[Management of patients with suspected septic arthritis admitted to Qazvin teaching hospitals [2003-2008]]

Septic arthritis is one of the most common causes of joint destruction. The aim of this study was to assess management of definitive or suspected cases of septic arthritis in educational hospitals of Qazvin University of Medical Sciences within 2003 to 2008. This was an observational study performed based on existing data. The medical files of patients with arthritis in three hospitals were assessed. Patients were hospitalized in orthopedic, rheumatology and pediatrics wards. Intravenous antibiotic receivers for arthritis [more than three days] were analyzed [174 cases] and all necessary information was collected. Data were analyzed by SPSS software using descriptive statistics. Of total study population, 57.5% of cases were males, 70.6% under the age 12 years, and 85.2% with mono-articular involvement. The most common joint involved was knee in adults [39.6%] and hip in children [47.2%]. Trauma was the most common predisposing factor [73%] whereas limitation in movement found to be the most frequent [85.6%] clinical manifestation at the time of admission. Only 57 patients underwent arthrocenthesis and positive culture results were found in 8 cases. Essential considerations such as smear, gram staining and assessing the presence of crystals in synovial fluid were not accomplished to an acceptable level yet the less important criteria such as lactate dehydrogenase, protein, and glucose concentrations of synovial fluid were tested for majority of patients. Antibiotic regimen composed of an anti-staphylococcal agent in most cases. Within the first four hours following admission, 54.6% of cases received intravenous antibiotics and 24.7% of cases received IV antibiotic therapy for longer than two weeks. According, to inappropriate management of patients with definite and suspected septic arthritis, attempts should be made to consider parameters such as careful history and physical examination, correct duration of antibiotic therapy, and the process of determining the type of microorganisms causing septic arthritis including smear and culture of synovial fluid as well as taking necessary measures to improve the current conditions

[Prevalence and pattern of infections among diabetes mellitus in-patients of Avesina Teaching Hospital of Qazvin [2009-2010]]

Infections are believed to occur with increased frequency in patients with diabetes mellitus. The goal of this study was to determine the common infections in diabetic patients referred to Avesina Hospital in Qazvin. This was a cross-sectional study performed on 656 diabetic patients who were referred to Avesina Hospital in Qazvin [Iran] during September 2009 to April 2010. A questionnaire containing demographic information, type of diabetes, duration of disease, and type of infection was completed for each patient. Data were later analyzed using SPSS software and chi- Square of 656 patients, 126 cases [19.2%] suffered infection and the commonest infections involved were diabetic foot [52%] and urinary tract infection [26%]. Considering the data found in our study, attempts to immediately diagnose the type of infection in diabetic patients to reduce the rate of mortality are necessary

[Ceftriaxon -resistant E.coli meningitis in a diabetic patient]

A 57-year-old Iranian woman with a 4-day history of fever, malaise, and disorientation is presented. Signs of meningeal irritation were evident on examination. The patient's medical history was remarkable for diabetes mellitus, and hypertension with several admissions to hospital. Ampicilin, ceftriaxon, and vancomycin were administered for possible bacterial meningitis. A brain CT scan without contrast was unremarkable. Analysis of CSF revealed compatible values for bacterial meningitis. Culture of urine and CSF samples led to isolation of E. coli. The patient's clinical condition showed no improvement after 3 days. Four days following hospitalization, re-culture of CSF sample again produced positive result for E. coli. Using disk diffusion method, the isolate was found to be resistant to ceftriaxone and imipenem but sensitive to ciprofloxacin. Ceftriaxone was replaced by IV ciprofloxacin plus ceftazidime. The results of repeated analyses of CSF were indicative of clinical improvement with negative result for CSF culture. Ciprofloxacin and ceftazidime were continued for a total of 21 days. The patient remained asymptomatic with no recurrence

[Determine the prevalence of tuberculose infection in diabetic patients in Qazvin]

Introduction: In Different Studies, diabetes is one of the most important Causes of reactivation of latent tuberculosis

Objective: Determine the prevalence of tuberculosis infection in diabetic patients in Qazvin

Materials and Methods: This study was performed as per census in the clinic of diabetes of Boo Ali educational hospital from Mar 2004 to Feb 2006. PPD test was asseced all patients and if the irresult was Negative, allergy skin test was used with diluted Tetanous-Diphteria Toxoid antigen, for evaluation of CMI [cell-Mediated Immunity]. If the result was positive and there was no clinical and radiographic abnormality, patients were reffered for chemoprophylaxis. In patients with clinical or radiographic signs of tuberculosis was performed sputom smear and active cases, and then were reffered for treatment

Results: PPD test was performed for 571 diabetic patients. The Results was: 415 [72.2%] 0 to 5mm, 88 [15/5%] 5- 10mm, 47[83%] 10-15mm and 43 [4%] >15mm .Alergy rate calculated as 27, 6 %. Four smear positive polmunary tuberculosis cases were detected [active case finding]. In all detected cases were seen abnormal findings in apical regions and in 3 out of 4 cases cavitary were seen in radiologyic report

Conclusion: In this study 12.3% of patients had more than 10mm induration in PPD skin test. Rate of alergy was comparable in diabetic patients to general population. Detection of 4 active cases of smear positive pulmonary tuberculosis implicates the high prevalence of tuberculosis in diabetic patients in comparison with general papulation

Epidemiological study of measles in Ghazvin, Islamic Republic of Iran, April 1997-April 2003

We studied measles incidence and morbidity in Ghazvin district by retrospective review of cases registered at the central health office and admitted to two hospitals in Ghazvin city during April 1997-April 2003. There were 824 clinically confirmed cases of measles over the 6-year period giving a mean annual incidence of 18.67 per 100 000 population, higher than for the country generally. There were no deaths from measles. Of the 824 cases, 591 [71.1%] had serum specimens for serological analysis and 199 [24.3%] were confirmed serologically. Of the serologically confirmed cases, the greatest proportion [44.2%] were over 20 years [median age was 17.5 years], 54.5% had been in contact with a measles case and 21.6% cases had received 2 doses of vaccine. We studied 33 serologically confirmed hospitalized cases. Common complications were vomiting [45.5%], diarrhoea [42.4%] and pneumonia [21.2%]. The mean duration of hospitalization was 3.8 days

Care management: Adherence to therapies among patients at Bu-Alicina clinic, Qazvin, Iran

Non-adherence to treatment is a problem of increasing concern for all stakeholders. This study was designed to determine the prevalence of non-adherence among the clients consulting internists or cardiologists at Bu-Alicina Clinic in Qazvin. A total number of 400 clients came to Bu-Alicina Clinic [center for internal medicine and cardiology] were randomly interviewed through a questionnaire during a two month period in 2003. Self-administered methods were used if the clients applied. The data were interpreted using statistical methods. The clients were between 14 and 78 years old [33.7+8.5] and 57.5% of them were women and 42.5% were men. Of total number, 30.7% were consulting for continuation of their therapies and of these clients, 41.5% had pooradherence to their current therapies. The more educated clients were 1.6 times [OR=1.62; 95% CI=0.71, 3.74] likely to be more adherent to the therapies.There was no significant difference between the internal diseases patients and cardiology patients in this regard [41.7%vs 40%]. Of the total number of 400 clients, 79.5% had history of consulting to medical clinics during the last three months and 37.4% of them had non-adherence to their past therapies. The more frequent factors were: forgetfulness [13.3%], not to be able to afford to pay for treatment costs [10.3%], disbelieve to the doctor and consulting another ones [8.4%], long distance [8.4%], feeling that it is not important to take medications [7.4%], side effects [7.4%], disbelieve to the diagnosis [7.1%], religious considerations [6.5%], and misunderstanding or lack of information about the prescription [5.8%]. No significant difference was found between men and women on this aspect. Patients need advice, supported information from professionals about their health and therapies. Certain studies must be done to determine the pitfalls and effective interventions address that barriers can be developed

[Prevalance of HBsAg carriers and AntiHBsAg in health care workers of Boali-sina teaching hospital in Qazvin]

Background: Frequent injections and blood taking for lab analysis in addition to hazards that exist during handling, make medical staff vulnerable to HBV, HCV and HIV infections and put these infectious agents among the most important occupational diseases in medical staff

Objective: A- HBsAg carrier prevalence and AntiHBs Ab titre determination among Medical staff. B- Identification of the most common route of transmission and occupational exposure to blood and other body fluid materials

Methods: We assessed the questionnaires of 270 medical staffs of Boali hospital and the results of HBsAg and AntiHBs Ab [qualitative] which has been extracted from their occupational documents

Findings: We found that 1.1% [3 person] had HBsAg [positive cases] and 63.4% had an acceptable level of AntiHBs Ab [Which denotes to efficacy of vaccine]. It was revealed that the most common occupational exposure in order of decrease in frequenciy were: needle stick 38.1%, accidental face contact with blood and other body fluids 36.6%, breakage of lab tube in hand 11.1%, accidental serum ingestion 2.2%

Conclusion: The importance of pre-exposure and post-exposure prophylaxis are confirmed by the study results

Presentations of two cases of extrapulmonary tuberculosis

More than 80 percent of new cases of TB are pulmonary TB produced by three different causes as follows: Adjacency to mucosal surfaces, anatomical adjacency of organs and lymphohematogen. Incidence of TB in different organs is different and in most of the cases is related to lymph node. In this article two cases of extrapulmonary TB is presented along with emphasizing diagnostic process. The first case was a 14- year- old girl with fever and abdominal pain for one month whom was treated for typhoid at first but complications such as arthritis and ascites happened. Ascites fluid for M. TB was negative and then peritoneal biopsy was done. The second case was a 40- year- old man with hoarsness, cough and hemoptysis for 6 years. Not only smear for M. TB was positive but also in laryngoscopy he had tumoral lesions. This lesions was positive for TB in pathologic test. Examination of these two methods showed that the best diagnostic method for TB peritonitis is biopsy and in laryngeal involvement sputum smear is usually positive but for confirming the diagnosis biopsy is suggested