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Background and Objective: Previous studies have shown that vitamin D is involved in host immune response toward Mycobacterium tuberculosis (MTB). The aim of this study was to determine if administration of vitamin D can improve treatment outcome and whether is able to increase the rate of sputum clearance of MTB in patients with pulmonary tuberculosis (PTB). Materials and Methods: This randomized clinical trial study was conducted on 96 patients with lung tuberculosis in Ahvaz, Iran during 2008-09. The patients were 18>=years old with sputum positive for acid fast bacillus. Patients were placed in two equal groups as cases and controls. Cases were treated by standard anti TB regimen plus 800 IU/day vit D orally. Controls were treated only by standard anti TB regimen. Follow up sputum examination for presence AFB was performed at the end of month 1, 2, 3, 4 and treatment period. Data were analyzed in SPSS-16 by using descriptive statistics test, chi square and fisher exact test. Results: Mean±SD age of cases and controls was 39.1±17.8 and 38.3±17.6 years, respectively. Overall cure rate in case and control was 93.8% and 95.8% respectively, with no significant difference. The rate of negative sputum of cases in the end of months 1, 2, 3, 4 and treatment period was 66.7%, 78.5%, 93.8% and 93.8% respectively, and for controls was 35.4%, 66.7%, 91.7% and 95.8% respectively. There was significant difference between two groups in the end of first and second month (P<0.05). Conclusion: This study showed that vitamin D as a supplemental drug does not improve the overall treatment outcome among lung TB patients, but it may be able to increase the rate of sputum clearance of Mycobacterium tuberculosis.

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Background and Objective: Previous reports on the effect of treatment on the serum immunologic parameters in patients with infective endocarditis are controversial. This study was conducted to asses the serum levels of CRP (C-reactive protein), RF (rheumatoid factor) and CIC (circulatory immune complex) before and after treatment in patients with infective endocarditis. Materials and Methods: In this discriptive study 30 hospitalized patients with infective endocarditis in Razi Hospital in Ahvaz during 2006. Blood samples obtained before and after treatment. 2.5 cc of each sample were used for CRP and RF and remaining 2.5 cc preserved at -20ºC until CIC examination. CRP and RF were measured by using nephlometry and CIC was detected by immundiffusion method. The data were analyzed using SPSS-16 and t-student test. Results: Out of 30 patients, 26 (86.7%) were male. Mean age was 29.53±10.28years. The mean values of CIC, CRP and RF before and after treatment were 0.847, 72.38, 60.45 and 0.80, 44.1, 41.2, respectively. The means of CRP and RF before and after treatment were statistically significant (p<0.05). Conclusion: This study showed that the serum level of CRP and RF reduce after effective treatments because most of the our patients were intravenous drug user, CRP and RF indeces may be useful measurment for treatment evaluation responses to infective endocarditis in these population.

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Background and Objective: Diagnosis of latent tuberculosis infection (LTBI) by tuberculin skin test (TST) is accompaind with limitations. A few documented data exist regarding the performance of serology tests for LTBI diagnosis in HIV infection. The aim of this study was to determine LTBI prevalency and compare TST results and IgM antibodies against M.tuberculosis antigens (IAMA) for the diagnosis of LTBI in HIV infected individuals. Materials and Methods: In this discriptive study, sixty two HIV infected subjects were chosen randomly from an addict treatment center in Ahvaz southwest Iran during 2008. The patients underwent TST, using 5 TU of purified protein derivative, and IAMA was measured. Data were analyzed using SPSS-15 software and Chi-Square test. Results: From 62 studied cases, 34 (54.8%) had positive result for TST, whereas 6 (9.7%) had positive IAMA. LTBI was diagnosed in 37 (59.7%) by either TST or IAMA. Overall concordance between TST and IAMA was 45.2%. In subjects with positive test by either TST or IAMA, only 4.8% had positive test by either diagnostic procedure. Discordant results were found in 54.8% of subjects. Positive results for both diagnostic methods in subjects with above and below 200 CD4-cell/mm3 did not show any significant differences. Conclusion: This study showed that LTBI prevalence among HIV infected individuals among addict patients, in this region is higher than other parts of the world. Also TST is a useful test for LTBI diagnosis is preferable to IAMA method.

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Background and Objective: The incidence of infections is one of the most disturbing problems in the management of patients with systemic lupus erythematosus (SLE). The aim of this study was to describe the role of tuberculosis (TB) as a cause of fever in SLE patients. Materials and Methods: In this descriptive study 103 SLE patients enrolled in Ahvaz, South-West of Iran during 2000 - 06. Patients were diagnosed according to American College of Rheumatology criteria (at least 4 of 11 criteria). Diagnosis of tuberculosis was based on Iranian National Program against TB criteria. The infection free patients were given corticosteroid therapy. Results: In this study 20 patients did not follow the complete cycle and finally 83 patients were established as sample population of this study. Mean age of patients was 22.2±10 years, female to male ratio was 9.2:1, mean duration of treatment was12±3.2 months and mean of daily dose of prednisolone was 28.2±13 mg.From total of patients, 8 (9.6%) had active tuberculosis. five patients had pulmonary and three with other type of TB, respectively. One of the above eight patients eventually died due to SLE/TB. Conclusion: Tuberculosis is one of the important causes of fever among patients with SLE under treatment of corticosteroid. In approaching febrile SLE patient TB should always be considered as a treat.

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Background and Objective: Risk factors of tuberculosis vary in communities according to different socioeconomic conditions. Knowing these risk factors help to control the disease. This study was done to determine the main risk factors of pulmonary tuberculosis acquisition in hospitalized patients. Materials and Methods: In this data based, case-control study 173 tuberculosis patients (as cases) and 305 non tuberculosis patients (as controls) hospitalized in Razi hospital in Ahvaz, Iran during 2001-07 were gone under investigation. Risk factors included injecting drug addiction, smoking, HIV infection, diabetes mellitus, imprisonment and corticosteroid usage. Data were analyzed using SPSS-13, Chi-Square and Fisher exact tests. Odds ratio was determined for risk factors. Results: Frequencies of the main risk factors in case and control groups were as: smoking 54.3%, 14.8% (p=0.0001, OR: 6.5), HIV infection 11.5%, 3% (p=0.0002, OR: 4.3), injecting drug addiction 18%, 3.3% (p=0.0001, OR: 6.7), diabetes mellitus 22.5%, 5.9% (p=0.0001, OR: 4.6) and imprisonment 20.2%, 3.9% (p=0.0001, OR: 6.2), respectively. Corticosteroid use and renal failure were similar in cases and controls. Conclusion: This study showed that smoking, HIV infection, injecting drug addiction, diabetes mellitus and imprisonment were the main risk factors for tuberculosis acquisition in this region.

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Background and Objective: Human immunodeficiency virus (HIV) pandemic is increasing word-wide. Tuberculosis is the main cause of death and low quality of life in HIV infected patients. The prevalence of Tuberculosis in HIV infected patients varies in different areas according to socioeconomic, cultural and geographical situation. This study was done to asses the pulmonary Tuberculosis risk factors in hospitalized HIV positive patients in Ahvaz, Iran. Materials and Methods: In this data based study all medical files of admitted HIV positive patients in Razi hospital in Ahvaz in south west of Iran were reviewed during 2001-09. Demographic characteristics and HIV Tuberculosis related variables were analyzed using SPSS-16, Fisher's exact test and Odds Ratio. Results: Out of 123 HIV cases 99 (80.5%) were injecting drug user (IDU), sixty eight (55.3%) had imprisoment history. Eighty one patients (65.8%) had Tuberculosis, in which 46 had co-morbidities such as infective endocarditis or viral hepatitis, 79 cases were IDU, 61 cases had imprisonment history and 24 cases had CD4 count below 200. There was a significant association between Tuberculosis and IDU, imprisonment and CD4 count (P<0.05). Conclusion: This study showed that the rate of Tuberculosis in HIV positive patients is higher than the rate in previous studies performed in Iran. Also exposure to Tuberculosis cases in prison, IDU and low CD4+ T- lymphocyte count are the main risk factors for Tuberculosis acquisition.

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Background and Objective: Indiscriminate use of antibiotics is one of the major health problems worldwide. Rapidly increasing incidence of antibiotic-resistant microbes warns healthcare authorities in the country to use drugs, reasonably. This study was carried out to assess the pattern of antibiotic usage in Razi teaching hospital in Ahvaz, southwest of Iran. Methods: This descriptive –analytical study was conducted on 17668 hospitalized patients in Razi teaching hospital Ahvaz, southwest of Iran during 2012. Proper or inappropriate antibiotic usage was judged based on existing national guidelines or guidelines referenced in textbooks. Results: 3119 of patients were received antibiotics which 20.4% of patients were being treated unnecessarily. 2482 (79.6%) of patients had indications for antibiotic therapy. Out of 2482 patients with indications for antibiotic therapy, 51.9%, 18.1 % and 6.5 % of patients were received incorrect antibiotic regiment, inadequate dose and unsuitable duration of therapy, respectively. The highest rate of unnecessary, inappropriate, incorrect duration and dosage of antibiotics were observed in internal, scorpion wards and the lowest was in infectious diseases and obstetrics wards (P<0.05). Conclusion: The pattern of antibiotic usage in Razi teaching hospital in Ahvaz was inappropriate. Unnecessary prescription, inappropriate antibiotic spectrum, inadequate dose and duration of antibiotics were inappropriate treatment strategy.