Assessment of Risk Factors in Patients with Chronic Hepatitis B Referred to Dr. Labbafi Nejad’s Hospital Hepatitis Clinic 2012-2014

Background: With the growing trend of unhealthy behaviors in the community, the likelihood of transmission of hepatitis B virus from infected people to society is increasing. So, early detection for preventing disease progression in patients and preventing the spread to the community has an important role. The aim of this study is assessment of risk factors in patients with chronic hepatitis B referred to Labbafi nejad’s Hospital hepatitis Clinic during 2012-2014.Materials and Methods: This cross-sectional study is done on 329 hepatitis B confirmed patients that were admitted to Labbafi nejad’s Hospital hepatitis Clinic 2012-15. Information was collected by interviewing patients by researcher-made questionnaire. Variables are, all risk factors for hepatitis B, respectively. Statistical analysis was performed by SPSS version 21. Average and frequency was used for descriptive and chi-square test was used for analysis.Results: 329 persons (59% males, 41%females) with a mean age of 44/83 years. 33/7% of these individuals have been identified through routine screening. The frequency of exposure to risk factors in this study are as follows: Some groups, such as history of dentist visit (62.3%), major surgery (45.5%) and hospitalization (54.7%) had higher prevalence than other groups. There were no cases of hepatitis B in history of cosmetics and splice joint, common use of blades and razors, HCV disease in patients at the same time, Family history of HIV positive in patients and HIV disease in patients at the same time.Conclusion: It seems to be of great importance to pay more attention to certain jobs, lifestyles and cultural matters in Iran that predispose people to a number of risk factors so as to implement measures to control HBV spread. Also, given the high levels of hepatitis B infection among housewives (in this study), it seems that increased awareness and social - health education in order to avoid unprotected sexual contact with an infected partner can be highly effective. Despite existence of a long list of risk factors, different epidemiological studies with alternative methodologies accompanied by meta-analysis of risk factors in each separate area seems to be helpful in providing information about transmission

Outcome of Accidental Exposure Prone to Blood Borne Viral Infections in an Educational Hospital

Background: The risk for transmission of blood-borne viruses (BBVs) such as Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) due to occupational exposure is a major concern in the health care setting.Materials and Methods: This study among 337 health care workers (HCWs) accidentally exposed to BBVs was carried out from January 2009 to March 2015. The data were reviewed in labbafinejhad hospital, Tehran, Iran.Results: 4 HCWs had exposure to HBS Ag positive, which HBS antibody titer of them was higher than 10 mlu/ml, 6 HCWs were exposed to HCV seropositive patients underwent laboratory investigations for  HCV-antibody on 4,12, 24 weeks that results were negative. 3 cases had exposure to HIV seropositive patients which received standard antiretroviral post exposure prophylaxis.Conclusion: Timely performance for PEP (Post Exposure Prophylaxis) reducing BBVs transmission among HCWs.prophylaxis. Conclusions: Timely performance for  PEP(Post Exposure Prophylaxis) reducing BBVs transmission among HCWs.Key words: Outcome; Accidental Exposure; Blood Borne Viral Infection

Daclatasvir/Sofosbuvir versus Ledipasvir/Sofosbuvir in Patients with Hepatitis C Virus Infection Genotypes 1 and 3

Background: The new direct-acting antiviral agents (DAAs) with high efficacy, low resistance, and low rate of adverse events (AEs) have shown promising outcomes for hepatitis C virus (HCV) treatment. This study assessed the efficacy and safety of Daclatasvir/Sofosbuvir (DCV/SOF) compared to Ledipasvir/Sofosbuvir (LDV/SOF) in patients with HCV infection in the real-world setting in Iran. Materials and Methods: A total of 42 patients with HCV infection were treated with either LDV/SOF (genotype 1) or DCV/SOF (genotypes 1, 3 or unknown) with or without ribavirin (RBV). Assessment of risk factors, laboratory tests, sustained virologic response at post-treatment week 12 (SVR12), and AEs were performed. Results: The highest risk factor for HCV transmission was major surgery (50.0%), followed by tattooing (40.5%), phlebotomy (40.5%), and dental surgery (40.5%). No statistically significant relationships between genotypes and risk factors were observed. In both treatment groups (LDV/SOF and DCV/SOF), all of the patients (100%) with or without cirrhosis and treatment-experience achieved SVR12. One patient with a history of failed LDV/SOF therapy achieved SVR12 following retreatment with DCV/SOF. Both treatment regimens were well-tolerated. No serious AEs or discontinuation due to AEs was observed. The most common AE across both treatment groups were fatigue (42.9%), followed by anxiety (28.6%). Numerically, more adverse events were found with the LDV/SOF regimen than with the DCV/SOF regimen. Conclusion: Our study showed an excellent safety and efficacy of DCV/SOF and LDV/SOF in Iranian patients infected with HCV. The incidence of AEs among patients treated with LDV/SOF was higher than those receiving SOF/DCV

Candiduria: Prevalence, Identification of Isolated Candida Species and Trends in Antifungal Susceptibility in Hospitalized Patients

Background: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Some of the predisposing factors of candiduria are extensive use of broad-spectrum anti-fungal agents, diabetes mellitus, indwelling urinary catheter, corticosteroids and, immunosuppressive drugs. There are some antifungal agents available for the treatment of candiduria. In recent years, resistance to antifungal agents has been increased. The aim of this study was to evaluate different Candida species (sp.) that cause candiduria and their susceptibility pattern to antifungal agents in patients admitted to educational hospitals.Materials and Methods: Urine samples (n=200) were obtained; they were spread onto Sabouraud Dextrose Agar plates. Plates were incubated at 37°C. Only specimens were considered as candiduria, which have a colony count of ≥104 CFU/mL colonies. Urine sediment was cultured in the CHROM agar Candida medium and incubated at 35°C for 48h. The cultures were evaluated based on color. PCR-RFLP was performed for a definite identification of Candida sp. In vitro antifungal susceptibility test of the Candida isolates against amphotericin B, fluconazole and itraconazole was performed using the microdilution method, according to the standard CLSI guidelines, document M27-S3.Results: Molecular findings confirmed the result of the morphological method. Candiduria rate was 11.5% among our patients. According to CHROM agar Candida and PCR-RFLP, the most common species isolated was C. albicans (74%), followed by C. glabrata (26%). In vitro susceptibility tests of urinary Candida isolates to antifungals have been evaluated. All species were sensitive to amphotericin B. None of C. glabrata isolates were sensitive to fluconazole and itraconazole.Conclusion: This study demonstrates the importance of Candida sp. in urine samples from hospitalized patients. It was concluded that Candida sp. obtained from candiduria in patients had excellent activity against Amphotericin B. Whereas, resistance against Itraconazole (21.7%) and especially Fluconazole (26%) was significant

Evaluation of the Clinical, Laboratory and Imaging Findings of Patients with COVID-19 and Their Associations with Clinical Outcomes in an Iranian Hospital: A Cross-Sectional Study

Background: Coronavirus disease 2019 (COVID-19) is a concern in the medical community as the virus spreads around the world. It has a heavy global burden, particularly in low-income countries. This virus has its specific outcomes in each population. Hence, it is necessary to design studies to find the epidemiological behaviour of this virus. Materials and Methods: This cross-sectional study was conducted in the Labbafinezhad hospital, Tehran, Iran. Demographic features include age, sex, past medical history, drug history, habitual file, influenza vaccination history, recent exposure history, clinical symptoms or signs, and the recorded symptoms. The clinical examination and para-clinical assessment, including chest computed tomography (CT) and laboratory testing on admission, were recorded. Results: It was found that patients with a history of kidney transplantation, high level of LDH, high level of AST, and increased neutrophil to lymphocyte ratio are most at risk of death. Conclusion: Parameters mentioned could help practitioners predict patient outcomes, and necessary interventions could be considered in this regard

Effects of adding convalescent plasma therapy for treatment of COVID-19 patients with severe and critical symptoms: a descriptive study of 12 cases

Background: Severe symptoms of COVID-19 could be actually life-threatening and fatal. No effective treatmenthas been proposed yet. Plasma from COVID19 recovered patients may be effective according to past similarstudies of some other viral infections.Materials and Methods: This study was conducted at the infectious disease ward of Shahid Labbafi NejadHospital (Tehran, Iran) from 3rd of April 2020 up until 3rd of May 2020. Clinical information for the 12 patients,before and after receiving convalescent plasma transfusion was obtained from a review of the hospital computermedical system retrospectively and analyzed.Results: Out of 12 patients with Covid-19 who received convalescent plasma, 7 patients were male (58.3%)and 5 were female (41.7%). The mean age of the patients was 52 years. Among them, 50% (n=6), improvedand discharged and the rest of them died. Mean O2 saturation of patients with final outcome of death anddischarged before plasma therapy were 67 (33%) and 77 (83%), respectively, an improvement, defining partialresolution of lesions of chest CT scan or stop in progression of infiltrations was detected in all of 6 dischargedpatients.Conclusion: Convalescent plasma may have effective role in improving O2 saturation, lymphopenia and CT scanlesions and also decreasing inflammatory factors of cases with severe manifestations but could not changeprognosis for critically ill patients. Therefore, an early administration of convalescent plasma may be helpful

Comparison of the Efficacy of Sofosbuvir and Kaletra on the Outcome of COVID-19. Is Sofosbuvir A Potential Treatment For COVID-19?

Background: The COVID-19 is a family of large enveloped non-segmented positive-sense RNA viruses which was first reported in December 2019 in Wuhan, China with a cluster of unexplained pneumonia. Although various medications have been tried to manage the COVID-19 pandemic, there is no exclusive medication or vaccine so far. In this study, we aimed to focus on the effectiveness of Hydroxychloroquine + Kaletra (lopinavir/ritonavir) versus Hydroxychloroquine + Sofosbuvir in patients hospitalized with COVID-19 to given the urgent need for an effective drug against SARS-CoV-2 in the current pandemic context. Materials and Methods: Fifty-four eligible patients with moderate to severe COVID-19 symptoms, according to the WHO criteria entered the study. Patients were randomized into two treatment groups. Thirty-two patients received Hydroxicholoroquine (400 mg stat) and Kaletra (400/100 mg q 12 h) as a control group (group A) and the trial group of 22 patients, received Hydroxicholoroquine (200 mg q 12 h) plus Sofosbuvir (400 mg daily) (group B) for a period of 7 to 14 days. Eventually, collected data included demographic characteristics, underlying diseases, clinical symptoms, laboratory data, and mortality were analyzed. Results: There was no significant difference in age, sex, and underlying diseases between the two groups. There was no significant statistical difference between the two groups on the seventh day of treatment in terms of cough relief, leukocyte count, and improvement of lymphopenia however in terms of the time of defervescence of fever, there was a significant difference between the two groups. Conclusion: Therefore, it can be said that our study is one of the first studies in the world to evaluate the effectiveness of sofosbuvir in the treatment of patients with COVID-19. According to our results, although Kaletra was assumed as an effective therapy, its superiority over Sofosbuvir was confined to the earlier effervescence of the 7-day fever and sofosbuvir can be used as an effective treatment, especially in patients with underlying heart disease who are at risk for arrhythmias with Kaletra

Seroprevalence of Hepatitis a in Hemodialysis Patient Candidate for Kidney Transplant Younger Than Forty Years

Background: Hepatitis A is a common infection during childhood, especially in developing countries. It can cause severe complications in immunocompromised patients. Due to the increasing number of kidney transplants in the country and epidemiologic shift of HAV which was observed in previous studies, we're going to evaluate the seroprevalence of hepatitis A in hemodialysis patients less than forty years serving kidney transplant candidates to follow vaccination policy for them.Materials and Methods: In a cross sectional study during 2014-2015 hepatitis A antibody levels in hemodialysis patients less than forty years in kidney transplant candidates examined in 12 hospitals in Tehran, Iran. Their serums were tested for anti HAV IgM and IgG by ELISA kits.Results: Hepatitis A virus antibody was positive in 66 (72.5%) of 91 patients. The prevalence of HAV was 0% at the range of younger than 20 and 45% in under 25 years age group. This significantly increased prevalence by increasing the age, and there was according to epidemiological shifts which were shown in other studies.Conclusion: Due to the availability of vaccine and hepatitis severe complications in immunocompromised individuals, as well as a low prevalence of positive serology in individuals under 25 years, it seems the check of antibodies in patients undergoing kidney transplantation and vaccination in seronegative persons is a logical

Assessment of Effectiveness and Adverse Effect of New Combination Chemotherapy (irinotecan, cisplatin, and dexamethasone) in Relapse and Refractory Hodgkin Lymphoma

Background: Chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) cannot cure all patients with Hodgkin lymphoma. In this study, we evaluated the efficacy and adverse effect of a new regimen consist irinotecan, cisplatin, and dexamethasone (ICD) in relapsed and refractory Hodgkin lymphoma as the second to fifth line of treatment. Materials and Methods: We performed a retrospective study in 26 relapsed or refractory patients with Hodgkin lymphoma receiving at least the first-line chemotherapy regimen (ABVD) and (ICD) as salvage therapy in Thaleghany Hospital from 2012 to 2018. This regimen consisted of irinotecan 65mg/m2 D1, D8, cisplatin 30mg/m2 D1, D8, and dexamethasone 40mg D1, 2, 8, and 9 was administered every 3 weeks for 6 cycles.  Treatment was discontinued in cases of disease progression or severe toxicity. Response to treatment was evaluated after two cycles. Patients with complete and partial remission were candidate high dose chemotherapy and autologous stem cell transplantation. Twenty-four patients were enrolled in the study. The mean age of 22 patients was 31.5 (19-67) years. Seven patients (29.1%) were in the first recurrence, and 17 (70.8%) were in the second or subsequent recurrence. Results: According to this study, three patients (12.5%) had complete response, 13 (45%) had partial response, four (16.6%) had stable disease, and four (16.6%) had progressive disease. Nine patients (37.5%) received high-dose chemotherapy and autologous stem cell support after ICD regimen. None of the cycles of chemotherapy were delayed due to treatment-related adverse event. Overall survival after six months in all patients was 91%, and mortality rate was 8.3% at the end of the study. Conclusion: The goal of salvage chemotherapy in relapsed or refractory Hodgkin Lymphoma is achieving CR or PR preparation patients for stabilization with BMT. Thus, we recommend ICD as one of the most effective protocols with overall response rate of 66% in this population.  

Assessment of Risk Factors in Patients with Chronic Hepatitis B Referred to Dr. Labbafi Nejad’s Hospital Hepatitis Clinic 2012-2014

Background: With the growing trend of unhealthy behaviors in the community, the likelihood of transmission of hepatitis B virus from infected people to society is increasing. So, early detection for preventing disease progression in patients and preventing the spread to the community has an important role. The aim of this study is assessment of risk factors in patients with chronic hepatitis B referred to Labbafi nejad’s Hospital hepatitis Clinic during 2012-2014.Materials and Methods: This cross-sectional study is done on 329 hepatitis B confirmed patients that were admitted to Labbafi nejad’s Hospital hepatitis Clinic 2012-15. Information was collected by interviewing patients by researcher-made questionnaire. Variables are, all risk factors for hepatitis B, respectively. Statistical analysis was performed by SPSS version 21. Average and frequency was used for descriptive and chi-square test was used for analysis.Results: 329 persons (59% males, 41%females) with a mean age of 44/83 years. 33/7% of these individuals have been identified through routine screening. The frequency of exposure to risk factors in this study are as follows: Some groups, such as history of dentist visit (62.3%), major surgery (45.5%) and hospitalization (54.7%) had higher prevalence than other groups. There were no cases of hepatitis B in history of cosmetics and splice joint, common use of blades and razors, HCV disease in patients at the same time, Family history of HIV positive in patients and HIV disease in patients at the same time.Conclusion: It seems to be of great importance to pay more attention to certain jobs, lifestyles and cultural matters in Iran that predispose people to a number of risk factors so as to implement measures to control HBV spread. Also, given the high levels of hepatitis B infection among housewives (in this study), it seems that increased awareness and social - health education in order to avoid unprotected sexual contact with an infected partner can be highly effective. Despite existence of a long list of risk factors, different epidemiological studies with alternative methodologies accompanied by meta-analysis of risk factors in each separate area seems to be helpful in providing information about transmission.</p