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BackgroundLead (Pb) poisoning among people using opium has been an increasing problem in Iran. The present study highlights the clinical effects of lead toxicity associated with opium use in Iran, Kerman province.MethodsBetween January 2016 and June 2016, patients with signs and symptoms of Pb poisoning were questioned to assess whether they had a history of opium dependency. In total, 249 patients were enrolled onto this cross-sectional study, all were opium dependent. Para-clinical data including blood lead level (BLL), demographic information, user preferences, and symptoms were obtained.ResultsThe patients used either opium (83.9%), refined opium (6.4%) or a combination of both (9.7%) via ingestion (71.9%), smoking (8.4%) or a combination of both (19.7%). The overall median BLL was 80.0 μg/dL [IQR: 51.7–119.0]. The median BLL did not differ significantly between opium and refined opium users. Further, BLL was not significantly affected by the type of substance, route of use, duration of use, or daily quantity consumed. Common symptoms included abdominal pain (86.9%), constipation (75.8%), anorexia (71.5%) and nausea (54.7%). Linear regression analysis showed log of BLL was significantly associated with abdominal pain, myalgia and anorexia.ConclusionsThe study unravelled an increase in opium-related Pb poisoning in the Kerman province. Raised awareness of this emerging Pb source and investigation of its aetiology is recommended. Pb poisoning should be considered among the primary differential diagnosis of opium users with gastrointestinal symptoms.

Background:Enteroaggregative Escherichia coli (EAEC) is commonly associated with pediatric diarrhea, in developing countries. Objectives: In this study, we investigated the distribution of virulence genes, enterotoxin and biofilm formation among EAEC strains isolated from stools of children with diarrhea referred to three hospitals in south east Iran. Patients and Methods: A total of 464 diarrheic stools were screen for the presence of E. coli using conventional tests. Well isolated colonies were then evaluated for the presence of EAEC diagnostic genes (aggR and pCVD432) by duplex polymerase chain reaction (D-PCR). Positive samples were further subjected to three sets of multiplex-PCR for detection of fimbrial subunits (AAF), serine protease autotransporter toxins (SPATE) and at least one enterotoxin gene. Hemolytic activity was observed on sheep blood agar. Biofilm formation was measured by using a microtiter plate assay. Results: Among the 322 E. coli isolated, 23 were identified as EAEC. All EAEC carried a 630-bp fragment of the plasmid (pAA) encoded pCVD432 and aggR genes. Four major EAEC fimbriae variants aggA, agg4A, agg3A and aafA were detected, with the frequencies of 21.7% (n = 5), 26.8% (n = 6), 21.7% (n = 5) and 4.3% (n = 1), respectively. The class I and II virulence toxins pic, sat, sepA, pet and sigA were detected with frequencies of 56.5% (n = 13), 30.4% (n = 7), 26.8% (n = 6), 21.7% (n = 5) and 4.3% (n = 1), respectively. A heat-stable Shigella enterotoxin-1 gene (astA) was detected in 17.3% (n = 4) of the cases. In addition, 56.4% of the EAEC isolates were α-hemolytic. Quantification of the biofilm revealed six isolates with strong biofilm. Conclusions: Overall, except for pCVD432 and aggR, we detected high heterogeneity of virulence factors among EAEC isolates causing diarrhea in children. One set of genes, in the combination, pic-sepA-agg4A, was associated with strong biofilm.

BACKGROUND

Background:Non-alcoholic steatohepatitis (NASH) is a progressive form of nonalcoholic fatty liver disease. Several studies suggest that pentoxifylline (PTX) can improve the disease outcome.Objectives:We aimed to compare the effect of pentoxifylline with placebo on liver aminotransferases and cytokines, including interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-α), and interleukin 8 (IL-8) in patients with NASH.Patients and Methods:Thirty patients with NASH were included in the study, based on ultrasonography and 1.5-fold mean change from baseline serum levels of liver aminotransferases. Patients with NASH were randomized to receive 1200 mg PTX (the intervention group) or placebo (the placebo group) for 6 months. The serum levels of liver aminotransferases and cytokines were compared between the intervention and placebo groups, at various time points.Results:The serum levels of liver aminotransferases were significantly reduced at 3 months and at 6 months, compared with baseline, in both groups. The serum levels of IL-6 were significantly decreased, in both groups, only at 6 months, compared with baseline. Compared to the placebo group, the serum level of TNF-α was significantly decreased in the intervention group, at 6 months. The serum level of IL-8 was increased, in both groups, after 6 months, without reaching clinical significance. There was no significant difference in serum levels of liver aminotransferases and cytokines, between intervention and placebo groups.Conclusions:Decreases in the serum levels of liver aminotransferases and cytokines, in both groups, are related to low-calorie diets and exercise, rather than PTX.