Brucella infection in HIV infected patients

The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study. 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 [6%] subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user [IDU] men and one was a rural woman. Considering both prevalence rates of Brucella infection [3%] and symptomatic brucellosis [0.1%] in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors

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

Pleural and pericardial effusions: rare presentations of brucellosis, Iran

We report a rare case of brucellosis presenting with pleural and pericardial effusions in a 35 year-old male rancher in Iran with fever and dyspnea. Such findings should prompt inclusion of brucellosis in the differential diagnosis in endemic areas

Wart lesion in a patient associated with HIV infection and treatment under IMOD therapy

We report a 27-year-old hemophilic male who was HIV positive and under Highly Active Antiretroviral Therapy [HAART] along with wart lesions. When IMOD therapy started concurrently with HAART, the skin lesions disappeared

Sensitivity and specificity of international prostate symptom score [IPSS] for the screening of Iranian patients with prostate cancer

We assessed the lower urinary tract symptoms [LUTS] in prostatic cancer patients and investigated the sensitivity and specificity of international prostate symptom score [IPSS] in the screening of these patients. A total number of 132 prostatic cancer patients as the case group who were confirmed by the pathologists and 101 noncancerous men as the control group, aged 50 or older, responded to a questionnaire which included seven questions regarding urination, named the International Prostate Symptom Score [IPSS]. Then, two groups were assessed and compared with each other and also the sensitivity and specificity of IPSS tool for screening of prostatic cancer patients were calculated. All participants filled out the questionnaire. 60 [59.4%] noncancerous men and 29 [22.0%] cases had mild LUTS, and 41 [40.6%] noncancerous men and 103 [78.0%] cases had moderate to severe LUTS. Moreover, the sensitivity and specificity of the IPSS tool were 78% and 59.4%, respectively. Urination status and problems could be easily assessed by IPSS and it is a sensitive and specific tool for screening of prostatic cancer patients. It appears that IPSS is a cost beneficial, sensitive, specific and easily-used screening tool to diagnose the prostate cancer cases. Therefore, it can be used more extensively by the health care providers as well as by men >/= 50 years old themselves

Evaluation of bone mineral density in Iranian HIV/AIDS patients

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy [na‹ve patients] and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects [77.3% in HIV positive na‹ve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002]. Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group [P=0.003]. Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection [P<0.0001] and antiretroviral treatment [P=0.012]. Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment

Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% [95% CI 0.005-1.2] with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future

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

case report of cyclic neutropenia associated with pyoderma gangrenosum

We present a 24-year-old female referred with non-healing wound of a few days duration on anterior aspect of her right foreleg. Biopsy of the wound was reported to be pyoderma gangrenosum on pathologic report. Further work up of the patient for high grade fever and occasional leukopenias revealed the diagnosis of cyclic neutropenia. Treatment with granulocyte colony-stimulating factor [G-CSF] resulted in patient's neutrophil counts correction and dramatic improvement in healing of her lower extremity wound

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

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

clinicopathologic study of lung cancer cases in Iran

Lung cancer remains the leading cause of cancer-related deaths in the world. In Iran, lung cancer is the fifth leading cancer and its prevalence rate has been increasing steadily. In this study, the clinicopathological aspects of lung cancer are discussed. Between October 2002 and November 2005, 242 [178 men, 64 women] patients with histologically confirmed lung cancer were interviewed according to a questionnaire. Women developed the disease at an earlier age than men [55.9 +/- 14.2 versus 61.3 +/- 12.3 years; p=0.004]; 66.5% of lung cancer patients [85.4% of men and 14.1% of women] were smokers [p<0.0001]; 76.3% of participants, who had exposure to secondhand smoke, were females. Among the environmental carcinogens, the most exposures were to inorganic dusts [49.8%] and chemical compounds [34.9%].Most male and female patients suffered from adenocarcinoma [28.9%] and non small cell carcinoma [28.5%]. The prevalence of adenocarcinoma was higher in the non-smoker group, whereas incidence of squamous cell carcinoma and small cell carcinoma was higher among smokers [p<0.0001]. In this study, most patients [74.0%] presented with an advanced-stage tumor [IIIB or IV]. Our results suggest that in addition to cigarette smoking, other environmental, occupational and socioeconomic factors may play a role in the development of lung cancer