Mehrnaz Rasoolinejad , Azar Hadadi , Mojtaba Hedayat Yaghoobi , Banafshe Moradmand Badie , Neda Alijani ,
Volume 71, Issue 7 (10-2013)
Abstract
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. |
Azam Azargoon , Raheb Ghorbani , Sahar Mosavi ,
Volume 72, Issue 4 (7-2014)
Abstract
Background: The use of Methotrexate (MTX) is a good and common practice for the treatment of women who were diagnosed early with ectopic pregnancy (EP). The aim of this study is to determine the predictors of treatment failure with a single dose of MTX injection.
Methods: In this quasi-experimental research, we studied 70 women with ectopic preg-nancies who were treated with MTX, according to a single dose protocol from 2010 to 2013. EP was diagnosed whenever an intrauterine gestational sac was not identified by transvaginal ultrasonography (TVUS), accompanied by an abnormal rise or plateau in human chorionic gonadotropin (beta-hCG) concentration. Briefly, women with ectopic pregnancies were considered candidates for MTX treatment if they were hemodynami-cally stable did not desire surgical therapy, agreed to weekly follow-up and did not have hepatic, hematologic, or renal disease. A Patient was considered a treatment suc-cess (group 1) if her beta-hCG levels decreased ≤10 m IU/ml after the first dose of MTX. Treatment failure (group 2) was defined as the need for a second or a third dose of MTX or surgery. The following risk factors were compared between the two groups: serum beta-hCG on the days 1 and 4, a ≥ 15% decrease in serum beta-hCG between the days 1-4 of the treatment, age, parity, gravidity, the size of the ectopic mass and the endometrial thickness.
Results: The success rate of MTX treatment was 77.1%. There were no significant dif-ferences between the two groups in regard to the age, parity, gravidity, the size of ec-topic mass and the endometrial thickness in vaginal sonography, but the mean serum beta-hCG concentration on days 1 and 4 was lower in the success group than the failure group. We also observed a ≥ 15% decrease in serum beta-hCG in 80.9% of the women from the success group and in 38.5% of the cases whose treatment had failed. The presence of fetal heart activity was seen in only one patient and this patient’s treatment failed. Two patients had previous history of ectopic pregnancy and the treatment of both ended in failure.
Conclusion: Among women with ectopic pregnancies who were candidates for MTX treatment, a high serum beta-hCG concentration on the days 1-4 and also a ≤ 15% fall in serum beta-hCG between the days 1-4 treatment, are the most important factors associated with the failure of the treatment with a single dose MTX protocol. It is better to use these factors for making decisions about the initiation of the treatment or the continuation of it.
Fariba Jaffary , Mohammad Ali Nilforoushzadeh , Latifeh Abdellahi , Hadis Tahmasebi Poor,
Volume 76, Issue 3 (6-2018)
Abstract
Background: Despite advances in diagnosis and treatment, leishmaniasis is now considered a severe public health problem, particularly in developing countries, such as Iran. Leishmaniasis is among the six most important, parasitic diseases of the world affecting 88 countries in almost every continent. The disease is complex with different clinical presentations such as visceral, cutaneous and mucocutaneous forms. Cutaneous leishmaniasis (CL) is the most common form of the disease in Iran. Antimony compounds are the first line treatment of CL. The treatment of leishmaniasis in endemic areas relies on chemotherapy, and in several parts of the world the mainstay remains the pentavalent antimony (SbV)-containing drugs Pentostam (sodium stibogluconate) and Glucantime (meglumine). There is no comprehensive study on treatment failure rate of this compounds. This study was designed to evaluate treatment failure rate and possible involving factors of antimonial resistance in CL to facilitate and improve treatment strategies of this disease.
Methods: All patients with CL referred to Skin Disease and Leishmaniasis Research Center (SDLRC), from October 2011 to October 2013, treated with antimony compounds were assessed in this study. Patient characteristics (gender, age and place of residence), number, type and location of the lesions, comorbidities and type of treatment were recorded and analyzed.
Results: Rate of treatment failure with Meglusan was 4.3%. Failure rate in men and in patients with previous history of cutaneous leishmaniasis was more than women or patients without CL history (P= 0.000, 0.024 respectively). The results of this study showed that treatment failure was higher in patients with systemic treatment than intralesional (IL) or combination therapy (both IL and systemic treatment) group but this difference was not statistically significant. Also, size and number of the lesions, wound infection, the patient's age, location, education and occupation do not have a significant correlation with treatment failure.
Conclusion: Greater treatment failure rate of Meglusan compared to Glucantime (4.3% versus< 1%, respectively) is an important issue to be considered in CL therapeutic strategy.
