How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time / 한국역학회지

OBJECTIVES@#Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis. @*METHODS@#An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas. @*RESULTS@#The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables. @*CONCLUSIONS@#The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

How to improve the human brucellosis surveillance system in Kurdistan Province, Iran: reduce the delay in the diagnosis time / 한국역학회지

OBJECTIVES@#Spatial information makes a crucial contribution to enhancing and monitoring the brucellosis surveillance system by facilitating the timely diagnosis and treatment of brucellosis. @*METHODS@#An exponential scan statistic model was used to formalize the spatial distribution of the adjusted delay in the diagnosis time of brucellosis (time between onset and diagnosis of the disease) in Kurdistan Province, Iran. Logistic regression analysis was used to compare variables of interest between the clustered and non-clustered areas. @*RESULTS@#The spatial distribution of clusters of human brucellosis cases with delayed diagnoses was not random in Kurdistan Province. The mean survival time (i.e., time between symptom onset and diagnosis) was 4.02 months for the short spatial cluster, which was centered around the city of Baneh, and was 4.21 months for spatiotemporal clusters centered around the cities of Baneh and Qorveh. Similarly, the mean survival time for the long spatial and spatiotemporal clusters was 6.56 months and 15.69 months, respectively. The spatial distribution of the cases inside and outside of clusters differed in terms of livestock vaccination, residence, sex, and occupational variables. @*CONCLUSIONS@#The cluster pattern of brucellosis cases with delayed diagnoses indicated poor performance of the surveillance system in Kurdistan Province. Accordingly, targeted and multi-faceted approaches should be implemented to improve the brucellosis surveillance system and to reduce the number of lost days caused by delays in the diagnosis of brucellosis, which can lead to long-term and serious complications in patients.

Clustering of pulmonary tuberculosis in hamadan province, west of Iran: a population based cross sectional study [2005-2013]

Background: This study was conducted to detect clusters of pulmonary TB cases in Hamadan Province, west of Iran

Methods: All patients with pulmonary tuberculosis recorded in the surveillance system from 2005 to 2013 were studied. The spatial scan statistic was used to detect significant clusters in status of unadjusted and adjusted for age, sex and location residence variables

Results: Clusters with high rate for both purely spatial and space-time analyses were seen in the same geographical areas composed of four city of Asadabad, Bahar, Toyserkan and Nahavand. Adjustment for mentioned variables did not change location of detected clusters with high rates

Conclusions: Findings revealed evidence of significant clusters in Hamadan Province. Study results may help the health system to develop effective public health interventions and extend preventive interventions. However more study are needed to better explain of detected clusters due to limited access to effecting factors

Prevalence of nasopharyngeal carriage of Streptococcus pneumonia in Iran: a meta-analysis

Background: Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide. Several studies have explored the nasopharyngeal carriage of S. pneumonia in Iran. This meta-analysis is aimed at exploring the overall prevalence of nasopharyngeal carriage of S. pneumoniae among healthy children and its resistance to antibiotics

Method: We have systematically reviewed published studies from international databases [PubMed, Web of Science, and Scopus] and national databases [Iranmedex, Magiran, Medlib, SID and Irandoc] and reference lists of articles published up to May 2015. Only cross-sectional studies supported with sensitivity test on samples collected from nasopharyngeal area were included and heterogeneity was assessed using Q-test and I[2] test statistic. Publication bias was explored using the Egger's and Begg's tests and the funnel plot. The overall prevalence of analyzed data were reported with 95% confidence intervals [CI] using the random-effects model

Results: A total of 16 studies were included in the final analysis. The pooled prevalence of S. pneumoniae nasopharyngeal carriage was 18% [95% CI: 14% - 23%]. Antibiotic resistance rates were 26% [95% CI: 15% - 37%] to penicillin, 30% [95% CI: 10% - 49%] to erythromycin and 34% [95% CI: 10% - 57%] to tetracycline respectively

Conclusion: This study could be able effectively estimate the overall prevalence of nasopharyngeal carriage of S. pneumoniae and its antibiotics resistance rate among healthy children in Iran. In addition, the findings evidenced the role of pneumococcal vaccination in reducing the prevalence of S. pneumoniae carriage among healthy children in Iran

Echocardiographic Assessment of Pulmonary Arteries Pulsatility Index in Fontan Circulation

BACKGROUND: Late complications after Fontan procedure may be due to the absence of pump and pulsatile pulmonary blood flow in this type of palliation. Our aim was to quantify the degree of pulsation by echocardiographic method in patients with extracardiac total cavopulmonary connection (ECTCPC) in comparison with biventricular circulation and few cases of pulsatile Fontan. METHODS: In a case series study, pulsatility index (PI) derived by echocardiographic method were compared between 20 patients with ECTCPC, 6 patients with pulsatile Fontan and 18 normal individual aged 4 to 20 years old. All patients were in New York Heart Association class of I and there was no report of complication. RESULTS: In patients with ECTCPC pulmonary artery branches Doppler flow study showed lower peak and mean velocities compared to the pulsatile Fontan and normal groups. ECTCPC patients had PI of 0.59 +/- 0.14 and 0.59 +/- 0.09 for right and left pulmonary arteries (RPA and LPA) respectively. PI was higher in patients with preserved antegrade flow (RPA PI = 0.94 +/- 0.26, LPA PI = 0.98 +/- 0.27) and in normal individuals (RPA PI = 1.59 +/- 0.12, LPA PI = 1.64 +/- 0.17) for both branches (p = 0.000). CONCLUSION: Using a Doppler derived index for pulsatility, patients with ECTCPC had the least pulsation. The pulmonary artery flow pattern in patients with preserved antegrade flow showed higher pulsatility indices in both branches. Normal individuals had the greatest pulsatility index.

Intrascrotal solitary neurofibroma: a case report and review of the literature

Solitary Neurofibroma of the scrotum is an extremely rare benign tumor, particularly when it is not associated with neurofibromatosis type I. To the best of our knowledge, less than 10 cases have been reported in the English literature. Herein, we report a 52-year-old man with the diagnosis of scrotal solitary neurofibroma

Comparing effects of continuous insulin infusion with or without subcutaneous glargine insulin on glycemic control in diabetic patients undergoing coronary artery bypass graft [CABG]

Hyperglycemia is associated with increased morbidity and mortality in diabetic patients following coronary artery bypass grafting. Tight glycemic control in perioperative period can reduce these events. The goal of this study was to determine whether combination of continuous infusion and subcutaneous glargine as a basal insulin could improve glycemic control. Diabetic patients who were candidate for CABG were randomized to receive continuous insulin infusion with or without subcutaneous Glargine insulin for at least 72 hours which started 24 hours before surgery and continued for 48 hours after surgery. A total 84 subjects were required. In group A [n=45] continuous insulin infusion was used for glycemic control and in group B [n=39] we used continuous infusion with subcutaneous glargine insulin. Blood glucose level was significantly better in desirable range in group B in comparison to group A. Total mean blood glucose level in group A was 186.1 mg/dl and in group B was 174.3 mg/dl [P=0.008]. Frequency of hypoglycemia [blood glucose <70 mg/dl] was 0.66% in group A and 0.5% in group B that was similar [P=0.530]. The mean length of stay in the hospital was not different between two groups [P=0.288]. We found out that a combination of continuous insulin infusion and glargine insulin as main basal insulin can improve glycemic control in diabetic patients undergoing coronary artery bypass grafting

Characterization of beta-lactamases from urinary isolates of escherichia coli in Tehran

Knowledge of antimicrobial resistance patterns in E. coli, the predominant pathogen associated with urinary tract infections [UTI] is important as a guide in selecting empirical antimicrobial therapy. To describe the antimicrobial susceptibility of E. coli associated with UTI in a major university hospital in Tehran [Iran], seventy-six clinical isolates of E. coli were studied for susceptibility to beta-lactam antibiotics by the disc diffusion method and Minimal Inhibitory Concentrations determination. All isolates were resistant to ampicillin, amoxicillin and oxacillin. Resistance to the other tested antibiotics was shown to be 93.4% to cefradine, 76.3% to carbenicillin, 47.3% to cefazoline, 50% to cefalexin and 32.8% to cephalothin while 1.3% expressed resistance to cefoxitime, and 2.6% were resistant to ceftizoxime and ceftriaxone. Two isolates [2.4%] harbored extended spectrum b-lactamases [ESBL] shown by the double disc diffusion method. Substrate hydrolysis by ultra violet spectroscopy showed that 87.4% harbored penicillinases, 9% produced cephlosporinases and 3.6% degraded both substrates. Clavulanic acid inhibited enzyme activity in 82.9%, of which 78.95% was penicillinases [group IIa] and 3.95% was cephalosporinases [group IIb] of the Bush classification system. The rest of the isolates [6.58%] were placed in group IV beta-lactamases. No group III b-lactamase was found, as EDTA inhibited none of the enzymes. DNA amplification by polymerase chain reaction using specific primers for ampC, TEM and SHV type beta-lactamases for all of the isolates showed that 47 organisms [60%] carried the TEM gene and 18 isolates [24%] harbored blaTEM and ampC genes. About 26% of the organisms harbored SHV type enzymes. These results indicate that E. coli can posses a variety of b-lactamases that are responsible for beta-lactam resistance

Hepatitis C among hemodialysis patients: a review on epidemiologic, diagnostic, and therapeutic features

Hepatitis C virus [HCV] is a major public health problem and is the most common liver disease among hemodialysis [HD] patients. The seroprevalence of HCV infection among HD ranged from 1.9% to 80% in reports published since 1999. The main risk factor for HCV acquisition in HD patients seems the length of time on HD. Phylogenetic analysis of HCV viral isolates has suggested nosocomial patient-to-patient transmission of HCV infection among HD patients. Lack of strict adherence to universal precautions by staff and sharing of articles such as multidose drugs might be the main mode of nosocomial HCV spread among HD patients. Currently, there are several dilemmas on the management of these patients: should HCV-RNA testing be included in the routine screening of HD population for HCV infection?; does periodic serum alanine aminotransferase testing have a role in screening HD patients for HCV infection?; can dialysis really 'save' the liver of HCV-infected HD patients?; should HCV-infected subjects be isolated and dialyzed by segregated machines?; is there any difference in treating HD and non-HD HCV-infected subjects? This article gathers the present evidence to address these issues and to demonstrate the current worldwide magnitude of HCV in HD population

Prediction of successful sperm retrieval in patients with nonobstructive azoospermia

Our aim was to evaluate the predictive values of factors that indicate successful sperm retrieval in men with nonobstructive azoospermia. We evaluated 85 infertile men with nonobstructive azoospermia who underwent multiple bilateral testicular biopsies. Factors including age, infertility period, surgical history, testicular volume, testicular consistency, serum follicle-stimulating hormone [FSH], serum inhibin B, serum luteinizing hormone, and serum total testosterone were assessed in relation to sperm retrieval results. Spermatozoa were retrieved in 18 biopsies [21.2%]. Follicle-stimulating hormone, serum inhibin B, and testicular volume were associated with the results of sperm retrieval. Men with a higher testicular volume, a higher serum inhibin B, and a lower FSH had successful sperm retrieval. The cutoff points were determined as 9.5 mL for testicular volume, 9.9 IU/L for serum FSH, and 39.8 pg/mL for serum inhibin B. These 3 factors had strong correlations with each other. The sensitivities and specificities were 88.9% and 94% for testicular volume, 97% and 83.3% for FSH, and 72.2% and 95.5% for serum inhibin B, respectively. The positive predictive value for a combination of serum FSH and inhibin B was 100%. Serum FSH and serum inhibin B are useful markers for evaluation of the presence of sperm in patients with nonobstructive azoospermia. Inhibin B has a high specificity when combined with serum FSH and their measurements can be helpful in all patients with nonobstructive azoospermia before decision making for sperm retrieval

Fournier Gangrene: a series of 12 patients

Fournier gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia, the perineum, or the abdominal wall that is associated with high morbidity and mortality. In this series, we describe 12 patients with Fournier gangrene who had presented to our medical center. Twelve men had been diagnosed with Fournier gangrene in Shohada-e- Tajrish hospital between March 2002 and September 2005. Their medical records were reviewed and the Fournier Gangrene Severity Index scores before and after the treatment were determined. Fifty percent of the patients were diabetic and their mean age was 58.2 ' 17.8 years. The mean delay between the onset of the disease and the admission was 4.9 days and the mortality rate was 16.6%. The median Fournier Gangrene Severity Index scores before the admission and at the time of discharge were 4.5 [range, 0 to 11] and 0 [range, 0 to 9], respectively [P = .005]. One of the patients who died had the scores of 11 and 9, respectively. Split-thickness skin graft was performed for 5 patients [41.7%]. In Fournier gangrene, a rapid diagnosis and emergent surgical intervention is crucial. The Fournier Gangrene Severity Index seems to be an excellent tool for outcome prediction

Immediate intravesical instillation of mitomycin C after transurethral resection of bladder tumor in patients with low-risk superficial transitional cell carcinoma of bladder

The aim of this study was to evaluate the effect of immediate intravesical instillation of mitomycin C after transurethral resection of bladder tumor [TURBT] in patients with low-risk superficial transitional cell carcinoma [TCC]. A total of 43 patients with low-risk superficial bladder cancer were randomly assigned into two groups after the surgery; 22 patients in group 1 were treated by immediate instillation of mitomycin C after TURBT, and 21 patients in group 2 received placebo. The two groups were compared using urine cytology and cystoscopy during the 24 postoperative months. Recurrence within the first 3 months was reported in none of the patients in group 1 and 5 in group 2 [P = .02]. Of these, 4 had recurrence of tumor in the primary site. At 12 and 24 months, there were 1 patient [4.5%] in group 1 and 8 [38.1%] in group 2 with recurrence [P = .007]. We had no patients with multifocal recurrence in group 1, but 3 [14.2%] in group 2. Nine-month tumor-free survival rate was 95% in group 1. Three-, 6-, 9-, and 12-month tumor-free survival rates in group 2 were 76%, 71%, 66%, and 62%, respectively [P = .007]. None of the patients in group 1 and 3 in group 2 [14.3%] experienced some degrees of tumor progression [P = .06]. Immediate instillation of mitomycin C after TURBT seems to be effective in the recurrence reduction and increase of recurrence-free interval at least in short term

Changes in serum prostate-specific antigen level after prostatectomy in patients with benign prostatic hyperplasia

The goal of this study was to investigate the effect of transurethral resection of the prostate and open prostatectomy on the serum prostate-specific antigen [PSA] level in men with benign prostatic hyperplasia. Serum prostate-specific antigen levels were determined before and 6 months after operation in 86 patients with benign prostatic hyperplasia who had undergone transurethral resection of the prostate or open prostatectomy. We measured the prostate volume by means of transrectal ultrasonography and weighed the surgical specimen. Changes in serum PSA levels and their correlation with prostate volume and the resected prostate weight were evaluated. Of 86 patients, 45 underwent transurethral resection of the prostate and 41 underwent open prostatectomy. Mean PSA levels were reduced by 67.4% [range, 0.40 ng/mL to 7.60 ng/mL] in the patients who had undergone transurethral resection of the prostate and 80.7% [range, 1.00 ng/mL to 14.50 ng/mL] in the patients with open prostatectomy. Removal of 1g of prostate tissue reduced serum PSA levels by an average of 0.15 ng/mL in those who underwent transurethral resection of the prostate and 0.10 ng/mL in those treated with open prostatectomy [P = .018]. Forty patients [88.9%] in the group who underwent transurethral resection of the prostate and 39 [95.1%] in the open prostatectomy group exhibited a postoperative PSA level of less than 2.00 ng/mL [P = .20]. A modified reference range seems necessary for the screening of prostate cancer via PSA level in men who have undergone prostatectomy for benign prostatic hyperplasia