Frequency of Mycobacterium tuberculosis infection among Iranian patients with HIV/AIDS by PPD test

Persons infected with the Human Immunodeficiency Virus (HIV) are particularly susceptible to tuberculosis, either by latent infection reactivation or by a primary infection with rapid progression to active disease. This study was done to determine the frequency of tuberculosis infection among Iranian patients with HIV/AIDS. A total of 262 HIV/AIDS patients attending all three HIV/AIDS health care centers of Tehran, Iran were enrolled in this study. A detailed history and physical examination were obtained from all HIV patients suspected of having pulmonary M. tuberculosis. A positive PPD skin test was used as a diagnostic parameter for probability of TB infection. Out of 262 HIV/AIDS patients, a total of 63 (24%) were shown to have the tuberculosis infection based on a positive PPD skin test. Of the patients with positive PPD skin test, 22 (35%) had pulmonary Tuberculosis, 2 (3.2%) had extrapulmonary tuberculosis, and 39 (53%) had no evidence of M. tuberculosis infection (latent infection). Also 8 (12.7%) had history of long term residence in a foreign country, 32 (50.8%) were exposed to an index case, and 9 (14.3%) had past history of pulmonary tuberculosis, while only 33.3% had clinical manifestations of TB (active disease). There was no resistant case of tuberculosis. Our study showed that near 24% of Iranian patients with HIV/AIDS were infected with M. tuberculosis. This finding denotes the need to improve the diagnostic and preventive measures, and also prompt treatment of this type of infection in the HIV infected individuals.     

Fabrication of long-acting insulin formulation based on poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) nanoparticles: preparation,optimization, characterization,and in vitro evaluation

The purpose of this research was the fabrication, statistical optimization, and in vitro characterization of insulin-loaded poly(hydroxybutyrate-co-hydroxyvalerate) (PHBV) nanoparticles (INS-PHBV-NPs). Nanopar-ticles were successfully developed by double emulsification solvent evaporation method. The NPs were characterized for particle size, entrapment efficiency (EE%), and polydispersity index (PDI). The NPs also were characterized by scanning electron microscopy (SEM), Fourier transformed infrared spectroscopy (FTIR), X-ray diffraction (XRD), differential scanning calorimetry (DSC), and circular dichroism (CD). The optimum conditions were found to be 1.6% polyvinyl alcohol (PVA), 0.9% of PHBV, and 15?mg/ml of insulin with the aid of the Box–Behnken experimental design results. The optimized NPs showed spherical shape with particle size of 250.21?±?11.37?nm, PDI of 0.12?±?0.01, and with EE% of 90.12?±?2.10%. In vitro drug release pattern followed Korsmeyer–Peppas model and exhibited an initial burst release of 19% with extended drug release of 63.2% from optimized NPs within 27?d. In conclusion, these results suggest that INS-PHBV-NPs could be a promising candidate for designing an injectable sustained release formulation for insulin.     

Evaluation of bone mineral density in Iranian HIV/AIDS patients

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy (na?ve patients) and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects (77.3% in HIV positive na?ve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002). Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group (P=0.003). Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection (P<0.0001) and antiretroviral treatment (P=0.012). Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment.     

Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% (95% CI 0.005-1.2) with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future.     

Sensitivity and specificity of international prostate symptom score (IPSS) for the screening of Iranian patients with prostate cancer

We assessed the lower urinary tract symptoms (LUTS) in prostatic cancer patients and investigated the sensitivity and specificity of international prostate symptom score (IPSS) in the screening of these patients. A total number of 132 prostatic cancer patients as the case group who were confirmed by the pathologists and 101 noncancerous men as the control group, aged 50 or older, responded to a questionnaire which included seven questions regarding urination, named the International Prostate Symptom Score (IPSS). Then, two groups were assessed and compared with each other and also the sensitivity and specificity of IPSS tool for screening of prostatic cancer patients were calculated. All participants filled out the questionnaire. 60 (59.4%) noncancerous men and 29 (22.0%) cases had mild LUTS, and 41 (40.6%) noncancerous men and 103 (78.0%) cases had moderate to severe LUTS. Moreover, the sensitivity and specificity of the IPSS tool were 78% and 59.4%, respectively. Urination status and problems could be easily assessed by IPSS and it is a sensitive and specific tool for screening of prostatic cancer patients. It appears that IPSS is a cost beneficial, sensitive, specific and easily-used screening tool to diagnose the prostate cancer cases. Therefore, it can be used more extensively by the health care providers as well as by men ≥50 years old themselves.     

A case report of cyclic neutropenia associated with pyoderma gangrenosum

We present a 24-year-old female referred with non-healing wound of a few days duration on anterior aspect of her right foreleg. Biopsy of the wound was reported to be pyoderma gangrenosum on pathologic report. Further work up of the patient for high grade fever and occasional leukopenias revealed the diagnosis of cyclic neutropenia. Treatment with granulocyte colony-stimulating factor (G-CSF) resulted in patient's neutrophil counts correction and dramatic improvement in healing of her lower extremity wound.     

Evaluation of serological tests using A60 antigen for diagnosis of tuberculosis

Identification of acid-fast bacilli (AFB) in sputum or tissue samples is among definite diagnostic methods of tuberculosis. However, this method of diagnosis is restricted by certain limitations. Serologic diagnosis of tuberculosis (TB) has been used for a long time. The aim of this study was to determine the sensitivity and, specificity of Antigen 60 (A60) IgG, IgA, IgM test results in TB diagnosis. Mycobacterial A60-based ELISA was used to measure specific IgA, IgM and IgG antibodies in the sera of 127 adult TB patients (consisted of 74 pulmonary and 53 extra-pulmonary cases), and 95 controls (46 healthy volunteers and 49 patients with various acute or chronic diseases other than tuberculosis). Data from A60 IgG-based ELISA, chest radiography, AFB culture and pathologic evaluation for AFB were obtained .The cutoff value of A60 IgG, IgA and IgM were chosen according to a receiver operating characteristic (ROC) analysis. The sensitivity, specificity and positive likelihood ratio were determined. The mean levels of IgG, IgA and IgM were significantly higher in patients with pulmonary tuberculosis when compared with control groups. Sensitivity of IgG test was 54.3 %, while the specificity was 84.2%. The IgA test showed a sensitivity of 70.1% with a specificity of 80 %. Combination of the IgG and IgA tests showed a total sensitivity of 45.7 % and a specificity of 94.7% and the positive likelihood ratio of 8.62. Chosen cutoff values of IgG, IgA, and IgM sets were 285,265 and 0.9 ELISA units respectively. Our study results showed a good specificity (94.7%) and a reasonable positive likelihood ratio (8.62) of the test when combined IgA and IgG with new cutoff points were considered on diagnosis of tuberculosis in adult patients. Combined use of both IgG and IgA tests results allows an increased accuracy in diagnostic of tuberculosis.     

A case-control study of risk factors for prostate cancer in Iran

Prostate cancer is a major cause of morbidity and mortality in Iran, yet there are few studies examining risk factors specific to the Iranian context. We conducted a case-control study to explore risk factors for prostate cancer in Mazandaran, Iran from 2005 to 2008. The cases were 137 men with clinicopathologically confirmed prostate cancer. Controls were 137 neighborhood and age match men without prostate cancer by PSA and digit examination. Analysis comprised an exploratory stage to identify potential risk factors, defined as variables associated with case status at the P < 0.20 level in conditional logistic regression. A second stage included all potential risk factors in multiple conditional logistic regression analysis, retaining those associated with prostate cancer at the P < 0.05 level. Potential risk factors for prostate cancer in exploratory analysis included family history of prostate cancer, history of other cancer, prostatitis, alcohol consumption, pipe or hookah smoking, walking to work, duration of occupational physical activity, intensity of occupational physical activity, body mass index, and older age. Multivariate analysis found intensity of occupational physical activity, prostatitis, and older age as independent predictors of increased risk for prostate cancer in this Iranian population. Our study confirms several recognized risk factors for prostate cancer, contributes evidence to the discussions of other hypothesized risk factors, and points to potentially new factors. Findings, along with confirmatory studies, can help guide efforts for early detection, treatment, and prevention for this common malignancy that is set to increase in Iran in future decades.     

Prevalence and Correlates of Hepatitis C Infection among Male Injection Drug Users in Detention,Tehran, Iran

For the benefit of planning for the future care and treatment of people infected with hepatitis C virus (HCV) and to help guide prevention and control programs, data are needed on HCV seroprevalence and associated risk factors. We conducted a cross-sectional sero-behavioral survey of injection drug users (IDU) detained for mandatory rehabilitation during a police sweep of Tehran, Iran, in early 2006. During the study period, a consecutive sample comprising 454 of 499 (91.0%) men arrested and determined to be IDU by urine test and physical examination consented to a face-to-face interview and blood collection for HCV antibody testing. Overall, HCV prevalence was 80.0% (95% confidence interval (CI) 76.2–83.6). Factors independently associated with HCV infection included history of incarceration (adjusted OR 4.35, 95% CI 1.88–10.08), age of first injection ≤25 years (OR 2.72, 95% CI 1.09–6.82), and history of tattooing (OR 2.33, 95% CI 1.05–5.17). HCV prevalence in this population of IDU upon intake to jail was extremely high and possibly approaching saturation. Findings support that incarceration is contributing to the increased spread of HCV infection in Iran and calls for urgent increased availability of HCV treatment, long-term preparation for the care of complications of chronic infection, and rapid scale-up of programs for the primary prevention of parenterally transmitted infections among drug users.