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Background: Brucellosis, especially if caused by Brucella melitensis, remains one of the most common zoonotic diseases worldwide with more than 500,000 human cases reported annually. In Iran, brucellosis was first recognized in 1932 and control of small ruminant brucellosis began in 1963. The aim of this study is to give an overview of the National Sheep and Goat Brucellosis Control Program in Iran. Materials and Methods: In this cross-sectional study, data were collected from Iran Veterinary Organization over a period of 45 years. The national control program was based on kid and lamb vaccination and testing and slaughtering infected animals. Results: B.melitensis biotype I in sheep, goat, and man was the predominant local infective biotype. This disease was reported in sheep, goat, cattle, horse, camel, and human. In addition, the prevalence of small ruminant brucellosis was estimated around 2.1%. Conclusion: Prevention of brucellosis is dependent upon increasing public awareness of ranchers through health education programs and more active co-operation between health and veterinary medicine organizations as well as animal movement control in the borders.

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Background: Brucellosis is one of the most common zoonotic diseases in the world which imposes a great financial burden on the endemic regions. Diagnosis of the human brucellosis is mainly based on blood culture and serological tests. PCR, however, is recommended for diagnosis at greater specificities and sensitivities. This study aims to compare the diagnosis of human brucellosis by PCR method using l7/l12 and 16srRNA genes and serological tests. Materials and Methods: In a cross-sectional study, a total of 700 blood samples were collected from patients suspected to brucellosis who had referred to the hospitals and laboratories of Ilam, Iran. The samples were selected through Rose Bengal test. Then 50 positive samples diagnosed by Rose Bengal test were assayed by Wright, Coombs Wright, and PCR using l7/l12 and 16srRNA genes and 50 negative samples diagnosed by PCR using these two genes were tested. Results: Of the total 700 samples assayed by Rose Bengal test, 125 were positive and the rest 575 were negative. The 50 positive Rose Bengal samples in PCR were shown to be positive by both genes and 50 negative Rose Bengal samples were shown negative by both samples. 47 samples in Wright test and 49 samples in Coombs test had titration levels above 1:60. Conclusion: PCR method has a higher sensitivity and specificity in diagnosis of human brucellosis in comparison with serological tests. Sensitivity of PCR by l7/l12 gene is similar to16srRNA and can be used for diagnosis of human brucellosis.

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Background: Guillain-Barré syndrome (GBS) has several variant signs and it often presents as an acute monophasic paralyzing illness provoked by a preceding infection. Campylobacter jejuni infection is the most commonly identified cause of GBS while cytomegalovirus, Epstein-Barr virus, and human immunodeficiency virus (HIV) infections have also been associated with GBS. Case: A 55-year-old villager man who was an animal keeper was admitted to Vali-Asr Hospital with symptoms of general weakness, fever, and night sweats. With positive serology of brucellosis (Wright=1:1280, 2ME =1:640), the patient was treated with rifampin, doxycyclin, and tereptomycin (1g/daily). Having received 9 injections of streptomycin, with weakness in the right extremity, the patient was hospitalized. Brain MRI and CT-Scan were reported normal. Within two days, however, the extremity weakness progressed and spread to 4 extremities (2.5 at the proximal and 3.5 in the distal). Generalized areflexia occurred and, three days later, impaired swallowing and facial weakness ensued. Streptomycin was discontinued upon admission. EMG indicated acute and severe demyelinating polyradiculoneuropathy. CSF analysis confirmed Guillain Barre Syndrome while Wright test for CSF was negative. The patient was admitted to the ICU and underwent intubation with progressed paralysis of four limbs, the patient died in 8 days after hospitalization. Conclusion: In endemic areas, brucellosis should be considered in patients with Guillain Barre syndrome.

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Background: Brucellosis is a zoonotic disease in humans and animals that its control is dependent on the prevalence of diseases in animal populations. The purpose of this study was to compare the sensitivity and specificity of common diagnostic tests for brucellosis. Materials and Methods: In an analytical cross-sectional study, 297 serum samples from an infected herd that had a history of abortion were prepared and evaluated through standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests. In addition, microbial culture was done for positive serum samples, lymph nodes, and infected organs. Results: Based on the total 297 serum samples tested, the sensitivities for standard tube agglutination, Rose Bengal, 2-Mercaptoethanol, complement fixation, and ELISA tests were 89, 81.5, 75.3, 89.7, and 93.2% , whereas specificities were determined to be 97.4, 94, 96, 98, and 99.3%, respectively. Conclusion: The findings of this study show that the standard tube agglutination test, complement fixation test, and ELISA are more sensitive than other tests. Moreover, ELISA test was the most sensitive and specific serological test for diagnosis of brucellosis in the present study

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Background: Brucellosis is a zoonotic disease which is endemic in Iran. Infection with brucella species during pregnancy can have negative impacts on the outcome of pregnancy however, there is no consensus on its leading to abortion or other severe complications. The aim of the present study is to determine the role of brucellosis in pregnancy and to characterize the risk factors, clinical presentations, and immunology of brucellosis based on the existing reports. Materials and Methods: In this review article, we studied papers on Pubmed, Elsevier, Cohrane, SID, Ovid, ISC, and IranMedex through such keywords as brucellosis, abortion, intra-uterine fatal diseases, and preterm labor. Results: Among the original research papers, 51 were found to be related to the title of this study and dealt with the outcome of brucellosis on pregnant women and had discussed the complications of pregnant patients suffering from brucellosis. Conclusion: According to the investigations made in this study, brucellosis in pregnancy can manifest as normal delivery, increased incidence of spontaneous abortion, intra-uterine fatal diseases, and premature delivery. Therefore, in endemic areas, especially those with inhabitants of low socioeconomic class, educating girls and women of childbearing age about brucellosis and its dangers and risk factors and isolating pregnant women may help prevent the disease and its complications in pregnancy. Moreover, further immunological investigation on the role of immunological reactions following brucellosis infection in pregnant women is required.

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Background: Low immunogenicity of hepatitis B vaccine is an important problem in patients with chronic renal failure (CRF). A possible solution is intradermal versus conventional intramuscular delivery of vaccine in this population. The goal of this study was to compare the efficacy of these routes of vaccination in Bu-alicina Dialysis Center, Qazvin, Iran. Materials and Methods: This randomized clinical trial was done on 29 CRF non-responders randomly allocated to two groups. Fifteen patients received 40 μg of euvax B vaccine intradermally and 14 patients received 160 μg of this vaccine intramuscularly. Anti-HBs antibody titre was measured after 1, 6, and 12 months. Seroprotection was defined as anti-HBs antibody titre above 10 lU/L. Data were analyzed using SPSS software version 16. Results: Difference of seroprotection rate between two groups was not statistically significant after1and 6 months however, after 12 months, seroprotection rate was 93.3% in the interadermal group versus 50% in the intramuscular group (p<0.05). Conclusion: Considering the high cost of vaccination, intradermal vaccination may be a reasonable choice in CRF patients.

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Background: Nowadays, one of the basic problems of tuberculosis treatment is drug resistance. This study was done to determine the drug resistance of mycobacterium strains isolated from patients with pulmonary tuberculosis to anti-tuberculosis drugs and determine the affecting factors. Materials and Methods: In a cross-sectional study, all patients with tuberculosis who were covered by Markazi Province Health Center (917 persons) during 2005 to 2010 were included in this study. For all patients with resistant pulmonary tuberculosis, culture and antibiogram by standard method (proportional) were done. Effective factors in drug resistance were identified by logistic regression model using SPSS software. Results: Overall, the rate of resistance in patients with smear-positive was 7.3% and the rate of MDR-TB was equivalent to 4.3%, and 0.5% of smear positive patients were resistant to all five drugs. The most resistant strains were isoniazid (68.8%), rifampin (62.5%), pyrazinamide (25%), ethambutol (21.9%), and streptomycin (21.9%), respectively. The highest rate of resistance was in the 15-45 years age group. The incidence of resistance was significantly associated with sex, grade of smear positivity, relapse of TB, and HIV infection. Conclusion: The study of drug resistant mycobacterium strains over six years showed a growing trend. Therefore, close attention to prevent the production and dissemination of resistant strains is very essential.

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Background: Pseudomonas aeruginosa is a human opportunistic pathogen which is considered one of the agents causing nosocamial infection. Recent studies have reported increased resistance of Pseudomonas aeruginosa to imipenem. The aim of this study was to determine resistance to antipseudomonal antibiotics including imipenem in Pseudomonas aeruginosa strains. Materials and Methods: In this cross-sectional study, 100 Pseudomonas aeruginosa strains obtained from clinical samples of patients in hospitals in Arak, Iran, were identified and isolated through microbiological methods, including Gram staining, oxidase test, Indol test, and oxidative-fermentative test. Then antibiotic susceptibility test was performed for imipenem, meropenem, gentamicin, amikacin, ciprofloxacin, and ceftazidime by disk diffusion method according to NCCLS (National Committee for Clinical Laboratory Standards) .Minimum inhibitory concentration (MIC) was done for determining imipenem-resistant strains Results: Antibiotic susceptibility test showed that resistance rates to imipenem, meropenem, gentamicin, amikacin, ciprofloxacin, and ceftazidime were 35%, 35%, 14%, 9%, 23% and 15%, respectively. Also, MIC test showed that 30 strains were resistant to imipenem, 27 to ceftazidime, 35 to cefepime, and 35 to ciprofloxacin. Conclusion: The results of this study indicated a high rate of antibiotics resistant of Pseudomonas aeroginosa strains to different antibiotic groups. Therefore, new and more effective methods should be found for controlling Pseudomonas infections and preventing the outbreak of its antibiotic-resistant strains.

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Background: Brucellosis is one of the most common zoonotic diseases in Iran. In most cases, the diagnosis of brucellosis is difficult not only because of its clinical similarity to many infectious and noninfectious diseases, but also because diagnostic methods often fail to detect organisms. PCR is a rapid and safe diagnostic method applied to the diagnosis of brucellosis. The purpose of this study was to determine the sensitivity and specificity of PCR for diagnosis of human brucellosis by using serum samples. Materials and Methods: This study which was done to evaluate diagnostic tests included30 serum samples from patients with clinical presentation of brucellosis with positive Wright test and serum samples of30 healthy people with negative Wright test. These samples were examined by PCR. Results: PCR results were positive for 15 samples of the patients group in comparison with 4 samples from the 30 healthy subjects. The sensitivity and specificity of PCR were 50% and 86.6%, respectively. Conclusion: Although in some studies, the preferred sample for diagnosis of brucellosis was serum, in this study, PCR on serum samples did not indicate high sensitivity and specificity in diagnosis of brucellosis. Hence, using a combination of methods for diagnosis of human brucellosisis suggested.

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Background: Chronic hepatitis B virus (HBV) infection is a multi-factorial disease that is accompanied with serious clinical complications. Host’s genetic background, especially immune–genetic factors, is critical in the pathogenesis of infection. Gamma interferon ((INF-γ) and its receptor have an important role in immune response to the virus and clinical course of the disease. The aim of this study is to investigate the association between single nucleotide polymorphism -611G/A located in promoter of gamma interferon receptor1 gene (INFGR1) and chronic HBV infection. Materials and Methods: In this Case Control study, genomic DNA from peripheral blood samples of 150 chronically HBV infected patients and 150 healthy controls was extracted by phenol-chloroform method. DNA analysis was performed by PCR-RFLP method and P<0.05 was considered significant. Results: After stages of genotyping and statistical analysis, a significant difference was observed between patient and control group, so that genotype GG was higher in the control group compared to the patient group. Conclusion: The host’s immune-genetic background can play an important role in the pathogenesis of infectious disease. Variations in INFGR1 were related to several diseases. The results showed that the presence of GG allele is accompanied by a decrease in susceptibility to chronic HBV infection.

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Background: Influenza type A virus is one of the most important viral agents in human respiratory diseases. The genetic variability of the influenza viruses leads to the incidence of new epidemics worldwide. Hence, there is a growing need for rapid and effective new methods capable of detection and differentiation of influenza virus circulating strains. This study was done to develop a method for rapid differentiation of the subtypes of influenza type A virus. Materials and Methods: In this experimental study, reverse-transcription and polymerase chain reaction (RT-PCR) were performed using a primer set based on M gene of H1N1, H3N2, H5N1, and H9N2 influenza subtypes. Then the amplified fragments were subjected to digestion using subtype specific restriction endonuclease enzymes. Results: The results of PCR reaction showed that the primer pair of the M gene was specific and capable of amplifying all influenza subtypes understudy. Also, different restriction fragment length polymorphism patterns (RFLP) were generated using enzyme digestion reaction on the amplified segment of M gene. Conclusion: RT-PCR and RFLP analysis of the M gene can be employed as a useful method for differentiating influenza virus subtypes

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Background: There are few investigations about the possibility of cyst production in human via accidental entrance of protoscoleces in ways other than cyst rupture in intestines. The objective of this study is to investigate the possibility of cyst production by cutaneous erosion, peritoneal injection, and oral inoculation in mice. Materials and Methods: In this experimental study, infected livers featuring hydatid cysts were collected from abattoir. Protoscoleces were examined for viability and lack of bacterial infection and washed 3 times by PBS. Protoscoleces were flown on the scratched skin, injected peritoneally, and inoculated orally to three groups (n=15) of mice. After 4 months, the mice were dissected and their skin and visceral were subjected to microscopic analysis. ELISA test for hydatidosis was also run for all of the groups. Results: All the mice were negative by ELISA test except the mice of peritoneum injection group which were positive with an average titer of 11.92±0.80 by ELISA. Only two mice had cysts on the peritoneum in the peritoneal injection (PI) group with an average size of 3mm. Cysts, however, were not observed in the other groups. Conclusion: The results of this study indicate that protoscoleces flow over scratched skin and oral inoculation do not produce hydatid cyst however, peritoneal implant of protoscolex can result in hydatidosis in mice.

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Background: Mycobacterium Tuberculosis usually infects the lungs but organs other than the lungs may also be involved. This study is an analysis of the situation of extra-pulmonary tuberculosis in the central province of Iran.

Methods and Materials: In this cross-sectional study, the information in the registration software of tuberculosis in health centers collected and for analyzing of data statistical software SPSS16 was used.

Results: In the survey a total of 1787 TB patients were identified, of which 24.2% were diagnosed with extra-pulmonary tuberculosis and 1.9% of patient with extra-pulmonary TB were associated with HIV infection. Female to male sex ratio is equal to 1.3. The 82.5% of the patients were Iranian citizen and mean age of patients were 43.3 years. Tuberculosis of the lymph nodes, skletal and pleural tuberculosis had the highest prevalence. Also extra-pulmonary tuberculosis in females, age 15-55 was more and the diagnosis delay was more in extra-pulmonary tuberculosis and relapse was more in pulmonary tuberculosis.

Conclusion: Because of more diagnosis delay in extra-pulmonary tuberculosis it is necessary to train physicians and other healthcare workers in the field of extra-pulmonary TB diagnosis and more planning to do about learning of it.

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Background: The emergence of drug-resistant strain of M.tuberculosis is one of the most critical issues facing TB researchers and clinicians. Rapid diagnosis of drug-resistant tuberculosis is essential for the prompt initiation of effective second-line therapy to improve treatment outcome and limit transmission of this obstinate disease. The aim of this study is to develop a Real-time PCR assay for the detection of mutations in RRDR (rifampcin resistance determinant region) of rpoB which conferring rifampicin resistance in Mycobacterium tuberculosis.

 Materials and Methods: In this experimental study, the primer and probe set were designed for a RRDR region of rpoB gene using a specialized software. Clinical specimens that had previously been evaluated resistant or sensitive by using convential method, were used for assessing the clinical sensitivity and specificity of the assay.

Results: The clinical sensitivity of the assay was determined 100%. The primers and the probes were rpoB specific and no cross-reaction was observed with other microorganisms and human genome bioinformatically. The clinical specificity of developed Real-time PCR assay was examined experimentally using 25 negative samples and determined to be 100%.

Conclusion: The developed real-time PCR assay can be used as an appropriate and efficient tool for the rapid detection of rifampicin-resistant Mycobacterium tuberculosis.

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  Background: Due to the lack of efficient anti-HIV vaccine, anti-HIV pharmaceuticals play an important role in controlling HIV infection. Also significant rise in drug resistance and drug toxicity has caused increased interest in finding new anti-HIV agents. In this study, a nano-sized version of lamivudine based on PEGylated chitosan was synthesized.

  Materials and Methods: In this research, nanoparticles of chitosan were efficiently PEGylated for increasing their stability in water and then the anti-HIV drug, lamivudine, was loaded on these PEGylated nanoparticles. After purification and lyophilization of new synthesized nanoparticle, the raw materials and final product were sampled and FTIR, HNMR and CHN analyses were done.

  Results: Results of HNMR spectroscopy showed that chitosan nanoparticle was successfully PEGylated. HNMR data confirmed FTIR results and indicated that lamivudine was conjugated on chitosan nanoparticle. In addition, CHN analysis data also confirmed both HNMR and FTIR data, and demonstrated that a high yield of chitosan nanoparticle PEGylation (approximately 97%) was done and illustrated a high capacity of lamivudine conjugation on nano-sized PEGylated chitosan (30% _W/W chitosan).

  Conclusion: In this study, lamivudine drug was successfully synthesized, based on PEGylated chitosan nanoparticle.

 

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Background: Survey and control of nosocomial infections in the world is a global priority that The objective is to minimize infections in addition to decreased length of hospitalization And also significantly reduce the cost of health care .The aim of this study was evaluating the knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection.

Materials and Methods: This Cross-sectional and analytical study that was carried out on 130nursing staff selectedin in Arak university of medical sciense in 2013. Data collected with validity and reliebility questionnaire including of knowledge, self-efficacy and Practice of nursing staff in Disciplines Standard Precautions in order to prevention of nosocomial infection. Data was analyzed by using descriptive and analytical statistical methods and pearson correlation.

Results: The mean knowledge was 46.92±14.66 and Practice 49.46±6.96 and average self-efficacy was 52.2±10.81 about infection prevention. There was not significant relationship between knowledge and Practice. But there was a significant relationship between self-efficacy, knowledge and Practice and marriage. Moreover there was a significant relationship between knowledge and gender. (p<0.05).

Conclusion: Despite moderate self-efficacy majority of Nurses do not have appropriate knowledge about prevention of nosocomial infection based on the findings of this study. Considering the important role of nurses in nosocomial infection prevention, training is necessary to increase nurses prevention behaviors. Therefor paying more attention by authorities to apply the necessary actions for training of nurses.

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Background: According to the studies, Iran’s per capita antibiotic consumption is remarkable. Since the emergence of Antibiotic Resistant Organisms (AROs) is considered a global problem in the community and hospitals, this study aimed to investigate the pattern of antibiotic resistance in Gram-negative bacteria isolated from patients in an academic and a non-academic hospital in Arak, Iran.

Materials and Methods: This descriptive cross-sectional study included all specimens referred to the microbiology laboratory at Amir Al-Momenin Hospital (academic hospital) and Imam Khomeini Hospital (non-academic hospital) in a one-year period from June 2012 to June 2013. The susceptibility of the isolated Gram-negative bacteria against the important antibiotics used in clinical practice was determined using the disk diffusion method.

Results: A total of 846 specimens were collected from patients in the two hospitals where 520 (61.5%) were Gram-negative bacteria, of which 63.3% were E. coli. The prevalence of Gram-negative organisms in the academic and the non-academic hospital was measured 79.8% and 20.2%, respectively (p=0.097). It was also determined that there is a significant difference between the two hospitals in the prevalence of ESBL (Extended-Spectrum Beta-Lactamase) Gram-negative bacteria (p=0.003).

Conclusion: There was a significant difference between the two hospitals in the prevalence of ESBL Gram-negative bacteria. Therefore, conducting regional surveillance programs to examine the patterns of antibiotic resistance is recommended.

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Background: The Infections that are related to vascular access, are regarded as Important factor in mortality and morbidity in the patients with immune deficiency including hemodialysis patients. Staphylococcus aureus is the most common and most Important organism involved in this regard and it cause bacteremia and its complications in the patients is important. This organism can cause carriage states and its most frequent carriage source is in the nose. The aim of this study is determination of staphylococcal carriage states in the Zanjan hemodialysis patients and control group.

Materials and Methods: This cross sectional study is designed in the patients with chronic renal disease who were referred to the hemodialysis wards. Nasal samples were collected with sterile swabs. Then they were inoculated in the blood agar culture media and incubated at (35-37) degree for (24-48) hours. This method was taken for control group too. The collected data were analyzed with SPSS and Chi-Square statistically methods.

Results: Based on this study, 7.4 percent of patients and 11.1 percent of the control group were nasal carriers of staphylococcus aureus. The results did not show any meaningful statistically difference between the cases and control groups. But a meaningful statistically difference was observed in the Staphylococcus hemolyticus carriages and the nasal carriage of this organism was more common in the women of case group.

Conclusion: Based on our study, we don't find high prevalence rate of nasal staphylococcus aureus carriage among our case group, and It seems this organism isnot an important agent in our hemodialysis wards.

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Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Although occult HCV infection is less aggressive than classic chronic HCV infection, nevertheless it is important in management of hemodialysis (HD) patients. Occult HCV infection has been described in two different clinical settings: in patients with normal liver enzymes or in patients with abnormal values of liver enzymes. The aim of this study was to detect the occult HCV infection in hemodialysis patients with elevated liver enzymes.

Materials and Methods: This cross sectional study was performed in hemodialysis patients referring to 3 dialysis units in Tehran. In 30 anti-HCV negative HD patients with elevated liver enzymes, presence of HCV-RNA in plasma samples was tested by Reverse Transcriptase-Nested Polymerase Chain Reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, HCV-RNA was checked in PBMC specimens by RT-nested PCR.

Results: A total of 30 HD patients with mean age 54.4± 14.1years and mean dialysis duration 81.2 ±64.4 months were enrolled in the study. All HD subjects were negative for HCV-RNA in plasma and occult HCV infection with RT-nested PCR method.

Conclusion: Occult HCV infection was rare in HD patients with elevated levels of liver enzymes.

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Background: The importance of maintaining and enhancing the quality of life in (tuberculosis TB) patients is essential. The purpose of this study was to use N - acetylcysteine to improve the quality of life in patients with tuberculosis.

Materials and Methods: This study is a double-blind clinical trial that performed on 88 patients on anti-TB treatment that aged over 50 years in the central province of Iran within 15 months. Data collection tools included a demographic questionnaire and the Short Form Quality of life (SF12). Data were analyzed using SPSS software and t-test, Chi-square, Mann-Whitney, ANOVA and Pearson correlation analysis were used. p less than 0.05 was considered significant.

Results: This study showed that the two groups before the intervention in different features were not significantly different, but in quality of life at the end of the first month. The intervention group compared with the control group in physical subscale score (p=0.0068) and psychological subscale scores (p=0.0284) and quality of life score (p=0.0112) were better. Also, our study showed that age of patients (p=0.0331), duration of disease (p=0.0416), and serum CRP mean (p= 0.0234) and type of tuberculosis (p=0.0372) were significantly related to total score of quality of life at the end of the first month in the intervention group.

Conclusion: According to this survey results we hoped to combine the use of adjuvant therapy with N-acetylcysteine and standard tuberculosis treatment improves quality of life and increase life expectancy of patients.