Tehran University Medical Journal

Background: Pulmonary TB is still the most common form of the tuberculosis in HIV infected patients with different presentations according to the degree of immunosuppression. The aim of this study was to investigate the impact of HIV infection on the clinical, laboratory and radiological presentation of tuberculosis.

Methods: We compared 80 HIV negative pulmonary TB patients with 40 HIV positive pulmonary TB patients during 1999-2005 in a teaching hospital of Tehran University of Medical Sciences, Iran.

Results: Tuberculosis was more common in men in both groups. The mean age of HIV positive patients was lower than HIV negatives (35.95+/-10.4 versus 46.95+/-20.39, P =0.002). Weight loss and chronic cough were significantly more frequent in HIV negative patients (76.3% vs. 45% p<0.001 and 93.8% vs. 80%, P<0.05 respectively), whereas fatigue were more prominent in HIV positives (45% vs. 21.3%, P< 0.001). Cavitations and infiltrations were reported in the CXR of HIV/TB patients less than HIV negative patients (OR=0.21, 95% CI: 0.05-0.97, P= 0.01 and OR=0.27%, 95% CI: 0.09-0.75%, P =0.02 respectively). Primary involvement pattern was observed more than secondary involvement in HIV/TB group (OR=3.95, 95% CI: 1.73-9.03, P =0.001). The laboratory findings in HIV/TB patients were as follows: more negative PPD skin (75% vs. 50%) tests, higher ESR (86.5% vs. 63.7%), lower mean Hb (10.6 vs. 12.4) and lower mean leukocyte (6545 vs. 9195) and lymphocyte count (1281 vs. 1838). In all of the above mentioned findings the differences between two groups were significant. Fourthy Seven% of patients had Lymphocyte count less than 1200 which means they were in AIDS stage.

Conclusion: Immune system suppression in HIV can alter the clinical, laboratory and radiological features of tuberculosis. It is crucial to consider tuberculosis in differential diagnosis of every HIV patients with respiratory symptoms.

Background: Health care workers (HCWs) are at substantial risk of acquiring bloodborne pathogen infections through contact with blood and other potentially infectious materials. The main objectives of this study were to determine the epidemiological characteristics of occupational exposure to blood/body fluids, related risk factors of such exposure, and hepatitis B vaccination status among HCWs.
Methods: This cross-sectional study was conducted from December 2004 to June 2005 at three university hospitals in Tehran, Iran. Using a structured interview, we questioned HCWs who had the potential for high-risk exposure during the year preceding the study.

Results: With a total number of 467 exposures (52.9%) and an annual rate of 0.5 exposures per HCW, 391 (43%) of the 900 HCWs had at least one occupational exposure to blood and other infected fluids during the previous year. The highest rate of occupational exposure was found among nurses (26%) and the housekeeping staff (20%). These exposures most commonly occurred in the medical and emergency wards (23% and 21%, respectively). The rate of exposure in HCWs with less than five years of experience was 54%. Percutaneous injury was reported in 280 participants (59%). The history of hepatitis B vaccination was positive in 85.93% of the exposed HCWs. Sixty-one percent had used gloves at the time of exposure. Hand washing was reported in 91.4% and consultation with an infectious disease specialist in 29.4%. There were 72 exposures to HIV, HBV and HCV exposure to HBV was the most common. In 237 of the enrolled cases, the source was unknown. Job type, years of experience and hospital ward were the risk factors for exposure.
Conclusion: Education, protective barriers and vaccination are important in the prevention of viral transmission among HCWs.

Background: Childhood nephrotic syndrome is frequently characterized by a relapsing course. Due to their adverse effects, the use of corticosteroids for the management of frequently relapsing nephrotic syndrome is limited. Levamisole, a steroid sparing agent, has been found to have low toxicity. This study was conducted to evaluate the efficacy of levamisole in steroid-sensitive nephrotic syndrome (SDNS). 

Methods: In this retrospective study from January 1988 to September 2006, we included data from 305 pediatric SDNS patients at the Children's Medical Center clinics in Tehran, Iran. Nephrotic syndrome was diagnosed using classic criteria. None of the patients had any signs or symptoms of secondary causes of nephrotic syndrome. All had received prednisolone 60 mg/m²/day. After remission, prednisolone administration was reduced to every other day and the steroid was tapered over the next three months. With every recurrence, prednisolone was prescribed with the same dosage, but after remission it was continued at a lower dosage for another six months or longer if there was risk of recurrence. Levamisole was administered to all patients at a dose of 2 mg/kg every other day.         

Results: Patients ranged in age from 1 to 20 years (mean±SD: 4.84 ±3.1) and 70.8% were male. At the last follow up, 84 (27.5%) were in remission, while 220 (72.1%) patients had relapsed or needed a low dose of steroid. Levamisole was effective in reducing the prednisolone dosage and long-term remission in 68 (22.3%) and 90 (29.5%) cases, respectively. A comparison of before vs. after levamisole treatment revealed a had significant decrease in the number of relapses (2.05±0.88 vs. 1.1±1.23 P<0.0001) and the prednisolone dosage (0.74±0.39 vs. 0.32±0.38 mg/kg/day P<0.0001). Only one patient developed levamisole-induced neutropenia.

Conclusions: In childhood steroid-dependent nephrotic syndrome, levamisole is an efficacious, safe initial therapy in maintaining remission while decreasing steroid dose, in addition to reducing the rate of relapse.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: One of the clinical manifestations of Human Immunodeficiency Virus (HIV) infected patients is cardiovascular disorder. The aim of this study was to evaluate the prevalence of cardiovascular disorders in HIV infected patients for the beginning treatment of these patients and reducing mortality and morbidity in these patients.
Methods: This cross-sectional study was performed on 134 HIV infected patients who referred to Imam Khomeini hospital, Tehran University of Medical sciences, Tehran Iran during years 2007-2008. Demographic characteristics, history of smoking and opium addiction, antiretroviral therapy, class of drugs and duration of consumption were recorded. After completion of physical examination, electrocardiography and echocardiography studies were done.
Results: In this study 98(73.1%) patients were male. The mean age of the patients was 36.5±10.3 years. The mean of the CD4 number were 296±181. Injection drug users were 54.4% of the study patients. Cardiovascular disorders were found in 84(62.7%) patients. Among patients with heart diseases, 75% were male. The most Electrocardiographic change was the axis deviation of the heart found in 32(23.7%) patients. Pericardial effusion and LVEF<50% were noted in 7(5.2%) and 23(17.2%) patients respectively. The involvement of the mitral valve in 59(44%), tricuspid valve in 21(15.7%) and aortic valve in 6(4.5%) patients were noted. Myocardial dysfunctions existed in 10(7.4%) patients.
Conclusions: Our results showed a high prevalence of cardiovascular disorder in HIV infected patients. We recommend the evaluation of the cardiovascular system in all HIV infected patients even if they are symptom free.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Staphylococcus aureus infection pervasively occurs in communities and hospitals and observing related guidelines is essential in preventing development of antibiotic resistance in Hospitals. In this study we tried to determine the prevalence of Methicillin and vancomycine resistant staphylococcus aureus (MRSA & VRSA) and find the most suitable diagnostic tool and treatment in affected patients.
Methods: This study was performed on hospitalized patients in Sina Hospital in Tehran, Iran during 2009-2010. Eighty-five staphylococcus aureus samples were evaluated for resistance to oxacillin and vancomycine by both disc diffusion and E-test methods.
Results: The study population included 46 male and 39 female patients. The mean age of the participants was 51.46±19.21 years. The MRSA frequency was 50%. 67 (78.8%) patients had hospital-acquired staphylococcus infection. The rate of hospital-acquired MRSA was 93%. Length of hospital stay, undergoing invasive methods, history of antibiotic use three months prior to hospitalization and its kind were recognized as MRSA risk factors. There were no reports of VRSA except one case of vancomycine-intermediate S. aureus (VISA). The results of disk effusion and E-test methods were consistent.
Conclusion: Considering the prevalence of methicillin resistance in hospital-acquired infections, it seems that oxacillin should not be used as the first-line option for empiric therapy against S. aureus till antibiogram results are available. Disc diffusion can also be reliably used instead of the more expensive E-test.

Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012.