mehrnaz rasooli nejad

Although the number of new HIV infections continues to decline in Iran, the number of HIV-infected patients aged ≥50 years continues to rise due to the introduction of new treatment and longer survival. The higher prevalence of medical comorbidities and treatment failure in this population is a critical challenge in HIV treatment. In the present study, prevalence of comorbidities, rate of response to treatment, and results of HIV drug resistance tests were explored in older patients.

A cross-sectional study was conducted at a tertiary referral HIV center in Tehran, Iran. The data for all the HIV-positive patients older than 50 years old were collected by reviewing their medical records within the last 15 years. Data included demographic and behavioral characteristics, immunologic and virologic response, rate of treatment failure, and HIV resistance.

The records for 100 patients with a mean age of 62.5 (range 50-79) years were reviewed and analyzed. Medical comorbidities were observed in 20% of the patients, with HCV co-infection, diabetes mellitus, and neuropsychiatric impairments being the most common. Complete immunologic and virologic responses were respectively observed in 88 and 97% of patients. The treatment regimen was modified in 66 patients, with drug side effects being the reason in 63 patients (95.4%). HIV drug resistance tests showed a low rate of resistance (<10%) to all drugs used in this population.

Our findings highlight the high prevalence of comorbidities in older HIV-positive individuals in Iran. A thorough endocrine and neuropsychiatric assessment at each visit is recommended for these patients. Access to an appropriate psychosocial support system will ensure earlier detection of HIV infection and comorbidities in the older population, and will undoubtedly improve the treatment outcome and quality of life among them.

There has been a significant decrease in HIV-related mortality following the introduction of antiretroviral therapies. This increase in life expectancy has caused an increased risk of cardiovascular and metabolic diseases. Lipid metabolism could be affected by the virus itself or antiretroviral medications. In this study, an attempt was made to investigate the effect of first- and second-line HIV medications on lipid profile in HIV/AIDS patients.

The present study is a retrospective cohort study. The medical records of 66 AIDS patients older than 18 years, who referred to the Behavioral Counseling Center of Imam Khomeini Hospital during the years 2009 to 2014, were retrieved. The patients were assigned into two groups including first- (36 patients) and second-line (30 patients) treatment groups. To ensure that the patients’ baseline information was matched, demographic information and baseline lipid profile were compared between two groups and no significant difference was found between them. To examine and compare the effect of HIV medications on lipid metabolism, patients’ lipid profile at the baseline and 6 months after treatment was compared.

The results showed that only triglyceride level was significantly affected by the type of HIV medication regimen (p <0.05). It was significantly higher in second-line medication group. Although the lipid profile (Cholesterol, HDL, and LDL levels) showed an overall increase over the course of treatment in both groups, it was not statistically significant.

In both groups, following antiretroviral medications (the first-and second-line), lipid profiles increased. Moreover, the triglyceride level was higher in second-line medications. Therefore, early screening and lipid lowering agents should be considered in HIV/AIDS patients receiving the retroviral medications in long term to prevent further cardiovascular complications.

We reviewed the medical charts of 1,700 patients diagnosed with HIV who referred to a central HIV clinic in Tehran between 2004 and 2017. Participants who had a viral load of > 200 copies/mL after six months or more on antiretroviral therapy (ART) were grouped as virologic failure (VF). We assessed the demographic characteristics, diagnosis date, first ART regimen, and resistance to various ART drugs. Out of 1,700 patients, 72 (4.2%) had a treatment failure. Among those with treatment failure, 51.3% were on zidovudine + lamivudine + efavirenz, 13.9% were on tenofovir + lamivudine + lopinavir/ritonavir, and 12.5% were on tenofovir + emtricitabine + efavirenz. In patients with treatment failure, the highest resistance was to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) combination (44.4%). In these patients, resistance to tenofovir (one of the NRTIs) was 29.1%. The highest treatment failure was observed among patients treated with nevirapine (NVP) and efavirenz (EFV)-based regimen. Our findings suggest that protease inhibitors should be considered as first-line drugs in ART regimens in VF patients in Iran.

This study aimed to evaluate the virologic failure rate of treatment for various types of antiretroviral treatment (ART) regimens in pediatric patients with HIV.

The present study was conducted among 75 HIV-positive pediatric patients characterized by the presence of a viral load of 200 or more copies per mL after six months of effective, continuous ART regimen. Therefore, treatment failure was defined based on virologic failure. We designed a questionnaire that included patients’ demographic characteristics, viral load markers, TCD4+ count, antiretroviral regimen received, and the probable treatment failure, along with the results of the drug resistance tests.

In total, 22 (29.2%) children experienced treatment failure. The most common primary antiretroviral regimen was Zidovudine (AZT)/Lamivudine (3TC)/Nevirapine (NVP) (59.2%), followed by AZT/3TC/Efavirenz (EFV) (29.6%). The highest rate of virologic failure was related to the AZT/3TC/NVP regimen (68.2%). In children who used NVP, the virologic failure was significantly higher than in children on other regimens (P = 0.02).

The present study showed that patients receiving ART regimens based on reverse transcriptase non-nucleoside inhibitors, especially NVP, experienced more treatment failure than patients receiving other regimens.

Community-acquired pneumonia (CAP) is a common disease considered as a major public health problem. It causes considerable morbidity and mortality despite antibiotic treatments. Hospital admission of CAP patients is a significant financial burden and many efforts are ongoing to decrease hospital stay durations. Vitamin D deficiency is associated with increased risk of respiratory infections. This study was designed to determine the association of vitamin D status with hospitalized CAP patient mortality and disease severity. This prospective cohort study examined 180 CAP patients admitted to a teaching Hospital in Tehran, Iran during 2016-2017. Their demographic and anthropometric characteristics were recorded. The disease severity was evaluated based on CURB-65. Vitamin D status was determined by measuring by serum 25-hydroxylated vitamin D (25(OH)D) with ELISA. The patients were followed for 30 days to evaluate their vitality. One hundred and eighty pneumonia patients, including 104 males and 84 females, were recruited from respiratory disease, infectious disease, emergency, and ICU wards. Nearly 18% of the patients were current smokers. The CAP severity, evaluated by CURB-65, was determined to be non-severe in 74.4% of the patients. Patients were classified as vitamin D sufficient, insufficient, or deficient. Thirty percent of the patients were vitamin D sufficient, 18% were insufficient, and 52% were deficient. Thirty-day mortality was 40% (72 cases).
Mortality was greater in males than in females (47.1% vs. 30.3%, p=0.03). The disease was significantly less severe in the patients who survived than in those who did not. The vitamin D status differed between males and females (p=0.027). The vitamin D status was lower in the more severe cases than in the less (p=0.036), and vitamin D deficiency was more prevalent in patients who died than in those who lived. Vitamin D concentration was negatively correlated with hospital stay duration. The 25(OH)D concentration was significantly greater in patients who survived than in those who did not (p<0.001). Pneumonia severity and mortality risk were greater and hospital stays longer in vitamin D-deficient patients than in those with higher vitamin D status.

Zika virus infection has recently attracted the attention of medical community. While clinical man-ifestations of the infection in adult cases are not severe and disease is not associated with high mortality rates, Zika virus infection can have an impact on fetal development and lead to severe neurodevelopmental abnormali-ties. To gain insight into different aspects of Zika virus infection, a comprehensive literature review was performed. With regard to epidemiology and geographical distribution of Zika virus infection, relevant infor-mation was extracted from CDC and WHO websites. In this review, we discuss different basic and clinical aspects of Zika virus infection including virology, epidemiology and pathogenesis of disease. Laboratory methods required for the diagnosis of disease together with ethical issues associated with Zika virus infection will also be discussed in detail. Herein, we have tried to provide a multi-faceted view of Zika virus infection, with greater emphasis on disease status in Eastern Mediterranean Region.

Over the past years, the prevalence and the progression rate of HIV infection in Iran especially through high-risk sexual relationships have regrettably been reported at very high levels. This cross-sectional study tries to analyze stigma, mental health, and coping skills on risky behaviors in HIV-positive adults in Tehran- Iran. This cross-sectional study was conducted on a sample of 450 HIV-positive adults. Participants completed a socio-demographic questionnaire, the General HealthQuestionnaire-28, the Berger HIV Stigma Scale as well as the Lazarus Ways of Coping Questionnaire (WOCQ). To analyze the data, the independent-samples t-test and Pearson Correlation were used. The findings of this study revealed that mental health, stigma, and avoidance-escape coping mechanisms were correlated with risky behaviors (p 0.05).Furthermore, the amount of stigma among female individuals compared to men was reported at higher levels and mental health status in the given group was lower than among male individuals. It seems that psychological treatment techniques could be effective in improving mental health and reducing risky behaviors

Considering reductions in AIDS-related mortalities following effective anti-retroviral treatments in HIV/AIDS patients, HCV-associated liver diseases have turned into a major concern for HIV/HCV co-infected patients. The present study aims at determining SVR rates in HIV/HCV co-infected patients under pegylated interferon and ribavirin treatment referring to Tehran Imam Khomeini hospital during 2010 - 2013.
In this descriptive cross-sectional study, all HIV/HCV co-infected patients under pegilated interferon and ribavirin treatment referring to Tehran Imam Khomeini Hospital during 2010 - 2013 entered the study. The variables include demographic information, genotype, liver involvement stage in biopsy, viral load levels prior to treatment, 4th, 12th, and 48th week as well as 6 months after treatment (sustained virologic response (SVR)), and CD4 count every 3 months.
In the total of 28 male HIV/HCV co-infected patients of this study, 21.4% and 78.6% received peg IFN alfa- 2b, and pegIFN alfa- 2a, respectively. There were 17 genotype I (61%), 9 (32%) genotype III, and 2 (7%) genotype II among the patients. The overall SVR rate of the patients was 67.8%; it was 52.9% in genotype I and 72.7% in genotypes II and III. Despite the CD4 count decline during treatment, opportunistic infections were not observed in any of the patients
SVR rates in this study are higher than studies conducted in other countries and this implies the possibility of a more favorable genetic trait in Iranian HCV patients responding to pegIFN and ribavirin. That is still the proper regimen due to high price of free interferon regimens in Iran.

High rate of adherence to antiretroviral therapy (ART) is critical for the optimized outcome. The present study aimed to determine the rate of retention in ART programs and its’ associated factors in a triangular clinic.
The present retrospective cohort study was conducted on people living with HIV receiving care in a triangular clinic affiliated with Iranian research center for HIV/AIDS, Tehran, Iran, from 2003 to 2008. Baseline variables, duration of ART, and cause of treatment discontinuation were gathered using patients’ profile and analyzed by SPSS 21 and STATA 11.
Three hundred and seventeen cases with the mean age of 37.69 ± 10.63 (2–76) years were included (83.9% male). Treatment discontinuation had happened in 142 (45.2%) cases. Cause of treatment discontinuation was death in 20 (13.7%) cases and personal preference in 126 (86.3%) individuals. 6, 12, 18, 24, 36, and 60 months retention rates were 81.1%, 58.4%, 48.3%, 35.6%, 22.9%, and 6.3%, respectively. The results of multivariate logistic regression analysis showed a significant association between treatment retention and female sex (OR: 4.10; 95% CI: 1.59–10.56, P=0.003), addiction/drug use (OR: 0.39; 95% CI: 0.21– 0.77, P=0.007), and lamivudine zidovudine indinavir treatment regimen (OR: 0.63; 95% CI: 0.46 -0.87, P= 0.005).
Based on the findings, male sex, addiction/drug use, and type of treatment regimen were among the most important risk factors for ART attrition in HIV-infected patients.

There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients'' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.

Aspergillus is a fungus found in the environment. In an immunecompetent person, inhalation of spores may cause localized infection. In immune compromised patients, these fungi can cause life-threatening invasive infections. Invasive aspergillosis has a poor prognosis.
We describe a case of cerebral aspergillosis in an immunecompetent patient. A 29-year-old woman was admitted with seizures and headaches. Magnetic resonance imaging (MRI) of the brain showed two masses one mass in the left frontal lobe and one in parietal lobe. Excisional biopsies showed granulomatous reactions, mixed inflammatory infiltration, fibrosis, and necropurulent material mixed with fungal hyphae featuring acute-angle branching and septation, which was compatible with aspergillosis. Amphotericin B deoxycholate (1 mg/kg IV daily) was begun. The results of testing for human immunodeficiency virus (HIV) and nitroblue tetrazolium (NBT) for chronic granulomatous disease (CGD) were negative. The patient had two subsequent recurrences, and surgery and medical treatments were prescribed. Presently, after two years of follow-up, she has no symptoms and her MRI is normal.
Most cases of invasive aspergillosis show that this organism is pathogenic in immunocompromised patients; however, some case reports show that invasive aspergillosis may not be so rare in immunocompetent patients. In these patients, virulent and drug-resistant forms of aspergillus may be responsible for the disease, and treatment with antifungal agents is often ineffective, so that surgical excision is required.

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital’s Consultation cen-ter for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome (AIDS). Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method (PCR-SSP). Seventy three patients (59.8%) were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% (95% CI: 0.005-7.30). No association between presence of allele and investigated vari-ables were identified. Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

Mycobacterium tuberculosis (MTB) is one of the most common causes of disseminated granulomatous diseases especially in developing countries.. We present a patient who had an unusual type of tuberculosis who was misdiagnosed with some other common diseases such as infective endocarditis and collagen vascular diseases. Pathological examination helped us to make decision.. MTB can present with protean clinical manifestations and cause various laboratory abnormalities. In endemic areas, vigilance is essential to control this infection..

Patients with human immunodeficiency virus (HIV) infection receiving antiretroviral therapy (ART), despite a reduced viral load and improved immune responses, may experience clinical deterioration. This so called “immune reconstitution inflammatory syndrome (IRIS)” is caused by inflammatory response to both intact subclinical pathogens and residual antigens. Cytomegalovirus retinitis is common in HIV-infected patients on ART with a cluster differentiation 4 (CD4+) counts less than 50 cells/mm3. We reported a patient with blurred vision while receiving ART. She had an unmasking classic CMV retinitis after ART.

HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB، those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran، we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure، relapse and mortality. Moreover، the relationship between outcomes and number of CD4، co-trimoxazole and antiretroviral intake، type of TB and AIDS defining illness was studied. This study had 135 patients، 8 (5. 9%) were females and 127 (94. 1%) were males. The mean age of the patients was 40. 14+10. 02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2. 22%) cases of failure، 15 (11. 1%) relapse، and 21 (15. 8%) deaths. Antiretroviral therapy، AIDS defining illness، type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [Hazard ratio: 0. 392 (0. 11-1. 4); Relative Risk: 0. 809 (0. 593-1. 103) (P=0. 068)]. However، regard to CI95%، the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0. 137 (0. 141-0. 45); Relative Risk: 0. 686 (0. 513-0. 918) (P=0. 001) Overall، receiving antiretroviral was the most important factor influencing the outcome of patients.

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus (HIV), highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A (H1N1), A (H3N2), and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A (H1N1), A (H3N2), and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annul influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus.

Despite the possibility of curing TB with medical therapy، it has a sizable impact on the lives of afflicted patients. This study aimed to evaluate of treatment effect of anti-tuberculosis drugs on the quality of life on tuberculosis patients admitted in Imam Khomeini hospital in Tehran. The investigation was a before and after study. It was done in 2006-2007 by fill in Persian translated questionnaire of WHOQOL- BREF on 46 pulmonary or extra pulmonary TB infected patients. Paired samples T-test was performed to find out the differences. After 8 weeks of treatment، mean score elevation was significant in physical (15. 76±23. 89، p<0. 001)، psychological (7. 84±17. 57، p=0. 004)، and social (6. 83±19. 48، p=0. 02) domains. It was not significant in environmental domain (2. 15±8. 48، p=0. 09). Mean score elevation at the discharge time in physical، psychological، social and environmental domains were: (5. 65±16. 56، p=0. 09)، (11. 69±19. 22، p=0. 001)، (1. 04±8. 60، p=0. 41)، and (4. 37±17. 77، p=0. 1)، respectively. In our study، after treatment of tuberculosis، patient’s physical، psychological and social -not environmental- domains of quality of life were elevated، but at the discharge، there was a significant elevation in physical and psychological domains. These results emphasize the importance of patient’s treatment at the first days of admission، with special attention to social and environmental domains.

There are many published international recommendations and guidelines for the management of Invasive Fungal Infections (IFIs). It is very important to develop Iranian recommendations to implement those guidelines in a daily routine practice in Iran considering the local specifications. This was the objective of this meeting, which was held on November 3rd, 2011 in Tehran. 17 Iranian scientific leaders met and reviewed all the available published International Guidelines for management of IFIs in different groups of patients. This was followed by an open discussion to develop local recommendations for appropriate implementation of International Guidelines using the available treatments in Iran. This review shows the outcome of this meeting. We believe that, putting these recommendations into practice may lead to better results of the management of cases with IFIs.

There is a high prevalence of HCV-HIV co-infection. In this group of patients increase of insulin resistance and lipodystrophy has been discovered but still sufficient data about the lipid profile has not been performed. In this research we tried compare the lipid profile changes between HIV-HCV patients with HIV and HCV mono infected patients that came to Imam Khomeini consult center of behavioral diseases clinic and also the hepatitis clinic during 2008-2010. Methodes: This study was an analytical, cross sectional one and was done through comparison of three groups: HIV, HCV, and HIV/HCV. Each group contained of 30 patients. Demographic variables such as age, behavioral attitudes, family history of cardiovascular diseases and hyperlipidemia did not have any difference between the 3 groups. The researcher also compared the parameters of liver disease including AST, ALT, and platelet between the aforementioned groups and found no significant difference among them.Moreover, when TG, Cholesterol, LDL, and HDL was compared between the groups it was found that the mean total of cholesterol and LDL decreased in the HIV/HCV group (p=.001).In addition, the 3 groups were also compared by the dyslipidemia criteria. (TG ≥ 200 mg/dl, cholesterol ≥ 240, HDL <40). When the 3 groups were compared by the dyslipidemia criteria it resulted in no significant difference between the 3 groups. Although HIV-HCV coinfected patients had lower mean cholesterol and LDL in comparison to the other two groups nevertheless no significant difference was found from the critical level of lipid profile between the 3 groups. Furthermore it was found that HCV can cause a decrease in cholesterol and LDL when it is accompanied by HIV.

It is estimated that one third of the world's population is latently infected with tuberculosis (TB). The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS (Systemic Inflammatory Response Syndrome) status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB.

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% (95% CI 0.005-1.2) with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future.

The FNA (fine needle aspiration) procedure is simple, inexpensive, available and a safe method for the diagnosis of a neck mass. FNA has numerous advantages over open surgical biopsies as an initial diagnostic tool; therefore we decided to compare the accuracy of this method with open biopsy. This Retrospective as well as Descriptive study comparing preoperative FNA results with existing data in the Pathology Department in Bu-Ali and Amir Alam Hospitals. Our study included 100 patients with neck masses of which 22 were thyroid masses, 31 were salivary gland masses, and 47 were other masses. Age ranged from 3 years to 80 years with the mean age of 42.6 years. There were 59 men and 41 women. The Sensitivity was 72%, Specificity 87%, PPV 85%, NPV 75% and diagnostic Accuracy 79%. In this study we had also26% false negative and 15% false positive. FNA is a valuable diagnostic tool in the management of neck masses; also it has been used for staging and planning of treatment for the wide and metastatic malignancy. This technique reduces the need for more invasive and costly procedures. According to the high sensitivity and high accuracy in this study, FNA can be used as the first step of diagnoses test in neck masses.

Human immunodeficiency virus (HIV)- infected patients are at risk of acquiring viral hepatitis, due to common routes of transmission. As the introduction of highly active antiretroviral therapy (HAART) reduced the frequency of opportunistic infections and improved survival, viral hepatitis emerged as an important cause of morbidity and mortality in HIV-infected cases. Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection without detectable hepatitis B surface antigen (HBsAg). There are conflicting reports on the impact of occult HBV infection on the natural history of HIV disease. In this review, we described the findings of studies on HIV and hepatitis B co-infection with focus on the prevalence of occult HBV infection. The results of this review demonstrated the importance of prevention, diagnosis and treatment of occult HBV infection in HIV-positive patients

Varicella-zoster viruses complications involving the CNS are estimated to occur rarely, transverse myelitis after Varicella-zoster virus in most patients is characterized by an abrupt onset of progressive weakness and sensory disturbance in the lower extremities, like other viruses. We describe the case of 17 year-old boy who experienced cervical transverse myelitis after chickenpox with inability to walk and with urinary retention. He was not treated with any medication but complete revovery has been occured.