JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2014 | Volume:19 | Issue:SUPPLEMENT 1|Papers Count:16

Background: Lipid metabolism is one of the hepatitis C virus (HCV) life cycle steps. Statins can reduce cholesterol level and finally can decrease HCV replication. Thus, we assessed the effect of Statins in combination with standard antiviral treatment on hyperlipidemic genotype I HCV infected patients.Materials and Methods: This study was a prospective clinical trial. 40 patients were selected from those referred to educational and Therapeutic Centers of Isfahan University of Medical Sciences from 2009 to 2010 with confirmed HCV viremia. All patients received Peg-interferon-a2a and ribavirin. 20 hyperlipidemic Patients received 20 mg atorvastatin nightly for 3 months and placebo was prescribed for 20 normolipidemic HCV infected patients as a control group. Liver enzymes and complete blood count were checked monthly and thyroid stimulating hormone was checked every 3 months. We also performed quantitative HCV-ribonucleic acid (RNA) test in 12th week of therapy, at the end of treatment and 6 months after therapy for all samples.Results: We didn’t find any significant differences in the mean of HCV-RNA numbers between statin and placebo groups in 12th week of treatment, in the end of treatment and 6 months after treatment (P>0.05).Conclusion: Atorvastatin has no effect on the mean of HCV viral load when we added it to standard treatment for hepatitis C infection. Further studies are necessary to examine the possible antiviral properties of statins and their potential role as adjuncts to standard HCV therapy.

Background: Idiopathic granulomatous mastitis (IGM) is defined as a rare, inflammatory, chronic and benign disease mimicking malignant hyperplasia of mammary glands. There is no definitive therapeutic strategy for IGM; nevertheless, some approaches can be exploited as beneficial strategies. In this study, the surgery strategy was compared with coincident treatment with azithromycin and corticosteroid in IGM patients.Materials and Methods: This study was implemented as clinical trial during 2011-2013 in Isfahan, Iran. The target population comprised women whose IGM was substantiated. The medical group consisted of 20 patients, which were compared with a historical control group treated through surgical approach. Surgical group comprised 39 patients. Partial mastectomy was implemented in the surgical group whereas treatment protocol comprising azithromycin and prednisolone administered in medical group. Recurrence of mass was followed for 12 months. Fischer exact test, Chi-square test, Mann-Whitney and regression tests were applied for statistical analysis. This study was registered in Iranian Registry of clinical trial (IRCT number: IRCT 2013123015999N1).Results: No significant differences were recognized in side of lesions, lymphadenopathy, fever and pain; however, number of abscesses, number of lesions and size of lesions were significantly higher in the surgical group (P<0.0001). Furthermore, probability of relapse correlated with the number of lesions, (odds ratio=24.67 confidence interval [CI]=2.2-269.3), whereas methods of IGM treatment did not contribute to the likelihood of relapse (odds ratio=12.5 CI=0.52-299).Conclusion: This clinical trial demonstrated that pharmaceutical treatment has appropriate efficacy, in treatment and prevention of IGM relapse. Moreover, this study presented hazf gardad number of the lesions as the most appropriate criteria for IGM prognosis, thus the probability of relapse decreases whether earlier IGM recognizing could be implemented.

Background: Health science students are at an increased risk of hepatitis A virus (HAV) infection even under accidental infection. The aims of this study were to assess the seroprevalence of HAV in 1st year medical students and to determine the risk factors of HAV vaccination program among this population.Materials and Methods: A cross-sectional study was conducted in autumn 2010. A total of 1028 newly admitted medical students in Isfahan, Kermanshah and Hamedan were included in the study. Participant data were obtained through predesigned data collection sheets. A serum sample was obtained for serologic testing for the presence of IgG anti-HAV using a commercially available enzyme-linked immunosorbent assay kit. Descriptive statistics, Chi-square and logistic regression tests were performed for statistical analysis and P < 0.05 was considered as significant.Results: The prevalence of HAV was detected in Isfahan, Hamedan, and Kermanshah newly admitted students 67.5%, 79.2%, and 50.6% respectively. There were significant relations between anti-HAV (IgG) positivity in drinking water and medical students provinces (P<0.001, RR=0.58 and 0.65 respectively). The household size did not significantly influence the anti-HAV (IgG) positivity in studied subjects (P=0.09, RR=1.26).Conclusion: Our results indicate that more than one-third of the medical students in all three faculties were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest students in a health care set up should undergo vaccination against HAV after prevaccination immunity screening.

Background: Drug injection is one of the most prominent risk factors for transmission of viral hepatitis. Prevalence of hepatitis B virus (HBV) is generally higher in prisoners compared with the general population. The object of this study was to assess the markers of HBV and related risk factors among intravenous drug users (IVDU) in prisoners.Materials and Methods: Through a cross-sectional study in 2012 HBV infection and its risk factors were assessed in prisoners with a history of intravenous drug use in Isfahan, Iran. A checklist was fulfilled for each participant and 5 ml blood was taken from each subject. Sera were analyzed for markers of the hepatitis B: Hepatitis B virus surface antigen (HBsAg), antibody to hepatitis B virus surface antigen (HBsAb) and hepatitis B virus core antibody (HBcAb) by ELISA. We used Chi-square test and logistic regression model to analyze data and P<0.05 was considered to be significant.Results: All of the studied participants (n=970) were men. The mean±standard deviation of the age of the subjects was 32.61±8.1 years and the majority of them had less than high school education. More than 40% of these men had a history of injection drug inside prison and 2.27% of them self-reported history of HBV infection. Of the 970 IVDU, 32 (3.3%) were positive for HBsAg. Among HBsAg + subjects, 23 (71.88%) were HBcAb+. 120 (12.37%) were found positive for isolated HBsAb, 45 (4.64%) for isolated HBcAb and 67 (6.9%) for both HBsAb and HBcAb. History of sharing needle (odds ratio: 2.25, 95% confidence interval: 1.09-4.65) had a significant association with HBsAg positivity.Conclusion: The results suggest that history of sharing needle had a significant association with HBsAg positivity. It seems that educational programs for injecting drug related behaviors, especially syringe sharing, are needed for IVDU.

Background: Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are the three prevalent viral and bloodborne infections worldwide. Considering the similar route of transmission in these infections, their co-infections would be more challenging for health care professionals. Therefore, we investigated the rate of HIV/HBV/HCV co-infection among injection drug users (IDUs) referred to Drop in centers (DICs).Materials and Methods: In this cross-sectional study (2008-2009), IDUs referred to DICs in Isfahan province were evaluated. Venous blood samples were obtained and HBsAg, HBcAb, HCVAb, and HIVAb measured by using enzyme linked immunosorbent assay method. Demographic data and risk factors in patients with HBV/HCV, HIV/HCV, and HIV/HBV co-infections were obtained by a trained social worker using a structured checklist. Data were analyzed using Chi-square test, t-test, and multiple logistic regressions.Results: Totally, 539 IDUs with mean (standard deviation [SD]) age of 35.3 (7.9) were studied. HBV/HCV, HCV/HIV, and HBV/HIV co-infections were presented in 65 (12.1%), 6 (1.1%), and 0 (0%) of IDUs, respectively. All HIV infected IDUs were infected with HCV as well. There was a significant association between HBV/HCV co-infection and behaviors related to sharing needle (odds ratio [OR]=2.06, 95% confi dence interval [CI]; 1.23-3.45) and imprisonment (OR=1.01, 95% CI; 1.04-1.06).Conclusion: According to the results of this study, history of imprisonment and needle sharing were the only adjusted risk factors for HCV/HBV co-infection in IDUs. This might be a warning for national health system and needs to urgent paying attention. It seems that expanded harm reduction strategies can be useful to reduce this co-infection and its mortality and morbidity rate among IDUs.

Background: Some evidence has shown a relationship between human cytomegalovirus (CMV) infection and pregnancy loss. However, whether recurrent or latent CMV infection or altered immune response to CMV is related to recurrent pregnancy loss (RPL) is unclear. We evaluated CMV infection and avidity of antibodies to CMV in women with RPL.Materials and Methods: This case-control study was conducted on 43 women with RPL referred to a clinical immunology out-patient clinic in Isfahan (Iran), and 43 age-matched multiparous women without history of abortion as control subjects. Patients and controls were evaluated for anti- CMV IgG and IgM antibodies and IgG avidity index (AI) using the enzyme linked immunosorbent assay method. Student’s t-test and Chi-square test were used to analyze the data.Results: One case (2.3%) of positive anti-CMV IgM was detected in each group. Anti-CMV IgG positivity was more frequent in patients than in controls (90.6% vs. 69.8%, P=0.014), but there was no difference between the two groups in anti-CMV IgG AI (79.4±11.4 vs. 80.1±10.2, P=0.781). IgG titer was significantly higher in seropositive cases with RPL than seropositive controls (5.18±1.99 vs. 2.00±0.81, P<0.001).Conclusion: We found that previous exposure to CMV was significantly higher in patients with RPL than the control group. However, no association was found between IgG AI and RPL. Further investigations are needed to find whether latent CMV infection starts an indirect process of autoimmune etiology in RPL or women with RPL have recurrent or reactivation of CMV infection.

Background: Detection of latent tuberculosis infection (LTBI) in transplant candidates is very important. The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are standard immunologic tools for LTBI detection. The aim of this study was to compare the TST results and T-SPOT®.TB test (a type of IGRAs) in kidney transplant candidates for the screening of LTBI and follow the patients with positive test for an activation of tuberculosis (TB) after transplantation and using anti-TB prophylaxis.Materials and Methods: This study was a prospective study and carried out in 44 renal transplant candidates from March 2010 to February 2011 in the teaching hospitals of Isfahan University of Medical Sciences, Iran. TST and T-SPOT®.TB test were performed and their results evaluated. Patients with a positive skin test and/or T-SPOT®.TB test were started on anti-TB prophylaxis and followed after transplantation for an activation of their LTBI for 1 year.Results: Overall, 8 (18.2%) patients were positive for TST and 6 (13.6%) patients for T-SPOT®.TB test. The agreement between TST and T-SPOT®.TB test was moderate (k=0.49, 95% confidence interval 0.145-0.839). The overall agreement between TST and T-SPOT®.TB test was 86%. No relation was found between the underlying diseases and TST or T-SPOT®.TB test positivity. Although isoniazid prophylaxis was used for patients with positive TST and/or T-SPOT®.TB test, one patient had reactivation of TB.Conclusion: In kidney transplant candidates both TST and T-SPOT®.TB test were comparable for the diagnosis of LTBI with reasonable agreement between the tests. However, further studies are needed to determine the ability of T-SPOT®.TB test to detect LTBI and to evaluate the need for prophylaxis in these patients.

Background: Common variable immunodeficiency (CVID) is characterized by a deficiency in the immune system with a heterogeneous collection of disorders resulting in antibody deficiency and recurrent infections. T helper 17 (Th 17) cells promote B-cell survival and synergize with the B-cell activating factor to induce their differentiation into the plasma cells. A sub-population of innate lymphoid cells (ILCs) also produces interleukin 17 (IL-17). This study aimed to measure the Th 17 specific genes and ILCs counts in the CVID patients in comparison with control subjects.Materials and Methods: Total messenger ribonucleic acid (mRNA) was extracted from the whole blood samples of 10 CVID patients and 10 healthy individuals. IL-17, retinoic acid receptor-related orphan receptor C2 (RORC2), IL-23R, and IL-9 gene expression were measured using the quantitative reverse transcriptase-polymerase chain reaction. Count of lineage negative/CD127+/CD90+ ILCs in the blood samples was performed by the flow cytometry method.Results: The transcript levels of IL-17 and RORC2 in CVID patients was strongly lower than control subjects (P=0.049 and P=0.046, respectively), but slight reduction in the IL-23R expression (P=0.252) have seen in the CVID patients. Accordingly, the number of ILCs decreased significantly (P=0.04). Interestingly, IL-9 mRNA level was more significantly in the CVID patients (P=0.001).Conclusion: The results presented in this study show that the Th 17 cell specific genes expression (as the determiner Th 17 cells) and ILCs (another lymphoid source of IL-17) are decreased in patients with CVID and this could be an explanation for the defect of their humoral immune response. In addition, elevation of the IL-9 gene expression may shed a new light into the way toward the understanding of the mechanism of autoimmunity in the CVID patients.

Background: Adaptive immune response is an important factor in the healing process and development of protection in cutaneous leishmaniasis (CL). Little information is available in human CL about the importance of the balance between effector and regulatory immune responses. Therefore, the aim of this study was to asses messenger ribonucleic acid (mRNA) expression of interleukin-10 (IL-10), IL-4, transforming growth factor-b1 (TGF-b1), interferon-g (IFN-g), and forkhead box P3 (Foxp3) (as a marker of regulatory T cells) in acute and chronic CL lesions caused by Leishmania major compared with normal skin samples.Materials and Methods: Thirty biopsies were obtained from CL patients with acute lesions (AL, n=13), chronic lesions (CH, n=11) and healthy volunteers (n=6). Relative expressions of target genes were determined by means of reverse transcription real time polymerase chain reaction and were compared with the controls.Results: Expression of Foxp3, IL-4, and IFN-g were significantly more in CH than AL group of patients (Foxp3: Median 0.48, inter-quartile range 0.32-0.76 [arbitrary units] for AL, and 0.97 (0.75-1.30) for CH, P=0.006; IFN-g: 45.98 (33.39-173.48) for AL, and 200.53 (97.49-361.76) for CH, P=0.023; IL-4: 0.49 (0.34-2.16) for AL, and 2.14 (1.30-7.11) for CH, P=0.021). Expression of TGF-b was not significantly different between groups.Conclusion: The results indicate that IL-4 secretion at the site of L. major infection rather than low IFN-g production might have a role in prolongation of disease. Despite a moderate increase of Foxp3 expression in chronic lesions, function of Tregs in persistent infection is not clear.

Background: Production of b-lactamase enzymes is the most common and important mechanism of resistance in Gram-negative bacteria. The objective of this study was to assess frequency of three main b-lactamase enzymes, including extended spectrum b-lactamases (ESBLs), metallo-b-lactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) enzymes in Escherichia coli and Klebsiella spp. isolated from nosocomial and community urinary tract infections (UTI).Materials and Methods: In a cross-sectional study from March to December 2012, midstream urine samples were obtained from patients suspicious of UTI who were hospitalized or referred to Al-Zahra Hospital, Isfahan, Iran. Samples were cultured and E. coli and Klebsiella spp. were isolated. Prevalence of ESBLs, KPC, and MBLs producing E. coli and Klebsiella spp. were studied by double-disk (combined-disk), the modified Hodge test and imipenem-ethylenediaminetetraacetic acid combined disc methods respectively. In addition, their antimicrobial susceptibility patterns determined and resistant to carbapenem drugs confirmed by minimum inhibitory concentrations based on E-test method.Results: A total of 1080 E. coli and 484 Klebsiella strains were isolated during study period. Among 720 E. coli and 384 Klebsiella isolates from hospitalized patients, 300 (41.7%) and 198 (51.5%) were ESBLs producers, respectively. In out-patients samples, the rate of ESBLs production was 25% (90.360) and 40% (40.100) in E. coli and Klebsiella isolates, respectively. Prevalence of MBLs producing in hospital E. coli and Klebsiella isolates were 0.3% (2.720) and 2.6% (10.384), and for KPC data were 1.4% (10.720) and 48.4% (186.384), respectively. No MBLs and KPC producing isolate was seen in non-hospital E. coli and Klebsiella isolates except for one non-hospital KPC producing Klebsiella isolate.Conclusion: The result of our study showed high prevalence of ESBLs and KPC, but low prevalence of MBLs in cultured bacteria from urine samples of patients with acute UTI. In addition, KPC was the main carbapenem resistance mechanism in Klebsiella and E. coli isolates.

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients with high morbidity and mortality rates. The etiology of VAP is usually bacterial. Opportunistic fungi such as Candida and Aspergillus species (spp.) are found frequently in the respiratory track secretions of immunocompetent critically ill patients known as colonization. Contribution of fungi colonization to severe bacterial VAP and poor prognosis of these patients has been documented in several studies. The aim of this study was to detect Candida spp. and Aspergillus fumigatus colonization in patients with a clinical diagnosis of VAP as a marker of high risk pneumonia.Materials and Methods: Bronchoscopic alveolar lavage (BAL) fluids from patients with VAP in central intensive care unit (ICU) of a tertiary university hospital in Isfahan were examined by real time polymerase chain reaction (PCR) to detect Candida spp. or A. fumigatus. Rate of fungi colonization and its association with clinical criteria of the patients was determined.Results: BAL fluids from 38 patients were tested from which six samples (15.8%) were positive for Candida spp. And five (13.2%) for A. fumigatus. Fungi colonization was not associated with age, sex, or mortality rate of patients. Rate of A. fumigatus colonization was significantly more in traumatic patients (P=0.036), and higher in patients ventilated more than 4 weeks (P=0.022).Conclusion: High rate of A. fumigatus colonization in our ICU patients indicates that underlying causes such as unfavorable ICU conditions and other patient related factors such as unnecessary antibiotic therapy should be further evaluated.

Background: Antibiotic resistance of enteric pathogens particularly Shigella species, is a critical world-wide problem and monitoring their resistant pattern is essential, because the choice of antibiotics is absolutely dependent on regional antibiotic susceptibility patterns. During summer 2013, an unusual increase in number of diarrheal diseases was noticed in Isfahan, a central province of Iran. Therefore, the antibiotic resistance of diarrheagenic Escherichia coli and Shigella species isolated were evaluated.Materials and Methods: According to the guideline on National Surveillance System for Foodborn Diseases, random samples from patients with acute diarrhea were examined in local laboratories of health centers and samples suspicious of Shigella spp. were further assessed in referral laboratory. Isolated pathogens were identified by standard biochemical and serologic tests and antibiotic susceptibility testing was carried out by disc diff usion method.Results: A total of 1086 specimens were obtained and 58 samples suspicious of Shigella were specifically evaluated. The most prevalent isolated pathogen was Shigella sonnei (26.58) followed by E. coli (25.58) and Shigella flexneri (3.58). A large number of isolated bacteria were resistant to co-trimoxazole (Shigella spp: 100%, E. coli: 80%), azithromycin (Shigella spp: 70.4%, E. coli: 44.0%), ceftriaxone (Shigella spp: 88.9%, E. coli: 56.0%) and cefixime (Shigella spp: 85.2%, E. coli: 68.0%). About88.3% of S. sonnei isolates, one S. flexneri isolate, and 56% of E. coli strains were resistant to at least three antibiotic classes (multidrug resistant).Conclusion: Due to high levels of resistance to recommended and commonly used antibiotics for diarrhea, continuous monitoring of antibiotic resistance seems essential for determining best options of empirical therapy.

Background: Hepatitis A virus (HAV) is a major cause of acute viral hepatitis worldwide. Annual medical and work loss costs of hepatitis A are significant even in low-endemic countries. It is recommended that each country should collect and review the information needed to estimate its national burden of hepatitis A to provide evidence for health policy makers to implement appropriate and cost-effective preventive strategy for HAV infection. The objective of this study was to estimate accurate prevalence of HAV infection in Iran for best preventive measures.Materials and Methods: MEDLINE, Institute of Scientific Information, Scopus, Iranmedex, Irandoc, Magiran and Scientific Information Database were searched. The seroprevalence of HAV were pooled by age, sex and residence using fixed and random effect models.Results: Sixteen papers representing 11857 subjects were included. The overall HAV seroprevalence was 51% (confidence interval [CI] 95%: 50-52%) in fixed and 66% (95% CI: 50-79%) in random effects models. The prevalence was 32% (CI 95%: 11-63%) in less than 20, 50% (CI 95%: 24-75%) in 20-30, and 67% (CI 95%: 17-95%) in more than 30 years of age. The difference was not significant in gender or residence subgroups.Conclusion: HAV infection in Iran may be considered as low or very low. Therefore, targeted vaccination of high-risk groups and more improvement in environmental sanitation would be the best preventive measure.

Background: Detection of hepatitis B virus (HBV) genomes without detectable hepatitis B surface antigen (HBs-Ag) is termed occult HBV infection (OHBV) that may be transmitted by blood transfusion or organ transplantation and has acute reactivation when an immunosuppressive status like human immunodeficiency virus (HIV) infection occurs. We aimed to evaluate OHBV in HIV-infected patients with isolated antibodies to hepatitis B core antigen (anti-HBc) in Isfahan, Iran.Materials and Methods: In a cross-sectional study during August-September 2011, serum samples from HIV-infected patients who attended Isfahan Consultation Center for Behavioral Diseases were tested for HBs-Ag and anti-HBc using ELISA method. HBV-deoxyribonucleic acid (DNA) was detected and quantified in plasma of HBs-Ag negative/anti-HBc positive subjects by real-time polymerase chain reaction.Results: From 64 HIV-positive individuals, 12 (18%) patients were HBs-Ag negative/anti-HBc positive, and from those 3 (25%) had detectable HBV-DNA in their plasma.Conclusion: It seems that occult HBV might be assessed and be treated in HIV-infected patients.

Background: Nosocomial infection caused by Acinetobacter baumannii has emerged as a serious problem world-wide. Finding the suitable drug is an important priority. The aim of this study was to determine colistin (polymyxin E) resistance in clinical isolates of A. baumannii from intensive care units (ICUs) of Al Zahra Hospital.Materials and Methods: Sixty isolates of A. baumannii from patients hospitalized in ICU (Al Zahra Hospital, Isfahan University of Medical Sciences [IUMS]) were studied. All isolates of A. baumannii were tested for colistin susceptibility by Eopsilometer test (E-test). Results: Of the 60 isolates 57, (95%) were multidrug resistant (MDR) and 76.6% (46.60) were highly resistant. The rate of colistin resistant with the E-test method was 11.6% (7.60). Conclusion: As the frequency of resistance to colistin is low, it can be used as an easily available drug for treatment of MDR A. baumannii strains, which are susceptible to colistin.

Background: Immunodeficiency is a heterogenous group of diseases affecting different components of the immune system. Patterns of infection, etiology and organ involvement are not similar in this risky population. This study was conducted to determine the prevalence of congenital and acquiring immunodeficiencies and also recognizing the most common infections and affected organs.Materials and Methods: In a retrospective, cross-sectional survey, during 2006-2012, we reviewed all hospital records with any kind of immunodeficiency admitted in, all departments of university referral hospital, Isfahan, Iran.Results: Various immunodeficiencies, sorted by prevalence, were as below: Primary immunodeficiency diseases (PIDs) 122 (27.4%), lymphohematogenous malignancy (LHM) 105 (23.5%), solid cancer 56 (12.6%), human immunodeficiency virus/acquired immunodeficiency syndrome 64 (14.5%), non-cytotoxic immunosuppresion 94 (21%), and splenectomy 5 (1.2%). Common sources of infection were blood, lungs and buccal cavity. Conclusion: The most frequent type of immunodeficiency was PIDs and LHM. Infection continues to be a major problem in all variety of immunodeficiency.