Iranian Journal of Infectious Diseases and Tropical Medicine
Year:2010 | Volume:15 | Issue:48|Papers Count:15

Background and objective: Intravascular catheters continue to be one of the main sources of hospital- acquired bacteremia especially in high risk wards such as Pediatric Intensive Care Units (PICUs). These infections can longer the hospitalization period and increase morbidity- mortality in hospitals. Planecta® (JMS Co., Ltd.) system is a close infusion system that has some profits: being needleless, easy to use, increasing the rate of infusion and elimination the dead space. We have compared the frequency of catheter related systemic infections with new hub device, Planecta, vs.conventional system.Materials and methods: This clinical trial study was performed on hospitalized patients in PICU ward at Mofid Children Hospital after dividing them into two random groups based on the bed numbers from Jan 2007 to Aug 2007. A Planecta system (6 parts) was used for interventional group and the conventional method for comparing group. The rate of sepsis due to catheterization was assessed according to NNISS criteria.Results: 254 patients were included with 99 in intervention and 155 in comparing group. There was no report of catheter related systemic infection in both groups. Median hospitalization period in Planecta group (4 days) was similar to comparing group (3 days) (p-value=0.67). Overall mortality rate in two groups was equivalent too (22.2% and 16.8% respectively, p-value=0.28).Conclusion: According to the results, it seems that Planecta wouldn't be cost-benefit as a device for reducing catheterization related systemic complications for all patients. Further studies should be done on special patients and applications such as infusion of viscous fluids and blood transfusion.

Background and objective: Numerous regimens of several antimicrobial agents are suggested for eradication of H. pylori infection. Resistance to antibacterial agents is common in H. pylori Strains in developing countries such as our country. Thus its eradication is an important issue. The aim of present study was to compare the triple, quadruple and sequential therapy regimens for eradication of H. pylori infection and achieve to most effective regimen for first line eradication therapy of H. pylori infection in our country.Materials and methods: We conducted a prospective randomized trial of 428 patients with peptic ulcer and Helicobacter Pylori infection from 2007 to 2008.Recruited patients were randomized into four equal groups (each groups contains 107 patients) for eradication regimens: Group A: Omeprazole 40mg b.d, amoxicillin 1g bid metronidazol 500mg b.d bismuth subcitrate 120mg q.d, for two weeks.Group B: Omeperazole 20mg b.d Amoxicillin 1gr b.d. clathromycin 500mg b.d, for ten days.Group C: Omeprazole 20mg b.d, Amoxicillin 1gr b.d both for two weeks and ciprofloxacin 500mg b.d just for the first week.Group D: Omeprazole 20mg b.d for ten days with amoxicillin Igr b.d for first 5 days then metronidazole 500mg b.d and clathromycin 500mg b.d 5days.Result was assessed at least 2 month after the end of antimicrobial therapy by stool Ag H.pylori test and BC 13C Urea Breath Test. We used SPSS 14 and our data were analyzed by chi-square. P-vallue< 0.05 was considered statistically significant.Results: H.pylori eradication was achieved in 84.1%, 90.7%, 65.4% and 80.4% in groups A, B, C and D, respectively. The eradication rate in group B was higher than group D (Pvalue<0.05) and group C (Pvalue<0.0001), while no significant differences were observed between group B and A.Our study showed group B is most effective regimen for eradication of H.pylori infection and group C is less effective.Conclusion: This study showed that in our region, clarithromycinbased triple therapy is first choice for treatment of Helicobacter pylori infection. If the cost of prescribing drug is important, metronidazole based quadruple therapy can be used as an alternative.

Background and objective: Human papillomavirus (HPV) infections are frequently associated with benign and malignant lesions of the female genital region and male ano-genital tract. Currently the possible role of HPV infections in prostate carcinoma is a subject of great controversy. In this study we aimed to investigate the involvement of HPV infection in prostate carcinoma (PCa).Materials and methods: The study included formalin-fixed paraffin-embedded tissue samples of 104 primary prostate adenocarcinoma cases and 104 control tissues of benign prostatic hyperplasia (BPH). HPV-DNA was purified and amplified through nested PCR and subsequently subjected to sequencing.Results: HPV-DNA was found in 13 of 104 (12.5%) PCa and 8 of 104 (7.7%) BPH samples.There was not any significant difference between PCa and BPH specimens regarding HPV-DNA presence. High-risk HPVs were detected in 10 of 13 (76.9%) PCa and 5 of 8 (62.5%) BPH samples with positive HPV-DNA. Low-risk HPVs were detected in 3 of 13 (23.1%) PCa and 3 of 8 (37.5%) BPH specimens with positive HPV-DNA. There was not any significant difference between PCa and BPH specimens regarding the presence of high-risk and low-risk HPVs.Conclusion: Our data do not support the involvement of HPV infection in prostate carcinoma.Furth. are studi.es are required to elucidate the involvement of HPV infection in human prostate Carcinoma.

Background and objective: Tuberculin skin testing (TST) is used for identification of tuberculosis infection.Interpretation of test is related to many factors such as prevalence of disease in community, use of vaccine, age of patients and exposure to non-tuberculosis mycobacterium. Cut off point of TST is reported between 2 to 16mm in different communities. In this study we aimed to determine the predictive value and cut off point of TST in probable patients with pulmonary tuberculosis (TB).Materials and methods: A total of 714 probable patients with pulmonary tuberculosis with mean age 57±20.11 years were included in this study. 52.9% of them were male. All subjects were tested using 5 tuberculin units of purified protein derivative (PPD). Gold standard for diagnosis of TB was considered positive smear or culture. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of TST were determined. Cut off point of PPD was determined using Roc curve.Results: 113 patients from 714 suspicious subjects (15.82%) had pulmonary tuberculosis.80% of them had positive sputum smear.Sensitivity, specificity, PPV and NPV for PPD³5mmwere 80%, 61%, 28% and 94% respectively.Sensitivity, specificity, PPV and NPV for PPD³10mm were 53%, 82%, 35% and 90% respectively. The calculated cut off point for PPD was ³4 mm.Conclusion: Our results emphasized that a TST reaction smaller than 5 mm was seen in patients with bacteriological confirmed pulmonary tuberculosis. Predictably, as the cut-off is moved to larger reactions, sensitivity decreases and specificity increases. More estimates are needed to identify the accurate cut off point of PPD in tuberculosis patients.

Background and objective: Anthrax is a disease of herbivorous animals caused by Bacillus anthracis and humans incidentally acquire the disease by handling the infected dead animals and their products.Materials and methods: 28 human anthrax cases were reported from Esfarayen village of north Khorasan province in Iran during Aug 2009. These cases occurred following an epizootic of anthrax among sheeps of the village and ingestion of contaminated meat by the villagers.Results: Persons who had slaughtered sheep and handled meat had a higher risk for illness than those who had not. Animal husbandry authorities surveyed all the animals in these areas and found 16 animals suffering from anthrax (the diagnosis was established by smear and culture studies).Nearly 3, 000 animals were vaccinated with live attenuated spore vaccine from Razi Institute, within a week of this outbreak under a mass vaccination program.Conclusion: In this paper, the authors identify potential causes for the occurrence of anthrax.Anthrax surveillance and farmer education about consumption of meat from animals, which had died of unknown causes, must be intensified, particularly in areas of high prevalence.

Background and Objective: Cutaneous Leishmaniasis is one of the parasitical diseases that caused by parasite called lieshmania. In Iran, the clinical presentation of Cutaneous Leishmaniasis is mainly in the form of dry type (urban form) or wet type (rural form). Sand fly is vector of disease.Human and dog are reservoir in urban form but many species of rodent are the reservoir of rural type. This study was carried out for the Control of vectors and reservoir of rural Cutaneous Leishmaniasis and decreases the incidence rate of disease in rural areas of Damghan district.Materials and methods: this interventional study carried out in 2005-2006 in rural areas of Damghan. Different methods were used to control the Cutaneous Leishmaniasis: Control of rodents, Insecticide impregnated bed nets, environmental sanitary, health education for personal protections and some time residual spraying.Results: Methods that used is effective to decrease the incidence rate of Cutaneous Leishmaniasis.In 2004, before the intervention, incidence rate of disease was 555 cases in 100000 people. But after use of the control methods decreased to 327 and 153 cases in 100000 people respectively in 2005, 2006.Conclusion: By used of control methods incidence rate of Cutaneous Leishmaniasis decreased clearly. Thus After two years interventions as the amount of incidence rate 3/6 times less. to Control of Zoonotic Cutaneous Leishmaniasis combination of various methods must be used. in same area of our country Health Education programs, rodent control, environmental sanitary as well as personal protections and Insecticide impregnated bed nets was suggested to prevention of disease.

Background and objectives: Enterococci are members of the normal gut flora of animal and human. They are a leading cause of nosocomial infections. According to transfer of resistant genes between bacteria and human, natural reservoir can affect the distribution of resistant species. The aim of the study was to detect and identify the Antibiotic resistance pattern within isolated Enterococci which was separated from number of Tehran chicken husbandry unites.Material and methods: 122 isolates of enterococci were selected on Membrane Filter Enterococcus Selective Agar medium, supplemented with vancomycin and identified at the species level by the common biochemical tests and specific genus and species primer. Antibiotic susceptibility test to 6 antibiotics was done by disc diffussion. MIC of vancomycin was also done using broth micro-dillution assay using CLSI recommendations.Results: Results showed that 26, 45 and 51 isolates were E. faecalis, E. faecium and E. gallinarum respectively. 39, 23, 19, 8, 19, 20 of the isolates were resistant to vancomycin, tetracycline, gentamycin, chloramphenicol, ciprofloxacin and erithromycin respectively. MIC test of the 70% of the isolates were³256 mg/ml.Conclusion: Although diversity of VRE isolates were restricted to 3 species, but E. faecium had high resistance to broad range of Antibiotics. Results of this study showed the important role of poultry samples as a reservoir of resistance elements. Chicken husbandry precise consideration must be given to sanitary and food industries.

Background and objective: Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection with undetectable HBsAg. Occult hepatitis B infection is more common in a number of subgroups, including injection drug users (IDUs) and they are considered as a high risk group for HBV infection.This study aimed to determine the prevalence of occult HBV infection among male IDUs with isolated anti-HBc.Materials and methods: A total of 153 IDUs were included in this study. HBsAg, anti-HBs, anti-HBc, anti-HCV and anti-HIV were tested in all subjects. The presence of HBV-DNA was determined in plasma samples of individuals with isolated anti-HBc by real-time PCR.Results: Of 153 injection drug users enrolled in this study, 11 subjects (7.2%, .95% CI, 3.2%- 11.2%) had isolated anti-HBc.HBV-DNA was detectable in none of 11 patients who had isolated anti-HBc. HBV-HCV co-infection was observed in 5.9%, HBV-HIV co-infection in 2% and HCVHIV co-infection in 5.2% of cases.1.3% of subjects were co-infected with HBV, HIV and HCV.Conclusions: Our survey showed that isolated anti-HBc and occult HBV infection were negligible in injection drug users who living in the Central province of Iran, where HBV prevalence is low, regardless of age, the type of drug (s) consumed, duration of injection drug use and HIV infection.

Background and objective: In traumatic patients, whom admitted in ICU, infection is the most important nosocamial event that treats the patient's life, can cause increase of admission days, economic costs and dissatisfaction.Materials and methods: All of the admitted patients in duration of lyear entered study and evaluate prospectively. National Nosocamial Infections Surveillance System (NNIS) forms were used to definitions.Results: 319 patients were studied. Fever detected in (45%) 145 people that were related to infection in 58 persons. Causes of 55% of fevers were noninfectious. Incidence of nosocamial infection was (18.2%). Among the nosocamial infection syndromes Ventilator associated pneumonia (56.9%) and sepsis with unknown origin (15.5%) were the most cornrnon. (p<0.008).The most important factors associated with both death and nosocamial infection were low GCS score, high APACHE II score, greater admission days, number of procedures perfomed, and fever ness after 5 days of admission.Nosocamial infection occurred in 62.1% of deceased and 34.5% of vivid patients and was associated with death in ICU admitted patients.Conclusion: Nosocamial infection is among the factors associated with death, so it must be effort to decrease its incidence.

Background and objective: Needle stick injuries (NSIs) are among the most important occupational injuries for health care workers (HCWs).The number of contaminated NSIs sustained by HCWs primarily due to underreporting, is still unclear. The aim of study was determine the NSIs and rate of reporting in population of nurses in emergency ward in Tehran university medical Sciences.Materials and methods: This cross-sectional study was conducted among 218 nurses in emergency ward in Tehran, Iran.To investigate the causes of these injuries with using purposive sampling method, we contributed and voluntarily filled in a questionnaire on the demographic and professional characteristics. In the study, data regarding the frequency of contaminated needle stick, the rate of reporting the injuries, the reasons for not reporting and hepatitis B vaccination status among nurses. The data obtained was analyzed with SPSS software, version 16.Result: The case incidence of needle stick injury (NSI) was 43/11% what only 68/08% of the nurses who had experienced NSIs in the previous 6month were reporting all exposure to the NSIs. 81/28% of nurses had been vaccinated against hepatitis B virus (HBV). The common reasons for not reporting injuries consisted of dissatisfaction with follow up (21.5%). There were significant deference between years of experience, age, knowledge level and needle stick.Conclusion: This study suggests that the frequency of NSIs and rate of underreporting among nurses are considerable. We recommend a surveillance system and a center managing injured persons, Standard reporting protocol, education and vaccination against hepatitis B virus.

Background and objective: Rotaviruses are the common causes of acute diarrhea in infants and children all over the world.Rota viral diarrhea is on the most important health problems. We conducted this study to determine the frequency of rotavirus diarrhea in Golestan province of Iran.Materials and methods: This cross-sectional study was done on children less than 6 years old presented with diarrhea in a referral hospital in Gorgan, Iran. Stool samples of 411 children were collected and rotavirus was searched by SDS-PAGE method in the samples.Results: Sixty (15.1%) out of 411 samples were infected with rotavirus.14.9% of boys and 15.3% of girls were infected. The prevalence of infection was higher in children aged 0-2 years (18.3%) and it was more common in autumn (28.8%) and winter (21.9%).Conclusion: Our results showed that the rotaviral diarrhea is relatively common, especially during cold seasons in our area.So it is recommended that this infection should be considered as potential etiology of diarrhea.

Introduction and goal: Yearly statistics show a considerable number of life loses in the world resulted from Malaria disease.Consequently, substantial efforts and budgets have to be dedicated to the control and elimination of this disease. Development of simulation models can help in understanding and studying the distribution of the disease. The goal of this research is to develop an easily-understandable patio-temporal model of the Malaria distribution.Methodology: To model the distribution of the disease, the spatial analysis capabilities of Geospatial Information Systems (GIS), Cellular Automata (CA) and epidemic model of SIR are used.The proposed model is implemented in Matlab and ArcGIS software environments. Different gray levels of the cells and proper time epochs are used for the visualization of the disease distribution process in space and time. A part of Minab township in Hormozgan province, in Iran, is selected as the study area, because of its high figures of the disease occurrences.Results: In the developed simulation model, by introducing the spatial data layers and the input parameters, the distributed of the disease in space and time is visualized. An important capability provided by the model is to generate and study different scenarios. As examples, the effect of distance to stagnant water bodies, the concurrent effect of temperature and humidity, and the effects of some other parameters, introduced by Malaria experts, in the distribution of the disease, are simulated.Conclusions: The simulation model developed in this research can help the managers to understand and predict the distribution of the Malaria in any given area or situation. Moreover, the model can be used to study the results of any decision taken by the managers, when trying to prevent or control the disease.For example, the effect of different levels of vaccination in an area can be tested and analyzed by the model.