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Genome-wide association studies (GWASs) have identified hundreds of loci associated with Crohn's disease (CD). However, as with all complex diseases, robust identification of the genes dysregulated by noncoding variants typically driving GWAS discoveries has been challenging. Here, to complement GWASs and better define actionable biological targets, we analyzed sequence data from more than 30,000 patients with CD and 80,000 population controls. We directly implicate ten genes in general onset CD for the first time to our knowledge via association to coding variation, four of which lie within established CD GWAS loci. In nine instances, a single coding variant is significantly associated, and in the tenth, ATG4C, we see additionally a significantly increased burden of very rare coding variants in CD cases. In addition to reiterating the central role of innate and adaptive immune cells as well as autophagy in CD pathogenesis, these newly associated genes highlight the emerging role of mesenchymal cells in the development and maintenance of intestinal inflammation.Large-scale sequence-based analyses identify novel risk variants and susceptibility genes for Crohn's disease, and implicate mesenchymal cell-mediated intestinal homeostasis in disease etiology.

Åsa H Everhov, 1, 2 Michael C Sachs, 2 Jonas F Ludvigsson, 3, 4 Hamed Khalili, 2, 5 Johan Askling, 2 Martin Neovius, 2 Pär Myrelid, 6, 7 Jonas Halfvarson, 8 Caroline Nordenvall, 9, 10 Jonas Söderling, 2 Ola Olén 1, 2, 11on behalf of the SWIBREG study group 1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; 2Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 4Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; 5Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 6Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 7Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden; 8Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 9Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 10Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden; 11Department of Pediatric Gastroenterology and Nutrition, Sachs’ Children and Youth Hospital, Stockholm, SwedenCorrespondence: Åsa H EverhovDepartment of Surgery, Stockholm South General Hospital, Stockholm SE 118 61, SwedenTel +46 8 616 2349Email asa.hallqvist-everhov@ki.sePurpose: Patients with Crohn’s disease have increased work loss. We aimed to describe changes in work ability in relation to pharmacological and surgical treatments.Patients and Methods: We linked data from the Swedish National Patient Register, The Swedish Quality Register for Inflammatory Bowel Disease SWIBREG, The Prescribed Drug Register, The Longitudinal Integrated Database for Health Insurance and Labour Market Studies, and the Social Insurance Database. We identified working-age (19– 59 years) patients with incident Crohn’s disease 2006– 2013 and population comparator subjects matched by sex, birth year, region, and education level. We assessed the number of lost workdays due to sick leave and disability pension before and after treatments.Results: Of 3956 patients (median age 34 years, 51% women), 39% were treated with aminosalicylates, 52% with immunomodulators, 22% with TNF inhibitors, and 18% with intestinal surgery during a median follow-up of 5.3 years. Most patients had no work loss during the study period (median=0 days). For all treatments, the mean number of lost workdays increased during the months before treatment initiation, peaked during the first month of treatment and decreased thereafter, and was heavily influenced by sociodemographic factors and amount of work loss before first Crohn’s disease diagnosis. The mean increase in work loss days compared to pre-therapeutic level was ∼ 3 days during the first month of treatment for all pharmacological therapies and 11 days for intestinal surgery. Three months after treatment initiation, 88% of patients treated surgically and 90– 92% of patients treated pharmacologically had the same amount of work loss as before treatment start. Median time to return to work was 2 months for all treatments.Conclusion: In this regular clinical setting, patients treated surgically had more lost workdays than patients treated pharmacologically, but return to work was similar between all treatments.Keywords: inflammatory bowel disease, sick leave, disability pension, TNF inhibitor, aminosalicylate, immunomodulator

Elaheh Kordzadeh-Kermani,1 Hossein Khalili,1 Iman Karimzadeh,2 Mohammadreza Salehi3 1Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 3Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, IranCorrespondence: Hossein KhaliliDepartment of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, P.o. Box 14155/6451, Tehran, IranTel/Fax +98 216 695 4709Email khalilih@tums.ac.irAbstract: The introduction of biologic and targeted immunomodulators is a significant breakthrough in the therapeutic area of various fields of medicine. The occurrence of serious infections, a complication of secondary immunosuppression associated with these agents, leads to increased morbidity and mortality. Implementing preventive strategies could minimize infection-related complications and improve therapeutic outcomes. The purpose of this review is to focus on current evident approaches regarding screening, monitoring, preventing (immunization and chemoprophylaxis), and management of infections in patients who are candidates for about 70 biologic and targeted immunomodulators. Recommendations are based on relevant guidelines, especially the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document series published in 2018.Keywords: biologic immunomodulators, targeted immunomodulators, immunization, chemoprophylaxis

Genome-wide association studies (GWAS) have identified hundreds of loci associated with Crohns disease (CD), however, as with all complex diseases, deriving pathogenic mechanisms from these non-coding GWAS discoveries has been challenging. To complement GWAS and better define actionable biological targets, we analysed sequenced data from more than 30,000 CD patients and 80,000 population controls. We observe rare coding variants in established CD susceptibility genes as well as ten genes where coding variation directly implicates the gene in disease risk for the first time.

Antibody-based medicines that target vascular endothelial growth factor (VEGF) are administered by intravitreal injection to treat chronic neovascular retinal diseases. Much ongoing effort is focused on enhancing therapeutic outcome of these medicines. One strategy is the use of dual acting drugs (e.g. bispecific antibodies) to simultaneously bind to more than one intraocular biological target. A dual acting molecule targeting components within the vitreal cavity could also potentially extend vitreous residence time. In this review, the applications of bispecific antibodies within the eye are described with consideration to potential targets, applications and suitable bispecific formats.

Effat Davoudi-Monfared, Hossein Khalili Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Abstract: Data on the status of carbapenem-resistant microorganisms in the Middle East countries are scarce. The aim of this review was to collect available data regarding resistance to carbapenems in a Middle East region. Available data regarding carbapenem-resistant isolates were considered for evaluation in this review. Biomedical electronic databases were systematically searched to find related articles. The key terms used were “carbapenem-resistant, resistant gram-negative bacilli, Enterobacteriaceae, fermenting and non-fermenting gram-negative bacilli, Pseudomonas, Acinetobacter, Klebsiella and Iran”. After primary screening, 275 relevant articles were selected to be assessed thoroughly. Resistance rate to carbapenems was reported between 1% and 86% during years 2006–2018. Most of the carbapenem-resistant microorganisms were isolated from burn patients. Modified Hodge test was a commonly used phenotypic test. Only in few studies, genotypic assays were considered. Pattern of antibiotic use can affect emergence of resistant microorganisms. Rational use of drugs, and specifically, antibiotics is a challenging issue in developing countries. Mean number of drugs per prescription in these countries was higher than the World Health Organization standards. Overuse of antibiotics, especially injectable ones, and easy access to antibiotics without prescription is a warning alarm for future antibiotic resistance in developing countries. Establishing antimicrobial stewardship’s programs is new in the hospitals. Unfortunately, rules and regulatory issues to restrict antibiotic access in community pharmacies and prescription by general physicians are limited. Keywords: carbapenem, resistant, gram-negative bacteria, antibiotics

Jacket platforms are redundant structures. Therefore, reliability analysis at system level is more applicable than at component level. Conventionally, system reliability analysis is estimated based on either fatigue loading or extreme environmental loading. The purpose of this study is to perform the structural reliability analysis of a jacket platform under both fatigue and extreme loading. In this study the fatigue limit state is defined based on the crack size, which is obtained by a fracture mechanics approach. The probability of failure for each component is calculated by using Monte-Carlo simulation. Important failure paths are identified by using a searching process. The system failure criterion is evaluated by comparing the platform strength and loading distributions in terms of base shear. In order to define a probabilistic formula for load, a global response surface method is adopted to relate the wave height to the response of the structure. A pushover analysis is also carried out to determine the capacity of the platform. Having calculated the structure strength and loading distributions, the annual probability of failure under extreme wave is calculated and compared to the tolerable probability of failure or target reliability. An application of the approach is presented.

In this study demographic, clinical, paraclinical, microbiological, and therapeutic features of patients with community-acquired acute bacterial meningitis admitted to a referral center for infectious diseases in Iran, have been evaluated. Medical records of adult (> 18 years) individuals with confirmed diagnosis of community-acquired bacterial meningitis during a 4-year period were retrospectively reviewed. All required data were obtained from patients’ medical charts. Available findings about antimicrobial susceptibility of isolated bacteria from CSF and/or blood were also collected. Kirby-Bauer disc diffusion method was used to determine their antimicrobial susceptibility profile. Details of medical management including antibiotic regimen, duration, patients’ outcome, and possible sequelae of meningitis were recorded. The most commonly isolated microorganism from CSF or blood of patients was Streptococcus pneumonia (33.33%) followed by Neisseria meningitidis (27.78%) and Haemophilus influenza (16.67%). The most common antimicrobial regimen was ceftriaxone plus vancomycin (69.44%) followed by ceftriaxone plus vancomycin plus ampicillin (11.11%). Neurological sequelae of meningitis including cranial nerve palsy, deafness, and hemiparesis were identified in 4 (11.11%), 2 (5.56%), and 1 (2.78%) subjects, respectively. Regarding mortality, only 3 (8.33%) patients died from bacterial meningitis and the remaining 33 individuals discharged from the hospital. In conclusion, findings of the current study demonstrated that the mean incidence of acute bacterial meningitis in a referral infectious diseases ward in Iran was 9 episodes per year. The majority cases of community-acquired acute bacterial meningitis admitted to our center had negative CSF culture and classic triad of meningitis was absent in them.

Objective: Based on Pittsburg Sleep Quality Index, it has been reported that most human immunodeficiency virus (HIV) positive patients suffer from various degrees of sleep problems. Sleep disorders can affect quality of life, physical and social functioning and can also cause chronic fatigue. Some psychological and physiological factors are related to sleep quality. The purpose of the present study was to evaluate sleep quality and its related psychological and physiological factors in Iranian human immunodeficiency virus positive patients who were candidates for initiation of antiretroviral therapy . Method: This was a cross- sectional study of 59 HIV positive out-patients in stages 2 or 3 of HIV disease who were candidates for initiation of antiretroviral therapy. Pittsburg Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS) and Somatization Subscale of Symptom Checklist 90 (SCL-90) were used to assess the patients’ sleep quality, depression, anxiety and physiological factors, respectively. SPSS software version 12 was used for data analysis. The Pearson correlation coefficient was utilized to analyze the correlation between PSQI and other quantitative variables. Results: Based on the sleep quality assessment, 47.5 % of the patients had PSQI > 5 that was defined as sleep disturbances. A significant correlation was found between sleep quality and HDRS (r = 0.531, p = 0.0001), HARS (r = 0.627, p = 0.0001) and somatization subscale of SCL-90 (r = 0.36, p = 0.05). Conclusion: This study showed that human immunodeficiency virus positive individuals suffer from sleep disorders at least as same as the general population, and that psychological variables including depression and anxiety and physiological variables including physical morbidities in different systems of the body lead to sleep disturbance in this population.

Antibiotic guidelines have proven to be a simple and effective intervention to guide the choice of appropriate empiric antibiotic regimens. The goals of this study were to evaluate adherence to guidelines and streamlining of antibiotics. Hospital records of hospitalized patients in infectious diseases ward Imam Khomeini Hospital, Tehran, Iran, from May 2008 to September 2009 were reviewed. Adherence to guideline was defined as the use of empiric antibiotic in accordance with the clinical diagnosis and local guideline recommendations. In this study, 528 patients with a confirmed infectious disease diagnosis were considered for analysis. The four most frequent diagnoses were skin and soft tissue infections, tuberculosis, respiratory tract infections, and HIV associated opportunistic infections. The most frequent prescribed antibiotic was ceftriaxone. Overall adherence to guideline was 70.8% and the adherence for the most frequent diagnosis was 68%. Frequency of compatibility with the guidelines for were administrated regimes on the basis of drug selection, dosage form and drug dosing were 86.2%, 97% and 84.7%, respectively. The mean lag time between patients' hospital admission and starting empiric therapy was 1.69±4.9 days. In general, physicians' adherence with guidelines for empiric antibiotic therapy was high in infectious disease ward with a justified delay. Larger studies are required to establish these conclusions.

Background: Drug Utilization Evaluation (DUE) studies are performed to define, determine, and finally improve the quality of drug usage. These types of studies are especially valuable for drugs with a narrow therapeutic index or specific indication, or for expensive medications. In Iran, vancomycin is only available by prescription for methicillin-resistant staphylococcal and enterococcal infections. It is obvious that extensive and irrational use of this drug can increase bacterial resistance to this antibiotic. The goal of this study was to assess vancomycin utilization. Methods: In a descriptive cross-sectional study performed during the fall and winter of 2004, this vancomycin DUE was done in the Infectious Disease Department of Imam Khomeini Hospital in Tehran. All of the patients receiving vancomycin were enrolled in this study. The Centers for Disease Control (CDC) and American Society of Hospital Pharmacists (ASHP) protocols have been used to perform this study. Results: Of the 565 inpatients at this hospital, 39 subjects (7%) received vancomycin. Vancomycin utilization among these patients was compatible with CDC and ASHP protocols in only 28% and 35% of the patients, respectively. Conculusion: Vancomycin is predominantly administered empirically, rather than being based on the antibiogram. This may be due to the routine protocol of the ward or the physician doubting the reliability of the antibiogram.

In recent years, Iran has been subject to severe international sanctions. Sanctions have caused additional ambiguity and uncertainty that can change investor behavior. The extant research considers recent scientific strategic investment theories in uncertainty, and considers how investors use this method in current conditions of Tehran stock exchange, in order to determine how much these theories are applied in investment decisions. It is noteworthy that studying recent scientific research on strategic investment in uncertainty reveals that prospect theory; cumulative prospect theory, real option theory, and behavioral finance (which are psychologically and behaviorally correlated to one another) are considered as basics of new strategic investment in uncertainty. In the present research, Spearman and linear regression are used for analyzing the research hypotheses. A single sample t test is used to describe investors’ behaviors, and independent two-sample t test is used to compare natural persons’ society and corporate personhoods’ society. Despite the research results indicating that investors find the investing environment replete with uncertainties, the impact of the uncertainty on investors’ approach to learning and applying new strategic investment methods, while controlling for behavioral biases, is not proven.

Calcification and inflammation are among the important cases of exudative age-related macular degeneration (E-ARMD). The aim of the present study was to elucidate if there is any relationship between serum Osteoprotegerin (OPG), soluble receptor activator of nuclear factor-kappa B ligand (RANK-ligand) and E-ARMD. In a cross-sectional study, we compared 45 E-ARMD patients with 45 matched controls. Diagnosis was confirmed by fluorescein angiography. Serum samples were analyzed for OPG, RANK-ligand, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG). The levels of OPG and RANK-ligand were measured by ELISA methods. The mean age was 72.0±11.5 years in the E-ARMD group and 68.2±8.9 years in the control group (p=0.09). The level of serum OPG was 132.10±75.49 pg/ml in the E-ARMD group and 94.88±61.65 pg/ml in the control subjects. E-ARMD patients had significantly high levels of OPG (p=0.012), as well as significantly high levels of LDL-C and TC (p=0.001 and p=0.005, respectively). We could not find any significant difference in RANK-ligand, HDL-C, or TG between two study groups (p>0.05). To the best of our knowledge, this is the first study investigating the levels of OPG in E-ARMD patients. The present study showed that E-ARMD patients had high levels of serum OPG. It may act as a protective factor for E-ARMD or only as a secondary phenomenon of different processes of E-ARMD. Further prospective studies would be necessary for prognostic and predictive significance of OPG in patients affected by E-ARMD.

Nowadays, Tehran stock exchange investors are faced with the concept of risk and uncertainty much more than a few years ago, and this uncertainty has a direct influence on investor behavior, and will change it gradually. In comprehensive words, investor behavior is dependent on several factors. Whereas, the authors intension in this book about the term “investor behavior” is on investors understanding of environmental uncertainty and strategic investments. So to speak, investors knowledge level of modern scientific theories (theories such as prospect theory, cumulative prospect theory, real options theory and behavioral finance topics) in terms of environmental uncertainty. That is to say, in case the investors believe the economic environment (the investment environment) is uncertain, should have inclination to learn new ways of strategic investment under uncertainty logically to relatively optimal behavior to achieve desirable profit without any damage to the economy, furthermore help to Iran’s economy developing and grow.

The big eye kilka, Clupeonella grimmi, is a marine fish living in depth of 20 to 200 meter of the Caspian Sea. Its eye and retina were processed for histological and SEM studies. Paraffin embedded retina was cut radially and tangentially in 5 µm thickness and stained with hematoxylin and eosin method. The unstained sections were manipulated for SEM image observations. Tangential retinal sections showed irregular arrangement of cones. Five morphologically different types of photoreceptors were distinguished as rods, short single cones, long single cones, twin cones and double cones. The cones were counted in each quadrant of the retina and cone density was determined. The cones showed increment in diameter but reduction in number at anti-clockwise direction without any specific arrangement. Presence of four types of cone cells and their pattern of distribution revealed assistance in near surface color vision and more light capture in dim light of deeper waters as an adaptation to planktivorous feeding habit and deep water living habitat.

Background: Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection. Methods: We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling. Findings: We included data for 29234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio [OR] 0·81; 95% CI 0·70-0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41-0·56; p

The astrophysical S-factor of the 4He-12C radiative capture is calculated in the potential model at the energy range 0.1-2.0 MeV. Radiative capture 12C(\alpha,\gamma)16O is extremely relevant for the fate of massive stars and determines if the remnant of a supernova explosion becomes a black hole or a neutron star. Because this reaction occurs at low-energies the experimental measurements is very difficult and perhaps impossible. In this paper, radiative capture of the 12C(\alpha,\gamma)16O reaction at very low-energies is taken as a case study. In comparison with other theoretical methods and available experimental data, excellent agreement is achieved for the astrophysical S-factor of this process., Comment: 6 pages, 1 figures, Submitted to Chinese Physics C

The astrophysical S-factor of the 4He-12C radiative capture is calculated in the potential model at the energy range 0.1-2.0 MeV. Radiative capture 12C(��,��)16O is extremely relevant for the fate of massive stars and determines if the remnant of a supernova explosion becomes a black hole or a neutron star. Because this reaction occurs at low-energies the experimental measurements is very difficult and perhaps impossible. In this paper, radiative capture of the 12C(��,��)16O reaction at very low-energies is taken as a case study. In comparison with other theoretical methods and available experimental data, excellent agreement is achieved for the astrophysical S-factor of this process., 6 pages, 1 figures, Submitted to Chinese Physics C

Infectious diseases are one of the most common causes of morbidity and mortality and the spread of resistant microorganisms is playing a significant role in this regard. The purpose of this study was to assess the trend in antimicrobial resistance of gram-positive bacteria at the main referral teaching hospital in Tehran during a 4-year period. All patients' biological isolates such as blood, urine, wound drainage, synovial fluid, sputum, and cerebrospinal fluid sent to the central laboratory of the hospital from 2007 to 2010 for identification and subsequently, antimicrobial susceptibility testing by Kirby-Bauer disc diffusion method were considered. All isolates (100%) of S. aureus were sensitive to vancomycin and linezolid and resistant to amoxicillin. The rate of S. aureus resistance to oxacillin increased from 60.78% in 2007 to 72% in 2010. All isolates of Streptococci in 2007 and 2008 were sensitive to vancomycin; while, 3.33% and 4.76% of Streptococci isolates were reported to be vancomycin-resistant in 2009 and 2010, respectively. Enterococci isolated from the entire specimens were identified to be sensitive to teicoplanin and linezolid and resistant to cloxacillin and oxacillin. The rates of Enterococci sensitivity to vancomycin were 90.91%, 81.25%, 86.67%, and 93.3% in 2007, 2008, 2009, and 2010, respectively. Changes of antibiotics sensitivity against g positive pathogens were significant during four years in this study. To minimize the spread of resistant gram positive pathogens, periodic and regular surveillance of antimicrobial resistance pattern is highly recommended.

Iterative Learning Control (ILC) is a learning control technique for the systems operated repeatedly. The Iterative Learning Controller learns to generate the desired set of input signals to compensate for the output tracking errors. Conventionally the performance of ILC algorithms has been based on the convergence of the output tracking error. In this paper, the convergence of the control input is investigated down to the sample-time level. Two scenarios are considered: Firstly, when the control input is updated with same initial conditions at the start of each batch/repetition/iteration/trial and secondly for varying initial conditions. The batch to batch evolution of control inputs at each sample time within a batch is formulated. Convergence of the control input signals has been based on the Eigen analysis of this relationship. This provides deeper insight about the ILC algorithms and exact factors affecting the convergence could be monitored. Limits of the learning process are clearly demonstrated as well. Performance of D-type & PD-type ILC algorithms has been investigated for a simple pendulum and further extended to bipedal locomotion. Bipedal walking robot is an interesting control problem but involves complexity being a hybrid system. It comprises of single support, impact with ground and double support phases. The non-linear impacts pose challenge since they cause non-zero initial errors for each step. For reasons of energy efficiency, passive dynamics has been chosen for compass gait model of the biped. Stable gait achieved from a fine-tuned PD controller provides the set of desired inputs for the joints of the compass gait robot. ILC learns/adapts the joint control for repetitive gaits. It represents learning a sequence of action by muscles. Due to the transfer of state error in a cyclic manner from the end of a previous step/repetition to the recent step/repetition, the convergence has to be established in joint control and state space. The steady gait is achieved for bipedal locomotion on flat surface as demonstrated through simulations.

Drug induced acute kidney injury (AKI) has been implicated in 8% to 60% of all cases of in-hospital AKI and as such is a recognized source of significant morbidity and mortality. Evaluation of incidence, risk factors, onset time, and outcome of antibiotics' associated acute kidney injury. During one-year period, all patients who developed acute kidney injury during their hospital stay in the infectious diseases ward of Imam Khomeini hospital were included in the study prospectively. Patients' demographic data, baseline diseases, cause of current hospital admission, history of past and current medications and hemodynamic parameters were collected and monitored closely. Drug induced acute kidney injury was defined based on acute kidney injury network criteria. From 424 admitted patients, 76 (17.9%) developed acute kidney injury. Aminoglycosides (gentamicin and amikacin), amphotericin B, vancomycin, beta-lactam antibiotics (cefazolin and ceftriaxone) in monotherapy and combination therapy were the causes of acute kidney injury in most of the patients. From the co-morbid diseases in patients with acute kidney injury, diabetes mellitus (26.3%) and hypertension (5.5%), were the most frequent ones. Presence of diabetes mellitus as comorbidity (OR=2.6; CI=1.3-5.7, P=0.01), dehydration of patients upon admission (OR=3.4; CI=1.9-6.4, P

The main aim of Supply Chain Management (SCM) is to produce, distribute, logistics and deliver goods and equipment in right location, right time, right amount to satisfy costumers, with minimum time and cost waste. So implementing techniques that reduce project time and cost, and improve productivity and performance is very important. Emerging technologies such as the Radio Frequency Identification (RFID) are now making it possible to automate supply chains in a real time manner and making them more efficient than the simple supply chain of the past for tracing and monitoring goods and products and capturing data on movements of goods and other events. This paper considers concepts, components and RFID technology characteristics by concentration of warehouse and inventories management. Additionally, utilization of RFID in the role of improving information management in supply chain is discussed. Finally, the facts of installation and this technology-s results in direction with warehouse and inventory management and business development will be presented.

Tacrolimus, a cornerstone of immunosuppressive therapy in solid organ transplantation, has a narrow therapeutic range with considerable inter-individual and intra-individual pharmacokinetic variability. To date, there is no information on the pharmacokinetics of tacrolimus in Iranian liver transplant recipients. This study was designed to determine pharmacokinetic properties of orally administered tacrolimus in Iranian adult liver transplant recipients. Tacrolimus doses and steady state whole blood trough concentrations as well as patient demographic and clinical data were obtained retrospectively using the 30 included patients' medical records. Pharmacokinetic parameters were estimated by using a nonlinear mixed effect model program (Monolix version 3.1). Absorption rate constant was fixed at two hours(-1). Drug apparent clearance (CL/F), apparent volume of distribution (Vd/F), and elimination half life (t½β) were calculated. The administered dose of tacrolimus to the patients ranged from 0.02 to 0.14 mg/Kg/day. Tacrolimus blood trough concentrations varied widely within the range of 1.8 to 30 ng/mL. The mean values of CL/F, Vd/F, and t½β were found to be 9.3 ± 0.96 L/h, 101 ± 29 L, and 7.5 hours, respectively. The pharmacokinetics of tacrolimus was highly variable among our patients. CL/F, Vd/F, and t½β of tacrolimus in this study were comparable to reported values from Italian heart transplant patients but somewhat different from reported ones from other solid organ transplant populations.

Anemia of chronic diseases (ACD) is a common problem in patients with infectious diseases and can influence the quality of life and patients' survival. Despite the clinical importance of ACD, data are still lacking regarding this problem in the infectious diseases. This study aimed to evaluate the prevalence, related factors, outcome and approaches to anemia in the infectious diseases ward. This retrospective study was performed to review the medical records of patients admitted to the infectious diseases department of Imam Khomeini hospital during a two-year period between 2009 and 2011. A standard protocol was developed to evaluate anemia. Patients' demographic data approaches to manage anemia and routine laboratory tests were recorded and compared with the protocol. Totally, 1,120 medical records were reviewed. ACD was recognized in 705 patients (63%). Only 5.1% of diagnostic and 8.7% of treatment approaches was based on the protocol. The majority of patients (89.4%) were received inappropriate treatment regarding. Mortality rate of patients with ACD was 3.4%. Moreover, a significant correlation between anemia and mortality was detected (r = 0.131; p = 0.026). A statistically significant correlation was also identified between patients' Hgb and ESR, CRP, reasons of admission, number of medications, and underlying diseases. In conclusion, results of this study suggested that ACD is a common problem in infectious diseases patients and significantly associated with patients' mortality. Moreover, the majority of studied patients were not received an appropriate diagnostic and treatment approach which arises more concerns regarding the management of ACD in infectious diseases setting.

Background: Hypersensitivity reaction (HSR) is a major adverse effect of abacavir (ABC), which occurs in 5–8% of Caucasians. The relationship between Human Leukocyte Antigen (HLA) and ABC HSR has been reported in various populations. It has been proposed to administer ABC only to HLA-B*5701 negative patients to avoid this reaction. The purpose of this study was to assess the prevalence of HLA-B*5701 in Iranian HIV positive patients. We also sought to find the relationship between this allele with ABC HSR in patients who received the medication. Materials and Methods: We screened patients for HLA-B*5701 allele using SybrGreen real time PCR-melting method on blood samples from HIV positive patients who were referred to our hospital. The quality of the extracted genome was evaluated by B-globin housekeeping gene as internal control prior to HLA-B*5701 allele screening. Results: Of 198 HIV-infected patients, 6 (3.0%) had the HLA-B*5701 allele (95% CI, 1%–5%). Among the 28 patients who were given ABC, one individual had the HLA-B*5701 allele and experienced ABC HSR. Conclusion: Prevalence of HLA-B*5701 in Iranian patients was lower than that in Caucasians but was comparable with that of other Middle Eastern populations. Screening for HLA-B*5701 before ABC administration as part of antiretroviral therapy may reduce the risk of HSR.

Vancomycin susceptibility of methicillin-resistant Staphylococcus aureus has been changed over time and its average minimum inhibitory concentration increased from 1.5 to 1.75 mg/L.A recently published guideline by the American Society of Health Pharmacist recommended a daily dose of 15-20 mg/Kg every 8 to 12 hours of vancomycin to achieve a trough concentration between 15-20 mg/L for treatment of severe infections. Medical records of 69 patients from infectious ward of Imam Khomeini hospital, with suspected or confirmed gram-positive infection who had at least one trough level of vancomycin, were evaluated regarding vancomycin therapeutic goal; efficacy and renal safety. Most of patients (60.6%) with severe infections did not achieve the recommended vancomycin trough level during treatment course. Time to normalization of the signs and symptoms of infection did not correlate with the patients' serum vancomycin trough levels. At the end of treatment course, there was no significant correlation between patients' creatinine clearance and vancomycin trough levels (P=0.32). However, patients'cratinine clearance showed a negatively significant correlation with trough level of vancomycin (P=0.01). Vancomycin induced nephrotoxicity was detected in 4.3% of the patients. These data showed that vancomycin trough level may not necessarily assure treatment success, and also it would not essentially predict the risk of vancomycin induced nephrotoxicity. However, more well designed studies with larger sample size needed for better clinical and practical judgment.

Background The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. Methods We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of, We found that neuraminidase inhibitor (NAI) treatment initiated on hospital admission to patients with clinically diagnosed or laboratory-confirmed A(H1N1)pdm09 virus infection was associated with a reduction in hospital length of stay when compared to later or no NAI treatment.

BACKGROUND: Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic inflammatory disorders of the colon. There is a paucity of data on differences in etiology, natural history, and treatment response between CC and LC. METHODS: Between 2002 and 2013, we identified new diagnoses of CC and LC using the Research Patient Data Registry in a tertiary referral center. We used chi square or Fischer's exact test and Wilcoxon rank-sum tests to compare the differences in clinical characteristics, treatment types, and response rates between LC and CC. RESULTS: Through 2013, we confirmed 131 patients with a new diagnosis of microscopic colitis (MC) (55 LC, 76 CC). Compared to cases of LC, patients with a diagnosis of CC were more likely to be women (86% vs. 69%, p = 0.03), have elevated erythrocyte sedimentation rate (mean 28 vs. 13 mm/h, p = 0.04), and less likely to be diabetic (5% vs. 18%, p = 0.02). Budesonide was the most effective treatment for both CC and LC (94% and 80%, respectively). However, there were no statistically significant differences in response to various treatments according to the type of MC (all p > 0.10). Older age at the time of diagnosis was associated with better response to bismuth subsalicylate (odds ratio: 1.76; 95% confidence interval: 1.21-2.56 for every 5-year increase) for both CC and LC. CONCLUSION: Despite differences in the clinical characteristics, response rates to available treatments appeared to be similar in both LC and CC. Older patients may have a better response to bismuth subsalicylate therapy.

This review describes the history of U.S. government funding for surveillance programs in inflammatory bowel diseases (IBD), provides current estimates of the incidence and prevalence of IBD in the United States, and enumerates a number of challenges faced by current and future IBD surveillance programs. A rationale for expanding the focus of IBD surveillance beyond counts of incidence and prevalence, to provide a greater understanding of the burden of IBD, disease etiology, and pathogenesis, is provided. Lessons learned from other countries are summarized, in addition to potential resources that may be used to optimize a new form of IBD surveillance in the United States. A consensus recommendation on the goals and available resources for a new model for disease surveillance are provided. This new model should focus on "surveillance of the burden of disease," including (1) natural history of disease and (2) outcomes and complications of the disease and/or treatments. Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.