Non-Infectious Complications in B-Lymphopenic Common Variable Immunodeficiency.

BACKGROUND AND OBJECTIVE: Common variable immunodeficiency (CVID) is considered the most symptomatic type of inborn errors of immunity in humans. Along with infectious complications, which have numerous consequences, non-infectious complications are also a major challenge among CVID patients. METHODS: All registered CVID patients in the national database were included in this retrospective cohort study. Patients were divided into two groups based on the presence of B-cell lymphopenia. Demographic characteristics, laboratory findings, non-infectious organ involvements, autoimmunity, and lymphoproliferative diseases were evaluated. RESULTS: Among 387 enrolled patients, 66.4% were diagnosed with non-infectious complications; however, 33.6% had only infectious presentations. Enteropathy, autoimmunity, and lymphoproliferative disorders were reported in 35.1%, 24.3%, and 21.4% of patients, respectively. Some complications, including autoimmunity and hepatosplenomegaly, were reported to be significantly higher among patients with B-cell lymphopenia. Among organ involvement, dermatologic, endocrine and musculoskeletal systems were predominantly affected in CVID patients with B-cell lymphopenia. Among autoimmune manifestations, the frequency of rheumatologic, hematologic, and gastrointestinal autoimmunity was reported to be higher compared to other types of autoimmunity independent from the B cell-lymphopenia. Furthermore, hematological cancers, particularly lymphoma, were slightly introduced as the most common type of malignancy. Meanwhile, the mortality rate was 24.5%, and respiratory failure and malignancies were reported as the most common cause of death in our patients without significant differences between the two groups. CONCLUSION: Considering that some of the non-infectious complications might be associated with B-cell lymphopenia, therefore, regular patient monitoring and follow-up along with proper medications (besides immunoglobulins replacement therapy) are highly recommended to prevent further sequels and increase the patients' quality of life.

The spectrum of inborn errors of immunity: a single tertiary center retrospective study in Alborz, Iran.

Summary: Background. Inborn errors of immunity (IEIs) are a group of heterogeneous disorders with inherited faults in the immune system that increase susceptibility to infections, malignancies, lymphoproliferation, and autoimmune/autoinflammatory disorders. Methods. We retrospectively studied the demographic characteristics, clinical features, and immunological profiles of the 90 IEIs patients, who were diagnosed and classified according to the European Society for Immunodeficiencies (ESID) and International Union of Immunological Societies (IUIS) criteria from July 2010 to June 2021. The study was carried out in the Non-communicable Diseases Research Center, Imam Ali Hospital, Alborz, Iran. Results. Within a period of 11 years, 53 (58.9%) males and 37 (41.1%) females were diagnosed and followed up for 20 IEI disorders. The median (IQR) age of onset, age of clinical diagnosis and diagnostic delay was 0.7 (0.08-2.0), 3.18 (1.0-8.0) and 1.5 (0.17-5.0) years, respectively. Twelve patients (36.4%) had a positive family history of IEI, and the majority of patients (84.5%) had recurrent infections. Pneumonia (51.7%) was the most common clinical manifestation among IEI patients, followed by skin complications (46.2%). The most frequently diagnosed IEI was immunoglobulin A deficiency (IgAD) (14.4%) and severe combined immunodeficiency (SCID) (11.1%). Predominantly antibody deficiencies group (36.7%) was the most common category, followed by combined immunodeficiencies with associated or syndromic features group (27.8%). Conclusions. IEIs have different patterns within populations with high consanguinity. There is a need to search for underlying genetic and epigenetic factors in most common IEIs in Alborz.

Effect of fish oil and canola oil supplementation on immunological parameters, feed intake, and growth of Holstein calves.

Supplemental n-3 fatty acids (FA) may support better immune responses than n-6 and n-9 FA in dairy calves. The objective was to evaluate the effect of n-3 FA, supplemented as a fish oil product (FO) in the milk replacer (MR), in comparison to n-6 and n-9 FA, supplemented as canola oil (CO), on body weight (BW), daily gain, and immunological parameters of preweaning Holstein calves. The study was conducted from September to December 2019. Calves were randomly allocated to a control group (n = 15; BW = 36.2 ± 1.5 kg; mean ± SEM) supplemented daily with 30 mL of CO and to an experimental group (n = 15; BW = 36.3 ± 1.5 kg) supplemented with 60 g of a product containing 30 g of FO. Both treatments were added to the MR during the morning feeding. All calves were fed 4 L of MR at 12.5% solids at 0700 and 1600 h for wk 1, 6 L from wk 2 to 7, and 3 L once daily (0700 h) during wk 8 until weaning (56 d). Blood samples were collected at 7, 14, 21, 28, 35, 42, 49, and 56 d of age for serum haptoglobin, TNF-α, IL-1ß, and protectin. Dry matter intake was recorded in all experimental calves daily. Seroneutralization titers to vaccination against viral diseases (infectious bovine rhinotracheitis, parainfluenza 3, bovine viral diarrhea, and bovine respiratory syncytial virus) were determined. Mixed models for repeated measures were developed to analyze variables over time. Seroneutralization titers were analyzed by the Kruskal-Wallis test. The other variables were compared by a generalized linear model. Serum FA profile at 35 d of age showed that FO supported higher concentrations of n-3 FA than CO. Final BW [65.2 vs. 62.0 kg, standard error of the mean (SEM) = 2.1 kg] and average daily gain (0.52 vs. 0.46 kg/d, SEM = 0.1 kg/d) tended to be higher for the FO than the CO group. An interaction of treatment × day for dry matter intake was observed, especially during weaning (2.17 kg vs. 1.94 kg, SEM = 0.158 kg, for FO and CO group, respectively). Blood lactate (mmol/L) was higher in the CO than in the FO group at d 7. Haptoglobin and IL-1ß were higher for the CO group on d 14 than the FO group. The TNF- α concentrations for the FO group were reduced over time, whereas the concentrations in the CO group remained constant. Protectin was higher in the FO group on d 14, but was lower on d 28, 35, and 49. Seroneutralization antibody titers postvaccination for the PI3 virus were higher for the FO than the CO group. In conclusion, calves supplemented with FO had lower concentrations of blood lactate, haptoglobin, IL-1ß and TNF-α than calves supplemented with CO during the study period. The FO supplementation had a higher DMI than CO supplementation. Results of this trial should be interpreted with caution due to the lack of a negative control group as well as the lower birth weight and growth rate observed under heat stress conditions.

Evaluation of Apoptosis Induction by Newcastle Disease Virus LaSota Strain in Human Breast Carcinoma Cells.

The innovation of therapeutic modalities with better clinical efficacy is necessary for the treatment of patients with advanced cancers. Newcastle disease virus (NDV), an avian pathogenic virus, is one of the most promising oncolytic viruses that can replicate selectively in human cancer cells. In humans, NDV can cause transient conjunctivitis and mild flu-like symptoms. However, this virus poses no hazard to human health. The elucidation of the mechanisms of cancer cell killing by NDV is helpful for the clinical application of NDV in cancer patients. Regarding this, the present study was performed to evaluate apoptosis induction by NDV LaSota strain vaccine in human breast carcinoma cells. To this end, MCF-7 cells, a human breast adenocarcinoma cell line, were infected with NDV in vitro. Tumor cell cytotoxicity, apoptosis induction, and expression levels of apoptosis-related genes were examined in NDV-infected breast carcinoma cells. Tumor cell cytotoxicity was measured by 3-[4,5-dimethylthiazol-2yl]2,5-diphenyl-tetrazoliumbromide (MTT) assay. The induction of apoptosis was assessed by annexin V/propidium iodide staining. In addition, the expression levels of apoptosis-related genes were evaluated using real-time reverse transcription polymerase chain reaction (PCR) technique. The NDV showed cytotoxic effects on MCF-7 cells and induced apoptosis in the infected carcinoma cells. The gene expression levels of BAX, caspase-9, and caspase-3, but not BAK-1, were increased in NDV-infected cancer cells, compared to the gene expression levels in the non-infected cancer cells. These results suggest that the induction of the intrinsic pathway of apoptosis is one of the mechanisms that can contribute to cancer cell killing by NDV. Additional studies are required to investigate other probable mechanisms involved in NDV-mediated cancer cell killing.

Evaluation of patients with primary immunodeficiency associated with Bacille Calmette-Guerin (BCG)-vaccine-derived complications.

BACKGROUND: Bacille Calmette-Guerin (BCG) vaccination has a great impact on the prevention of severe complications of tuberculosis. However, in patients with primary immunodeficiencies (PID), it can lead to severe complications such as severe combined immunodeficiency, chronic granulomatous disease, and Mendelian susceptibility to mycobacterial disease. This study highlights the demographics, clinical complications and laboratory parameters among PID patients associated with BCG vaccination side effects. METHODS: One hundred and thirty-seven PID patients with BCGosis were evaluated in this study, based on the complications following BCG vaccination. RESULTS: The mean age of the patients with BCG complications at the time of the first visit was five years. The within-group comparison of patients showed a highly significant incidence of pneumonia and hepatomegaly in severe combined immunodeficiency patients. Furthermore, the immunologic data showed an increase in the overall rates of lymphocytes such as CD3+, CD4+ and CD8 + T cells in Mendelian susceptibility to mycobacterial disease patients. The level of immunoglobulins has also increased in chronic granulomatous disease patients. CONCLUSION: The high rate of undiagnosed PIDs predisposes individuals to a high risk of severe side effects as a result of BCG vaccination, as well as infants that are less than one month of age. Therefore, there is a need for early screening and diagnosis of PIDs before exposing unknown PID status patients to BCG vaccination. The benefits of screening and early diagnosis of PID cannot be overemphasized, especially in patients with a previous family history of immunodeficiency.

Economics of production efficiency: Nutritional grouping of the lactating cow.

Nutritional grouping of lactating cows under total mixed ration (TMR) feeding systems has been discussed in the literature since 1970. Most studies have concluded that using multiple, more-homogeneous TMR feeding groups is economically beneficial because of either nutrient cost savings, improved productivity, or both. Nonetheless, no consensus has been formed around this technique nor has it been widely adopted. By using optimal criteria for grouping and more precise nutrient specifications of diets, the latest studies have reported a consistently greater income over feed cost ($/cow per year) with multiple TMR groups compared with 1 TMR (3 TMR=$46 and 2 TMR=$21 to $39). Critical factors that determine the economic value of nutritional grouping are: (1) criteria for grouping, (2) nutrient specifications of diets, (3) effects on milk production, (4) health and environmental benefits, (5) number, size, and frequency of grouping, and (6) additional costs and benefits. It has been documented that grouping cows according to their simultaneous nutritional requirements (a.k.a., cluster grouping) is optimal. Cluster grouping is superior to other methods, such as grouping according to days in milk, milk production, or production and body weight combined. However, the dairy industry still uses less-than-optimal grouping criteria. Using cluster grouping will enhance the positive economic effects of multiple TMR. In addition, nutrient specifications of diets for groups do not seem optimal either. Milk lead factors, which are only based on group average milk production, are used. Diets could, however, be formulated more precisely based on overall group nutrient requirements. Providing more precise diets should also be in favor of grouping economics. Furthermore, an area that requires more attention is the potential negative effect of grouping on the milk production of moved cows because of either or both social interactions or diet concentration changes. Although the literature is inconclusive on this subject matter, the latest studies indicate that multiple TMR groups economically outperform 1 TMR, even after considering plausible potential milk losses when grouping. Moreover, additional positive effects of nutritional grouping of improved herd health and environmental stewardship should be translated into economic benefits. Finally, additional costs of management, labor, facilities, and equipment required for grouping are farm specific. The few studies that have integrated these factors in their analyses found that multiple TMR groups would still be economically superior to 1 TMR.

Economic impact of nutritional grouping in dairy herds.

This article evaluates the estimated economic impact of nutritional grouping in commercial dairy herds using a stochastic Monte Carlo simulation model. The model was initialized by separate data sets obtained from 5 commercial dairy herds. These herds were selected to explore the effect of herd size, structure, and characteristics on the economics and efficiency of nutrient usage according to nutritional grouping strategies. Simulated status of each cow was updated daily together with the nutrient requirements of net energy for lactation (NEL) and metabolizable protein (MP). The amount of energy consumed directly affected body weight (BW) and body condition score (BCS) changes. Moreover, to control the range of observed BCS in the model, constraints on lower (2.0) and upper (4.5) bounds of BCS were set. Each month, the clustering method was used to homogeneously regroup the cows according to their nutrient concentration requirements. The average NEL concentration of the group and a level of MP (average MP, average MP+0.5SD, or average MP+1SD) were considered to formulate the group diet. The calculated income over feed costs gain (IOFC, $/cow per yr) of having >1 nutritional group among the herds ranged from $33 to $58, with an average of $39 for 2 groups and $46 for 3 groups, when group was fed at average NEL concentration and average MP+1SD concentration. The improved IOFC was explained by increased milk sales and lower feed costs. Higher milk sales were a result of fewer cows having a milk loss associated with low BCS in multi-group scenarios. Lower feed costs in multi-group scenarios were mainly due to less rumen-undegradable protein consumption. The percentage of total NEL consumed captured in milk for >1 nutritional group was slightly lower than that for 1 nutritional group due to better distribution of energy throughout the lactation and higher energy retained in body tissue, which resulted in better herd BCS distribution. The percentage of fed N captured in milk increased with >1 group and was the most important factor for improved economic efficiency of grouping strategies.

Semen collection using phantom in dromedary camel.

Semen collection is relatively long, unsafe, and tedious procedure in dromedary camel. The innovation of safe, hygienic, and simple approach to collect semen could make great progress in development of AI program in this species. This study investigated two methods of semen collection using phantom and artificial vagina in dromedary camel. Semen was collected using phantom (n = 4 bulls; 26 collections) and artificial vagina (n = 6 bulls; 11 collections) and diluted with INRA96 at the ratio of 1:10. The duration of semen collection, semen parameters, and morphometric features of sperm were evaluated. For specimen collected through phantom and AV, the respected duration of semen collection (411.2 ± 48.19 vs 326 ± 37.05 sec), volume (6.6 ± 0.87 vs 6 ± 1.57 ml), osmolarity (328 ± 1.6 vs 319.4 ± 3.21 mOsm/kg H2O), pH (7.7 ± 0.06 vs 7.9 ± 0.16) of semen, concentration (161.4 ± 44.05 × 10(6)/mL vs 160.2 ± 58.42 × 10(6)/mL), total motility (84.1 ± 1.89 vs 78.3 ± 3.97%), progressive forward motility (45.5 ± 3.69 vs 44.3 ± 6.41%), live percentage (72.2 ± 3.11 vs 76 ± 2.53%), and plasma membrane integrity (61.5 ± 2.49 vs 58.9 ± 4.19%) of sperm were similar (P > 0.05). The number of specimens contaminated with visible particles was greater using AV (72.7%) compared to phantom (0%; P < 0.05). Total length, head, middle-piece, and tail length of sperm were 45.9 ± 0.1, 5.6 ± 0.01, 7 ± 0.02, and 34.2 ± 0.16 µm, respectively. The frequency of abnormal sperm was 13.28% among which coiled tail, detached head, and proximal protoplasmic droplets had greater incidence. In conclusion, phantom could be considered as a suitable approach to collect semen due to simplicity, safety, and lack of specimen contamination in dromedary camel.

Molecular characterization, genetic diversity and antibacterial susceptibility of Escherichia coli encoding Shiga toxin 2f in domestic pigeons.

This study aimed to evaluate prevalence, characteristics, genotypic diversity and antibacterial susceptibility of Escherichia coli encoding Shiga toxin 2f in domestic pigeons in different provinces of Iran. A total of 117 faecal samples were collected from pigeons and were subjected to molecular detection of stx2f. In total, 20, 25·8, 21·4 and 9% of pigeons from Tehran, Ferdows, Garmsar and Babol cities carried stx2f+ isolates, respectively. Of the 460 E. coli isolates examined, 43 were stx2f+ and most also carried eae (95·3%) and astA (97·7%) genes. Some of the stx2f+ isolates harboured cnf (9·3%), but all were negative for stx1, stx2 (other subtypes) and ehly. Most Strains (90%) were assigned to B1 phylogroup and possessed Intimin-ß. Fingerprinting of the stx2f+ isolates using either enterobacterial repetitive intergenic consensus sequences (ERIC) or random amplified polymorphic DNA (RAPD)-polymerase chain reaction revealed seven distinct profiles by each method, with one prevailing (65·1 and 46·5%, respectively). By the combination of methods, 10 profiles were recognized. Ten isolates from different profiles were shown to belong to O20, O78 and O115 serogroups, and eight were 100% identical in the stx2f gene sequence. The strains were consistently resistant to amoxicillin and lincospectin and commonly resistant to tetracycline (88·4%) and doxycycline (74·4%). Overall, the results indicate a limited degree of genetic diversity in stx2f-harbouring E. coli from pigeons. Significance and impact of the study: Carriage of stx2f gene tends to be underreported in pigeon Escherichia coli isolates because most routine genetic and phenotypic tests cannot efficiently target this gene or detect the toxin. Nevertheless, pigeons frequently carry E. coli strains that are stx2f-positive, and this situation is not limited to any distinct geographical area. The current results suggest that genetic background of stx2f-encoding E. coli is distinct from most Shiga toxin-producing E. coli strains. However, the factors that contribute to host preferences and pathogenicity remain unclear. These findings have public health significance that should be addressed in future research.

A daily herd Markov-chain model to study the reproductive and economic impact of reproductive programs combining timed artificial insemination and estrus detection.

Our objective was to compare the economic and reproductive performance of programs combining timed artificial insemination (TAI) and different levels of AI after estrus detection (ED) using a daily Markov-chain model. A dairy herd was modeled with every cow following daily probabilistic events of aging, replacement, mortality, pregnancy, pregnancy loss, and calving. The probability of pregnancy depended on the combination of probability of insemination and conception rate (CR). All nonpregnant cows had a probability of pregnancy between the end of the voluntary waiting period and days in milk cutoff for AI. After the cutoff, cows were labeled as do not breed and replaced when milk production was below a minimum milk threshold. A similar model was created to represent a replacement heifer herd to simulate and adjust the supply and demand of replacements. The net value (NV) of a program was the sum of milk income over feed cost, replacement and mortality cost, income from newborns, and reproductive costs. The model was used to compare the NV of 19 programs. One program used 100% TAI (42% CR for first TAI and 30% for second-and-later services), whereas the other programs combined TAI with ED. The proportion of cows receiving AI after ED for the combined programs ranged from 30 to 80%, with levels of CR of 25, 30, and 35%. As the proportion of cows receiving AI after ED increased, the CR of cows receiving TAI decreased. The combined programs with CR of 35% for cows receiving AI after ED had the greatest NV and reproductive performance at all levels of ED. The program using 100% TAI had greater NV and better reproductive performance than all programs with 25% CR after ED inseminations, whereas it had very similar performance to combined programs with up to 60% of cows receiving AI after ED and 30% CR. The factor with the greatest relative contribution to the differences among programs was income over feed cost, followed by replacement and reproductive costs. Adjusting the days in milk cutoff for AI to match the supply and demand of heifer replacements improved the NV of all programs except for those with 25% CR after ED, which had either no change or a decrease in NV. In summary, the economic value of reproductive management programs combining TAI and ED depended on the proportion of cows receiving AI after ED and the resulting CR. Adjusting the heifer supply and demand increased the NV of programs with heifer surplus and decreased the NV of programs with heifer deficit.

The effect of reproductive performance on the dairy cattle herd value assessed by integrating a daily dynamic programming model with a daily Markov chain model.

The objective of this study was to determine the effect of reproductive performance on dairy cattle herd value. Herd value was defined as the herd's average retention payoff (RPO). Individual cow RPO is the expected profit from keeping the cow compared with immediate replacement. First, a daily dynamic programming model was developed to calculate the RPO of all cow states in a herd. Second, a daily Markov chain model was applied to estimate the herd demographics. Finally, the herd value was calculated by aggregating the RPO of all cows in the herd. Cow states were described by 5 milk yield classes (76, 88, 100, 112, and 124% with respect to the average), 9 lactations, 750 d in milk, and 282 d in pregnancy. Five different reproductive programs were studied (RP1 to RP5). Reproductive program 1 used 100% timed artificial insemination (TAI; 42% conception rate for first TAI and 30% for second and later services) and the other programs combined TAI with estrus detection. The proportion of cows receiving artificial insemination after estrus detection ranged from 30 to 80%, and conception rate ranged from 25 to 35%. These 5 reproductive programs were categorized according to their 21-d pregnancy rate (21-d PR), which is an indication of the rate that eligible cows become pregnant every 21 d. The 21-d PR was 17% for RP1, 14% for RP2, 16% for RP3, 18% for RP4, and 20% for RP5. Results showed a positive relationship between 21-d PR and herd value. The most extreme herd value difference between 2 reproductive programs was $77/cow per yr for average milk yield (RP5 - RP2), $13/cow per yr for lowest milk yield (RP5 - RP1), and $160/cow per yr for highest milk yield (RP5 - RP2). Reproductive programs were ranked based on their calculated herd value. With the exception of the best reproductive program (RP5), all other programs showed some level of ranking change according to milk yield. The most dramatic ranking change was observed in RP1, which moved from being the worst ranked for lowest milk yield to the second ranked for highest milk yield. Within a reproductive program, RPO changed based on the stage of lactation at pregnancy. Cows getting pregnant in the early stage of a lactation had higher RPO compared with getting pregnant later in the lactation. However, the RPO at calving was similar for early and late lactation pregnancies.

Determining the optimum replacement policy for Holstein dairy herds in Iran.

The objective of this study was to determine the optimum replacement policy for Holstein dairy herds in Iran using a dynamic programming model. Cows were described in terms of state variables that included milk production class, parity, pregnancy status, and month in milk with a 1-mo stage length. The objective function maximized the net present value of cows over a 15-yr planning horizon. Markov simulation was used to estimate expected herd dynamics under the optimal decision plan determined by dynamic programming. Stochastic elements included probabilities of pregnancy and abortion, production level, and involuntary culling. The optimum annual culling rate was estimated to be 31.4%, and cows had an expected herd life (time from first calving until culling) of 3.18 yr. High replacement cost and low carcass value resulted in only 2.87% voluntary culling (i.e., optimal model-based replacement). Assuming a heat detection rate of 0.4, cows averaged 2.8 services per lactation under the optimal policy. Sensitivity analyses were carried out to evaluate the effect of milk price, herd-average production, feed cost, heifer price, and carcass value on optimum replacement decisions. Herd-average production, replacement cost, and risk of involuntary culling were important factors affecting the optimal culling policy. Changes in the price of feed, calves, and milk and the probability of pregnancy had no considerable effect on the optimal policy considering the market situation in Iran during 2008.

Microbial profiles of on-line--procured sprouting seeds and potential hazards associated with enterotoxigenic Bacillus spp. in homegrown sprouts.

We examined the microbiological quality of sprouting seeds sold through the Internet. Overall, five types of seeds each from six organic and six conventional sources were evaluated. The growth and toxin production of naturally occurring Bacillus spp. in sprouts produced using home-scale sprouting devices also were investigated. For alfalfa, broccoli, lentil, mungbean, and radish seeds, the average microbial counts were 3.3, 4.0, 2.8, 3.5, and 3.6 log CFU/g, presumptive B. cereus counts were 0.7, 1.0, 0.8, 1.0, and 0.9 log CFU/g, and total coliform counts were -0.3, -0.4, -0.5, 0.0, and -0.4 log of the most probable number per gram, respectively. No Salmonella, Escherichia coli O157, other fecal coliforms, or Staphylococcus aureus was found on seeds. Compared with conventional seeds, the organic seeds had lower or equivalent counts for total microorganisms, presumptive B. cereus, and total coliforms. When seeds were sprouting using a glass jar, the growth of presumptive B. cereus was significant for radish and broccoli but not for alfalfa, lentil, and mungbean sprouts; the counts exceeded 5.0 log CFU/g in radish sprouts. When sprouts were grown using an automatic sprouting device, presumptive B. cereus showed slight growth (< 3.0 log cycles) in radish, broccoli, and mungbean sprouts but no growth in alfalfa and lentil sprouts. Although the presumptive B. cereus isolates were enterotoxigenic, they did not produce or accumulate detectable levels of diarrheal toxins in freshly produced sprouts.

Characteristics of tuberculosis patients in Yazd province, Islamic Republic of Iran, 1997-99.

We determined the incidence of tuberculosis and some demographic characteristics among 604 patients in a 3-year period (1997-99) in Yazd province, Islamic Republic of Iran. The average annual rate of tuberculosis was 26.8 per 100 000 (22.9 in males and 31.0 per 100 000 in females). The highest rate of tuberculosis was in the > 50 years age group (111.1 per 100 000). The average annual proportion of pulmonary and extra-pulmonary tuberculosis cases was 75.8% and 24.2% respectively. On average 66.7% of TB patients were cured, 8.4% transferred to a different catchment area, 17.7% were treatment failures and 7.1% died. Of the total, 63.2% were Iranian, 36.1% Afghan refugees. Despite efforts in prevention, diagnosis and treatment of patients and refugees, tuberculosis is still an important problem in this province.