Association of TREX1 polymorphism with disease progression in human immunodeficiency virus type-1 (HIV-1) infected patients.

The time interval between HIV-1 infection and AIDS development is not the same in all patients and depends largely on the genetic background of the individual. Polymorphisms in the TREX1 gene, the main enzyme in the clearance of cytosolic DNA, affect type 1 interferon-mediated inflammatory response in HIV-1 infection. We aimed to study the role of a single nucleotide polymorphism (rs3135941) of the TREX1 gene and the rate of disease progression in patients infected with HIV-1. A total of 190 HIV-1 infected patients were recruited. Patients' demographic and laboratory data including CD4 counts, viral load, and antiretroviral therapy (ART) were collected. The genotype of rs3135941 was determined by a PCR-SSP method. The rate of progression to AIDS was calculated with Kaplan-Meier survival analysis using Stata software. The patients were divided into rapid and slow progressors based on time interval of CD4 drop below 350/µl. Kaplan-Meier analysis revealed an accelerated disease progression in patients with TC and CC genotypes (HR = 1.49, 95% CI = 1.01-2.17). The mean values of the first 5-year CD4 counts were significantly different in patients who had CC and TC genotypes compared to the TT group (p = 0.036). The result of this study emphasizes the importance of TREX1 polymorphism in HIV-1 progression. These data warrant further investigation into the role of other polymorphisms of TREX1.

Rapid Detection Test for COVID-19 among Healthcare Workers and the Role of Personal Protective Equipment.

BACKGROUND: In this study, we assessed the prevalence of positive rapid detection test (RDT) among healthcare workers (HCWs) and evaluated the role of personal protective equipment (PPE) and knowledge of the pandemic. METHODS: In a cross-sectional study conducted between August 2020 and October 2020 in a tertiary referral center (Tehran, Iran), we enrolled 117 physicians, nurses, and other HCWs (OHCWs)-aides, helpers, and medical waste handlers-regularly working in coronavirus disease 2019 (COVID-19) wards. The RDT kit was utilized to reveal recent infection; data on demographics, PPE use and availability, and knowledge of the pandemic was collected through pre-defined questionnaires. RESULTS: Overall, 24.8% (95% CI: 16.8-32.7%) of HCWs had positive RDTs. The more PPE was available and used, the less the chance of positive RDT was (OR: 0.63 [0.44-0.91], P = 0.014 and 0.63 [0.41-0.96], P = 0.030). The same was true for the knowledge of prevention and adhering to preventive rules (OR: 0.44 [0.24-0.81], P = 0.008 and 0.47 [0.25-0.89], P = 0.020). OHCWs had the highest prevalence of positive RDT, while they had more shifts per month, less accessibility to PPE, and less knowledge of the pandemic than physicians. CONCLUSION: The findings of this study suggest that HCWs should have a thorough knowledge of the pandemic along with using PPE properly and rationally. Furthermore, adhering to preventive regulations plays a crucial role in HCWs' safety. It is also noteworthy that shifts should be arranged logically to manage exposures, with a special attention being paid to OHCWs.

Efficacy of a multiple-indication antiviral herbal drug (Saliravira®) for COVID-19 outpatients: A pre-clinical and randomized clinical trial study.

BACKGROUND: The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. METHODS: In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. RESULTS: On the 8th day, the "mean reduction rates" of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value < 0.05. The improvement of 10 out of 14 COVID-19 symptoms in the intervention group was significantly accelerated. The mean treatment duration of patients in the intervention group was 4.9 days less than the control group. In addition, no patients in the intervention group were hospitalized compared to 28% of the control group needed to be hospitalized.

The Persistence Time of SARS-CoV-2 RNA in Hospitalized COVID-19 Patients: A Prospective Study.

BACKGROUND: In late December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), the causative agent of coronavirus disease 2019 (COVID-19), spread to almost all countries worldwide. The outbreak of this virus has been confirmed on 19th February, 2020, in Iran. OBJECTIVE: The aim of this study was to investigate the time of viral RNA clearance in swab and serum samples of COVID-19 patients having received different medications. We also evaluated different factors that may affect viral RNA persistence in patients infected by SARS-CoV-2. METHODS: In March 2020, twenty-one hospitalized COVID-19 patients participated in this prospective study. All patients received antiviral agents in their routine care. Throat swabs and blood samples were obtained from all patients in different intervals, including day 3 or 5, day 7, day 10, and finally, 14 days after the first positive real-time RT-PCR (rRT-PCT) test. RESULTS: The median time from the symptom onset (SO) to the first negative rRT-PCR results for throat swabs and serum samples of COVID-19 patients was 18 and 14 days, respectively. These times were more significant in patients with lymphopenia, oxygen saturation ≤ 90%, and comorbidity. CONCLUSION: This preliminary study highlights that SASR-CoV-2 RNA was not detectable in the upper respiratory tract for longer than three weeks. In addition, SARS-CoV-2 may persist for a long period of time in the respiratory than in the serum samples. This study supports the idea that in limited resource settings, the patients should be tested earlier than three weeks for discharge management.

Predictors of the chest CT score in COVID-19 patients: a cross-sectional study.

BACKGROUND: Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient's signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings. METHODS: All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0-25). RESULTS: Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period. CONCLUSIONS: Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

Influenza vaccination coverage and obstacles in healthcare workers (HCWs) and the follow up of side effects: a multicenter investigation in Iran.

INTRODUCTION: Seasonal influenza is an annual common occurrence in cold seasons; but the COVID-19 pandemic is also currently ongoing. These two diseases can't be distinguished from their symptoms alone; therefore, the importance of preventing influenza by vaccination is more than ever. Due to the high exposure of hospital personnel, widespread influenza vaccination of these high-risk groups seems to be a necessity. This Study conducted to determine vaccination coverage in the personnel of four tertiary referral collegiate hospitals in 2019 and to further investigate individual obstacles for Influenza vaccination. METHODS: In this cross-sectional descriptive study, 637 personnel were selected randomly from distinctive hospitals in a list-wised. Ones vaccinated filled the side effects questionnaire and who not vaccinated filled the vaccination obstacles questionnaire. The study was approved by the ethics committee of Tehran University of Medical Sciences with this reference number: IR.TUMS.IKHC.REC.1398.218. RESULTS: The mean vaccination coverage was 29.4% and the coverage difference among centers was not statistically significant (p = 0.192). The following items had the most impact on personnel decision: confidence about one's immune system (p < 0.05), the experience of side effects from previous vaccinations (p = 0.011), attitude about vaccination in colleagues (p = 0.021) and work experience (p < 0.05). About 23% of vaccinated individuals reported side effects following vaccination and the most common side effect was mild cold symptoms with 12.3% prevalence. CONCLUSION: The results of the current study revealed that influenza vaccination coverage among HCWs is not satisfactory in Iran. Hospital authorities and infection control units should plan to remove the obstacles of influenza vaccination.

Pulmonary Valve Endocarditis: A Case Report.

BACKGROUND: Isolated pulmonary valve endocarditis (PVE) is an extremely uncommon clinical finding comprising less than 1.5-2% of cases for infective endocarditis. It is a challenging condition to diagnose mainly because of nonspecific signs and symptoms at presentation. CASE PRESENTATION: A 58-year-old married and retired man was admitted to a community hospital for evaluation of chest pain. Transesophageal echocardiography (TEE), 2 days after, revealed semi-mobile vegetation on the pulmonary valve and pulmonary artery wall. Moreover, occlude devices at the root of the aorta, and the pulmonary artery was seen. Left ventricular ejection fraction (LVEF) with systolic dysfunction, mild aortic insufficiency (AI), mild tricuspid regurgitation (pulmonary artery pressure of 50 mmHg) without pericardial effusion, was also reported in the Echocardiography. Blood cultures, viral markers, and Brucella IgG and IgM titration were negative during the admission. The patient received a 4-week course of intravenous antibiotic therapy, including Ceftriaxone and Teicoplanin (Targocid).

Bone Marrow Aspiration/Biopsy in the Evaluation of Fever of Unknown Origin in Patients with AIDS.

BACKGROUND: HIV can interrupt the normal development of bone marrow cell lines. Bone marrow aspiration/biopsy (BMA/B) has been described as a diagnostic tool in AIDS patients with fever of unknown origin (FUO). In this review, we aimed to study patients with AIDS who had undergone a BMA/B to investigate FUO and describe the pathologies diagnosed in the biopsy. METHODS: Thirty-four BMA/B samples were collected from AIDS patients admitted for work-up of FUO to the infectious disease ward of a tertiary referral HIV center in Tehran, Iran, between September 2014 and September 2015. Data including age, sex, duration of disease, CD4 cell counts, hepatitis B (HBV) and C (HCV) coinfection, the primary presentation of AIDS, and the treatment history were retrieved and analyzed. Patients underwent BMA/B. An expert pathologist reviewed the BMA/B specimens. RESULTS: The mean age of the patients was 37.5 years (range, 26-56), and 27 (79%) were men. Twenty-seven (79%) patients contracted HIV from injection drug use, and 7 (21%) via sexual transmission. Only 3 (9%) of the BMA/B examinations were normal. Hypocellular bone marrow was diagnosed in 22 (65%) patients. Other pathologies included granulomas in 6 (18%), hematologic malignancies in 2 (6%), and leishmaniasis Aspergillosis, each in 1 (3%) patient. Six (17%) of the specimens were found to have tuberculosis infections. CONCLUSION: Hypocellular bone marrow was the most common pathology on BMA/B examinations, followed by the presence of granulomas. Tuberculosis, Aspergillosis, and Leishmaniasis the opportunistic infections diagnosed on BMA/B specimens. Our results support BMA/B as an appropriate diagnostic tool for early diagnosis of opportunistic infections and malignancies in AIDS. BMA/B is indispensable in the armament of diagnostic tools of the physicians managing AIDS patients.

Does an antimicrobial stewardship program for Carbapenem use reduce Costs? An observation in Tehran, Iran.

BACKGROUND: Inappropriate administering of antimicrobials has led to increased antibiotic resistance as well as burden of infectious diseases. Antibiotic stewardship programs (ASPs) help prevent resistance through improved utilization of antimicrobial agents while potentially decrease costs of treatment. METHODS: We reviewed 186 infectious disease (ID) consultations from two internal disease wards in a tertiary center where ID specialists were asked to confirm carbapenem use in patients within 48 hours of initiation. The records were reviewed in terms of age, gender, and final decision about carbapenem use. The crude mortality rates during the 5-month period of the study (May to September 2016) as well as hospital spendings were compared with the same time of the year before the implementation of the ASP. RESULTS: Of the 186 consultations conducted by the ID specialists, 28 (15%) consultations led to antibiotic change, 46 (25%) led to discontinuation, while 112 (60%) carbapenems were continued. An estimate of 14,000 € was saved based on the annual hospital costs during the 5-month period of the study. Although antimicrobial resistance patterns could not be evaluated, the crude mortality rate in the two IM wards was calculated to be 2.6% with no significant change compared to previous year (CMR: 2.9%). CONCLUSION: Based on findings of the present study, ASPs for carbapenems (as wide-spectrum agents) can lower costs with no increased mortality rates in a tertiary center located in a middle-income country.

Safety and effectiveness of azithromycin in patients with COVID-19: An open-label randomised trial.

As no specific pharmacological treatment has been validated for use in coronavirus disease 2019 (COVID-19), we aimed to assess the effectiveness of azithromycin (AZM) in these patients at a referral centre in Iran. An open-label, randomised controlled trial was conducted on patients with laboratory-confirmed COVID-19. A total of 55 patients in the control group receiving hydroxychloroquine (HCQ) and lopinavir/ritonavir (LPV/r) were compared with 56 patients in the case group who in addition to the same regimen also received AZM. Patients with prior cardiac disease were excluded from the study. Furthermore, patients from the case group were assessed for cardiac arrythmia risk based on the American College of Cardiology (ACC) risk assessment for use of AZM and HCQ. The main outcome measures were vital signs, SpO2 levels, duration of hospitalisation, need for and length of intensive care unit admission, mortality rate and results of 30-day follow-up after discharge. Initially, there was no significant difference between the general conditions and vital signs of the two groups. The SpO2 levels at discharge were significantly higher, the respiratory rate was lower and the duration of admission was shorter in the case group. There was no significant difference in the mortality rate between the two groups. Patients who received AZM in addition to HCQ and LPV/r had a better general condition. HCQ+AZM combination may be beneficial for individuals who are known to have a very low underlying risk for cardiac arrhythmia based on the ACC criteria.

Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment.

BACKGROUND: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. OBJECTIVE: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. DESIGN: Cross-sectional study. METHODS: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. RESULTS: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. CONCLUSION: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran.

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.Conclusions. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.

A Randomized Clinical Trial of the Efficacy and Safety of Interferon ß-1a in Treatment of Severe COVID-19.

To the best of our knowledge, there is no published study on the use of interferon ß-1a (IFN ß-1a) in the treatment of severe COVID-19. In this randomized clinical trial, the efficacy and safety of IFN ß-1a were evaluated in patients with severe COVID-19. Forty-two patients in the interferon group received IFN ß-1a in addition to the national protocol medications (hydroxychloroquine plus lopinavir-ritonavir or atazanavir-ritonavir). Each 44-µg/ml (12 million IU/ml) dose of interferon ß-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group consisted of 39 patients who received only the national protocol medications. The primary outcome of the study was time to reach clinical response. Secondary outcomes were duration of hospital stay, length of intensive care unit stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects, and complications during the hospitalization. Between 29 February and 3 April 2020, 92 patients were recruited, and a total of 42 patients in the IFN group and 39 patients in the control group completed the study. As the primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 ± 5.8 versus 8.3 ± 4.9 days, respectively, P = 0.95). On day 14, 66.7% versus 43.6% of patients in the IFN group and the control group, respectively, were discharged (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.05 to 6.37). The 28-day overall mortality was significantly lower in the IFN than the control group (19% versus 43.6%, respectively, P = 0.015). Early administration significantly reduced mortality (OR, 13.5; 95% CI, 1.5 to 118). Although IFN did not change the time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality. (This study is in the Iranian Registry of Clinical Trials under identifier IRCT20100228003449N28.).

Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran.

BACKGROUND: Surveillance of health care-associated infections (HCAIs) is an integral part of infection control programmes, especially in intensive care units (ICUs). Device-associated infections (DAIs) are a major threat to patient safety. AIM: To measure DAI rates in ICUs. METHODS: Central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter- associated urinary tract infection (CAUTI) were assessed in the ICUs of 4 tertiary-care teaching hospitals in Tehran, Islamic Republic of Iran. RESULTS: The incidence rate of CLABSI, VAP and CAUTI was 10.20, 21.08 and 7.42 per 1000 device-days, respectively. The utilization ratio for central lines, ventilators and urinary catheters was 0.62, 0.47, and 0.84, respectively. The most common organisms were Acinetobacter (33.5 %) and Klebsiella (19.0 %). Sixty to eighty percent of Enterobacteriaceae were extended- spectrum beta-lactamase producing. About half of Pseudomonas aeruginosa isolates were resistant to piperacillin/ tazobactam and carbapenem. Acinetobacter resistance rate to ampicillin/sulbactam and carbapenem was 70-80 %. The prevalence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus was 84.6 % and 83.3 %, respectively. CONCLUSIONS: This study showed high incidence rates of DAIs and resistant organisms, and appropriate interventions are necessary to reduce these rates.

Evaluation of the association between Addiction Severity Index and depression with adherence to anti-retroviral therapy among HIV infected patients.

Adequate adherence to anti-retroviral therapy is required to achieve viral suppression and desirable treatment outcomes among HIV patients. The aim of this study was to examine the associations between adherence and severity of substance use as well as adherence and severity of depressive symptoms among Iranian HIV patients. In a prospective study, HIV patients with current substance use were assessed for adherence level via self report and pill count methods, severity of depressive symptoms (Beck Depression Inventory- II) and substance use (Addiction Severity Index) during a three months follow up after initiating antiretroviral therapy. The adherence level, severity of depressive symptoms and substance use were assessed one month, two months and three months after initiation of anti-retroviral therapy. Addiction Severity Index (ASI) composite scores were calculated for each domain and the associations between ASI domains and adherence as well as severity of depressive symptoms and adherence were assessed. Twenty six HIV patients with current substance use disorder completed the study. At the end of the first month, adherence to therapy via pill count and self-report were 80%±31.9% and 85.12%±32%, respectively. At the end of the second month, adherence to therapy via pill count and self report were 87%±32% and 93.94%±23% respectively. At the end of the third month, the measured adherence via pill count and self report were 85%±33.7% and 90.1%±25.7% respectively. Adherence was higher among married patients and those who used reminder systems. Composite scores of the medical status and psychiatric status were related to higher adherence after first month. Substance use was inversely associated with adherence at the second follow up (r=-0.4, p=0.04). Also, severity of depressive symptoms was not related to adherence level. The repeated measurement analysis showed a significant decrease in psychiatric status domain of the ASI composite score after three months of initiating therapy (p=0.02). Preventive measures should aim treatment of substance use among HIV patients in order to increase adherence level. Also, conducting psychological evaluations is necessary considering the high prevalence of depression among Iranian HIV patients.

Diabetic foot: infections and outcomes in Iranian admitted patients.

BACKGROUND: Diabetes mellitus (along with its complications) has become a global problem. Diabetic foot infection, among the most common complications, is responsible for 40 to 50% of foot amputations. Antibiotic-resistant microorganisms, however, have compromised empiric therapy in the infected patients. OBJECTIVES: The current study aimed to determine the most common microorganisms involved in diabetic foot infection in order to minimize the failure of antibiotic therapy and the risk of developing complications. PATIENTS AND METHODS: All patients with diabetic foot infection admitted to the infectious diseases, surgery and endocrinology wards of two teaching hospitals from 2007 to 2010 (n = 196) were recruited. In this retrospective study, demographic characteristics, type of lesions, history of hospitalization/antibiotic therapy, isolated microorganisms, clinical complications, administered treatment (medical or surgical) and outcome were recorded. RESULTS: Patients' mean age was 60.84 (± 10.30) years. Totally, 113 (57.65%) of the patients were male and 83 (42.35%) were female. According to Wagner's grading, deep ulcers with/without osteomyelitis accounted for the majority of lesions. A single microorganism was isolated (most common: Escherichia coli, Staphylococcus aureus and Klebsiella spp.) from 81 of the patients (80.20%); while for the remaining polymicrobial infection was reported. Isolated pathogens showed no significant correlation with duration of diabetes, type of the lesions (P = 0.13) and history of hospitalization (P = 0.61). The majority of patients (n = 118, 60.20%) were treated surgically; however 11 patients expired due to sepsis. Amputation (most common at toes and below the knee) was performed for 89 patients (45.40%). The response rate to medical treatment was 31.6% for single-pathogen and 10% for polymicrobial infection (with a 30% mortality rate). CONCLUSIONS: Physicians are recommended to take microbiological cultures before starting empirical therapy recommended to cover Gram-negative microorganisms in order to lower the risk of antibiotic resistance.

Invasive candidiasis in intensive care unit; consensus statement from an Iranian panel of experts, July 2013.

Invasive candidiasis (IC) is associated with high mortality in intensive care unit (ICU) patients. Timely diagnosis of this potentially fatal condition remains a challenge; on the other hand, the criteria for initiating empirical antifungal therapy in critically ill patients are not well defined in different patient population and ICU settings. Alongside the international guidelines, reaching regional and local consensus on diagnosis and management of IC in ICU setting is essential. This report summarizes our present status of IC management in ICU, considered by a group of Iranian experts in the fields of intensive care and infectious diseases. A round table of 17 experts was held to review the available data and discuss the optimal treatment strategies for IC in critical care setting. Comparative published data on the management of IC were analytically reviewed and the commonly asked questions about the management of IC in ICU were isolated. These questions were interactively discussed by the panel and audience responses were taken to consolidate point-to-point agreement with the panel arriving at consensus in many instances. The responses indicated that patients' risk stratification, clinical discretion, fungal diagnostic techniques and the empirical therapy for IC are likely to save more patients. Treatment options were recommended to be based on the disease severity, prior azole exposure, and the presence of suspected azole-resistant Candida species. This report was reviewed, edited and discussed by all participants to include further evidence-based insights. The panel expects such endorsed recommendations to be soon formulated for implementation across the country.

Sequences type analysis of Candida albicans isolates from Iranian human immunodeficiency virus infected patients with oral candidiasis.

The growing number of immunocompromised individuals has increased the incidence of infections caused by Candida species during the recent decades. Typing of C. albicans on the basis of DNA sequences at multiple loci has greatly advanced our knowledge about the epidemiology and phylogeny of candidiasis. The aim of this study was to evaluate the diversity, and genetic relationships among C. albicans isolates obtained from HIV patients in Iran. using multilocus sequence typing (MLST) method. We analyzed 25 C. albicans isolates obtained from HIV positive patients referred to Iranian Research Center for HIV/AIDS. After diagnostic test and DNA extraction C. albicans isolates were typed using the original MLST scheme explained previously include of six loci: ACC1, VPS13, GLN4, ADP1, RPN2, and SYA1. Fifty one (2.17%) nucleotide sites were found to be polymorphic; all were found to be heterozygous in at least one isolate. For the 25 clinical isolates, 22 diploid sequence types were defined by the genotypes identified from the six loci. The MLST data suggest a relatively high level of divergence in the population structure of C. albicans isolated from HIV infected patients. These findings indicate that in these patients there is a favorable context for the growth of potential pathogenic C. albicans. We found no association between fluconazole resistance, highly active antiretroviral therapy (HAART) receiving and either sequence type or group.

Effect of an educational course at an Iranian dental school on students' knowledge of and attitudes about HIV/AIDS.

This study investigated the effects of an educational program designed to improve the knowledge and attitudes of senior dental students in an Iranian dental school about caring for patients with HIV/AIDS. As part of an extramural program in community dentistry, a new educational program about HIV/AIDS was developed at Tehran University of Medical Sciences in 2009. The program consisted of two days' observation at the Consultation Center for Behavioral Diseases and a one-day workshop on infection control. A control group was selected from dental students at Shahid Beheshti University of Medical Sciences. Before and after the intervention, students in both the intervention and control groups completed a questionnaire concerning their knowledge of and attitudes about HIV/AIDS. Students in the intervention group also expressed their opinions in a post-test questionnaire. An independent sample t-test was used for statistical analysis. In the control group, the means of students' knowledge and attitude scores did not differ significantly from pre-test to post-test. In the intervention group, however, the means of both knowledge and attitude scores on the post-test were significantly higher than on the pre-test (p=0.001 and p=0.009, respectively). In the intervention group, more than 96 percent of the students reported that they would completely follow infection control principles in future practice. This study concludes that the educational program improved the students' knowledge of and attitudes about HIV/AIDS and will have a positive effect on their future practice.