Counseling and harm reduction centers for vulnerable women to HIV/AIDS in Iran

Human immunodeficiency virus [HIV] is a public health challenge facing both developing and developed nations. Although injecting drug use is even the main route of HIV transmission in Iran, sexual route is rising gradually. Vulnerable women have been considered as important bridging population for driving HIV epidemics. To increase the access to vulnerable women, in 2007, 5 pilot centers were established in risky areas to deliver comprehensive services to women who themselves or their spouses are engaged in drug use, risky sexual behavior or have history of imprisonment. Management of Sexually Transmitted Infection, psychological counseling and harm reduction are provided by female staff. The aim of this study was to report the activities conducting in 2008. Registered information was used to assess the demographic characteristic, HIV/ AIDS related risk factors and services delivered to clients. Till March 2008, 442 clients have been admitted. Most of them [36.2%] had 25-34 years old. 14.3% were illiterate and 31% were totally jobless. The most prevalent risk factors were risky sexual behavior [27.1%] and non-injecting drug use [23.2%]. Injecting drug use was detected in 11.3% of attendees. Dividing clients according to marital status, risky sexual behavior was the main risk factor in unmarried [40.2%] and divorced [26.9%] but in married and widow ones, non-injecting drug use was the most [25.8% and 36.5% respectively]. Harm reduction [40.5%] and counseling [36.6%] were the most delivered services. Since vulnerable women play a critical role to spread HIV-epidemic to general population, increasing centers provide more access to this population

[High-risk behaviors of HIV positive individuals referred to behavioral counseling centers of universities of medical sciences in Tehran]

Development of effective antiretroviral therapies [ART] has reduced mortality and increased life expectancy among individuals with HIV infection. Antiretroviral therapy regiments have improved symptoms and quality of life among these patients, whose sexual and reproductive needs, have, therefore, increased as well. In 2010, 20.8% of HIV-infected Iranians acquired the disease through sexual relations. The objective of this study was to define high-risk sexual behaviors among individuals infected with HIV referred to the Triangular Clinics of Universities of Medical Sciences in Tehran. This cross-sectional interview-based survey included 400 HIV-positive individuals selected by consequential sampling. The majority [60%] of the subjects was males, and 44.2% of men and 51.3% of women with HIV were in the age group 34-25 years. On the whole, 15.6% of the women and 49.6% of the men had high-risk sexual behaviors after diagnosis of HIV infection. Further analysis of the data showed that 62.5% of HIV-positive individuals were not aware of the risks of unsafe sexual relationship [using no condom] for HIV-positive transmission.. Based on the logistic regression module, it was found that factors strongly associated with high-risk sexual behavior were being male, being single, under high school diploma/graduate degree, alcohol intake and use of hormonal and permanent methods of family planning [p<0.05]. The findings of this study confirm previous reports showing common high-risk sexual behaviour after diagnosis in HIV-positive populations. Providing suitable health services and advice on fertility and sexual health will result in no- or low-risk sexual life for couples

Cutaneous leishmaniasis in Bam: a comparative evaluation of pre- and post- earthquake years [1999-2008]

The recent devastating earthquake of December 26 in Bam, 2003 created various risk factors; caused a sharp increase in incidence of anthroponotic cutaneous leishmaniasis [ACL] cases and reached to an epidemic proportion. The objective of this study was to evaluate the status of ACL cases five years before the earthquake compared to the cases occurred five years after the earthquake [1999-2008]. Status of disease was assessed retrospectively for the five years before the earthquake and prospectively for the five years after the earthquake. Identification was confirmed by smear and polymerase chain reaction [PCR]. The mean annual incidence of ACL for the period from 1999 to 2003 was 1.9 per 1000 comparing to post earthquake period, which was 7.6 per 1000. Most of the infection was in individuals of <20 years, more frequently in females before the earthquake, whilst in contrast, there was a progressive rise in the number of cases, significantly in male individuals of >20 years [P< 0.0001] in post earthquake era. The anatomical distribution of lesions considerably changed during the two periods. Most of the cases were limited to three zones within the city prior to the earthquake, whereas it was spread throughout different zones after the earthquake. PCR indicated that the CL was due to Leishmania tropica in the city. The results strongly suggest that in natural disasters such as earthquakes various precipitating factors in favor of disease will be created, which in turn provide a suitable condition for propagation of the vector and the transmission of the parasite

Molecular epidemiology of measles virus before and after the 2003 mass vaccination campaign for measles/rubella in Iran

Molecular epidemiology of measles virus [MV] is important, not only to measure the success of measles vaccination programs but also to monitor the circulation and elimination of the virus worldwide. In this study, we compared MV obtained from patients before the 2003 mass vaccination MR campaign and viruses detected after 2003 until 2008 in Iran. The nucleoprotein [N] gene of 29 MV strains circulating in Iran between 2002 and 2008 were amplified by RT-PCR and subjected to sequence and phylogenetic analysis. Molecular characterization of MV studied here revealed that although the outbreaks in Iran were associated with MV genotype D4, the isolated viruses clearly belonged to several different lineages. Maximum and minimum homology within the 29 Iranian strains in our study was100% and 94.9% within the carboxyl terminus of the N gene, respectively. Using Clustal X program, the alignment of Iranian MV sequences showed nine lineages. This study provides the usefulness of MV sequence analysis for the demonstration of local interruption of indigenous strain transmission as well as providing a valuable means for monitoring the elimination processes of MV control

Cost-benefit and effectiveness of newborn screening of congenital hypothyroidism: findings from a national program in Iran

In this study, the cost-benefit of a screening program based on the rial, the unit of currency used, was analyzed. The intelligence quotient [IQ], and height and weight were evaluated as indices for a population of children suffering from congenital hypothyroidism [CH]. The total cost for the screening program, including hormone tests, diagnosis, medicine, treatments and care was identified and calculated up to the age of seventy years and this was compared to the costs related to training and caring for patients suffering from mental retardation, who had not been screened. The screening test was done using S and S filter paper and thyroid stimulating hormone [TSH] was determined by the ELISA test. The future costs and benefits with an annual rate of 3% discount of their current value was estimated. To evaluate the effectiveness of the screening program, IQs of 32 patients were identified and compared to 36 healthy children between 2004-2005. The IQs were evaluated according to "Good Enough" and "Proteus Maze" tests. During 2008, 1165169 of 12489136 newborns [51% male, 49% female] underwent screening for CH, 92% cover-age of all newborns for that year. Four percent of recalled infants, with TSH>5 were subjected to diagnostic tests [T4, TSH, T3RU] and finally 2745 patients were identified. Benefit to cost ratios, based on a 3% annual discount rate, were 22, 41, 32, 34, 47 and 60 times lower, respectively. No significant differences were found with regard to differences in IQ scores between cases and controls [cases: 105 +/- 19.3, controls: 111 +/- 19.4], height [cases: 106 +/- 0.7, controls: 102 +/- 4.9 cm] and weight [cases: 15.6 +/- 4.6, control 15.3 +/- 3.2 kg]. The national Newborn Screening [NBS] program for CH has been successful and quite effective in Iran. The method not only has economical advantages but also reduces capital expenditures and preserves normal IQ of the patients under treatment and prevents mental retardation and growth complications

Prevalence of oropharyngeal colonization by Haemophilus influenzae type b in Iranian children

Healthy carriers of Haemophilus influenzae type b [Hib] play an important role in the spread of invasive disease. The aim of this study was to assess the need for Hib vaccination in Iranian children by estimating the prevalence of Hib oropharyngeal colonization among children in Tehran. Cultures were prepared from oropharyngeal swabs of 1000 children in 25 day-care centres in Tehran from October 2005 to March 2006. The prevalence of Hib carriers was 7.6%, similar to other developing countries prior to inoculation with the conjugate Hib vaccine. We recommend Hib vaccination be included in the Iranian national programme of immunization

Meningococcal carrier rate before and after hajj pilgrimage: effect of single dose ciprofloxacin on carriage

We determined the carriage rate of Neisseria meningitidis before and after hajj pilgrimage among a group [1] of 674 randomly selected Iranian pilgrims, and the effect of 500 mg of ciprofloxacin given 24 hours before return on the reduction of meningococcal carriers among another group [2] of 123 randomly selected Iranian pilgrims. Throat specimens taken 1 hour before departure on the hajj and immediately on return were cultured. Carriage rates of N. meningitidis in group 1 were 5.2% before and 4.6% after pilgrimage [P = 0.65]; 3 new serogroups [Z, Z' and A] were identified on return. In group 2, the carriage rate decreased from 8.1% to zero before and after pilgrimage

Use of meta-anaglysis to determining the associated factors of an outbreak occurred in the summer 2005 in Iran

According to the report of Iranian Center of Disease Control, in the summer of 2005 an outbreak of cholera [Inaba serotype] occurred in Iran. The outbreak lasted the mid of September. The aim of this study was to use the result of different studies performed during this period to determine source of infection. This is a meta-analysis study, which studies performed in Qum, Arak, Karaj, Golestan and Ghazvin were eligible. All of these studies were case control ones performed during the August 2005. The total of cases were 531 Pooled odds ratios was used to estimate by fixed and random method. All computations were performed by Stata 8 software. The estimated pooled odds ratios resulted from 5 differemt studies were used in the meta-analysis as the following: travelling [1.64; 95% CI: 0.98-1.88], non-pasteurized ice cream [0.88; 95%CI: 0.48-1.61], post toilet hand washing [3.72; 95% CI: 0.86-16.05], eating meal outside home [2.38; 95% CI: 1.46-3.90], raw fruit eating [0.98; 95% CI: 0.42-2.18] and raw vegetables use [5.36; 95%CI: 2.4-12]. According to the results of this study raw vegetable use and having meal outside home were significantly associated to the cholera in mentioned provinc

[Osteoporosis; diagnosis and treatment]

Osteoporosis is the most common metabolic disorder which is increasing all over the world. It is associated with age and sex, therefore the highest prevalence of the disease is seen in post menopausal women. Increase in life expectancy and number of old people will cause significant rise in the prevalence of osteoporosis in future. In our country according to Tehran survey, prevalence of osteoporosis in 60-69 yr. women in spine and hip region is 52.4% and 5.9% and in the same age range in men is 9.4% and 3.1%, respectively. Osteoporosis is thus a problem of the world in second half of the present century specially in Asia, so prevention, diagnosis and treatment of disease is imperative for health improvement. One of the most important complications of osteoporosis is fracture of spine and femur neck which increases mortality and morbidity. More than 90% of hip and femur neck fractures occur in 50 yr old or above, and 80% of them are women. Osteoporotic fractures incur high cost for the patient and community. Major risk factors of osteoporosis are: age, low bone density, history of fragility fracture and history of familial osteoporosis. Today the diagnosis of osteoporosis is based on bone density measurement. Osteoporosis is a mulitfactorial disorder and its prevention and treatment are difficult. Most of the treatments available for treatment of osteoporosis recent have antiresorptive effects which reduce bone distruction. Some of these drugs also decrease pathologic fractures. New drugs increasing bone formation are coming up. However in all kinds of treatments existance of sufficient calcium and vitamin D reserve is necessary for efficacy of medications that could be provided by nutrition or supplements