Extrinsic and intrinsic coagulation pathway, fibrinogen serum level and platelet count in HIV positive patients

Infection with human immunodeficiency virus [HIV] is a progressive condition which may cause endothelial dysfunction and liver damage leading to coagulopathy. With adventure of highly active antiretroviral therapy [HAART], life expectancy has prolonged in HIV positive patients but several acquired immunodeficiency syndrome [AIDS]-related conditions such as coagulopathies are responsible for associated morbidity and mortality. This study aimed to evaluate the extrinsic and intrinsic pathways of coagulation, serum level of fibrinogen and platelet count in HIV positive patients and compare it with negative healthy individuals. Through a case-control study, 114 HIV seropositive patients were compared with 114 seronegative samples in terms of hematological and other coagulation parameters. Mean age of study patients was 37.48 years. Intra venous drug abuse was the most common route of infection transmission with a prevalence of more than 50%. HIV route of transmission had a direct relationship with PTT abnormal levels [P<0.0001]. However, this relationship was not significant for PT values. Stages of HIV disease and administration of HAART did not reveal any significant relationship with PT and PTT. There was also a statistically significant correlation between CD4[+]< 200 and PT in case group [P=0.008]. On the other hands, in control group, CD4[+] had a weak relationship with PTT [P=0.02] and an inverse correlation with serum fibrinogen [P=0.013]. Hematological parameters and serum fibrinogen are decreased in HIV positive patients especially in direct relation with CD4[+] cell count<200 cell/ micro l. PT and PTT abnormal values are also more prevalent in this population

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

<p><b>OBJECTIVE</b>To identify the frequency of syphilis among Iranian HIV-positive patients.</p><p><b>METHODS</b>A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital, Tehran, Iran. The lab tests including CD4 cell count, cerebrospinal fluid, veneral disease research laboratory (VDRL), fluorescent treponema antibody-absorption (FTA-Abs) and viral load were performed for all the patients. Data regarding medical history and their demographics were also collected.</p><p><b>RESULTS</b>Of all 450 HIV-positive patients, 24 (5.3%) had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45% of them had a definite co-infection of syphilis. 65.3% of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%. We did not find any patient with neurosyphilis.</p><p><b>CONCLUSIONS</b>Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations, the diagnosis of syphilis should be timely established using screening tests among such patients.</p>

[In vitro antifungal susceptibility of oral candida species from Iranian HIV infected patients]

Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS [PLWHA] in the present study. One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud's dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI. Candida albicans [50.2%] was the most frequent isolated yeast, followed by C. glabrata [22%]. Non-Candida albicans species were isolated from 71 [61%] positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole [MIC >/= 64 micro g/ml] as were 21.9% and 16.4% to ketoconazole and clotrimazole [MIC>0.125 micro g/ml], respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole. Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested

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