Assessment of health-related quality of life among patients with tuberculosis in Hamadan, western Iran

Tuberculosis is one of the oldest infections known to affect humans. The aim of the study was to assess the quality of life including physiological, general health perception and social role functioning among patients with tuberculosis in Hamadan, Western Iran. A cross sectional analytical study was conducted between December 2009 and March 2011, the quality of life scores of 64 tuberculosis cases were measured by SF-36 questionnaire before treatment, after the initial phase and at the end of treatment and were compared with those of 120 controls. The association of the quality of life with age, type of tuberculosis, sputum smear, duration of disease, and the stage of treatment were assessed among the patients. Before treatment, all scores of tuberculosis patients were lower than those of the controls [p<0.05]. The patients' score increased signififificantly after two months of treatment [p=0.01], but the difference was not significant between two and six months after treatment [p=0.07]. The lowest score in tuberculosis patients was related to physical functioning and energy [45 +/- 42, 44 +/- 24, respectively]. According to the results, tuberculosis patients still have a low quality of life in spite of receiving new care strategies. Therefore, enhancement in quality of life may improve adherence to anti-tuberculosis treatment, functioning and well-being of patients with tuberculosis.

Seroprevalence of Bordetella pertussis antibody in pregnant women in Iran

The increasing incidence of pertussis among adolescents and adults in recent years is an alarming factor in transmission of the infection to non-immune infants and children. Vaccination of pregnant women, immediately after delivery and before being discharged from the hospital may help to protect mothers and their newborns against the disease. Decision making process, regarding maternal immunization, requires credible information and knowledge about seroepidemiology of the infection in pregnant women. The aim of this study was to determine the seroprevalence of Bordetella pertussis antibody among admitted pregnant women in Hamadan, western Iran. In this cross-sectional study, 288 pregnant women admitted to the Fatemiyeh Hospital, Hamadan, western Iran, were enrolled into the study. After obtaining consent from every patient, serum samples were taken from patients and were kept frozen until testing. Serum level of B. pertussis antibody was measured using ELISA. Level of antibody higher than 24 U/ml was considered positive. The obtained data were analyzed using the statistical software SPSS. From 288 pregnant women, 126 [43.8%] were in their second trimester. Serological results in 103 patients [35.8%] were positive. The mean age of mothers with positive serology was 27.5 +/- 6 years old. Thirty-five percent of patients had a valid immunization record, and 1.57% of those with no vaccination record had a positive serology. The level of immunity against B. pertussis in pregnant women was low. Immunization before or during pregnancy can stimulate newborn's immune response and gives them required protection against pertussis infection

prevalence of antibiotic resistance of Enterobacteriaceae strains isolated in community- and hospital-acquired infections in teaching hospitals of Hamadan, west of Iran

The prevalence of antimicrobial resistance among Enterobacteriaceae is increasing worldwide. Identification of pathogens and their resistance to antimicrobials is mandatory for successful empiric antibiotic treatment. The aim of this study was to investigate the prevalence of antimicrobial resistance of Enterobacteriaceae isolated from hospital-acquired and community-acquired infections. In a descriptive-comparative study, during 2010, all clinical isolates of Enterobacteriaceae and their antibiograms from laboratories of Sina and Bessat Hospitals, Hamadan, west of Iran were included. Hospital-acquired infections were identified by records from infection-control units. A questionnaire containing information about demographic characteristics, source of specimen, kind of En-terobacteriaceae and their antimicrobial resistance was filled for each patient. Data were analysed using SPSS. A total of 574 samples were collected, out of which the most prevalent pathogens were Escherichia coli and Klebsiella pneumoniae. Almost all isolates of Enterobacteriaceae were resistant to ampicillin [98.8%], and the least resistance was to piperacillin [3.7%]. In addition, most isolates were resistant to cefazolin, cefixime, and co-trimoxazole. Among third generation cephalosporins, the highest resistance to ceftriaxone and the least resistance to ceftizoxime were observed. 19.3% of isolates were resistant to imipenem. In terms of fluroquinolones, nosocomial infections and community acquired infections were resisitant to ciprofloxacin 33% and 4.1% respectively. The rate of resistance in nosocomial infections was higher than that of community-acquired infections. The prevalence of multidrug resistant Enterobacteriaceae is increasing both in community-acquired and hospital-acquired infections. Because of propable increasing resistance to fluoro-quinolones and newer betalactams, reassessment of resistance of Enterobacteriaceae must continue in future years

Evaluation of fibronectin and c-reactive protein levels in patients with sepsis: a case-control study

Sepsis is a significant health problem with an estimated 750,000 new cases in the USA annually. It is also the third leading cause of death in developed countries, equaling the number of fatalities from acute myocardial infarction. The high sepsis-related mortalities mean there is an urgent need to improve the diagnosis and management of sepsis patients. The aim of this study was the evaluation of fibronectin and C-reactive protein [CRP] plasma levels in patients with sepsis and other infectious diseases without sepsis. In a case-control study, 90 patients with sepsis and 90 patients with other infectious diseases without sepsis were studied. Serum levels of fibronectin and CRP were measured. The data were analyzed by SPSS version 15. The mean levels of fibronectin in the cases and controls were 288.97 +/- 89.10 mg/l and 341.24 +/- 110.53 mg/l respectively [P=0.001]. The mean levels of CRP in the cases and controls were 89.42 +/- 54.05 micro g/ml and 27.42 +/- 25.89 micro g/ml respectively [P<0.001]. Concerning the source of infection, the mean CRP levels were significantly higher in septic patients with urinary tract infection, pneumonia, and soft tissue infection [P<0.001]. Decreased levels of fibronectin and increased levels of CRP may be considered as reliable diagnostic markers for sepsis. Also, CRP could be a better predictive factor for sepsis than fibronectin

Nosocomial bacterial infections and their antimicrobial resistance paterns in university hospitals of Hamedan, Iran

Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in educational hospitals of Hamadan, western, Iran. During a 1-year period from April 2006 to March 2007, all patients with culture-proven nosocomial infections from educational hospitals in Hamedan, western Iran were included. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48h after admission in the hospital. Antimicrobial susceptibility testing of isolated bacteria was performed by disc diffusion method. A total of 170 cases of culture-proven nosocomial infections were diagnosed. Most cases were in intensive care units [ICUs] [57.4%]. The common sites of infection were lower respiratory tract [51.8%] and urinary tract [31.9%]. Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens [32.7%, 22.9%, and 14.8% respectively]. Most enterobacteriacea isolates were resistant to third generation cephalosporins. The resistant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to ciprofloxacin. Among S. aureus isolates, 80% were methicillin-resistant. The patients in the ICUs are at a higher risk of nosocomial infections. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs

Screening for tuberculosis among patients with chronic psychiatric disorders in Hamedan

Tubercle bacilli most often are transmitted from one person by the airborne route. The aim of the present study was to determine the frequency of latent tuberculosis infection and active pulmonary tuberculosis among patients with chronic psychiatric disorders in Hamedan. In a cross sectional study, 215 patients with chronic psychiatric disorders were investigated for tuberculin skin test. Those with an induration of >/= 10 mm were introduced for further evaluation, including a chest-x-ray and examination of the sputum for acid-fast bacilli for those with radiographic abnormalities. Of 215 patients, 62 [28.8%] had positive tuberculin skin test reaction. Age and duration of psychiatric disorders were significantly associated with test positivity. Of 62 tuberculin-positive patients, 25 [40.3%] had radiographic evidences of inactive pulmonary tuberculosis. None of them had positive sputum smear for tuberculosis. Chronic psychiatric patients are more susceptible to tuberculosis infection. Screening tests should be applied for these patients

Electiveness of hepatitis B vaccination in children of chronic hepatitis B mothers

Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained. The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen [HBsAg] and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993. Chronic infection [HBsAg positivity] was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group [relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02]. Previous infection of hepatitis B [HBcAb positivity] was found in 29 [29.9%] children in the exposed group, but only one [1.2%] in the unexposed group [RR=26.01, 95% CI: 3.61-186.95]. Immunity [HBsAb positivity] in the exposed group measured 48 [49.5%] and unexposed group measured 56 [64.4%] [R.R=0.76, 95% CI: 0.59-0.99]. Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth