Seroprevalence of transfusion-transmitted infections among blood donors in Makkah, Saudi Arabia.

INTRODUCTION: Blood donation is vital for healthcare; however, transfusion-transmitted infections (TTIs) pose a serious risk. This study investigated the seroprevalence of TTIs among Saudi blood donors. METHODOLOGY: This retrospective study included male blood donors aged ≥ 18 years who donated blood at Al-Noor Specialist Hospital in Makkah from January 2017 to December 2022. The blood units were screened for hepatitis B surface antigen (HBsAg) and core antibodies (HBc-IgG), hepatitis C antibodies (HCV-Abs), syphilis, HIV-1 antigen/antibody (HIV-1 Ag/Ab), human T-lymphotropic virus 1, 2 (HTLV-1/2), and malaria. RESULTS: There were 40,287 donors with an average age of 44.33 ± 18.12 years, and 62.3% (n = 25103) were Saudis. The overall rate of TTIs seropositivity was 7.4% (n = 2953); HBc-IgG (6.1%; n = 2473) was the most common, followed by HCV-Abs (0.4%; n = 177), and syphilis (0.34%; n = 136). All cases were negative for malaria, whilst HIV and HTLV positive donors were 0.06% (n = 24) and 0.13% (n = 52), respectively. Syphilis was more prevalent among non-Saudis (0.24%; n = 83) than among Saudis (0.1%; n = 53), whereas anti-HBc antibodies seropositivity was significantly higher among Saudi (3.4%; n = 1373) than non-Saudi donors (2.7%; n = 1100). CONCLUSIONS: Hepatitis B virus was the most frequently detected bloodborne pathogen, followed by hepatitis C virus and syphilis. Hepatitis B virus was also more prevalent among Saudi donors, whilst expatriates had higher rates of syphilis. Additional prospective multicenter studies are needed to accurately determine the prevalence of TTIs in Saudi Arabia.

Association of CSF Total Protein with Clinical Heterogeneity, Disease Severity and Electrophysiological Pattern in GBS Patients.

Guillain-Barre Syndrome (GBS) is considered as an immune mediated inflammatory disease of peripheral nerves and nerve roots. The significance of CSF total protein (CSF-TP) in subtypes of Guillain-Barre syndrome has not been well established. This observational, cross sectional study's aim was to identify association of CSF total protein with clinical heterogeneity, disease severity and electrophysiological subtypes in GBS patients. This study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2017 to February 2019 on 50 (fifty) admitted GBS patients as per inclusion and exclusion criteria. About 3-5 ml of CSF was taken around 10±2 days from disease onset for detection CSF cell count and protein. Pattern of clinical presentation, disability status by Hughes scale and NCS findings of these patients was documented. Mean CSF-TP were substantially higher for Sensori-motor GBS (195.42 mg/dl) and GBS with cranial involvement (226.12 mg/dl) than that of GBS with motor (134.00 mg/dl) and autonomic involvement (155.21 mg/dl). Mean CSF total protein (CSF-MTP) in severely ill GBS patients (Grade-IV) was 217.04 mg/dl and very severely ill GBS patients (Grade-V) was 138.00mg/dl which was significantly higher than mean CSF total protein in mild GBS patients (CSF-MTP: 99.86mg/dl) and moderately ill GBS patients (CSF-MTP: 172.00 mg/dl). Mean CSF total protein is 245.00mg/dl in AIDP which is also higher than mean CSF total protein of AMAN (153.36 mg/dl) and AMSAN (165.17mg/dl). CSF-TP is thought to be a sensitive test for GBS in the second week after onset, but it may be a reliable predictor of clinical severity. There is a significant association of CSF-TP elevation with demyelinating electrophysiologic pattern.

Symptom Analysis of Early Parkinson's Disease and its Correlation with High Sensitivity C-reactive Protein.

Parkinson's disease is a debilitating neurodegenerative disease for which there is no cure. It is characterized by bradykinesia, resting tremor, rigidity and postural instability, due to impairment of function of the basal ganglia which is involved in the coordination of body movement. Neuro-inflammation is pathogenesis of development in early Parkinson's disease. High-sensitivity C-reactive protein level is a useful non-specific biochemical marker of inflammation. Objective of this study was to analyze the symptoms of Parkinson disease and it's correlation with high sensitive CRP. Seventy-six Parkinson's disease patients were enrolled in this Cross-sectional observational study that was attended in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from September 2014 to March 2016. Analysis of the symptoms of Parkinson disease and it's correlation with high sensitive CRP were done among these patients. This study was performed on 76 Parkinson disease patients with presented early with symptoms. a positive and highly significant correlation were seen in between duration of tremor and High sensitivity CRP (r=0.430, p<0.001) and between duration of bradykinesia and High sensitivity CRP (r=0.426, p<0.001) which indicate increase duration causes increase level of high-sensitivity C-reactive protein value. The neuro-inflammation plays a significant role in the pathogenesis of symptoms development in early Parkinson's disease.

Clinical Profile of Parkinson's Disease Patients in a Tertiary Hospital.

Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer disease. The pathogenesis of PD is yet unknown. Aim of this study was to analyze the clinical profile of patient with early Parkinson disease. A total of seventy-six early Parkinson's disease patients were enrolled in this cross-sectional observational study which was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from September 2014 to March 2016. Analysis of the history and clinical findings were done among these patients. This study was performed with 76 early Parkinson disease patients. Among them, male and female were 69.7% and 30.3% respectively. The mean±SD age of patients was 53.25±11.53 years with an age range of 24 to 77 years. The patients were found in primary level accounted for 42.1% which was followed by secondary 19.7% and illiterate or non-formal education 17.1%. Only 5.3% study population was found in post-graduate. Occupant as 28.9% were service holder, 26.3% as a housewife, 1.3% as business and 43.5% other occupations. Regarding smoking, 28.9% was a current smoker, 59.2% non-smoker and 11.8% ex-smoker. Of them, 11.8% had a family history of Parkinson's disease. Of the total population, 30.3% had dyslipidemia, 21.1% had hypertension, and 7.9% had diabetes mellitus. Males are predominant in affecting this disease. Middle aged people are vulnerable to it. Parkinson's disease is common in nonsmoker and dyslipidaemia. Few patient had family history of Parkinson's disease.

Cabergoline in Treatment of Methamphetamine-Dependent Patients and Its Effect on Serum Level of Glial Cell-Derived Neurotrophic Factor: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial.

BACKGROUND: Methamphetamine use disorder is an important public health problem, especially in the younger generation, and associated with various psychiatric, cognitive, social, economic, and legal issues. Cabergoline, a drug with dopaminergic properties and long half-life, has been considered for the treatment of stimulant dependence. The systemic use of cabergoline has been shown to increase glial cell-derived neurotrophic factor (GDNF) expression. OBJECTIVE: In this study, we investigated the effects of cabergoline on the serum level of GDNF and its effect on abstaining from methamphetamine in individuals treated for methamphetamine use disorder. METHOD: Sixty male subjects with methamphetamine use disorder were randomly assigned to 2 groups receiving cabergoline and placebo, respectively. During a 12-week follow-up, we compared the serum level of GDNF, urine test results for methamphetamine use, and depression scale between the 2 groups. RESULTS: We found that serum GDNF was lower in subjects who used methamphetamine than healthy subjects (p < 0.0001). However, the serum level of GDNF was not associated with cabergoline use. The rising number of cases testing positive in the placebo group showed a trend resulting in no significant difference between cases testing positive and negative (p = 0.585) at the end of week 12. In the verum group, however, the significantly high number of cases who tested negative - sober - for substances observed in early stages (weeks 7-8) continued to remain significantly higher till the end of the study (p = 0.043), resembling an association between treatment with cabergoline and remaining sober. Although reduced during treatment, recovery from depression was not associated with cabergoline treatment. CONCLUSION: The findings of this study confirmed the effect of cabergoline in reducing methamphetamine use. However, a serum level of the GDNF increase, as seen in animal studies, was not associated with cabergoline treatment of human subjects. This study was registered at the Iranian Registry of Clinical Trials (TRN:IRCT2015050422077N1, October 06, 2015, https://en.irct.ir/trial/19134).

Public policy, attitudes and willingness to pay for treatment of substance dependence in Iran.

BACKGROUND: Evaluation of costs and benefits of substance use treatment programs through a standard economic framework is necessary for optimal policy making. However, drug policy making is seldom supported by economic justification. Measurement of willingness to pay is a tool to provide better understanding of intangible substance use treatment outcomes and to help a balanced policy in treatment of substance use between maintenance treatment and abstinence-based approach. AIM: To assess the reciprocal association between economic indexes and attitudes about substance use and its treatment as indicators of tendency toward the two different treatment. METHOD: Willingness to pay for treatment was measured by contingency valuation method among 109 treatment cost payers of which 78 subjects were from outpatient methadone maintenance clinics and 31 were from abstinence-based residential facilities. To analyze predictors of willingness to pay, we used income to capture heterogeneity of purchasing power among subjects. Further, we checked bivariate correlation of different attitudes of cost payers with willingness to pay. In the next step using backward regression equation we tried to reach the best specification of the model. Selected variables include cost payers' attitudes toward substance use and its treatment, effectiveness of treatment, social attitude toward the condition of substance use in Iran, fairness of treatment prices, and government financial support for addiction treatment. RESULTS: In methadone maintenance clinics the payers' income had a pivotal role in determining willingness to pay for substance use treatment by 50% (p<0.001 ). On the other hand, in abstinence-based residential facilities positive attitude toward substance use (61%, p<0.01) was the major direct determinant of willingness to pay for treatment. Attitude to public financial support for substance use treatment (55%, p<0.01 ) and consumption experience (45%, p<0.01 ) showed an inverse association with WTP in regression equation. CONCLUSION: This study expanded the understanding of the nature of payment in different substance use treatment modalities. The suggestion to policy makers is that before taking position on different types of treatment services, it is necessary to pay attention to factors that determine values cost payers put on treatment. In other words, economic indexes, payers' views about substance use and its treatment, and their opinion about effectiveness of substance use treatment programs may jeopardize the success of the policy.

A Case Report and Literature Analysis:A Supracondylar Femur Fracture in a Super-Obese Patient.

INTRODUCTION: Rate of obese patients are on the rise and fractures on these patients are difficult to treat, risk of management failure is high as they are more prone to develop wound infection, hardware failure, malunion and prolonged procedure time. CASE REPORT: In this report, we present a case on how we successfully managed a supracondylar femur fracture in a patient with a body mass index of 98.1 kg/m2 with surgical site infection as the main complication. No literature reported such a case with an astonishing weight of 264 kg given the case uniqueness and importance. CONCLUSION: A retrograde intramedullary nailing of the femur was performed under difficult circumstances, with a variety of modification to be considered pre-peri and post-operatively. It is advised based on the literature review and expert opinion to take the recommendations into consideration for better outcome.

Thyroid Dysfunction and Autoimmunity in First Trimester of Pregnancy, Single Center Experience in Bangladesh.

Study on thyroid function and thyroid autoantibody status in pregnancy considering the trimester specific range, is scarce in Bangladesh. This cross sectional study done in Bangabandhu Sheikh Mujib Medical University, Bangladesh from August 2012 to June 2013 encompassed 186 pregnant women of first trimester for study of thyroid function (TSH, FT4) and anti-thyroid antibodies (anti-TPO, anti-TG). Age of the subjects was 25.4±4.9 years (mean±SD), median gestational age was 9 weeks. Applying the trimester-specific normal reference range set by American Thyroid Association (ATA), 48(25.8%) of the women were found to have thyroid dysfunction; 40(21.5%) subclinical hypothyroid (SCH), 1(0.5%) overt hypothyroid (OH) and 7(3.8%) hyperthyroid; 40(21.5%) women had goiter. If non-pregnant adult normal rage is used, 22 of SCH women as per ATA criteria will be labeled as normal and 19 normal women as per ATA cut off will be labeled as hyperthyroid. There was statistically significant disparity for functional status defined by these two references cut off value (p<0.001). 29(15.6%) women had thyroid autoimmunity and the autoantibody positivity was more frequent in women with thyroid dysfunction than euthyroid women (22.92% vs. 13.04%, p<0.001). Even though universal screening for thyroid dysfunction is not yet a recommendation, it should be considered in our population.

Toward a real-time system for temporal enhanced ultrasound-guided prostate biopsy.

PURPOSE: We have previously proposed temporal enhanced ultrasound (TeUS) as a new paradigm for tissue characterization. TeUS is based on analyzing a sequence of ultrasound data with deep learning and has been demonstrated to be successful for detection of cancer in ultrasound-guided prostate biopsy. Our aim is to enable the dissemination of this technology to the community for large-scale clinical validation. METHODS: In this paper, we present a unified software framework demonstrating near-real-time analysis of ultrasound data stream using a deep learning solution. The system integrates ultrasound imaging hardware, visualization and a deep learning back-end to build an accessible, flexible and robust platform. A client-server approach is used in order to run computationally expensive algorithms in parallel. We demonstrate the efficacy of the framework using two applications as case studies. First, we show that prostate cancer detection using near-real-time analysis of RF and B-mode TeUS data and deep learning is feasible. Second, we present real-time segmentation of ultrasound prostate data using an integrated deep learning solution. RESULTS: The system is evaluated for cancer detection accuracy on ultrasound data obtained from a large clinical study with 255 biopsy cores from 157 subjects. It is further assessed with an independent dataset with 21 biopsy targets from six subjects. In the first study, we achieve area under the curve, sensitivity, specificity and accuracy of 0.94, 0.77, 0.94 and 0.92, respectively, for the detection of prostate cancer. In the second study, we achieve an AUC of 0.85. CONCLUSION: Our results suggest that TeUS-guided biopsy can be potentially effective for the detection of prostate cancer.

Predictors of time to relapse in amphetamine-type substance users in the matrix treatment program in Iran: a Cox proportional hazard model application.

BACKGROUND: The aim of this study was to determine which predictors influence the risk of relapse among a cohort of amphetamine-type substance (ATS) users in Iran. METHODS: A Cox proportional hazards model was conducted to determine factors associated with the relapse time in the Matrix treatment program provided by the Iranian National Center of Addiction Studies (INCAS) between March 2010 and October 2011. RESULTS: Participating in more treatment sessions was associated with a lower probability of relapse. On the other hand, patients with less family support, longer dependence on ATS, and those with an experience of casual sex and a history of criminal offenses were more likely to relapse. CONCLUSION: This study broadens our understanding of factors influencing the risk of relapse in ATS use among an Iranian sample. The findings can guide practitioners during the treatment program.

Predictors of treatment retention in a major methadone maintenance treatment program in iran: a survival analysis.

BACKGROUND: To identify correlates related to retention time of a cohort study of the opioid-dependent patients participating in the Methadone Maintenance Treatment (MMT) program offered by a major addiction treatment clinic in Tehran, Iran between April 2007 and March 2011. METHODS: Several parametric Survival models assuming Weibull, Log-normal and Log-logistic distributions were compared to search for association between covariates and risk of relapse and dropping out of treatment among 198 patient participants. RESULTS: According to Akaike Information Criterion (AIC), Log-normal model had the best fitting. Estimates of this model indicated that increase in average methadone dosage was associated with longer retention time. Correlates associated with shorter retention time were suffering from mental disorders, using stimulant drugs, being poly-substance dependents and having prior treatments. CONCLUSIONS: Findings of this study provide support for giving more attention to patients who are poly-substance or stimulant-drug dependents, have non-substance psychiatric comorbidity and the ones with addiction treatment history. Independent of patient characteristics, retention improved as the dose of methadone increased.

Factors Correlated With Hepatitis C and B Virus Infections Among Injecting Drug Users in Tehran, IR Iran.

BACKGROUND: In Iran, the number of injecting drug users (IDUs) has increased in recent years. The rates of hepatitis C virus (HCV) and hepatitis B virus (HBV) infections among IDUs are reportedly high. OBJECTIVES: The purpose of this study was to assess factors correlated with HCV and HBV infections among IDUs in Tehran. PATIENTS AND METHODS: A cross-sectional study included 899 IDUs recruited from the community, drug treatment centers, and drop-in-centers. The study involved interviews conducted using an adapted version of the WHO Drug Injection Study Phase II (Version 2b) questionnaire and blood testing for the HCV antibody, hepatitis B surface antigen, and hepatitis B core antibody. A logistic regression model was used to identify independent factors correlated with HCV and HBV infections. RESULTS: HCV infection was found to be primarily associated with female gender [odds ratio (OR) 5.0, 95% confidence interval (CI) 2.0-10.0)], unmarried status (OR 2.9, 95% CI 1.9-4.4), drug use for more than 10 years (OR 2.7, 95% CI 1.8-3.9), drug injection frequency of more than once per day (OR 2.6, 95% CI 1.6-4.2), history of imprisonment (OR 2.5, 95% CI 1.6-4.0)], and a history of shared injection needles in prison (OR 2.3, 95% CI 1.5-3.6). HBV infection was mainly correlated with a history of imprisonment (OR 1.9, 95% CI 1.4-2.7) and drug use for more than 10 years (OR 1.4, 95% CI 1.1-1.9). CONCLUSIONS: Because a considerable number of IDUs in Iran are receiving reduction services, tailoring services for prevention of hepatitis infection are necessary.

Colles' fracture - is it a signal of osteoporosis?

Asymptomatic post-menopausal osteoporosis is common but some-times associated with pain and deformity. Symptomatic osteoporosis is usually associated with fracture. A 59 years old post-menopausal woman presented with a history of acute low-back-pain. She had menopause for 12 years. She gave history of colles' fracture at about two years back. Her mother died as consequences of femoral neck fracture. MRI of vertebral spine showed demineralization with partial collapse of D6,7,12 and L1 vertebra. Dual energy X-ray absorptiometry of vertebra showed BMD T-score of -4.5. Patient was managed with IV infusion of zoledronic acid, oral intake of vitamin D and calcium supplements and with regular non-weight-bearing exercises. Her condition improved gradually. During post-menopausal period, every women must be aware of osteoporosis and any fracture in that time must be evaluated to rule out osteoporosis.

Comparison of ring artifact removal methods using flat panel detector based CT images.

BACKGROUND: Ring artifacts are the concentric rings superimposed on the tomographic images often caused by the defective and insufficient calibrated detector elements as well as by the damaged scintillator crystals of the flat panel detector. It may be also generated by objects attenuating X-rays very differently in different projection direction. Ring artifact reduction techniques so far reported in the literature can be broadly classified into two groups. One category of the approaches is based on the sinogram processing also known as the pre-processing techniques and the other category of techniques perform processing on the 2-D reconstructed images, recognized as the post-processing techniques in the literature. The strength and weakness of these categories of approaches are yet to be explored from a common platform. METHOD: In this paper, a comparative study of the two categories of ring artifact reduction techniques basically designed for the multi-slice CT instruments is presented from a common platform. For comparison, two representative algorithms from each of the two categories are selected from the published literature. A very recently reported state-of-the-art sinogram domain ring artifact correction method that classifies the ring artifacts according to their strength and then corrects the artifacts using class adaptive correction schemes is also included in this comparative study. The first sinogram domain correction method uses a wavelet based technique to detect the corrupted pixels and then using a simple linear interpolation technique estimates the responses of the bad pixels. The second sinogram based correction method performs all the filtering operations in the transform domain, i.e., in the wavelet and Fourier domain. On the other hand, the two post-processing based correction techniques actually operate on the polar transform domain of the reconstructed CT images. The first method extracts the ring artifact template vector using a homogeneity test and then corrects the CT images by subtracting the artifact template vector from the uncorrected images. The second post-processing based correction technique performs median and mean filtering on the reconstructed images to produce the corrected images. RESULTS: The performances of the comparing algorithms have been tested by using both quantitative and perceptual measures. For quantitative analysis, two different numerical performance indices are chosen. On the other hand, different types of artifact patterns, e.g., single/band ring, artifacts from defective and mis-calibrated detector elements, rings in highly structural object and also in hard object, rings from different flat-panel detectors are analyzed to perceptually investigate the strength and weakness of the five methods. An investigation has been also carried out to compare the efficacy of these algorithms in correcting the volume images from a cone beam CT with the parameters determined from one particular slice. Finally, the capability of each correction technique in retaining the image information (e.g., small object at the iso-center) accurately in the corrected CT image has been also tested. CONCLUSIONS: The results show that the performances of the algorithms are limited and none is fully suitable for correcting different types of ring artifacts without introducing processing distortion to the image structure. To achieve the diagnostic quality of the corrected slices a combination of the two approaches (sinogram- and post-processing) can be used. Also the comparing methods are not suitable for correcting the volume images from a cone beam flat-panel detector based CT.

Sequential algorithm for life threatening cardiac pathologies detection based on mean signal strength and EMD functions.

BACKGROUND: Ventricular tachycardia (VT) and ventricular fibrillation (VF) are the most serious cardiac arrhythmias that require quick and accurate detection to save lives. Automated external defibrillators (AEDs) have been developed to recognize these severe cardiac arrhythmias using complex algorithms inside it and determine if an electric shock should in fact be delivered to reset the cardiac rhythm and restore spontaneous circulation. Improving AED safety and efficacy by devising new algorithms which can more accurately distinguish shockable from non-shockable rhythms is a requirement of the present-day because of their uses in public places. METHOD: In this paper, we propose a sequential detection algorithm to separate these severe cardiac pathologies from other arrhythmias based on the mean absolute value of the signal, certain low-order intrinsic mode functions (IMFs) of the Empirical Mode Decomposition (EMD) analysis of the signal and a heart rate determination technique. First, we propose a direct waveform quantification based approach to separate VT plus VF from other arrhythmias. The quantification of the electrocardiographic waveforms is made by calculating the mean absolute value of the signal, called the mean signal strength. Then we use the IMFs, which have higher degree of similarity with the VF in comparison to VT, to separate VF from VTVF signals. At the last stage, a simple rate determination technique is used to calculate the heart rate of VT signals and the amplitude of the VF signals is measured to separate the coarse VF from VF. After these three stages of sequential detection procedure, we recognize the two components of shockable rhythms separately. RESULTS: The efficacy of the proposed algorithm has been verified and compared with other existing algorithms, e.g., HILB 1, PSR 2, SPEC 3, TCI 4, Count 5, using the MIT-BIH Arrhythmia Database, Creighton University Ventricular Tachyarrhythmia Database and MIT-BIH Malignant Ventricular Arrhythmia Database. Four quality parameters (e.g., sensitivity, specificity, positive predictivity, and accuracy) were calculated to ascertain the quality of the proposed and other comparing algorithms. Comparative results have been presented on the identification of VTVF, VF and shockable rhythms (VF + VT above 180 bpm). CONCLUSIONS: The results show significantly improved performance of the proposed EMD-based novel method as compared to other reported techniques in detecting the life threatening cardiac arrhythmias from a set of large databases.

Effect of single dose intravenous zoledronic acid on bone mineral density in post-menopausal osteoporosis of Bangladeshi women.

The osteoporosis is a major health threat that affects every third post-menopausal women. Postmenopausal osteoporosis is complicated with vertebral, femoral or radius fracture. This prospective study on post-menopausal osteoporosis was carried out in the Pain Centre, Department of Anaesthesia, Analgesia and Intensive Care Medicine of BSMMU, Dhaka during the period of January 2008 to January 2010. The post-menopausal women with back pain were screened by spinal radiographs and dual-energy X-ray absorptiometry (DXA) of lumbar spine to determine the bone mineral density (BMD). The woman after menopause with a BMD T-score of -2.5 or less with or without evidence of vertebral fracture is considered as post-menopausal osteoporosis. A total of 55 post-menopausal osteoporotic patients were assigned to receive a single dose of IV infusion of zoledronic acid (5 mg) along with dietary calcium and vitamin-D. The spinal radiographs and dual-energy X-ray absorptiometry (DXA) were repeated in all the 55 patients at 12 months following zoledronic acid infusion. The mean BMD of lumbar spine increased significantly from pre-infusion value of 0.75695 g/cm2 to post-infusion of 0.80216 g/cm2. The T-score also increased from pre infusion value of -3.567 +/- 0.77 to -3.158 +/- 0.08 in 12 months following the infusion (P < 0.01). The increase is 5.026% higher than pre infusion values. The spinal radiographs taken before infusion of zoledronic acid, showed 14 fractures. There was no new fracture in any case during the 12 months study period. So, it can be concluded that once yearly IV infusion of zoledronic acid is associated with a significant increase in BMD and decrease in the risk of vertebral fracture.

HIV, hepatitis C virus, and hepatitis B virus co-infections among injecting drug users in Tehran, Iran.

OBJECTIVES: To assess the prevalence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections and co-infections among injecting drug users (IDUs) in Tehran. METHODS: A sample of 899 IDUs (861 male and 38 female) was recruited in Tehran from treatment and harm reduction facilities and from drug user hangouts in public areas in equal proportions. ELISA testing for HIV, HCV antibody (HCV-Ab), hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb) was carried out. Positive HIV tests were rechecked by Western blot. RESULTS: The prevalence of HIV was 10.7%, HCV infection was 34.5%, and past or current HBV infection was 50.7%. Infection with all three viruses was seen in 6.5% (95% confidence interval 4.9-8.2) of participants. HIV/HCV, HIV/HBV, and HBV/HCV co-infections were seen in 8.7%, 7.8%, and 21.0% of participants, respectively. The rate of HCV infection among HIV-positive cases was significantly higher than in HIV-negative IDUs (80.6% vs. 28.7%, p<0.0001). There was no significant association between these infections and co-infections with gender and source of sampling. CONCLUSION: In general, co-infection with these three blood-borne viruses is common among IDUs. Since co-infection increases the morbidity and mortality of all infections, the observed level of co-infection in the high number of IDUs in Iran necessitates a serious comprehensive response.

Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran.

BACKGROUND: In Iran, there are an estimated 200,000 injecting drug users (IDUs). Injecting drug use is a relatively new phenomenon for this country, where opium smoking was the predominant form of drug use for hundreds of years. As in many countries experiencing a rise in injecting drug use, HIV/AIDS in Iran is associated with the injection of drugs, accounting for transmission of more than two-thirds of HIV infections. This study aimed to: describe the range of characteristics of IDUs in Tehran, Iran's capital city; 2) examine the injecting-related HIV risk behaviors of IDUs, and 3) suggest necessary interventions to prevent HIV transmission among IDUs and their families and sex partners. METHODS: Using rapid assessment and response methods with a qualitative focus, six districts of Tehran were selected for study. A total of 81 key informants from different sectors and 154 IDUs were selected by purposeful, opportunistic and snowball sampling, then interviewed. Ethnographic observations were done for mapping and studying injecting-related HIV risk settings and behaviors. Modified content analysis methods were used to analyze the data and extract typologies of injecting drug users in Tehran. RESULTS: Evidence of injecting drug use and drug-related harm was found in 5 of 6 study districts. Several profiles of IDUs were identified: depending on their socioeconomic status and degree of stability, IDUs employed different injecting behaviors and syringe hygiene practices. The prevalence of sharing injection instruments ranged from 30-100%. Varied magnitudes of risk were evident among the identified IDU typologies in terms of syringe disinfection methods, level of HIV awareness, and personal hygiene exhibited. At the time of research, there were no active HIV prevention programs in existence in Tehran. CONCLUSION: The recent rise of heroin injection in Iran is strongly associated with HIV risk. Sharing injection instruments is a common and complex behavior among Iranian IDUs. For each profile of IDU we identified, diverse and targeted interventions for decreasing sharing behavior and/or its harms are suggested. Some notable efforts to reduce the harm of injecting drug use in Iran have recently been accomplished, but further policies and action-oriented research for identification of effective preventive interventions are urgently needed.

Effect of aerobic exercise on patients with primary fibromyalgia syndrome.

Sixty eight adult patients of fibromyalgia were included in this prospective study from the Outpatient Department of Physical Medicine and Rehabilitation of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of January 2003 to June 2003. Study samples were assigned into two treatment groups: Group A (n = 38) with exercise by static bicycle and aerobic walking in addition to tricyclic antidepressant and analgesic and Group B (n = 30) was non exercise group, treated with tricyclic antidepressant and analgesic only. The total duration of treatment was 16 weeks. Pre-treatment (week 0) and post treatment (week 16) evaluation was performed in both groups. Evaluation parameters included pain grade, number of trigger points, occurrence of arousal at night, frequency of micturition and global evaluation by the physician. After 16 weeks, mean improvement of exercise group and non exercise group was 48% and 39% respectively but this difference was not statistically significant. Therefore, from this study it was observed that aerobic exercise showed no significant benefit to fibromyalgia patients.

Doxorubicin-induced apoptosis in caspase-8-deficient neuroblastoma cells is mediated through direct action on mitochondria.

UNLABELLED: The induction of p53 expression and stimulation of the Fas/caspase-8 pathway represent major mechanisms by which cytotoxic drugs induce apoptosis, but in neuroblastomas, the caspase-8 gene is often not expressed. PURPOSE: The aim of this study was to determine whether doxorubicin could induce apoptosis in caspase-8-deficient neuroblastoma cells and to define its mechanism of action. METHODS: The caspase-8-deficient human neuroblastoma cell line, SKN-SH, was incubated with doxorubicin and the apoptotic response, as well as expression of apoptotic molecules in the p53/ Fas/caspase-8 pathway, were determined. RESULTS: SKN-SH cells incubated with doxorubicin readily underwent apoptosis in a concentration-dependent manner. Western blot analyses with specific antibodies demonstrated that both p53 and Fas ligand were endogenously expressed in SKN-SH cells, but their expression was not stimulated by doxorubicin. Fas receptor was not detected in these cells and caspase-8 was totally absent. Electron microscopic analyses of SKN-SH cells treated with doxorubicin revealed pronounced alterations in mitochondrial structure. This treatment also induced the release of cytochrome c from mitochondria and activated the downstream apoptotic intermediate, caspase-3. CONCLUSION: These results indicate that the p53/Fas/caspase-8 system does not play a role in mediating the apoptotic action of doxorubicin in the human neuroblastoma cell line SKN-SH. Thus, mitochondria and downstream apoptotic signaling intermediates may be considered as key targets for doxorubicin-induced apoptosis in neuroblastoma tumors having deficiencies in the Fas/caspase-8 system.