Calculation of reproductive number using data from H1N1 patients in Fars province, Southern Iran

Effective reproductive number [Re] is an index which considers the proportion of susceptible people in a community. There are different methods for calculation of basic reproductive number. The aim of this study was to evaluate the reproductive number using data from H1N1 patients in Fars Province, southern Iran. According to the data obtained, 233 cases were confirmed between July 15[th] and December 3[rd], 2009 Two waves were observed during this period with a peak in October 21[st] in Fars Province. In the first wave, the highest amount of Ro was 3.22 and the lowest amount was 2.12 and in the second wave, the highest and lowest amounts of Ro were 3.42 and 2.42, respectively. Effective reproductive number could not be more than 1.54. Thus in order to maintain Ro below 1, using preventive measures like vaccination, only 70% of population should be immune. As 54.9% of Fars population were immune against H1N1 if only 15.1 of them take part in vaccination program, the disease will not reach an epidemic level

Talents for future: report of the second national medical science Olympiad in Islamic Republic of Iran

This report describes a unique experience of Second National Medical Science Olympiad that was held in August 2010 in Shiraz, Islamic Republic of Iran. The history of medical science Olympiad in Iran and the development, process and domains in the Olympiad and the way for future will be discussed

Introduction of a pyramidal model based on primary health care: a paradigm for management of 2009 H1N1 Flu pandemic

Primary health care [PHC] as the first level of contact of all individuals, the family and the community with the national health system has a prominent role in response to different health events such as H1N1 pandemic. Regarding the great potentials of PHC and several experiences achieved in previous natural disasters and epidemics in Iran, in this study there is an attempt to propose a pyramidal model to combat against H1N1 pandemic. Pyramidal model puts all key components such as community, NGOs, PHC, hospitals, policy makers together to confront concurrent H1N1 pandemic and other health issues by a comprehensive, integrated and organized approach. This model should be regarded as a continuous, flexible and dynamic solution to pandemics. H1N1 pandemic, as a multi-wave and unpredictable event of the 21st century that involved most countries, threatens communities and confronts hospitals with growing demands of patients for health services. By defining the role of PHC and other important parts of pyramidal models such as community, we can fight against H1N1 pandemic appropriately with the least human and financial resources

Influenza A [H1N1] virus pandemic in Fars Province: a report from southern Iran, July-December 2009

Influenza type A [H1N1] virus is considered as a major concern for health care system all over the world and imposes a considerable burden on the community. The aim of this study was to evaluate the pattern of the disease in order to help health administrators in making decision for preventive measures. 297 definite cases of influenza A [H1N1] diagnosed from 15 July to 3 December 2009 in Fars province, south of Iran, were included in this study. Diagnosis was confirmed performing Real time-PCR. The patients' information including age, gender, occupation, nationality, education, residency area and history of overseas or domestic travel, history of contact with other influenza patients, and symptoms were collected and analyzed. The mean age at the time of diagnosis was 24.4 +/- 15.8 years. 76 [25.6%] patients were admitted in the hospitals, of whom, 11 cases died due to related influenza complications with Case Fatality Ratio [CFR] of 4.4%. The most common reported symptoms were fever, cough and sore throat. There were two waves in the disease incidence, one about 1 month after emergence of the disease and another around 1 month after school openings. The first peak was observed mainly among adults with a history of foreign travel while the second peak was mainly observed among school students. The magnitude of the epidemic was much higher when the disease was transmitted between students at the beginning of the school year. Considering the high incidence of H1N1 flu among the students [41%], vaccination programs and preventive measures should target this age group

efficacy of hepatitis B vaccination among school age children in southern Iran

Primary prevention by vaccination to increase herd immunity remains the main thrust in the control of hepatitis B virus [HBV] infection and many countries such as Islamic Republic of Iran have incorporated HBV vaccination into their national expanded program of immunization. This study was performed to determine the vaccine efficacy of hepatitis B infection between vaccinated and non-vaccinated school-aged children. Three hundred and ninety four students aged 6 to 8 years who received the hepatitis vaccine in the infancy and 314 students aged 9 to 10 years who did not receive it in Sepidan, southern Iran were enrolled. We also determined the titer of anti HBs Ab in the vaccinated students. Two students [0.5%] were HBV infected [positive HBC Ab] and none were a chronic carrier. Two hundred and forty nine students [63.2%] had anti HBs titer greater than 10 IU/ml. One hundred and seventeen students [30%] had anti HBs titer between 1 and 10 IU/ml and only 28 children had anti HBs titer less than 1 IU/ml. Five [1.6%] were HBV infected [positive HBc Ab] and 2 [0.6%] were chronic carriers [positive HBs Ag]. The efficacy of the vaccine 6-8 years after vaccination was 67.9% [95 Cl 78-92]. Our results showed that similar to other studies, vaccination could not reduce the infection rate but had a significant effect on the reduction of chronic infection and carrier state, emphasizing on the role of vaccination in the control of HBV infection in an endemic region

17 years old girls with Kikuchi-Fujimoto disease [KFD] and severe leukopenia

Kikuchi-Fujimoto disease [KFD] is an enigmatic, benign and self-limited syndrome characterized by regional lymphadenopathy with tenderness, usually accompanied by mild fever and night sweats. A 17 years old girl admitted in infectious diseases ward with chief complaint of fever and cervical lymphadenopathy since one week ago. Her problems started with fever and pharyngitis. Three days later, she developed one cervical lymphadenopathy. Blood sample revealed a WBC count of 1700 cells/mm[3], platelets count of 137000/mm[3]. IgG-anti EBV antibody [VCA] level was 98.7 [upper limit of normal 20] and IgM-anti EBV antibody level was 52.7 [upper limit of normal 40]. In hospital course her leucopenia became worse and reached 700cells/mm[3]. After two weeks WBC count recovered, and reached 5100 cells/mm[3]. Lymph node biopsy was achieved and showed necrotizing lymphadenitis with histiocytic reaction consistent with Kikuchi disease. Kikuchi-Fujimoto disease must be considered in differential diagnosis of patients with acute severe neutropenia

Therapeutic response to folinic acid in methanol poisoning epidemic in Shiraz

Methanol poisoning may result to death and permanent complications, sporadic cases of methanol poisoning are fairly rare and the largest experience are generally gained from managing methanol intoxication epidemics. The main metabolite of methanol is acid formic that is the prime metabolite responsible for toxic effects of methanol and since folate dependent systems are responsible for the oxidation of formic acid to CO2 and water. It is believed that administration of folic acid enhances the metabolism of formate. Though therapeutic effects of folic or folinic acid has never been fully tested in clinical trails in human. Our objective was to evaluate therapeutic effect of folinic acid in methanol poisoned persons. In recent methanol poisoning epidemic due to "bootleg" Liquor consumption in Shiraz at 2004, Sixty-two patients have hospitalized. Folinic acid was administered to 19 patients and therapeutic effect of folinic acid was studied. There was no significant difference between two groups of patients and number of decreased visual acuity, renal function, hospital stays and needs to bicarbonate therapy and hemodialysis. The only effect was decreasing acidosis in folate treated patients. Regardless of prior animal studies and case reports, with attention to our study limitation we didn't found significant protective effect of folinic acid infusion among methanol poisoning patients. The only effect was decreasing acidosis in folate received patients. Further studies in optimal situation is needed for definite judgment

Internal medicine residents'views and understanding of evidence based medicine in Shiraz medical school

Evidence based medicine has become on increasing important topic in recent years in medical schools. The internal medicine residents as important group in managing patient need evidences for better diagnosis and treatment. Our intension was to investigate view and understanding of evidence-based medicine [EBM] among internal medicine residents. in 3 teaching hospital in shiraz university of medical school in Iran, a questionnaire was give to internal medicine residents to determine their view about EBM and their ability to access, use and interpret evidences. The overall response rate was 80% [40/50]. The result showed that 90% of them had previously received education in research methodology but none of them had a course about EBM. All of residents had access to MEDLINE and word web wide [www] in work place but their use isn't favorable. Only 10% of them thought they able to critically evaluate medical literatures. The ability to evaluate the literature and apply methods of data analysis, should be educate to all trainees

Mycotic infection of tinea capitis in Teheran

From 687 patients referred to the Medical Mycology Depatment of the school of public Health, 184 cases showed Tinea capitis infection, direct microscopy and culture was positive in 86.2% and 75.29% of the cases respectively. From the positive cultures 5 different dermatophtes were identified as: Microsporum canis, Trichophyton violaceum, Trichophyton verrucosum, Trichophyton schoenleinii, Trichophyton mentagrophytes. M. canis was found to be the commonest causative organism of Tinea capitis in Tehran [53, 84%] followed by T.violaceum [22.37%], T. verrucosum [13.98%], T.shoenleinii [11.18%] and T.mentagrophytes [6.69%]. Candida albicans and other candida species were also isolated from two patients