سال:1387 | دوره: | شماره: |تعداد مقالات:11

By end of 2008, 48 countries have planned strategic pre-pandemic program against influenza. Strategic planning for a new influenza pandemic is now a top global public health priority. Influenza prevention can be considered under the broad categories of antiviral, vaccine and non pharmaceutical (case isolation, household quarantine, school or work place closure, and restriction on travelers). The World Health Organization (WHO) has advocated that countries should develop pandemic preparedness plans to control or mitigate the effects of a future influenza pandemic

Background: Streptokinase (SK) is most widely used for treatment of myocardial infarction, however, it is the most expensive thrombolytic agent. A major drawback to SK use is the widespread presence of anti–streptokinase antibodies (Abs). These Abs cause allergic reactions and neutralize streptokinase therapeutic effects.Materials and methods: To produce an engineered variant of streptokinase being functional and less antigenic than the native molecule, we cloned and expressed streptokinase mutant gene lacking the C-terminal 42 amino acids. Recombinant protein was confirmed by western blot analysis with anti T7 monoclonal antibodies.Results: pGEMEX-1 expression vector contains T7 gene 10 protein as fusion protein immediately downstream of T7 promoter and before multiple cloning site, streptokinase mutant gene was cloned after fusion protein.Conclusion: We cloned and expressed mutant streptokinase gene, lacking the C-terminal 42 amino acids. If mut-C42 activity was less affected by neutralizing antibodies compared with native streptokinase, this engineered variant could be a preferred alternative to native streptokinase for thrombolytic therapy.

Background: Brucellosis is a zoonotic, chronic and infectious disease, which is caused by bacteria of genus Brucella. The present study investigated exactly what species and biovars of Brucella are responsible for brucellosis in Iran.Materials and methods: The various species of Brucella were mostly being isolated from suspected specimens of animal fetus, placenta, vaginal swab, lymph nodes, milk, and human blood and bone marrow cultures. A total of 618 strains of B. abortus and 2413 strains of B. melitensis have been subjected to the identification procedures.Results: Of 3031 isolates, 618 and 2413 were B. abortus and B. melitensis, respectively. Strains of B. abortus were isolated from cattle (612 cases) and sheep (6 cases). These isolates were biovars 1 (70 cases), 2 (1 case), 3 (511 cases), 4 (1 case), 5 (30 cases) and 9 (5 cases). Biovar 3 is considered as the endemic one and biovars 1 and 5 are the most prevalent. B. melitensis strains were isolated from sheep and goats (1717 cases), cattle (109 cases), camel (5 cases), dogs (4 cases) and human beings (497 cases). These isolates were biovars 1 (2102 cases), 2 (205 cases) and 3 (106 cases). B. suis, B. neotomae, B. ovis and B. canis were not isolated.Conclusion: In many regions of Iran B. abortus biovar 3 still remains the dominant one, however, for B. melitensis biovar 1 is the most prevalent one.

Background: Acute hepatitis A in patients with chronic liver diseases (CLD) may lead to a more severe outcome for which routine vaccination is recommended in many regions. Nevertheless, studies of HAV seroprevalence and exposure predictors in populations with CLD are scanty in our region.Patients and methods: We studied 200 patients with CLD between September 2005 and September 2006. Patients were stratified on the basis of age, gender, size of family, place of residency and etiology of liver disease. The HAV seroprevalence in patients with CLD was compared with age- and sex-matched controls. Independent predictors of HAV exposure were identified by logistic regression analysis.Results: Of 200 patients, HAV seroprevalence was available for 190 (96.5%). Hepatitis B and C, alcohol, autoimmune hepatitis and Wilson’s disease were the causes of CLD. Most of the seronegative patients aged 10-20 years. The overall HAV seroprevalence was 97.3% in controls. None of the risk factors were identified as independent predictors.Conclusion: Age stratified seroprevalence of HAV in patients with CLD is close to that of the general population. High prevalence of HAV must be considered in vulnerable travelers to our country.

Background: Acute diarrhea is the fifth leading cause of death due to infectious diseases and responsible for 16.2% of the infectious disease burden in Iran. This study assessed the incidence and some determinants of acute diarrheal diseases in Tehran, the capital of Iran.Patients and methods: Using cluster sampling, a population based survey was conducted among 2095 children aged 6 to 60 months in the southern districts of Tehran during May 2005. The incidence of acute diarrhea during the past 2 weeks, the duration and frequency of diarrhea, acute diarrhea in siblings and socioeconomic determinants were gathered by a questionnaire.Results: Totally, 10.3% of children experienced new onset of diarrhea during the past two weeks with the average number of episodes of 2.8 per child. Half of the cases were 6-18 months of age (p<0.001). The mean (±standard deviation) duration of disease was 4.5±2.1 days and the frequency of diarrhea was 5.1±5 episodes per day. In 9.1% of the families, other cases of concurrent acute diarrhea were reported in siblings (OR=1.29, 95%CI:0.67-2.47). The mean age of the mothers was 31±7.5 years. Less than 4% of the parents were illiterate.Conclusion: Childhood acute diarrhea remains a public health concern in Tehran. Improving the environmental sanitation and personal hygiene and raising the socioeconomic status of the population will contribute to the elimination of the underlying causes of acute diarrhea.

Background: Brain abscess is a focal intracerebral infection, which begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule. In the present study, we studied all patients with brain abscess admitted in Ardabil Fatemi hospital.Patients and methods: In a retrospective hospital-based study, 24 patients with brain abscess entered the study. Medical records of patients were reviewed from January 2004 to January 2006. Brain abscess was defined as one or more localized lesions with the following characteristics in brain imaging (CT scan): hypodense center with a peripheral uniform ring enhancement following the injection of contrast material, or affected region surrounded by variable hypodense area of brain edema or nodular enhancement or area of low attenuation without enhancement. Predisposing factors for brain abscess were surveyed by reviewing medical records.Results: The study population included 17 males and 7 females with the mean age (± standard deviation) of 27.0±21.3 years. The following predisposing factors were noted in 22 (91.6%) patients; contiguous focus of infection (sinusitis and chronic otitis media) in 10 (41.6%), congenital heart disease in 5 (20.8%), post traumatic complications in 3 (12.5%), super infected hydatid cyst in 2 (8.3%) and neurosurgical complications in 2 cases (8.3%).Conclusion: Ear in cerebellar and temporal lobe, frontal sinus in frontal lobe and heart in parietal lobe abscesses should be evaluated for the possible source of infection. Meanwhile, hydatid cyst may be an important risk for brain abscess in endemic areas like Ardabil.

Background: Tuberculosis (TB) is a common infectious disease worldwide especially in developing countries. Diagnosis of TB is difficult and often needs paraclinical studies. Measuring immunoglobulin's against A-60 antigen of TB microorganism has been reported as a useful technique. The aim of the present study was to evaluate the diagnostic value of serologic test (IgA, IgM, IgG) against A-60 antigen in tuberculosis.Patients and methods: For this case-control study, 176 TB patients (124 patients with smear-positive pulmonary TB and 52 patients with extra pulmonary TB) and 283 healthy controls were enrolled. Then, all subjects were tested for IgM, IgA and IgG against A-60 antigen using ELISA technique.Results: Sensitivities of IgM, IgG and IgA test were 15%, 25% and 40%, respectively while the following specificities were also reported 100%, 75% and 90%, respectively. Positive predictive values (PPV) were 100%, 57% and 72%, however, negative predictive values (NPV) were 65%, 72% and 70%, respectively. Combination of immunoglobulins' results increased sensitivity, for which the most sensitivity was observed in combination of IgG and IgA results.Conclusion: Our results revealed the usefulness of serologic testing in TB diagnosis. Although its sensitivity is not high enough, combination of immunoglobulin results may improve the sensitivity.

Background: Risk for HIV is primarily associated with two behaviors of unprotected sexual contact and injected drug use (IDU). This study was carried out to determine the demographic data and high-risk behaviors in HIV positive individuals in southern Iran.Patients and methods: Totally, 304 HIV-infected individuals referring to Center for Counseling of Behavioral Changes in Shiraz entered our study. Their demographic data and risk factors for HIV (injection addiction, unprotected sexual contact, and blood transfusion) were recorded. Blood specimens were provided and tested for HIV antibodies using an enzyme-linked immunosorbent assay (ELISA) at Fars Blood Transfusion Organization were carried out. Specimens reactive upon enzyme-linked immunosorbent assay were confirmed by western blot assay.Results: Study population included 269 males and 35 females mostly aged 25-34 years. Totally, 60% of females and 30.8% of males were married, while 80.3% of males and 74.3% of females belonged to poor-educated level (had not got diploma). Of 269 males, 247 (91.8%) had been jailed. The risk behaviors were as follow: 40.8% IDU, 16.4% unprotected sexual contact, 32.6% both IDU and unprotected sexual contact, 1.6% blood transfusion, 7.9% other high risk behaviors including tattooing, shared blade and knife injury and 0.7% had unknown high risk behavior. Maternal transmission was not observed.Conclusion: It seems that establishing Drop In Center for giving free disposed syringes to IDUs, training a correct injection and a good dressing service, bathroom, nutrition and methods replacement therapy would be effective means to reduce high risk behaviors.

Background: Resistance is the consequence of mutations that emerge in the viral proteins targeted by antiretroviral agents. Thus, we focused our attention on mutations in HIV-1 reverse transcriptase to define their association with specific NRTIs and NRTI resistance mutations at therapeutic failure.Patients and methods: The study population included 5 Iranian HIV-positive patients referring to Counseling Behavioral Modification Center in Shiraz who received a combination of antiretroviral therapy (lamivudine, stavudine and nevirapine). PBMC DNA was isolated from blood and PCR was performed to produce a 1200 bp amplicon and resolved by electrophoresis on a 0.7% agarose TBE gel, visualized with ethidium bromide. PCR products from HIV-1- infected patients were cloned into pCR2.1TOPO, then sequenced. Finally, sequence data were analyzed.Results: Results showed drug resistance in 2 patients, of whom one had NNRTI resistance mutations (M230G, L234R and K238H) and other had both NRTI (V75M) and NNRTI (F227L) resistance mutations.Conclusion: Confirmation of genetic resistance in HIV-positive patients who show therapy failure can help physicians to change their drug regime in order to achieve better outcome.

Background: Diabetes mellitus is a prevalent disease worldwide and infection is a major problem in diabetics. This study investigated the frequency of diabetes mellitus and its associated factors in patients with sepsis.Patients and methods: This is a descriptive cross-sectional study including 300 randomly selected cases admitted to Rasoul-e-Akram Hospital with the diagnosis of sepsis between March 2003 and February 2006.Results: Of 300 septic patients, 158 (52.7%) had diabetes mellitus with the mean age (± standard deviation) of 52.7±28.4 years. The most common site of infection was respiratory tract. Evaluation of the outcome of patients in two diabetic and non-diabetic groups demonstrated a statistical difference (p=0.001). Mortality rate increased with aging, delay in therapy commencement and the number of SIRS criteria (p=0.001). Evaluation of the mortality rate in 3 diabetic groups (blood glucose> 250, 180-250 and <180 mg/dl) demonstrated a statistical difference (P=0.001).Conclusion: Aging can increase the rate of sepsis and its associated mortality in both diabetic and non-diabetic patients. Mortality of sepsis is more in diabetics when compared with non-diabetics. Severity of disease (further SIRS criteria) increases mortality and tight control of blood glucose may be associated with better prognosis.

Background: Mycobacterium tuberculosis is a multi-systemic infection. A resurgence of cases of M. tuberculosis infection and extrapulmonary involvement has occurred in parallel with the HIV epidemic. Tuberculosis is rarely associated with cutaneous or osteoarticular infection.Patient: In this case report we described an unusual case of tuberculosis presenting with concurrent cutaneous abscess and osteomyelitis. The final diagnosis was confirmed by radiographic and cultural findings.Conclusion: Cutaneous tuberculosis should be included in the differential diagnosis of patients with cutaneous abscesses or musculoskeletal complaints, particularly in high risk populations such as immigrants from endemic regions and immunosuppressed patients.