Tehran University Medical Journal

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Background: Anemia is a common complication accompanied by high morbidity and mortality in hemodialysis patients. Considering the fact that the reduction of erythropoietin (EPO) synthesis is the main cause of uremic anemia, receiving recombinant human erythropoietin (rHuEPO) can improve the condition in these patients. Some of these hemodialysis patients, however, have acceptable hemoglobin levels without any need to EPO. Higher BMI, higher albumin and leptin plasma levels and longer durations of hemodialysis are possible factors contributing to the reduced need for rHuEPO in these patients. The present study is designed to asses the relationship between the plasma levels of leptin and the reduced EPO need.

Methods: Fifty eligible hemodialysis patients with hemoglobin levels higher than 11 mg/dl were enrolled in the cross-sectional study. The information on age, sex, hemodialysis duration and the cause of renal dysfunction were extracted from the files. The baseline plasma levels of Leptin and albumin were measured. The patients BMI and the weekly need for rHuEPO were also calculated.

Results: There was no correlation between the weekly need for rHuEPO and sex, BMI, the cause of renal dysfunction and the plasma levels of albumin and leptin it, however, was related with age and the duration of dialysis. While age negatively influences the weekly need, the duration of dialysis has a positive effect on the need.

Conclusion: The plasma levels of leptin are not directly correlated with the required amounts of rHuEPO, indicating that leptin is not an effective factor in erythropoiesis. Conversely, older age and shorter hemodialysis durations are accompanied by reduced need for rHuEPO.

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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.

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Background: Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment.
Methods: A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected.
Results: In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus.
Conclusion: The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.

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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.

Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4) Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45) Relative Risk: 0.686 (0.513-0.918) (P=0.001) Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients.