Zika virus: A review of literature

Zika virus (ZIKV) has two lineages: African and Asian. Mosquito-borne flaviviruses are thought to replicate initially in dendritic cells and then spread to lymph nodes and the blood stream. Risk for infection through blood transfusion, sexual practices and perinatal transmission exists. The possible routes of perinatal transmission are during delivery, breastfeeding and by close contact between the mother and her newborn. Also, mucocutaneous exposures to the virus by infected blood or monkey bite, organ transplantation or hemodialysis are the other routes of ZIKV transmission. There are two types of ZIKV infection; Zika fever and congenital infection. Clinical presentation of Zika fever varies from asymptomatic infections to a self-limiting febrile disease with low grade fever, conjunctivitis, maculopapular rash, headache, retro-orbital pain and arthritis/arthralgia with periarticular edema, myalgia, vertigo, vomiting and asthenia. This clinical feature could be mistaken for dengue or chikungunya fevers. Microcephaly is the most important and frequently reported clinical picture of suspected congenital Zika syndrome. Laboratory tests are needed for diagnosis of ZIKV infection, because there is no known pathognomonic clinical, biochemical or radiological features. RT-PCR is the most well-liked assay. Serum samples are tested by immunoglobulin G ELISA with ZIKV antigen. Samples are also tested by immunoglobulin M ELISA. There is no certified vaccine or therapeutic medication. In asymptomatic or uncomplicated patients, treatment is not necessary.

Ebola viral disease: A review literature

Ebola virus is transmitted to people as a result of direct contact with body fluids containing virus of an infected patient. The incubation period usually lasts 5 to 7 d and approximately 95% of the patients appear signs within 21 d after exposure. Typical features include fever, profound weakness, diarrhea, abdominal pain, cramping, nausea and vomiting for 3-5 days and maybe persisting for up to a week. Laboratory complications including elevated aminotransferase levels, marked lymphocytopenia, and thrombocytopenia may have occurred. Hemorrhagic fever occurs in less than half of patients and it takes place most commonly in the gastrointestinal tract. The symptoms progress over the time and patients suffer from dehydration, stupor, confusion, hypotension, multi-organ failure, leading to fulminant shock and eventually death. The most general assays used for antibody detection are direct IgG and IgM ELISAs and IgM capture ELISA. An IgM or rising IgG titer (four-fold) contributes to strong presumptive diagnosis. Currently neither a licensed vaccine nor an approved treatment is available for human use. Passive transfer of serum collected from survivors of Junin virus or Lassa virus, equine IgG product from horses hypervaccinated with Ebola virus, a "cocktail" of humanized-mouse antibodies (ZMapp), recombinant inhibitor of factor VIIa/tissue factor, activated protein C, RNA-polymerase inhibitors and small interfering RNA nano particles are among the therapies in development. Preclinical evaluation is also underway for various vaccine candidates. One is a chimpanzee adenovirus vector vaccine; other vaccines involve replication-defective adenovirus serotype 5 and recombinant vesicular stomatitis virus.

Prevalence of HIV infection and the correlates among homeless in Tehran, Iran

<p><b>OBJECTIVE</b>To determine the prevalence of HIV infection among homeless men and women and the related risk behaviors in Tehran, Iran.</p><p><b>METHODS</b>In 2007-2008, Tehran municipality stacked up 10672 homeless men and women for assessment of HIV and began collaboration with Iranian Research Center for HIV/AIDS (IRCHA) departments to conduct HIV infection prevalence surveys in homeless populations. The results were analyzed for associations with demographic information, family support, status of drug abuse and relation with family and friends.</p><p><b>RESULTS</b>Overall HIV prevalence was 1.7% (95% confidence interval 1.4-1.9). Factors independently associated with HIV infection included history of using drugs [AOR 8.15 (4.86-13.67)], older age [AOR 1.80 (1.08-2.99) for 40-55 yr], occupation [AOR 1.64 (1.19-2.24) for unemployed], and no relation with family [AOR 1.82 (1.30-2.54)].</p><p><b>CONCLUSIONS</b>This study supports the idea that injection drug use is contributing to the increased spread of HIV among Iranian homeless. Harm reduction programs should be expanded, particularly among homeless injection drug users.</p>

Addressing predictors of HIV related risk behaviors: demographic and psychosocial profile of Iranian patients

For effective implementation of HIV-related behavioral interventions, better understanding the demographic characteristics of infected patients in relation with high-risk behavior profiles, physical and mental health are essential. In a cross-sectional descriptive study, 400 HIV infected patients from December 2011 through January 2013 were evaluated regarding their demographic features, and four selected subscales [high-risk behaviors, self-efficacy, well-being, and social participation]. A validated questionnaire of 62 items was used for assessment. Almost 33% of all participants were women, 28% were younger than 30 years old, and 43% were never married; 50% had no permanent jobs. Women, widowed participants, patients <30 years, and those with higher educational levels had higher mean HIV risk behavior scores. In simple and multiple linear regression models, women >50 years and <30 years had the highest scores [beta = 2.714, p < 0.0001; beta = 2.00, p < 0.001]. Furthermore, male and illiterate patients had higher social participation scores while female and divorced participants had higher well-being and self-efficacy scores. We propose that demographic features play a critical role in increasing engagement in HIV-related high-risk behaviors; these characteristics also affect patients' social participation, well-being and self-efficacy. High-risk behaviors and social participation scores among women of different age groups and the youth highlight the need for future age and gender-specific educational and behavioral interventions among them

Health needs of people living with HIV/AIDS: from the perspective of policy makers, physicians and consultants, and people living with HIV/AIDS

HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran

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>

Role of fine-needle aspiration in the management of thyroid nodules

To show the benefits of fine-needle aspiration biopsy [FNAB] in managing thyroid nodules. As a retrospective study, reports of 888 FNABs of the thyroid performed during a period of 11 years [1996-2007] at Tehran University of Medical Sciences, Sina Hospital and Endocrine Clinic, Tehran, Iran were reviewed. Histological diagnoses were available for 182 cases, and we compared cytological diagnoses of FNAB with pathologic reports. The cytology diagnoses by FNAB were: papillary 6 [3.2%]; follicular neoplasm 51 [28%]; follicular adenoma 10 [5.4%]; Hurthle cell neoplasm 8 [4.3%]; suspicious 20 [10.9%]; inconclusive 2 [1%]; and benign 85 [46.4%]. Due to surgery pathologic reports, malignant cytologies were: 6 [100%] for papillary, 1 [1.96%] for follicular neoplasm, 4 [50%] for Hurthle cell neoplasm. In suspicious reports, 11 [55%] reports of pathology were malignant; and in inconclusive reports, one report [50%] was malignant. Fine needle aspiration is a useful technique for selecting patients with nodular thyroid disease for surgery