[Pattern of antibiotic usage in Razi hospital in Ahvaz, Iran [2011-12]]

Indiscriminate use of antibiotics is one of the major health problems worldwide. Rapidly increasing incidence of antibiotic-resistant microbes warns healthcare authorities in the country to use drugs, reasonably. This study was carried out to assess the pattern of antibiotic usage in Razi teaching hospital in Ahvaz, southwest of Iran. This descriptive -analytical study was conducted on 17668 hospitalized patients in Razi teaching hospital Ahvaz, southwest of Iran during 2012. Proper or inappropriate antibiotic usage was judged based on existing national guidelines or guidelines referenced in textbooks. 3119 of patients were received antibiotics which 20.4% of patients were being treated unnecessarily. 2482 [79.6%] of patients had indications for antibiotic therapy. Out of 2482 patients with indications for antibiotic therapy, 51.9%, 18.1% and 6.5% of patients were received incorrect antibiotic regiment, inadequate dose and unsuitable duration of therapy, respectively. The highest rate of unnecessary, inappropriate, incorrect duration and dosage of antibiotics were observed in internal, scorpion wards and the lowest was in infectious diseases and obstetrics wards [P<0.05]. The pattern of antibiotic usage in Razi teaching hospital in Ahvaz was inappropriate. Unnecessary prescription, inappropriate antibiotic spectrum, inadequate dose and duration of antibiotics were inappropriate treatment strategy

[Implementation and designing of line-detection system based on electroencephalography [EEG]]

In Brain-based lie detection systems which have been recently introduced as substitutes or classic lie detection systems, the procedure for recognition of guilty and innocent subjects is done by inspection of brain signals which are acquired during the specific Polygraph test. With the aim of increasing the performance, this paper presents a powerful method for detection of Guilty persons in lie detection systems using brain signals. It was an experimental study. The employed method is based on the extraction of P300 components from brain signals. In this way, the test protocol was designed based on Odd-ball method, firstly. This test was done on 16 people and their brain signals were acquired. After preprocessing, p300 amplitude was extracted for each person from brain signals, and finally Guilty and Innocent persons were classified by comparing amplitude through Bootstrapped Amplitude Difference [BAD] method. The obtained results show that the proposed method has detected correctly 7 out of 8 guilty persons and 8 out of 8 innocent persons. Also, the validated results show the promise of the proposed approach in discrimination of guilty subjects from innocent subjects by the accuracy of 93.75%. Knowing the existence of precious information in brain signals and their relation with brain's cognitive activities and also considering the performance of the proposed method, there are enough reasons use the proposed approach for detection of guilty persons from innocent ones. Further, in comparison with previous methods, the impact of man ability to control brain signal parameters and creating incorrect feelings been reduced through the proposed method

[Pulmonary tuberculosis risk factors in hospitalized HIV positive patients in Ahvaz, Iran [2001-09]]

Human immunodeficiency virus [HIV] pandemic is increasing word-wide. Tuberculosis is the main cause of death and low quality of life in HIV infected patients. The prevalence of Tuberculosis in HIV infected patients varies in different areas according to socioeconomic, cultural and geographical situation. This study was done to asses the pulmonary Tuberculosis risk factors in hospitalized HIV positive patients in Ahvaz, Iran. In this data based study all medical files of admitted HIV positive patients in Razi hospital in Ahvaz in south west of Iran were reviewed during 2001-09. Demographic characteristics and HIV Tuberculosis related variables were analyzed using SPSS-16, Fisher's exact test and Odds Ratio. Out of 123 HIV cases 99 [80.5%] were injecting drug user [IDU], sixty eight [55.3%] had imprisoment history. Eighty one patients [65.8%] had Tuberculosis, in which 46 had co-morbidities such as infective endocarditis or viral hepatitis, 79 cases were IDU, 61 cases had imprisonment history and 24 cases had CD4 count below 200. There was a significant association between Tuberculosis and IDU, imprisonment and CD4 count [P<0.05]. This study showed that the rate of Tuberculosis in HIV positive patients is higher than the rate in previous studies performed in Iran. Also exposure to Tuberculosis cases in prison, IDU and low CD4+ T- lymphocyte count are the main risk factors for Tuberculosis acquisition

[ main risk factors of pulmonary tuberculosis acquisition in hospitalized patients in Razi hospital, Ahvaz-Iran [2001-07]]

Risk factors of tuberculosis vary in communities according to different socioeconomic conditions. Knowing these risk factors help to control the disease. This study was done to determine the main risk factors of pulmonary tuberculosis acquisition in hospitalized patients. In this data based, case-control study 173 tuberculosis patients [as cases] and 305 non tuberculosis patients [as controls] hospitalized in Razi hospital in Ahvaz, Iran during 2001-07 were gone under investigation. Risk factors included injecting drug addiction, smoking, HIV infection, diabetes mellitus, imprisonment and corticosteroid usage. Data were analyzed using SPSS-13, Chi-Square and Fisher exact tests. Odds ratio was determined for risk factors. Frequencies of the main risk factors in case and control groups were as: smoking; 54.3%, 14.8% [p=0.0001, OR: 6.5], HIV infection; 11.5%, 3% [p=0.0002, OR: 4.3], injecting drug addiction; 18%, 3.3% [p=0.0001, OR: 6.7], diabetes mellitus; 22.5%, 5.9% [p=0.0001, OR: 4.6] and imprisonment; 20.2%, 3.9% [p=0.0001, OR: 6.2], respectively. Corticosteroid use and renal failure were similar in cases and controls. This study showed that smoking, HIV infection, injecting drug addiction, diabetes mellitus and imprisonment were the main risk factors for tuberculosis acquisition in this region

Determination of seroprevalence rate of Toxocara canis in 6-15 years aged rural and urban school children in Ahvaz, Iran

Toxocariasis is a worldwide zoonosis caused by the acaridae of dogs and rarely cats. Seroprevalance of toxocariasis vary with geographic regions. In this study, the sera of school children aged between 6 to 15 years were examined for the presence of anti T.canis antibodies. In this descriptive cross-sectional study the sera of 203 randomly selected school children aged between 6 to 15 years from urban and rural regions in Ahvaz, south western of Iran from 2007 to2008 was examined by means of ELISA with excretory-secretary antigen of infectious larva stage. CBC was performed for the presence of eosinophilia or hypereosinophilia. A short questionnaire was fulfilled to obtain data of age, sex, history of pica, contact with dogs and living area [urban or rural]. Of total 203 students 90 [44.3%]were female and 113 [55.7%] were male. 86 [42.9%] were rural and 114 [57.1%] were urban, 67 [33%] had contact with dogs,35 [17%] had history of recent cough,5 [2.5%] had pica, on had hypereosinophilia but 21 [10.3%] had eosinophlia, 4 [2%] had positive ELISA for T.canis IgG, of them one was male and three were female, two were urban and two were rural, non had history of contact with dogs, pica, chronic cough or asthma, and also non had hypereosinophilia but all had eosinophilia. Our study showed that toxocariasis is present in the school children of Ahvaz, but it is lower than was expected and also lower than similar tropical regions

[ effects of oral administration of solution containing minerals and organic substances in parturient dairy cows and the prevention of mineral deficiency and negative energy balance]

Negative energy balance and mineral deficiency are the most important metabolic disorders in fresh dairy cows. In order to evaluate the effect of the feeding of solution [LICVITE [registered sign]] containing minerals [calcium, phosphorus and magnesium] and organic substances [propylene glycol and niacin] in parturient dairy cows, 30 cows were examined in a dairy farm with 500 milking dairy cows. 500 ml of Licvite syrup was fed to 15 dairy cows one hour post partum, and once again 14 hours after calving [treatment group]. Fifteen parturient dairy cows, almost at the same physical situation as the treatment group, did not receive any substances after calving and were chosen as the control group. Jugular blood samples were taken from two groups as follow: 12- 15 days before parturition; 14 and 24 hours after calving; and, 10 days after parturition. Analysis of sera showed that the mean serum concentration of calcium in the treatment group at 24 hours after parturition, and mean serum concentration of phosphorous in all the measured times after parturition, were significantly higher than the control group [p<0.05]. After parturition it was noticed that there was a decreased level of BHBA and NEFA in the cows in the treatment group. The differences, however, were not statistically significant. The results of present study showed that oral administration of a solution containing mineral and organic substances, to dairy cows during the first day after parturition, had a very significant effect on the prevention of subclinical mineral deficiency and the negative energy balance

Gelatin, ringer or modern hydroxyethyl starch solutions: which is better after coronary artery bypass graft?

Hemodynamic stability in patients after coronary artery bypass graft surgery [CABG] with the cardiopulmonary bypass pump [CPB], especially during transfer to ICU ward and the early hours of ICU admission is very important. Adequate fluid therapy and intravascular volume maintenance as a matter of principle is essential using various intravenous fluids, but there is always the question of what is the ideal intravenous fluid?. The aim of this study is to compare the effects of gelatin, hydroxyethyl starch [HES 6%, Voluven], and Ringer's solution to maintain hemodynamic status after cardiopulmonary bypass in patients undergoing coronary artery bypass surgery. In this randomized double blind clinical trial, 92 patients who were candidates for onpump CABG were studied. After discontinuation of CPB, all patients were transferred to the ICU and were put randomly into three groups. The first group received Ringer's solution, the second group gelatin 4%, and the third group HES 6% [Voluven]. Hemodynamic parameters like heart rate, mean arterial pressure, systolic blood pressure, diastolic blood pressure, central venous pressure, cardiac output and the presence of arrhythmias were documented. The volume that was needed for maintaining normal blood pressure and central venous pressure [CVP] in the range of 10 to 14 mmHg was less in the HES group than the other groups, but was similar in the gelatin 4% and Ringer's groups in the first 24-hours after surgery. Urinary output in the first four hours and 24 hours after surgery were significantly higher in the HES group than the other two groups, and mean creatinine levels were significantly lower in the HES group. HES 6% has better volume-expanding effects than gelatin 4% and Ringer's solution and its short-term effects on renal function are also better

Prevalence of cryptosporidium infection in immunocompromised patients, in south-west of Iran, 2009-10

Cryptosporidium is a protozoan parasite with worldwide distribution. The aim of this study was to estimate the prevalence of Cryptosporidium infection by antigen detection in faeces among immunocompromised patients referred to educational hospitals of Ahvaz City, South-West of Iran, 2009-1010. Fecal samples from 176 immunocompromised patients were collected and Cryptosporidium coproantigen test was performed using ELISA method [DRG kit, Germany]. A questionnaire was completed for each case and the results were analyzed using descriptive and Chi-square test, SPSS statistical software [15[th] version]. Our study indicated 5.1% Cryptosporidium infection prevalence in the immunocompromised participated population. Furthermore, 4.2%, 4%, 4.5% and 9.1% infection rates were identified in children suffered from hematopoietic malignancy, adult cancer patients, renal transplant recipients, and HIV[+] cases, respectively. There was not significant correlation between the infection and age and gender [P>0.05]. Infection was most frequent among HIV[+] patients. The present study confirmed the high prevalence of Crytosporidium antigen in fecal samples of immunocompromised patients in the region. As no chemotherapeutic agents have yet proven, especially in immunosuppressed patients, therefore our results highlight the importance of preventive intervention in these groups

Tuberculous spondylitis: risk factors and clinical/paraclinical aspects in the south west of Iran

Tuberculous spondylitis [TS] is both the most common and the most dangerous form of TB infection. Delay in diagnosis and management causes spinal cord compression and spinal deformity. The aim of this study was to identify the clinical and paraclinical aspects and also to describe its risk factors in Khuzestan, a province located in the south west of Iran. In this medical record-based retrospective study 69 cases of TS registered in Khuzestan Health Center from 1999 to 2008, were reviewed. For each TS case two extra pulmonary TB cases [without spinal involvement] were randomly selected as control. Related data in patients were analyzed in SPSS software [version 16, USA] using chi square and Fishers exact test. Differences with P<0.05 were considered significant. The mean age of patients was 43.7 +/- 18.3 years, and 60.8% were males. The mean time of delay: for patients' delay, doctors' delays and from diagnosis to initiation of treatment was 1.8 +/- 1.1, 6.8 +/- 4.3 and 1.3 +/- 1.2 months, respectively. In 56 cases [81.1%], TS was diagnosed on lumbosacral radiograph, in remaining cases by lumbosacral MRI. Twenty patients [30.4%] had a previous TB history, 30.4% had underlying medical disorders such as diabetes mellitus [30%], steroid use [45%], chronic renal failure [50%]. The most common clinical findings were: backache 98.5%, fever 26.1%, spinal tenderness 84.1%, paraparesis 26.1%, and kyphosis 28.9%. Laboratory results were: elevated sedimentation rate [ESR] 92.8% and positive CRP 86.9%. There were statistically significant differences in age, gender, CRF, imprisonment and previous TB infection between the two groups. TS is therefore a diagnosis that attending doctors need to consider early. Patients in endemic area of TB, presenting with back pain in association with constitutional symptoms and elevated ESR and or positive CRP should be investigated to exclude TS. Older age, male gender, chronic peritoneal dialysis, imprisonment and previous TB infection may be the main risk factors of TS

[Evaluation of epidemiological, clinical and laboratory findings of admitted patients with meningitis in infectious diseases ward of Razi hospital, Ahvaz]

Familiarity with the epidemiological, clinical and laboratory features of bacterial meningitis [BM] is important for rapid diagnosis and initiation of antibacterial therapy. This study aimed at evaluating these patients based on their epidemiological, clinical and laboratory findings and comparing these variables with patients with aseptic meningitis [ASM]. Admitted patients aged 18 years or more who were hospitalized because of meningitis, were studied between 2003 and 2007. Cases were grouped as BM and ASM and compared for their epidemiological, clinical and cerebrospinal fluid [CSF] laboratory aspects. Among 312 patients with meningitis, 215 [68.9%] had BM [42 definite, 156 probable and 17 partially treated] and 97 [31.1.%] had ASM. The mean age of patients with BM was 44.7 +/- 26.7 years and for ASM was 37.3 +/- 15.5 years [P>0.05]. Twelve percent of cases had triad of fever, neck stiffness and low level of consciousness. The means for CSF-WBC, CSF- glucose and CSF-protein in BM compared with ASM patients were 4021.6 +/- 1035.2 and 163.2 +/- 116.4 cell/microl of CSF; 27.5 +/- 17.3 and 68.7 +/- 16.lmg/dl and 689.8 +/- 476.8 and 132.6 +/- 107.7mg/dl, respectively [P<0.05]. The prevalence of BM was higher than that of ASM. Tuberculous meningitis had a considerable frequency among ASM patients. Confirmed BM based on CSF culture was lower than other studies. The number of performed LP procedures was not in accordance with the total meningitis cases. Similarly, WBC and glucose in CSF were helpful in differential diagnosis of BM vs. ASM

[Seroprevalence of legionella pneumophila in patients with, community acquired pneumonia]

Legionella pneumophila [LP] is a major cause of pneumonia worldwide. In spite of suitable epidemiological conditions and probability of LP existence in the region, the incidence of LP infection has not been determined in Ahvaz. Determination the seroprevalence of LP in patients with Community Acquired Pneumonia [CAP]. In this prospective descriptive study, during one year period [2007-2008], 80 admitted patients were selected in Razi Hospital of Jundi Shapoor University of Medical Science in Ahvaz with CAP and was studied the serprevalence of LP among them. Sera were tested for L. pneumophila IgG and IgM by using Elisa kit [Vircell, Spain]. Data were analyzed by using SPSS, version 16 statistical package. Among 80 serum samples, 12 cases [15%] were positive for LP- IgG+ IgM. Age, gender and area of residency did not significantly affect the seroprevalence of L P. [P>0.05]. The prevalence of L P seropositivity was not significantly affected by co-morbidities except diabetes mellitus [P>0.05]. Smoking and receiving antibiotic was observed in 100% seropositive patients. Legionella Pneumophila is a prevalent infectious agent in Ahvaz and should be considered in patients with CAP especially in diabetic and smoker patients

[Comparative study on knowledge about tuberculosis in two cities with different tuberculosis epidemiological index in Khuzestan, 2004]

Tuberculosis [TB] is a global health problem. One of the most important and effective ways of TB control is health education. Health planning depends on public health needs. The aim of this study was to assess the general population's knowledge about tuberculosis. This study is a comparative descriptive study which was conducted in 2004 in Behbahan and Omidieh, two cities in Khuzestan province with different TB epidemiological index. Nine hundred and seventy five individuals referring to health centers of these cities were asked to answer questions about TB. Data were obtained from questionnaires with 92% reliability and 98%validity and were analyzed with SPSS software using t test with 95% confidence. Of total 975 individuals 546 [56%] were living in Behbahan and 429 [44%] in Omidieh. Mean knowledge score for signs and symptoms, transmission and control of tuberculosis in Behbahan and Omidieh were 26, 10, 13 and 14, 6, 9 respectively. There was a significant difference in tuberculosis knowledge between two cities [P<0.05]

[ correlation between hepatitis E seropositiveness and intravenous drug using in the drug users who referred to the drug treatment centers in Ahvaz, 2005-2006]

Hepatitis E virus [HEV] infection is endemic in Iran and some cases of fulminant hepatit with high mortality rate caused by this virus have been reported in patients with chronic hepatitis E and in pregnant women. Although HEV is mainly transmitted via fecal-oral route, but recently there have been some reports indicating transition of this virus via transfusion. Therefore, this study was aimed to investigate the association of hepatitis E seropositiveness and intravenous drug using in the drug users. This is an analytical-descriptive study which was conducted in a drug treatment center in Ahvaz from 2005 to 2006. A total of 114 intravenous drug users [IVDUs] and 114 inhaling addicts [IADs] were subjected to full physical examination. Subsequently a questionnaire including individual characteristics and related variations was filled in and also a blood sample was obtained. Using ELISA method, the samples were tested for anti-HEV antibody. Data were analyzed using Chi square, t and odds ration [OR] tests. The mean age of the two groups, IVDUs and IADs, were 33.24 +/- 8.04 and 31.2 +/- 7.59 years respectively, with no significant difference [P>0.05]. The mean of duration of addiction in IVDUs and IADs groups was 11.58 +/- 6.92 and 9.95 +/- 6.42 years, respectively [P>0.05]. Anti-HEV antibody was detected in 22.8% of IVDUs and 7.9% of IADs [P<0.01, OR=3.44]. There was no significant relationship between previous imprisonment and anti-HEV antibody positiveness in the drug addicts studied [P>0.05, OR=1.15]. As it was shown in this study, HEV is probably transmitted via blood transfusion and thus screening of blood donors for anti-HEV antibody may block this route of infection

[Comparison of ciprofloxacin and co-trimoxazole on typhoid fever]

Typhoid fever is a systemic infection caused by Salmonella typhi. The global emergence of multi-drug resistant [especially to ciprofloxacin] strains of this bacterium is of great concern. Therefore, the aim of this study was to compare the efficacy of co-trimoxazole with ciprofloxacin in empirical treatment of typhoid fever in outpatient cases from Ahvaz. In this clinical trial study, which was conducted in Ahvaz, 50 of outpatients were divided randomly into two groups. Group one were treated using ciprofloxacin [7.5mg/kg bid, 7 days] and the second one treated by co-trimoxazole [4.20mg/kg bid, 14 days]. A blood sample taken from the patients before, at the end and 3 weeks after the treatment, and tested for S.typhi. The outcome of the treatment was regarded as responded [disconnection of fever and the culture became negative], failure to treatment, and relapse of the infection. These results were analyzed using SPSS11 software using t and Chi- Squared tests. The mean age of the patients in ciprofloxacin and co-trimaxazole groups were 22.4 and 22.1 years, respectively [p>0.05]. The responses to the treatment [no fever, negative culture] with ciprofloxacin and co-trimoxazole were 81.81% and 78.57%, failure of treatment with ciprofloxacin and co-trimoxazole were 13.63% and 14.28% and relapse was 4.56% and 7.15%, respectively. This study showed that the effect of co-trimoxazole is similar to that of ciprofloxacin. Therefore, regarding the recent reports indicating increasing resistance of this bacterium to ciprofloxacin and limitation of using of it in children and pregnant women, we recommend co-trimoxazole for treatment of empirical typhoid fever

Comparison of two chemotherapy regimen: doxycycline-rifampicin and doxycycline cotrimoxazol in the brucellosis patients Ahvaz, Iran, 2004-2006

To compare two drugs regimen, doxycycline-rifampicin and doxycycline-cotrimoxazol in the treatment of brucellosis patients. It is a comparative clinical study conducted in Ahwaz a city southwest Iran, from April 2004 to January 2006. This study was conducted on 102 nomads' patients with brucellosis. The diagnostic criteria were the finding of >/= 1/80 [Wright] with a 2 mercaptoethanol [2 ME] >/= 1/40, in association with compatible clinical findings [back pain, sweating and fever]. Patients were enrolled into the two antimicrobial therapy groups, doxycycline plus rifampicin [DR group] and doxycycline plus co-trimoxazole [DC group]. The data in the two groups were statistically compared with SPSS by chi square test. Failure of treatment was seen in one [1.94%] and 5 [9.81%] cases treated in the DC group and DR group, respectively. Relapse was seen in three cases [5.88%] treated in the DC group and in six cases [11.76%] treated in the DR group. Failure of treatment plus relapse was seen in four [7.84%] and 11 [21.56%] cases treated in the DC group and DR group, respectively [p <0.05]. Risk for relapse and failure of treatment in DR group was 2.75 times higher than DC group. This study showed that co-trimoxazole plus doxycycline regimen has a better therapeutic effect than doxycycline plus rifampicin regimen

Seasonal variation in the characteristics of the Azarbaijani buffalo [Bubalus bubalis] semen

To study the seasonal variation in the characteristics of the Azarbaijani buffalo semen, three 2-4-year-old bulls of Azarbaijani water buffaloes, kept in the Buffalo Breeding Center, in Urmia, northwest of Iran, were selected. Semen samples were collected once a week for a period of one year using artificial vagina and a buffalo cow as a dummy. Semen volume, colour, pH and motility and spermatozoa motility, viability, morphology and concentration were examined. During one calendar year, 129 semen samples were examined. The mean values were plotted and a curve was drawn for the annual variations in each parameter. The comparison of the mean values in each sampling and in different seasons and the correlation between these variations and ecological factors, such as temperature, rainfall and day length were also studied. Semen was characterized by a mean [ +/- SEM] ejaculation volume of 4 +/- 0.14 ml, semen colour density score of 3.75 +/- 0.07, pH of 6.97 +/- 0.03 and motility score of 2.89 +/- 0.05. The sperm motility of 75.85% +/- 1.59% and sperm viability of 73.2% +/- / 1.56% were observed; 11.55% +/- 0.42% of spermatozoa had abnoraml morphology. The mean [ +/- SEM] sperm concentration was 1239.9 +/- 34.11 x 10 [6] cells/ml. All of the studied parameters showed fluctuations throughout the year but these variations were statistically significant only in some occasions and were mostly correlated with length of the day. Semen of better quality was collected in summer and autumn

[Effects of hypothyroidism on the reproductive system of male lambs]

The effects of hypothyroidism induced by oral feeding of thiourea [50 mg/kg] in four indigenous male lambs of 5-7 months of age were studied. Blood samples from jugular vein were collected before and after 40 and 80 days of treatment and the levels of T[4], T[3], LH, FSH, prolactin and testosterone in the serum were estimated, and compared with two negative controls. The weight and dimensions of thyroid gland in hypothyroid lambs were greater than the controls being statistically significant for the length of the gland [P <0.05] and highly significant decrease for the levels of T[4] and T[3] in the serum [P <0.001]. The levels of LH, FSH and prolactin in the serum did not significantly change during the experiment while the dimensions and weight of the testis showed a decrease though not statistically significant. However, testosterone [T] was not detectable in the serum, and the dimensions of accessory glands did not change. Histological examination of the hypothyroid lambs showed hyperplasia and metaplasia in the secretory cells of the thyroid gland, with a complete degeneration of germ cells in seminiferous tubules of the testis. There was an increase in the number of leydig cells and their surrounding fibroblasts, but these cells also showed signs of degeneration. No sperm cells were observed in the epididymis. Degeneration and vacuolation were observed only in the seminal vesicle cells. It is concluded that hypothyroidism diminishes all the germ cells and hormone producing cells in the testis