Publications by authors named "Sirous Jafari"

36 Publications

Adrenal function in patients receiving rifampin-based anti-tuberculosis regimens: A cross-sectional study in Iran.

Caspian J Intern Med 2020 ;11(4):458-459

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

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http://dx.doi.org/10.22088/cjim.11.4.458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911767PMC
January 2020

The efficacy of remdesivir in coronavirus disease 2019 (COVID-19): a systematic review.

Iran J Microbiol 2020 Oct;12(5):376-387

Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Background And Objectives: Researchers all around the world are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the efficacy and safety of treatment with Remdesivir in hospitalized patients with COVID-19.

Materials And Methods: We performed a systematic search in Pubmed, Embase, Web of Science, Google scholar and MedRxiv for relevant observational and interventional studies. The outcomes measures were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates.

Results: Three randomized controlled trials and 2 cohort studies were included in our study. In the 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day efficacy of treatment with Remdesivir versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that the efficacy of Remdesivir was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowered 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have a significant difference; however, severe adverse event rate was lower in the 5-day Remdesivir group compared to the 10-day and placebo groups.

Conclusion: 5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe, and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.
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http://dx.doi.org/10.18502/ijm.v12i5.4597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867703PMC
October 2020

Efficacy and safety of sofosbuvir/ ledipasvir in treatment of patients with COVID-19; A randomized clinical trial.

Acta Biomed 2020 11 10;91(4):e2020102. Epub 2020 Nov 10.

Tehran University of Medical Sciences, Tehran, Iran..

Background: There is no study regarding the use of SOF/LDP in treatment of COVID-19.  Objectives: In this study, the efficacy and safety of SOF/LDP were assessed in treatment of patients with mild to moderate COVID-19.

Methods: Among an open-label randomized clinical trial, 82 patients with mild to moderated COVID-19 were assigned to receive either SOF/LDP 400/100 mg daily plus the standard of care (SOF/LDP group, n=42) or the standard of care alone (control group, n=40) for 10 days. Time to clinical response, rate of clinical response, duration of hospital and ICU stay and 14-day mortality were assessed.

Results: Clinical response occurred in 91.46% of patients. Although rates of clinical response were comparable between the groups but it occurred faster in the SOF/LDP group than the control group (2 vs. 4 days respectively, P= 0.02). Supportive cares were provided in the medical wards for most patients but 17.07% of patients were transferred to ICU during the hospitalization course. However, durations of hospital and ICU stay were comparable between the groups.  14--day mortality rate was 7.14% and 7.5% in the SOF/ LDP and control groups respectively. No adverse effects leading to drug discontinuation occurred. Gastrointestinal events (nausea, vomiting and diarrhea) were the most common side effects (15.85%).

Conclusion: Added to the standard of care, SOF/LDP accelerated time to the clinical response. However, rate of clinical response, duration of hospital and ICU stay and 14-day mortality were not different. No significant adverse event was detected.  More randomized clinical trials with larger sample sizes are needed to confirm the efficacy and safety of SOF/LDP in the treatment of COVID-19.
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http://dx.doi.org/10.23750/abm.v91i4.10877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927527PMC
November 2020

An Update to Enterococcal Bacteremia: Epidemiology, Resistance, and Outcome.

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

Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sci-ences, Tehran,. Iran.

Background: An increase in resistant gram-positive cocci, especially enterococci, requires an epidemiologic re-assay and its results may affect empirical treatments for these infections.

Objective: In this study, we investigated the microbial epidemiology and resistance pattern of enterococcal bacteremia.

Methods: This study was a cross-sectional study that investigates all cases of positive blood cultures with Enterococcus spp. at a tertiary referral colligates hospital in Tehran in 2018.

Results: Enterococcus spp. was isolated from blood cultures of a total of 73 patients. The most patients were male 42 (57.7%). The mean age of the patients was 58.8 (±18.8) years. Hospital-acquired infection was the most type of infection involving enterococcal bacteremia (80.8%) comparing with community-acquired (6.7%) and health care-associated (12.3%). Renal failure and cancer were the most underlying disease in E. faecalis and E. faecium, respectively. Mortality for Vanco-mycin-resistant enterococci (VRE) was approximately two times more than the sensitive ones. Between the dead/alive groups, the following items were different significantly (P.Value<0.05): Vancomycin resistance for enterococcus isolated, immunodeficiency as underlying disease, Mechanical ventilation, hospitalization period, and the empiric regimen.

Conclusion: Increased antibiotic-resistant strains, especially Vancomycin-resistant enterococci (VRE), pose a serious threat to the general public, especially hospitalized patients, and increase mortality. Surveillance of microorganisms and antimi-crobial resistance is a crucial part of an efficient health care system.
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http://dx.doi.org/10.2174/1871526520999201103191829DOI Listing
November 2020

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

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

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

As no specific pharmacological treatment has been validated for use in coronavirus disease 2019 (COVID-19), we aimed to assess the effectiveness of azithromycin (AZM) in these patients at a referral centre in Iran. An open-label, randomised controlled trial was conducted on patients with laboratory-confirmed COVID-19. A total of 55 patients in the control group receiving hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) were compared with 56 patients in the case group who in addition to the same regimen also received AZM. Patients with prior cardiac disease were excluded from the study. Furthermore, patients from the case group were assessed for cardiac arrythmia risk based on the American College of Cardiology (ACC) risk assessment for use of AZM and HCQ. The main outcome measures were vital signs, SpO levels, duration of hospitalisation, need for and length of intensive care unit admission, mortality rate and results of 30-day follow-up after discharge. Initially, there was no significant difference between the general conditions and vital signs of the two groups. The SpO levels at discharge were significantly higher, the respiratory rate was lower and the duration of admission was shorter in the case group. There was no significant difference in the mortality rate between the two groups. Patients who received AZM in addition to HCQ and LPV/r had a better general condition. HCQ+AZM combination may be beneficial for individuals who are known to have a very low underlying risk for cardiac arrhythmia based on the ACC criteria.
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http://dx.doi.org/10.1016/j.ijantimicag.2020.106143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445147PMC
October 2020

CT-scan Findings of COVID-19 Pneumonia Based on the Time Elapsed from the Beginning of Symptoms to the CT Imaging Evaluation: A Descriptive Study in Iran.

Rom J Intern Med 2020 Jul 27. Epub 2020 Jul 27.

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

Background: Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.

Methods: Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.

Results: The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%), and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.

Conclusions: Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.
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http://dx.doi.org/10.2478/rjim-2020-0019DOI Listing
July 2020

Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella.

J Infect Dev Ctries 2020 06 30;14(6):660-663. Epub 2020 Jun 30.

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

Introduction: Ventilator-associated pneumonia (VAP) has been considered as a healthcare-associated infection with high mortality. Acinetobacter baumannii and Klebsiella pneumoniae are the common causes of VAPs around the world.

Methodology: This research was a retrospective observational study in the intensive care unit (ICU) in a tertiary referral collegiate hospital in Tehran between March 2016 and May 2018. Patients who fulfilled VAP due to documented Multidrug Resistant Acinetobacter baumannii (MDR-AB) or Extended Spectrum Beta Lactamase-producing Klebsiella pneumoniae (ESBL-KP) criteria were enrolled. General demographic features, duration of hospital stay, antimicrobial treatment regimens, duration of ICU admission, the period of mechanical ventilation (MV) and 30-day mortality were documented and compared.

Results: 210 patients were found with clinical, microbiological and radiological evidence of VAP. In total, 76 patients with MDR-AB and 76 patients with ESBL-KP infections were matched in the final analysis. Duration of hospitalization in the patients with MDR-AB was significantly more than that of patients infected with ESBL-KP (p-value: 0.045). Patients diagnosed with MDR-AB VAP had a 65.8% mortality rate compared to 42.1% in the ESBL-KP infection group (p = 0.003).

Conclusions: Results of the present study demonstrated that VAPs caused by MDR-AB may be more hazardous than ESBL-KP VAPs because they could be accompanied by a longer hospitalization course and even a higher mortality.
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http://dx.doi.org/10.3855/jidc.12889DOI Listing
June 2020

Pulmonary nocardiosis in pemphigus vulgaris patients from Tehran, Iran.

Infect Disord Drug Targets 2019 Dec 31. Epub 2019 Dec 31.

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

Objective: Nocardiosis is an opportunistic infection in individuals who had organ transplants and in patients with immunosuppressive diseases, such as pemphigus vulgaris (PV), diabetes mellitus, and HIV. Nocardiosis rate has not been assessed in Iranian PV patients, and this was the first study to estimate nocardiosis rate in these patients. In this study, 103 PV patients have been studied. BAL samples were obtained and direct smear was analyzed by PAS staining. Samples were cultured on antibiotic containing blood and chocolate agar media. DNA extraction and PCR were performed on positive cultures, and final identification was done by 16S rRNA gene sequencing. Drug susceptibility testing was done by micro-broth dilution method.

Results: Four positive cultures (3.88%) were found in the samples (n = 103). According to sequence analysis, 2 isolates were identified as N. cyriacigeorgica and 2 as N. otitidiscaviarum and N. cerradoensis. N. cerradoensis isolated from an invasive brain infection. Isolated bacteria were susceptible to majority of the tested antibiotics, except 1 isolate of N. cyriacigeorgica and isolate of N. cerradoensis. This was the first isolation of N. cerradoensis of human infection in Asia. PV patients are as susceptible to nocardiosis as other immunocompromised patients.
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http://dx.doi.org/10.2174/1871526520666191231144607DOI Listing
December 2019

Comparison of HIV Indicators after the Implementation of a New Model for TB and HIV Management in an Iranian Prison.

Infect Disord Drug Targets 2020 ;20(6):778-783

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

Objectives: A new national clinical guideline for the management of tuberculosis and HIV in Iranian prisons was released in 2011. The aim of this study was to compare HIV indicators in the case and control prisons after implementation of the new guideline.

Methods: This report examines outcomes observed during the pilot phase of its implementation at a case prison from October 2013 to June 2014 compared to a control prison that had not yet implemented the guideline. The case prison included incarcerated individuals in the Great Tehran Prison. A prison in Alborz province was considered as a control group. Pearson's Chi-squared, two-sample t-test, paired t-test and Kruskal-Wallis were used for the analysis.

Results: The intervention significantly increased the total number of inmates tested for HIV and of diagnoses of HIV-positive inmates in the case prison compared to the control prison (P<0.001). Moreover, coverage of antiretroviral therapy was higher in the case prison compared to the control prison (P=0.015).

Conclusion: We recommend the implementation of this guideline in all Iranian prisons.
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http://dx.doi.org/10.2174/1871526519666191015151639DOI Listing
January 2020

Bacteria Producing Extended Spectrum β-lactamases (ESBLs) in Hospitalized Patients: Prevalence, Antimicrobial Resistance Pattern and its Main Determinants.

Iran J Pathol 2019 27;14(1):61-67. Epub 2018 Dec 27.

Dept. of Pathology, Shariati Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objective: There is a growing concern regarding the lack of new antibiotics, especially for multidrug- resistant bacteria that produce Extended Spectrum -Lactamases (ESBLs). The present study aims to assess the preva- lence of bacteria producing ESBLs, their antimicrobial resistance pattern, and its main determinants among hospitalized patients.

Methods: The study population included 383 consecutive patients with a definitive diagnosis of urinary tract infection (UTI). All eligible subjects for the study had a positive culture for gram-negative microorganisms in urine specimens. ESBL producing isolates were characterized phenotypically for ESBL production using the double disc synergy test.

Results: In total, 383 specimens were assessed, among which 212 (55.4%) were related to bacteria producing ESBLs (ESBL+). Of those with ESBL + infections, 65.5% were sourced from catheters (as hospital-associated UTIs), and 35.5% were categorized as community-associated UTIs. In the group consisting of bacteria producing ESBLs, the high- est sensitivity was observed with Imipenem (72.2%), while the highest resistance was revealed with ceftriaxone (100%).

Conclusion: We have shown that our community faces a high prevalence of bacteria producing ESBLs, mostly sourced from the catheterization of hospitalized patients. The highest bacterial sensitivity was observed with Imipenem, nitrofu- rantoin, and amikacin, while the highest resistance was found with ceftriaxone and cotrimoxazole, suggesting the inef- fectiveness of using the two latter antibiotics for eradicating these bacterial infections. On the other hand, a history of urinary catheterization and previous hospitalization were two main determinants of their presence, a finding which em- phasizes the importance of avoiding catheterization and hospitalization of patients with UTIs without proper indications.
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http://dx.doi.org/10.30699/IJP.14.1.61DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708561PMC
December 2018

Levofloxacin Versus Ceftriaxone and Azithromycin Combination in the Treatment of Community Acquired Pneumonia in Hospitalized Patients.

Recent Pat Antiinfect Drug Discov 2018 ;13(3):228-239

Graduation Program of Health Sciences, Faculty of Medicine, Federal University of Mato Grosso, Cuiaba, Brazil.

Background: In Asia, an estimated one million deaths are caused by communityacquired pneumonia (CAP) each year. Despite the high mortality in elderly people, a large number of CAP patients have been treated and survived with optimal life expectancy. A few studies have been done on adult CAP therapeutic approaches in Asia. Moreover, differences have been noted between these studies and European data. We aimed to investigate the efficacy of oral Levofloxacin (TAVANEX), 750 mg, once daily for five days versus parenteral Ceftriaxone 1gr BD, plus oral Azithromycin (250 mg, once daily) for seven to ten days (standard regimen) in CAP treatment.

Materials And Methods: We conducted a prospective randomized trial among 150 patients with CAP in Qaem Hospital of Alborz city from December 2016 to June 2017. A group of CAP patients were randomized in two treatment groups. One group was treated with oral Levofloxacin (TAVANEX), 750 mg, once daily for five days and the other group with parenteral Ceftriaxone 1gr BD plus oral Azithromycin (250 mg, once daily) for seven to ten days (standard regimen). The efficacy and side effects of the assigned drugs were compared between two groups. The probability level for statistical significance was set at P ≤ 0.05.

Results: The body temperature (P value=0.09), WBC count (P value=0.15), respiratory sounds (P value=0.18) and admission duration (P value=0.15) showed no significant differences after treatment between two groups. There was no report of hospital mortality, clinical deterioration and antibiotic escalation during hospital admission in both groups of study. In standard regimen group, only two (2.7%) patients had skin rash while in Levofloxacin group one case (1.3%) had skin rash, two patients (2.7%) had gastrointestinal problems and three (4%) patients showed central nervous system (CNS) complications. In both groups, the reticulonodular pattern was more frequently observed in Chest X-ray. Although standard regimen group (n=27, 36%) showed more consolidation than patients in Levofloxacin group (n=22, 29.3%), and the ground glass pattern was observed more in Levofloxacin group.

Conclusion: We concluded that monotherapy with oral Levofloxacin was as effective as treatment with Ceftriaxone plus Azithromycin combination in patients with CAP who required hospitalization.
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http://dx.doi.org/10.2174/1574891X13666181024154526DOI Listing
April 2019

Molecular Epidemiology and Drug Resistance Pattern of Carbapenem-Resistant Klebsiella pneumoniae Isolates from Iran.

Microb Drug Resist 2019 Apr 23;25(3):336-343. Epub 2018 Oct 23.

1 Department of Microbiology, School of Medicine, Tehran University of Medical Sciences , Tehran, Iran .

The emergence and dissemination of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates and their involvement in several nosocomial outbreaks are of high concern. This study was conducted to investigate the genetic relatedness and molecular determinants of carbapenem resistance in 100 CRKP isolates. Susceptibility to carbapenems as well as other antibiotics was determined by using disk diffusion method. The Modified Hodge test was performed for detection of carbapenemase production. The minimum inhibitory concentrations of selected antibiotics were determined by broth microdilution method. The presence of bla, bla, bla, and bla carbapenemase genes was examined by PCR, and clonal relatedness of CRKP isolates was investigated by pulsed-field gel electrophoresis (PFGE) analysis. bla was the most frequent carbapenemase gene (72%), followed by bla (31%). None of the isolates harbored bla and bla genes. PFGE separated the majority of isolates into 10 clusters, including the major clusters A and B, carrying bla, and clusters C and D, carrying bla, and 4 isolates had a unique PFGE pattern. An increased rate of colistin resistance (50%) was detected among the isolates. Tigecycline was found to be the most active agent against CRKP isolates. Our results revealed that high prevalence of bla and bla carbapenamses and resistance to colistin are alarming threats, necessitating an immediate action to prevent the spread of carbapenem-colistin-resistant K. pneumoniae isolates in Iran.
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http://dx.doi.org/10.1089/mdr.2017.0404DOI Listing
April 2019

High prevalence of OXA-type carbapenemases among Acinetobacter baumannii strains in a teaching hospital of Tehran.

Acta Microbiol Immunol Hung 2017 Dec 5;64(4):385-394. Epub 2017 Sep 5.

1 Department of Microbiology, Karaj Branch, Islamic Azad University , Karaj, Iran.

Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has created a public health concern all around the world. In this study, 100 isolates of CRAB from hospitalized patients during 2015-2016 at Imam Khomeini Hospital were investigated to determine the rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains using Kirby-Bauer disk diffusion method. The minimum inhibitory concentrations (MICs) of six antibiotics were determined by broth microdilution method. Multiplex polymerase chain reaction (PCR) was performed to detect bla and bla, bla, and bla that are encoding resistance to carbapenems. All CRAB isolates were MDR and XDR and 2% of them were pandrug-resistant (PDR), whereas colistin, polymyxin B, and tigecycline were the most effective agents. All isolates were positive for bla by PCR. The frequency of bla and bla was 81% and 22%, respectively. Findings of this study showed that very few therapeutic options remained for the treatment of CRAB infections and bla is a dominant resistance gene in CRAB at this hospital.
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http://dx.doi.org/10.1556/030.64.2017.031DOI Listing
December 2017

Effect of Septimeb as a new natural extract on severe sepsis: A randomized clinical trial.

Caspian J Intern Med 2017 ;8(1):35-43

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

Background: Septimeb as a herbal medicine has regulatory effects on inflammation. This study set to evaluate the effects of Septimeb among patients with sepsis on inflammatory biomarkers and survival rate.

Methods: In this randomized clinical trial, 51 patients with sepsis from the ICU and medical ward of Imam Khomeini Hospital were divided into two groups: Septimeb (n=25) and control group (n=26). In the control group, the patients received a standard treatment only for 7 days, while Septimeb group received Septimeb (6cc vial with 500cc serum glucose infusion 5% daily for one to two hours) plus standard treatment of sepsis for 7 days. Then, blood samples were analyzed. APACHE (Acute Physiologic and Chronic Health Evaluation), SOFA (Sequential Organ Failure Assessment), and GCS (Glasgow Coma Score) values were calculated daily.

Results: Treatment with Septimeb showed a significant decrease in SOFA value (1.54±0.83) compared to the control group (2.39±0.88) (P<0.001) and a significant increase in GCS value (14.46±0.88) compared to the control group (12.86±1.78) (P<0.001). Improvements of these values can confirm the potential of Septimeb in the reduction of severity of sepsis (P<0.05). There were significant decreases in lactate and blood sugar and WBC levels. In addition, inflammatory factors such as ESR (Septimeb group: 52.07±34.80, control group: 51.75±42.10, P=0.98) and CRP (Septimeb group: 48.86±23.21, control group: 49.93±36.22, P=0.92) decreased, but did not show a significant reduction.

Conclusion: Septimeb has positive effects on reduction of the severity of sepsis which leads to reduction of patients' mortality rates.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412247PMC
January 2017

Efficacy of Intralipid infusion in reducing amphotericin-B-associated nephrotoxicity in head and neck invasive fungal infection: A randomized, controlled trial.

Ear Nose Throat J 2017 Feb;96(2):E18-E22

Department of Infectious Diseases, Amir-Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Amphotericin B deoxycholate (ABD) is the best therapeutic agent available for the treatment of most systemic fungal infections. However, some untoward adverse effects such as nephrotoxicity may limit its appropriate therapeutic use. We conducted a randomized, controlled trial ofthe infusion of fat emulsion (Intralipid) shortly after the infusion of ABD to evaluate its effects on reducing ABD-associated nephrotoxicity. Our patient population was made up of 31 patients who were randomized into two groups: an intervention group (n = 16) and a control group (15 patients). There were no statistically significant differences between the two groups in demographic or clinical variables. All patients received 1mg/kg/day of ABD in dextrose 5%. In addition, the patients in the intervention arm received Intralipid 10%, which was started as soon as possible within 1 hour after the infusion of ABD. ABD-associated nephrotoxicity was defined as a minimum 50% increase in baseline serum creatinine to a minimum of 2mg/dl. We also measured daily serum creatinine changes during the first 2 weeks of treatment, and we compared some other relevant indices of renal function, as well as ABD-related hypokalemia. We found no statistically significant differences between the two treatments in terms of ABD-associated nephrotoxicity or any of the other indices. We conclude that the administration of Intralipid 10% early after infusion of ABD in dextrose 5% does not have any effect in decreasing ABD-associated nephrotoxicity or hypokalemia.
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http://dx.doi.org/10.1177/014556131709600214DOI Listing
February 2017

Approach to Anemia in Hospitalized Patients with Infectious Diseases; Is it Appropriate?

Iran J Pharm Res 2015 ;14(2):487-93

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

Anemia of chronic diseases (ACD) is a common problem in patients with infectious diseases and can influence the quality of life and patients' survival. Despite the clinical importance of ACD, data are still lacking regarding this problem in the infectious diseases. This study aimed to evaluate the prevalence, related factors, outcome and approaches to anemia in the infectious diseases ward. This retrospective study was performed to review the medical records of patients admitted to the infectious diseases department of Imam Khomeini hospital during a two-year period between 2009 and 2011. A standard protocol was developed to evaluate anemia. Patients' demographic data approaches to manage anemia and routine laboratory tests were recorded and compared with the protocol. Totally, 1,120 medical records were reviewed. ACD was recognized in 705 patients (63%). Only 5.1% of diagnostic and 8.7% of treatment approaches was based on the protocol. The majority of patients (89.4%) were received inappropriate treatment regarding. Mortality rate of patients with ACD was 3.4%. Moreover, a significant correlation between anemia and mortality was detected (r = 0.131; p = 0.026). A statistically significant correlation was also identified between patients' Hgb and ESR, CRP, reasons of admission, number of medications, and underlying diseases. In conclusion, results of this study suggested that ACD is a common problem in infectious diseases patients and significantly associated with patients' mortality. Moreover, the majority of studied patients were not received an appropriate diagnostic and treatment approach which arises more concerns regarding the management of ACD in infectious diseases setting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403065PMC
April 2015

Hospitalizations and its related factors in HIV/AIDS patients in Tehran, Iran.

Med J Islam Repub Iran 2014 16;28:70. Epub 2014 Jul 16.

4. Specialist of Infectious Diseases, Department of Infectious and Tropical Diseases, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: HIV/AIDS patients are mainly hospitalized for HIV-related diseases and opportunistic infections.ions. This study was performed to determine the causes of hospitalization and its related factors in HIV/AIDS patients in Tehran's Imam Khomeini Hospital during 2009-2012.

Methods: This study was a descriptive cross-sectional study. HIV patients admitted to the Imam Khomeini Hospital were included in the study through census method, during the study. Demographic variables, hepatitis co-infection, CD4 count, history of receiving anti- retroviral therapy (ART), cause of admission, length of hospitalization and patient's outcome were recorded. Data were analyzed by SPSS software and by means of Chisquare and Mann Whitney U tests.

Results: During the study, 555 HIV patients were included in, 84.9% of whom were male, with the mean age of 36.59±8.51 years and the average length of hospitalization for 16.04±18.82 days. Opportunistic infections were the most common cause of hospitalization (46.5%) with prevalent of which was pulmonary tuberculosis being the most prevalent (37.6%). Patients suffering from opportunistic infections had significantly lower CD4 count and longer hospitalization than the other diseases. A significant difference was detected between patients outcome and the history of ART.

Conclusion: Low CD4 count may contribute to an increase in number and length of hospitalization in HIV/AIDS patients. Accordingly, it appears to affect outcome of their treatment and ART was accompanied by a drop in the death rate of hospitalized patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219897PMC
November 2014

Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients.

Asian Pac J Trop Biomed 2014 May;4(Suppl 1):S171-6

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

Objective: To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients.

Methods: This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy.

Results: Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count <200 cell/µL) vs. HIV(+) patients (CD4 count >200 cell/µL).

Conclusions: Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis.
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http://dx.doi.org/10.12980/APJTB.4.2014C1253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025326PMC
May 2014

Frequencies of CD4+ T Regulatory Cells and their CD25(high) and FoxP3(high) Subsets Augment in Peripheral Blood of Patients with Acute and Chronic Brucellosis.

Osong Public Health Res Perspect 2014 Jun 15;5(3):161-8. Epub 2014 May 15.

Nejadeh Med lab, Varamin, Iran.

Objectives: Brucellosis remains one of the most common zoonotic diseases worldwide. In humans, brucellosis can be a serious, debilitating, and sometimes chronic disease. Different mechanisms can be postulated as to the basis for the induction of the chronic status of infectious diseases that T regulatory cells are one of the most important related mechanisms. The current study was designed to determine whether percentage of CD4+Treg cells and their CD25(high) and FoxP3(high) subpopulations in peripheral blood are changed in human brucellosis samples in comparison to a control group.

Methods: In total, 68 brucellosis patients (acute form: n = 43, chronic form: n = 25) and 36 healthy volunteers entered our study. After isolating of peripheral blood mononuclear cells, heparinized venous blood samples were obtained from both patients and healthy donors, CD4, CD25, and FoxP3 molecules were evaluated by two- and three-color flow cytometric methods.

Results: The results revealed a new finding in relation to Treg cells and human brucellosis. The numbers of CD4(+)Treg cells and their CD25(high) and FoxP3(high) subsets increase significantly in the peripheral blood of acute and chronic forms of brucellosis samples compared with healthy groups, with this increase being greater in the chronic group.

Conclusion: There seems to be a correlation between increase of CD4+Treg cells and their subsets and the disease progress from healthy state to acute and chronic brucellosis.
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http://dx.doi.org/10.1016/j.phrp.2014.04.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4147229PMC
June 2014

Carnitine for prevention of antituberculosis drug-induced hepatotoxicity: a randomized, clinical trial.

J Gastroenterol Hepatol 2014 May;29(5):997-1004

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background And Aim: In the present study, the potential benefits of oral carnitine in preventing antituberculosis drug-induced hepatotoxicity (ATDH) were evaluated.

Methods: Fifty-four patients in the carnitine and 62 patients in the placebo group completed the study. The carnitine group received 1000 mg oral carnitine solution twice daily for 4 weeks. The placebo group received 10 mL of oral placebo solution twice daily for 4 weeks. ATDH was defined as an increase in the serum level of aspartate aminotransferase or alanine aminotransferase greater than three or five times of the upper limit of normal with or without clinical symptoms of hepatotoxicity, respectively.

Results: During the study period, 29 (25%) patients experienced ATDH. Among these patients, nine (16.7%) and 20 (32.3%) were in the carnitine and placebo groups, respectively (P = 0.049). Based on multivariate logistic regression model, age over 35 years old (odds ratio [OR] = 7.01, P = 0.002), human immunodeficiency virus infection (OR = 40.4, P < 0.001), diabetes mellitus (OR = 37.6, P = 0.001), and placebo treatment (OR = 0.1, P = 0.01) were identified as predisposing factors for ATDH.

Conclusion: Results of our preliminary clinical trial suggested that cotreatment with 2000 mg oral L-carnitine solution daily for 4 weeks significantly decreased the rate of ATDH.
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http://dx.doi.org/10.1111/jgh.12474DOI Listing
May 2014

Carnitine deficiency and its possible risk factors in TB patients: first report.

Immunotherapy 2013 Sep;5(9):945-53

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Enghelab Avenue, 1417614411, PO Box 14155/6451, Tehran, Iran.

Aim: To assess carnitine serum levels and possible risk factors of its deficiency in patients with TB.

Patients & Methods: All newly diagnosed TB patients admitted to an infectious diseases ward were recruited. Demographic, clinical and paraclinical characteristics of the patients were collected. Total carnitine serum concentrations were measured. To investigate factors that can predict carnitine deficiency, logistic regression analysis with odds ratio and 95% CI was performed.

Results: The mean ± standard deviation of carnitine serum levels of patients was 43.77 ± 32.92 µmol/l. Carnitine deficiency was detected in 47.7% of the study population. According to the final model of multivariate logistic regression analysis, increased serum triglyceride levels and hypoalbuminemia were identified as predictive factors of carnitine deficiency in TB patients aged over 35 years old.

Conclusion: Nearly half of Iranian patients with TB were carnitine-deficient. Increased serum triglyceride levels and hypoalbuminemia were identified as independent risk factors of carnitine deficiency in patients aged over 35 years. Considering malnutrition as a major risk factor of TB and the safety of carnitine supplementation, use of carnitine as an adjunctive modality instead of other standard interventions may show beneficial effects in patients with TB.
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http://dx.doi.org/10.2217/imt.13.90DOI Listing
September 2013

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

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

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

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

Cyproheptadine for prevention of neuropsychiatric adverse effects of efavirenz: a randomized clinical trial.

AIDS Patient Care STDS 2013 Mar 26;27(3):146-54. Epub 2013 Feb 26.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Cyproheptadine prevention of the neuropsychiatric adverse effects of an antiretroviral regimen including efavirenz has been evaluated in a randomized clinical trial. Twenty-five patients (16 males and 9 females with mean±SD ages of 36±9 years) in a cyproheptadine group, and 26 patients (17 males and 9 females with mean±SD ages of 34±7 years) in a control group completed the trial. Sexual contact and injection drug use were the main routs of HIV infection in both groups. The patients' neuropsychiatric adverse effects were evaluated based on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation, and Somatization Subscale of Symptom Checklist 90 at baseline and 4 weeks after treatment. Cyproheptadine significantly decreased the scores of Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation of the patients after 4 weeks in comparison with control group. All of the scores increased in control group following antiretroviral therapy. Although short duration of the patients' follow-up was a major limitation of the study, the results of the study showed that cyprohepradine is effective in prevention of depression, anxiety, hallucination, aggressive behaviors, emotional withdrawal, poor rapport, poor impulse control, active social avoidance, suicidal ideation, and improved sleep quality of HIV-positive patients after initiation of antiretroviral therapy including efavirenz.
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http://dx.doi.org/10.1089/apc.2012.0410DOI Listing
March 2013

Multiple brain abscesses due to nocardia in an immunocompetent patient.

Arch Iran Med 2013 Mar;16(3):192-4

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

Nocardia cerebral abscesses are rare intracranial lesions. They account for only 1% to 2% of all brain abscesses. They are important in immunocompromised patients, but rarely occur in immunocompetent hosts. Here, we present a case of multiple primary brain abscesses with Nocardia in an immunocompetent patient, who was treated successfully with oral antibiotic therapy.
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http://dx.doi.org/013163/AIM.0015DOI Listing
March 2013

Changes in gram negative microorganisms' resistance pattern during 4 years period in a referral teaching hospital; a surveillance study.

Daru 2012 Sep 10;20(1):28. Epub 2012 Sep 10.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Unlabelled:

Background And Purpose: Surveillance studies evaluating antimicrobial susceptibilities are of great value in preventing the spread of resistant pathogens by elucidating the trend of resistance in commonly used antibiotics and as a consequence providing information for prescribing the most appropriate agent. This study is a longitudinal antimicrobial resistance surveillance study designed to evaluate the trend in antimicrobial resistance to gram negative microorganisms from 2007 to 2010.

Method: During a four-year period (2007-2010) isolates derived from all patients admitted to infectious diseases ward of Imam Khomeini Hospital, the major referral center for infectious disease in Iran with the highest admission rates, were evaluated. Based on disk diffusion method and zone of inhibition size, the microorganism was regarded as to be sensitive, resistant or has intermediate susceptibility to the antimicrobial agents.

Results: The widest spread Gram-negative microorganism in all of isolates taken together in our study was E.coli (30%) followed by Stenotrophomonas maltophilia in 28.6% and Enterobacter spp. in 11.9%, respectively. The susceptibility to amikacin, imipenem, piperacillin/tazobactam, and nitrofurantoin was equal or above 50% for all microorganisms over four years. However, the susceptibility to ampicillin, ampicillin/sulbactam, cefotaxim, and ceftriaxone was less than 50% in derived isolates during the study period.

Conclusion: In conclusion, the finding of the present study revealed that resistance rate to common antimicrobial agents in Iran is growing and isolates were susceptible mostly to broad-spectrum antibiotics including imipenem and piperacillin/tazobactam.
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http://dx.doi.org/10.1186/2008-2231-20-28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555731PMC
September 2012

Lung hydatid cysts.

BMJ Case Rep 2012 Sep 3;2012. Epub 2012 Sep 3.

Department of Pulmonary Medicine, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

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http://dx.doi.org/10.1136/bcr-2012-006551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4544180PMC
September 2012

Changes in 4-year antimicrobial resistance pattern of gram-positive bacteria at the main referral teaching hospital, Tehran, Iran.

Acta Med Iran 2012 ;50(7):493-504

Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Iran.

Infectious diseases are one of the most common causes of morbidity and mortality and the spread of resistant microorganisms is playing a significant role in this regard. The purpose of this study was to assess the trend in antimicrobial resistance of gram-positive bacteria at the main referral teaching hospital in Tehran during a 4-year period. All patients' biological isolates such as blood, urine, wound drainage, synovial fluid, sputum, and cerebrospinal fluid sent to the central laboratory of the hospital from 2007 to 2010 for identification and subsequently, antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method were considered. All isolates (100%) of S. aureus were sensitive to vancomycin and linezolid and resistant to amoxicillin. The rate of S. aureus resistance to oxacillin increased from 60.78% in 2007 to 72% in 2010. All isolates of Streptococci in 2007 and 2008 were sensitive to vancomycin; while, 3.33% and 4.76% of Streptococci isolates were reported to be vancomycin-resistant in 2009 and 2010, respectively. Enterococci isolated from the entire specimens were identified to be sensitive to teicoplanin and linezolid and resistant to cloxacillin and oxacillin. The rates of Enterococci sensitivity to vancomycin were 90.91%, 81.25%, 86.67%, and 93.3% in 2007, 2008, 2009, and 2010, respectively. Changes of antibiotics sensitivity against g positive pathogens were significant during four years in this study. To minimize the spread of resistant gram positive pathogens, periodic and regular surveillance of antimicrobial resistance pattern is highly recommended.
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January 2013

Effects of vitamin D supplementation on the bone specific biomarkers in HIV infected individuals under treatment with efavirenz.

BMC Res Notes 2012 Apr 26;5:204. Epub 2012 Apr 26.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Background: It was reported that antiretroviral drugs such as efavirenz can increase the catabolism of vitamin D in HIV infected individuals. We have not found any study that evaluated effects of vitamin D supplementation on the bone specific biomarkers in HIV positive patients under treatment with antiretroviral regimen containing efavirenz.

Findings: Vitamin D deficiency was detected in 88.4 % of included patients. Baseline osteocalcin, but not collagen telopeptidase, serum levels were lower than normal range in all of these individuals. Both bone biomarkers' concentrations increased significantly (p < 0.001 for both of them) after supplementation of vitamin D and it was more predominant for osteocalcin.

Conclusion: In the HIV-infected patients under treatment with efavirenz, vitamin D deficiency is prevalent. After supplementation with single dose of 300,000 IU vitamin D in this population, the activation of osteoblasts and osteoclasts stimulates bone formation and resorption respectively with favorable bone formation without any adverse event. Significant percent of HIV infected individuals are vitamin d deficient that could benefit from vitamin D supplementation.
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http://dx.doi.org/10.1186/1756-0500-5-204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3527201PMC
April 2012

Serum vitamin D concentration and potential risk factors for its deficiency in HIV positive individuals.

Curr HIV Res 2012 Mar;10(2):165-70

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

Human immunodeficiency virus (HIV) infected individuals are prone to malnutrition, and deficiencies of some minerals and vitamins. The aim of this study is to evaluate the frequency of vitamin D deficiency and determine the possible risk factors associated with this problem in HIV-infected individuals. This cross-sectional study was performed on 98 adult patients referred to the Emam Khomeini Hospital Complex, Tehran, Iran. The patients' serum vitamin D concentration was determined using radioimmunoassay method. The possible correlations between demographic and clinical data with the level of vitamin D were evaluated. Vitamin D levels less than 35 nmol/l were considered as deficient in this study. Eighty-five (86.7%) of the patients had serum vitamin D deficiency (concentrations less than 35 nmol/l) in this study. Coinfection with hepatitis C virus (HCV) was present in 54 (55.1%) of the patients. Only daily intake of vitamin D (r = 0.304, p = 0.002), duration of sun exposure (r = 0.268, p = 0.009), the level of PTH (r = -0.459, p < 0.001), daily intake of calcium (r = 0.239, p = 0.018) and GFR of more than 90 ml/min (OR = 1.208, CI 95% = 1.080-1.350, p = 0.033) had a correlation with serum vitamin D concentration. Being female (OR = 7.224, CI 95% = 3.640-14.335, p < 0.001), unemployed (OR = 1.627, CI 95%= 1.209-2.190, p < 0.001) and infected with HCV (OR = 1.811, CI 95% = 1.331-2.465, p < 0.001) were related to the severe serum vitamin D deficiency. Vitamin D deficiency is a common problem in Iranian HIV-infected patients and with concern of this vitamin's important role in health issues, early evaluation of its status and providing appropriate nutritional support seems to be important.
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http://dx.doi.org/10.2174/157016212799937272DOI Listing
March 2012

Brucella infection in HIV infected patients.

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

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

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