Publications by authors named "Saeed Kalantari"

25 Publications

  • Page 1 of 1

Mental health care for hospitalized COVID-19 patients; an experience from Iran.

Med J Islam Repub Iran 2020 2;34:162. Epub 2020 Dec 2.

Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.47176/mjiri.34.162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004565PMC
December 2020

A rare manifestation of extrapulmonary tuberculosis: left ventricular cardiac tuberculoma in an HIV infected male "case report".

Cardiovasc Diagn Ther 2020 Oct;10(5):1341-1344

Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran.

Cardiac tuberculosis (TB) is rare and most commonly manifests itself as tuberculous pericarditis. Involvement of other parts of the heart is unusual and descriptions in the literature are confined to case reports regarding mainly pericardial TB and very few cases of cardiac tuberculoma. Tuberculomas are space occupying lesions most commonly found in the brain of immunocompromised individuals. These space occupying lesions previously described only after autopsies are now more diagnosed with the use of advanced imaging techniques. Herein, we describe a first case of pericardial TB manifesting as left ventricular (LV) cardiac tuberculoma in a 34-year-old human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infected male. Upon presentation the patient complained mainly of progressive dyspnoea over the past month. Primary investigations including chest computed tomography (CT) scan and transthoracic echocardiography (TTE) suggested probable diagnosis of cardiac and pericardial TB which was later confirmed by histopathological modalities. The patient received anti-TB therapy along with surgical subtotal pericardiotomy which resulted in improvement of symptoms, complete resolution of the mass and reduction in the size of pericardial thickening. Although very rare it is crucial to bear in mind the importance of having cardiac tuberculoma as differential diagnosis in patients with a cardiac mass and implement the optimum diagnostic and therapeutic courses.
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http://dx.doi.org/10.21037/cdt-20-446DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7666929PMC
October 2020

Subcutaneous tocilizumab in adults with severe and critical COVID-19: A prospective open-label uncontrolled multicenter trial.

Int Immunopharmacol 2020 Dec 13;89(Pt B):107102. Epub 2020 Oct 13.

Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Potential therapeutic approaches in coronavirus disease 2019 (COVID-19) comprise antiviral and immunomodulatory agents; however, no immunomodulator drug has been approved. This multicenter, prospective, open-label, uncontrolled study aimed to assess the use of subcutaneous tocilizumab in adult patients with severe and critical COVID-19. Tocilizumab was added to the standard care of therapy at a dose of 324 mg (<100 kg bodyweight) or 486 mg (≥100 kg bodyweight). The study endpoints were all-cause mortality rate, changes in oxygen-support level, oxygen saturation, body temperature, respiratory rate, and laboratory variables during the study, and drug safety. Of 126 patients enrolled, 86 had severe and 40 had critical disease. Most patients were male (63.49%) and aged below 65 (78.57%). By day 14 of the study, 4.65% (4/86) of severe patients and 50.00% (20/40) of critical patients died. By the end, 6.98% (6/86) of severe patients and 60.00% (24/40) of critical patients died.Outcomes concerning three additional endpoints (oral temperature, oxygen saturation, and respiratory rate)were significantly improved as early as three days after tocilizumab administration in both groups of subjects, more considerably in severe patients. Significant improvement in the required level of oxygenation was reported in severe patients seven days after tocilizumab administration. No tocilizumab-related serious adverse event occurred in this study. Subcutaneous tocilizumab might improve some clinical parameters and reduce the risk of death in COVID-19 patients, particularly if used in the early stages of respiratory failure.
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http://dx.doi.org/10.1016/j.intimp.2020.107102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553010PMC
December 2020

Oropharyngeal candidiasis in hospitalised COVID-19 patients from Iran: Species identification and antifungal susceptibility pattern.

Mycoses 2020 Aug 23;63(8):771-778. Epub 2020 Jul 23.

Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background: Emergence of coronavirus disease 2019 (COVID-19) is a major healthcare threat. Apparently, the novel coronavirus (SARS-CoV-2) is armed by special abilities to spread and dysregulate the immune mechanisms. The likelihood of oropharyngeal candidiasis (OPC) development in COVID-19 patients with a list of attributable risk factors for oral infections has not yet been investigated.

Objectives: We here aim to investigate the prevalence, causative agents and antifungal susceptibility pattern of OPC in Iranian COVID-19 patients.

Patients And Methods: A total of 53 hospitalised COVID-19 patients with OPC were studied. Relevant clinical data were mined. Strain identification was performed by 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, amphotericin B, caspofungin, micafungin and anidulafungin was performed according to the CLSI broth dilution method.

Results: In 53 COVID-19 patients with OPC, cardiovascular diseases (52.83%) and diabetes (37.7%) were the principal underlying conditions. The most common risk factor was lymphopaenia (71%). In total, 65 Candida isolates causing OPC were recovered. C albicans (70.7%) was the most common, followed by C glabrata (10.7%), C dubliniensis (9.2%), C parapsilosis sensu stricto (4.6%), C tropicalis (3%) and Pichia kudriavzevii (=C krusei, 1.5%). Majority of the Candida isolates were susceptible to all three classes of antifungal drugs.

Conclusion: Our data clarified some concerns regarding the occurrence of OPC in Iranian COVID-19 patients. Further studies should be conducted to design an appropriate prophylaxis programme and improve management of OPC in critically ill COVID-19 patients.
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http://dx.doi.org/10.1111/myc.13137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361944PMC
August 2020

Evolution and resolution of brain involvement associated with SARS- CoV2 infection: A close Clinical - Paraclinical follow up study of a case.

Mult Scler Relat Disord 2020 Aug 21;43:102216. Epub 2020 May 21.

Department of neurology, School of Medicine, Hazrat Rasool-e Akram General Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran. Electronic address:

The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.
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http://dx.doi.org/10.1016/j.msard.2020.102216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240267PMC
August 2020

Evaluation of a PCR assay for diagnosis of toxoplasmosis in serum and peripheral blood mononuclear cell among HIV/AIDS patients.

J Parasit Dis 2020 Mar 11;44(1):159-165. Epub 2019 Dec 11.

6Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Cerebral toxoplasmosis is one of the neurological infections with high morbidity and mortality in patients with AIDS, so the accurate method for diagnosis of cerebral toxoplasmosis seems necessary. In this study, nested PCR assay using B1 gene was evaluated in diagnosis of toxoplasmosis in serum and peripheral blood mononuclear cell (PBMC) among HIV/AIDS patients. One hundred eight blood samples from HIV/AIDS patients, including four patients with cerebral toxoplasmosis and 104 HIV/AIDS patients without cerebral toxoplasmosis were evaluated for the antibodies using Enzyme Linked immunosorbent Assay. DNA of serum and PBMC of these patients were extracted and nested-PCR was carried out. Of 108 participants, 95 cases (88%) were positive for IgG antibodies and one patient was found positive for IgM antibody. In general, four patients, including three patients with cerebral toxoplasmosis, who were positive for IgG antibodies and one patient without cerebral toxoplasmosis who was positive for IgM antibody were found to be PCR positive. DNA of was detected in both serum and PBMC in two cerebral toxoplasmosis patients; however DNA was detected in only PBMC in other cerebral toxoplasmosis patient. All cases with cerebral toxoplasmosis were also diagnosed by clinical and radiological manifestations. The results of this study showed that the numbers of positive samples by PCR in PBMC were higher than serum specimens for diagnosis of toxoplasmosis. If molecular method and immunological assay are complemented with magnetic resonance imaging, the results can be useful for diagnosis of cerebral toxoplasmosis.
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http://dx.doi.org/10.1007/s12639-019-01176-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7046870PMC
March 2020

HIV-1 reverse transcriptase and protease mutations for drug-resistance detection among treatment-experienced and naïve HIV-infected individuals.

PLoS One 2020 2;15(3):e0229275. Epub 2020 Mar 2.

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

Background: The presence of drug resistance mutations (DRMs) against antiretroviral agents is one of the main concerns in the clinical management of individuals with human immunodeficiency virus-1 (HIV-1) infection, especially in regions of the world where treatment options are limited. The current study aimed at assessing the prevalence of HIV-1 DRMs among naïve and treatment-experienced HIV-1-infected patients in Iran.

Methods: From April 2013 to September 2018, the HIV-1 protease and reverse transcriptase genes were amplified and sequenced in plasma specimens of 60 newly diagnosed antiretroviral-naive individuals and 46 participants receiving antiretroviral therapies (ARTs) for at least six months with an HIV viral load of more than 1000 IU/mL to determine the HIV-1 DRMs and subtypes.

Results: Among the 60 treatment-naïve HIV-1-infected participants, 8.3% were infected with HIV-1 variants with surveillance DRMs (SDRMs). The SDRMs, D67N and D67E, belonged to the NRTIs class in two patients and K103N and V106A belonged to the NNRTIs class in three patients. The phylogenetic analysis showed that 91.7% of the subjects were infected with subtype CRF35_AD, followed by subtype B (5.0%) and CRF01_AE (3.3%). Among the 46 ART-experienced participants, 33 (71.7%) carried HIV-1 variants with SDRMs (9.1% against PIs, 78.8% against NRTIs, and 100% against NNRTIs). M46I and I47V were the most common mutations for PIs, M184V was the most common mutation for the NRTIs, and K103N/S was the most common mutation for NNRTIs. Phylogenetic analysis of the polymerase region showed that all of the 46 HIV-1-infected patients who failed on ART carried CRF35_AD.

Conclusions: The moderate prevalence of SDRMs (8.3%) in treatment-naïve and ART-failed (77.1%) Iranian patients with HIV-1-infection emphasizes the need for systematic viral load monitoring, expanding drug resistance testing, carefully surveilling individuals on ART regimens, and facilitating access to new antiretrovirals by health authorities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229275PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051075PMC
June 2020

HIV-1 integrase drug-resistance mutations in Iranian treatment-experienced HIV-1-infected patients.

Arch Virol 2020 Jan 18;165(1):115-125. Epub 2019 Nov 18.

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

The latest class of antiretrovirals (ARVs), including integrase strand transfer inhibitors (INSTIs), has been demonstrated to be effective for antiretroviral therapy (ART). Despite all the distinguishing characteristics of these drugs, including a high genetic barrier to resistance and lower toxicity than other ARVs, unfortunately, INSTI drug resistance mutations (DRMs) have occasionally been observed. The aim of this study was to investigate the presence of DRMs associated with INSTIs among treatment-experienced HIV-1-infected patients. From June 2012 to December 2018, a total of 655 treatment-experienced HIV-1-infected patients enrolled in this cross-sectional survey. Following amplification and sequencing of the HIV-1 integrase region of the pol gene, DRM and phylogenetic analysis were successfully carried out on the plasma samples of patients who had a viral load over 1,000 IU/ml after at least 6 months of ART. Out of the 655 patients evaluated, 62 (9.5%) had a viral load higher than 1,000 IU/ml after at least 6 months of ART. Phylogenetic analysis showed that all of the 62 HIV-1 patients experiencing treatment failure were infected with CRF35_AD, and one of these patients (1.6%) was infected with HIV-1 variants with DRMs. The DRMs that were identified belonged to the INSTI class, including E138K, G140A, S147G, and Q148R. This survey shows that DRMs belonging to the INSTI class were detected in an Iranian HIV patient who has experienced treatment failure. Therefore, regarding the presence of DRMs to INSTIs in ART-experienced patients, it seems better to perform drug resistance mutation testing in HIV patients experiencing treatment failure before changing the ART regimen and prescribing this class of medication.
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http://dx.doi.org/10.1007/s00705-019-04463-yDOI Listing
January 2020

Enteric Opportunistic Infection and the Impact of Antiretroviral Therapy among HIV/AIDS Patients from Tehran, Iran.

Iran J Public Health 2019 Apr;48(4):730-739

Consult Center of Behavior Diseases, West Health Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Opportunistic parasites have been identified as human pathogens, especially in immunodeficient patients. Microsporidian and coccidian infections cause chronic diarrhea as common clinical manifestation in HIV positive patients. In this study, the frequency of opportunistic infections, including microsporidian and coccidian infections, was evaluated in HIV/AIDS patients from Tehran and phylogenic analysis was performed for isolates from these patients.

Methods: One hundred and two stool samples were collected from confirmed HIV/AIDS patients, referred to Consult Center of Behavior Diseases, West Health Center, Iran University of Medical Sciences in Tehran, Iran. The samples were transferred to Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences from Jan 2016 to Dec 2016. After conventional formalin-ether concentration, aniline blue staining method and acid-fast staining technique were used for detection of microsporidian spores and oocysts. DNA was extracted and nested PCR was performed.

Results: Two (1.96%) cases were found to be positive for intestinal microsporidia infection using aniline blue staining method and were confirmed as by nested PCR. One patient was found with infection by acid-fast staining method and PCR. and were detected as non-opportunistic parasites in 1/102 (0.98%) and 2/102 (1.96%) of the HIV positive patients, respectively.

Conclusion: With respect to the use of antiretroviral therapy (ART) in HIV positive patients, we found a low frequency of infection.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500529PMC
April 2019

Co-infection with bacterial and fungal endocarditis at scar tissue in an immunocompromised patient.

J Cardiol Cases 2019 Apr 17;19(4):117-120. Epub 2018 Dec 17.

Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran.

We present the case of a 65-year-old immunocompromised male with a history of kidney transplantation, diabetes, coronary artery bypass, and cardiac resynchronization therapy device implantation who was finally diagnosed with an unusual form of infective endocarditis due to co-infection of fungal and bacterial pathogens. He was afebrile at the time of admission and presented with decompensated heart failure and pneumonia. A spleen abscess was discovered incidentally and prompted us to search for a cardiac source of emboli. Culture of the suppurative fluid drained percutaneously from the abscess was positive for and species. Transthoracic and transesophageal echocardiography revealed a mobile vegetation attached to the scarred myocardium of anterior septum - an unusual location for intracardiac vegetations. With regard to the prohibitive risk for redo surgery, the patient was managed medically with broad spectrum antimicrobial therapy. Finally, the patient died with severe sepsis. < Immunocompromised patients are at risk of opportunistic infections such as fungal endocarditis. Co-infection of fungal and bacterial pathogens is very rare. Early diagnosis of such infections needs a high level of clinical suspicion due to its non-specific presentations and culture negative essence. Many patients are afebrile during the disease course. Fungal endocarditis is characterized by large vegetations highly prone to systemic embolization even in the early stages of infection. Mortality is high despite optimal antimicrobial and timely surgery.>.
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http://dx.doi.org/10.1016/j.jccase.2018.11.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451046PMC
April 2019

Single and multi-locus association study of TCF7L2 gene variants with susceptibility to type 2 diabetes mellitus in an Iranian population.

Gene 2019 May 15;696:88-94. Epub 2019 Feb 15.

Cellular and Molecular Research Center, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Prior studies indicated that some of transcription factor 7-like 2 (TCF7L2) gene variants such as rs7903146, rs12255372 and rs11255372 are constantly associated with Type 2 diabetes mellitus (T2DM) in various populations and ethnic groups. The purpose of this study was to assess the association between TCF7L2 variants (rs7903146, rs11196205, and rs11255372) and T2DM by TaqMan assay. Statistical analysis was performed through SNPAlyze and SPSS. Significant associations of rs7903146 (P = 1.9 × 10-7), and rs11255372 (P = 2.98 × 10-10) both under a dominant model were found. Based on allele frequency, there was a significant difference between the two study groups at rs7903146 and rs12255372 variants (P = 6.8 × 10-10, and P = 9.3 × 10-11, respectively). Two haplotypes including Hap-1 (C-G-G) and Hap-2 (T-G-T) indicated a significant difference between the two study groups (P = 1.174 × 10-9and P = 7.432 × 109 respectively). In conclusion, rs7903146 and rs12255372 were significantly associated with T2DM in the specified Northern Iranian population.
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http://dx.doi.org/10.1016/j.gene.2019.01.040DOI Listing
May 2019

Prevalence and Associated Risk Factors of Hyperglycemia and Diabetes Mellitus Among HIV Positive Patients in Tehran, Iran.

Infect Disord Drug Targets 2019 ;19(3):304-309

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

Background: The introduction of Antiretroviral Therapy (ART) has resulted in the emergence of some metabolic complications including hyperglycemia and diabetes mellitus among HIV positive patients. The aim of this study was to investigate the prevalence of hyperglycemia, diabetes mellitus and their associated risk factors in HIV positive patients.

Methods: This cross-sectional study was conducted on HIV positive patients who visited Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital, Tehran, Iran (2004-2013). Medical records of patients were reviewed retrospectively. A logistic regression model was applied for analysis of the association between glycemic status and relevant risk factors.

Results: Out of 480 patients who were included in this study, 267 (55.6%) had hyperglycemia, including 28 (5.8%) with diabetes mellitus and 239 (49.8%) with pre-diabetes. The higher frequency of hyperglycemia, was found to be significantly associated with older age (OR for patients ˃40 years old, 2.260; 95% CI, 1.491, 3.247), male gender (OR, 1.555; 95% CI, 1.047, 2.311), higher Body Mass Index (OR for patients with BMI˃25 Kg/m², 1.706; 95% CI, 1.149, 2.531) and prolonged duration of HIV infection (OR for patients with duration of HIV infection ≥60 months, 2.027; 95% CI, 1.372, 2.992).

Conclusion: Hyperglycemia, especially pre-diabetes, is highly frequent among Iranian people living with HIV. Male gender, older age, prolonged duration of HIV infection, and higher BMI were associated with a higher prevalence of hyperglycemia. Hence, it is important to screen all HIV infected patients at the time of diagnosis and then periodically for hyperglycemia.
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http://dx.doi.org/10.2174/1871526518666180723152715DOI Listing
February 2020

The Diagnostic Value of Color Doppler Ultrasonography in Predicting Thyroid Nodules Malignancy.

Authors:
Saeed Kalantari

Int Tinnitus J 2018 Jun 1;22(1):35-39. Epub 2018 Jun 1.

Department of Endocrinology, Razi Hospital, Guilan University of Medical Science, Rasht, Iran.

Background And Objective: Thyroid nodules are common medical and surgical problems. Although ultrasound has been proposed for evaluation of these nodules by many studies, but there is no consensus regarding its diagnostic accuracy and discriminatory cutoffs. We aimed to investigate the diagnostic value of Gray-scale and Color Doppler US in predicting thyroid nodules malignancy.

Method: This is an analytical cross-sectional study which was conducted on 63 patients with thyroid nodules. The patients with nodular goiter were evaluated by Color Doppler and Gray scale US, fine needle aspiration and surgery was performed in all the subjects. The sensitivity, specificity, positive predictive value, and negative predictive value of the finding in US and their cut offs were calculated. Data were analyzed by Chi-square and Mann Whitney U test in SPSS19. P-value less than 0.05 considered as statistically significant.

Results: 63 patients consisting of 55 (87.3%) female and 8 (12.7%) male patients with the age range of 20-70 years were enrolled in this study. 14% of nodules were reported as malignant in pathology. Singularity, hypo echogenicity, irregular margin, and micro calcification were significantly correlated with malignancy in nodules (p<0.05). Micro calcification and hypo echogenicity of the nodule were the most and the least discriminator of malignancy in nodules (sensitivity 77%, specificity 76% vs. 24%, PPV 41% vs., 14% and NPV 94% vs. 86%) respectively. Pulsatility Index and Mean Systolic Velocity were the most and the least predictor factors of thyroid malignancy (PPV 62% vs. 23% and NPV 100% vs. 91%, respectively). There was a significant association between Resistive Index and Pulsatility Index with malignancy with a cutoff of RI ≥ 0.715 (P=0.005) and PI ≥ 0.945 (P=0.007), respectively. The combination of calcification, RI ≥ 0.715 with PI ≥ 0.945 had a very diagnostic yield for diagnose of malignancy (PPV 66.6% and NPV 98.4%).

Conclusion: According to results, it seems that Grayscale US combined with Color Doppler are valuable modalities for evaluating thyroid nodules and can be used as a para-clinical method in order to assess the risk of malignancy in the patient with thyroid nodules.
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http://dx.doi.org/10.5935/0946-5448.20180006DOI Listing
June 2018

Correlation between Vitamin D3 level and extrahepatic manifestation in chronic hepatitis type-C virus patients.

J Res Med Sci 2018 27;23:22. Epub 2018 Mar 27.

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

Background: Chronic hepatitis type-C virus (HCV) infection is one of the most common worldwide viral disorders, which leads to various clinical complications as well as extrahepatic manifestations. Furthermore, Vitamin D3 has also been reported to have relationship with the mentioned complications. The aim is to evaluate the correlation between Vitamin D3 level and extrahepatic manifestation in chronic HCV patients.

Materials And Methods: This cross-sectional study has been carried out on 90 patients with chronic hepatitis C. The level of Vitamin D3 was assessed in plasma of 90 patients with chronic HCV. Genotyping was done and clinical and sign and symptoms of recruited patients were gathered. Extrahepatic manifestations were evaluated and the correlation of blood, hepatic, and immunological factors and the level of Vitamin D3 were assessed.

Results: Most of our patients were male (92% vs. 8%). Twenty-nine percent had the insufficient amount of Vitamin D3 (21-30 ng/ml), and the remains had the Vitamin D3 level between 13-20 ng/ml. Furthermore, our assessment demonstrated that deficiency of Vitamin D3 was associated with the extrahepatic manifestations such as purpura (odds radio [OR] [95% confidence interval (CI) 95%] = 8.80 [1.74-44.47], = 0.004), vasculitis (OR [95% CI] = 11.70 [3.01-45.41], < 0.001), arthralgia (OR [95% CI] = 20.26 [4.21-97.47], < 0.001), myalgia (OR [95% CI] = 4.00 [1.01-17.27], = 0.048), and glomerulonephritis ( = 0.021).

Conclusion: According to our results, the extrahepatic manifestation in the patients with sufficient levels of Vitamin D3 would be less possible. In fact, it could be stated that deficiency in the Vitamin D3 can have a significant relationship with these manifestations.
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http://dx.doi.org/10.4103/jrms.JRMS_366_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894268PMC
March 2018

Investigation of the effects of a prevention of mother-to-child HIV transmission program among Iranian neonates.

Arch Virol 2018 May 30;163(5):1179-1185. Epub 2018 Jan 30.

HIV Laboratory of National Center, Iran University of Medical Sciences, Tehran, Iran.

Human immunodeficiency virus (HIV) infection is mostly spreading in developing countries. One of the most important pathways of HIV infection in these nations is the vertical route, from mother to infant. Therefore, this study evaluated the effectiveness of the prevention of mother-to-child transmission (PMTCT) program for HIV among Iranian neonates born to HIV-positive mothers. A total of 54 neonates born to HIV-1 positive mothers, all of whom were in a PMTCT program for HIV, as per the Iranian guidelines, were enrolled in this descriptive cross sectional study from March 2014 to July 2017. After RNA extraction of a plasma specimen, HIV-1 viral load was tested by an Artus HIV-1 RG RT-PCR Kit. Out of 54 evaluated neonates, 32 (59.3%) were male. The mean age of the HIV-infected mothers was 30.1 ± 5.4 (range: 19-47) years, and 36 (66.7%) of the mothers were in the age group 26-34 years. In the present study, it was found that none of the neonates whose mothers had previously entered PMTCT programs had HIV. 15 children were found who were born to HIV-positive mothers who had not entered the PMTCT program. Three of these children were infected with HIV (CRF35_AD), and none of them carried HIV-1 variants with SDRMs. The results of this study indicate that if HIV-positive pregnant women enter the PMTCT program for HIV, they can realistically hope to give birth to a non-infected child.
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http://dx.doi.org/10.1007/s00705-017-3661-1DOI Listing
May 2018

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

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

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

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

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

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

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

Predictors of early adulthood hypertension during adolescence: a population-based cohort study.

BMC Public Health 2017 11 28;17(1):915. Epub 2017 Nov 28.

Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Some longitudinal studies have shown that blood pressure tracks from adolescence to adulthood, yet there is limited evidence regarding the predictive factors of adulthood hypertension during adolescence. This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) to investigate the role of some factors in adolescence, measured in the first examination (1999-2001), to predict adulthood hypertension in the 4th examination (2009-2011).

Methods: Overall, 1579 subjects, aged 10-19 years, were used for the analysis of the current study. Mean age (SD) of participants at the baseline was 14.2 (2.5) years and 55% of them were female. A forward stepwise approach (p-value <0.2 for enter and >0.05 for removal) was considered to keep significant covariates among common variables including gender, body mass index, waist circumference, wrist and hip circumferences, fasting blood sugar, triglycerides, high density lipoprotein cholesterol, total cholesterol (TC), systolic (SBP) and diastolic blood pressure (DBP). Variance inflation factor (VIF) showed some multicollinearity for anthropometric variables (VIFs between 3.5 and 10). Multivariable logistic regression revealed that gender, blood pressure, wrist circumference and total cholesterol in adolescents are important predictors for adulthood hypertension.

Results: The risk increased by 4% and 39% per each 10 mmHg and 1 mmol/L increase in SBP/DBP and TC, respectively; additionally, females had a 70% lower risk. Among anthropometric variables, wrist circumference remained in the model, with 50% per centimeter increase in the risk of hypertension.

Conclusions: Wrist circumferences and TC had significant roles in predicting hypertension through adolescence to adulthood.
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http://dx.doi.org/10.1186/s12889-017-4922-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5706303PMC
November 2017

Presence of different hepatitis C virus genotypes in plasma and peripheral blood mononuclear cell samples of Iranian patients with HIV infection.

J Med Virol 2018 08 23;90(8):1343-1351. Epub 2018 Apr 23.

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

Due to the similar routes of transmission, individuals infected with the human immunodeficiency virus (HIV) may become infected with the hepatitis C virus (HCV) simultaneously. The aim of this study was to investigate the frequency of HCV co-infection in Iranian individuals with HIV infection, and to genotype HCV in plasma and PBMC specimens of these patients. From September 2015 to October 2016, a total of 140 Iranian individuals with HIV infection were enrolled in this cross-sectional study. The RNA from plasma and PBMC specimens was extracted, and genomic HCV-RNA was amplified using RT-nested PCR with primers that target 5'-UTR. The HCV genotyping used the RFLP technique. To confirm HCV genotype, 10 randomly selected HCV-positive samples were also submitted for sequencing. The mean age of patients was 35.7 ± 13.5 years (range: 1-66). Out of 140 patients, 62 (44.3 %) were positive for anti-HCV antibodies; among these, viral genomic RNA was detected in 34 (24.3%) and 39 (27.9%) of the plasma and PBMC specimens, respectively. The HCV genotyping showed a similar pattern of subtypes 1a (44% vs 46.2%), 3a (32.4% vs 33.3%), and 1b (17.6% vs 17.9%) in all sera and PBMC samples. It is noteworthy that the HCV genotypes in plasma and PBMC specimens of 6 HCV co-infected patients were not the same. This study reveals that HIV/HCV co-infection is high in Iranian patients (44.3%), especially in people who have high-risk factors (83.9%). Also, HIV/HCV co-infected individuals may have dissimilar HCV genotypes in their plasma and PBMC specimens.
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http://dx.doi.org/10.1002/jmv.24925DOI Listing
August 2018

HIV-1 genetic diversity and transmitted drug resistance frequency among Iranian treatment-naive, sexually infected individuals.

Arch Virol 2017 Jun 8;162(6):1477-1485. Epub 2017 Feb 8.

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

In recent years, the patterns of human immunodeficiency virus 1 (HIV-1) transmission in Iran have been changing gradually from drug injection to unprotected sexual contact. This study sought to investigate the phylogenetic trends and characteristics of transmitted drug resistance (TDR) mutations of HIV-1 in a population that is mainly infected through homo/heterosexual contacts. Sixty newly diagnosed antiretroviral-naive individuals with HIV infection living in Tehran were recruited to this survey, and among them, 42 subjects were established to be infected through sexual intercourse. Following amplification and sequencing of the main part of the HIV-1 pol region, phylogenetic and drug-resistance mutation (DRM) analysis was successfully performed on these 42 patients. Phylogenetic analysis showed that the majority of the subjects were infected with subtype CRF35_AD (88%), followed by subtype B, with 7.1%, and subtype CRF01_AE, with 4.7%. A total of 7.1% of the subjects were found to be infected with HIV-1 variants with surveillance drug-resistant mutations (SDRMs) according to the last world health organisation (WHO) algorithm. All of the identified SDRMs belonged to the non-nucleoside reverse transcriptase inhibitors (NNRTIs) class, including K103 N and V106A, which were found in three patients. Two minor HIV protease-inhibitor-related mutations (L10I and G73S) were detected in two patients, but these mutations are not included in the WHO SDRMs list. The dominance of HIV-1 subtype CRF35_AD was observed among subjects of this study who were infected through sexual contact. The moderate prevalence of SDRMs (7.1%) in this population emphasises the fact that the risk of treatment failure in HIV-infected individuals might increase in the future, and preventive measures should be considered by health authorities.
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http://dx.doi.org/10.1007/s00705-017-3228-1DOI Listing
June 2017

Childhood cardiovascular risk factors, a predictor of late adolescent overweight.

Authors:
Saeed Kalantari

Adv Biomed Res 2016 16;5:56. Epub 2016 Mar 16.

Department of Endocrinology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: We conducted a prospective study to elucidate the effects of increased cardiovascular risk factors on future weight gain and also the relation between body mass index (BMI) and other cardiovascular risk factors in children and adolescents.

Materials And Methods: This study was conducted on 1525 nonobese children and adolescents with an age range of 3-16 years old, participating in the 1(st) phase and follow-up phases of Tehran Lipid and Glucose Study. The subjects were evaluated 4 times with a 3-year time interval regarding lipid profile status and BMI, and other cardiovascular disease (CVD) risk factors. All the cases had a BMI <85% and had been appraised in at least two evaluation points.

Results: Cardiovascular risk factors, high-density lipoprotein (HDL) (P = 0.019), low-density lipoprotein (P = 0.016), triglyceride (TG) (P < 0.001), and blood pressure (BP) (P = 0.001); had significant effects on weight gain. There was also no difference between boys and girls and no age trend for increasing weight in both groups. The associations between BMI with cardiovascular risk factors were assessed cross-sectionally. For both sexes, BMI was significantly correlated to systolic and diastolic BP and TG (P = 0.05). For girls, BMI was significantly related to HDL (P = 0.05) regardless to age, but in boys, the relation of BMI with HDL only increased with age (P = 0.05).

Conclusion: Increased CVD risk factors are predictors of future overweight in childhood and adolescent and increased weight is linked significantly with dyslipidemia and hypertension in this age group.
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http://dx.doi.org/10.4103/2277-9175.178802DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817401PMC
April 2016

Thyroid gland volume of schoolchildren in the North of Iran: Comparison with other studies.

J Res Med Sci 2015 Nov;20(11):1070-6

Department of Radiology, Guilan University of Medical Sciences, Rasht, Iran.

Background: Few studies have shown the limitation of the World Health Organization (WHO)/ International Council for the Control of Iodine Deficiency (ICCIDD)-adopted thyroid gland volume references as universal normative values for thyroid gland volume. So we decided to measure thyroid gland volume by sonography in schoolchildren in Rasht, Gilan Province, Iran - Rasht is a metropolitan city on the Caspian Sea coast - and compare them to WHO normative values.

Materials And Methods: In a cross-sectional study, 2,522 schoolchildren, aged 6-13 years, in Rasht, Gilan Province, Iran were selected by multistage random sampling. Data were collected on their age, sex, weight, height, body surface area (BSA), and thyroid gland size by palpation and sonography. The terminal phalange of thumb finger volume was calculated with the same formula used in sonography, for the thyroid gland in 1,085 of these cases.

Results: Goiter prevalence was 64% (1613 cases) by palpation, 76.1% (1228 subjects) grade I and 23.9% (385 cases) grade II. The mean thyroid gland volume in girls was more than boys (3.67 ± 1.89 mL vs 3.41 ± 1.58 mL, P < 0.0001). According to the 1997 WHO thyroid gland volume reference, none of the children had goiter based on BSA and age even in those with grade II goiters (23.9%). In contrast, the median thyroid gland volume in our cases was larger than the 2004 WHO reference. The best single predictor of thyroid gland volume was age (R (2) = 0.391, P < 0.0001) followed by BSA (R (2) = 0.151, P < 0.0001). There was also a significant difference between thyroid gland and finger volume in all grades of goiter and grade II goiters (3 ± 1.4 mL vs 9.59 ± 2.4 mL; P < 0.0001. 4.3 ± 1.4 mL vs 9.3 ± 2.5 mL; P < 0.0001).

Conclusion: The WHO standards for thyroid gland volume by sonography may underestimate or overestimate the goiter prevalence in many areas and populations. Finger volume was much larger than thyroid gland volume in even visible goiters.
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http://dx.doi.org/10.4103/1735-1995.172824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755094PMC
November 2015

Association of depression with type 2 diabetes and relevant factors.

Adv Biomed Res 2014 29;3:244. Epub 2014 Nov 29.

Department of Emergency Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Based on the high prevalence of diabetes and depression in Rasht, we conducted a study to evaluate the prevalence of depression in type 2 diabetic patients, and its association with glycemic control, chronic complications, and some clinical and paraclinical parameters in this northern state of Iran.

Materials And Methods: Beck depression inventory was used for evaluating depression on 90 type 2 diabetics and 90 healthy controls selected. Information on demographic and clinical and paraclinical characteristics was collected by interviews and from medical records.

Results: This cross-sectional study was performed on 90 type 2 diabetic patients (63 female and 27 male with a mean age of 54.17 ± 10.57 years) and 90 healthy matched controls. Overall, depression was significantly more prevalent in case group [37.8% vs. 16%, odds ratio (OR) = 3.29, P = 0.001]. The prevalence of depression in diabetic women was significantly higher than nondiabetic ones (39.7% vs. 15%, P = 0.002). We could not find any significant correlation between depression and positive family history of depression, duration of diabetes, HBA1c level, and body mass index. The prevalence of depression was prominently more in diabetic patients with retinopathy than in those without this complication (55.6% vs. 24%, P = 0.015). Logistic regression analysis indicated that diabetes itself was the only significant determinant of having depression (OR = 3.29, P = 0.005, 95% confidence interval: 0.118-0.667).

Conclusion: There was a prominent prevalence of depression in type 2 diabetics overall. Depression was not correlated with duration of diabetes and glycemic control. There was a significant association between depression and retinopathy in diabetic patients. Diabetes itself was the only significant determinant of having depression after matching with other variables.
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http://dx.doi.org/10.4103/2277-9175.145753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260271PMC
December 2014

Statin therapy and hepatotoxicity: Appraisal of the safety profile of atorvastatin in hyperlipidemic patients.

Adv Biomed Res 2014 19;3:168. Epub 2014 Aug 19.

Department of Internal Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.

Background: Statins are one of the most frequently prescribed medications to reduce the risk of cardiovascular events. Statins appear to be safe however, there are contradictory data regarding their adverse effects, which might be due to genetic variation in their metabolism. Hence, this prospective study was aimed to evaluate the effects of atorvastatin on liver transaminase changes in a clinical setting, in north Iran.

Materials And Methods: This prospective semi-experimental study was performed on hyperlipidemic adults in 2010-2011. Patients received atorvastatin (5-40 mg/d) based on the American National Cholesterol Education Program guidelines. Liver aminotransferases were measured in three occasions of baseline, 8 and 16 weeks period.

Results: A total of 206 patients were included in the study. Of which 178 were female and 30 were male. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were in normal range before intervention in the majority, except in 25 (12.1%) and 16 (7.8%) of patients, respectively. In general, ALT and AST remained in normal range over the study period (23.3 IU/L and 21.8 IU/L, respectively). There was found no relationship between different doses of atorvastatin prescribed and ALT/AST changes in the patients. The males' ALT means at baseline (26.9 IU/L), 8 weeks (30 IU/L) and 16 weeks (28.8 IU/L) after statin therapy were significantly higher than females (22 IU/L, 22.2 IU/L and 22.1 IU/L, respectively; P < 0.05 for all).

Conclusion: The absence of any hepatic adverse effect in the present study supports safety of atorvastatin and emerging opinion that routine screening of liver function tests is not necessary in patients on statins.
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http://dx.doi.org/10.4103/2277-9175.139133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4162033PMC
September 2014

Insight into in vivo magnetization exchange in human white matter regions.

Magn Reson Med 2011 Oct 4;66(4):1142-51. Epub 2011 Mar 4.

Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada.

Water exchange can play an important role in interpreting compartment-specific magnetic resonance imaging data in brain. For example, an MR method of myelin measurement, known as myelin water fraction imaging, assumes that water exchange processes are slow compared with the measurement time scale. In this article, we examined whether water exchange processes have an effect on myelin water fraction values. A previously established four pool model of white matter was used to simulate the interactions between two aqueous compartments (myelin water and intra/extracellular water) and nonaqueous compartments (myelin and nonmyelin tissues). To extract the water exchange cross relaxation times, the Bloch equations were solved analytically. As the water exchange time scales are dependent on the spin-lattice T(1) relaxation of each of these four pools and due to the current uncertainties regarding the T(1) associated with each pool, exchange cross relaxation times for three different T(1) scenarios were calculated. The corrections that need to be considered in order for myelin water fraction to be an accurate marker for myelin were found to be less than 15%. This work indicates that regional variations in white matter myelin water fraction values are most likely due to variations in myelin content rather than regional differences in exchange rates.
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http://dx.doi.org/10.1002/mrm.22873DOI Listing
October 2011

Cervical transverse myelitis after chickenpox in an immunocompetent patient.

Acta Med Iran 2010 Nov-Dec;48(6):417-8

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

Varicella-zoster viruses complications involving the CNS are estimated to occur rarely, transverse myelitis after Varicella-zoster virus in most patients is characterized by an abrupt onset of progressive weakness and sensory disturbance in the lower extremities , like other viruses. We describe the case of 17 year-old boy who experienced cervical transverse myelitis after chickenpox with inability to walk and with urinary retention. He was not treated with any medication but complete recovery has been occurred.
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July 2011