فهرست مطالب mohraz

One of the most common hazards among the nurses is exposure to harmful chemicals. Cytotoxic drugs are among highly hazardous substances in the healthcare centers that can lead to DNA damage and cancer development. Therefore, this study was conducted to investigate the knowledge and attitude of nurses working in the oncology departments of Tehran hospitals regarding the risks and safety measures related to handling of cytotoxic drugs. In this cross-sectional study to develop an instrument, a questionnaire on knowledge and attitude regarding exposure to cytotoxic drugs was translated into Persian language and its validity and reliability evaluated and confirmed. The questionnaire was administered to 111 nurses working in 10 oncology departments (eight hospitals of Tehran) selected by random multistage sampling. For instrument validation, CVI and Cronbach's alpha were used. Descriptive analyses were done to analyze field work data. In this study, 22 men (19.8%) and 89 women (80.2%) participated. The mean age of participants was 33.6 (SD 8.6) years. Only 45% of participants constantly used gloves when handling drugs. Results indicated that 54.1% of participants had accidental exposure to cytotoxic drugs, 22.5% of who reported their exposure as being acute. Only 12.6% of participants reported that their efforts to reduce the risks of exposure as effective. At least 84.4% of the nurses had been trained in the handling of cytotoxic drugs, 54% of whom reported that the training was not effective. While confirming the reliability and validity of the instrument, this study showed that the training on improving the safety of the personnel is ineffective and insufficient, and most staff are at risk of direct and indirect exposure to cytotoxic drugs. Further the immunization of the workplace and the preparation and proclamation of safety and health protocols for handling of these drugs or attending their storage places can be beneficial.

In recent years, mobile phones and intelligent instruments have become important technologies to deliver health care around the world. These technologies can be used for health control and self-management of people with chronic diseases such as HIV/AIDS. This study was a development research to determine the data requirements and technical capabilities of a mobile-based self-management intelligent system for people living with HIV/AIDS (PLWH).
A review was conducted in relevant databases including PubMed, Scopus, Science direct, and Web of Science to find appropriate sources of technical requirements and data elements of a mobile-based self-management system for PLWH. In the second stage, the infectious disease specialists and health information management consulted by the questionnaire for system requirements.
Three categories of requirements, including demographic and clinical data elements and technical capabilities for system design were determined. Medication reminding, educational messages providing, diet reminding, security requirements, internet access, and Appointment reminding were the most important technical requirements of mobile-based self-management system for people living with HIV. Furthermore, clinical data elements of the system in order of priority were: fever, weight loss, diarrhea, loss of appetite, joint pain, and the first signs of disease.
The requirements for the design and implementation of an intelligent system to support mobile-based self-management for PLWH were obtained. Using these requirements, designing self-management system architecture will be possible. The system features such as the ability to provide care plan will be specific to each person uniquely. Using this system, may improve the patient's self-management skills and facilitate PLWH communication with health care providers.

Pulmonary tuberculosis is still the most common form of tuberculosis in HIV infected patients having differ­ent presentations according to the degree of immunosuppression. This study appraised the impact of HIV infection on clini­cal, laboratory and radiological presentations of tuberculosis. The clinical, laboratory and radiological presentations of pulmonary TB in 56 HIV-infected patients were com­pared with 56 individually sex and age matched HIV-seronegative ones, admitted to Imam Hospital in Tehran (1999-2006) us­ing paired t-test in a case control study. All cases and the controls were male. Fever was found in 83.9% of the HIV positive patients compared to 80% of the HIV negative ones. Cough was the most common clinical finding in the HIV negative group (89.3% vs. 82.1% in HIV posi­tive group). Among radiological features, cavitary lesions, upper lobe and bilateral pulmonary involvement were ob­served significantly less often in the HIV-infected group. On the contrary, lymphadenopathy was just present in the HIV posi­tive group in this series of patients (12%) and primary pattern tuberculosis was more common, as well (71% vs. 39%, P= 0.02). The Tuberculin test was reactive in 29% of the HIV/TB patients. The coexistence of both infections alters the picture of tuberculosis in many aspects and should be taken into ac­count when considering a diagnosis of HIV infection and its potential for TB co-infection, and vice-versa.

Background and the purpose of the study: Following the phase I clinical trial of the herbal drug IMODTM in HIV/AIDS patients، further studies were required to assess the drug efficacy and side effects. Therefore its safety and efficacy in HIV infected patients in a phase II were examined، and clinical trial phase III were designed. This study was conducted in three stages. In the first stage six patients who were resistant to highly active anti retroviral therapy (HAART) regimen were chosen and offered therapy with Setarud. Subsequently another group of 27 patients with CD4 count less than 350 but without AIDS defining criteria were enrolled to the study and randomly assigned to intervention. In the third stage a double-center randomized clinical trial was conducted at two independent research centers and universities of Iran. Seventy patients were recruited and randomly allocated into groups، called "control" and Setarud groups، using a balanced block randomization method. The main outcome measure was CD4 count. Patients were observed and thoroughly examined (Clinical and laboratory) for six months. In stages I and II، the mean CD4 count gradually increased within 3 and 6 months intervals. In the stage III the baseline of CD4 counts and other characteristics between two groups were quite similar. The mean increase in CD4 count in Setarud group was about 2-3 fold higher than controls. This effect was much more pronounced in a subgroup of patients with a baseline CD4 count of 200-400 (168 vs. 65، 203 vs. 58، 299 vs. 143 and 285 vs. 109، for time intervals of follow-up، respectively) (p<0. 001). There was a significant improvement in the immune system of HIV patients receiving Setarud therapy by increase in the CD4 count to the higher and more protective level in most subjects. Considering results of the safety tests and reports of the durability of the Setarud effects the use this drug in HIV patients، especially at the pre-AIDS period، as a therapeutic vaccine to slow down the progression of the disease، is recommended.

A new herbal drug, Setarud (IMODTM) that has been shown to have beneficial immune effects was tested to determine its acute and chronic toxicity in animals and to establish its intravenous form maximum tolerated dose (MTD) in an open-labeled phase I clinical trial. BALB/c and C57BL/6 mice and Wistar rats were monitored for general state and biochemical markers for chronic test. At the end of chronic test, animals examined macroscopically and histologically. HIV-infected asymptomatic male patients with CD4 counts more than 200, were enrolled in the trial. Baseline dose was calculated from the 10% lethal dose (LD10) established in laboratory animal studies. Dose escalation was performed in four cohorts of 3 patients receiving IMODTM intravenously at a cohort-specific dose of 2, 4, 6.7, and 10 ml daily for 4 weeks. Patients were clinically examined at days of 1, 2, 3 and then weekly; and the safety was assessed on the basis of reports of adverse events, laboratory-test data and toxicity signs. LD50 values in acute toxicity test were 42-66 and 50-56 ml/kg in i.m. and i.p. injections, respectively. Total scores of embryotoxicity during pregnancy were significantly lower in the Setarud group (p < 0.05). Pre-implantational deaths in the Setarud group were significantly higher, but post-implantational deaths level was lower than those in the control group. Inhibition of ossification in the skeletons of the fetuses and incidence of still birth were significantly higher while body weight of new-born rats of treatment group in the first month of their lifes were lower than those of the control group.In all four cohorts, there were no major side effects or dose-limiting toxicity, except for a mild sweating and weight loss in two patients from the first group that was reversed without discontinuation of the treatment. No clinically relevant trends in laboratory test results or ECG changes were noted. No adverse effect due to IMODTM was observed at one month of follow-up. Maximum tolerated dose of IMODTM was 10 ml a day. Results of this study has identified a safe dose of IMODTM that can be used in future clinical trials.

Tuberculosis (TB) is the most common infectious disease. It causes more than 2 millions deaths annually around the world. The aim of this study was to investigate the effectiveness of designed health education package on healthy behaviors of patients with tuberculosis at Pasteur Institute of Iran. This research was a quasi-experimental study that was carried out on 31 smear positive patients who referred to Pasteur Institute in 2004. Questionnaire and self report checklist were used to collect the required data. The educational needs were recognized and then the health educational package was designed. After that, the questionnaire and checklist filled out and educational package was performed for 8 weeks. The effect of training was evaluated by post-test after two months and the obtained results compared with the results of pretest. The main data was analyzed by analysis of variance, paired T-test and Pearson correlation coefficient tests in order to evaluate the effectiveness of intervention on knowledge, attitude and behavior of the patients before and after the intervention. The average age in study group was 33.71 years old (SD=13.68) and the sex frequency was 54.8 % for males and 45.2 % for females. There was a significant correlation between the change of attitude and the previous family history of TB (P<0/001). However, there was no significant correlation among the past jail and the previous tobacco use with the patient’s knowledge, attitude and practice. Analysis of the data, before and after the educational package intervention showed a significant difference among knowledge, attitude and practice before and after education (p<0/001). Health education has an important role in improving knowledge, positive attitude and adopting healthy behaviors in the patients with Tuberculosis.

Anemia is a frequent complication of infection with human immunodeficiency virus (HIV). The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology. Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9±9.2 months. The mean (±SD) hemoglobin level was 12.9 ±2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia (defined as hemoglobin<10 mg/dL) was 10.3%. Anemia was positively associated with female sex (OR=3.01), CD4 level (CD4 count of <200) (OR=3.49), and antituberculous drug administration (OR=4.57). Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study.

Background and A wide spectrum of endocrine abnormalities including thyroid dysfunction has been observed in HIV-infected patients with different results. This study was conducted to determine the frequency of thyroid dysfunction and to identify factors affecting the development of hypothyroidism in HIV-infected patients. Methods and Materials: Free T4, FT3, TSH, and thyroglobulin levels of 88 HIV-infected patients receiving care at UT counseling center for Behavioral Disorders in Tehran, an out patient referral center, were measured and data on their age, sex, body weight, BMI, history of opium and injection addictions, duration of HIV infection, disease stage, history of opportunistic infection or malignancy, CD4 cell count, antiretroviral treatment with antiretroviral drugs (HAART), receipt of other drugs (TMP-SMX, antituberculosis drugs, and steroids), and hepatitis C virus Co-infection were collected. Inclusion of the subjects was simply random. 17% of subjects had hypothyroidism; 1.1% had overt hypothyroidism; 2.3% subclinical hypothyroidism and 13.6% had low FT4 levels. The multivariate analysis showed that none of the studied factors were associated with the development of hypothyroidism. As none of the above-mentioned factors are not associated with the development of hypothyroidism, hypothyroidism should be considered in HIV-infected patients.

Cryptosporidium is an apicomplexan parasite of humans and a wild range of domestic as well as wild animals. An 833-bp fragment of the 18S-rRNA gene was used to identify Cryptosporidium spp. recovered from children and adult patients, in human immunodeficiency virus (HIV) positive and negative patients in Iran. Initial identification of cryptosporidiosis was carried out by Ziehl-Neelsen acid-fast staining method of stool samples. The samples, then, were identified specifically by nested PCR, targeting the most polymorphic region of the 18S-rRNA gene. The genotype encountered was detected by restriction endonuclease digestion of the nested-PCR product. Among 17 analyzed isolates, two different genotypes of Cryptosporidium were identified; 24% of the isolates belonged to C. parvum human genotype, and 76% to the potentially zoonotic species of C. parvum bovine genotype. The results of the present study showed that in contrast to HIV negative individuals, HIV positive individuals were more likely to be infected with zoonotic genotypes of the parasite; it was also confirmed the fact that zoonotic transmission of the parasite in Iran was as frequent as the transmission of anthroponotic origin. These outcomes are helpful for researchers to establish the corresponding prevention and treatment measures.

Injection drug use has been the major route of HIV transmission over the past several years in some countries. The aim of this study was to describe epidemiologic and demographic factors, as well as the risk behavior data in HIV-positive patients referred to a private clinic in Tehran. A retrospective study was conducted in 2005 based on documents of 150 HIV-infected patients referred to a private clinic from 1992 through 2004 in Tehran. Documents of 150 HIV-positive patients (124 males and 26 females) were analyzed. Injection drug use with one other risk factor, namely shared needle (n = 46), injection drug use without any other known risk factor (n = 37), and sexual activity (n = 25) were the major possible routes of transmission of HIV infection. The major possible route of transmission in female patients was sexual activity (n = 17), mostly from infected husbands (13/17).There was no patient with a history of drug abuse from 1992 to 1997. The frequency of HIV-positive injection drug users was 1 in 1997 – 1998, 6 in 1999, 3 in 2000, 24 in 2001, 32 in 2002, 37 in 2003, and 11 in 2004.Eighty-three (55%) of 150 and 64 (74%) of 86 patients had a history of drug abuse and incarceration, respectively. We observed high rates of hepatitis C and B virus coinfection in our HIV-positive patients. Injection drug use is the main risk factor associated with HIV infection in

The objective of this study was to determine the frequency of positive purified protein derivative (PPD) skin test in those infected with human immunodeficiency virus (HIV) and to investigate its association with CD4-positive T cell count, demographic factors, and possible routes of transmission in Iran. Fifty-one (36 males and 15 females) patients from an HIV clinic were selected and tested by a 5-tuberculin unit PPD. The mean ± SD age of patients was 32.2 ± 7.9 years. The probable route of HIV transmission was intravenous drug using in 21 (41%, CI95%: 28 – 54%) and sexual transmission in 17 (33%, CI95%: 20 – 46%) patients. Thirteen (26%, CI95%: 14 – 38%) patients had other risk factors. There were 13 (25%; 10 males and 3 females) PPD-positive patients among HIV-infected patients when a cut-off value of 5 mm was used; there were 15 (29%; 11 males and 4 females) when a cut-off point of 2 mm was employed. In addition, there was no significant correlation between the PPD test using both cut-off values of 5 and 2 mm, and none of the three probable routes of HIV transmission including intravenous drug using, sexual, and others. The mean ± SD CD4+ T cell count was 674 ± 487/mm3 in men and 573 ± 327/mm3 in women (P > 0.05). No significant correlation could be demonstrated between the patient’s PPD positivity rate and CD4+ T cell count. Considering the high rate of tuberculin reactivity, more attention should be paid to the importance of PPD test and isoniazid preventive therapy against tuberculosis in HIV-infected patients.

Genital mycoplasmas can cause infection of the genitourinary tract. Thses organisms are associated with bacterial vaginosis, pelvic inflammatory disease, endometritis, cervicitis, Nongonococcal urethritis. Spontaneous abortion, premature birth, neonatal pneumonia and meningitis, and infertility. The aim of this study was to determine the ability of PCR method for diagnosis and identification of genital mycoplasma in culture negative samples taken from women suffering from bacterial vaginosis. 174 genital samples were taken from women suffering from bacterial vaginosis during January until December 2005. Two genital swabs were taken from each patient. One of them was cultured on the mycoplasma specific media for isolation of mycoplasma. The other swab was immersed in PBS buffer and frozen until DNA extraction. To detect the presence of mycoplasma and ureaplasma in genital DNA Samples: a 520-bp fragment of the 16S rRNA was amplified. The specific primers used for this purpose were: MGSO, UGSO, MY- ins. From 174 samples, 71 samples (40.8%) were positive by culture for mycoplasma & ureaplasma. From 103 culture negative samples. According to PCR results, 14 samples (13.6%) were positive and 89 Samples (86.4%) were negative for mycoplasma and ureaplasma. This study showed that PCR method is more sensitive than culture for detection genital mycoplasma, Therefore PCR is a rapid, sensitive and easy method to detect genital mycoplasmas in urogenital swabs.

The aim of this study was to verify the occurrence of intestinal parasitic infections in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients in Iran in comparison with non-HIV individuals. A total of HIV+/AIDS patients (Group I) and 1220 clinically healthy individuals (Group II) were submitted to coproparasitological examination from 2003 to 2005. The overall prevalence of intestinal parasites in group I and group II was 11.4% and 11.6%, respectively, without significant difference between two groups. The prevalence of infection for each helminth and pathogenic protozoan, in every group, was as follows: Group I: Blastocystis hominis (6.1%); Giardia lamblia (4.2%); Cryptosporidium spp. (0.9%); Isospora belli (0.26%); Strongyloides stercoralis (0.26%); Hymenolepis nana (0.13%); and Rhabditis axei (0.13%). Group II: Blastocystis hominis (6.5%); Giardia lamblia (4.1%); Strongyloides stercoralis (0.33%); Hymenolepis nana (0.16%); and Trichostrongylus sp. (0.16%). Although the prevalence of infection for extracellular parasites was not statistically different between two groups, however, the infection rates for enteric coccidians including Cryptosporidium spp. and I. belli were significantly higher in patients at AIDS stage than Group II. The results emphasize the needs for especial consideration of enteropathogenic intracellular coccidians in immunocompromised patients.

Current mainstay of treatment for human immunodeficiency virus (HIV)-infected patients is highly active antiretroviral therapy (HAART) but little is known about the long-term clinical outcome for HIV-infected patients who have received HAART. Determining factors associated with longterm survival in the course of treatment may allow modification to be made for patients who are at a greater risk of treatment failure. In this study patients who were under HAART from March 2002 to September 2003 were evaluated. They were visited from 2 to 5 times and clinical and lab findings and CD4 count on every visit were recorded. Rates of progression from the initiation of HAART to treatment failure, defined as constant decline of CD4 numbers, occurrence of AIDS criteria and death, were determined. Forty three patients, 31 male and 12 female, with an average age of 39.6 were selected. The most common finding on initiation of treatment in these patients was wasting syndrome (16.3%). Overall, treatment failure occurred in 37.2%. Mean time to treatment failure was 13.3 months. There was correlation between baseline CD4 and survival of patients with history of monotherapy (P<0.05). Initial CD4 as a prognostic factor was valuable only in patients with history of monotherapy, also low initial CD4 correlated to death. Initial CD4 may help clinician to predict patient''s response to HAART. A multicentric longterm follow-up of patients treated with HAART is imperative. Drug resistance is the major factor in treatment failure. It is also correlated to lack of drug diversity and virologic lab tools.