Estimation of influenza and severe acute respiratory illness incidence [burden] in three provinces of the Islamic Republic of Iran, 2012 and 2013

There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection [SARI] and influenza-associated SARI [F-SARI] in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza [F-SARI] over 12 months [seasonality], and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend [seasonality] of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique. The age groups most at-risk were children aged under 2 years and adults older than 50 years

First report of asthma prevalence in Afghanistan using international standardized methods

No data on the prevalence of asthma in Afghanistan have been published before. In a school-based survey in 2010-2011 the wheezing section of the International Study of Asthma and Allergies in Childhood [ISAAC] questionnaire was completed by a random sample of 1500 children aged 6-7 years and 1500 adolescents aged 13-14 years old. The prevalence of physician-diagnosed asthma was 12.5% in 6-7-year-olds and 17.3% in 13-14-year-olds [P = 0.002]. The prevalence of wheeze in the last 12 months was similar in children and adolescents [19.2% and 21.7% respectively]. The prevalence of ever wheezing, night attacks, speech-limiting wheeze and exercise-induced wheeze was 23.1%, 4.8%, 12.2% and 9.6% respectively in children and 30.5%, 4.4%, 13.0% and 13.6% respectively in adolescents. These rates are higher than those in neighbouring countries. This first epidemiological survey of asthma in Afghanistan shows that asthma and wheezing are common in Kabul students

[Survey validity of translation for Persian and cultural adaptation of Fatigue Impact Scale [FIS] questionnaire in multiple sclerosis patients in Iran]

Fatigue is one of the most common problem of multiple sclerosis. It is a sign of inefficiency in the physical, social, and cognitive function. It is a major factor in limiting the responsibilities of social work of patients. The aim of this study was to translate and culturally adapt the Fatigue Impact Scale [FIS] in Iranian and create an appropriate tool for measuring the impact of fatigue and effectiveness of treatment and also rehabilitation interventions on fatigue in Iranian patients. In order to use the FIS in Iranian patients, the forward and backward translation and assessing the patient's perspective was done and the Persian version of the questionnaire was prepared. The questionnaire was completed by twenty patients with multiple sclerosis. The time duration of filling out of each questionnaire took ten to twenty minutes .The final corrections was carried out. All questions of patients was acceptable and understandable and questions of "sexual activity" was completed only by married patients. The question of "financial support" was completed only by employed person [working people]. Finally, as much as possible, this questionnaire was adapted with Iranian culture and sentences were confirmed by MAPI Institute. Persian version of the FIS is an appropriate tool for measuring the impact of fatigue, effectiveness of treatment and rehabilitation interventions on fatigue in patients with multiple sclerosis

[ function of vulnerable and at-risk women in prevention of HIV/AIDS]

Regarding little information about sexual behavior of vulnerable women to AIDS, mentioned in the second report of Ministry of Health and Medical Education [2006], this study has been conducted to determine the function of vulnerable and at-risk women to AIDS in Tehran in 2009. This descriptive study was done on 128 vulnerable and at-risk women who participated in this study in Tehran in 2009. The samples were a combination of available visitor passed to Drop-in Centers, behavioral or triangular clinic and those who were introduced by participant women through Respondent Driven Sampling. Data were collected by trained interviewers. Quantitative and qualitative descriptive statistics was reported as numbers, percentages, and, also, Mean and Standard deviation respectively. Analytical findings and determination of differentiations and correlation were evaluated based on Chi-squared test. In this study only 22 [17.2%] of participants mentioned that they have always used condom. Partner unwillingness was the most common reason [64%] for not using condom. Twenty-four percent of participants have received free condom from triangular, Drop-in and health centers in the last year. Only 32[25%] had done HIV test. The study showed the function of at-risk women in prevention of HIV/AIDS is not satisfactory. If the situation continues in this way, vulnerable women and society will be at more risk

Mortality from pandemic influenza a [H1N1] in Iran

Due to worldwide spread of influenza A [H1N1] virus, the World Health Organization declared the first pandemic of influenza in four decades. This study aims to report the mortality from pandemic influenza A [H1N1] in Iran population and its epidemiologic and clinical characteristics up to December 21, 2009. The data were obtained from all provinces and reported to center for disease control of Ministry of Health and Medical Education [MOHME] of Iran through nationwide surveillance system for influenza A [H1N1] was implemented by MOHME since April 2009. Of 3672 confirmed cases of influenza A [H1N1] in Iran between 22 May and 21 December 2009, 140 [3.8%] deaths were reported, mostly in 15-65 year old [yo] age group [67%]. The highest admission mortality rate was in > 65 yo group [107 deaths/1000 hospitalized cases]. Of decedent patients, 54% had no long term condition or risk factor, 34% had one, 11% had two, and 1% had three. Diabetes mellitus, pregnancy, chronic respiratory diseases and hypertension were the most common underlying conditions. The most common clinical pictures of death were acute respiratory distress syndrome and viral pneumonia. Although 66% of decedent patients received oseltamivir, enough information was not available about time of onset of antiviral therapy. As death due to influenza A [H1N1] occurs in all age groups and in those with and without any predisposing factors, we recommend health policy makers to provide influenza vaccination for people with underlying conditions and respiratory hygiene for all people

Prevalence of mold allergy in asthmatic patients of less than 18 years old in semnan

Asthma is a chronic inflammatory disease of the airways which is associated with the triad of cough, wheezing and dyspnea. Allergic asthma is often associated with a personal or family history of allergic diseases and mostly begins at early childhood. Mold is one of the most common irritants of asthma and allergic rhinitis. In the last 20 years there has been 30% increase in the prevalence of moldsrelated asthma. In this study the prevalence of mold allergy in asthmatic patients of less than 18 years old who refrred to Semnan allergy clinic during 2007-2008 was determined. Skin prick test with standard mold allergens was performed and sensitivity to the most prevalent molds like Alternaria, Penicillium, Aspergillus, cladosporium and mucor was evaluated. From 220 studied subjects, 35% [95% Confidence Interval: 28.7-41.3%] were shown to be sensitive to at least one mold. The prevalence rates of sensitivity to molds were as follow: Alternaria14.5%, Aspergillus 12.7%, Cladosporium 13.2%, Penicilium 12.7% and Mucor 2.7%. There was a significant relationship between sensitivity to molds and the grade of asthma [P<0.05] and episodes of admissions [P<0.05], but mold sensitivity showed no significant relationship with age, gender, personal or family history of other allergic diseases and the duration of asthma. Association between grade of asthma and episodes of admissions with the number of sensitizing molds was significant [P<0.05]. Since asthma is the most common childhood disease and molds especially Alternaria and Cladpsporium are among the most important triggers of asthma and its progression, detection of this type of allergens and warning patients to avoid them could be an effeicient way to prevent and control the disease progress

[Emerging and pandemic of influenza A[H1N1]]

Influenza is one of the known viral infectious diseases, which has killed millions of peoples during pandemics, epidemics and sporadic forms. One of the most remarkable features of influenza virus is the frequency of changes in antigenicity. Alteration of the antigen structure of the virus leads to infection with variants to which little or no resistance is present in the population at risk. Pandemics of influenza type A, result from the emergence of a new virus which the population contains no or limited immunity to it. The interval between pandemics is 10-30 years. But Influenza virus has been causing epidemics of febrile respiratory disease every 1 to 3 years. Pandemic [H1N1] 2009 is a new virus that has not circulated among human population before. This virus is different from previous or current human seasonal influenza viruses. Influenza type A[H1N1] virus is transmitted by inhaling infected droplets expelled by coughing or sneezing or by touching contaminated hands or surfaces as the same as the normal seasonal flu. The symptoms and signs of A[H1N1] influenza are as similar as seasonal influenza and include fever, coughing, runny nose and sore throat. Some people have also reported, nausea, vomiting and diarrhea. People with existing cardiovascular disease, respiratory disease, diabetes and cancer are at higher risk of serious complications. Asthma and other respiratory disease are other underlying conditions associated with severe disease. Pregnant women are at higher risk for more severe disease and obesity may be another risk factor for severe disease. To prevent spread, people should cover their mouth and nose when coughing or sneezing, stay at home when they are unwell, clean their hands regularly, and avoid crowded areas if possible. The pandemic virus is currently susceptible to neuraminidase inhibitors; Oseltamivir and Zanamivir but resistant to Amantadine and Rimantadine. Ministry of health and medical education, Center for Infectious Diseases Management in Islamic Republic of Iran is ready for control and management of novel influenza A[H1N1]

Prevalence of methicilin resistance staphylococcus aureus in different wards of Imam Hossein Hospital in Tehran, in 2007-2008

Always Staphylococcus aureus is among the most frequent causes of morbidity and mortality worldwide. The unique ability of this organism to develop resistance to virtually any new antibacterial agent reflects the extraordinary capacity of this organism to adapt and survive in a great variety of environments. The purpose of this study is the detection of prevalence of Methicilin Resistance Staphylococcus Aureus [MRSA] in Imam Hossein Hospital, in Tehran. This prevalence helps us to apply the best and correct antibiotic for this pathogen. For this cross sectional study- all samples of admitted patients [with a suspicion of infection], were evaluated from Nov. 2007 to Aug. 2008. Isolated staphylococci- tested for methicilin sensitivity by disc diffusion method [Methicilin disc]. Of 6640 tested samples, 143 [2.1%] revealed to be positive for Staphylococcus aureus of whom 113 [79%] were MRSA. Logistic regression showed a significant association between wards with prevalence of MRSA [p<0.028]. The prevalence was more visible in Orthopedic, Neurologic Wards, and ICU. In this study there was no association between gender, sample type and age of patients with MRSA rate. In our study, prevalence of MRSA infection in Imam Hosein Hospital was 79%. Different Hospitals should identify prevalence of MRSA in different wards and declare causes of more prevalence in some wards then a coordinated program would lead to measures designed to reduce this incidence. The results highlight the need for effective implementation of infection control measures in the hospital. There is a need for the judicious use of antimicrobial agents in the hospital and outside as their indiscriminate use can exert pressure in selecting out MRSA and other multidrug resistant organisms

[Effect of applying progressive muscle relaxation technique on fatigue in multiple sclerosis patients]

Fatigue is the most frequent and disabling symptom in 92% of multiple sclerosis [MS] patients. Fatigue interferes with daily functioning and prevents sustained physical exertion, limits work and social role performance, and is related to lower quality of their life. Complementary therapies are widely used in treatment of people with MS and Progressive Muscle Relaxation Technique [PMRT] is a form of complementary therapies. The aim of this study was to assess the effects of applying PMRT on fatigue in MS patients. In this Quasi-experimental study, a total of 66 MS patients were selected with convenient sampling according to specific criteria and then were divided randomly into two groups of experimental and control [33 patients in each group]. PMR performed for 63 sessions on experimental group during two months but no intervention was done for control group. Data were collected using demographic questionnaire, Fatigue Severity Scale [FSS], and Self report checklists. Statistical analysis was done by SPSS software and use of paired-t test, student-t test, analysis of variance [ANOVA] and correlation between variables. Student t-test showed that there was no significant difference between two groups in mean scores of fatigue before the study but this test showed significant difference between the two groups, one month [4.69 +/- 1.03 and 5.43 +/- 0.96, P<0.01] and two months [4.09 +/- 1.06 and 5.43 +/- 1.08, P<0.001] after intervention, respectively. ANOVA test with repeated measurements showed that there is a significant difference in mean score fatigue between two groups in 3 times [P<0.01]. The results of this study showed that PMR is practically feasible and could decrease fatigue of MS patients, so that applying this technique offered to these patients

[ effect of Orem based self-care program on physical quality of life in multiple sclerosis patients]

Multiple sclerosis is a chronic, progressive and degenerative myelin sheath of the central nervous system. Which significantly affects quality of life? The aim of this study was to assess the effect of Orem based self-care program on physical quality of life in multiple sclerosis. In this clinical trial a total of 70 patients with multiple sclerosis with age range 20-40 years, [members of multiple sclerosis association] were randomly divided into two groups of experimental and control [35 patients in each group]. The experimental group was treated with self-care program based on Orem self-care frame work compared to the control group. Data were analyzed using x[2], t, and paired t tests. There was no significant difference in the cases of quality of life and demographic characteristics of patients in the control and test groups, before intervention. The mean score of life quality, after intervention, in the test group [66.5 +/- 41.8] was more than that [43.24 +/- 12.79] in the control group [P<0.001]. In the test group and after the intervention, life quality was significantly increased [P<0.001], but no significant difference was seen in the control groups. Drawing and utilizing self care program base on the Orem frame work on physical quality of life in the multiple sclerosis patients would be beneficial. This is a non-invasive intervention and is safe, inexpensive and is complementary to medical intervention that can be used in the multiple sclerosis centers

[Relation between chronic urticaria and thyroid autoimmunity]

Chronic urticaria is a tormenter and does not have a known etiology. Association between chronic urticaria and thyroid auto-immunity has shown different results. The aim of this study is to evaluate the effect of Levo-thyroxine on the chronic urticaria and association between chronic urticaria with thyroid auto-immunity. In a prospective case-control study, we compared the frequency of thyroid auto antibodies in 60 patients [all females, with exception of six males, ages 15 to 60 years] with chronic urticaria and compared with 60 mached age healthy volunteers. All cases with chronic urticaria and control group were normal CBC, antinuclear antibodies, rheumatoid factors, complement, stool exam, liver function test [LFT], kidney function and skin prick test, prior to being referred to us. We performed thyroid auto antibodies, thyroid hormones and IgE antibodies before treating all subjects. Half of them with positive anti-thyroid antibody [n=11], received Levo-thyroxine [100 micro g] daily for 1 month and the remaining half [n=11] were control group. The frequency of thyroid auto antibodies was significantly higher in patients with chronic urticaria than in healthy control [36.6% vs. 9%; p<0.01]. All patients were euthyroid, however, one was found to have increased anti-thyroid antibody levels with sub clinical hypothyroidism [TSH increased, low T4]. Total serum IgE increased in ten cases of patients group [16.6%] compared with six control groups [10%]. Nine patients [40%] had complete response, five patients [30%] had partial response and five patients [30%] did not show any response to treatment compared with control group, in which complete and partial resolution was 30% and others with no resolution. Chronic urticaria may be associated with thyroid disorders [positive anti- thyroid antibodies] despite normal thyroid function test. For chronic urticaria despite increase serum IgE level with unknown origin, must be evaluated by a thyroid function test, along with anti -thyroid antibodies and treatment if necessary

[Clinical course and prognosis of 203 patients with MS in Shahid Mostafa Khomeini Hospital, Tehran 2002]

Multiples sclerosis is a common demyelinating disease of CNS and the main cause of disability in young adults all over the world so any research in different aspects of the disease has great value. researches in Iran are few in quantity and low in sample size. To determine clinical course and prognosis of the disease in Iranian MS patients we have studied these items in a considerable sample size. Two hundred and three definite MS patients [according to MC'donalds 2001 criteria] included in this study and a planned questionnaire completed by visiting the patients or by degree of disability estimated according to EDSS [Expanded Disability Status Scale] score system. The results analyzed with SPSS software. Mean age of the patients was 35. All required examinations have been done by a neurologist and 60.6 percent were female. Mean duration of disease was 8.3 years. the main form of onset of symptoms was sensorimotor [mixed]. Mean Attack rate was 5.5 times during the disease duration. Clinical course in 72.4 percent was relapsing-remitting type. Mean disability scale number according to EDSS was 5.2. Death rate was two percent. 69.3 percent of patients were able to work in the society. The degree of disability increased with increasing age, in lower educational state, in longer duration of the disease and in male gender. The results of clinical course and type of MS, mean of disease duration from the onset and mean EDSS are compatible and comparable with similar studies in other countries though some results are different. For future large sample, multicenter studies recommended

[Fatigue in multiple sclerosis: a study of fatigue and some factors influencing it in Iran]

Fatigue is one of the most common and important disabling symptoms in multiple sclerosis [MS] patients. Fatigue in patients could be due to neuroimmunology, disability secondary to the disease process, muscular fatigue due to spasticity, drugs and problems such as depression and sleep disorders. In order to evaluate the prevalence and degree of fatigue severity in MS patients and to determine some influencing factors, we studied sixty patients with definite MS in Iran and assessed fatigue [According to FSS score] and also some factors such as depression [According to BDI score], disability status [according to EDSS score] in them. In our 60 patients the range of age was 20-24 years. 73% of the patients were female. In 70% of the patients clinical course of MS was compatible with Relapsing-Remitting type and in 30% secondary progressive form. The prevalence of fatigue [According to FSS] was very high; exactly 100% but only 10% of the patients had self-complaint of fatigue. There are some correlations between fatigue and presence of disability [according to EDSS], depression and age of the patients. Fatigue was more frequent in Secondary Progressive form of MS. We didn't find any correlations between fatigue and sex, duration of the disease, the rate of attacks during the first year of the disease, using MS-specific drugs and fatigue modifying drugs in the patients. It seems that fatigue is more frequent in MS Iranian patients than it has been thought. The correlation between fatigue and depression and degree of disability in patients should alert physicians in considering proper treatment of depression and prevent the progression of MS in the patients as much as possible

investigation of human apolipoprotein e polymorphisms in multiple sclerosis patients of Iran

Multiple sclerosis [MS] is a chronic inflammatory disorder of the central nervous system, with a complex etiology that includes a strong genetic component. The chromosome 19q13 region surrounding the apolipoprotein E [APOE] gene has shown consistent evidence of involvement in MS. In a cross-sectional study, to show the APOE genotype and allele frequency in the MS population of Iran in comparison with the control group, we genotyped its polymorphisms [sigma 2, sigma 3 and sigma 4 alleles]. The authors investigated 81 patients with clinically definite MS and 93 asymptomatic elderly volunteers. The frequency of the APOE allele in the MS population in comparison with controls was 9.3% vs. 0.5% for sigma 4, 44.4% vs. 51.6% for sigma 3, and 46.3% vs. 47.8% for sigma 2. The highest frequency of APOE genotype was from sigma 2/sigma 3 with 66.7% vs. 94.6% and the lowest, sigma 4/sigma 4 genotype with 2.5% vs. 0%. The authors found significant differences in the distribution of 84 allele between patients with MS and controls [9.3% vs. 0.5%; X[2]=15.2;df=2; p<0.001]. The highest frequency of sigma 4 allele in MS patients was in Pure Turkish [25.0% vs. 5.3%] ethnicity. There was no significant relation between ethnicity and genotype. In the present study sigma 2/sigma 4, sigma 3/sigma 4 and sigma 4/sigma 4 genotypes were more common in bout-onset cases compared to primary progressive cases, and the secondary progressive disease was higher in carriers of sigma 4 allele. Also, the sigma 2 allele was higher in relapsing remitting disease

clinical survey in determination of common side effects of AVONEX [b if 1a] therapy in 50 Iranian MS patients

To determine common systemic, local and laboratory side effects of Avonex therapy in Iranian multiple sclerosis patients. 50 confirmed MS patients [according to McDonald 2001criteria] treated with 30mcg weekly bifia, Avonex, were studied and questioned for presence of common known adverse effects of the drug and probable depression induced or aggravated by it. The study was following up regularly at the onset of Avonex therapy and afterl,3 and 6 months. At the end of 6 months follow up study the data was analyzed. 70% of the patients were between 20 to 30 years. 78% were female. The patients had a duration of MS of 0-12 years. The most common side effects were systemic type out of which flu like syndrome was predominant [90%]. Local [injection site] side effects were seen in 42% and anemia was seen in 8% as a predominant laboratory side effect. Reduction of the frequency of all of the side effects except local one was seen in the follow up duration. No correlations were found between side effects and sex and age of the patients. Avonex therapy had no effect in inducing induction or aggravating depression in our patients. Discontinuation of Avonex therapy was not seen among these patients because of the side effects. It seems that Avonex therapy in Iranian MS patients has more and relatively prolonged adverse effects but mainly these side effects fade away with continuation of therapy. The side effects do not lead to discontinuation of therapy. In spite of frequent complaints of the patients, all of the adverse effects are well tolerated

Catamenial anaphylaxis

It is well documented that the hormonal changes during menstrual cycle influences systemic diseases, among them are allergic disorders. There are some reports of cyclic anaphylactic reactions during menstrual period which is reffered as [Catamenial anaphylaxis]. It must be differentiated from a closely related condition called [APD] or autoimmune progesterone dermatitis which is also a rare condition. It seems that hormonal changes especially rising progesterne levels and other mechanisms like back-diffusion of prostaglandines from contracting uterus into the systemic circulation may have some role in pathogenesis of these conditions. In catamenial anaphylaxis symptoms appear in direct association with the start of the menstrual flow but in APD, sign and symptoms begin earlier in the pre-menstrual phase. A 19 year old girl [not married] was referred because of a 8-months history of recurrent monthly urticarial and anaphlactoid reactions. Her symptoms began at first day of menstruation and lasted 1 to 2 days. The eruptions started as a sense of flushing and intense pruritis all over the body. Soon urticarial lesion as giant hives appeared which in some instances was associated with respiratory distress. The patient denied any changes in her diet and had taken no medications. Complete blood Count and erythrocyte sedimentation rate [ESR] revealed no abnormalities but VDRL positivity led us to consider rheumatological background like systemic lupus erythematosous. Anti cardio Lipin antibody [ACLA] was surprisingly above normal laboratory values. Her serum was taken in an episode of cyclic anaphylactic reactions and stored to be used later in her cycle when no more menstruating. Skin prick test with autologous serum collected during menstruation is performed at the midcycle and also in the late-cycle period in another ovulatory cycle. Both prick tests led to resurgence of severe allergic reactions as flushing, urticaria, pruritis and dry cough which were managed appropriately. The patient's history and physical examination and hormonal assay were consistent with catamenial anaphylaxis. She is currently under control and follow up, using cyclic conjugated estrogens