The effect of self-care education through teach back method on the quality of life in hemodialysis patients.

BACKGROUND: Self-care education can play an important role in improving the quality of life in hemodialysis patients. PURPOSE: The purpose of this study was to determine the effect of self-care education with teach back method on the quality of life in hemodialysis patients. METHODS: In this pre- and post-test clinical trial, 45 patients with end-stage renal disease undergoing hemodialysis at Sina hospital in Tehran were included. Patient education was done with teach back method. The duration of training were 3 sessions and the time of each session lasted from 45 minutes to one hour. To collect data from patients, a demographic questionnaire was used and to assess the quality of life of patients, kidney disease quality of life-short form before and after education was used. A significant level of 5% was determined. RESULTS: The mean age of patients was 58.49±9.97 years. Among the dimensions of quality of life before education, the highest score was for physical role (64.24±7.68) and the lowest was related to job status (28.33±11.06). After training, the most score was related to emotional role (71.15±2.84) and the least was related to job status (43.87±11.54). A significant difference between the quality of life at before and after education was seen (P=0.000). CONCLUSION: This study showed that self-care education through teach back method improves the quality of life in hemodialysis patients. Therefore, it is recommended that nurses in the hemodialysis unit implement self-care education through teach back method as an important task.

Detection of Human Metapneumovirus and Respiratory Syncytial Virus by Real-Time Polymerase Chain Reaction Among Hospitalized Young Children in Iran.

BACKGROUND: Acute respiratory infection plays an important role in hospitalization of children in developing countries; detection of viral causes in such infections is very important. The respiratory syncytial virus (RSV) is the most common etiological agent of viral lower respiratory tract infection in children, and human metapneumovirus (hMPV) is associated with both upper and lower respiratory tract infections among infants and children. OBJECTIVES: This study evaluated the frequency and seasonal prevalence of hMPV and RSV in hospitalized children under the age of five, who were admitted to Aliasghar children's hospital of Iran University of Medical Sciences from March 2010 until March 2013. PATIENTS AND METHODS: Nasopharyngeal or throat swabs from 158 hospitalized children with fever and respiratory distress were evaluated for RSV and hMPV RNA by the real-time polymerase chain reaction (PCR) method. RESULTS: Among the 158 children evaluated in this study, 49 individuals (31.1%) had RSV infection while nine individuals (5.7%) had hMPV infection. Five (55.5%) of the hMPV-infected children were male while four (44.5%) were female and 27 (55.2%) of the RSV-infected patients were females and 22 (44.8%) were males. The RSV infections were detected in mainly < one year old children and hMPV infections were detected mainly in > one year old children. Both RSV and hMPV infections had occurred mainly during winter and spring seasons. CONCLUSIONS: Respiratory syncytial virus was the major cause of acute respiratory infection in children under one-year of age while human metapneumovirus had a low prevalence in this group. The seasonal occurrence of both viruses was the same.

Different Morphologies of Leishmania major Amastigotes with No Molecular Diversity in a Neglected Endemic Area of Zoonotic Cutaneous Leishmaniasis in Iran.

BACKGROUND: Molecular diversity of Leishmania major and its morphological changes have become a controversial issue among researchers. Some aspects of polymorphic shapes of amastigotes in clinical manifestations along with molecular variation were evaluated among suspected patients of some exceptional zoonotic cutaneous leishmaniasis locations in Northern Khuzestan, Southwestern Iran. METHODS: Suspected patients (n = 165) were sampled in zoonotic cutaneous leishmaniasis foci over two consecutive years during 2012-2014. Prepared smears were stained, scaled and measured by ocular micrometer. DNA was extracted from smears; ITS-rDNA and Cytochrome b (Cyt b) markers were amplified, and PCR products were digested by BsuR1 restriction enzyme. Then the RFLP and sequencing were employed. RESULTS: Only L. major was identified in patients containing regular amastigotes' shapes (oval or round) with a size of 2-4 µm in each of classical wet, dry, mixed lesions. Meanwhile, irregular shapes (spindle, pear, or cigarette) were observed separately in non-classical wet lesions with more than 4 µm. Interestingly, a few amastigotes with an external flagellum were observed in some lesions. All sequenced ITS-rDNA and Cyt b genes of L. major did not show any molecular variation (χ 2 P > 0.05), including only one common haplotype (GenBank access no. EF413075). CONCLUSION: Findings proved that unlike other endemic foci, there is not a meaningful correlation between phenotypic and genotypic features of L. major isolates. This study is considered as the first comprehensive report to incriminate morphometric shapes of L. major amastigotes, which enhances our knowledge concerning their relevance with various clinical appearances and genotypic traits.

Epidemiological and clinical survey of scorpionism in Khuzestan province, Iran (2003).

Epidemiological and clinical survey of scorpion envenomation was carried out by statistical method of stratified cluster random sampling in Khuzestan, the southern province of Iran, cross-sectionally. We analyzed 12,150 cases recorded in Emergency Unit of the hospitals of six cities in Khuzestan province during the year 2003. The prevalence rate of human scorpion stings in the province is 3.1/1000 inhabitants. The percentage of prevalence in selected cities was as follows: Masjed-Soleiman (27.1%), Ramhormoz (26.6%), Izeh (15.3%), Shush (12%), Baghmalek (11.7%), and Behbahan (7.3%). The scorpions, responsible for the majority of stings in Khuzestan province of Iran were identified as 53.3% yellow (Mesobuthus eupeus, Hottentotta saulcyi, Odonthobuthus doriae and Hemiscorpius lepturus), and 17.4% black (Androctonus crassicauda and Hottentotta schach), and 29.3% unknown colors. Most stings occurred throughout the year, however, the highest and lowest frequency occurs in June (16.0%) and February (0.6%), respectively. Nocturnal envenomations (60.9%) were more common than diurnal (39.1%), and 39.3% of stings were on the hands and 37.3% on the feet Most envenomings were mild (74.5%) that all evolved to cure, except for three deaths. Envenomation was characterized by local pain (63.3%), erythema (10.1%), vomiting (1.3%), restlessness (0.6%), hyperthermia (0.5%), sweating (0.4%), and spasmic (0.3%). With respect to the outcoming results, scorpionism in Khuzestan province of Iran is a public health problem, which needs to be monitored carefully by the government.

Fungistatic effects of optical brightener 220 against Trichophyton tonsurans, Aspergillus fumigatus and Candida albicans.

BACKGROUND: Dermatophytes are one of the main causes of dermal infections. Moreover, there are some opportunistic fungi such as Aspergillus fumigatus (mycelial form) and Candida albicans (yeasty form) that in immunosuppressed patients can cause cutaneous disease. OBJECTIVES: The possible effect of optical brightener 220 (OB-220) on the growth of fungi has been evaluated in this study. METHODS: Isolates were grown on agar plates containing OB-220 in concentration between 0.06 and 11.68 mg ml(-1). MICs of OB-220, ketoconazole and fluconazole were obtained by the agar dilution method. Hyphae and yeasts grown with OB-220 were compared with controls by fluorescence and transmission electron microscopy. The cell cytotoxicity of OB-220 was also assessed. RESULTS: The MIC(90) of OB-220 was obtained: 1.17-1.46 mg ml(-1) for A. fumigatus, 0.58-1.17 mg ml(-1) for C. albicans and 0.29 mg ml(-1) for Trichophyton tonsurans. Electron microscopy revealed a thickening and blurred contours of the cell wall by OB-220. OB-220 in concentrations up to 11.68 mg ml(-1) posed no mammalian cell toxicity. CONCLUSION: OB-220 suppresses the growth of fungi by interfering with the formation of normal chitin.

PCR detection and sequencing of parasite ITS-rDNA gene from reservoirs host of zoonotic cutaneous leishmaniasis in central Iran.

Leishmania major is the causative agent of zoonotic cutaneous leishmaniasis (ZCL) in which gerbils are the reservoir host. ZCL is of great public health importance in Iran. In the current investigation, nested polymerase chain reaction (PCR) protocols were used to amplify a region of the ribosomal RNA amplicon of Leishmania (ITS1-5.8S rRNA gene). The PCR assays detected L. major in three rodent species: Rhombomis opimus, Meriones lybicus and, for first time, Meriones persicus. L. major parasite was found in Natanz, Isfahan Province in the center of Iran in a focus of rural zoonotic cutaneous leishmaniasis. Four L. major infections were detected in R. opimus species, three in M. Lybicus, and two in M. persicus. All nine rodent infections of L. major were found to be the same haplotype based on the PCR detection and sequencing of parasite ITS-ribosomal DNA gene. In addition, also for the first time, the nested PCR assays detected Leishmania tropica only in one M. persicus. Allied to studies in country, the new findings mean that past conclusions about the reservoir of L. major in Iran must be treated with caution. Finding two Leishmania species in different rodent species as reservoir in Iran, therefore, careful molecular eco-epidemiological investigations will be an essential part of modeling the roles of different gerbil species in maintaining and spreading ZCL foci.

Persistence of hepatitis B vaccine immunity in hemodialysis patients.

Although the efficacy of hepatitis B vaccines in patients undergoing chronic hemodialysis (HD) treatment has been documented, the persistence of immunity in this population remains largely unknown. In this study we evaluated the persistence of hepatitis B vaccine immunity in HD patients. We followed 37 hepatitis B vaccinated HD patients (following a four-dose vaccination schedule of 40 mug injections intramuscularly in the deltoid muscle at 0, 1, 2, and 6 months) for up to one year to evaluate the persistence of immunity (as indicated by serum levels of hepatitis B surface antibody (anti-HBs) equal to or higher than 10 IU/L). One year after vaccination, 18.9% of patients had lost their anti-HBs (transient responders), while 81.1% still had detectable antibodies in the serum (persistent responders). From 81.1% of persistent responders 11.5% and 88.5% were weak and high responders, respectively. There was no significant difference between persistent and transient responders regarding age, sex, or nutritional factors. We did not find any factors that related to maintaining protective levels of anti-HBs in HD patients. It seems that an antibody titer above 100 IU/L following vaccination is necessary in order to maintain that level of antibody one year later.

Determination of HLA-B27 subtypes in Iranian patients with ankylosing spondylitis.

The human leukocyte antigen-B27 is one of the class I molecules of the major histocompatibility complex which is strongly associated with ankylosing spondylitis (AS). The strength of the disease association with B27 varies markedly among racial and ethnic populations. It is an allele family, which constitutes about 31 subtypes, with a considerable geographic and ethnic difference in distribution. It is important to know whether certain subtypes show any preferential association with AS. Because there is no report regarding HLA-B27 subtypes in Iranian patients with AS, the main purpose of the present study was to assess the frequency of subtypes of human leukocyte antigen (HLA)-B27 in patients with ankylosing spondylitis in Iranian populationOne hundred and nineteen AS patients (82 HLA-B27 positive and 37 HLA-B27 negative) were selected for this study. HLA-B27 positive patients were screened by polymerase chain reaction amplification with sequence-specific primers (PCR-SSP) for B*27 subtyping.The results of present study revealed that only two subtypes were detected in Iranian patients, including B*2705 (52 patients, 63.4%) and B*2702 (30 patients, 36.6%). Our results showed a restricted number of HLA-B27 subtypes associated with AS in Iran and an elevated frequency of the B*2705 allele in these patients similar to other Euro-Caucasoid (Aryan) groups in the world.

Globin chain synthesis is a useful complementary tool in the differential diagnosis of thalassemias.

The present study aimed at differentiating rare types of heterozygous beta-thalassemia (thal) with normal Hb A(2) values from alpha-thal in Iranian carriers by globin chain synthesis in addition to other hematological parameters. Our study groups consisted of 51 normal subjects, 24 heterozygous beta- thalassemic subjects with high Hb A(2), 62 alpha-thal-2 subjects, 34 alpha-thal-1 subjects, six Hb H disease thalassemic subjects, 14 silent beta-thal subjects with normal Hb A(2) values, five deltabeta-thal subjects and two subjects with an association of alpha- and deltabeta-thal (total = 198). Analysis of globin chains was performed by high performance liquid chromatography (HPLC). The results showed that the alpha/beta ratio averages were close to the ones in the published literature, but with a greater standard deviation and a wider range. Globin chain synthesis (GCS) could be valuable in differentiating between microcytosis produced by silent beta-thal (heterozygous beta-thal with a normal Hb A(2) level) and that caused by alpha-thal. Since the complex genotype/phenotype relationship can lead to diagnostic difficulties, GCS cannot be used as the only diagnostic tool for thalassemia carrier detection. Therefore, a combination of different tests for each patient is required.

Pharmacological evaluation of anti-leishmanial activity by in vivo nitric oxide modulation in Balb/c mice infected with Leishmania major MRHO/IR/75/ER: an Iranian strain of cutaneous leishmaniasis.

Cutaneous leishmaniasis with a variation in its clinical signs is still one of the health problems in the world, region and Iran. Immune responses against leishmania consist of cytokines, immune cells and mediators. Macrophages participate actively in the inflammatory response by releasing chemokines and mediators including nitric oxide (NO) and reactive oxygen and nitrogen intermediates. This study investigates whether NO had anti-leishmanial effects and/or mediated pathology in mice infected with Leishmania major MRHO/IR/75/ER (IR/75). NO inducer lipopolysaccharide (LPS) and NO donor S-nitrosoglutathione (SNOG) were used for their ability to increase RNI and to modify leishmania infection in susceptible Balb/c mice, in order to evaluate the effects of NO production on size and lesion macroscopy, delay of lesion formation and proliferation of amastigotes inside macrophages. Liver, spleen and lymph nodes were also studied as target organs to detect amastigotes. In addition to plasma, liver and spleen suspensions were investigated for NO induction by using Griess microassay. Statistical analysis of data revealed an association between increases in NO level with the pathology of disease in Balb/c mice infected with L. major IR/75. The survival of leishmania parasite inside the macrophages and its proliferation was affected by LPS and SNOG-treatments. An inconsistent relationship was evident between the NO modulation and pathological changes in treated Balb/c mice infected with L. major IR/75.

Dominant Th1 cytokine production in early onset of human brucellosis followed by switching towards Th2 along prolongation of disease.

Human brucellosis is a worldwide zoonotic infectious disease which is caused by intracellular bacteria belonging to the genus Brucella. Based on murine studies it has been shown that host resistance to Brucella depends on Th1 response, whereas Th2 response is involved in the severity of the disease. Since the immune response during human brucellosis has not been profoundly studied we have tried to evaluate cytokine production in patients suffering from brucellosis. Diluted whole blood samples were cultured in the presence of the mitogen, heat inactivated bacteria or medium alone. IL-12, IFN-gamma and IL-10 were measured by specific sandwich ELISA. In addition, the percentage of CD3(+) T cells producing either IL-13 or IFN-gamma was determined by flow cytometry. It was found that not only IFN-gamma production but also the number of CD3(+) IFN-gamma-producing cells decreased with prolongation of the disease but the percentage of CD3(+) IL-13(+) T cells were significantly increased. No correlation between duration of disease and IL-10 or IL-12 production was found. In conclusion, it is proposed that at the onset of brucellosis, Th1 response dominates while diminishing with prolongation of the disease.

Evaluation of Anti- HLA Class I Antibodies in Chronic Rejection of Kidney Transplantation.

Studies have shown that patients who do not produce donor specific and /or panel reactive anti-HLA antibodies have a longer graft survival. The purpose of this study was to evaluate the posttransplant humoral immune response towards HLA-class I antigens and the measurement of the serum creatinine levels which are used in monitoring posttransplant function of kidney. Serum samples from 132 renal transplant recipients were screened for preformed anti-HLA class I panel reactive antibodies (PRA) by means of microlymphocytotoxicity assay. The results revealed the presence of PRA in 26 (19.7%) out of 132 transplanted patients. Graft function was evaluated by measurement of serum creatinine levels which revealed the mean of 1.75 mg/dl (SD: 1.08). Because of clinical significance of presence of different PRA amounts (>10%, > 20% and >50% of panel reactivity) in patients, correlation with kidney function status was analyzed. The obtained data highlighted a higher presence of serum creatinine levels in PRA-positive patients compared to negative patients (P<0.01). These results (and further studies for class II, ...) can be used to implement new therapeutic strategies to curtail post transplant alloantibodies production and better allografts survival.

Molecular epidemiology of malaria in endemic areas of Iran.

In this study, 333 blood samples of malaria cases positive by microscopic test (70.6% male and 29.4% female, p<0.05) were investigated. The group included 55 cases (16.52%) from Minab (Hormozgan Province), 116 cases (34.82%) from Iranshahr (Sistan-Baluchesta Province) and 162 cases (48.65%) from Kahnouj (Kerman Province). The results showed 244 cases (73.27%) were diagnosed as P. vivax, 87 cases (26.13%) P. falciparum and 2 cases (0.6%) showed a mixed infection of both Plasmodia. In a molecular study of the same samples using nested-polymerase chain reaction (nested-PCR), 185 cases (55.6%) were P. vivax, 50 cases (15%) P. falciparum and 95 cases (29%) both Plasmodia. Comparing the two methods used in this study, the highest rate of infection was found to be P. vivax. However, the rate of mixed infections (0.6% microscopy, 29% nested-PCR) varied and depended on the assay used. This indicated that the sensitivity of nested-PCR was greater than microscopic examination, especially for the detection of mixed-infections (p<0.05) in the current malaria epidemiology study.