محمود صفاری

Increased prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and treatment of infections due to these resistant strains is one of the most important health challenges. In this study, antimicrobial resistance patterns of Staphylococcus aureus isolates from patients were determined to commonly prescribed and last-resort antibiotics, and methicillin-resistant Staphylococcus aureus strains were isolated according to detection of mecA and femA genes.

This research was done on 146 Staphylococcus aureus isolates from hospitalized and outpatients who referred to Isfahan Hospitals and Shahid-Beheshti Hospital of Kashan from June 2017 to September 2018. Antimicrobial resistance patterns to common antibiotics were determined by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines. Also Vancomycin minimum inhibitory concentration (MIC) of MRSA strains was determined using broth microdilution method. Isolation of MRSA strains were phenotypically done using cefoxitin disk and for confirmation mecA and femA genes were detected in these strains.

From 146 collected clinical samples, frequencies of MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) were 24 (16.4%) and 122 (83.6%) respectively. The most resistance rate were detected to erythromycin 44 (30.1%) and vancomycin resistance was not seen among the S. aureus isolates, whereas linezolid resistance was 2/1 percent. In molecular study using PCR method, all MRSA strains carried mecA and femA genes.

Current study showed that the frequency of MRSA among clinical samples isolated from Isfahan and Kashan Hospitals is relatively high. Also the presence of resistance to new and important antibiotics as last resort treatment is considered a serious alarm.

Endophthalmitis is the most devastating complications of cataract surgery that can lead to visual loss, blindness and death in severe cases. Pseudomonas aeruginosa is a gram negative rod that known to cause keratitis and endophthalmitis. The emergence of multidrug resistant Pseudomonas aeruginosa strains is a serious problem. The treatment of endophthalmitis by multidrug resistant Pseudomonas aeruginosa strains is very difficult due to the limitation for the choice of effective antibiotic. A 63-year-old woman was admitted to the hospital with severe pain and blurred vision. She had (PE+PCIOL) surgery in her right eye three days ago. Endophthalmitis was diagnosed and the Pseudomonas aeruginosa was identified in culture. The study of antimicrobial resistance pattern showed the Pseudomonas aeruginosa strain was multidrug resistant. After vitrectomy the patient had vision loss and finally the severe vitreous reaction led to death. Pseudomonas aeruginosa endophthalmitis is a rapidly progressive infection and associated with sight loss. The treatment of multidrug resistant Pseudomonas aeruginosa endophthalmitis is difficult and rapid treatment with appropriate antibiotic according to determination of antimicrobial resistance pattern is essential.

Bachground: Klebsiella pnomoniae is one of the most important etiologic agents of urinary tract infection (UTI). An increasing occurrence of antimicrobial resistance among uropathogenic bacterial isolates has complicated the treatment process. The aim of this study was to determine antibiotic susceptibility patterns and prevalence of the metallo-beta-lactamase enzyme of K. pneumoniae isolates collected from UTI.
This cross-sectional study was conducted on patients with complicated UTI reffered to hospitals in Qom city, Iran. A total of 1807 culture positive samples of pathogens were collected from the patients, among which 457 isolates were K. pneumoniae. The isolates were tested for antimicrobial susceptibility by the disc-diffusion method recommended by the guidelines of Clinical and Laboratory Standards Institute (CLSI 2013). In addition, the dubble disk synergy test was used to detect the K. pneumoniae isolates of metallo-beta-lactamase enzyme.
The prevalence of UTI infection due to K. pneumoniae was 25.3%. Among 1807 positive urine cultures, 62.4% were from females and 37.6% from males. Results of antimicrobial susceptibility showed that the highest antibiotic resistance was seen for trimetoprium-sulfametoxazole (98.5%) and the lowest resistance levels were seen for amikacin (9.4%), meropenem (22.8%) and imipenem (25.6%). The results of the imipenem-EDTA combined disk showed that 93.2% imipenem resistance isolates were positive for the metallo-beta- lactamase enzyme.
Carbapenem resistance and production of the metallo-beta-lactamase enzyme in K. pneumoniae uropathogenic are increasing. However, amikacin is still effective against these bacterial infections and its effectiveness should be maintained.

Pseudomonas aeruginosa is a nosocomial pathogen which especially causes infections among burn patients. Carbapenems are extensively used for the treatment of infections caused by multidrug-resistant P. aeruginosa isolates. The emergence of carbapenemases producing isolates is an outcome of increased utilization of carbapenems. The aim of this study was to determine the bla-IMP-1 and bla-IMP-2 genes in metallo-β-lactamase (MBL) -producing Pseudomonas aeruginosa isolated from burn patients in Isfahan.
Material and A total of 150 P. aeruginosa were isolated from burn patients hospitalized in Imam-Mousakazem hospital in Isfahan. Antimicrobial susceptibility was determined using disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Double Disk Synergy Test (DDST) was carried out for screening of MBL production in imipenem-resistant strains. PCR assays were used for detection of bla-IMP-1 and bla-IMP-2 genes among metallo-β-lactamase-producing Pseudomonas aeruginosa isolates. The purified PCR products were sequenced.
Of 150 Pseudomonas aeruginosa isolates, %100 identified as multi-drug resistant strains. The most resistance rates were seen against ciprofloxacin, tobromycin, meropenem and imipenem. All of 144 imipenem-resistant Pseudomonas aeruginosa isolates were MBL producing by DDST test. Twenty-nine (19.3%) and 8(5.3%) MBL producing Pseudomonas aeruginosa isolates harbored bla-IMP-1 and bla-IMP-2 genes respectively.
According to results of this study high level resistance to imipenem and MBl genes carriage was seen among Pseudomonas aeruginosa isolated from burn patient infections in our region.

Uropathogenic Escherichia coli (UPEC) is one of the most important etiologic agent of urinary tract infection (UTI). UPEC strains have various types of virulence factors such as adhesins, toxins and iron uptake systems. Virulence genes are located on transmissible genetic elements and/or in particular locus on the chromosome called pathogenicity islands (PAI). The aim of this study was to investigate the prevalence of UPEC and the virulence factors among the UPEC isolates. Of 370 urine samples collected from hospitalized patients with UTI in Kashan Shahid-Beheshti hospital, a total of 150 E.coli strains were isolated between December 2012 and June 2013. Biochemical and standard microbiological techniques were used to identify the E.coli followed by screening for virulence genes using the polymerase chain reaction (PCR). The prevalence of UTI infection was 40.5% and the frequency of UPEC virulence genes was traT (74%), aer (30.7%), PAI (61.4%), sfa (0%), pap (16.7%), cnf1 (0%), afa (0%) and hly (4.5 %). Our study showed that the traT, PAI and aer virulence genes were highly prevalent among the UPEC strains isolated from hospitalized patients in our region; therefore, these genes could be studied as targets for medical interventions.

Klebsiella is opportunistic pathogen and one of the most common causes of nosocomial infections this pathogen cause a variety of diseases including urinary tract infections.Today, the prevalence of ESBL-producing pathogens (ESBLS) is important, so these infections are associated with prevalence of diseases and increase healthcare costs associated. The aim of this study was to determine the prevalence of genes blaTEM isolates of Klebsiella pneumoniae isolated from urinary tract infections in Qom.After identification of isolates using culture and biochemical methods, 140 isolates of Klebsiella pneumoniae was identified. The sensitivity of the isolates to different antibiotics was performed by disk diffusion method based on the standard (CLSI2013). The phenotypic confirmatory test ESBL strains have done followed by PCR method to detection of blaTEM gene. Out of 300 samples, 140 isolate identified as Klebsiella pneumoniae that 52 (%37.14) isolates were ESBL. The most antibiotic resistance was related to ceftazidime (%50.72). Out of 52 ESBL positive strains, 32 (61.53%) strains were shown to have blaTEM gene.Considering the high prevalence of ESBL-producing isolates in hospitals, early detection and follow-up to prevent the spread of resistant isolates it all the more essential. It must also change in the pattern of antibiotics, hospital infection control measures are highly recommended.

Group B Streptococcus (GBS) has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia، Ib، II-VIII. Due to the changes in serotypes'' distribution pattern over time and also variation in different geographic areas، production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts، respectively. Capsular typing was perform ed using the multiplex PCR method to identify the Ia،Ib،II-VIII serotypes. Thirty-six (9. 4 %) out of 382 pregnant women were carriers of GBS. The most common types were III (32. 14%)، V (21. 43%)، and IV (14. 3%)، respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III، V and IV serotypes in this study، they are potential sources for the production of multivalent GBS vaccines in near future.

Acute and chronic cholecystitis and cholangitis are common cases in general surgical diseases. Considering the role of infections in pathogenesis of these diseases, prescribing appropriate antibiotics is important to control the biliary tract infections. The aim of this study was to recognize the biliary pathogens as well as evaluate their antibiotic susceptibility in cholecystectomized patients.

This cross-sectional study was performed on 288 cholecystectomized patients with acute and chronic cholecystitis and cholangitis. During the operation, a sterile bile sample was aspirated from the gallbladder which was sent to the laboratory for culture and antibiogram evaluation.

Sixty-two (21.5%) patients were positive for bile culture. There were more positive cultures in cholangitis cases (64.7%) than the acute and chronic cholecystitis (22.8%, 12.2%, respectively; P=0.001). Thirty-six isolated pathogens were E.coli (58%) and 8 Klebsiella (12.9%). Moreover, the most effective antibiotics against the gram-negative bacteria: imipenem (100%), amikacin (98.1%) and gentamicin (90.4%) and for gram-positive bacteria: imipenem, vancomycin, rifampcin and clindamycin.

The third-generation cephalosporins, as an empirical treatment for biliary tract infections, lack the effective antibiotic susceptibility. Considering the high susceptibility (more than 90%) and the reasonable price of amikacin and gentamicin, cephalosporins are recommended as the first line treatment for biliary tract infection. Imipenem, an expensive broad-spectrum antibiotic, is not recommended as the first line treatment to avoid drug resistance.

Helicobacter pylori (H. pylori) infection is a worldwide problem nowadays. Considering H. pylori resistance to antibiotics, the need for complementary therapies or substances that reduce antibiotic resistance is completely obvious. The purpose of this study was to investigate the antimicrobial properties of pomegranate seed and peel extract against H. pylori. Pomegranate seed and peel extract were prepared in different concentrations (10, 15 and 20 percent) separately using the DMSO. Mixtures of these concentrates with meteronidazol and claritromycin (each with 3 concentrates) as well as the discs for each concentrate were prepared. Finally, H. pylori resistance in stomach biopsies of candidates for esophagoscopy was evaluated for each disc during 2008-2009 in Kashan. Considering an inhibitory zones around each disc and comparing those to the tables of national committee for clinical laboratory standards (NCCLS), antibiotic sensitivity to clarithromycin and meteronidazol increased significantly with pomegranate peel extract and it was not significantly increased with the pomegranate seed extract compared to the antibiotic discs alone. Although the pomegranate seed and peel extract has no effect on inhibition zone of H. pylori, it can be used in reducing antibiotic resistance of meteronidazol and clarithromycin to eradicate H. pylori.

Considering the importance of chemical and physical parameters such as temperature, moisture, pH and carbon to nitrogen (C:N) ratio in producing compost, the purpose of this study was aimed to evaluate these parameters in producing compost by stack method.

This descriptive study was carried out on municipal solid waste generated in Kashan during a 63-day period from Oct 3 to Dec 4, 2010. Compost samples were taken from the top one-third, the center and also the bottom of the compost pile and mixed; the compost pile was aerated (if necessary). Thereafter, samples were analyzed for carbon and nitrogen content using Fourti method.

The initial temperature of the compost pile was 38°C and then increased to 65°C at the 9th day, and reached to 26°C at the last day of composting. The moisture at the beginning of the process was 67.5%, increased to 73% at the 5th day and decreased to 38% at the last day. The initial pH of the compost was 5.5, increased during the compost process, and reached an optimal value of 7.7 at the end of the process. The C:N ratio at the beginning of the process was 35:1 and in mature compost decreased to 12.5:1.

Presence of actinomycetes and the dark-brown color of the prepared compost on the 63rd day of composting indicate that the compost meets the required standards. Consequently, the implementation of this method is suitable for tropical cities like Kashan.

Food contamination with fungi and the production of mycotoxins, such as aflatoxin, allow the toxins to enter human body. Continuous contamination with low doses of these agents can act as a major risk factor for hepatocellular carcinoma. Thus the present study was carried out to evaluate the detection of contamination in eggs with aflatoxin by PCR method. In a cross-sectional study, a total of 144 suspicious and 211 intake eggs were collected and three samples of fungi including aspergillus niger, penicillium expansum, and fusarium verticillioides as negative controls and 14 samples of aspergillus flavus as positive controls were selected and examined using TLC and PCR. The results were analyzed through SPSS software. By PCR, neither aflR, omt-A, and ver-1, nor-1 was detected in intake eggs by PCR. Of the suspected eggs, four samples with nor-1, two samples with aflR, and two samples with omt-A could be detected. Three samples of the 14 strains of aspergillus flavus were shown to be positive through the use of TLC and the four primers. One strain of aspergillus flavus was positive with all of the four primers; however, it was negative in TLC. The findings of this study indicated that PCR is a sensitive, fast, and specialized technique, but it cannot detect the presence of the fungi before the appearance of colonization. Thus for indicating toxcification, other complementary tests are also required.

Methicillin-resistant Staphylococcus aureus (MRSA) is the main cause of hospital infection. The aim of present study was to investigate the molecular characteristics of Staphylococcus aureus (SA), to detect mecA gene, and to type SCCmec in the strains isolated from patients at Kashan Shahid Beheshti Hospital. This descriptive study was carried out on SA isolates (n=150) collected from the clinical samples at Kashan Shahid Beheshti Hospital, Iran during 2009. The identification of all tested isolates were confirmed using Gram's stain, coagulase, DNase and manitol salt agar. In addition, the genotypes of SCCmec in the MRSA isolates were determined by multiplex PCR. Eighty seven (58%) out of 150 SA isolates were confirmed as MRSA harboring mecA gene detected by PCR. Thirty four out of 87 (39.1%) were HA-MRSA and the remainig 53 (60.9%) were CA-MRSA. The multiplex PCR assay for SCCmec complex of MRSA strains (n=87) showed that 3(3.4%) samples were SCCmec type I, 12(13.8%) SCCmec type II, 8(9.2)% SCCmec type IVb, 4(4.6%) SCCmec type IVd and 3(3.4%) SCCmec type V. More than 50% of SA strains were positive for mecA gene and more than 60% of them were CA-MRSA. Moreover, SCCmec type II was the predominant strain of the identified MRSA.

Considering the increased antimicrobial resistance to Staphylococcus aureus and also the importance of vancomycin as a treatment, the aim of this work was to determine the minimum inhibitory concentration (MIC) of vancomycin, the pattern of antibiotic susceptibility, removing the isolates producing beta-lactamase enzyme and determining the risk factors for prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical samples in Shahid Beheshti Hospital of Kashan-Iran. This descriptive study was carried out on 150 Staphylococcus aureus isolates. The sample strains were identified using gram staining, catalase test, tube coagulase test, growth on manitol salt agar medium and the DNAase test. The antibiotic sensitivity test was determined by disk diffusion method on nine antibiotics. MIC of vancomycin was determined using Broth Microdilution Method. The production of beta-lactamase enzyme was performed using acidometry method. Among the 150 Staphylococcus aureus isolates, MIC value was 0.5-4 µg/mL. The highest MIC of vancomycin was 2 µg/mL. All of isolates were sensitive to vancomycin. Mean age of patients was 31.3+25.8. Penicillin and vancomycin revealed the highest and the lowest resistant rate, respectively (93℅ and 0℅). Resistance to methicillin was 62%. Eighty-seven percent of the isolates produced enzyme beta lactamase. Risk factors for prevalence of methicillin resistant Staphylococcus aureus were high age and previous antibiotic therapy. Considerining the vancomycin as the selective antibiotic, on following the preventive guideline, preparing the antibiogram and adding MIC test are recommended.

Tuberculosis is an important cause of death in some countries. The world health organization estimates that if stronger measures are not taken up to control the prevalence of this disease, from 2000 to 2020 a billion people will be infected by the bacterium. According to time consuming of common detection methods of Mycobact-erium tuberculosis such as culture, it is necessary to evaluate a rapid detection tests such as PCR. Rapid diagnosis of tuberculosis may have profound effects in patients’ care According to importance of rapid detection and treatment of tuberculosis and for determine of sensitivity, specificity, positive predictive value and negative predictive value of PCR by using IS6110 this study was

As there is a high prevalence of cutaneous Leishmaniasis in Iran, the problems and expenses for culture of the parasite are important. The effect of different types of blood human, cattle, sheep and goat on growth of leishmania tropica promastigote, L.major were examined and compared with rabbit blood. This study was preformed during 2001-2003 in Kashan. This analytical study was performed on promastigote L. tropica and L. major which was confirmed by the World Health Organization. The examination was repeated 10 times. The time of compatibility with culture medium, maximum and minimum growth based on decrease in number of active parasite as compared to the basic number at the time of culture were determined and judged statistically. The time of compatibility with culture medium was equal in all cases and it was about 1 to 3 days. With human, sheep and goat blood, maximum growth of parasite was reached in a shorter time period as compared to0 cow blood. The minimum growth in the blood of rabbit and cow was more than human, goat and sheep blood. The growth of 2 kinds of parasites in rabbit blood was more than human, goat and sheep blood (P<0.05), but it was similar to the amount of growth of these parasites in rabbit and cow blood. In places where it is difficult to have access to rabbit or cow blood, human B negative blood can be used.

Pseudomonas aeroginosa is a gram negative bacterium which is found in the intestinal tract and skin as normal flora. It can cause opportunistic infections, contaminated wounds especially burn lesions, and is resistant to many antibiotics. Many studies support the use of honey for these infections. The aim of this study was to investigate the possible bactericidal effects of different kinds of honey, on P. aeroginosa, in Kashan. This was a labaratory study. Eight out of 15 honey samples were selected and their reducing sugars, saccharose were quantified, also Diastase enzyme activity was determined. The included specimens were then classified to natural (6 specimens), synthetic unnatural (2 specimens) and a sample prepared by sugar, and two by heat-inactivated natural honeys. Different concentration (V/V) containing 5, 10, 15, 20, 25, 30 percent of honeys were added in the Muller Hinton agar and P. aeroginosa (ATCC=27853) were then cultured. The results showed that natural honeys at the concentration of 10%, had bactricidal effects on the growth of P.aeroginosa. The synthetic honeys did not show this effect. but heating process reduced bactricidal properties of the honeys. We concluded that natural honeys can be used for the treatment of infectious wounds especially in burns, and superficial lesion. In vivo studies are also warranted to confirm the bactericidal effects of honey. Keywords:

Some fungi such as Sporothrix Schenckii may rarely cause arthritis. A 36-year old woman presented with complaining monoarthritis of right knee. Sporothrix Schenckii was revealed in the joint effusion for the first time in Iran. Case Report: She received ketoconazol, 400 mg daily in two divided doses. During the treatment functional liver test and other necessary laboratory tests were evaluated every month. After 8 weeks, effusion, pain and movement limitation decreased. After 2 months, some yeast was seen in microscopic evaluation of sinovial fluid. Six month after treatment, pain and swelling completely disappeared. Based on the result of this study, Ketoconazole is recommended as choice treatment of sporothrical arthritis.

Nocardiosis is a chronic sub acute suppurative infection that mainly affects lungs, however, other organs such as skin or central nervous system may also be involved. This is usually occurred in patients who have suppressed immune system. The present study was conducted on patients residing in Arak who have suffered from pulmonary infection. For this descriptive study 600 subjects with pulmonary infection were included. Sputum was stained using modified Ziehl-Neelson technique in the paraffin agar medium. Specimens were determined using biochemical tests including gelatin, casein, and thyrosin hydrolysis. Finally, the prevalence of nocardiosis and its related factors were determined. Of 600 patients, 26 (4.33%) were revealed to have nocardia asteroides. There was no significant association between pulmonary nocardiosis and sex, age, occupation, and season. Since the clinical features of pulmonary nocardiosis are similar to TB and other fungal infections of the lungs, despite different therapeutic approaches, clinical practitioners should be considered this infection and try to treat it.

With respect to the efficacy of thrombolytic agents in the treatment of acute myocardial infarction, the present study was conducted on CCU patients in Shaheed Beheshti hospital in Kashan in 1999-2000. We have determined the efficacy of streptokinase (Sk) based on anti-streptokinase before and after the treatment. For this clinical trial 45 patients with acute myocardial infarction were selected. Their diagnosis was made according to their clinical manifestations as well as EKG and paraclinical studies. Anti-streptokinase was measured by ELISA method. The efficacy of streptokinase was determined by Q wave in EKG. Of 45 patients, 35 had low and 10 had high level of anti-streptokinase. In 35 patients (28 with low and 10 with high anti-streptokinase) the Q wave remained unchanged following the drug administration. Drug side effects were hypotension (15.5%), bleeding (9%) and allergic reactions (4.5%). No mortality was reported. With respect to the high prevalence of streptococcal infections in our society, determining the anti-streptokinase level prior to the therapy is recommended. In case of low titer, we suggest streptokinase otherwise other thrombolytic agents should be administered.

History and Extraction and purification of polysaccharide capsule is the first step for preparation preventive vaccines in infections as a result of encapsulated Staphylococcus aureus. This study was carried out to extract and purify Staphylococcus aureus type 2. The descriptive and explorative strategy of this study was conducted on Staphylococcus aureus (Smith diffuse variant) in BHI broth in a shaking incubator (200 rpm) in an aerobic condition at a temperature of 37°C. The capsule was extracted using dilute acid and heating method. Then, dialysis was done overlight at 4°C and the product was lyophilized. Lyophilized powder was purified using a cellulose DEAE column (2.6×50 cm) by gradient method using bicarbonate ammonium buffers (0.01-1 M) at a velocity of 60 mt/h (Ion exchange chromatography). Finally absorption spectrum was plotted and purified capsule was analyzed using scanning spectrophotometer. Polysaccharide capsule was collected in final growth phase at 0.1 HCL and at a temperature of 100°C. Absorption spectrum were evaluated using H2SO4/galacial acetic acid assay at wavelength range of 350-620 nm. The result showed that chromatographs are well matched with previously purified antigens. Conclusion and Recommendations: It is concluded that it is possible to extract and purify the capsule of Staphylococcus aureus type 2 and it is recommended to produce the related preventive vaccines.

History and Considering the high incidence of gastrointestinal disorders and the involvement of Helicobacter pylori in the occurrence of gastritis, duodenal ulcers and gastric adenocarcinoma and the absence of a generally-accepted and standard method for its diagnosis, this study was carried out to compare the invasive and non-invasive methods on referrals of Shaheed Beheshti hospital in Kashan in 2000. The clinical trial and diagnostic strategy of this study was performed on 127 cases with variant symptoms of gastric disorder and with endoscopic indication. During gastroscopy, samples were collected from antrum for culture, pathological diagnosis and fast urease and 5ml of blood was obtained for evaluation of IgG against, bacterium. The golden standard in this study was on the basis of a positive result for culture, pathological evaluation and fast urease. Then, the sensitivity, specificity, PPV and NPV were determined for criteria of culture, fast urease, histology and ELIZA. The study was performed on 127 cases with an age of 46.3±18 years and 57.5% out of them were male and the remainder (42.5%) were female. The results showed that each test individually or two of the three tests (Histology, fast urease and ELIZA) can not have an appropriate diagnostic value. In this respect, a combination of urease with PPV and/or with NPV can have the greater diagnostic value of 59.3% and 92.3% respectively. Meanwhile, combination of culture and PPV and/or NPV showed the least diagnostic value, i.e. 56.7% and 50% respectively and combination of histology and PPV and/or NPV showed the highest value, i.e. 90% and 100% respectively. Furthermore, ELIZA test in comparison with golden standard had the least sensitivity, even in the presence of histologic evaluation and fast urease. It can be concluded that a combination of fast urease and histology is of high value in diagnosis of Helicobacter pylori in Iran. In addition, the serologic ELIZA test recommended not to be performed because of its low specificity. However, its negative results might be helpful in some cases.