BackgroundHepatitis B virus (HBV) infection is a major health problem worldwide.ObjectivesThe aim of this study was to investigate the frequency of occult hepatitis B infection (OBI) and its associated risk factors, together with the molecular characterization of the virus in injecting drug users of Tehran.Patients and MethodsThe study consisted of 229 injecting drug users. Serum samples were collected and tested for the presence of hepatitis B core antibody (HBcAb) and hepatitis B surface antigen (HBsAg) by an enzyme-linked immunosorbent assay (ELISA). HBV B virus DNA was extracted from the serum samples, and a fragment of the S gene was amplified using the nested polymerase chain reaction. The genotype, subgenotypes, subtype, and S gene mutation of HBV were determined by direct sequencing. A phylogenetic tree was constructed using the neighbor-joining method.ResultsSixty-four (28%) participants were HBcAb positive, 59 cases were HBcAb positive and HBsAg negative, and 5 cases were HBsAg positive. Hepatitis B DNA was found in three HBsAg-positive cases. Thirteen of 59 (22%) individuals were hepatitis B DNA positive. The phylogenetic tree of hepatitis B DNA showed the existence of genotype D. The only significant correlation was between sharing a syringe and OBI.ConclusionsIn comparison with the rate of HBcAb positivity reported in other Iranian studies, the rate was higher in the present study. There were a few variations, genotypes, and subtypes among the infected injecting drug users. Further investigations are needed to unravel the molecular characterization of OBI.
BackgroundSevere acute respiratory syndrome (SARS) coronavirus-2 may infect red blood cells (RBCs) and impact oxygenation. We aimed to evaluate the efficacy of RBC exchange as an adjunctive treatment for hypoxemia and the survival rate of patients with severe coronavirus disease 2019 (COVID-19).MethodsIn a randomized clinical trial, we divided sixty patients with severe COVID-19 into two groups. The intervention group received the standard treatment of severe COVID-19 with RBC exchange three to four times in 2 days. The control group only received the standard treatment. Our primary outcomes were improving hypoxemia in 7 days, recovery or discharge, and death in 28 days. We conducted Chi-square test, independent samples t-test, and Fisher’s exact test to analyze the results. The ethical committee of Aja University of Medical Sciences approved the study (IR.AJAUMS.REC.1399.054), and the Iranian clinical trial registration organization registered it (IRCT20160316027081N2).ResultsTwenty-nine men and thirty-one women with a mean age of 67.5 years entered the study. The frequency of hypertension and diabetes mellitus was 86.7 and 68.3%, respectively. The most common symptoms of severe COVID-19 were dyspnea (91.6%), cough (75%), and fever (66.6%). Our results showed that hypoxemia improved in 21 of the 30 patients (70%) in the intervention group and 10 of the 30 patients (33.3%) in the control group (P < 0.004). The recovery and discharge rates were 19 of 30 patients (63.3%) in the intervention group and 2 of 30 patients (6.7%) in the control group (P < 0.001).ConclusionThe RBC exchange improved the oxygenation and survival rate in patients with severe COVID-19.
Background: Exposure to hepatitis B virus (HBV) or human immunodeficiency virus (HIV) infection is common among hepatitis C virus (HCV)-infected Intra venous drug users (IVDUs); however there exist only a few data about frequency and risk factors of HCV, occult HBV infection (OBI) and HIV among IVDUs. Objectives: This study aimed to investigate the prevalence and associated risk factors for OBI and HIV infections among Iranian HCV infected IVDUs. Methods: Serum samples were screened for the presence of hepatitis C virus antibody (HCVAb), hepatitis B core antibody (HBcAb), hepatitis B surface antigen (HBsAg), and human immunodeficiency virus antibody/antigen (HIVAb/Ag) using enzyme linked immunosorbent assay (ELISA). For detection of OBI, presence of HBV DNA among HBcAb positive/HBsAg negative subjects was determined using nested polymerase chain reaction (PCR). Results: Among all subjects, 94 cases (53.5%) were positive for HCVAb from which 7% and 23.4% were positive for HCV/OBI and HCV/HIV co-infections, respectively. A significant association existed between HCVAb with type of drug, sharing syringes and needles and a history of imprisonment. In the case of HCV/OBI co-infections, the only significant correlation was between sharing a syringe and occult hepatitis B infection. Also no significant association existed between risk factors and HCV/HIV co-infections. Conclusions: the present data documented an alarming prevalence of HCV and HIV as well as co-infections among IVDUs, which emphasizes the requirement for expansion of public health interventions for this at-risk population. Despite previously high prevalence reported for HCV/HBV/HIV triple infections among IVDUs, low prevalence of triple HCV/OBI/HIV infections was obtained. The reason for this difference may be related to the effect of HCV on HBV expression in case of OBI which had been suggested previously.
Background Fever is the most frequent reason for medical consultation in children, and makes up 15–25% of all consultations in primary care and emergency departments. In here we report a case of a 13 year-old girl who referred with an unusual presentation of fever and was misdiagnosed with recurrent urinary tract infection for 8 years. Case presentation This is a Clinical Reasoning Cycle case study. A 13 year-old girl was referred with a chief complaint of recurrent fevers from 8 years. During her first febrile episode, she had a 5-day high-grade fever associated with loss of appetite. Her physical examination at that time was unremarkable. Blood tests showed leukocytosis with a shift to the left and urine examination was in favor of pyuria. The urine culture was positive for bacterial growth. The episodes of fever were repeated every 45 days. Accordingly, the patient was diagnosed as a case of recurrent urinary tract infection. In the intervals between her febrile episodes, the patient was healthy and laboratory tests were normal. Ultrasonography, voiding cystourethrogram and dimercaptosuccinic acid scans were normal. During her last visit, the patient mentioned difficulty in swallowing and on examination cervical lymph nodes, exudative tonsillitis and painful aphthous stomatitis were detected. All antibiotics were stopped and corticosteroids were started. The patient’s symptoms were relieved and the interval between her febrile episodes became longer. Conclusions Our study shows that a patient should never be marked, particularly when the symptom and signs aren’t completely justifying a patient’s condition.
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