Seroprevalence of toxoplasmosis in HIV+/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male [male to female ratio: 5 to 1] with the mean age of 36 +/- 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 +/- 22.4 cells/micro l. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 +/- 15.5 cells/micro l and there was a significant association between CD4 count and rate of toxoplasma encephalitis [P<0.001]. Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B [HBsAg, anti-HBc, anti-HBs] and Hepatitis C [anti-HCV] markers, during 2004- 2005. HBsAg was positive in 27 patients [13.4%], anti-HBc was positive in 60 patients [29.8%] and anti-HBs in 23 patients [11.4%]. Anti-HCV Ab was positive in 135 of 201 [67.2%]. HBV and HCV coinfection was observed in 73 of 201 [36.3%]. The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively [P<0.0001]. The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients wife [HIV+ patients who were infected by monogamous sexual contact with their HIV positive husband] both of them were 8% [P<0.0001]. This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran

Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran

Serum samples from 201 HIV positive patients were collected to determine the seroprevalence of CMV infection in Iranian HIV infected patients during March 2004 until March 2005 using conventional ELISA kits. An antibody level of>1.1 Iu/ml was considered positive. The seroprevalence of CMV infection was 94%.The maximum prevalence of CMV antibody was seen in patients with unsafe sex and IDUs. Prevalence of CMV was much higher in patients with low socioeconomic status and low level of education. 83% of patients with CD4<100 were CMV seropositive. Our study showed that a significantly high prevalence of CMV in HIV positive patients in Iran. By increasing the level of education and socioeconomic status the prevalence of CMV infection decreased

Thyroid-associated ophthalmopathy in Iranian patients

We determined the frequency of clinical thyroid ophthalmopathy in Iranian patients. This crosssectional study was performed at the Endocrinology Institute of Tehran University of Medical Sciences. All patients with documented thyroid disorders from September 2003 to July 2005 were recruited. Eye examinations included evaluation of soft tissue changes, measurement of proptosis, lid width, lagophthalmos, evaluation of eye muscle function, and determination of visual acuity. The activity of ophthalmopathy was scored according to the NOSPECS scale. Among 851 visited patients, 303 cases had thyroid eye disease [TED]. The nature of the ophthalmopathy breaks down as follows: 53.4% were hypothyroid [9.3% Hashimoto disease], 5.5% euthyroid and 41.1% had Graves' disease. The prevalence of TED in males was 60% which was nearly 2 times the prevalence of TED in females. There was a significant relationship between presentation of TED and active smoking of the patients [P<0.0001] while no significant relationship with passive smoking was obtained [P=0.181]. The most common clinical sign of TED in descending order respectively were proptosis with 63.4%, soft tissue involvement [40.9%], extraocular muscle involvement [22.1%], corneal involvement [12.9%] and optic nerve dysfunction [6.3%]. Myasthenia gravis occurred in only 2 patients. In the logistic regression, occurrence of TED was influenced by cardiovascular disease [OR=5.346], Graves' disease [OR=47.507], radioiodine therapy [OR=2.590], and anti-thyroid medications [OR=0.650]. Thyroid ophtalmopathy [orbitopathy] is a matter of important health concern among patients with thyroid disorder. Since TED occurred with a high prevalence in all thyroid states, a close collaboration between endocrinologists and ophthalmologists along with timely referrals of patients with any eye complaint is deemed necessary. Also smoking was the most important risk factor for developing TED. Therefore, it is advisable to raise awareness and to strongly encourage smokers with thyroid disorders to quit smoking

Respiratory complications in Iranian hospitalized patients with HIV/AIDS

The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. All patients were males. The mean age was 35 years [age range: 15 to 63 years]. Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm[3]. Nearly half the patients [47.7%] had respiratory symptoms. The most common pulmonary complications were cough [86.3%], sputum [71.6%], dyspnea [54.7%], and hemoptysis [10.5%]. The most common diagnosis was pulmonary tuberculosis [27.1%], followed by other bacterial pneumonias [16.6%] and pneumocystis carinii pneumonia [4.5%]. Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection [59%], and other bacterial pneumonias [52%].Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS

Change in quality of life after medical and surgical treatment of Graves' ophthalmopathy

To assess the changes in quality of life [QOL] of patients after treatment of their Graves' ophthalmopathy [GO]. In this prospective, cross-sectional study, the GO-QOL questionnaire was completed by 67 subjects before and at least 6 months after steroid treatment [61 subjects, group 1] or optic neuropathy orbital decompression [6 subjects, group 2]. Visual, psychosocial, education and counseling scores [higher score = better health], GO severity and clinical activity scores and minimal clinically important difference [MCID] were recorded and analyzed for correlation and statistical significance. A P-value <0.05 was considered statistically significant. The mean age of patient enrolled in the study was 38.3 years, with 43 females [64.2%]. The mean duration of thyroid dysfunction and GO were 40.1 and 26.5 months, respectively. Two treatment groups were similar for all the variables [0.06 < P < 0.9], except for higher mean age in the orbital decompression group [45.2 versus 37.7 years] [P = 0.03]. Mean severity, activity, visual function and psychosocial function scores significantly improved in group 1 [steroid group] [P < 0.05, all cases]. A significant improvement in clinical activity score and psychosocial scores occurred in group 2 [decompression group] [P < 0.05]. MCID was achieved in two-thirds of the patients, with no significant difference between groups [P > 0.05]. There was no significant effect of duration of thyroid disease and GO and severity and activity of GO on QOL scores either before or after treatment [P > 0.05, all cases]. Steroid treatment and orbital decompression significantly improve the QOL in GO. Duration, severity and activity of GO did not have a significant impact on the QOL

cross-sectional study of anemia in human immunodeficiency virus-infected patients in Iran

Anemia is a frequent complication of infection with human immunodeficiency virus [HIV]. The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology. Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9 +/- 9.2 months. The mean [ +/- SD] hemoglobin level was 12.9 +/- 2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia [defined as hemoglobin<10 mg/dL] was 10.3%. Anemia was positively associated with female sex [OR = 3.01], CD4 level [CD4 count of <200] [OR=3.49], and antituberculous drug administration [OR=4.57]. Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study

Tuberculin skin test conversion among students during their educational course in medical and pharmacy schools: a multiple cohort study

Mycobacterium tuberculosis can be transmitted via aerosols in hospital wards and affect medical students as well as other hospital personnel. This study aimed to assess the changes of tuberculin skin test in medical students compared to pharmacy students during their education. This was a natural multiple cohort study performed in the medical education system to assess the rates of TST conversion among students. Tuberculin skin tests were performed on 212 students, including100 pharmacy students and 112 medical students before the initiation of their clinical rotations and repeated 36 months later after their exposure to hospital wards. Participants completed self-administered questionnaires. Tuberculin skin test [TST] conversion in medical and pharmacy students was 18.1% and 4.3%, respectively during the years 2003 and 2006. Although there was no significant difference between positive TST of the two groups at baseline, a significant difference [P=0.005] was observed after their exposure to hospital wards. There were no significant correlations between TST conversion and age or gender of students. Exposure of medical students to tuberculosis during their education is substantial in Iran and more attention should be paid to prevention strategies in medical students prior to and during their clinical training

Quality of life in patients with thyroid eye disease

To evaluate quality of life [QOL] before and after corticosteroid therapy for thyroid eye disease [TED] and to determine the impact of the disease on QOL. A modified TED-QOL questionnaire was completed by consecutive patients before and at least 6 months after steroid therapy. All patients were clinically and biochemically euthyroid during the course of the study. QOL was assessed in subscales of visual function, psychosocial, and educational/counseling; TED was classified by severity score [NOSPECS] and Mourits' clinical activity score. Overall, 61 patients including 18 [29.5%] male and 43 [70.5%] female subjects with mean age of 37.3 +/- 13.7 [range, 18-33] years were enrolled. Mean duration of thyroid dysfunction and TED were 40.1 +/- 44.8 and 26.5 +/- 38.2 months, respectively. Mean disease severity and activity significantly decreased, and visual and psychosocial function scores significantly improved following corticosteroid therapy for TED. Psychosocial score was significantly worse than visual function score before but not after steroid treatment. Linear regression analysis and Spearman correlation test showed no significant correlation between duration of thyroid dysfunction, duration of TED, disease severity and activity on one hand, and QOL scores on the other hand, before or after treatment. TED seems to adversely affect psychosocial activity more than visual function. Corticosteroid therapy significantly improves QOL. No significant correlation seems to exist between QOL scores and the severity or activity of TED