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Background and Objective: Vancomycin-resistant enterococci (VRE) are the major causative agents of urinary tract infections (UTIs) in hospitalized patients. The aim of this study was to determine the prevalence of urinary tract infections caused by enterococcus faecium and the level of resistance to vancomycine and other antibiotics which are effective in enterococcal infection therapy of hospitalized patients in four university teaching hospitals of Tehran. Materials and Methods: This study was carried out between September 2011 and May 2012. Urine samples were collected from hospitalized patients in Taleghani, Loghman , Mofid and Labaffi nejad Hospitals in Tehran. Enterococcus species were detected by biochemical and molecular tests. Antimicrobial susceptibility and minimum inhibitory concentration (MIC) of vancomycine were determined by disk diffusion and micro agar dilution methods. The presence of vanA and vanB genes were investigated in VRE strains by PCR. Results: 86 enterococci were isolated from urine samples of which 45(52%) were E.faecium. 42.2% of E. faecium isolates were resistant to vancomycin (VRE) and showed vanA genotype. All VRE isolates were resistant to ampicillin, gentamicin, ciprofloxacin and erythromycin, and 78% were resistant to nitrofurantoin. Furthermore, all VRE isolates were sensitive to linezolide and quiopristin-dalfopristin. MIC50 ≥ 128 and MIC90 ≥ 256 were detected in the VRE strains. Conclusion: The increase in the prevalence of vancomycin resistant E. faecium with high risk resistance profiles is a serious threat for some Iranian hospitals and limits the therapeutical options for patients infected with E. faecium. [ABSTRACT FROM AUTHOR]

Blastocystis is an unusual enteric protozoan parasite of humans and many animals whose pathogenic potential is still controversial. To increase the understanding of the molecular epidemiology of this emerging parasite and due to its potential impact on public health, its subtypes (STs) in Iranian symptomatic and asymptomatic individuals were determined. A total of 100 Blastocystis isolates by microscopy and culture methods were obtained. DNA was extracted from the positive culture isolates, and the Blastocystis subtypes were identified using seven subtype-specific sequenced-tagged site (STS) primers. Four subtypes, ST3 as dominant (53 %), followed by ST1 (48 %), ST5 (33 %), and ST2 (7 %) were identified. In this study, ST1 in gastrointestinal patients compared to asymptomatic individuals was significantly dominant ( p = 0.001). From 33 (33 %) mixed subtype infections, ST1, 3 (14 %) was significantly related to GI symptoms ( p = 0.045), and eight mixed infections with three different STs, which are under reported, were also identified. [ABSTRACT FROM AUTHOR]

Background: A number of methods for detecting diversity in Entamoeba have been described over the years. In the present study the genetic polymorphism of noncoding locus A-L was analyzed using PCR and sequencing in order to clarify the genotypic differences among E. dispar isolates. Methods: A total of 28 E. dispar from patients with gastrointestinal symptoms were determined and the genomic DNA was extracted directly from stool. For genotype analysis; Locus A-L was amplified by PCR and PCR products were sequenced .The sequences obtained were edited manually and aligned using Gene Runner software. Results: With sequencing of PCR products a reliable genetic diversity in size, number and position of the repeat units were observed among the Iranian E. dispar isolates in locus A-L gene. Sequences showed variation in length from 448bp to 507bp and seven distinct types were identified. Conclusion: The genetic diversity of loci like A-L shows them to be suitable for epidemiological studies such as the characterization of the routes of transmission of these parasites in Iran. [ABSTRACT FROM AUTHOR]

Background & Aims: Hepatitis E virus (HEV) is the second prevalent causative agent of acute hepatitis in adults after hepatitis B. Transmission routes of this infection is fecal-oral. There are limited studies on epidemiology of this virus in Iranian general population. In this study, we evaluated the prevalence of hepatitis E infection in general population of some towns of Tehran province and Eastern and Northern section of Tehran city. Materials & Methods: In this cross-sectional study conducted in 2006 and 2007 a number of 501 subjects selected by random cluster sampling from Tehran province were studied. Demographic data (through a questionnaire) and blood samples were collected and anti-HEV antibodies were measured by ELISA method. Chi-square test, logistic regression, and T-test were used for statistical analysis. Result: O f the total 493 subjects with mean age of 40.98± 17.10, 180 were men and the rest (313 subjects) were women. Of these numbers, 48 subjects (9.7%) were positive for anti-HEV antibody. There were no significant differences in HEV seropositivity and different sex or age groups. Conclusion: The prevalence in Tehran province was high and this indicates the endemic state of this infection in the studied population. Results are similar to those in eastern section of Golestan province and are in contradiction with results from Isfehan Province. [ABSTRACT FROM AUTHOR]

Background: Cryptosporidium is a worldwide protozoan parasite and one of the most common causes of infection and diarrhea in humans and cattle. The aim of the present study was determination of subtypes of Cryptosporidium among children with diarrhea in Tehran by sequence analysis of the highly polymorphic 60-kDa glycoprotein (GP60) gene. Methods: Fecal samples were collected from 794 diarrheic children. Initial identification of Cryptosporidium was carried out on stool samples by Ziehl-Neelsen acid-fast staining method. DNA was extracted from positive microscopically samples and Cryptosporidium genotypes and subtypes were determined, accordingly. Results: Out of 794 collected samples, 19 (2.40 %) were positive for Cryptosporidium oocysts. Sequences analysis of GP60 gene showed that 17 (89.47 %) of the positive isolates were Cryptosporidium parvum and 2 (10.52 %) were C. hominis. All subtypes of C. parvum isolates belonged to allele families IIa (6/17) and IId (11/17). The most common allele in all 17 isolates belonged to IId A20G1a (41.18%). A22G1 (IF) subtype was detected in two C. hominis isolates of the children. Conclusion: The predominancy of C. parvum species (specially, IId A20G1a subtype) in current study underlines the importance of zoonotic Cryptosporidium transmission in Iran. [ABSTRACT FROM AUTHOR]

Background: Although, family history of cancer is an important risk factor for upper gastrointestinal cancers development, but limited information is available on the upper gastrointestinal cancers associated with family history in Iran. The purpose of this study was to define upper gastrointestinal cancers risk associated with family history of cancer. Methods: This study was conducted as a case control study. A total number of 1,010 cases of upper gastrointestinal cancer and 1,010 healthy controls were recruited. For family history of cancer, questions were asked about any malignant tumor in first and second degree relatives. Adjusted odds ratio estimates for the association family history and upper gastrointestinal cancers risk and corresponding 95% confidence intervals were obtained. Results: A family history of any malignant tumor in relatives was associated with 1.3 fold increased risks of upper gastrointestinal cancers. A first-degree family history of esophageal and gastric cancer was significantly associated with upper gastrointestinal cancers development, with an adjusted OR of 4.7(CI 95%: 2.6-8.4). Conclusion: Our findings suggested that risk for upper gastrointestinal cancers increases among individuals with family history of cancer. Therefore, appropriate screening strategies especially in relatives of patients should be considered to prevent and control of disease. [ABSTRACT FROM AUTHOR]

Background and Objective: Several strains of the Echinococcus granulosus have been described based on morphological characters, intermediate host specificity and/or genetic analysis of mitochondrial and nuclear DNA. The aim of this study was to characterize different E.granulosus isolates by using sequences of mitochondrial atp6 gene. Materials and Methods: In this study, Sixty infected liver and lungs of cattle, sheep and goats were collected from the abattoir of Varamin city-Iran during 2008. Protoscoleces were removed from each fertile cyst and DNA extracted. New and specific primers were designed for two existing genotypes (G1 and G6) of E. granulosus known to occur in Iran and applied in PCR reactions. Results: The new primers selectively amplified the G1 and G6 genotypes of E. granulosus with specific bands of 708 and 705 bp respectively. The G1 genotype was identified in all fertile cyst samples. Conclusion: This study showed that the new primer pairs which specifically amplify portions of the mitochondrial atp6 gene of the G1 and G6 strains of Echinococcus granulosus are proper molecular marker for investigating genetic variation in a number of isolates of E. granulosus from a range of hosts (sheep, goats, cattle) in Iran. The result of sequenced samples showed that our sequences were the same as those reported previously for these strains. [ABSTRACT FROM AUTHOR]

Background: Although the Cox proportional hazard regression is the most popular model for analyzing the prognostic factors on survival of cancer patients, under certain circumstances, parametric models estimate the parameter more efficiently than the Cox model. The aim of this study was to compare the Cox regression model with parametric models in patients with gastric cancer who registered at Taleghani hospital, Tehran, Iran. Methods: In a retrospective cohort study, 746 patients with gastric cancer were studied from February 2003 through January 2007. Gender, age at diagnosis, distant metastasis, extent of wall penetration, tumor size, histology type, tumor grade, lymph node metastasis and pathologic stage were selected as prognosis, and entered to the models. Lognormal, Exponential, Gompertz, Weibull, Log-logistic and Gamma regression were performed as parametric models, and Akaike Information Criterion (AIC) were used to compare the efficiency of the models. Results: Based on AIC, Log logistic is an efficient model. Log logistic analysis indicated that wall penetration and presence of pathologic distant metastasis were potential risks for death in full and final model analyses. Conclusion: In the multivariate analysis, all the parametric models fit better than Cox with respect to AIC; and the log logistic regression was the best model among them. Therefore, when the proportional hazard assumption does not hold, these models could be used as an alternative and could lead to acceptable conclusions. [ABSTRACT FROM AUTHOR]

Background: Cancer is the third most common cause of death in Iran. Gastric cancer (GC) and colorectal cancer (CRC) are two important causes of mortality due to cancer. With regards to cancer mortality, data are important to monitor the effects of screening program, earlier diagnosis, demographic data and other prognostic factors. The aim of this study was to evaluate the mortality rates and trends from GC and CRC in Iranian population during a period of almost a decade, i.e. from 1995 to 2003. Methods: National death Statistic Reported by the Ministry of Health and Medical Education (MOH&ME) from 1995 to 2003, stratified by age group, sex, and cause of death are included in this study. CRC and GC were expressed as the annual mortality rates/100,000, general and/or per gender, and age group. Results: The general mortality rate of CRC slightly increased during the years under study from 0.44 to 2.54 and CRC mortality was higher for older age and male. The general mortality rates of GC showed a sharp increasing from 1.68 to 9.67. In addition to this, GC mortality rate was higher for male than female. Conclusion: Our study indicated remarkable increasing trends in GC and CRC mortality. So developing for a gastric cancer for both primary prevention and early detection programs and manage the delays of diagnosis is recommended to decrease the trend of GC mortality. For CRC, since the rate of CRC screening is very low in Iran, it is recommended that in Iran screening be started as a public program in order to control the mortality and burden of CRC in the future. [ABSTRACT FROM AUTHOR]

Background: Clinical and epidemiological variation was seen between the colon cancer (CC) and rectum cancer (RC). So, there is not so much data available about the epidemiological and clinicopathological differences and prognostic factors regarding to CC and CR in Iran, we aimed to perform this study. Methods: All cases of CC and RC referred to oncology and gastroenterology wards of Taleghani General Hospital, Teheran, Iran between 2002 and 2008 were retrospectively reviewed. The research group were reviewed all medical records in the study period for collecting the required data. All patients under study were followed up until end day of 2008 (closed day) from their diagnosis. Results: There are 856 cases of CC and 427 cases of RC. Mean survival time of CC cases was relatively higher than RC cases (P <0.05). Regarding to the age at diagnosis, about 42% of CC and 42.6% of RC patients was diagnosed less than 50 years of age. Positive family history of any cancer was relatively higher in CC (40.0%) patients than RC (31.0%) patients (P<0.05). significant difference was seen between CC and RC regarding to depth of tumor invasion, pathologic stage and type of first treatment. RC patient were diagnosed in more advanced pathologic stages. Regarding to histology type of tumor 75.0% of CC cases and 79.4% of RC cases was adenocarcinoma. Abdominal pain (74.4%) and blood per rectum (89.7%) were the most prevalent symptoms mentioned by patients for CC and RC, respectively. Distant metastasis, lymph node metastasis, lower BMI and poor grading of tumor was related to increased risk of death due to CC. Regarding to RC, only pathologic stage was determine as prognostic factor. Conclusion: Results of this study emphasis that RC has a poorer prognosis comparing to CC. Up to 42 percent of patients with CC and RC are lower than 50 years of age. Patterns of CC versus RC indicate major variations in demographic and clinicopathologic characteristics that suggest possible differences in etiology and pathogenesis. So we suggest that for the analysis of cancer data, CC and RC should be investigated as separate cancers and not to be as colorectal cancer. Abdominal pain and blood per rectum should be emphasis for detection of CC and RC, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: In around 10 to 15% of all colorectal cancer (CRC) cases, a positive family history of colorectal cancer is observed. Although increased risk of colorectal cancer in individuals with a family history of the disease has been observed consistently in the past studies, limited information is available on colorectal cancer associated with family history in Iran. AIMS: The purpose of this study is to define the risk of colorectal cancer associated with a family history of cancer. SETTING AND DESIGN: The present study was designed as an unmatched case control study. The cases were 393 patients with histologically confirmed colorectal carcinomas and there were 393 controls, randomly selected from among the healthy participants in a health survey. METHODS: The family history was extracted from a standard history form completed by the patient or from the record created by a health care provider. STATISTICAL ANALYSIS: Mantel-Heanszel Odds Ratio was computed for removing the confounding effect of age and sex. RESULTS: A positive family history of cancer was reported by 36.4 and 24.4% among the cases and controls, respectively. Colorectal cancer risk increased two-fold in subjects who reported having first degree relatives with cancer. The adjusted odds ratio was 4.76, indicating that having a positive family history of colorectal cancer among relatives increased one's risk of colorectal cancer about 4.5-fold. CONCLUSION: According to our findings, a family history of cancer increased the risk of CRC. Due to this fact that there is no current colorectal cancer screening program in Iran, it is recommended that first degree relatives of patients with colorectal cancer should be considered as a priority group for screening programs. [ABSTRACT FROM AUTHOR]

Background. Rotavirus is the most common causes of severe, acute diarrhea during childhood and is an important cause of morbidity and mortality in developing countries. We established active hospital-based surveillance of childhood diarrhea to assess the scope of severe rotavirus disease in Iran. Methods. From May 2006 through April 2007, prospective surveillance of rotavirus diarrhea among children aged <5 years was conducted in 5 sentinel hospitals in Iran. Stool samples were tested for rotavirus using a commercially available enzyme immunoassay, and rotavirus-positive samples were genotyped using reverse-transcriptase polymerase chain reaction. Results. Of 2198 children admitted to the hospital for acute gastroenteritis, 1298 (59.1%) had stool samples test positive for rotavirus by enzyme immunoassay. Of the rotavirus episodes, 85% occurred during the first 2 years of life, with the peak prevalence of severe rotavirus disease occurring from September through January. Among the 110 rotavirus-positive samples that were genotyped, G4P[8] was the most commonly detected rotavirus genotype (30.9% of strains). Other commonly detected genotypes included P[8] with G nontypeable (21.8%), G4 with P nontypeable (13.6%), G1[P8] (10.9%), and G2[P4] (5.5%). Conclusions. Rotavirus is the most common cause of severe diarrhea in Iran, which indicates that safe and effective rotavirus vaccination in Iran is a public health priority. [ABSTRACT FROM AUTHOR]

Background and Aim: Cancer for a long time has been recognized as a fatal disease. Thus it is known to be major health problem in many countries throughout the world. In recent years, cancer morbidity and mortality increased in our country and especially gastric cancer has second order among all cancers. The aim of this study was to analysis the survival of patients diagnosed with gastric cancer and the factors which modify prognosis. Methods: Retrospective study of overall patients diagnosed with gastric cancer registered in the cancer registry center of Research Center for Gastroenterology and Liver Disease (RCGLD), Shahid Beheshti University,M.C, Tehran, Iran, between Dec. 2001 and Dec. 2006 was done. Survival status of patients was followed by the telephone contact. The Kaplan-Meier statistical method was employed to determine the probability of survival and log-rank test to compare those. Cox regression was used to determine prognosis factors. P <0.05 was considered as statistically significant. All calculations were carried out by SPSS (version13.0) statistical software. Results: Of 746 patients, 38.6% are dead. The mean and median survival time was 42.45 and 22.8 months, respectively and five-year survival rate was 25.3%. With univariate analysis, Age at Diagnosis, surgery treatment, type of first treatment, pathologic stage, tumor size, histology type of tumor, extent of wall penetration and pathologic distant metastasis were significant prognostic factors related to overall survival time. Tumor size greater than 35mm (HR=2.12) and have a metastasis (HR=2.04) were found to be the statistically significant poor prognostic factors related to survival in multivariate analysis. Conclusions: According to results, early detection of cancer in lower ages and in primary grades of tumor is important to increase patient's life expectancy. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) infection is a major cause of liver disease worldwide. Eight genotypes and 24 subgenotypes of HBV have been identified. The aim of this study was to determine the distribution of HBV genotypes, subgenotypes and subtypes, and to understand HBV genetic variability in the HBV genome circulating in Iranian provinces. Two hundred and forty-nine sera from HBV-infected patients living in 25 provinces of Iran were collected (2004–2007). A part of the HBV S/ pol and whole BCP/ C genes were amplified, sequenced and then subjected to phylogenetic, recombination and genetic variability analysis. Results revealed genotype D of HBV in all samples and subgenotypes  D1 (98.52%), D2 (0.74%) and D3 (0.74%) among Iranian patients living in different provinces of Iran. Subtypes  ayw2 (94.4%), ayw1 (2.8%), ayw3 (2%) and ayw4 (0.4%) were deduced, on the basis of HBV small surface antigen (HBsAg) amino acid sequences. The mean percentage intra-genotypic distance of S plus core regions was 2.8%; the mean percentage inter-genotypic distance of this region between Iranian strains and genotype D isolates was 3.1%; and this rate for other genotypes was 5.2–11.4%. Various rates of point mutations have been found within different HBV genes, e.g. HBsAg (17.2%), precore-G1896A (59.5%) and Basal core promoter (BCP) double mutations (49.2%), whereas no recombination was found. In conclusion, these results indicate that the only genotype circulating in the provinces of Iran is genotype D. There exist high genetic variabilities in the S/ pol and BCP/ C regions among the Iranian HBV isolates. [ABSTRACT FROM AUTHOR]