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A prospective, randomized, blinded experiment was conducted to compare the effects of intranasal (IN) dexmedetomidine (Dex, 10µg/kg; n=12) alone or combined with midazolam (DexM, 0.3mg/kg; n=12) or ketamine (DexK, 2mg/kg; n=12) in healthy dogs. Ease of administration (EA1), total administration time (TAT), time for first (TA1) and second nostril administration (TA2), and adverse events during atomization were recorded. Two days later, EA2 was assessed by IN atomization of injectable water as an additional outcome variable. Onset of sedation was evaluated, along with behavioral scores and physiological parameters from T0 (baseline) to T120. Statistical analyses included Chi-square, one-way ANOVA or Kruskal-Wallis, repeated measures or Friedman's ANOVA, and Wilcoxon's tests. Significance was p≤0.05. Onset of sedation was 12.9 ± 4.1, 18.2 ± 7.5, and 9.9 ± 4.3mins (mean ± SD) for Dex, DexM, and DexK, respectively. Onset was shorter in DexK compared to DexM (p=0.002), explaining the lower behavioral scores in DexM at T15. All dogs in Dex and DexK reached adequate sedation, with peak sedation occurring at T30, while some dogs in DexM never reached adequate sedation and this group peaked at T45. Adverse events such as saliva drooling and pawing at the nose were significantly higher in DexM and DexK, explaining their differences in TA2, TAT, and EA1 comparing to Dex. EA2 was also higher in Dex compared to DexM and DexK. In conclusion, Dex was better tolerated in dogs and DexK showed faster and more profound sedative effects. Due to paradoxical excitement, unpredictable sedation, and nasal irritation, DexM is not recommended.
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Chemotherapy is frequently unsuccessful in fully eradicating bacterial biofilm infections. Persisters are a main cause for the failure of antibiotic therapies and are assumed to significantly impact the increased multidrug tolerance and unsuccessful elimination of chronic biofilm infections. Pseudomonas aeruginosa infections are frequently linked to high rates of drug-tolerant persisters, triggering a major challenge to human health. It is crucial to classify persisters to develop novel useful therapeutic strategies to fight infectious diseases. In this study, the mqsR gene was selected as a novel antimicrobial target, and silencing was with antisense peptide nucleic acid (PNA) assay to eradicate the P. aeruginosa persisters. First, they were analysed by experimental procedures. Functionality was assessed by stress conditions. We found that the expression of mqsR (as the toxin) compared with mqsA (as antitoxin) was increased under stress conditions. We demonstrated that when mqsR was targeted and treated with different concentrations of mqsR-PNA after 24 hours; the formation of P. aeruginosa persisters was eradicated. Antisense mqsR-PNA in concentrations of 35 µM or more could eradicate persister cell formation in P. aeruginosa. It was suggested that other toxin-antitoxin loci in P. aeruginosa are examined by antisense PNA to detect their functionality. However, considering the importance of persisters in human infections, ex vivo, in vivo, preclinical and clinical settings should be highlighted.
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Abstract: Full attention must be given to the follow-up of patients recovered from Coronavirus disease 2019, which developed in Wuhan, China in December 2019. Among the most serious issues since the emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 has been whether those who had it can experience a second episode of infection and what that implies for immunity. The earlier studies on COVID-19 disease focused primarily on the epidemiological, clinical, and radiological characteristics of patients with CO-VID-19. However, conclusions of these studies still require to be warranted by more careful design, larger sample size and statistically well structured studies. COVID-19 is an under-studied infection, and several aspects of viral transmission and clinical progress remain at present unclear. There is a concern about the persistence of SARS-CoV-2 on various surfaces and in the respiratory system of patients who have survi-ved. One of the most concerning issues since the emergence of the SARS-CoV-2 is persistence in patients and whether patients can be re-infected. After hospital discharge, recovered patients were reported to have positive SARS-CoV-2 test in China, Japan, and South Korea. In addition to the persistence of the virus, SARS-CoV-2 re-infection may occur in survivors. In this paper, we focused on the evidence of persistence and re-infection of SARS-CoV-2.
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COVID-19/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Pandemias , SARS-CoV-2/patogenicidade , COVID-19/imunologia , COVID-19/prevenção & controle , COVID-19/transmissão , Teste para COVID-19 , Síndrome da Liberação de Citocina/etiologia , Reservatórios de Doenças/virologia , Fômites/virologia , Interações Hospedeiro-Patógeno/imunologia , Humanos , Recidiva , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificaçãoRESUMO
OBJECTIVE: Aspergillus sections Terrei and Nidulantes are the less common causes of invasive aspergillosis and pulmonary aspergillosis (PA) in immunocompromised patients when compared to A. fumigatus and A. flavus. Identifying these fungi as the infectious agent is crucial because of the resistance to amphotericin B (AMB) and increased lethality. The aim of this study was to identify the molecular status, evaluate the genetic diversity and examine the antifungal susceptibility profile of the uncommon Aspergillus species. Forty-five uncommon Aspergillus species were identified based on the microscopic and macroscopic criteria. Then, the molecular identification was performed using the sequencing beta tubulin (benA) gene. In vitro antifungal susceptibility to amphotericin B (AMB), itraconazole (ITC), ravuconazole (RAV), voriconazole (VRC), caspofungin (CFG) isavuconazole (ISA) and posaconazole (POS) test was performed according to the CLSI M38-A2 guidelines. RESULTS: A. terreus was the most species detected, followed by A. nidulans, A. latus, A.ochraceus, and A. citrinoterreus, respectively. The analysis of the benA gene showed the presence of 12 distinct genotypes among the A. terreus isolates. The other species did not show any intraspecies variation. CFG exhibited the lowest MEC50/MIC50 (0.007µg/mL), followed by POS (0.125µg/mL), VRC, ITC, ISA (0.25µg/mL), RAV (0.5µg/mL), and AMB (8µg/mL). Among all the isolates, only 15.5% (7/45) were susceptible to AMB. CONCLUSION: Antifungal susceptibility pattern of the uncommon Aspergillus species is useful to improve patient management and increase knowledge concerning the local epidemiology. Moreover, this information is necessary when an outbreak dealing with drug-resistant infections occurs.
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Antifúngicos/farmacologia , Aspergilose/microbiologia , Aspergillus , Farmacorresistência Fúngica/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspergilose/diagnóstico , Aspergilose/epidemiologia , Aspergillus/classificação , Aspergillus/efeitos dos fármacos , Aspergillus/isolamento & purificação , Aspergillus nidulans/classificação , Aspergillus nidulans/efeitos dos fármacos , Aspergillus nidulans/isolamento & purificação , Feminino , Humanos , Lactente , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/microbiologia , Irã (Geográfico)/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Técnicas de Tipagem Micológica , Filogenia , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/epidemiologia , Aspergilose Pulmonar/microbiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Little is known about the toxin profiles, toxinotypes and variations of toxin Clostridioides difficile C (tcdC) in Iranian C. difficile isolates. A total of 818 stool specimens were obtained from outpatients (n = 45) and hospitalized patients (n = 773) in Tehran, Iran, from 2011 to 2017. The 44 C. difficile isolates were subjected to PCR of toxin C. difficile A (tcdA), toxin C. difficile B (tcdB), tcdA 3'-end deletion, toxinotyping and sequencing of the tcdC gene. Thirty-eight isolates (86.36%) were identified as tcdA and tcdB positive, and the remaining six isolates (13.63%) were nontoxigenic. All tcdA- and tcdB-positive isolates yielded an amplicon of 2535 bp by PCR for the tcdA 3' end. Fourteen (36.84%), seventeen (44.73%) and seven (18.43%) isolates belonged to wild-type, toxin C. difficile C subclone3 (tcdC-sc3) and tcdC-A genotype of tcdC, respectively. Thirty-one isolates (81.57%) belonged to toxinotype 0, and seven isolates (18.42%) were classified as toxinotype V. This study provides evidence for the circulation of historical and hypervirulent isolates in the healthcare and community settings. Furthermore, it was also demonstrated that the tcdC-A genotype and toxinotype V are not uncommon among Iranian C. difficile isolates.
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BACKGROUND: Since gamma interferon release assays (IGRAs) cannot differentiate between active tuberculosis and latent tuberculosis infection (LTBI), development of rapid and specific diagnosis tools are essential for discriminating between active tuberculosis (TB) from LTBI. Both IGRAs are based on Mycobacterium tuberculosis-specific antigens, namely, early secretory antigenic target 6 (ESAT-6) and 10kDa culture filtrate (CFP-10). The aim of this study was to evaluate the potential value of IL-2 secretion by whole blood cells after stimulation with rESAT-6 and rCFP-10 for discriminating between active and latent tuberculosis. METHODS: Interleukin-2 and IFN-γ were measured after blood stimulation of 90 cases (30 with active TB, 30 with LTBI and 30 healthy controls) with recombinant ESAT-6 and CFP-10. Receiver operating characteristic (ROC) curve analysis was conducted to determine the best IL-2 and IFN-γ result thresholds in discriminating between cases with active or latent TB, and the corresponding sensitivity and specificity were recorded. RESULTS: The IFN-γ release assay demonstrated a good sensitivity and specificity (sensitivity 83-84% and specificity 92%) for diagnosis of tuberculosis. The discrimination performance of IL-2 assay (assessed by the area under ROC curve) between LTBI and patients with active TB were 0.75 and 0.8 following stimulation with rESAT-6 and rCFP-10, respectively. Maximum discrimination was reached at a cut-off of 11.6pg/mL for IL-2 after stimulation with recombinant rESAT-6 with 72% sensitivity and 79% specificity and 10.7pg/mL for IL-2 following stimulation with rCFP-10 with 75% sensitivity and 79% specificity, respectively. CONCLUSION: This study demonstrates that rESAT-6 and rCFP-10 can provide a sensitive and specific diagnosis of TB. In addition, it was shown that IL-2 may be serving as a marker for discriminating LTBI and active TB
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Interleucina-2/análise , Interleucina-2/imunologia , Interferon gama/análise , Interferon gama/imunologia , Tuberculose/diagnóstico , Tuberculose/imunologia , Tuberculose/patologia , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Ensaio de Imunoadsorção Enzimática/métodosRESUMO
BACKGROUND: Since gamma interferon release assays (IGRAs) cannot differentiate between active tuberculosis and latent tuberculosis infection (LTBI), development of rapid and specific diagnosis tools are essential for discriminating between active tuberculosis (TB) from LTBI. Both IGRAs are based on Mycobacterium tuberculosis-specific antigens, namely, early secretory antigenic target 6 (ESAT-6) and 10kDa culture filtrate (CFP-10). The aim of this study was to evaluate the potential value of IL-2 secretion by whole blood cells after stimulation with rESAT-6 and rCFP-10 for discriminating between active and latent tuberculosis. METHODS: Interleukin-2 and IFN-γ were measured after blood stimulation of 90 cases (30 with active TB, 30 with LTBI and 30 healthy controls) with recombinant ESAT-6 and CFP-10. Receiver operating characteristic (ROC) curve analysis was conducted to determine the best IL-2 and IFN-γ result thresholds in discriminating between cases with active or latent TB, and the corresponding sensitivity and specificity were recorded. RESULTS: The IFN-γ release assay demonstrated a good sensitivity and specificity (sensitivity 83-84% and specificity 92%) for diagnosis of tuberculosis. The discrimination performance of IL-2 assay (assessed by the area under ROC curve) between LTBI and patients with active TB were 0.75 and 0.8 following stimulation with rESAT-6 and rCFP-10, respectively. Maximum discrimination was reached at a cut-off of 11.6pg/mL for IL-2 after stimulation with recombinant rESAT-6 with 72% sensitivity and 79% specificity and 10.7pg/mL for IL-2 following stimulation with rCFP-10 with 75% sensitivity and 79% specificity, respectively. CONCLUSION: This study demonstrates that rESAT-6 and rCFP-10 can provide a sensitive and specific diagnosis of TB. In addition, it was shown that IL-2 may be serving as a marker for discriminating LTBI and active TB.
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Testes de Liberação de Interferon-gama/métodos , Interferon gama/sangue , Interleucina-2/sangue , Tuberculose Latente/diagnóstico , Linfócitos T/imunologia , Adolescente , Adulto , Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Biomarcadores/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Curva ROC , Proteínas Recombinantes/imunologia , Sensibilidade e Especificidade , Adulto JovemRESUMO
Mycobacterium tuberculosis remains as a major threat to global health. Nearly a third of the world's population is estimated to have latent M. tuberculosis infection, and this is considered to be a major reservoir of potential active disease. Immunocompromised individuals, such as those with chronic renal failure requiring haemodialysis, solid organ transplant recipients, and individuals infected with the human immunodeficiency virus (HIV) have an increased likelihood of progression from latent infection to active disease, due to impaired cell-mediated immunity. Owing to the absence of a systematic review evaluating concordance between interferon-gamma release assays (IGRAs) and the tuberculin skin test (TST) in the diagnosis of latent tuberculosis infection (LTBI) among immunodeficient individuals, this literature review aims to evaluate the reported agreement between IGRAs and TST in the diagnosis of LTBI. It will also assess the utility of IGRAs among individuals with weak immune systems as well as determine the degree of concordance among three diagnostic tests (TST, QuantiFERON, and TSPOT-TB) for LTBI.
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Tuberculose Latente/diagnóstico , Humanos , Hospedeiro Imunocomprometido , Testes de Liberação de Interferon-gama , Tuberculose Latente/imunologia , Reprodutibilidade dos Testes , Teste TuberculínicoRESUMO
SETTING: National Referral Centre for Tuberculosis (TB), Tehran, Iran. OBJECTIVE: To determine the impact of chronic renal failure (CRF) on TB treatment outcomes. DESIGN: A retrospective study was conducted among adult TB patients with CRF and age- and sex-matched TB controls without CRF treated at the National Research Institute of Tuberculosis and Lung Disease from 2004 to 2011. Multivariate analysis was performed to determine the impact of CRF on drug-induced hepatitis (DIH), treatment failure and all-cause mortality. RESULTS: A total of 55 TB cases with CRF and 165 TB cases without CRF were included in the study. Baseline demographic and clinical characteristics were similar, except that TB cases with CRF were more likely to be of Iranian nationality (94.5% vs. 83%, P = 0.04). During anti-tuberculosis treatment, 40 (18.2%) patients developed DIH, none failed treatment and 15 (6.8%) died. Patients with CRF were more likely to develop DIH (27.3% vs. 15.2%, P = 0.04) and to die during treatment (16.4% vs. 3.6%, P = 0.001). CRF remained significantly associated with all-cause mortality (HR 4.87, 95%CI 1.73-13.65) in multivariate analysis, whereas the relationship with DIH was not. CONCLUSION: TB patients with CRF are at increased risk of death. More intensive monitoring of patients with CRF should be considered by the National TB Programme.
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Antituberculosos/uso terapêutico , Insuficiência Renal Crônica/complicações , Tuberculose/tratamento farmacológico , Idoso , Antituberculosos/efeitos adversos , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Distribuição de Qui-Quadrado , Feminino , Humanos , Irã (Geográfico) , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/mortalidadeRESUMO
The risk of death is significantly higher in HIV-infected patients with tuberculosis (TB). This study aims to evaluate the impact of demographic, clinical and laboratory characteristics on the treatment outcome and mortality of TB/HIV co-infected patients in a tertiary TB centre in Iran. In total, 111 patients were recruited from 2004 to 2007. Mycobacteriological studies and demographic, clinical, and laboratory data from all patients were analysed and predictors of unsuccessful outcomes as well as mortality were determined. The mean age for all 111 TB-HIV patients was 38 ± 9 years (range 22-70) and 107 (96.3%) were men; 104 (93.7%) had a history of drug abuse and 96 (86.4%) had a history of imprisonment. The method of HIV transmission was intravenous drug use in 88 (79.3%). Twenty-three (20.7%) had a history of Category 1 (CAT I) TB treatment and six (5.4%) Category 2 (CAT II) treatment. Combination antiretroviral therapy (cART) was given to 48 (43.2%). No significant associations were found between treatment outcomes or mortality and gender, smoking, drug and alcohol abuse, imprisonment, method of transmission, history of CAT I and CAT II treatments, CD4 counts or adverse effects (P > 0.05). Administration of cART led to significantly better outcomes (P < 0.001). Lower serum albumin levels and low body weight were significantly associated with mortality.
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Infecções por HIV/parasitologia , Tuberculose/virologia , Adulto , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Tuberculose/mortalidadeRESUMO
Patterns of drug resistance in recurrent cases of tuberculosis may be different than in those without a history of treatment. In this retrospective study, the drug resistance pattern and outcome of treatment with DOTS category I (CAT I) regimen was compared in 63 recurrent cases and 872 new cases of pulmonary tuberculosis from April 2003 to January 2008 at the National Research Institute of Tuberculosis and Lung Disease in Tehran, Islamic Republic of Iran. Resistance to isoniazid and ethambutol was significantly more common in recurrent cases, but there were no differences in rates of resistance to rifampin, pyrazinamide, streptomycin or the rate of multi-drug resistant strains. Resistance to streptomycin was the most common. No significant differences in treatment outcome and deaths were found between the 2 groups. Due to the low frequency of multi-drug resistance in the recurrent cases, a CAT I regimen may be suitable for empirical therapy before drug sensitivity results become available.
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Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adulto , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores Socioeconômicos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológicoRESUMO
Patterns of drug resistance in recurrent cases of tuberculosis may be different than in those without a history of treatment. In this retrospective study, the drug resistance pattern and outcome of treatment with DOTS category I [CAT I] regimen was compared in 63 recurrent cases and 872 new cases of pulmonary tuberculosis from April 2003 to January 2008 at the National Research Institute of Tuberculosis and Lung Disease in Tehran, Islamic Republic of Iran. Resistance to isoniazid and ethambutol was significantly more common in recurrent cases, but there were no differences in rates of resistance to rifampin, pyrazinamide, streptomycin or the rate of multi-drug resistant strains. Resistance to streptomycin was the most common. No significant differences in treatment outcome and deaths were found between the 2 groups. Due to the low frequency of multi-drug resistance in the recurrent cases, a CAT I regimen may be suitable for empirical therapy before drug sensitivity results become available
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Tuberculose Resistente a Múltiplos Medicamentos , Resistência a Medicamentos , Resultado do Tratamento , Recidiva , Estudos Retrospectivos , Tuberculose Pulmonar , Isoniazida , Etambutol , Rifampina , Pirazinamida , Estreptomicina , TuberculoseRESUMO
BACKGROUND: We assessed bronchoalveolar lavage (BAL) cultures of brain dead donors seeking to achieve better donor management and decrease transplant complications. Determining the most common source of some postoperative infections causing morbidity and mortality among lung recipients would help to reach this goal. MATERIALS AND METHODS: This prospective study was performed on 80 brain dead donors from August 2008 to August 2009. Donors with partial pressure of arterial O2 to the fraction of inspired O2 (PaO2/FIO2)>300 mm Hg and a normal chest x-ray underwent bronchoscopy to obtain a BAL. FINDINGS: The mean donor age was 30±14 years and 50 (63%) were males with 21 (26%) showing a positive history for smoking and 32 (40%) with turbid tracheal secretions. Chest x-ray was abnormal in 49 (61%). Positive culture BAL results were observed among 30 (38%) patients: there were 17 (90%) bacterial and 6 (22%) fungal. Finally, 16 donors (20%) were considered suitable lung donors, allowing 10 lung transplantations. CONCLUSION: Only 20% of donors had acceptable lungs for transplantation. The high rates of positive bacterial and fungal BAL cultures in donors suggest the need for more aggressive critical care management and antibiotic therapy which may be beneficial to prevent future infections in recipients. Further prospective studies are needed to assess the correlation between donor BAL results and posttransplant morbidity and mortality.
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Líquido da Lavagem Broncoalveolar/microbiologia , Transplante de Pulmão/métodos , Adolescente , Adulto , Morte Encefálica , Broncoscopia/métodos , Feminino , Humanos , Pulmão/microbiologia , Masculino , Oxigênio/química , Pneumonia/prevenção & controle , Complicações Pós-Operatórias , Estudos Prospectivos , Radiografia Torácica/métodosRESUMO
We describe the efficacy and outcome of standardised second-line anti-tuberculosis (TB) medications during pregnancy. Treatment outcomes of five pregnant women with documented multidrug-resistant TB (MDR-TB) referred to the National Research Institute of Tuberculosis and Lung Diseases from 2003 to 2009 were analysed in two categories, maternal and neonatal. Patients became pregnant during treatment for MDR-TB without any changes in their anti-tuberculosis regimen. None of them had any adverse effects during pregnancy and delivery. No adverse effects were observed in mothers or neonates. The treatment of MDR-TB during pregnancy with a standardised second-line regimen in this study population was safe, with an acceptable rate of treatment success.
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Antituberculosos/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/efeitos adversos , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Resultado da Gravidez , Resultado do Tratamento , Adulto JovemRESUMO
Non-tuberculosis mycobacteria (NTM), as certain species of mycobacteria, can affect human in several ways. In the preceding years, the rate of NTM detection has risen in both immunocompromised and immunocompetent patients. On the other hand, several reports have debated the possibility of co-infection of both Mycobcateriu tuberculosis (MTB) and NTM in individuals that puts the role of NTM in disease manifestations under question. Moreover, it is now proven that some of the cases that are identified as anti-TB treatment failure or suspected for drug resistance are actually NTM.
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BACKGROUND: Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006. OBJECTIVE: To describe our 8-year experience in lung transplantation. PATIENTS AND METHODS: During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation. RESULTS: The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection. CONCLUSION: Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.
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Transplante de Pulmão/estatística & dados numéricos , Adolescente , Adulto , Causas de Morte , Países em Desenvolvimento/estatística & dados numéricos , Feminino , Humanos , Irã (Geográfico) , Pneumopatias/classificação , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Sobreviventes , Adulto JovemRESUMO
The objective of this study was to determine the drug resistance prevalence and its pattern among tuberculosis (TB)-HIV patients in Iran. In this retrospective study, all admitted TB/HIV patients presenting to our tertiary centre during 2005-2007 were considered. After confirmation for TB-HIV, first-line DST was performed for culture-positive patients. The drug resistance patterns and the treatment outcomes were analysed. Of the total 92 TB/HIV patients, 27 were culture negative, and DST were available in 65. Intravenous drug abuse was seen in 59 (90.8%). Thirty-seven (57%) were 'sensitive' cases and 28 (43%) were 'any drug resistance' cases. Twenty-one (32.3%) were mono-drug, three (4.6%) poly-drug and four (6.1%) were multidrug-resistant TB patients. Previous anti-TB medication was significantly associated with any drug resistance (P = 0.041; 95% confidence interval =0.086-0.984); however, having any drug resistance did not affect the treatment outcome (P = 0.56). Streptomycin showed the highest resistance rate (27%) followed by isoniazid (20%), pyrazinamide (9.8%), rifampin (9.2%) and ethambutol (3%). Drug resistance to antitubercular agents in TB-HIV co-infected patients in Iran is high compared with other reports. Drug resistance is higher among those who have had prior anti-TB medication.
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Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antituberculosos/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Farmacorresistência Bacteriana , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológicoRESUMO
Socioeconomic problems limit the access of drug users to health-care services. This descriptive cross-sectional study was carried out by making use of the medical records of new case tuberculosis (TB) patients hospitalized at Masih Daneshvari Hospital, the national referral centre in Iran, from 2003 to 2006. Demographic and personal characteristics of the patients and type of disease were collected and categorized. Of the 944 patients with confirmed TB, 143 (15.1%) were drug users, among whom 140 (97.9%) were men with just three women drug users. The mean age of the drug users group was 43.04 +/- 13.81 years. The type of drug used was opium in 100 cases (69.9%), heroin in 29 (20.3%), opium and heroin together in four (2.8%) and all three, opium, heroin and crack, in two (1.4%). For 238 high-risk patients, an HIV test was performed and HIV infection was confirmed in 33 cases. Patient delay was longer in drug users (P = 0.000) against other patients, whereas diagnosis delay was shorter (P = 0.007). Drug susceptibility tests were performed for 515 patients with positive cultures. One hundred and thirty-three (14.1%) were found to have 'any resistance' to anti-TB drugs, and 10 (1.1%) individuals had multidrug-resistant TB. Twenty-six (19.5%) of the individuals who showed resistance to first-line agents were drug users. There was no significant relation between drug resistance and drug use (P = 0.4). In conclusion, it seems that active case finding for TB and HIV in addict cases must be contained in harm reduction packages. Moreover, the manifestations of the disease should be considered seriously regardless of attributing them to drug use.
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Cocaína Crack/administração & dosagem , Farmacorresistência Bacteriana Múltipla , Heroína/administração & dosagem , Ópio/administração & dosagem , Abuso de Substâncias por Via Intravenosa/complicações , Tuberculose/epidemiologia , Adolescente , Adulto , Idoso , Antituberculosos/farmacologia , Antituberculosos/uso terapêutico , Estudos Transversais , Diagnóstico Diferencial , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Mycobacterium tuberculosis/efeitos dos fármacos , Aceitação pelo Paciente de Cuidados de Saúde , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoRESUMO
BACKGROUND: Aspergillosis is one of the most important opportunistic infections after organ transplantation. Early diagnosis and initiation of appropriate antifungal therapy are key factors for better prognosis. METHODS: We reviewed the medical records of patients with solid organ transplantation with evidence of Aspergillus infections from December 2001 to January 2008, evaluating patient demographics, time of onset after transplantation, risk factors, radiologic appearance, diagnostic criteria, antifungal therapy, and outcome. RESULTS: We observed aspergillosis in 8 lung, 3 kidney, and 1 heart recipient, with overall mean age of 40.6 years. Seven cases of Aspergillus tracheobronchitis were diagnosed in lung transplant recipients, all of them in the first 6 months after transplantation. All patients responded to antifungal therapy and bronchoscopic debridement. We observed 5 cases of invasive pulmonary aspergillosis. Three patients survived in response to antifungal treatment. The two patients who died were treated with a combination of itraconazole and amphotericin B, whereas all cured patients had been treated with voriconazole alone or in combination with caspofungin. CONCLUSION: It seems that the prognosis of aspergillosis in solid organ recipients is improving with new treatment regimens, particularly if they are used in early stages of infection.
Assuntos
Antifúngicos/uso terapêutico , Transplante de Coração/efeitos adversos , Transplante de Rim/efeitos adversos , Neoplasias Pulmonares/cirurgia , Aspergilose Pulmonar/epidemiologia , Adolescente , Adulto , Desbridamento/métodos , Quimioterapia Combinada , Feminino , Humanos , Irã (Geográfico) , Transplante de Rim/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/cirurgia , Estudos Retrospectivos , Análise de Sobrevida , Sobreviventes , Adulto JovemRESUMO
A two-year-old, male, crossbreed dog was presented for evaluation of licking, biting and severe self-mutilation of its penis, which resulted in ulcers and haemorrhagic preputial discharge. History revealed signs of separation anxiety such as active greeting behaviour, excessive vocalisation and intermittent episodes of licking of the penis when the dog was left alone. The owner reported that he had been hospitalised after a car accident, and he had no chance of seeing the dog. During that time, the behaviour progressed to frequent episodes of licking and biting of the penis. Three weeks of treatment with clomipramine in addition to the presence of the dog's brother, who was brought into the dog's living environment, appeared to produce a considerable degree of improvement. The purpose of this report is to contribute to an increased awareness within veterinary practice of unusual signs of separation anxiety such as penile self-mutilation.