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Background: Human adenoviruses can cause a wide spectrum of infections including respiratory and ocular disease, gastroenteritis and cystitis. Although adenovirus respiratory infection occurs in children and neonates but several outbreaks of acute respiratory disease (ARD) are documented in military recruits. Methods: In a cross-sectional survey in autumn 2012, all prisoner patients with acute lower respiratory disease referred to Emergency room of Alzahra Hospital, Isfahan, Iran, were enrolled in this study. For diagnosis of the etiology, a panel of different tests was used including PCR (polymerase chain reaction) for respiratory pathogens. Findings: From 23 cases, 21 were positive for adenovirus types in PCR assay of brochoalveolar lavage (BAL). All other Microbiologic tests including Gram staining, culture, and Ziehl-Neelsen staining were negative. The most prevalent radiologic finding in chest X-ray was bilateral interstitial infiltration. Conclusion: Acute respiratory infection by adenovirus may be a cause in respiratory outbreaks in closed environments like prisons and military recruits. PCR is a valuable diagnostic method for early and accurate diagnosis.

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in critically ill patients with high morbidity and mortality rates. The etiology of VAP is usually bacterial. Opportunistic fungi such as Candida and Aspergillus species (spp.) are found frequently in the respiratory track secretions of immunocompetent critically ill patients known as colonization. Contribution of fungi colonization to severe bacterial VAP and poor prognosis of these patients has been documented in several studies. The aim of this study was to detect Candida spp. and Aspergillus fumigatus colonization in patients with a clinical diagnosis of VAP as a marker of high risk pneumonia. Materials and Methods: Bronchoscopic alveolar lavage (BAL) fluids from patients with VAP in central intensive care unit (ICU) of a tertiary university hospital in Isfahan were examined by real time polymerase chain reaction (PCR) to detect Candida spp. or A. fumigatus. Rate of fungi colonization and its association with clinical criteria of the patients was determined. Results: BAL fluids from 38 patients were tested from which six samples (15.8%) were positive for Candida spp. and five (13.2%) for A. fumigatus. Fungi colonization was not associated with age, sex, or mortality rate of patients. Rate of A. fumigatus colonization was significantly more in traumatic patients (P = 0.036), and higher in patients ventilated more than 4 weeks (P = 0.022). Conclusion: High rate of A. fumigatus colonization in our ICU patients indicates that underlying causes such as unfavorable ICU conditions and other patient related factors such as unnecessary antibiotic therapy should be further evaluated.

Background: Health science students are at an increased risk of hepatitis A virus (HAV) infection even under accidental infection. The aims of this study were to assess the seroprevalence of HAV in 1 st year medical students and to determine the risk factors of HAV vaccination program among this population. Materials and Methods: A cross-sectional study was conducted in autumn 2010. A total of 1028 newly admitted medical students in Isfahan, Kermanshah and Hamedan were included in the study. Participant data were obtained through predesigned data collection sheets. A serum sample was obtained for serologic testing for the presence of IgG anti-HAV using a commercially available enzyme-linked immunosorbent assay kit. Descriptive statistics, Chi-square and logistic regression tests were performed for statistical analysis and P < 0.05 was considered as significant. Results: The prevalence of HAV was detected in Isfahan, Hamedan, and Kermanshah newly admitted students 67.5%, 79.2%, and 50.6% respectively. There were significant relations between anti-HAV (IgG) positivity in drinking water and medical students provinces (P < 0.001, RR = 0.58 and 0.65 respectively). The household size did not significantly influence the anti-HAV (IgG) positivity in studied subjects (P = 0.09, RR = 1.26). Conclusion: Our results indicate that more than one-third of the medical students in all three faculties were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest students in a health care set up should undergo vaccination against HAV after prevaccination immunity screening.

Background: Hepatitis B virus (HBV) vaccination is a well-known, safe and effective way for protection against HBV infection; however, non-responders remain susceptible to infection with HBV. This is so important in patients with any kind of chronic liver disease, especially chronic hepatitis C virus (HCV) patients in whom acute HBV infection may lead to decompensation of liver disease. Some of the studies have shown that immunogenicity of HBV vaccination is decreased in these patients. The aim of this study was to evaluate the efficacy and safety of double dose vaccination of HBV in these patients, compared with standard dose vaccination in similar patients and healthy adults. Methods: A total of 64 patients with chronic HCV infection were randomized into 2 groups of 32. Group A received standard dose HBV vaccine, at 0, 1, 6 months, whereas group B received double dose HBV vaccine. Group C consisted of 32 healthy adults who also received standard dose vaccination. At 1 month after the end of vaccination, Hepatitis B surface antibody (HBsAb) titer was checked in all participants and the results were compared. Results: There was no significant difference in age or sex among three groups. The response rate in groups B and C was 100% (all had HBsAb titer >10 mIU/mL), while in group A, 4 patients (12.5%) were non-responders (HBsAb titer < 10 mIU/mL). The difference in response rate was statistically significant between Group A and the other two groups (P < 0.05). Conclusions: The efficacy of standard dose HBV vaccination in patients with chronic HCV infection was suboptimal. Using double dose vaccination in these patients was an effective way to increase the antibody response.

Background: Serum biomarkers can be used as alternative method for liver biopsy in order to assess the level of fibrosis in patients with chronic Hepatitis C. The determination of Hepascore is a non-invasive method to assess the level of fibrosis among patients. This study aims to compare the liver biopsy results with Hepascore among the Genotype 1 Hepatitis C patients in Isfahan. Methods: A sample of 39 patients with chronic Hepatitis C is selected through the simple non-random sampling method for a liver biopsy and Hepascore test. After biopsy, the patients are categorized based on the Metavir scoring system. The Hepascore algorithm is computed based on age, sex, total Billirubin, δ-glutamyl transferase, α2-Macroglobin, Hyaluronic acid. Using the Spearman and ROC test in SPSS15, collected data have been analyzed. Finding: The liver biopsy results showed 6 patients with F0, 12 patients with F1, 10 patients with F2, 3 patients with F3, and 8 patients with F4. The Hepascore value above 0.37 cut off point for detecting significant level of fibrosis has shown 67% sensitivity, 61% specificity, 67% positive predictive value, 61% negative predictive value. For a Hepascore value above 0.66, the results are: 82% sensitivity, 89% specificity, 75% positive predictive, 89% negative predictive value. For a Hepascore value higher than 0.84 for detecting cirrhosis, the results are: 100% sensitivity, 97% specificity, 89% positive predictive, and 100% negative predictive value. Conclusion: This study shows that the Hepascore method is accurate enough to measure the level of fibrosis, particularly cirrhosis. Therefore, it can use for screening of patients that need liver biopsy.

Background Hepatitis D virus (HDV) is dependent on hepatitis B virus (HBV) infection. Acute infection with HDV can occur simultaneously with acute HBV infection or be superimposed onto a chronic HBV infection. Objectives This study aimed to identify cases of HDV and determine its prevalence in patients with chronic HBV infection for the first time study in Isfahan, central Iran. Patients and Methods In a cross-sectional study in 2009, 346 who had been diagnosed for at least 6 months with chronic HBV were enrolled consecutively. Anti-HDV was measured by ELISA in the serum of these patients. Results The study included 245 males (70.8%) and 101 (29.2%) females with a mean age of 39 ± 12.4 years. Anti-HDV was present in 8 (3.5%) HBe antibody-positive patients (p = 0.36) and in 2 (2.3%) HBe antigen-positive cases (p = 0.68). No association was found between hepatitis D and probable risk factors. Conclusions This study demonstrates that the prevalence of HDV infection is higher in patients who are positive for HBeAb compared those who are HBeAg-positive. Therefore, most HDV antibody-positive cases in Isfahan are HBV/HDV superinfections but not coinfections.

Background: Hepatitis C virus (HCV) is a major public health problem in the world which drug injection is a primary mode of transmission for it. So, this study was conducted to determine seroprevalence of HCV in intravenous drug abusers (IVDA) in Isfahan province Drop in centers (DIC). Methods: This qualitative/quantitave study used triangulation method in data collection and analysis. Five semi-structured focus groups with open-ended questions were disposed to evaluate and discuss on aspects of the study. Intravenous drug abusers in Isfahan province Drop in centers by non-probable purposive sampling method entered into the study voluntarily and blood sample was obtained from them. Serum samples were tested for HCV-Ab using ELISA method. Finding: There were seven govermental Drop in centers including 4 related to Isfahan University of Medical Sciences and 3 related to welfare organization which contained 1581 intravenous drug abusers members. From them, 539 patients (34%) enterd into the study from which, 250 (47.1%) patients were positive for HCV-Ab without significant differences between men and women. The main impressive factors for the project were wage for blood obtaning, occupational insurance, problems in interview and sampling, and time restriction. Conclusion: This was a good experience for other investigators and health directors’ strategies to design simillar studies or harm reduction.

Background: Post-transplant infection with polyoma viruses (BK and JC viruses) is an important cause of graft loss and nephropathy. The objective of this study was to compare the frequency of BK and JC viruria in renal transplant recipients with and without graft dysfunction. Methods: In a case-control study, we selected 60 kidney transplant patients with and without graft dysfunction in the first two years after transplantation. Each group consisted of 30 patients evaluated for basic demographic and laboratory characteristics. First morning urine samples were sent for BK and JC virus detection with QIAamp DNA Mini Kit and real-time polymerase PCR. Chi-square test with Yates′ correction, Student t-test and Mann-Whitney U test were used as indicated. P value of less than 0.05 was regarded as statistically significant. Results: Both groups were similar in age, gender, and time after transplant and pretransplant dialysis. In both groups, seven patients (23.3%) were JC virus positive whereas in case group 14 patients (46.7%) and in control group 9 patients (30%) were BK virus positive. There were no statistical significant difference between case and control groups for both JC and BK virus infection rate. Conclusions: We concluded that JC and BK virus infection is very prevalent in the first 2 years after transplant and might be monitored appropriately.

Background: Toxoplasmosis is a worldwide infection. Most studies on toxoplasmosis are in women in child bearing ages. We conducted an epidemiological survey on the population of the Isfahan Province to identify characteristics of the individuals associated with seropositivity. Methods: In a cross sectional study, 599 serum samples were randomly collected for seroepidemiology of Hepatitis A and E, and were also used for titration of IgG anti-toxoplasma gondii antibody by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Data were analyzed using SPSS software 15 . Chi square and Fisher exact tests were employed to examine antibody status in different age, gender, education and residency groups. Results: The overall prevalence was 41.4% (248/599). There was a statistical significant association between seroprevalence with age, education, and gender (p < 0.05) but not with residency state. The peak age for acquisition of the infection in females was 20-29 and in males 20-39 years old. Conclusions: Results of current study showed a moderate prevalence of toxoplasma gondii infection. However higher seroconversion rate in active social and reproductive ages, females and low educated individuals necessitate active preventive programs in these high risk groups.

Background: Juveniles in custody are affected by sexually transmitted infections due to risky behaviors. Therefore, they have a disproportionate burden of hepatitis B virus (HBV) and human immunodeficiency virus (HIV). In this study, the prevalence and associated characteristics of hepatitis B and HIV infections were assessed in young prisoners. Materials and Methods: In this cross-sectional study, prevalence of HBV and HIV infections was assessed among young prisoners during 2008-2009. A checklist consisting of demographic, social, and risk factors was filled out and blood was drawn for their tests. Sera were analyzed for hepatitis B surface antigen (HBs Ag), hepatitis B surface antibody (HBs Ab), hepatitis B core antibody (HBc Ab) and HIV Ab, and Western blot test was performed on antibody-positive HIV. Results: A total number of 160 young prisoners (147 boys and 13 girls) were evaluated. The mean age of the subjects was 16.59 ± 1.24 year. HBs Ag, HBc Ab, HBs Ab, and HIV Ab were detected in 1 (0.63%), 1 (0.63%), 52 (32.5%), and 1 (0.63%), respectively. Conclusion: With respect to national vaccination program against HBV infection, the juvenile prisoners had low prevalence of HBs Ab.

Objectives: Clinical laboratory health care workers can become infected through their occupation with blood-borne pathogens by percutanous injuries and mucocutaneous blood contacts such as cuts, needle sticks, splashes to mucous membranes or other body injuries. The purpose of this study was to determine the seroprevalence of, Hepatitis C virus (HCV), and some of the risk factors in medical laboratory health care workers. Methods: Through a descriptive cross sectional study, 203 participants employed in the clinical laboratories of the city of Isfahan, composed of medical laboratory technologists, technicians and cleaning staff were studied. Participant data were obtained through a self-reporting questionnaire and the level of anti-HCV antibody was measured by enzyme linked immunosorbent assay (ELISA). Chi-square test was used to determine risk factors associated with infection. Results: The mean age of the individuals (n = 203) was 35.8 ± 9.54 years. There were 115 women (56.7%) and 88 men (43.3%). All of the subjects were negative for HCV Ab. Conclusions: Hepatitis C infection is infrequent in laboratory health care workers in Isfahan province.

Background: Hepatitis C is a major worldwide problem with remarkable medical burden which is emerging mostly due to intravenuos drug abuse. The prevalence of hepatitis C infection is higher among prison inmates because of the high proportion of injecting drug users. So, the aim of this study was to determine the seroprevalnce of hepatitis C infection among prisoners with history of intravenous drug abuse in Isfahan province-Iran. Methods: In this cross-sectional study, active and inactvie intravenous drug abusers were enrolled into study volluntarily with ethical considerations. Participants were interviwed using a structured questionnaire and a blood sample was collected for detection HCV antibody using ELISA method. Finding: From 6000 prison inmates in Isfahn central prison and Assadabad Camp, approximatly 20 percent (1200 ones) had hsitory of intravenous drug abuse from which, 951 ones (80%) were intered in this study. The prevalenc of HCV infection was 42 percent and the main factores earned from this project experience were: problem in giving samples, problem in prison interance, separate interveiw and sample collecting, and desirable participants’ cooperation. Conclusion: According to success in obtaning nearly 80% of prison inmates with history of drug abuse, this is a good experience for other investigators and health directors to design simillar studies or executive protocols.

Objectives: Hepatitis C virus (HCV) is one of the major public health problems worldwide which is transmitted through contact with infected blood or blood products. One of the most prevalent modes of HCV transmission is injecting drug with unclean needles or syringes. Therefore intravenous drug users (IVDUs) are the most important group who should be considered. The aim of this study was to evaluate seroprevalence and risk factors of hepatitis C virus in IVDUs population. Methods: The cross-sectional study was carried out on intravenous drug users who attended health and social care Drop-in centers during November 2008 to February 2009 in Isfahan province, Iran. Data was gathered using interviewer-administered questionnaire including demographic characteristics and main risk factors for HCV infection. 5ml venous blood sample was obtained from each subject. The HCV-Ab test was performed on all blood samples by ELISA. The data was analyzed using descriptive statistical methods and multiple logistic regressions by SPSS software, version 15. Results: The mean age of participants was 31.77 ± 8.51. 503 (94.7%) were men and 28 (5.3%) were women. HCV seroprevalence was 47.1% (95% CI: 42.9, 51.3). The multiple logistic regressions demonstrated that history of tattooing (OR 1.72, 95% CI 1.02-2.90), history of imprisonment (OR 2.49, 95% CI 1.40-4.42) and sharing needles/syringes (OR 2.76, 95% CI 1.54-4.95) are significant predictors of risk of HCV in IVDU population. Conclusions: In conclusion, according to the high prevalence of HCV infection among IVDUs and high adds of HCV infection from tattooing, sharing of needles/syringes and imprisonment, effective harm reduction programs should be expanded among IVDUs to prevent new HCV infections.

Background: Detection of latent tuberculosis infection (LTBI) in transplant candidates is very important. The tuberculin skin test (TST) and interferon-gamma release assays (IGRAs) are standard immunologic tools for LTBI detection. The aim of this study was to compare the TST results and T-SPOT® .TB test (a type of IGRAs) in kidney transplant candidates for the screening of LTBI and follow the patients with positive test for an activation of tuberculosis (TB) after transplantation and using anti-TB prophylaxis. Materials and Methods: This study was a prospective study and carried out in 44 renal transplant candidates from March 2010 to February 2011 in the teaching hospitals of Isfahan University of Medical Sciences, Iran. TST and T-SPOT® .TB test were performed and their results evaluated. Patients with a positive skin test and/or T-SPOT® .TB test were started on anti-TB prophylaxis and followed after transplantation for an activation of their LTBI for 1 year. Results: Overall, 8 (18.2%) patients were positive for TST and 6 (13.6%) patients for T-SPOT® .TB test. The agreement between TST and T-SPOT®.TB test was moderate (κ = 0.49, 95% confidence interval 0.145-0.839). The overall agreement between TST and T-SPOT® .TB test was 86%. No relation was found between the underlying diseases and TST or T-SPOT® .TB test positivity. Although isoniazid prophylaxis was used for patients with positive TST and/or T-SPOT® .TB test, one patient had reactivation of TB. Conclusion: In kidney transplant candidates both TST and T-SPOT® .TB test were comparable for the diagnosis of LTBI with reasonable agreement between the tests. However, further studies are needed to determine the ability of T-SPOT® .TB test to detect LTBI and to evaluate the need for prophylaxis in these patients.

Objectives: Patients with Hepatitis C Virus infection are at high risk of getting hepatitis A virus. Hepatitis A virus is an important widespread virus that usually causes more severe medical consequences in patients with chronic liver disease. The purpose of this study was to evaluate prevalence of Hepatitis A Virus antibody in patients with chronic HCV in Isfahan province, Iran. Methods: A cross-sectional study was carried out on 117 patients with chronic hepatitis C virus from spring 2010 to spring 2011. Subject′s characteristics such as age, gender, education, genotype of HCV infection and history of intravenous drug use were collected by questionnaire and studied. Statistical analysis was done by SPSS software (version 19.0. 2010, SPSS) using Chi-square test, Fisher Exact tests and Cochran-Armitage trend test. Results: The mean age of the subjects was 33.18 ± 10.97 years. The seroprevalence of HAV was 94.9% in patients with chronic HCV. The prevalence of anti-HAV increased nearly as age increased. But, there was no statistically significant difference in HAV positive rate according to the age groups (P = 0.242) and other patient′s characteristics. Conclusions: According to the high HAV immunity in our study and less severe form of HAV infection, vaccination was not required in these patients. However, hepatitis A vaccination program should be performed in HAV seronegative patients with HCV to produce an adequate immune response.

BACKGROUND: The polymorphisms of cytochrome P450 2C19 (CYP2C19) gene are major prognostic factors for the response to clopidogrel therapy in patients with coronary artery diseases (CAD). The CYP2C19*2 is the most important allele responsible for resistance to clopidogrel therapy. This study examined CYP2C19 gene polymorphism (CYP2C19*1 and *2) in Iranian patients. METHODS: This cross-sectional study was performed on 43 Iranian patients with CAD who underwent percutaneous coronary intervention (PCI) and received drug-eluted stents (DES). CYP2C19 polymorphisms were assessed using real time PCR and frequency of CYP2C19*1 and CYP2C19*2 were determined, and then homo- or heterozygous state of genes was detected by Melt Curve Analysis method. RESULTS: Forty three patients (mean age = 58.8 ± 10.0 years, 79.1% male) participated in this study. CYP2C19*1/CYP2C19*1 genotype was observed in 31 (72.1%) of participates, CYP2C19*1/CYP2C19*2 genotype in 10 (23.3%), and CYP2C19*2/CYP2C19*2 genotype in 2 patients (4.7%). The frequency of CYP2C19*2 allele in the sample was 27.9%. CONCLUSION: This study demonstrated a high prevalence of CYP2C19*2 gene polymorphism in Iranian patients. Further studies with larger samples or longitudinal are required to determine the effects of this polymorphism on the prognosis of CAD patients in our population. Keywords: CYP2C19, Polymorphism, Clopidogrel, Coronary Artery Disease, Iran. &nbsp

Background: Injection drug use plays the most important role in transmission of hepatitis C. In Iran, surveys have been conducted on various high risk groups but this is the first announcement based study for anti-HCV prevalence among cases with history of intravenous drug using (IVDU) in the country. Methods: The announcement-based detection and follow-up of patients with anti-HCV positive project in volunteers with history of intravenous drug using was conducted in Isfahan province. At the first step, six focus groups were conducted and 2 pilot studies were carried out in two cities to design the main study. Comprehensive community announcement was done in all of public places and for physicians. The volunteers were invited to Isfahan reference laboratories and the serum samples were sent to Infectious Diseases Research Center Laboratory in standard conditions and HCV-Ab was tested by ELISA method. Finding: In this study, 1747 individuals that are estimated 50% of all expected intravenous drug users in the community were presented themselves. The most important reasons of success in recruiting volunteers in this study were the perfect propaganda, appropriate cooperation of lab staffs, continuous evaluation, and good cooperation in Isfahan province administrations. HCV-Ab was detected in 34% of them and the HCV-Ab positives were sent for further follow-up procedures including confirmatory test, education, and treatment. Conclusion: In spite of some limitations to select real cases, this study considered as a successful experience. Compared to the surveys in Iran on HCV prevalence in intravenous drug users, the results of this study which was based on volunteers by announcement seems to be noteworthy.

Background and Objectives: Iranian chronic HBV carrier’s population has shown a unique pattern of genotype D distri- bution all around the country. The aim of this study was to explore more details of evolutionary history of carriers based on structural surface proteins from different provinces. Materials and Methods: Sera obtained from 360 isolates from 12 Different regions of country were used for amplificationand sequencing of surface proteins. A detailed mutational analysis was undertaken. Results: The total ratio for Missense/Silent nucleotide substitutions was 0.96. Sistan and Kermanshah showed the lowest rate of evolution between provinces (P = 0.055). On the other hand, Khorasan Razavi and Khoozestan contained the highest ratio (P = 0.055). The rest of regions were laid between these two extremes. Azarbayjan and Guilan showed the highest proportion of immune epitope distribution (91.3% and 96%, respectively). Conversely, Sistan and Tehran harbored the least percentage (66.6% and 68.8%, respectively). Kermanshah province contained only 5.2%, whereas Isfahan had 54.5% of B cell epitope distribution. In terms of T helper epitopes, all provinces showed a somehow homogeneity: 22.58% (Fars) to 46.6% (Khuz- estan). On the other hand, distribution of substitutions within the CTL epitopes showed a wide range of variation between 6.6% (Khuzestan) and 63% (Kermanshah). Conclusion: Further to low selection pressure found in Iranian population, the variations between different regions designate random genetic drift within the surface proteins. These finding would have some applications in terms of specific antiviral regimen, design of more efficient vaccine and public health issues.

Background: A number of researchers have suggested that the clinical course of hepatitis A virus (HAV) infection is more severe in patients with chronic liver disease (CLD). However, there is not adequate information about the seroprevalence and risk factors of HAV in the population with chronic hepatitis B or C infection in Isfahan, Iran. Methods: We studied 168 patients with chronic hepatitis B or C between spring 2007 and spring 2009. Patients were stratified based on age, gender, family size, intravenous drug abuse, education, and genotype of hepatitis C. Independent predictors of HAV were identified by logistic regression analysis. Findings: Of 168 patients, 162 persons (96.4%) were HAV seropositive. We found a significant relation between genotypes of hepatitis C and HAV seropositivity (P < 0.001). Other risk factors were not identified as independent predictors. Conclusion: Considering the high seroprevalence of HAV in patients with hepatitis B or hepatitis C, general vaccination against HAV is not necessary. Further studies should be conducted to draw a firm decision on vaccination of seronegative patients. Keywords: Hepatitis A virus, Chronic liver disease, Hepatitis B virus, Hepatitis C virus, Patients

Objective(s)The aim of this study was to characterize the hepatitis B virus surface protein genotypes and sequence variations among hepatitis B virus surface antigen (HBsAg) positive chronic patients in Hormozgan province, south of Iran.Materials and MethodsA total of 8 patients enrolled in this study. The surface gene was amplified and directly sequenced. Genotypes and nucleotide/amino acid substitutions were identified compared to the sequences obtained from the database.ResultsAll strains belonged to genotype D. Overall 77 “muta¬tions” occurred at 45 nucleotide positions, of them, 44 (57.14%) were silent (no amino acid altering) and 33 (42.86%) were missense (amino acid changing). A number of 24 (80%) out of 30 amino acid changes occurred in different immune epitopes within surface protein, of which, 9 (30%) in B cell epitopes in 7 residues (2 occurred in “a” determinant region); 8 (42.1%) in T helper epitopes in 7 residues and 7 (10%) in 4 residues inside CTL epitopes.ConclusionHepatitis B virus genome containing mutated immune epitopes no longer could be recognized by specific T-cells of the host immune surveillance and did not enhance anti-HBs production. This could led to the progression of chronicity of hepatitis B virus infection.

Background: Tuberculosis (TB) remains one of the leading infectious diseases throughout the world. Among various forms of extrapulmonary TB, tuberculous meningitis (TBM) is the most severe form and remains a major global health problem with a high mortality rate. Our study was designed to evaluate tuberculous polymerase chain reaction (PCR) positive rate in patients who present with fairly long symptoms of meningitis. Materials and Methods: The 162 Patients with an indolent onset of symptoms compatible with central nervous system infection were admitted. Sample of cerebrospinal fluid (CSF) was evaluated for biochemistry and tuberculous real-time PCR. Data analyzed by Student's t-test and Fisher's test. Results: Patients were mostly male (69.8%), with a median age of 43.69 ± 22.67 years. CSF real-time PCR results in 6 patients (3.7%) were positive for tuberculous DNA. Of these 6 patients, 4 of whom were men and two of whom were women. In other words, the frequency of positive tuberculous DNA was in male 5.3% and female 1.4%, respectively. Conclusion: Given that we live in Iran and in the vicinity of the tuberculous endemic countries, if we face a meningitis case with lasting symptoms and tendency to be chronic, TBM should be considered.

Background: Hepatitis B with its complications has become one of the universal problems. Injection drug use is one of the most important risk factors in the transmission of hepatitis B. Therefore, we assessed hepatitis B virus prevalence among cases with a history of intravenous drug use (IVDU) as the first announcement-based study in this regard. Materials and Methods: The announcement-based detection of hepatitis B seroprevalence in volunteers with a history of intravenous drug use was conducted in the Isfahan province. A comprehensive community announcement was made in all the public places and to all physicians, in all the regions. One thousand five hundred and eighty-eight volunteers were invited to the Isfahan reference laboratories and serum samples were tested for HBs-Ag, HBc Ab, and HBs-Ab, using the enzyme-linked immunosorbent assay (ELISA) method. Results: In this study, 1588 individuals volunteered, who were estimated to be 50% of all the expected intravenous drug users in the community. HBs Ag was detected in 4.2% of them. HBc Ab and HBs Ab were detected in order in 11.4 and 17.3%, respectively. Conclusion: We estimated that the seroprevalence of hepatitis B positivity in intravenous drug users was moderate to high. Therefore, it was suggested that this group be encouraged to prevent acquiring infection by vaccination, education, counseling for risk reduction, and treatment of substance abuse, and finally hepatitis B virus (HBV) screening.

Background: Nosocomial infection caused by Acinetobacter baumannii has emerged as a serious problem world-wide. Finding the suitable drug is an important priority. The aim of this study was to determine colistin (polymyxin E) resistance in clinical isolates of A. baumannii from intensive care units (ICUs) of Al Zahra Hospital. Materials and Methods: Sixty isolates of A. baumannii from patients hospitalized in ICU (Al Zahra Hospital, Isfahan University of Medical Sciences [IUMS]) were studied. All isolates of A. baumannii were tested for colistin susceptibility by Eopsilometer test (E-test). Results: Of the 60 isolates 57, (95%) were multidrug resistant (MDR) and 76.6% (46/60) were highly resistant. The rate of colistin resistant with the E-test method was 11.6% (7/60). Conclusion: As the frequency of resistance to colistin is low, it can be used as an easily available drug for treatment of MDR A. baumannii strains, which are susceptible to colistin.

Background: Hepatitis C, as a major public health problem, has serious complications and intravenous drug users are the most high risk group for it. This study was performed to determine hepatitis C seroepidemiolgy and related risk factors among intravenous drug users in Isfahan province. Methods: In this cross-sectional study, intravenous drug users (IVDUs) in central prison, Assadabad camp and Drop in Centers in Isfahan province were selected using census sampling method. After completion validated questionaire including demographic and risk factors by interiew, a 5 cc blood sample was obtained and HCV-Ab was detected using ELISA method. Finding: Among 1485 intravenous drug users (1457 male) with mean age of 32 ± 7 years, 644 (43.4%) were HCV-Ab positive. Not being married, tatooing, needle share, prison history, history of going to dentist and duration of intravenous drug abuse were indepenedent risk factors for hepatitis C. Also, men with men sex, sex with intravenous drug users and unprotected sex (without condom) had significant relationship with hepatitis C. Among HCV risk factors, needle share and prison history had hightest relative and attributable risks. Using ROC curve, the cut off point for duration of intravenous drug abuse was estiamted as three months. Conclusion: The main results of this study indicated high prevalence rate of hepatitis C and the major role of needle share and prison history among intravenous drug users population in Isfahan province that needs to pay attention by governments.

Background: Considering that there was not any regional survey in Isfahan, Iran regarding the epidemiology of acute respiratory tract infections (ARTI) in different age groups of general population, the aim of this study was to determine the epidemiologic feature of ARTIs in Isfahan using multiplex polymerase chain reaction (PCR) method. Materials and Methods: In this cross-sectional study, patients aged 15 years old). Rhinovirus was the most common cause of ARTI in patients aged 50 years. Influenza virus B was the most common cause of ARTI in patients aged 5-50 years. Conclusion: Our study provides baseline information on the epidemiologic and clinical feature of outpatients with ARTIs in Isfahan city. Though our findings in this pilot study could be helpful in diagnosis, treatment, and prevention of ARTI, planning preventive interventional.