Quality of life and asthma control in pregnant women with asthma.

BACKGROUND: Asthma is the most commonly occurring respiratory illness during pregnancy. Associations with complications of pregnancy and adverse perinatal outcome have been established. However, little is known about quality of life (QoL) in pregnant women with asthma and how it relates to asthma control particularly for Iran. OBJECTIVE: To determine the relationship between asthma related QoL and asthma control and severity. METHODS: We conducted a prospective study in pregnant women with asthma. We used the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire (AQLQ) and the guidelines of the Global Initiative for Asthma for assessment of asthma severity. RESULTS: Among 1603 pregnant women, 34 were diagnosed with asthma. Of these 13 had intermittent, 10 mild, 8 moderate and 3 severe persistent asthma. There was a significant decrease of QoL with poorer asthma control (p = 0.014). This decline could be due to limitations of activity in those with poorer asthma control, which is underlined by the significant decline of QoL with increasing asthma severity (p = 0.024). CONCLUSION: Although the majority of pregnant women with asthma had a favorable score in AQLQ, reduced QoL was related to increased asthma severity and poor asthma control. This underlines the importance of controlling asthma during pregnancy not only for the prevention of adverse pregnancy outcomes but also for the preservation of QoL.

Posttraumatic stress disorder, depression, executive functioning, and autobiographical remembering in individuals with HIV and in carers of those with HIV in Iran.

Two studies examined autobiographical remembering in those with HIV (Study 1) and in carers of those with HIV (Study 2) in Iran. Study 1 investigated posttraumatic stress disorder (PTSD) and depression symptoms, executive control, and autobiographical remembering in those with HIV. Individuals with HIV (n = 34) and healthy controls (n = 34) completed the Impact of Event Scale-Revised, Beck's Depression Inventory-II, Beck's Anxiety Inventory, Autobiographical Memory Interview, Autobiographical Memory Test, Wisconsin Card Sorting Test, and Tower of London. The results indicated higher PTSD and depression symptoms among the HIV group. The findings also showed that those with HIV had lower levels of executive functioning, deficits in autobiographical remembering (semantic and episodic) and retrieved less specific autobiographical memories than the control group. Study 2 examined depression, executive functioning, and autobiographical memory performance among carers of those with HIV (n = 26) and healthy controls (n = 26). The same measures were completed as in Study 1. The results indicated higher depression among the carers group but the groups did not differ in terms of executive functioning or semantic recollection. The carers had lower episodic recall scores and less specific memories than the control group. The findings are discussed in terms of the processes involved in nonspecific retrieval of autobiographical material in relation to HIV.

Prediction of Alzheimer's in People with Coronavirus Using Machine Learning.

Background: One of the negative effects of the COVID-19 illness, which has affected people all across the world, is Alzheimer's disease. Oblivion after COVID-19 has created a variety of issues for many people. Predicting this issue in COVID-19 patients can considerably lessen the severity of the problem. Methods: Alzheimer's disease was predicted in Iranian persons with COVID-19 in using three algorithms: Nave Bayes, Random Forest, and KNN. Data collected by private questioner from hospitals of Tehran Province, Iran, during Oct 2020 to Sep 2021. For ML models, performance is quantified using measures such as Precision, Recall, Accuracy, and F1-score. Results: The Nave Bayes, Random Forest algorithm has a prediction accuracy of higher than 80%. The predicted accuracy of the random forest algorithm was higher than the other two algorithms. Conclusion: The Random Forest algorithm outperformed the other two algorithms in predicting Alzheimer's disease in persons using COVID-19. The findings of this study could help persons with COVID-19 avoid Alzheimer's problems.

Mutations in the E2 and NS5A regions in patients infected with hepatitis C virus genotype 1a and their correlation with response to treatment.

Heterogeneity of subgenomic regions of hepatitis C virus (HCV) may be associated with response to interferon (IFN) therapy. The amino acid sequences of the PKR/eIF-2α phosphorylation homology domain (pePHD), IFN sensitivity determining region (ISDR), PKR binding domain (PKRBD), and variable region 3 (V3) were studied in 19 patients before and after 4 weeks of treatment. All patients were infected with HCV genotype 1a and were treated with pegylated-IFN and ribavirin. Thirteen patients achieved sustained viral response (responders) and six failed to clear viral RNA (nonresponders). The amino acid sequences in the pePHD and ISDR were identical in responders and nonresponders. However, amino acid substitution at position 2252 of PKRBD was significantly different between responders and nonresponders (P = 0.044). A larger number of mutations were observed in the V3 region of responders (P < 0.001). In this region, the amino acid in position 2364 differed between responders and nonresponders (responders: aspartic acid and serine, nonresponders: asparagine, P = 0.018). The amino acid sequences in the regions which were studied did not change after 4 weeks of treatment. It is concluded that the presence of specific amino acids in position 2252 of PKRBD and position 2364 of V3 might be associated with clinical response to IFN.

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

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

A cross-sectional study of anemia in human immunodeficiency virus-infected patients in iran.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.

Musculoskeletal symptoms in workers.

Self-report measures of musculoskeletal discomfort are a widely used and generally accepted risk factor for musculoskeletal disorders in epidemiologic research. The aim of this study was to investigate the prevalence of musculoskeletal symptoms in packing workers. A cross-sectional study of 75 workers was carried out using a modified Nordic questionnaire. Prevalence was determined with the percentage of positive responses to questions on musculoskeletal symptoms. Odds ratios and 95% confidence intervals were the measures of association between prevalent musculoskeletal symptoms and demographic factors; they were determined with logistic regression. Most musculoskeletal symptoms in workers were from the low back (44.0%), shoulders (33.3%) and neck (32.0%). Years worked were strongly significantly associated with musculoskeletal symptoms and pain in the neck, shoulders and wrists/hands, P < .001-.050. Hazards related to repetitive movements and discomfort postures could be reduced with stretching exercises, rotation schedules and through new engineering solutions.

Quality of life among human immunodeficiency virus-1 infected and human immunodeficiency virus-1/hepatitis C virus co-infected individuals in Iranian patients.

BACKGROUND: The aim of this study was to compare the quality of life (QOL) of people infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The study design was a cross sectional descriptive survey, using self administered questionnaires. MATERIALS AND METHODS: A convenience sample of 242 patients (131 of them HIV/HCV), Iranian adults (aged 18-57) living with HIV/AIDS, was recruited from outpatient referring to Imam Khomeini Hospital behavioral counseling center in Tehran city, Iran. The instruments included the Multidimensional QOL HIV (MQoL HIV) and a demographic section. RESULTS: The majority of the samples were male and single. The mean age was 36.52 years (standard deviation = 8.5). HIV mono infected patients reported higher scores in social support and physical functioning, but lower scores in physical health compared with HIV/HCV co infected individuals. There was no significant difference in overall MQOL HIV score between HIV and HIV/HCV patients. CONCLUSION: Future studies will need to explore the impact of HCV on HIV infected individuals' QOL.

Community disaster resilience: a systematic review on assessment models and tools.

INTRODUCTION: Recent years have witnessed community disaster resilience becoming one of the most heavily supported and advocated approach to disaster risk management. However, its application has been influenced by the lack of assessment tools. This study reviews studies conducted using the resilience concept and examines the tools, models, and methods adopted. It examines the domains, indicators, and indices have been considered in the tools. It provides a critical analysis of the assessment tools available for evaluating community disaster resilience (CDR). METHODS: We investigated international electronic databases including Scopus, MEDLINE through PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar with no limitation on date, and type of articles. The search terms and strategy were as follow: (Disaster* OR Emergenc*) AND (Resilience OR Resilient OR Resiliency) that were applied for titles, abstracts and keywords. Extracted data were analyzed in terms of studied hazards, types of methodology, domains, and indicators of CDR assessment. RESULTS: Of 675 publications initially identified, the final analysis was conducted on 17 full text articles. These studies presented ten models, tools, or indices for CDR assessment. These evinced a diverse set of models with regard to the domains, indicators and the kind of hazard described. Considerable inter dependency between and among domains and indicators also emerged from this analysis. CONCLUSION: The disparity between the articles using the resilience concept and those that offer some approach to measurement (675 vs. 17) indicates the conceptual and measurement complexity in CDR and the fact that the concept may be being used without regard to how CDR should be operationalized and assessed. Of those that have attempted to assess CDR, the level of conceptual diversity indicates limited agreement about how to operationalize the concept. As a way forward we summarize the models identified in the literature and suggest that, as a starting point for the systematic operationalization of CDR, that existing indicators of community disaster resilience be classified in five domains. These are social, economic, institutional, physical and natural domains. A need to use appropriate and effective methods to quantify and weigh them with regard to their relative contributions to resilience is identified, as is a need to consider how these levels interrelate to influence resilience. Although assessment of disaster resilience especially at the community level will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further empirical investigation is needed to develop a operational and measurable CDR model.

Demographic Determinants of Disaster Preparedness Behaviors Amongst Tehran Inhabitants, Iran.

BACKGROUND: Tehran is vulnerable to natural hazards, especially earthquakes. Disaster preparedness behaviors (DPB) are measures that can mitigate the adverse consequences of disasters. Demographic factors affect DPB, however, the role of some of these factors is not still clear. By understanding these effects, disaster specialists could design interventions toward specific demographics. In the present study, we aimed to investigate demographic determinants of DPB. METHODS: This cross-sectional survey was conducted in August 2014. The target population included inhabitants of Tehran who were 18 years or older. A total of 1250 participants were selected randomly and interviewed using a standardized questionnaire. RESULTS: Results of our study showed that monthly income level, previous disaster experience, residential district and occupation are demographic factors that influence DPB significantly. However, disaster preparedness was not affected by gender, educational level, number of household members, home type, home ownership and being the head of household. CONCLUSION: To promote DPB in Tehran, disaster specialists should focus on improving DPB in low-income and unemployed people, and individuals who live in high risk districts, especially in those who have not experienced disasters. KEY WORDS: Disaster, Preparedness behavior, Demographic determinants.

Efficacy of adding metformin to pegylated interferon and ribavirin in treatment naïve patients with chronic hepatitis C: a randomized double-blind controlled trial.

BACKGROUND Evidence indicates that insulin resistance results in poor sustained viral response (SVR) in patients with chronic hepatitis C (CHC). Metformin is an oral hypoglycemic agent which improves insulin resistance. METHODS We sought to determine if the addition of metformin to the treatment regimen could improve SVR in treatment-naïve CHC patients in a randomized, double-blind, placebo-controlled trial. We randomized 140 consecutive CHC patients to receive either metformin 500 mg three times a day or placebo in addition to pegylated interferon (PEG-IFN) and ribavirin (RBV). Only treatment-naïve subjects aged between 15 and 65 years of age were included. SVR was defined as no detectable HCV RNA six months after the end of treatment.Subjects who received at least one dose of PEG-IFN were included in the finala nalysis. RESULTS The SVR rate in the metformin group was 75% versus 79% in controls (intention-to-treat) which was not significantly different. Also, the difference between the placebo and metformin group was not significant in subsets of different genotypes or those with homeostasis model assessment of insulin resistance (HOMA-IR) levels greater than 2 or body mass index greater than 25. The most common complaint was gastrointestinal discomfort (13% in metformin group versus 4% in controls; p=0.002) that lead to discontinuation of metformin in 8 participants. CONCLUSION Although triple therapy with metformin, PEG-IFN and RBV is relatively well tolerated, the addition of metformin did not significantly improve viral response in CHC patients.

Development and Application of an In-house Line Probe Assay for Hepatitis C Virus Genotyping.

BACKGROUND: Hepatitis C virus (HCV) is the major cause of chronic liver disease. HCV is a single stranded positive sense RNA of approximately 9.6 Kb. Because of high conservativeness of 5΄untranslated region of HCV genome, it is widely used for virus genotyping. Different methods are used for the virus genotyping, but all involve some difficulties. OBJECTIVES: The aim of the present study was to develop an in-house reverse hybridization method as a line probe assay, for HCV genotyping. MATERIALS AND METHODS: Sixty serum samples were collected with newly diagnosis of HCV infection. Genotyping process had already been performed for the samples using RT-PCR RFLP method. After total RNA extraction from the samples and cDNA synthesis, nested PCR method was applied for amplification of the target sequence on the 5΄UTR. In the nested PCR, biotinylated oligonucleotides were used as inner primers. Optimized concentrations of the biotinylated inner primers (as positive control), two universal and seven specific probes were spotted onto nylon membrane stripes in a defined pattern. Hybridization process was conducted between the probes and the denaturized biotin labeled PCR products. Finally, the stripes were developed by using streptavidin conjugated alkaline phosphate as a signal generating agent. To determine the diagnostic sensitivity and specificity of the home made LiPA, a panel containing 60 confirmed sera with positive results for HCV (and PCR-RFLP genotyped) was subjected to evaluate. RESULTS: Agarose gel electrophoresis of the nested PCR products using the outer and inner primers showed 305 and 234 bp fragments respectively. After performing hybridization and detection processes on the prepared strips, the colored bands were formed for the positive control, universal probes and the corresponding genotypes. HCV genotype results were found to be in 100% concordance through studying 60 sera that were successfully typed by the two methods. P-value of 0.045 conveys that the two methods were the same and had no significant difference. CONCLUSIONS: The most common genotyping method in Iran is RT-PCR RFLP. Given the results and advantages of this homemade technique, such as high specificity and sensitivity, ability for detection of most genotypes, it provides possibility of evaluating much of the isolates without needing electrophoresis stage.

Prevalence of transmitted HIV drug resistance in Iran between 2010 and 2011.

OBJECTIVE: Drug-resistant (DR) HIV emerges during combined antiretroviral treatment (cART), creating concern about widespread transmission of DR-HIV as cART is expanded in resource-limited countries. The aim of this study was to determine the predominant HIV-1 subtypes and prevalence of transmitted DR mutations among antiretroviral-naïve patients in Iran. DESIGN: To monitor transmission of DR HIV, a threshold surveillance based on the world health organization (WHO) guidelines was implemented in Iran. METHODS: For this HIVDR threshold surveillance study, blood samples were collected from 50 antiretroviral-naïve HIV-1-infected patients. Antiretroviral-resistant mutations were determined by sequencing HIV-1 protease, reverse transcriptase and integrase regions. The HIV-1 subtype was determined by sequencing the p17 and C2-V5 regions of the gag and env genes, respectively. RESULTS: Phylogenetic analyses of the sequenced regions revealed that 45 (95.7%) of 47 samples that were successfully obtained were CRF35_AD. The remaining two cases were subtype B (2.1%) and CRF01_AE (2.1%). Consistent results were obtained also from Env and Gag sequences. Regarding prevalence of transmitted DR viruses, two cases were found to harbor reverse transcriptase-inhibitor-resistant mutations (4.3%). In addition, although not in the WHO list for surveillance of transmitted mutations, 13 minor protease-inhibitor-resistant mutations listed in the International AIDS Society-USA panel of drug resistance mutations were found. No DR mutations were detected in the integrase region. CONCLUSIONS: Our study clarified that CRF35_AD is the major subtype among HIV-1-infected patients in Iran. According to the WHO categorization method of HIVDR threshold survey, the prevalence of transmitted drug resistant HIV in Iran was estimated as moderate (5-15%).

Exacerbation of Skin Lesions in a 50 year old Man with Psoriasis during Treatment by Pegylated Interferon.

Chronic hepatitis C might lead to several immunological dysfunctions. Studies have shown a positive association between hepatitis C virus (HCV) infection and psoriasis. These results suggest that the infection may be one of the triggering factors for the development or exacerbation of psoriasis. Here, we present a case of chronic HCV infection with psoriasis who developed exacerbation of skin lesions during therapy with peginterferon alpha-2a plus ribavirin. We discuss the management, course and results of HCV treatment in this patient.

A case report of cyclic neutropenia associated with pyoderma gangrenosum.

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

Bell's palsy associated with chronic HCV infection before and during peginterferon alfa and ribavirin therapy.

Neuropsychiatric side effects of peg interferon-α (PEG-IFN-α) therapy consist of a large spectrum of symptoms. Organic personality syndrome, organic affective syndrome, psychotic manifestations and seizures are more common side effects of PEG-IFN-α whereas cranial neuropathy and movement disorders are less common. Bell's palsy is often idiopathic, but has been linked to some viral infections, particularly with herpes viruses. Other infections, such as human immunodeficiency virus infection and Lyme disease, may also lead to idiopathic facial paralysis. Neither acute nor chronic Hepatitis C infection has been implicated previously in Bell's palsy, but PEG-IFN-α may play a role. Two patients with CHC who developed Bell's palsy before and during treatment with PEG-IFN-α and Ribavirin are presented here.

Frequency of HIV Infection among Sailors in South of Iran by Rapid HIV Test.

Information on the prevalence and risk factors for HIV infection among sailors is scarce. The aim of this seroprevalence study was to evaluate the frequency of HIV infection among sailors in south of Iran using rapid HIV test. The study included 400 consecutive participants in Lengeh, Shahid Rajaie, and Shahid Bahonar ports in south of Iran in May 2010. We observed only one case (0.25%) of HIV infection in this sample of sailors. While prevalence appears low at present, we recommend periodic HIV serosurveillance with detailed behavioral measures for this population in the future.

Seroprevalence of toxoplasmosis in HIV(+)/AIDS patients in Iran.

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male (male to female ratio: 5 to 1) with the mean age of 36 ± 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 ± 22.4 cells/µl. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 ± 15.5 cells/µl and there was a significant association between CD4 count and rate of toxoplasma encephalitis (P<0.001). Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran.

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran.

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B (HBsAg, anti-HBc, anti-HBs) and Hepatitis C (anti-HCV) markers, during 2004- 2005. HBsAg was positive in 27 patients (13.4%), anti-HBc was positive in 60 patients (29.8%) and anti-HBs in 23 patients (11.4%). Anti-HCV Ab was positive in 135 of 201 (67.2%). HBV and HCV coinfection was observed in 73 of 201 (36.3%). The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively (P<0.0001). The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients' wife (HIV(+) patients who were infected by monogamous sexual contact with their HIV positive husband) both of them were 8% (P<0.0001). This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran.

Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran.

Serum samples from 201 HIV positive patients were collected to determine the seroprevalence of CMV infection in Iranian HIV infected patients during March 2004 until March 2005 using conventional ELISA kits. An antibody level of >1.1 Iu/ml was considered positive. The seroprevalence of CMV infection was 94%.The maximum prevalence of CMV antibody was seen in patients with unsafe sex and IDUs. Prevalence of CMV was much higher in patients with low socioeconomic status and low level of education. 83% of patients with CD4<100 were CMV seropositive. Our study showed that a significantly high prevalence of CMV in HIV positive patients in Iran. By increasing the level of education and socioeconomic status the prevalence of CMV infection decreased.