سال:1395 | دوره: | شماره: |تعداد مقالات:8

Dear Editor,Rabies is a deadly neurological disease. The best prevention is post exposure rabies vaccination (1). In the present day, there are several techniques for vaccine administration. Both intradermal (ID) and intramuscular (IM) administration can be used and different numbers of injection site is applicable. There are some reports comparing the effectiveness of different techniques. The recent publication by Warrell et al. compared several techniques and can be useful for further policy making (2). Nevertheless, the important concern in decision making is “cost” and “effectiveness”. In addition, “safety” has to be considered. Here, the author performed an analysis on cost-safety-effectiveness analysis of different methods of rabies vaccination. Data on cost refers to the standard vaccine cost, in US dollar, from the Red Cross Society, Thailand. The effectiveness and safety refer to the published data by Warrell et al. (2). The cost-safety-effectiveness analysis can be defined as cost per safe fraction of vaccine effectiveness, which can be calculated using the following equation.

Background: A growing number of elderly patients are hospitalized for various causes and age has been described inconsistently as a risk factor for acquiring nosocomial infections with a subsequent higher mortality rate compared to younger patients.Objectives: To describe the incidence, type, and microbiological characteristics of nosocomial infections in elderly and non-elderly patients.Patients and Methods: Retrospective analysis of all hospital-acquired infections (HAIs) in an academic community hospital. Patients were stratified into two groups: non-elderly (18 - 64 years) and elderly (> 65 years).Results: A total of 18469 patients were included (108555 hospital days) in this study. About 79.6% of HAI were infected non-elderly and 20.3% elderly (P<0.0001) patients. Higher infection rates for ventilator-associated pneumonia (VAP), secondary bacteremia, and catheter-associated urinary tract infections were noted for elderly as well as a higher frequency of positive cultures for Gram-negative bacteria, particularly Klebsiella spp. and fungal infections (P>0.05). Hospital mortality increased with every HAI diagnosed per patient.Conclusions: The study showed that HAIs were more frequent in elderly population predominately with respect to VAP and infections by Gram-negative pathogens. Overall mortally was greater in the elderly group although the odds ratio for death was higher in younger patients and increased with every HAI diagnosed.

Background: Hepatitis C virus (HCV) infection is an important global concern, with a frequency of 3% (i.e., 170 million of the population has HCV-Ab). Additionally, 50% of HCV and 80% of transfusion transmitted infections (TTI) are chronic. In 20% of cases, HCV occurs as an acute infection, and in the remaining 80% of cases, it becomes chronic. In chronic patients, risk of cirrhosis is up to 44%, risk of hepatocellular carcinoma (HCC) is 13%, and risk of mortality is 14%. As there is no vaccine available for the virus yet, and since most of the cases are asymptomatic, attention to the epidemiology of the disease among the population is a pressing concern.Objectives: The aim of this study is to determine the prevalence and risk factors of HCV in Birjand city.Patients and Methods: In this descriptive-analytical study, 5,235 people who live in Birjand city were selected, after gaining permission for the study, a signed consent form was obtained from each patient. Prevalence of HCV was determined by ELISA test, and positive cases underwent Polymerase chain reaction (PCR) and genotyping for confirmation.Results: The mean age of the participants was 39.7±14.4. Among them, 52.2% were female and 29.9% had university degrees. Prevalence of HCV-Ab+ was about 0.2% with ELISA, and 0.14% of entire group were confirmed by PCR. No significant relationship was found for age, sex, and education (P>0.05). Also, there was no significant relationship found with risk factors such as endoscopy, blood transfusion, surgery, hospitalization, phlebotomy, and alcohol drinking (P > 0.05). HCV-Ab was 200 times more prevalent in IV-drug abusers compared to non-addicted people. Also, the prevalence of HCV-Ab in non-IV-drug abuser addicts was 9.3 times higher than in non-addict patients. Prevalence of HCV-Ab in patients who reported illicit sexual activities was 13.3 times higher. In patients with a familial history of HCV, infection was 26.3 times more prevalent than in patients with no familial history (P<0.001).Conclusions: In this study, the prevalence of HCV was 0.2%, which is lower than the mean prevalence in Iran (1%). Prevalence of HCV had a significant relationship with IV-drug abuse.

Background: Invasive fungal infections (IFI) represent a serious threat for severely immunocompromised patients. Infection control interventions, including protective environment (PE) implementation, are essential to reduce IFI incidence, mortality and burden of hospitalization, among high-risk patients. Information about the impact of these strategies in cancer patients with chemotherapy-induced neutropenia (CIN), in developing countries, is insufficient.Objectives: To assess the impact of PE implementation on IFI incidence, consumption and cost of antifungal treatment, in a general, tertiary teaching hospital, in Southern Brazil.Patients and Methods: We conducted a quasi-experimental study to evaluate an institutional intervention, in a hospital ward, for patients with CIN, which consisted in renovation of the ward and measures involving air-quality technologies installation, the main one being high efficiency particulate air (HEPA) filters. Simultaneously, infection control routines were implemented. Neutropenic patients, admitted to any other hospital ward, prior to the renovation, were included in the historical control group. The IFI incidence was defined, according to the criteria proposed by the European Organization for Research and Treatment of Cancer. Direct costs of antifungal drugs were recorded, for all neutropenic patients.Results: A total of 190 and 181 hospital admissions were included in the intervention and control groups, respectively. Total IFI incidence was reduced in the PE group (7.4% vs. 18.2%, P=0.002) and the same was observed when considering only proven and probable IFI (1.6% vs. 8.3%, P=0.003). This benefit persisted even after adjusting for antifungal prophylaxis (OR=0.17, 95% CI=0.05 - 0.60). We observed a decreasing trend in molds and yeasts IFI incidence, in the intervention group. Although the final cost of antifungal agents was lower, after intervention (78347.37 USD vs. 154176.60 USD), the median cost per admission did not differ between groups (1.00 USD=1.9 Brazilian Real, in May 2007). Considering all admissions with IFI, the median cost was significantly higher than recorded in admissions without IFI.Conclusions: This study showed that preventive measures, including PE implementation, reduce IFI incidence in patients with CIN, admitted in a hospital in a developing country. This suggests that those strategies may overcome their costs on the long-term, by saving costs associated with fungal infections.

Background: Febrile convulsions are seizures associated with fever during childhood. They generally have excellent prognosis. However, as they may signify a serious underlying acute infectious disease, each case must be carefully examined and appropriately investigated.Objectives: The aim of this study was to investigate the causes of infectious diseases, which tend to get into febrile convulsion in patients hospitalized in 17th Shahrivar Hospital in Rasht city, Iran.Patients and Methods: This descriptive cross-sectional study was conducted on all children hospitalized with infectious diseases in 17th Shahrivar Children’s Hospital in Rasht city, Iran, between August 2008 and August 2009. They were recruited using the convenient method. Data were collected using a form including age, sex, season of admission and possible diagnosis and analyzed by descriptive statistics (mean, standard deviation and frequency) using SPSS software version 16.Results: In this study, 191 patients (14%) had febrile convulsion. According to the results, respiratory tract infection was mentioned in 97 cases (47.3%) and considered as the leading cause of fever.Conclusions: According to results, it seems that clinicians should assess patients with infectious disease thoroughly to prevent further health problems.

Background: The extracts of many plants have been used for their applications in the prevention of bacterial growth, however, these applications need more investigations.Objectives: The major aim of the current study was to investigate the antimicrobial activity of an extract of the Peganum harmala flower and Heracleum persicum against Acinetobacter baumannii. Materials and Methods: The minimum inhibitory (MIC) concentrations Minimum Bactericidal Concentration of extract and essential oil were investigated by microdilution method and antibiotic resistance was evaluated using the disk diffusion test.Results: In this study, the levels of MIC extract and essential oil of Peganum harmala were observed in ranges from 6.25 ppm to 12.5 ppm and 3.1 ppm to 25 ppm, respectively. The highest MIC value was observed as 12.5 ppm in A. baumannii. The levels of MIC extract and essential oil of Heracleum persicum were observed in ranges from 5 ppm to 20 ppm and 12.5 ppm to 10 ppm, respectively. The highest level of MIC extract and the highest essential oil value of Heracleum persicum were observed as 20 ppm and 10 ppm, respectively, in A. baumannii.Conclusions: Results of this study suggest that the extract alone of Peganum harmala and Heracleum persicum may be useful to treat bacterial infections.

Measles is one of the most contagious infectious diseases in the world. It has a secondary infection rate of about 90% in susceptible people. It is a childhood disease, but it can affect people of all ages (1, 2). Uncomplicated measles presents with a generalized rash, temperature of 38.3oC or higher, coryza, conjunctivitis, and a cough lasting 7 days or more. Laboratory confirmation is made by serologic testing for measles-specific IgM or IgG antibodies, isolation of the virus, and reverse-transcriptase polymerase chain reaction (RT-PCR) (1-3). The treatment of measles is mainly supportive, including well hydration and sometimes intravenous (IV) hydration if the dehydration is severe. Vitamin A supplementation also should be considered. The complications of measles occur more often in people younger than 5 years of age or older than 20 years, complications also occur in people with vitamin A deficiencies, malnutrition, immune deficiency disorders, such as human immunodeficiency virus (HIV) infection, and in those with a history of inadequate vaccination (2-5). The risk of death among patients is usually 0.2%, but it can rise to 10% in those with malnutrition and other immunodeficiency disorders. Immunocompromised patients are susceptible and are at risk of severe illness and superinfections, such as pneumonia and otitis. Patients should be under follow-up care for surveillance of complications of the infection. The measles vaccine is effective in preventing the disease.

Introduction: Varicella gangrenosa is an uncommon but serious complication of chicken pox in young children. It should be suspected in any child with a history of varicella infection and increasing complaints of pain and swelling in an extremity or other body area, along with increasing fever, erythema, lethargy, and irritability. Early surgical intervention with intensive antibiotic therapy is essential to prevent fatal consequences.Case Presentation: We describe a case of a previously healthy child who presented with sepsis due to varicella gangrenosa. While she initially responded well to a conservative antibiotic and acyclovir treatment, her subsequent rapid deterioration required urgent and repeated debridement.Conclusions: This report highlights the significance of prompt diagnosis and early surgical intervention for management of varicella gangrenosa.