin treatment.
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http://dx.doi.org/10.4103/jrpp.JRPP_18_53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298137PMC
January 2019

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

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

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

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

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

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

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

Prevalence of Fungemia in Pediatric Patients with Febrile Neutropenia.

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

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

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

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

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

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

Respiratory Viruses in Febrile Neutropenic Patients with Respiratory Symptoms.

Adv Biomed Res 2018 22;7. Epub 2018 Jan 22.

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

Background: Respiratory infections are a frequent cause of fever in neutropenic patients, whereas respiratory viral infections are not frequently considered as a diagnosis, which causes high morbidity and mortality in these patients.

Materials And Methods: This prospective study was performed on 36 patients with neutropenia who admitted to hospital were eligible for inclusion with fever (single temperature of >38.3°C or a sustained temperature of >38°C for more than 1 h), upper and lower respiratory symptoms. Sampling was performed from the throat of the patient by the sterile swab. All materials were analyzed by quantitative real-time multiplex polymerase chain reaction covering the following viruses; influenza, parainfluenza virus (PIV), rhinovirus (RV), human metapneumovirus, and respiratory syncytial virus (RSV).

Results: RV was the most frequently detected virus and then RSV was the most. PIV was not present in any of the tested samples. Furthermore, no substantial differences in the distribution of specific viral species were observed based on age, sex, neutropenia duration, hematological disorder, and respiratory tract symptoms and signs ( > 0.05).

Conclusion: Our prospective study supports the hypothesis that respiratory viruses play an important role in the development of neutropenic fever, and thus has the potential to individualize infection treatment and to reduce the extensive use of antibiotics in immunocompromised patients with neutropenia.
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http://dx.doi.org/10.4103/abr.abr_433_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812103PMC
January 2018

Recurrent Vulvovaginal Candidiasis: Could It Be Related to Cell-Mediated Immunity Defect in Response to Candida Antigen?

Int J Fertil Steril 2017 Oct 27;11(3):134-141. Epub 2017 Aug 27.

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

Background: Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to candida antigen in RVVC cases.

Materials And Methods: Our cross-sectional study was performed in 3 groups of RVVC patients (cases), healthy individuals (control I) and known cases of chronic mucocutaneous candidiasis (CMC) (control II). Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mononuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to candida antigen via flow cytometry.

Results: T lymphocyte proliferation in response to candida was significantly lower in RVVC cases (n=24) and CMC patients (n=7) compared to healthy individuals (n=20, <0.001), but no statistically significant difference was seen between cases and control II group (P>0.05). Family history of primary immunodeficiency diseases (PID) differed significantly among groups (P=0.01), RVVC patients has family history of PID more than control I (29.2 vs. 0%, P=0.008) but not statistically different from CMC patients (29.2 vs. 42.9%, P>0.05). Prevalence of atopy was greater in RVVC cases compared to healthy individuals (41.3 vs. 15%, P=0.054). Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy (P=0.01, P=0.02).

Conclusion: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components.
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http://dx.doi.org/10.22074/ijfs.2017.4883DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582140PMC
October 2017

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

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

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

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

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

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

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

Resolution of aspergillosis in neuroimaging of an immunocompromised patient with pulmonary and cerebral lesions.

Asian J Neurosurg 2016 Oct-Dec;11(4):456

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

Central nervous system (CNS) aspergillosis is uncommon and considered the most lethal form of aspergillosis. Indeed, current therapeutic strategies such as combination antifungal regimen, neurosurgical resection of infected tissue, and removal of infection source fail to improve the unsatisfactory prognosis of CNS aspergillosis in the majority of the patients. The authors describe a case of chronic pulmonary aspergillosis with concomitant CNS lesions that dramatically responded to antifungal therapy and the CNS lesions resolved in follow-up imaging.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974992PMC
http://dx.doi.org/10.4103/1793-5482.175644DOI Listing
October 2016

New horizon in the treatment of sepsis: a systematic review of alternative medicine.

J Complement Integr Med 2016 Dec;13(4):317-332

BackgroundDespite great advancement in treatment of sepsis, mortality of sepsis remains unacceptably high, even with the modern antibiotic and intensive care technologies. Considering the key role of immune dysfunction in sepsis pathophysiology, different treatments were evaluated, but failed to improve survival of patients. Natural remedies have been tested in various studies to overcome sepsis. In this study, we aim to review some of the evidence from clinical, in vitro and in vivo studies about the effect of alternative medicine on sepsis management. MethodsThe following databases were searched up to March 2014: PubMed, Scopus, Web of Science, Ovid and Google Scholar using combination of Mesh term. All in vitro and in vivo studies, also clinical trials, published in English, which evaluated alternative medicine in management of sepsis were included. Results Out of 95 relevant studies, the inclusion criteria were met for 79 cases. Among them, 18 studies were performed on humans. The most herbal medicine, including Xubijing (n=10) and then Rhubarb (n=3). Most of the reviewed botanical medicines modulate the immune system. Reduction of mortality was also reported in studies. ConclusionsModulation of immune system, anti-inflammatory activities and improvement of survival were the action of herbal medicine. A monovalent approach is not enough for treatment of sepsis, we recommend further studies to identify active component of herbal and use them in combination. Also an animal model of sepsis does not exactly mimic human sepsis, so more clinical studies should be performed. With no new drug on the horizon, herbal medicine will be promising for treatment of sepsis.
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http://dx.doi.org/10.1515/jcim-2016-0003DOI Listing
December 2016

Nasal colonization in children with community acquired methicillin-resistant Staphylococcus aureus.

Adv Biomed Res 2016 11;5:86. Epub 2016 May 11.

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

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infections. The changing epidemiology of MRSA became evident in the 1990s when CA-MRSA cases were first reported. Nasal carriage of CA-MRSA is associated with an increased risk for development of infections in various populations.

Materials And Methods: Anterior nares culture for the presence of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA was taken from 345 children attending kindergartens, who didn't have any known risk factor for MRSA colonization. Also, children demographic variables were recorded. Identification of SA and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) with standard microbiological test was performed. Finally, the susceptibility of isolated to various antibiotics determined. The data were analyzed with Whonet 5.6 software.

Results: Of 345 children, 20 children (5.8%) were colonized with CA-MRSA, 86 children (24.9%) with MSSA and 239 cases (69.3%) didn't have SA colonization. The highest rate of MSSA and MRSA colonization was obtained at the age of 6 years. The frequency distribution of SA (MSSA and MRSA) colonization prevalence didn't have any significant differences based on age, gender and the admission time (P > 0.05); but it was significantly different in the urban areas (P < 0.001). The lowest resistance rate of CA-MRSA isolates, with a frequency of 10%, was detected with gentamicin, rifampin, and trimethoprim-sulfamethoxazole.

Conclusions: In summary, CA-MRSA colonization was observed in child care centers remarkably. Therefore, by facing various infections due to SA especially in areas of low socio-economic status, it must be considered. Based on antibiogram test, empirical treatment with rifampin, gentamicin and ciprofloxacin is recommended during CA-MRSA infections.
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http://dx.doi.org/10.4103/2277-9175.182217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879855PMC
June 2016

Screening and evaluation of chronic and occult Hepatitis B in chemo - radiotherapy patients with cancer.

Adv Biomed Res 2016 11;5:85. Epub 2016 May 11.

Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hepatitis B virus infection (HBV) and its complications is one of the most serious problems of the health system in many parts of the world. In the present study, we will assess chronic and occult HBV and isolated anti-Hepatitis B core antigen whose screening and evaluation is not routine in different populations.

Materials And Methods: This descriptive analytical study was conducted on 213 patients undergoing chemotherapy - radiotherapy referred to the hematology - oncology clinics of Isfahan, Iran in 2012. In order to determine the serum levels of hepatitis B surface antigen (HbSAg), Hepatitis B Antigen and Antibody (HBCAb), aspartate aminotransferase (AST), alanine transaminase (ALT) and Alkaline phosphatase (ALK.P), venous blood samples were obtained. If the HBCAb sample was positive, another sample of the serum was sent to the laboratory to perform polymerase chain reaction and to determine viral load.

Results: The mean age of the patients was 47.7 ± 9 years, with an age range of 27 -73 years; 98 (46%) and 115 (54%) cases were male and female, respectively, with mean age of 51.9 ± 8.3 and 44.1 ± 8.1 years, and there was no significant difference (P < 0.001). The mean level of liver enzymes including AST, ALT and ALK.P were 34.2 ± 36.02, 38.9 ± 47.1 and 252.1 ± 234.7, respectively. Two cases were HbSAg positive (0.9%) and six cases were HBCAb positive (2.8%) and HbSAg negative. Three cases had a high viral load at the rate of starting treatment among positive anti-HBC patients.

Conclusion: Because occult hepatitis is investigated less commonly in routine studies, it seems that screening and evaluating its prevalence is useful in the management of patients.
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http://dx.doi.org/10.4103/2277-9175.182216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879852PMC
June 2016

Case series of rhinocerebral mucormycosis occurring in diabetic patients.

Caspian J Intern Med 2015 ;6(4):243-6

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

Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%).

Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database.

Conclusion: In patients with mucoreosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4649276PMC
December 2015

Bacillary Angiomatosis in Immunocompetent Patient with Atypical Manifestations.

Indian J Dermatol 2015 Sep-Oct;60(5):523

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

Bacillary angiomatosis is an infectious disease caused by two Gram-negative bacilli; this disease usually affects immunosuppressed hosts with a history of cat scratch. We report a rare case of bacillary angiomatosis in an immunocompetent 26-year-old woman with no history of exposure to cats, and with atypical clinical features (very pruritic vascular papules and nodules with ulceration and hemorrhage on the right arm and fingers). She was successfully treated with clarithromycin for 3 months. Bacillary angiomatosis must be kept in mind in the differential diagnosis of any papules and nodules in cases of unknown etiology and also in immunocompetent patients and HIV-negative individual.
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http://dx.doi.org/10.4103/0019-5154.164444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4601457PMC
November 2015

A female with positive serum nontreponemal tests.

J Res Med Sci 2015 Apr;20(4):422

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468463PMC
April 2015

Purified protein derivative test and its booster phenomenon in patients with rheumatoid arthritis.

Adv Biomed Res 2015 8;4:80. Epub 2015 May 8.

Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Rheumatoid arthritis (RA) is a common disease in the community, with various complications. An appropriate solution is immunosuppressive drugs, which may lead to weakening of the cellular immune system and body unresponsiveness to tuberculosis (TB). As TB sensitivity is determined by the amount of induration created in the Purified Protein Derivative (PPD) test, this study aims to evaluate the immune response to the PPD test and its booster in RA patients.

Materials And Methods: This cross-sectional study was performed on rheumatoid arthritis patients referred to Alzahra Hospital, Isfahan, treated with ‹20 mg glucocorticoid daily or 7.5 mg Methotrexate (MTX) weekly. The sampling method was simple and accessible. The PPD test was performed in patients using the Mantoux method after 72 hours, and seven days later, the results were interpreted in 72 hours after the PPD booster injection. Induration ≥5 mm was considered to be positive. The data was analyzed using the SPSS software.

Results: Nineteen patients had positive results in the initial and reminder tests and 81 patients had negative results in both tests. Six patients (6.9%) with negative results in the initial test changed to positive in the reminder test. There was no positive result in the initial test and negative result in the reminder one. The frequency distribution of the reminder test, based on the initial test was significant (P < 0.001). Also, the McNemar test showed that the changes in the reminder test based on the initial test had a significant difference (P = 0.031).

Conclusion: It seems that in the endemic and developing areas, the PPD booster is applicable for diagnosing latent tuberculosis in patients with rheumatoid arthritis.
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http://dx.doi.org/10.4103/2277-9175.156638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434455PMC
May 2015

Morphine mouthwash for the management of oral mucositis in patients with head and neck cancer.

Adv Biomed Res 2015 11;4:44. Epub 2015 Feb 11.

Department of Community Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment-induced mucositis.

Materials And Methods: Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2% or magic solution (contained magnesium aluminum hydroxide, viscous lidocaine, and diphenhydramine), 10 ml for every 3 h, six times a day, for 6 days. Both groups received same dietary and oral hygiene instructions and care. Mucositis was graded at baseline and every 3 days after treatment. Patients' satisfaction and drug effect maintenance were also evaluated.

Results: Twenty-eight patients (mean age of 49.5 ± 13.2 years, 63.3% female) completed the trial; 15 in the morphine group and 13 in the magic group. There was a decrease in mucositis severity in both of the morphine (P < 0.001) and magic (P = 0.049) groups. However, at the 6(th) day, more reduction was observed in mucositis severity in the morphine compared with magic group (P = 0.045). Drug effect maintenance was similar between the two groups, but patients in the morphine group were more satisfied by their treatments than those in the magic group (P = 0.008).

Conclusions: Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment-induced oral mucositis. More studies with larger sample size and longer follow-up are required in this regard.
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http://dx.doi.org/10.4103/2277-9175.151254DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358035PMC
March 2015

Knowledge, attitude, and performance of medical staff of teaching healthcare settings about hepatitis B and C in Isfahan, Iran.

Adv Biomed Res 2014 31;3:267. Epub 2014 Dec 31.

Epidemiologist, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: hospital personnel are at high risk of exposure, infection, and transmission of viral hepatitis. The present study aimed at investigating the knowledge, attitude, and performance of health service providers to provide them with the information required for their educational promotion on viral hepatitis.

Materials And Methods: This cross-sectional study was conducted on 400 staff of the forenamed healthcare settings such as on nurses, midwives, licensed practical nurses, and lab officials in Isfahan, Iran, in 2012. A checklist including demographic data and questions associated with the knowledge (18 questions), attitude (4 questions), and performance (15 questions) on hepatitis B and C was completed by the participants.

Results: A total of 388 participants completed the checklist. Participants' knowledge on the ways of transmission, prevalence, vaccination, and prevention methods was moderate (total score = 58.56 ± 10.1 percent) and the attitude was generally positive. Proper vaccination was carried out by 81.4% of the participants. Accidental injury by a needle was reported in 47.7% of the participants, but only 37.6% of them reported it to higher authorities and of them only 13.7% received appropriate treatment. Only 44.3% and 11.6% of participants reported always using gloves and masks, respectively, and 58.8% of the staff covered the needle cap before transferring it to the safety box.

Conclusions: Due to excessive contact with patients, a paramedic-educated society is expected to have an optimal level of knowledge, attitude, and performance related to viral hepatitis. Our results from the checklists showed that medical personnel are not appropriately aware of viral hepatitis and their performance, too, is not satisfactory. Further continuous training is required and there needs to be more emphasis on actions regarding behaviors with high risk of infection transmission.
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http://dx.doi.org/10.4103/2277-9175.148249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298875PMC
January 2015

Creeping eruption of the hand in an Iranian patient: Cutaneous larva migrans.

Adv Biomed Res 2014 31;3:263. Epub 2014 Dec 31.

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

Cutaneous larva migrans (CLM), a serpiginous cutaneous eruption is the most commonly acquired tropical dermatosis. It is caused by infection with hookworm larvae in tropical and sub-tropical areas, and people who have a history of travel in these countries. The most frequent location of CLM is the distal lower extremities or buttocks. We describe a case of 57-year-old Iranian female patient with CLM of hand (unusual site) without traveling to endemic countries that was successfully treated with oral albendazole. To the best of our knowledge, this is the first report of CLM in Iran.
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http://dx.doi.org/10.4103/2277-9175.148239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298879PMC
January 2015

Comparison of three phenotypic and deoxyribonucleic acid extraction methods for isolation and Identification of Nocardia spp.

Adv Biomed Res 2014 31;3:151. Epub 2014 Jul 31.

Department of Bacteriology and Virology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The aerobic Actinomycetes are a large group of soil-indwelling bacteria that are distributed in world-wide. These Gram-positive bacteria are most commonly associated with opportunistic infections in both immunocompromised and immunocompetent hosts.

Materials And Methods: In this study, three phenotypic and deoxyribonucleic acid (DNA) extraction methods for isolation and identification of Nocardia genus were compared. Samples were taken in five different locations of Isfahan's suburb from hospitals area, parks, agricultural lands, gardens, arid lands with different soil temperature and pH.

Results: In this study, showed that slip-buried-method was better than two other phenotypic methods; 14 out of 70 soil samples (20%) were positive for Nocardia spp. DNA of positive samples were extracted with three techniques and DNA extraction by microwave technique was better than others. This technique was confirmed with observation of DNA bands on 1% agarose gel.

Conclusions: These bacteria are important in immune deficient patients such as cancer patients, transplant recipients, tuberculosis; acquired immunodeficiency syndrome etc., Their affluence is unsteady in different zones of the world. In this study, among the three phenotypic methods for the isolation of Nocardia slip-buried method was better than other methods. Among DNA extraction techniques, DNA extraction by microwave method would be selective method for DNA extraction of Nocardia spp. compared with others techniques.
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http://dx.doi.org/10.4103/2277-9175.137839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162071PMC
September 2014

Orf Disease Following "Eid ul-Adha": A Rare Cause of Erythema Multiforme.

Int J Prev Med 2014 Jul;5(7):912-4

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

Orf, also known as contagious pustular dermatitis, is an exanthemous disease caused by a parapox virus. It is usually a benign locally self-limiting illness; it can have systemic complication or progressive infected locations can include the finger, hand, arm, and face. Development of erythema multiforme following Orf infection is very rare. In Islamic populations such as those of Iran, Orf can be observed in individuals who are not occupationally involved, but may be in contact with sheep or goats after the Islamic worship as an "Eid ul-Adha." Here we report an erythema multiforme associated with multiple lesion of Orf disease following the "Eid ul-Adha" in Iranian housewives.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124571PMC
July 2014

Immunocompromised patients: Review of the most common infections happened in 446 hospitalized patients.

J Res Med Sci 2014 Mar;19(Suppl 1):S71-3

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

Background: Immunodeficiency is a heterogenous group of diseases affecting different components of the immune system. Patterns of infection, etiology and organ involvement are not similar in this risky population. This study was conducted to determine the prevalence of congenital and acquiring immunodeficiencies and also recognizing the most common infections and affected organs.

Materials And Methods: In a retrospective, cross-sectional survey, during 2006-2012, we reviewed all hospital records with any kind of immunodeficiency admitted in, all departments of university referral hospital, Isfahan, Iran.

Results: VARIOUS IMMUNODEFICIENCIES, SORTED BY PREVALENCE, WERE AS BELOW: Primary immunodeficiency diseases (PIDs) 122 (27.4%), lymphohematogenous malignancy (LHM) 105 (23.5%), solid cancer 56 (12.6%), human immunodeficiency virus/acquired immunodeficiency syndrome 64 (14.5%), non-cytotoxic immunosuppresion 94 (21%), and splenectomy 5 (1.2%). Common sources of infection were blood, lungs and buccal cavity.

Conclusion: The most frequent type of immunodeficiency was PIDs and LHM. Infection continues to be a major problem in all variety of immunodeficiency.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078380PMC
March 2014

Seropositivity of cytomegalovirus in patients with recurrent pregnancy loss.

J Res Med Sci 2014 Mar;19(Suppl 1):S22-5

Poursina Hakim Research Institution, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Some evidence has shown a relationship between human cytomegalovirus (CMV) infection and pregnancy loss. However, whether recurrent or latent CMV infection or altered immune response to CMV is related to recurrent pregnancy loss (RPL) is unclear. We evaluated CMV infection and avidity of antibodies to CMV in women with RPL.

Materials And Methods: This case-control study was conducted on 43 women with RPL referred to a clinical immunology out-patient clinic in Isfahan (Iran), and 43 age-matched multiparous women without history of abortion as control subjects. Patients and controls were evaluated for anti-CMV IgG and IgM antibodies and IgG avidity index (AI) using the enzyme linked immunosorbent assay method. Student's t-test and Chi-square test were used to analyze the data.

Results: One case (2.3%) of positive anti-CMV IgM was detected in each group. Anti-CMV IgG positivity was more frequent in patients than in controls (90.6% vs. 69.8%, P = 0.014), but there was no difference between the two groups in anti-CMV IgG AI (79.4 ± 11.4 vs. 80.1 ± 10.2, P = 0.781). IgG titer was significantly higher in seropositive cases with RPL than seropositive controls (5.18 ± 1.99 vs. 2.00 ± 0.81, P < 0.001).

Conclusion: We found that previous exposure to CMV was significantly higher in patients with RPL than the control group. However, no association was found between IgG AI and RPL. Further investigations are needed to find whether latent CMV infection starts an indirect process of autoimmune etiology in RPL or women with RPL have recurrent or reactivation of CMV infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4078373PMC
March 2014

Prevalence and antimicrobial susceptibility pattern of isolated microorganisms from central venous catheters in ICU patients.

Adv Biomed Res 2014 25;3:102. Epub 2014 Mar 25.

Medical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The abundance of infections associated with intensive care unit (ICU) is increasing due to the increased use of aggressive medical equipments like the central venous catheter (CVC). This study was designed and performed in 2010-2011 at Alzahra hospital, which is a referral center. This study aimed at determining the relative abundance and microbial sensitivity of organisms, which were creating contamination with CVCs in hospitalized patients in the ICUs of Alzahra hospital.

Materials And Methods: This is a cross-sectional study performed on 71 patients who were hospitalized in the Alzahra hospital ICU and had CVCs during 2010-2011. The data obtained was analyzed by SPSS version 20 software and descriptive statistical approaches and chi-square and t-test trials.

Results: In the sample culture obtained from the patients' catheter in 19 cases (26/8%), no microorganism was grown and in 52 cases (73.3%) at least one type of microorganism including bacteria or fungus was grown. In this study, average hospitalization time in patients who got positive results from their catheter culture was significantly more compared with patients who did not grow any kinds of microorganism in their sample cultures.

Conclusion: In this study, CVCs microbial contamination has a high prevalence, which is a major cause of prolonged patients staying in ICUs, and therefore, it is essential to take precaution and discharge the patient early for decreasing the catheter contamination and preventing the hospital infections incidence in the ICU patients.
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http://dx.doi.org/10.4103/2277-9175.129379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4007321PMC
May 2014

Galactomannan antigen assay from bronchoalveolar lavage fluid in diagnosis of invasive pulmonary aspergillosis in intensive care units patients.

Adv Biomed Res 2014 27;3:68. Epub 2014 Jan 27.

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

Background: Invasive pulmonary aspergillosis (IPA) is an important infection in critically ill patients including patients of intensive care units (ICU). Different diagnostic tools are available and since its mortality is high, it is vital to start the antifungal therapy as soon as possible. Knowing the epidemiology of this disease in each ICU and area will help to better and more rapid management of such patients. The aim of this study is to determine the frequency of IPA based on the level of galactomannan in bronchoalveolar lavage fluid in ICU of Al-Zahra hospital, Isfahan, Iran.

Materials And Methods: This was a cross sectional study, which was conducted in Al-Zahra hospital, Isfahan, Iran, between 2010 to 2011. The study population was all the patients admitted to ICU and were suspected to have invasive Aspergillus spp pneumonia. The level of galactomannan in bronchoalveolar lavage was measured and demographic data were gathered by the questionnaire.

Results: The frequency of IPA in this study was calculated as 2.43% while galactomannan level in bronchoalveolar lavage fluid of this patient (2.50) was significantly higher than others (0.03 ± 0.02).

Conclusion: Larger studies are required to determine the exact frequency of IPA and the best antifungal therapy for it.
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http://dx.doi.org/10.4103/2277-9175.125851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950792PMC
March 2014

The comparison between proton pump inhibitors and sucralfate in incidence of ventilator associated pneumonia in critically ill patients.

Adv Biomed Res 2014 27;3:52. Epub 2014 Jan 27.

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

Background: Ventilator associated pneumonia (VAP) are one of the most common nosocomial infections in intensive care unit (ICU). The ICU patients are at risk of stress ulcer and gastrointestinal bleeding for different reasons. In order to prevent this complication, anti acids are used for patients. This study compared pantoprazole with sucralfate in incidence of ventilator associated pneumonia.

Materials And Methods: This randomized clinical trial was carried out on ICU patients with mechanical ventilation in Alzahra university hospital in Isfahan from 2010 to 2011. One hundred forty eight ventilated patients were randomly allocated in two groups. The first group was treated with sucralfate and the second group was treated with pantoprazole for stress ulcer prophylaxis and followed up during hospitalization in ICU for nosocomial pneumonia. Data analyzed by SPSS software.

Results: One hundred thirty seven patients were selected for study. During the study period, 34 cases (24.8%) acquired pneumonia, of which 10 were in the sucralfate group and 24 were in the pantoprazole group (14.1% vs. 36.4%). According to Chi-square test, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group (P < 0.001).

Conclusion: On the basis of the results, there is a significant relationship between the kind of drug used for stress ulcer and ventilator associated pneumonia. According to this article, rate of pneumonia was significantly lower in patients receiving sucralfate than the pantoprazole group.
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http://dx.doi.org/10.4103/2277-9175.125789DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950838PMC
March 2014

Relative frequency of Human T-cell Lymphotropic Virus I/II in HIV/AIDS patients.

Adv Biomed Res 2014 9;3. Epub 2014 Jan 9.

General Practitioner, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Human T-cell lymphotropic virus HTLV-I/II is a retrovirus that has been associated with different diseases. HTLV-I/II routes of transmissions are exposure to contaminated blood, blood transfusion, needle sharing, breast feeding, and sexual contact. The seroprevalence of HTLV-I/II in HIV infected patients has not been well characterized in Iran. We conducted a serological survey to determine the relative frequency of HTLV-I/II in HIV+/AIDS and healthy blood donors in Isfahan.

Materials And Methods: In this cross-sectional study, we compare the relative frequency of HTLV-I/II in HIV+/AIDS group (56 persons) with asymptomatic blood donors (57 persons) in Isfahan. Participant completed the questionnaires that include demographic information, age, sex, and sexual partnership during last 6 months, sexual behavior and past history of blood transfusion or other blood products. We confirm the HIV+ status in patients group with western blot test. Evaluation of HTLV-I/II were done using ELISA test with DRAPIO third generation kit. Questionnaire data and laboratory results were analyzed by SPSS18.

Results: During the period of 2010-2011, a total of 56 HIV-infected patients and 57 healthy persons participated in this study. Among HIV positive patients, one person had positive test for HTILV-I/II representing the relative frequency of 1.8%, and in healthy individuals none of them were positive.

Conclusion: In our survey, relative frequency of HTLV-I/II was 1.8% in HIV+ patients. This study reveals that relative frequency of HTLV-I/II in HIV positive patients is considerable but determining the need for screening of HTLV-I/II requires further investigation.
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http://dx.doi.org/10.4103/2277-9175.124635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3929035PMC
March 2014