ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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
ABSTRACT
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
Subject(s)
Humans , Carrier State , Pneumococcal Infections , Nasopharynx , Prevalence , Meta-Analysis as Topic , Child , Drug Resistance, MicrobialABSTRACT
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
Subject(s)
Humans , Male , Female , Insulin/administration & dosage , Insulin/analogs & derivatives , Coronary Artery Bypass , Injections, Subcutaneous , Infusions, Intravenous , Blood GlucoseABSTRACT
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