فهرست مطالب آمیتیس رمضانی

Data on the safety of COVID-19 vaccines in obese or overweight subjects are limited and have been conducted in several studies with a small sample size worldwide. The aim of this study was to investigate and compare the incidence of adverse events after the first and second doses of Sinopharm and COVID-19 booster in overweight and obese subjects compared to normal weight subjects.

261 subjects who had received three doses of COVID-19 vaccine (two doses of Sinopharm + Sinopharm or PastoCovac or PastoCovac Plus booster) were enrolled in the study. Subjects' demographic characteristics and vaccine adverse events were recorded in a questionnaire during a telephone interview on days 7 and 21 after each dose of COVID-19 vaccine. Subsequently, the frequency of adverse events was compared between the 3 study groups.

Of the 261 participants, 59 were obese (BMI ≥ 30), 96 were overweight (BMI = 25-29.9), and 106 were normal weight (BMI = 24.9-18). The overall frequency of adverse events after all three doses of the COVID-19 vaccine was higher in obese subjects than in overweight or normalweight subjects. Pain at the injection site was the most common adverse event reported within seven days of booster vaccination in all groups. No adverse events occurred after receiving the PastoCovac booster in obese/overweight subjects, and the incidence of adverse events after PastoCovac plus booster and Sinopharm booster administration was similar. Overall, no serious vaccine-related adverse events were observed in the three groups.

The results of this study indicate that the inactivated and protein-based COVID -19 vaccines are safe and did not cause serious adverse events in obese or overweight individuals. In addition, the PasteCovac booster is more suitable for these people because it has no adverse effects. Therefore, further studies with a larger sample size are needed to identify a more effective booster with fewer adverse events in obese subjects

Today, with the introduction of the interferon-free direct acting antiviral (DDA) drug regimen, as well as the brilliant advances that have been made in the prevention, diagnosis and treatment of hepatitis C, medical science has come closer to eradicating hepatitis C infection. Now the question is why, despite the existence of such very effective treatments that can even eradicate the infection, the infection is still stable in many patients and reduces the quality of life of many people, the death of many patients and also transmission to other people and thus its prevalence has increased in the community. Therefore, in this study, we aimed to examine the treatment status of patients with hepatitis C and also the therapeutic capacity of these patients in Arak city.

In this study, which is a descriptive-analytical study, people with chronic hepatitis C in Arak city in 2018-19, whose disease was confirmed, were included in the study. Then, the information of these patients was collected in a questionnaire that contained demographic information, risk factors, tests and treatment process of the patient, through the information obtained from the laboratory and also during a telephone interview. Finally, the collected data were analyzed using SPSS software version 24.

In this study, a total of 429 patients whose PCR or Elisa test were positive in the years 98-97. We were able to conduct a complete telephone interview with 152 patients and prepare a complete questionnaire for them, of which 96 had a positive PCR and 56 had a positive Elisa. After interviewing the first group, it was found that 70% of patients have completed treatment and 30% have not started treatment or left it incompletely. In the second group it was found that only 43% of the patients followed and completed the treatment, and 57% did not follow the treatment. The main reason for not pursuing treatment was lack of knowledge about the disease and then addiction and treatment costs, respectively.

The treatment process in PCR-positive patients was more favorable than in ELISA-positive patients. In the first group, lack of knowledge about the dangers of the disease and in the second group, lack of knowledge about the disease was the main reason for not treating these patients. Therefore, one of the ways to eradicate hepatitis C in the community is to provide adequate information to patients.

Acinetobacter baumannii (A. baumanni) is one of the most important pathogens of Ventilator- associated Pneumonia in hospitals. Ventilator-associated pneumonia usually develops after more than 48 hours of tracheal intubation and mechanical ventilation. Prevalence of Multidrug-resistant (MDR) in Acinetobacter baumannii species is increasing. This organism can cause severe infections in hospital settings, especially in the ICU. In the past, carbapenems such as meropenem and imipenem have been used as the drug of choice in the treatment of multidrug-resistant Acinetobacter infections. Carbapenem resistance is currently increasing. Despite numerous studies to treat ventilator-associated pneumonia caused by Carbapenem- resistant A. baumanni, the best drug choice for the treatment of this pneumonia remains unclear. Although some studies suggest Colistin as a first-line drug choice for critically ill patients with ventilator-associated pneumonia, the results of a systematic review study in 2017 showed that monotherapy with sulbactam in the treatment of pneumonia caused by drug-resistant Acinetobacter is preferable to treatment with intravenous colistin. Researchers have recommended clinical trials to confirm the findings in this pneumonia. Therefore, the purpose of this study was to compare colistin based vs. Ampicillin-Sulbactam based therapy in carbapenem-resistant A. baumanni ventilator- associated pneumonia.

In this double-blind clinical trial study, 43 patients with ventilator-associated pneumonia who were admitted to the ICU of Valiasr Hospital in Arak, Iran, were included in the study and were assessed in two groups: colistin based vs. Ampicillin-Sulbactam based. Patients were evaluated at baseline and at the end of treatment for white blood cell count, ESR, and sputum culture and mortality. Inclusion criteria included age over 16 years and ventilator-induced pneumonia with carbapenem-resistant A. baumanni. Exclusion criteria included discontinuation of treatment and patient dissatisfaction to continue the study. Lower Respiratory Secretion was collected from these patients and sent to the laboratory. Isolation of bacteria was performed according to the standard bacteriological method and then using isolated biochemical methods, the isolated bacteria were identified up to the species. E-test was used to determine the lowest growth inhibitory concentration (MIC) to colistin and ampicillin sulbactam. The sample size was 33 patients in each group. There were 33 patients in the Colistin group. In the ampicillin-sulbactam group, 10 patients and 20 laboratory samples with ampicillin-sulbactam discs were also performed by antibiogram method. Laboratory sputum culture was used because antibiotic resistance was observed in the first 10 patients in the ampicillin-sulbactam group and there was no complete recovery and therefore due to concern for the lives of patients; The rest of the samples were performed in vitro. Patients were evaluated at the beginning and end of treatment on day 14. It should be noted that in order to double-blinded study, the patient and the data analyzer did not know about grouping. Data were analyzed by SPSS 20 software using descriptive statistics, t-test and chi-square. The normality of quantitative data distribution was checked by Kolmogorov-Smirnov test. The code of ethics of this dissertation was IR.ARAKMU.REC.1397.89. The registration code in Iran Clinical Trial Center for the above dissertation was IRCT20141209020258N126.

In this double-blind clinical trial study, 33 patients in the colistin group and 10 patients and 20 sputum culture samples in the ampicillin-sulbactam group were studied. The mean ± standard deviation of age of 43 patients was 48.23±16.85 years. The minimum age was 19 years and the maximum age was 85 years. In the cholistin + carbapenem group, out of 33 patients who were initially admitted to the study, 3 died before the end of the study and in the ampicillin-sulbactam group, out of 10 patients admitted to the study, 2 died before the end of the study. The number of WBC and the rate of ESR in the colistin + carbapenem group were decreased significantly (p<0.05) and 23 cases of sputum culture were negative for acinetobacter at the end of the study. in the colistin based group on day 14 of treatment, only 2 patients had higher than normal WBC counts and 24 cases had normalized chest X-rays. In the ampi-sulbactam+carbapenem group, at the end of treatment, 3 patients had normal WBC counts. Only one sputum culture was negative and 1 case had normal chest x-ray at the end of study. In 20 sputum culture samples that were examined in vitro, only two samples were sensitive to ampicillin-sulbactam and 18 cases were resistant to ampicillin-sulbactam.

The use of colistin+carbapenem improves clinical and laboratory response of patients. Therefore colistin-based therapy for the treatment of Carbapenem- resistant A. baumanni ventilator-associated pneumonia is recommended..

Treatment of leishmaniasis is a challenge due to problems such as high price and dose of the drug, drug resistance and side effects.

The study aims to introduce plants compounds, which their antileishmanial effects were approved in vivo conditions.

This study as a review article was performed by searching the keywords of “medicinal plants with in vivo antileishmanial effects, nanocarrier, clinical trials, and mechanism of action” in the well-known databases to 2018. In this study, 14 medicinal plant compounds with antileishmanial effects were reviewed and mechanism of action and their in vivo therapeutic effect were evaluated.

It was found that while some of these compounds had low antileishmanial effects, their efficacy against leishmaniasis was significantly increased through loading into nanocarriers.

This study indicated that active component of medicinal plants especially along with nano carriers can be of interest for the treatment of Leishmania.

 Clostridium difficile is the main cause of Antibiotic-Associated Diarrhea (AAD) in the hospital setting. Today, the use of probiotics for the prevention and treatment of AAD and colitis is increasing. In this study, we investigated the effect of probiotic yogurt on the frequency of Clostridium difficile.

 In this randomized clinical trial study, 132 elderly patients admitted to the infectious ward of Vali-e-Asr Hospital in Arak, who were under antibiotic treatment, were randomly divided into two groups, case (yogurt probiotic, 200 mg/d for 8 days) and control group (common yogurt). All patients were trained about the signs of colitis. We evaluated the colitis signs and the presence of Clostridium difficile by Polymerase Chain Reaction (PCR) and compared them between the groups. The obtained data were analyzed with appropriate statistical tests in SPSS V. 16.

 The Research Ethics Committee of Arak University of Medical Sciences approved this study (Code: 10-165-93). Also, it was registered at the Iranian Registry of Clinical Trials (Code: IRCT2016092229915N1).

 Clostridium difficile was detected in 4 (6.1%) patients of the case, and 1 (1.5%) patient of the control group, at the beginning of the study. There was no significant difference between the frequency of Clostridium difficile and colitis syndrome between two groups at the end of the study (P>0.05).

 Probiotic yogurt has no significant effect in reducing the frequency of Clostridium difficile and colitis syndrome in our study.

Community-acquired pneumonia (CAP) is an acute infectious disease of respiratory system. CAP is a common and potentially serious illness and is associated with considerable morbidity and mortality particularly in elder adult patients and those with significant comorbidities. One of the important causes of pneumonia is Mycoplasma pneumonia which has a mild course and rarely leads to hospitalization. In this study we aimed to determine the prevalence of pneumonia caused by M. pneumoniae in hospitalized patients in Arak city.
This study was conducted in 415 hospitalized patients older than 18 years, diagnosed with CAP in Valiasr hospital in Arak city. Pharyngeal swabs or sputum were taken from all patients and tested for M. pneumoniae by real time PCR.
A total of 415 cases with mean age 53.73± 19.88 years were enrolled in the study. 54.7% of them were men and 45.3% were female. M. pneumonia was detected in 9.4% of patients. Cases were infected with M. pneumoniae had significantly lower age compared to patients with pneumonia due to other pathogens (P value: 0.001). The highest incidence of mycoplasma pneumonia was observed in the spring and summer.
This study showed that M. pneumonia is causative agent of pneumonia in 9.4% of hospitalized CAP patients. Due to highest prevalence of mycoplasma pneumonia in spring and summer and in younger cases, M. pneumoniae should be considered as a causative agent of pneumonia in younger hospitalized CAP patients in these seasons.

Hepatitis D virus (HDV) is a defective RNA virus that depends on the hepatitis B surface antigen (HBsAg) for its replication. Infection with hepatitis D virus in hepatitis B virus chronic carriers causes accelerated progression to chronic active hepatitis, cirrhosis and hepatic carcinoma. In studies conducted in Iran and different countries, different prevalence of HDV had been reported. The aim of this study was to determine the frequency of hepatitis D virus infection in chronic hepatitis B patients in Arak city.
Patients and This cross-sectional study was conducted on 95 chronic hepatitis B patients in Arak city. Demographic characteristics and risk factors for HDV transmission were recorded. Hepatitis D antibody (Anti-HDV) was determined by ELISA in the serums of patients.
In this study 95 chronic hepatitis B patients were enrolled. 61% of cases were male and 39% were female. Anti-HDV was detected in 2 (2.1%) of chronic hepatitis B patients. There was no significant association between HBV/HDV co-infection and sex, age, education level and occupation (P values: 0.74, 0.52, 0.95 and 0.65 respectively). There was no history of injection drug use, unprotected sexual contacts, tattooing and history of familial contact in hepatitis D infected patients.
Our results showed that Arak is an area of low HDV infection in Iran.

Plasmid mediated AmpC β-lactamase resistance in Escherichia coli is an emerging problem worldwide. Phenotypic methods are commonly used for detection of resistance production in Gram-negative isolates, but molecular data about the prevalence of plasmid-mediated AmpC-type resistance at the national level are needed. Hence, a prospective study was undertaken to determine of antibiotic resistance and detection of plasmid-mediated AmpC beta-lactamases among clinical isolates of Escherichia coli from Patients of Vali-e-Asr hospital in Qom city.

In this cross-sectional, descriptive study (conducted between 20 March and 20 May, 2016), 61 specimens of E. coli were collected from patients visiting Vali-e-asr Hospital in Qom, Iran, using conventional microbiological methods. To determine antibiotic resistance of the specimens, antibiogram obtained from disk diffusion test was used. Then, the screened strains were examined for PCR amplification of (CITM, FOX)-type plasmid-mediated AmpC beta-lactamases- producing genes. The results were analyzed by using SPSS software.

Among 61 E. coli specimens, 54 specimens (88.5%) were associated with urine and the rest (11.5%) with blood. In terms of gender, 49 patients (80.3%) were female and 12 patients (19.7%) were male. Among the specimens, the highest and least antibiotic resistance was observed against amoxicillin and imipenem, respectively. Resistance to ceftazidime was seen in 27 specimens (69.2%). From the results, CITM was identified in 7.4% of specimens, but FOX was not detected in specimens.

Results showed that the prescription of antibiotics for patients with plasmid-mediated AmpC beta-lactamases -producing strains not only did not stimulate recovery, but also led to the formation of resistant strains. In addition, the phenotypic methods do not produce the actual number of AmpC β-lactamase strains. Therefore, the conduction of genotypic studies in society leads to effective and faster treatment of patients, and prevents the spread of resistant bacterial isolates.

Mycoplasmataceae are the smallest self-replicating organisms without cell wall. The Mycoplasma hominis, Mycoplasma genitalium and Ureaplasma urealyticum are associated with genitourinary tract and non-genital infections and could cause complications such as infertility, preterm delivery, itching vagina, abortion. This study designed for rapid detection of Mycoplasma hominis, Mycoplasma genitalium and Ureaplasma urealyticum among infected women by Multiplex PCR .
In this cross-sectional descriptive study in a period of 6 months (June to November 2015), 115 vaginal swabs samples were collected from women with genital tract infections referring to diagnostic laboratories in Tehran. All specimens were subjected to Multiplex PCR and cultivation methods. The results and the sensitivity and specificity of test were analyzed by Chi-squared and Independent T tests using SPSS software.
Our results indicated that 38 cases (33%) were positive for Mycoplasma infection by cultivation method while 54 cases (46.9%) were positive by Multiplex PCR method. Mycoplasma hominis, Mycoplasma genitalium andUreaplasma urealyticum were detected in 13.9%, 7.8% and 23.4% respectively. In 1.8% we found coinfection that infected by two species. The maximum rate of infection were detected among 30- 42 years old group, that statistically is significant (P= 0.001). The sensitivity of Multiplex PCR method for detection of Mycoplasma hominis, Mycoplasma genitalium andUreaplasma urealyticum were 100% while its specificity for them were 96.1%, 97.2% and 92.63% respectively.
Regarding the importance of genital Mycoplasmas among genital infections and their related complications and regarding the difficulty of cultivation method and its low sensitivity, we recommend Multiplex PCR method for their detection. Multiplex PCR method is very sensitive and rapid and its specificity for detection of all genital Mycoplasmas significantly is acceptable.
Iranian Journal of Infectious Diseases and Tropical Medicine Vol 21 , No 74 , 2016
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Key words: Mycoplasma hominis, Mycoplasma genitalium ,Ureaplasma urealyticum, Multiplex PCR

Brucellosis is a worldwide bacterial zoonotic disease. Infection with brucella species results in the activation of cell-mediated immune response. The interaction between T-helper cell type 1 (Th1) /Th2 cytokines determines the outcome of disease. The analysis of cytokine levels is valuable to determine the role of immune system in brucella pathogenesis. The aim of this study was to investigate the levels of serum interlukine-8 (IL-8) and its relation with treatment acute brucellosis patients. Thirty-three acute brucellosis patients and 19 controls were enrolled in the study. The diagnosis of brucellosis was on the basis of the symptoms، clinical findings and standard tube agglutination test. IL-8 levels were tested in controls and patients before and after treatment by ELISA. IL-8 levels were significantly lower in brucellosis cases compared to controls. At the end of the treatment، the serum levels of this cytokine increased but there is no significant difference between this cytokine levels before and after treatment. This study showed that IL-8 was lower in brucellosis cases and after treatment، the serum levels of IL-8 increased in these patients. Further studies with more patients are needed to determine the role of this cytokine in the pathogenesis of brucellosis.

Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Although occult HCV infection is less aggressive than classic chronic HCV infection، nevertheless it is important in management of hemodialysis (HD) patients. Occult HCV infection has been described in two different clinical settings: in patients with normal liver enzymes or in patients with abnormal values of liver enzymes. The aim of this study was to detect the occult HCV infection in hemodialysis patients with elevated liver enzymes. This cross sectional study was performed in hemodialysis patients referring to 3 dialysis units in Tehran. In 30 anti-HCV negative HD patients with elevated liver enzymes، presence of HCV-RNA in plasma samples was tested by Reverse Transcriptase-Nested Polymerase Chain Reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA، HCV-RNA was checked in PBMC specimens by RT-nested PCR. A total of 30 HD patients with mean age 54. 4± 14. 1years and mean dialysis duration 81. 2 ±64. 4 months were enrolled in the study. All HD subjects were negative for HCV-RNA in plasma and occult HCV infection with RT-nested PCR method. Occult HCV infection was rare in HD patients with elevated levels of liver enzymes.

Hepatitis E virus (HEV) is considered as a self-limited viral disease in tropical and subtropical countries which is transmitted as oral-fecal route. Some studies showed that HIV infected patients acquire HEV infection more frequent. This study was aimed to determine the seroepidemiology of HEV infection among HIV positive patients.

In this study 134 HIV infected patient and 52 matched healthy controls were enrolled. All cases were evaluated for the presence of anti-HEV antibodies (IgG and IgM) using ELISA.

Out of 132 HIV patients, 16 (11.9%) and out of 52 controls 6 (11.5%) were anti-HEV IgG positive. There is no significant difference between case and controls regarding anti-HEV IgG seroprevalence. Anti-HEV IgM was negative in all cases and controls. There was no association between anti-HEV IgG seropositivity and age, sex, possible route of HIV acquisition, aminotransferases levels, CD4, antiretroviral therapy, HBV and HCV co-infection

Our survey showed that HEV seroprevalence was similar in HIV infected patients and controls; therefore these patients are not at high risk for acquisition of this infection and screening of HIV patients and their vaccination is not recommended.

Brucellosis is an enzootic disease that can involve many organs and tissues. Brucella epididymo-orchitis is a focal complication of the brucellosis. The aim of this study was to compare epidemiologic، clinical، and laboratory features of patients suffering from Brucella induced epididymo-orchitis with cases of nonspecific epididymo-orchitis. This analytical cross-sectional study was performed in Valiasr Hospital in Arak from 2007 to 2011. A total of 40 cases of Brucella epididymo-orchitis were compared with 40 cases of bacterial (non-specific) epididymo-orchitis and the data were analyzed by SPSS ver. 16 software and Student t-test، and Mann-Whitney U and chi-square tests. We found no significant differences between the age (P-value = 0. 82)، fever (P-value = 0. 17)، history of urologic manipulation (P-value= 0. 23)، increased ESR (P-value = 0. 28)، and positive CRP (P-value = 0. 45) between the two groups. However، there was a significant difference between the presence of arthritis and arthralgias (P-value = 0. 02)، leukocytosis (P-value <0. 05)، pyuria (P-value = 0. 002)، symptoms of dysury-frequency (P-value = 0. 004)، sweating (P-value <0. 05)، and location (P-value =0. 004) between the two groups. This study shows that the existence of epididymo-orchitis without symptoms like dysuria and frequency، leukocytosis، and pyuria is suggestive of brucella epididymoorchitis. The physicians in endemic areas could use these findings for expediting the diagnosis and treatment of Brucella epididymo-orchitis.

Hepatitis viruses of oral-fecal origin are responsible for a high morbidity and mortality throughout the world, even if they never result in chronic hepatitis. Two viruses, the virus of hepatitis A (HAV) and of hepatitis E (HEV) are at present the cause of severe viral hepatitis of enteric origin.this study was conducted with the aim of determining the extent of seroprevalence of hepatitis A and hepatitis E in the Qom Province. Totally 740 blood samples were collected from population over 15 year old in all part of Qom province. Specimens were examined for the presence of hepatitis A and hepatitis E using the EIA method. our findings revealed that prevalence rate of anti - HAV and anti - HEV IgG infection were 78.6% and15.5%, respectively. It appeared to be a statistically significant association between HAV and HEV with age groups and residence. Our results showed that the presence of antibodies against hepatitis A and E in this province is very high, and vaccination against hepatitis A is not necessary now in Qom province. Also the prevalence of HEV infection is endemic in Qom province. The application of public health education to people, especially pilgrims to control and dissemination of HEV infection would be effective.

Human immunodeficiency virus (HIV) is the etiological agent of AIDS in humans. The infection is usually accompanied by changes in the synthesis and secretion of several cytokines, and dysregulation of these cytokines has an important role in HIV infected individuals. A switch from a T helper 1 (Th1) to a Th2 cytokine has been proposed as an important factor in progression of HIV infection to AIDS. The aim of the present study was to assess the levels of Th1 and Th2 cytokines in HIV infected individuals in order to identify the switch from Th1 to Th2 cytokines.

This study was carried out in 140 HIV infected patients and 35 matched healthy controls. The serum samples were checked with ELISA for interleukin (IL)-2, IL-4, IL-10 and interferon (IFN)-gamma.

IL-2 level was relatively higher and IL-10, IL-4 and IFN-gamma levels were relatively lower in the treatment naïve group than the under treatment group. Except for IL-2, all of the other cytokines exhibited a negative correlation with the CD4 cell counts and IFN-gamma levels showed the strongest negative correlation.

Our observations did not demonstrate switching of the type 1 to type 2 T helper cells cytokine profile in HIV infected patients and suggested more complex changes in Th1 to Th2 cytokine patterns in HIV infection.

Environmental factors and host genetic are important factors indifferent outcomes of HBV infection. One of these genetic factors is polymorphisms of regulatory genes of cytokines. Single nucleotide polymorphisms (SNP) in the promoter region of the interleukin (IL)-10 gene has been reported to have a role in determining of hepatitis B virus (HBV) infection outcome. The present study was undertaken to evaluate the association between HBV infection and SNP in the promoter region of the IL-10 gene. A total of 127 cases including 30 subjects who had spontaneouslyrecovered from HBV infection, 34 healthy carriers, 32 patients with chronic hepatitis B and 31 healthy controls were enrolled in this study. The three biallelic (-819,-592,-1082) polymorphisms in the IL-10 gene promoter were analyzed by PCR and direct sequencing. No significant difference was found in frequencies of genotypes and haplotypes of IL-10 gene promoter region at position -1082, -819 and -592 among controls, individuals spontaneously recovering from HBV infection, carriers and patients with chronic hepatitis B infection. However, frequencies of A/A genotype at position -592 and T/T genotype at position -819 were higher in the HBV clearance group while frequency of G/G genotype at position-1082 was higher in persistence group. GCC/GCC and GCC/ACC haplotypes were significantly more frequent in anti-HBe positive patients. It seems that genetic polymorphisms of IL-10 promoter region are not associated with HBV infection outcome. However, patients with high and intermediate producer haplotypes of IL- 10 had more ability to produce anti-HBe than those with low producer haplotypes.