[Prevalence of HLA-B*57:01 allele in HIV-infected patients in a university hospital in Tehran]

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital's Consultation center for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome [AIDS]. Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method [PCR-SSP]. Seventy three patients [59.8%] were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% [95% CI: 0.005-7.30]. No association between presence of allele and investigated variables were identified. Frequency of HLA-B*57: 01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings

Elevated vancomycin trough concentration: increased efficacy and/or toxicity?

Vancomycin susceptibility of methicillin-resistant Staphylococcus aureus has been changed over time and its average minimum inhibitory concentration increased from 1.5 to 1.75 mg/L.A recently published guideline by the American Society of Health Pharmacist recommended a daily dose of 15-20 mg/Kg every 8 to 12 hours of vancomycin to achieve a trough concentration between 15-20 mg/L for treatment of severe infections. Medical records of 69 patients from infectious ward of Imam Khomeini hospital, with suspected or confirmed gram-positive infection who had at least one trough level of vancomycin, were evaluated regarding vancomycin therapeutic goal; efficacy and renal safety. Most of patients [60.6%] with severe infections did not achieve the recommended vancomycin trough level during treatment course. Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels. At the end of treatment course, there was no significant correlation between patients' creatinine clearance and vancomycin trough levels [P=0.32]. However, patients'cratinine clearance showed a negatively significant correlation with trough level of vancomycin [P=0.01]. Vancomycin induced nephrotoxicity was detected in 4.3% of the patients. These data showed that vancomycin trough level may not necessarily assure treatment success, and also it would not essentially predict the risk of vancomycin induced nephrotoxicity. However, more well designed studies with larger sample size needed for better clinical and practical judgment

Effectiveness of motivational interviewing in promoting hand hygiene of nursing personnel

Motivational interviewing [M.I.] is an option for modifying an individual's behavior. It is used as an educational method in recent years. The aim of our study was to indicate whether or not education, using lecture alone and lecture with M.I., would affect the performance of nursing personnel regarding their hand hygiene. If so, which of these two methods were most effective for this purpose? This was an interventional study conducted in Bahrami Pediatric Hospital in Tehran. The study population consisted of all nursing personnel in the hospital. Considering the responsibilities of different nurses and their educational status, we divided them into three classes. The participants of each class were randomly assigned to either the control or experiment groups training lecture alone or lecture with M.I., respectively. We used Independent-t, Paired-t, Mann-Whitney U and Wilcoxon signed ranks tests for analysis. Education using lecture alone improved the hand hygiene performance of nursing personnel only in the first and third classes [P = 0.002 and P = 0.001, respectively]. Similarly, lecture combined with M.I. improved the hand hygiene performance of personnel in the first and third classes [P < 0.001 and P = 0.004, respectively]. The latter method was more effective compared to lecture alone in the first and third classes [P < 0.001 and P = 0.013, respectively]. Education based on lecturing improves hand hygiene performance among nursing personnel. It will be more effective if combined with M.I

Diagnostic value of interferon-gamma assay in tuberculosis pericardial effusions: study on a cohort of Iranian patients

Tuberculosis pericarditis as a potentially fatal complication of tuberculosis requires effective diagnosis and treatment. We evaluated the efficacy of interferon-gamma [IFN-gamma] and adenosine deaminase [ADA] for diagnosing tuberculosis pericarditis in a cohort of Iranian patients presenting with pericarditis. We enrolled 38 patients with presentation of pericarditis. All patients underwent diagnostic and therapeutic pericardiostomy with drainage and biopsy. Adenosine deaminase and interferon-gamma levels were determined in pericardial fluid samples of all patients. Pericardial tissue samples were submitted for histopathologic and microbiologic studies. Polymerase chain reaction [PCR] was performed on all pericardial fluid samples to detect Mycobacterium tuberculosis. From 38 patients with pericarditis, 7 cases were diagnosed as having tuberculosis pericarditis [18.4%]. Mean concentration of interferon-gamma in tuberculosis group was significantly higher compared to non-tuberculosis group [69257 pg/l [range: 26600-148000] vs. 329 pg/l [range: 0-2200], P<0.000]. Receiver operating characteristic [ROC] curve showed a value of 14400 pg/l as the cutoff point with a sensitivity of 100% and specificity of 100% for diagnosing tuberculosis pericardial effusion. Adenosine deaminase was not found to be significantly higher in tuberculosis group in comparison with non-tuberculosis causes of pericardial effusion [35.7 [range: 9-69] vs. 36.03 [range: 8-420], P=0.28]. In this study interferon-gamma showed to be a valuable diagnostic test for detection of tuberculosis pericarditis among a cohort of Iranian patients. We suggest using interferon-gamma to diagnose tuberculosis pericarditis to make diagnose in case of suspicion. While in this study, adenosine deaminase measurement did not prove to have the characteristics of an accurate diagnostic test for tuberculosis pericarditis

Attitudes, concerns, perceived impact and coping strategies for avian influenza among the first year medical students and interns in Tehran university of medical sciences

To study and compare the attitudes, concerns, perceived impact and coping strategies for avian influenza [AI] among the first year medical students [FYMS] and interns in Tehran University of Medical Sciences. This was a cross sectional study carried out on FYMS [n=158] and interns [n=158] in 2008. The data collection tool was a questionnaire containing 37 questions in five parts. The three choices including "agree, disagree and unsure" were considered for all questions. We used Chi-square and Fisher's exact tests for analysis. Most of FYMS and interns [78.2%] believed their health would be depended on the care of their selves. Most of them [95.3%] believed that if they knew avian flu better, they could be more prepared for it. The majority were concerned about risk to their health from their work [62.7%]. Most [67.7%] accepted the risk and only 5 [1.6%] would consider stopping work. For non-work concerns, 70.9% were concerned about their spouses/sexual partners and 65.8% about their children. For perceived impact, most [66.5%] believed that they would feel stressed at work and the majority [74.4%] expected an increased workload. FYMS and interns have positive attitudes but major concerns about contracting AI and its relation to medical practice.

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