Tehran University Medical Journal

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Due to the important role of the trace elements (i.e. zinc and copper) in the biochemical processes of body and the effects of exogenous and endogenous hormones in distribution, absorption and excretion of these elements, we decided to determine the rate of the zinc and copper content of serum in women taking (LD) OCPs. Our finding indicates that the rate of the zinc content decreased significantly (P<0.001), whereas the copper content of women serum during this period showed a significant increase (P<0.001). In regard to previous months, the process of increasing were lasting for six months. Therefore, we would like to suggest that the serum content of these two elements should be monitored during the period of medication with OCPs, to avoid the deleterious effect of flactuation rates of these elements in serum.

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To examine the relation between oral contraceptive (OCPs) use, body mass index, parity, familial history of gallstone disease, history of diabetes, history of hyperlipidemia and gallstone disease in women, we have undertaken a case-control study. The study population comparison 80 hospital patients with diagnosed acute gallstone disease as case group and 200 controls who were patients in hospital with no history of gallstone disease. The data were analyzed by Chi-square and T-student test. The results revealed that: The use of OCPs in case group is higher than that of control group. But there is no significant difference between them. No relation was found between gallstone disease and body mass index, parity, history of diabetes, familial history of gallstone disease, use of OCPs of different types and duration of use. While there was a significant difference between the 2 groups regarding history of hyperlipidemia (P<0.05). Finally we found no correlation between the history of use, types and duration of use of OCPs and symptomatic gallstone disease. There was no indication of any interaction between oral contraceptive use and other risk factors and duration of OCP use and other risk factors in the production of disease.

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The arthroscopic study of knee joint is of outstanding interest in assessment of knee complaints. The present article describes the results of arthroscopic examination of 100 patients (Mean age 29.4 years 82% male) evaluated from 1996 to 1997 in Imam Khomeini hospital of Tehran. Sport injury was the most prevalent cause of referral (40%). The 2 most frequent complaints were knee pain (94%) and tenderness (63%). Arthroscopic findings were pathologic changes of synovial fluid in 8, changes on articular surface of patella in 23, pathologic findings of femoral condyles and changes on articular surface of tibial plate in 24 cases. Other findings included plica in 18, tears of meniscus in 49, complete or partial tears of anterior cruciate ligament in 23 patients. Diagnostic accuracy of pre-arthroscopic clinical diagnosis was 88% and 93% for tears of meniscue and anterior cruciate ligament respectively. Arthroscopy of patellofemoral joint is an important adjunct to clinical and radiographic examination in diagnosis of knee complaints.

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Ovarian cancer is second prevalent cancer among gynecologic malignancies and the most common type of ovarian cancer is epithelial form (85-90 percent). To detect the risk factors for the epithelial ovarian cancer, a case-control study was conducted in Valieasr hospital in 1988. In this study, 118 cases with epithelial ovarian cancer (according histological records) and 240 controls without any gynecological cancer in gynecologic clinic had been interviewed. For data analysis, T-test, Chi2 test and logistic regression have been used at a =0.05 as level of significance. The mean age in cases was 50±13 and in controls was 49.9±12 years, without significant different. The mean number of pregnancies and parity in cases was less than controls, significantly (P<0.03). The mean months of breast feeding in cases was less than controls (54.9±71.2 versus 82.4±62.7) (P<0.001). The cases had a lower mean age of menarch than controls (P=0.03). 58 percent of cases and 21.3 percent of controls hadn't used any contraception methods (P=0.00001). The mean years of contraception was significantly less in cases versus controls (P<0.001). The odds ratio for epithelial ovarian cancer was 0.24 (95 percent CI: 0.13-0.48) in OCP users, 0.47 (95 percent CI: 0.005-0.43) in TL method, and was 0.41 (95 percent CI: 0.22-0.76) in other contraception methods, relative to women who hadn't used any contraception methods. This study reveals that epithelial ovarian cancer risk increases significantly with earlier menarch, decreasing number of pregnancy, deliveries duration of breast feeding and use of contraception methods. Use of contraception pill and tubal ligation method decreases risk of epithelial ovarian cancer.

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Regarding the prevalence of cancer in tongue and the management procedure of cases who have recurrence in cervical lymph nodes after partial glossectomy and in order to determine appropriate management of neck in early oral tongue cancer it was decided to conduct a study. A retrospective review of 62 patients with T1,2 N0 M0 SCC of the oral tongue treated by only partial glossectomy at Cancer Institute of Tehran university was conducted (from 1991 to 2000). Most of these patients were in 7th decade of life, men were affected more than women. Cervical lymph node recurrence at 2 years was 45.1 percent (28 patients from 62). In 34 patients (54.9 percent) who had not any recurrence in neck, 12 patients had received prophylactic neck radiation therapy after operation. With excluding this group of patients, the rate of cervical recurrence in early oral tongue cancer will rise to 56 percent. According to these findings, it is recommended that elective node dissection should be considered in the initial management of T1,2 N0 M0 oral tongue squamous cell carcinoma in our country.

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Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

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Background and Aim: In epileptic patients, behavioral disorders are the most important deficits therefore evaluation of deficits by animal model should be essential. The role of Zinc in behavioral disorder and its relation with hippocampus or serum zinc may help explain why some brain region is commonly facilitated while other did not harm. The main purpose of this study was to evaluate Zinc itself effect on changing behavioral disorder and control of brain seizure.

Materials and Methods: Type of this study is prospective, empirical and blind. The population was adult male Sprauge-Dawley rats and randomly assigned in six groups (n=8). Each group was treated two months before of inducing animal model of seizure by Zinc(248 mg/lit) or tap water and also in group 1 and 4 saline, group 2and 5 bicuculine(1mg/kg) and group 3 and 6 pentobarbital(10mg/kg) .epileptic model was induced by injection of Lithium chloride (127mg/kg)and 24 hr later ,pilocarpin(50 mg/kg) in to peritoneum. During this study, neurological deficits (behavior) was recorded at 1, and 2 hrs after sizuring.

Results: The results showed that Zn had a minus feature on neurological deficits. GABA A antagonists had the same effect as Zn on neurological deficits but GABA A agonists ameliorate it significantly. Serum zinc level didn&apost change significantly among the animals but hippocampus zinc was altered significantly in Zn treated animals compared with the controls.

Conclusion: This study shows that Zn deleterious effects on neurological deficits were carried out via GABAergic system.

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Background and Aim: Adenoids and tonsils are active lymphoid organs and playing an important role against invading antigens of upper aero digestive tract in children. The purpose of this study is observing the changes in cellular and humoral immunity of children six months after adenotonsillectomy.

Materials and Methods: The study population consisted of 30 children (aged 4-10 years) with chronic adenotonsillar hypertrophy and 30 age- matched healthy children. In all children serum level of IgM and IgG, percentage of T lymphocytes (CD3) , T helper (CD4) , T (CD8) and B lymphocytes (CD20) were measured. These parameters were re-measured in patients 6 months after adenotonsillectomy.

Results: Before the operation, a reduction in percentage of T lymphocytes (CD3) , TCD4, TCD8 and B CD20 was seen compared with control group. This reduction was only significant in T lymphocytes (CD3) (P.Value=0.03). The serum IgM level was not different in two groups and IgG level was elevated in two groups but not significantly different. Six months after operation the percentage of lymphocytes T CD3+, TCD8+, TCD4+ and BCD20+ was increased and reached the control group. The IgG level was also significently decreased in patients after operation (P.Value=0.00).               

Conclusion: Our results indicate that cellular and humoral immunity decreases in children with chronic adenotonsillar hypertrophy preoperatively and increases to healthy children level, six months postoperatively. It means that chronic adenotosillar hypertrophy affects some parameters of cellular and humoral immunity and adenotonsillectomy by removing chronic stimulations reverses these changes without any negative effect on immune function of patients.

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Background and Aim: In obstetrics, calcium antagonists, in particular nifedipine, have become increasingly popular for the management of preterm labor and are more effective tocolytic agents than beta 2-sympathomimetics. Our aim was to evaluate the effects of oral nifedipine therapy on ultrasonographic cord blood flow parameters in pregnant women with short cervical length.

Materials and Methods: In a case-series study, 20 patients at risk of preterm labor with shortening cervix in serial examinations were included. Patients received oral nifedipine administered 40 mg per day until 37w of gestational age (GA). Umbilical artery Doppler parameters including systolic/diastolic ratio (SD) and pulsatility index (PI) were recorded before and biweekly after nifedipine prescription.

Results: The mean of age was 25.55±4.58 years. The mean cervical length was 19.68±6.32. nifedipine consumption was initiated at the 26.4±4.12w and was terminated at 36.10±2.65w. The side effects of nifedipine were occurred in 2 patients (10%). In no patient no SD and PI measure get out of normal values. In contrast to PI, after nifedipine consumption SD was significantly higher than before (2.28±0.45 vs. 2.65±0.21). Two neonates (10%) were delivered before 37w and less than 2500gr. Just one neonate needed NICU stay.

Conclusion: Oral nifedipine can be used as a safe and effective tocolytic treatment in patients at risk of preterm labor with shortened cervical length.

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Background: Psychological debriefing has been widely advocated for routine use following major traumatic events. Cognitive Behavioral Interventions, art supportive therapies, and sport and recreational support activities are other interventions for reducing posttraumatic stress disorder. We assessed the effects of theses methods individually and in combination on reduction posttraumatic stress disorder symptoms in adolescents who had experienced Bam earthquake.
Methods: In a field trial, we evaluated the efficacy of psychological debriefing, group cognitive-behavioral therapy, art and sport supportive interventions in 200 adolescents with PTSD symptoms who survived of Bam earthquake and compare it with a control group. Patients were randomly assigned to one of intervention programs including: group cognitive-behavioral therapy group CBT plus art and sport interventions art and sport interventions without group CBT and control group.
Results: Thirty one individuals were excluded because of migration. A statistically significant reduction in overall PTSD symptoms as well as in avoidance symptoms was observed after group cognitive-behavioral therapy. There was no significant difference in reduction of overall PTSD and avoidance symptoms between the other groups.
Conclusion: Psychological interventions in form of group cognitive behavioral therapy can reduce the symptoms of PTSD symptoms but we couldn't find the art and sport supportive therapy alone or in combination with group CBT to be useful in this regard.

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Background: A plan for management of infected arterial pseudoaneurysm has evolved from our experience with forty two cases of such aneurysms treated between 1378 and 1382.
Methods: Clinical data of 42 patients with femoral pseudoaneurysm resulting from addictive drug injection who presented in emergency department of Sina Hospital between 1378 and 1383 were retrospectively reviewed.
Results: All patients were men with the mean age of 36.9 years. Twenty eight patients were referred from other medical centers. The mean time of delay in presentation was 17.3 days. The mean duration of drug injection was 14 months. Primary repair and emergent vascular bypass were performed in 3(7.1%) and 2(4.8%) patients, respectively. 5(11.9%) patients undergone delayed revascularization. Thirty two (76.2%) patients returned to their normal lifestyle without any vascular bypass. One patient required amputation and one patient died due to sepsis and acute renal insufficiency.
Conclusion: Management of infected femoral pseudoaneurysms is simple ligation of the external iliac or femoral artery. When Doppler is not available “Operation Room and postoperative Direct Observation” is recommended in such patients to avoid unnecessary revascularization surgery.

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Background: Many studies have shown the efficacy of cognitive – behavioral therapy and psychological debriefing in treatment of post traumatic stress disorder (PTSD) and a few evidences are available for using these techniques in large scale disasters. This study aimed to asses the effect of some psychological interventions in reducing PTSD symptoms after Bam earthquake in different age groups.
Methods: In a before-after quasi experimental clinical trial, we compared the efficacy of one session of psychological debriefing and three sessions of group cognitive-behavioral therapy in bam earthquake PTSD symptoms in different age groups. We evaluated PTSD symptoms before and immediately and three months after interventions by CASP scaling system and analyzed data.
Results: one hundred and thirty persons entered in the study and 51 persons excluded during interventions because of migration. Interventions were showed to be effective only in short term period. The means of PTSD symptoms frequency and severity of avoidance symptoms were reduced during three months period of study which were statistically significant P<0.05. Interventions showed no efficacy for recall symptoms in long term and hyper arousal symptoms in short term and long term periods. There was no statistically significant difference among age groups.
Conclusion: Psychosocial supportive interventions may be effective on some of the PTSD symptoms but there is no difference in different age groups.

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Background: Tibial and femoral fractures, commonly seen in emergency departments, may be associated with various knee ligament injuries. The aim of this study was to determine the prevalence of such fracture-associated knee ligament problems, with especial attention to rapid diagnosis.
Methods: This study was carried out in patients with femoral or tibial fractures who were operated on in Imam Khomeini Medical Center from March 2003 to March 2005. All patients underwent surgical repair immediately after acute fracture, followed by a thorough knee examination. Patients with positive clinical findings were further evaluated using the stress view and arthroscopy.
Results: We enrolled 470 cases in this study, of which 266 were tibial and 204 were femoral fractures. There were 404 men and 67 women, with an average age of tibial fracture patients was 34.5 and 44.6 years for those with femoral fractures. Of all fractures, 66% were due to car accidents, 16% to industrial accidents and 8% due to falling. The overall prevalence of ligament injuries in tibial fractures was as follows: 6.58% ACL tearing, 2.5% PCL, 21.95% MCL and 14.63% LCL. The overall prevalence of ligament injuries in femoral fractures was as follows: 6% ACL tearing, 3% PCL, 14% MCL and 8% LCL.
Conclusion: The prevalence of ligament injuries of the knee was highest in distal femoral and tibial plateau fractures. It is prudent to perform a thorough knee examination once the fracture is stabilized in the operating room for the early detection of ligament injuries and prevention of further complications.

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Background: Cow's milk protein allergy (CMPA) is the most common food allergy during the first year of life. Strict avoidance of specific foods is the only accepted treatment for food-induced allergic reactions. This is often an unrealistic therapeutic option, since cow's milk is a basic food that is extensively used in infant formula. The recent preliminary experience of oral desensitization to cow's milk by Meglio & Patriarca seems promising. The object of this study was to investigate the desensitization of children with CMPA to cow's milk.

Methods: All the patients referred to the Allergology Department of the Children's Medical Center Hospital, Tehran from March 2004 to November 2005 suspected to have CMPA were evaluated. The patients were included in the intervention or control groups of the study. For the intervention group, Meglio's protocol was performed. We observed and examined the control group for at least 6 months. Eventually both groups were reevaluated for the symptoms and persistence of positive specific IgE for cow milk proteins.

Results: We enrolled 20 patients for oral desensitization and 13 patients were enrolled in the control group. Both groups were similar with regard to the mean age, sex and clinical symptoms. In 18 (90%) of the intervention subjects, oral desensitization with cow's milk was successfully performed. The entire protocol was completed by 14 (70%) of the intervention subjects. At the end of the six-month observation period, all the patients in the control group were still symptomatic after ingestion of cow's milk. The levels of specific IgE for cow's milk in the intervention group decreased significantly, which was not observed in the control group.

Conclusion: We successfully desensitized 90% of our CMPA patients. Considering that all the patients in the control group remained symptomatic after the period of observation and our promising results in oral desensitization with cow's milk, we can safely propose this protocol as a hopeful alternative in the treatment of CMPA. We speculate that oral desensitization to cow's milk does not alter the natural outcome of CMPA, but substantially increases the threshold dose necessary to elicit allergic symptoms.

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Background: Oral clefts are among the most common congenital anomalies. Infants with oral clefts often have other associated congenital defects, especially congenital heart defects. The reported incidences and the types of associated malformations and congenital heart defects vary between different studies. The purpose of this study was to assess the incidence of associated congenital heart defects in children with oral clefts.
Methods: All infants with cleft lip and palate referred to the Children's Medical Center and Bahramy the teaching Hospitals of the Tehran University of Medical Sciences from 1991 to 2005 were prospectively enrolled in this study group. All patients were examined and noted by an academic cleft team contain a pediatrician and a pediatric surgeon, and received cardiac consultation and echocardiography by a pediatric cardiologist. non cardiac associated anomalies, still born and patients without echocardiography were excluded from the study. Data including age, gender, exposure to contagions and high risk elements ,consanguinity and familial history of oral cleft, type of oral cleft, results of cardiac consultation and echocardiography and associated cardiac anomalies were cumulated and analyzed by SSPS version 13.5
Results: Among the 284 infants with oral clefts, 162 were male (57%) and 122 were female (43%). Seventy-nine patients (27.8%) had cleft lip, 84 (29.5%) had cleft palate and 121 (42.6%) had both cleft lip and palate. Of all the patients, 21.1% had congenital heart defects. the most common type Of these congenital heart defects(28.3%) was atrial septal defect.
Conclusions: For patients with cleft lip and palate, we recommend preoperative cardiac consultation, careful examination and routine echocardiography for associated cardiac anomalies, as well as appropriate management and prophylactic antibiotic therapy for those with associated congenital heart anomaly.

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Background: The aim of this survey is to compare the emotional and behavioral problems of children with only one parent versus those from two-parent families. We analyzed behavioral problems such as aggression, delinquency and socialization issues, as well as emotional problems such as depression, anxiety, and somatic complaints.
Methods: Using a multi-stage cluster sampling, 10 of the 20 geographic regions covered by Imam Khomeini Charity were selected. Using systematic random sampling, 460 families with children aged 4-18 years were selected. All children were evaluated using the Child Behavior Check List (CBCL) to determine behavioral and emotional problems. Logistic regression tests were conducted to measure the effects variables, including age, gender, number of parents in the family, psychiatric history of each child and history of parental psychiatric treatment, on the internalizing, externalizing and total CBCL scores. A cut-off score of 64 was used to convert raw scores.
Results: No differences were observed in CBCL subscales between single-parent children vs. children of two-parent families.
Conclusion: Regarding the two-parent families among the study population, the results could not be generalized. As these families have qualified for assistance, the father cannot manage the family because of his disability, such as physical or mental problems. This minimizes the effect of having a father in a two-parent family, rendering them similar to single-parent families. Thus, differences were not observed between the two types of families. Further studies are necessary to compare single-parent families with two-parent families among the community.

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Background: The insertion of endotracheal tube is essential for most surgical operations, mechanically ventilated patient in ICU wards, During cardiopulmonary resuscitation and so for transport of patients. The aim of this study was determination of airway related distances in Iranian patients.

Methods: In a cross- sectional study during year 2007 in Imam Khomeini university Hospital a total of 75 ASA class I and II patients who were admitted to pulmonary ward evaluated for determination of incisor-vocal cord and incisor- carina distances. The nasal nare- vocal cord distance was determined too.

Results: A total of 71 patients, 45(63%) male and 26(36.6%) female were evaluated. The Incisor-vocal cord distance in males and females was 16.83±0.75mm against 15.04±1.12mm (P=0.03). The difference of nare-vocal cords and Incisor- vocal cord  distances was 2-3Cm

Conclusions: There was direct association between height and tracheal length in the study patients. The tracheal length (suitable insertion depth) in our patients was different from the recommendations (23 & 21 Cm for men and women) for non- Iranian, 25.9 versus 22.6 for Iranian men and women respectively. The difference of nasal nare-vocal cord and upper incisor-vocal cord distances in our patients was 2-3 cm, the lower range of accepted or reported one. We offer to do another experience with larger study group to apply the data to Iranian population.

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Background: Hepatitis C is a major cause of chronic liver disease and hepatocellular carcinoma. Hepatitis C infection also has extrahepatic manifestations, including cryoglobulinemia and lichen planus. Lichen planus is a relatively common mucocutaneous disorder, and, due to its chronic pattern and increased incidence of malignancy, diagnosis and treatment of this disease are very important. The aim of the present study was to investigate the prevalence of oral lichen planus in HCV-infected patients.

Methods: In this cross sectional- descriptive study, the prevalence of oral lichen planus was evaluated by means of observation, clinical examination, questionnaire and evaluation of the medical records of 150 patients referred to the hepatitis clinic, gastrointentrology and infectious disease wards of Imam Khomeini Hospital and the Iran Blood Transfusion Organization, Tehran, Iran. We used a sequential method for sampling. Data were analyzed using statistical software (SPSS ver. 11) and the chi-square test.

Results: From a total 150 patients, 133 were male and 17 female. Six cases (4%) had oral lichen planus. All patients with oral lichen planus were male and the buccal mucosa was the most common site.

Conclusions: According to this study, the prevalence of oral lichen planus in patients afflicted with HCV is higher than in the normal population. We should pay more attention to oral lichen planus as one of the extrahepatic manifestations of hepatitis C.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Oropharyngeal candidiasis is the most frequent fungal infection in HIV patients. The aims of this study were to appraise prevalence of oropharyngeal candidiasis and to determine factors associated with oropharyngeal candidiasis and oral yeast colonization among Iranian HIV patients.
Methods: The patients were composed 150 Iranian HIV positive individuals referred to Iranian Research Center for HIV & Aids (IRCHA), Imam Khomeini Hospital complex in Tehran, Iran. Oral samples were obtained and cultured on mycological media. TCD₄ lymphocyte count/percentage was measured and patients were categorized. Patients evaluated for some risk factors for oropharyngeal candidiasis and oral candida colonization.
Results: Fifty nine percent of patients were presented with oropharyngeal candidiasis and the carriage rate of yeasts was 116 (77.2%). The most frequent isolated candida species were Candida albicans (102) 50.2% and Candida glabrata (45) 22%. Thrush in 57(38%), perleche in 30(20%) and erythematous lesions in 7(4.7%) of patients were observed. Significant differences in TCD₄ count (p=0.01), gender (p=0.02), antifungal therapy (p=0.001), smoking (p=0.02), and intravenous drug use (p=0.03), between asymptomatic and symptomatic patients were observed.
Conclusion: Oral candidiasis is a frequent complication among Iranian HIV individuals. C. albicans and C. glabrata are most important etiologic agents of oral candidiasis. In Iranian HIV individuals TCD₄ count, antifungal therapy, gender, smoking and intravenous drug use are important risk factors for oropharyngeal candidiasis. Denture wearing and age are predisposing factors for oral colonization.