Bacterial infection of pacemaker in patients with endocarditis

The advancement of technology in recent decades has been lead to use the electrophysiology cardiac devices. Although these devices are used increasingly, but the frequency of subclinical infection is unknown. We investigate bacterial infections due to implantable cardioverter defibrillator [ICDs] in patients with endocarditis. Population of the study was considered among all adult patients in whom the cardiac electrophysiology device was removed. Associated infection endocarditis defined by the Duke criteria. 35 pacemakers [PM] were aseptically removed from these patients during January 2012 to November 2014. Intraoperative swabs from the different part of devices were collected, cultured in BHI [Brain Heart Infusion Broth] and then bacterial classical cultures were done under aerobic and anaerobic conditions. Biochemical and differential media were used to detect the bacteria species. Data analysis was performed by using SPSS version 16 software. 13 cases of 35 patients with endocarditis diagnosed by modified Duke Criteria and removed pacemaker had positive culture. Of the 13 cases with infection 43% were identified as gram positive and 57% had gram negative bacteria. Based on our study and similar studies, bacteria can colonize in electrophysiology devices which can lead to bacterial infections

Drug resistance of acinetobacter in selected hospitals

Nowadays, nosocomial infection with multidrug-resistant Acinetobacter is an important problem in the world, which is facing wide spectrum antibiotics and hence has become resistant. In this study, positive cultures of Acinetobacter from one hundred clinical samples in seven hospitals from Tehran during 2012-2013 were collected for checking antibiotic susceptibility. Samples test with Ceftazidim, Cefepime, Amikacine and Imipenem by E-test and for Tazocin, Colistin and Tigecycline was performed with disk diffusion method. For Colistin 10 samples, and for Tazocin, 40 samples were performed by E-test method. Then boumannii species of bacteria and non-baumannii Acinetobacter were separated by PCR and antibiotic susceptibility testing was performed on them. 89% of Acinetobacter samples were boumannii species, which was isolated from respiratory secretions at ICU. Boumannii and non-boumannii species of bacteria with a high percentage were resistant to Ceftazidim, Amikacine, Cefepime, Tazocin and Imipenem. All baumannii and non-boumannii Acinetobacter were sensitive to Colistin, were only 75% sensitive to Tigecycline, which is a new glycylcycline. Colistin and Tazocin results in samples limited to the E-test method were similar with disk diffusion

[ incidence of acute diarrhea in children under five years old in Rasht city in 2009: the first phase if the effect of using sewerage system]

The lack of a proper sewage collection and disposal system, the water and sewerage project, in the city of Rasht, became a priority by Guilan province Urban Water and Sewerage Company with the government partnership and World Bank financial support. The objective of this research was to complete the first phase of a two-phase study, to determine the impact of using an urban sewerage system on acute diarrhea in children under five years old, in Rasht city in the Guilan province. The study is a concurrent control before and after field trial which is carried out in two phases: before [phase I] and after [phase II]. Sampling for phase I was performed in the middle month of each season, November and February 2009 and May and August 2010. The incidence of acute Diarrhea was measured with the participation of 1560 mothers of children under 5 years old. This was done in two groups: the intervention group [inside the sewerage system project perimeters] and the control group [outside the project perimeters]. Data was collected by local female general practitioners and medical students by doorto- door interviews with mothers. Data was analyzed using the SPSS 11.5 software package. The Pearson Chi-Square was used to compare qualitative variables between groups, whilst the t-test and One-Way ANOVA was used to compare quantitative variables. The average annual incidence of acute diarrhea in children under five years old was 10.4% [9.4% in the intervention group and 11.4% in the control group]. The seasonal pattern of acute diarrhea incidence was 10.5% [9.3% in the intervention group and 11.7% in the control group] in May, 12.5% [11.5% in the intervention group and 13.4% in the control group] in August, 9.3% [8.1% in the intervention group and 10.5% in the control group] in November, and 9.1% [8.5% in the intervention group and 9.8% in the control group] in February respectively. The study showed the incidence of acute diarrhea in children under five years old in Rasht city is moderate and it follows a seasonal pattern. The highest rate was seen in summer and the lowest rate in winter. It is expected to decrease with the initiation of the sewerage system program

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

[Research priority of cardiovascular research center of Shahid Beheshti university of medical sciences in 2009]

Allocation of limited resources to research proposals with high priority helps achievement of acceptable level of health. Therefore, priority setting in research centers is a necessary action. The objective of this study is to report the research priorities of the Cardiovascular Research Center of Shahid Beheshti University of Medical Sciences in 2009. This study involved 48 faculty members and other stakeholders in 2009. There were five basic principles including stakeholders' participation and consensus, situation analysis, need assessment, defining research priority topics, and scoring the criteria. This is a modified version of the proposed model of "The Council on Health Research for Development [COHRED]. Twenty diseases were determined as research priorities of the cardiovascular research center of Shahid Beheshti University of Medical Sciences. These priorities included myocardial infarction, hypertension, unstable angina, atherosclerosis, dyslipidemia, heart failure, stable angina, metabolic syndrome, coronary bypass complications, pulmonary embolism, heart valve diseases, prevention of deep vein thrombosis, rheumatic fever, cardiogenic shock, cardiac arrhythmia, cardiac arrest and sudden cardiac death, Peripheral vascular disease, syncope, angioplasty and valvuloplasty, cardiovascular diseases: epidemiology, etiology, risk factors, prevention, rehabilitation, socioeconomic factors, knowledge, attitude, and practice to risk factors and prevention. Providing researchers with a list of research priorities and commitment to it, conduct research topics toward priorities and consequently the most productivity is achieved from the limited resources

Comparison of mono and biphasic culture media in isolating bacteria from blood and evaluation Bu-Ali hospital lab quality

Blood Culture is an important diagnostic method in infectious diseases and has positive results in 30%- 50% and even to 80% of cases due to sample volume. In Bu-Ali Hospital, Tehran, it decreases to 2-3%. In this survey, quality of hospital lab and difference between Mono and Biphasic culture media in isolating bacteria from blood of patients suggestive of sepsis were evaluated.106 [48 F + 58 M] newly admitted patients with impression of sepsis as SIRS [Systemic Inflammatory Response Syndrome] [36[degree sign]C >OT>38.3[degree sign]C , tachycardia more than 100/min, leukocytosis with shift to left or leucopenia] with infectious source were sampled for culture [5ml blood 3 times in 1 Biphasic and 2 Monophasic media] in the infectious ward. One Monophasic Media in hospital lab and the two other [1 Monophasic + 1 Biphasic Media] in Reference Laboratory of Iran, Research Center were handled. Media were quality-controlled at beginning and in the middle of study by NCCLS [National Committee for Clinical Lab Standard] with ATCC [American Type Culture Collection] samples. Sampling, transfer, and handling were all in standard conditions usually used in hospital. Results were compared by Fisher Exact Test. Clinical diagnosis were bacterial in 84 [79%], and nonbacterial in 22 [21%] patients at admission. 57 [54%] patients had not used antibiotics in the past 72 hours. In Monophasic Media of hospital lab 2 [1.9%] positive cultures [S. epidermidis] one with history of Erythromycin use were reported. In both Monophasic and Biphasic Media in reference lab 3 [2.8%] positive cultures [2 S.epidermidis, 1 E. coli] were reported equally, one with history of Erythromycin use. Growth Index in both Monophasic and Biphasic Media were standard in quality control. Qualities of Mono and Biphasic Media in growing bacteria were alike and Biphasic Media had no superiority to Monophasic Media in routine bacterial isolation. Positive culture in both labs had no significant statistical difference. So, negative results are not due to media and laboratorial fields, and it is needed to educate and evaluate two other fields: Sampling and Transferring. Also, we may have more positive cultures by increasing blood samples from 5 to 20 ml which can be compared in next studies

Family social status and dietary adherence of patients with phenylketonuria

There are several problems associated to the management of patients with phenylketonuria [PKU]. Social status could be one of the affecting factors on dietary adherence in these patients. The aim of this study was to evaluate family social status and dietary adherence of PKU patients in Iranian population. In a cross-sectional study, we studied 105 Iranian PKU patients [born 1984 to 2010], treated and followed at Mofid Children's Hospital, Tehran. Social status was defined by number of children in family, number of affected children in family, maternal and paternal education, marital and employment status of the parents. Age at diagnosis and duration of treatment were also recorded. Mean plasma phenylalanine level was considered as a sign of dietary adherence in PKU patients and was calculated considering the phenylalanine measurements throughout at least one year. Mean plasma phenylalanine concentration was 5.9 +/- 3.6 mg/dl in patients <12 years old and 13.1 +/- 3.9 mg/dl in patients >12 years old. Blood phenylalanine concentrations in 47.6% of patients were in normal age-related reference range. There was a significant association between divorced and unemployed parents, and higher levels of blood phenylalanine concentration [P=0.02 and P=0.03 respectively]. There was a significant positive correlation between number of affected children in the family [r=0.43, P<0.001], age at diagnosis [r=0.2, P=0.03], treatment duration [r=0.7, P=<0.001] and blood phenylalanine concentrations. There was no significant relation between parental education, family size and dietary adherence. Social status affects dietary adherence to some extent. We suggest exploring care-givers dietary knowledge as the next step to improve dietary compliance in these patients

Urogenital chlamydia trachomatis infection among prisoner men

Chlamydia trachomatis [C.trachomatis] is one of the most common curable STDs. Little information is available on its incidence among prisoner men. This study aimed to investigate the frequency of urogenital infection with C.trachomatis among imprisoned men as a high risk group. In this cross-sectional study, 130 imprisoned men aged 16-49 years in one of Tehran prisons were randomly selected. After completing informed consent, each volunteer dedicated a urine sampler and a completed questionnaire. DNA extraction and PCR assay were performed in Avicenna Research Institute. Among the 130 prisoner men, only 3 [2.3%] had positive PCR test results. Mean age of participants was 28.00 +/- 4.58 and the mean age at first sexual contact was 20.33 +/- 3.51. All had at least elementary education while 66.7% were unmarried and 33.3% were unemployed and had less than 1000000 Rails per month. Moreover, 33.3% were homeless and others living in rental houses. Furthermore, 66.6% had more than 4 sexual partners. There was no difference in condom use and none of them mentioned urinary discharge or dysuria. Additionally, 66.6% were IVDU and had more than 3 prison admissions. There was no report of HIV, HCV or HBV infection among them. The low incidence of C.trachomatis in this study showed that screening of asymptomatic men by PCR is not cost-effective and in order to obtain more epidemiological information, low-cost techniques such as serological methods can be recommended. Moreover, studies with broader distribution and higher sample size should be performed to determine real prevalence of chlamydia infection and make a definite decision about screening

Performance of QuantiFERON-TB Gold test compared to tuberculin skin test in detecting talent tuberculosis infection in HUV-positive individuals in IRAN

There is limited data about the performance of QuantiFERON-TB Gold [QFT-G] test in detecting latent tuberculosis infection [LTBI] in our region. We intended to determine the performance of QFT-G compared to conventional tuberculin skin test [TST] in detecting LTBI in HIV-positive individuals in Iran. This study was conducted in a HIV clinic in Tehran, Iran in April 2007. A total of 50 consecutive HIV-positive patients, not currently affected with active tuberculosis [TB], were recruited; 43 [86%] were male. The mean age was 38 +/- 7.2 years [21-53]. All had history of Bacillus Calmetta Guerin [BCG] vaccination. A TST with purified protein derivative [PPD] and whole-blood interferon-gamma release assay [IGRA] in reaction, to ESAT-6 and CFP-10 antigens was performed and measured by enzyme-linked immune-sorbent assay [ELISA]. The agreement between TST and QFT=G results were analyzed using Kappa test. A total of 36 [72%] patients had negative TST. For QFT-G, 20 [40%] tested positive, 19 [38%] tested negative, and the results in 11 cases [22%] were indeterminate. A total of 14 [28%] patients had a CD4 count of < 200 .Of the 14, TST + group, 12 had QFT-G +, only one case TST +/QFT-G-, and QFT-G was indeterminate in one TST positive case. Of the 36 patients with negative TST test, 8 [22%] had positive GFT-G and 10 [28%] yielded indeterminate results. There was no association between a positive TST and receiving highly active anti-retroviral therapy [HAART] or CD4 counts was not significant [P=0.06]. Although TST results were not significantly different in patients with CD <200 vs. CD4>200 [P=0.095], association between QFT-G results and CD4 cutoff of 200 reached statistical significance [P= 0.027]. Agreement Kappa coefficient between TST and QFT-G was 0.54 [Kappa = 0.54, 95% CI = 38.4-69.6, P < 0.001]. Detecting LTBI in HIV-positive individuals showed moderate agreement between QFT-G and LTBI in our study. Interestingly, our findings revealed that nontuberculous mycobacteria and prior BCG vaccination have minimal influence on TST results in HIV patients in Iran

[Effect of infection on serum lipid level, a prospective study in Iran]

Serum lipid level may change due to acute febrile illness. This study was designed to evaluate serum lipid level changes in acute infectious diseases and emphasis on importance of serum lipid level measurement in infectious disease. This study also compares diagnostic value of serum lipids and acute phase reactant markers. This study was performed on 100 critically ill patients in 3 tertiary care hospitals in Tehran, Iran. 50 patients with infectious diseases were selected as case group and 50 patients without infectious diseases as control group. Serum level of total cholesterol [TC], high density lipoprotein [HDL], low density lipoprotein [LDL] and triglyceride [TG] were compared in case and control groups. Patients with critical illness and infection had lower level of HDL than patients with critical illness without infection. Mean and standard deviation of FIDL was 40 +/- 19 in case and 53 +/- 14 in control groups. HDL value as a guide to diagnosis infection is equal to erythrocyte sedimentation rate [ESR] and C- reactive protein [CRP]. Serum lipid level change in acute febrile illness. Serum level of high density lipoprotein decreases in infectious diseases and diagnostic value of high density lipoprotein is equal to erythroeyte sedimentation rate [ESR] and C- reactive protein [CRP] in our study

Evaluation of the effect of elective percutaneous coronary intervention as a treatment method on the left ventricular diastolic dysfunction in patients with coronary artery disease

Although percutaneous coronary intervention [PCI] is an excellent therapy for coronary artery disease, there is a paucity of information on the efficacy of PCI in improving diastolic function, especially in Iran. Because of the high prevalence of left diastolic dysfunction in coronary artery disease patients and its probable progression to heart failure, an evaluation of the role of PCI in improving diastolic function is required. Thirty patients scheduled for elective PCI were enrolled in this study providing that their systolic ejection fraction was > 40%. Before PCI and 48 hours and 3 months after PCI, echocardiography was done to evaluate some diastolic values in these patients. The mean age of all the patients was 54 +/- 10 year, and 20 patients were male. All the patients had a low degree of left ventricular diastolic dysfunction. Isovolumic relaxation time [115 +/- 10 before treatment versus 120 +/- 1 and 119 +/- 3 respectively 48 hours and 3 months after treatment], mitral E wave velocity in septal [0.70 +/- 0.05 before treatment vs. 0.71 +/- 0.15 and 0.72 +/- 0.12 respectively 48 hours and 3 months after treatment], and the peak velocity of late filling due to atrial contraction [mitral A wave velocity] in septal [0.74 +/- 0.02 before treatment vs. 0.73 +/- 0.01 and 0.68 +/- 0.16 respectively 48 hours and 3 months after treatment] showed improvement after PCI. It is notable that early diastolic mitral annulus velocity [E'] wave velocity in the septal part of the mitral annulus improved significantly 48 hours and 3 months after PCI [p value < 0.05]. The early-to-late diastolic tissue velocity ratio of the mitral annulus [E/A] ratio of the mitral inflow improved 48 hours after PCI; it was statistically significant [p value = 0.05]. Also, mitral A wave velocity in septal and the E/A ratio of the mitral inflow improved significantly 3 months after PCI [p value < 0.05]. Improvement in some of values related to left ventricular diastolic function followed by PCI shows thai this method can be used to improve cardiac diastolic function in patients with symptomatic coronary artery disease

Research priority setting of Shaheed Beheshti medical university and tropical medicine research center in 2007

It is obvious that because of the lack of resources, we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study was research priority setting of infectious diseases using COHRED [Council on Health Research for Development] model. First of all, the stakeholders were identified and the situation of the field of infectious diseases was analyzed. Then, research areas and titles were specified using announcement, infectious diseases sources, [International Classification of Diseases 10] ICD10 and consensual qualitative techniques including brainstorming sessions, focal group discussion and Delphi. Finally, research priorities were specified by giving scores according to the criteria. Twenty-five research areas were obtained as priorities of infectious diseases and tropical medicine. These areas are HIV/AIDS, tuberculosis, drugs, infections in special hosts, avian flu, nosocomial infections, infections due to needle stick injury, malaria, viral hepatitis, viral hemorrhagic fevers, surgical- and burn- related infections, fever, central nervous system infections, effectiveness of vaccination, bloodstream infections, influenza, lower respiratory tract infections, gastrointestinal infections due to Entamoeba histolytica, bone and joint infections due to brucella, bioterrorism, brucellosis, hydatidosis, anthrax, botulism, and the role of migrants in the distribution of infectious diseases in Iran. Three subheadings including treatment, prevention and control and diagnosis methods got the most priorities, respectively. Although about half of the priorities are related to two subheadings including treatment and diagnosis methods, research priorities of prevention and control methods [22% of all priorities] indicate the importance of prevention for clinicians who gave scores to the titles

Source and response of antibody to hepatitis B vaccine in hemodialysis patients

All chronic hemodialysis patients for hepatitis B infection have to be tested and vaccinated against HBV infection routinely. A descriptive study was designed in 47 hemodialysis patients. After a blood sample was taken for serologic status, three doses [0, 1, 6 month] of hepatitis B vaccine were administered. Repeated titers were obtained one month after the last vaccination and analyzed by ELISA. 39 patients [83%] became immune with protective levels of HBs antibody. There was not a significant correlation between sex, age, smoking, underlying diseases, weight, duration of dialysis and positive HBs antibody after vaccination. Hmodialysis patients need follow-up testing

Seroprevalence of anti-helicobacter pylori antibodies in hepatitis B and C patients with cirrhosis: a case-control study

Cirrhosis is terminal stage of many chronic liver diseases like hepatitis C and hepatitis B. In some studies the role of helicobacter pylori has been demonstrated in progress of cirrhosis and its complications, but none of the previous studies has investigated the role of socioeconomic conditions of patients in childhood period in this issue. In a case-control study, we examined 100 cirrhotic patients due to hepatitis [49 hepatitis B and 51 hepatitis C patients] and 101 socioeconomically matched healthy controls presenting to Taleghani Hospital for IgG antibody to helicobacter pylori. IgG antibody to helicobacter pylori was present in 73% of cirrhotic patients and 52% of control group [P < 0.003]. Odds ratio for the presence of IgG antibody to helicobacter pylori in cirrhotic men comparing with healthy men was 3.2 [95%CI: 1.4-7.4]. The relative frequency of IgG antibody to helicobacter pylori found to be higher in cirrhotic patients than in controls with regard to socioeconomic condition in childhood

Frequency of positive purified proterin derivative test in those infected with human immunodeficiency virus

The objective of this study was to determine the frequency of positive purified protein derivative [PPD] skin test in those infected with human immunodeficiency virus [HIV] and to investigate its association with CD4-positive T cell count, demographic factors, and possible routes of transmission in Iran. Fifty-one [36 males and 15 females] patients from an HIV clinic were selected and tested by a 5-tuberculin unit PPD. The mean +/- SD age of patients was 32.2 +/- 7.9 years. The probable route of HIV transmission was intravenous drug using in 21 [41%, CI95%: 28 - 54%] and sexual transmission in 17 [33%, CI95%: 20 - 46%] patients. Thirteen [26%, CI95%: 14 - 38%] patients had other risk factors. There were 13 [25%; 10 males and 3 females] PPD-positive patients among HIV-infected patients when a cut-off value of 5 mm was used; there were 15 [29%; 11 males and 4 females] when a cut-off point of 2 mm was employed. In addition, there was no significant correlation between the PPD test using both cut-off values of 5 and 2 mm, and none of the three probable routes of HIV transmission including intravenous drug using, sexual, and others. The mean +/- SD CD4[+] T cell count was 674 +/- 487/mm[3] in men and 573 +/- 327/mm[3] in women [P > 0.05]. No significant correlation could be demonstrated between the patient's PPD positivity rate and CD4[+] T cell count. Considering the high rate of tuberculin reactivity, more attention should be paid to the importance of PPD test and isoniazid preventive therapy against tuberculosis in HIV-infected patients

Tetanus antitoxin levels and cutaneous anergy in hemodialysis patients in two University Hospitals in Iran

The global incidence of tetanus is about I million cases annually. Tetanus antibody values decrease with age. Some patients with humoral immune deficiencies may not respond adequately to tetanus toxoid vaccination. The incidence of infectious disease is increased in patients with chronic renal failure. The purpose of this study was to determine tetanus antitoxin level and cutaneous anergy test in hemodiaksis patients. A cross sectional study was performed on 44 hemodialysis patients who had been on dialysis thrice a week for at least 2 months. Quantitation of tetanus-specific antibodies was achieved by ELISA technique. Then, for Manteaux test 0.1 ml of 1/10 saline diluted solution of tetanus and diphtheria toxoid was injected intradermally to the volar surface of the shunt-free arm. Induration was recorded 48 - 72h and 7 - 9 days after the injection. Twenty-eight [64%] patients had induration /= 0.1 IU/ml. There was no significant correlation between age, sex, duration of dialysis, frequencies of dialysis history of tetanus-diphtheria vaccination, and tetanus antitoxin levels. There was a significant difference between induration size of anergy test results recorded on two separate observations [48 - 72h and 7 - 9 days after the test] [p < 0.05]. Our results indicate that immunization history was not consistent with protective antibody level, so monitoring immunization status and administering the tetanus vaccine in hemodialysis patients are required. Keywords: Anergy test, Anti-tetanus antibody, Hemodialysis

Evaluation of tuberculin skin test and booster effect in hemodialysis patients

Tuberculosis is an endemic disease in Iran which may occur mor frequently among hemodialysis patients. We have evaluated tuberculin skin test [TST] in hemodialysis patients in a university hospital in 2003 - 2004. Materials and methods: Sixty-seven hemodialyis patients were enrolled for tuberculin skin tests. Indurations were measured 48 - 72 hours after the injection and then on the 7th day. Those with indurations less than 5mm in TST1 were introduced for TST2. Of 67 patients, 18 [26.9%] had indurations of less than 5mm in TST1 and were introduce for TST2 among whom 7 [39%] had an induration measured less than 5mm. Of 18 cases, 11 [61%] were revealed to have booster effect that represent a ratio of 16% of all studied hemodialysis patients in our study. It seems that the second TST is a better indicator of infectivity in hemodialysis patients, especially for patients who require repeated or annual estimation for M. tuberculosis infection. Keywords: hemodialysis, Booster effect, Tuberculosis, Tuberculin skin test

Effect of misoprostol on acute phase of viral hepatitis B in Iran

Most therapeutic interventions in acute phase of viral hepatitis B patients are conservative. Prostaglandins have absorbed many scientists' attention for improving these patients condition, therefore, the present study was designed to evaluate misoprostol [PGE1 Analogue] effect on acute phase of viral hepatitis B. A randomized matched controlled clinical trial was performed on two equal groups each included fifteen male acute phase hepatitis B patients who were anti HBC IgM and HBs Ag positive, hepatitis C negative and their total bilirubin level was more than 10 mg/dl. The experimental group received 800 micro g misoprostole [200 micro g x 4 times a day] while the control group received placebo for 14 days. Their bilirubin and serum transaminases concentrations as well as PT and PTT were checked before and after the therapy and compared by chi square and tstudent tests using SPSS software. At the end of the treatment phase, serum bilirubin, SGPT and PTT were significantly lower in the experimental group. After three weeks follow up, only SGOT was not significantly lower in experimental group. At the end of the 4th and the 5th week after treatment initiation, serum bilirubin, SGPT, alkaline phosphatase and PTT were significantly lower in experimental group. These results confirm that misoprostol improves hepatitis B patients' condition and reduces their serum bilirubin, SGPT, alkaline phosphatase and PTT

Frequency of tuberculous pericarditis in patients with diagnosis of pericarditis

During the past decades the prevalence of tuberculosis [TB] has declined and its prognosis has changed dramatically due to chemotherapy; however, cases of tuberculous pericarditis are still reported worldwide. The study population included 19 men and 11 women aged 12-76 years admitted to the hospital for acute pericardial disease. The diagnosis of tuberculous pericarditis was verified based on the adenosine deaminase activity [ADA], culture on Lowenstein-Jensen media, Ziehl Neelsen staining, biopsy of pericardial tissue and evaluation of tuberculin test. Of 30 patients, 13 [43.3%] had tuberculous pericarditis. All of whom had clinical TB manifestations. The culture of pericardial fluid in 6 patients [46%], staining in 3 [23%], and the culture of pericardial tissue in 6 patients [46%] were positive. The caseating granuloma was identified in 46% of cases. Ten case [77%] had positive PPD reaction. All tuberculous pericarditis patients had ADA level of >45U/l. Results have revealed that measurement of ADA level may prove a good screening test for early diagnosis of tuberculous pericarditis

Prevalence of Staphylococcus aureus carriage in patients on hemodialysis and the pattern of antibacterial resistance

Staphylococcus aureus is a virulent pathogen that is currently the most common cause of infection in hospitalized patients. These days, increment in antimicrobial resistance coupled with increasing prevalence of the agent as a nosocomial infection makes the situation even more complex. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the prevalence of Staphylococcus aureus nasal carriage in a group of Iranian patients on hemodialysis. For this descriptive study, sterile-cotton-tripped swabs were rotated into anterior nares of 96 patients on hemodialysis, and then cultured on blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase and coagulase tests were all performed and the pattern of antibacterial sensitivity was determined. Of 96 patients on hemodialysis, 44 [45.8%] were nasal carrier of S. aureus. All isolated S. aureus were resistant to methicillin [MRSA], while 95% were resistant to cloxacillin, 6.81% to clindamycin, 6.81% to ciprofloxacin and 4.5% to rifampin; however, all microorganisms were sensitive to vancomycin. Patients on hemodialysis are at increased risk of S. aureus contamination, thus, screening these susceptible patients should be served as a health priority. Meanwhile, antibiogram should be ordered for all cases to optimize treatment options