[Apoptotic effect of Kyprolis on multiple myeloma KMM-1 cells through p73-mediated induction of G1 cell cycle arrest]

Background and Aim: Since proteasome is strongly considered to be involved in the development and progression of a wide variety of hematological malignancies in particular, multiple myeloma, blockage of this hemostasis system with different types of proteasome inhibitors seems to be a promising way of treatment for multiple myeloma. In this study, we investigated the effect of Kyprolis, a new irreversible proteasome inhibitor [PI], on the survival rate of multiple myeloma -derived KMM-1 cell line

Material and Methods: To evaluate whether inhibition of proteasome using Kyprolis could exert cytotoxic effect in multiple myeloma, KMM-1 cells were cultured with different concentrations [25-150 nM] of the inhibitor for 24 and 48 hours. Then trypan blue exclusion assay, MTT assay, flocytometric cell cycle analysis were performed and we evaluated gene expression changes associated with apoptosis

Results: The results of this study demonstrated that Kyprolis induced both cytotoxic and anti- proliferative effects on KMM-1 cells. This inhibitor is able to reduce the cell survival and metabolic activity in a dose- and also time-dependent manner [p

Conclusions: The results of this study clearly indicated that Kyprolis had anti-tumor activity against KMM-1 cells

[Drug susceptibility testing of clinical isolates of Candida albicans against Amphotericin B and Ketoconazole by microdilution and disk diffusion methods]

Background and Objective: Candida albicans is the normal flora of the body as opportunistic fungi. It causes candidiasis in immunocompromised condition. This study was done to drug susceptibility testing of Candida albicans isolated from patients against Amphotericin B and Ketoconazole

Methods: In this descriptive - analytic study, drug susceptibility of 30 Candida albicans isolated from patients admitted to Tehran hospitals, Iran was tested against Amphotericin B and Ketoconazole by micro dilution method in accordance with CLSI M27-A2 guideline and disk diffusion method in accordance with CLSI M44-S2 guideline. Standard isolate Candida albicans PTCC [5027] and Candida krusei PTCC [5295] were used for quality control

Results: The minimum and maximum MIC against Amphotrericin B was 0.0625 micro g.ml[-1] and 4 micro g.ml[-1], respectively. The minimum and maximum MIC against Ketoconazole was 0.5 micro g/ml[-1] and 32 micro g/ml[-1], respectively. The minimum and maximum zone diameter was 6 and 28 mm for both drugs. The results of drug susceptibility testing by two methods did not show significant differences. 25 isolates [83.3%] against ketoconazole and 2 isolates [6.7%] against Amphotericin B were resistant

Conclusion: Amphotericin B administration seems better choice in candidiasis treatment in comparision with Ketoconazole

[Introduction of hematological and molecular algorithms for diagnosis of factor XIII deficiency in Iran laboratories]

Factor XIII deficiency [FXIIID] is an extremely rare hemorrhagic disorder with an approximately 12 higher incidence in comparison with reported global incidence of the disorder. A standard diagnostic algorithm was proposed by the International Society of Thrombosis and Hemostasis [ISTH] for FXIIID, however, due to the lack of investments all parts of this algorithm cannot be applied in Iran. Thus, this study presented a national algorithm for diagnosis of FXIIID in Iran. For presentation of a national algorithm, all previously published data about Iranian patients with FXIIID as well as practical methods for diagnosis of FXIIID were collected using Science Direct, Google Scholar and PubMed databases. With available facilities, an algorithm with regards to the laboratory assessment, clinical presentations as well as family history can be suitable for an on time and less expensive diagnosis of FXIIID in Iran. Since ISTH diagnostic algorithm is expensive and time consuming, an economical and more suitable national algorithm with regards to available equipment may reduce the rate of misdiagnosis and its life-threatening consequences

[Study the development level of provinces in Iran: a focus on health indicators]

Introduction: access to health care is one of the main goals in all societies. This study aimed to investigate the access level in provinces in Iran

Methods: this descriptive-applied and cross-sectional study was conducted in 2012. Statistical population consisted of all provinces in Iran. Data were collected through library and online research. The Ministry of Health and Medical Education and Statistics Center of Iran as authorities of Information, were referred to for collecting relevant data. Taxonomy techniques were used to assess the of development level of provinces, Shannon entropy techniques were used to determine the weights of indicators and TOPSIS techniques were employed to rank states in terms of access to health care

Results: based on Taxonomy technique from among 31 provinces, 12 provinces were considered to be developed, 9 semi-developed and 10 underdeveloped. Based on Shannon entropy, the ratio of the number of pharmacists to province population was the most important indicator. According to TOPSIS, in term of access to health services; Markazi and Ardabil provinces ranked the first and the last respectively

Conclusion: due to the large differences among provinces, planners and officials are recommended to allocate the funds according to the development level

[Endocarditis associated with Erysipelothrix rhusiopathiae in a fat-tailed ram]

Endocarditis is rarely reported in sheep and information presented for ovine endocarditis is based mostly on comparative findings in the cattle. Infective vegetative endocarditis of the right heart was diagnosed in a 3-year-old fat-tailed ram. Clinical findings included tachycardia, marked brisket edema, jugular veins distention and pulsation and pale mucous membranes. Hematologic abnormality included neutrophilic leukocytosis. Necropsy confirmed severe right atrioventricular and pulmonary valves vegetative endocarditis with evidence of right heart failure. Erysipelothrix rhusiopathiae was isolated from those vegetative lisions.

[Effect of anti - cyclic citrullinated peptide antibody and Rheumatoid factor on clinical diseases activity index in patients with rheumatoid arthritis]

Background and Objective: Rheumatoid arthritis is a chronic, inflammatory and systemic disease with peripheral, symmetric polyarthritis symptoms. Several genetic, environmental, and immunological factors contribute greatly to the disease pathogenesis. This study was done to evaluate the effect of anti-cyclic citrullinated peptide [anti - CCP] and rheumatoid factor on clinical disease activity index [CDAI] in the patients with rheumatoid arthritis

Methods: This prospective cohort study was done on 64 rheumatoid arthritis patients according to ACR criteria [1978] whom referred to Rheumatology Clinic of Hajar Hospital in Shahrekord, Iran. Patients were clinically examined for primary CDAI and tested for anti - CCP and rheumatoid factor in the prior and six months after the initiation of the study

Results: 81.3% and 74% of the patients had high titers of anti - CCP antibody and positive rheumatoid factor, respectively. A non-significant recudtion was observed in intensity of secondary clinical activity of the disease in compare to primary clinical activity in the patients with high antibody titer

Conclusion: This study indicated the important role of rheumatoid factor and anti- CCP antibody in the on time diagnosis of rheumatoid arthritis

[Effect of Amphotericin B and fluconazole on hospital wards fungi]

Nosocomial fungal infections have considerably increased due to incrasing of immunocompromised diseases. This study was done to evaluate the antifungal activity of Amphotericin B and Fluconazole on hospital wards fungi. In this descriptive - analytic study, 33 fungal samples isolated from Imam Khomini hospital in Tehran, Iran during 2013. Samples were identified using slide culture method. Serial dilution of drugs and fungal suspensions were supplied from 0.25-128 microg/ml and range 0.5-5×10[5] cfu/ml, respectively. Minimum inhibitory concentration [MIC] was determined in accordance with NCCLS M38-p guideline. The most frequent isolated fungus was Aspergillus spp. with 39.4% while the low frequent were Alternaria Spp. and Circinella with similar frequency [3%]. MIC range for Fluconazole and Amphotericin B were 64-128 microg/ml and 16-64 microg/ml, respectively. Amphotericin B showed a MIC significant reduction in comparision with Fluconazole [P<0.05]. Hospital wards fungi were resistant to Amphotericin B and Fluconazole

Drug susceptibility of aAspergillus flavus and A.fumigatus to itraconazole and amphotericin B

Aspergillosis is the most current causative agent of exogenous fungal nosocomial infection. This study was done to evaluate the drug susceptibility of Aspergillus flavus and A.fumigatus to itraconazole and amphotericin B. This Laboratory study was done on 25 Aspergillus fumigatus and 25 Aspergillus flavus species isolated from transplant's patients. Drug susceptibility test was done according to NCCLS M38-P document. Fungal suspensions of mentioned fungi were supplied with ranges 0.5-5x10[4] by spectrophotometer at 530 nm. Serial dilutions of drugs were supplied from 0.03125 to 16 microg/ml and MICs determined following 48h incubation at 35C. Obtained MICs ranges for Aspergillus fumigatus and Aspergillus flavus were 1-4 microg/ml and 0.5-4 micro g/ml for itraconazole, respectively while MICs ranges against Aspergillus fumigatus and Aspergillus flavus were 0.5-2 micro g/ml and 0.25-2 microg/ml for amphotericin B, respectively. Amphotericin B MICs were significantly lower than itraconazole [P<0.05]. Aspergillus flavus and A.fumigatus were susceptible to amphotericin B and itraconazole

Efficacy of ultraviolet radiation on drug susceptibility of Candida Spp. to itraconazole, fluconazole and amphotericin B

Ultraviolet [UV] radiation is an important disinfectant. Fungal infections with resistant isolates in patients culminate in recurrence of disease even with worse condition. This study was done to evaluate the efficacy of ultraviolet radiation on drug susceptibility of Candida Spp. To itraconazole, fluconazole and amphotericin B. This laboratory study was done on 12 Candida spp. isolated from patients according to NCCLS M27- A method. Samples were suspended with sterile saline and optical density was read by spectrophotometer at the wavelength of 530 nm. Serial dilutions [0.0313-16 microg/ml] and [0.0313-128 microg/ml] were supplied for itraconazole, amphotericin and fluconazole, respectively. MICs were determined after 48h incubation at 35°C. Following UV radiation for 1, 2, 5, 10, 60, 90 and 120 seconds MICs were determined, subsequently. The highest MIC pre UV radiation was [>128 microg/ml] for fluconazole. After UV radiation, MICs were steadily decreased for all mentioned drugs while after 10 sec, MICs of itraconazole and amphotericin B were >0.0313 microg/ml. Secondary MICs significantly decreased with respect to MICs obtained in pre UV radiation [P<0.05]. UV radiation reduces MICs of Candida spp. to itraconazole, fluconazole, amphotericin B

Effect of adding soymilk on physicochemical, microbial, and sensory characteristics of probiotic fermented milk containing Lactobacillus acidophilus

The aim of the present study was to investigate the effect of addition of soymilk on physicochemical, microbial, and sensory characteristics of milk fermented with Lactobacillus acidophilus. Soybeans were blended 1:5 w/v with distilled water. The prepared soymilk was added to milk in combinations of 20%, 40%, and 60%. Milk was used as the control. All the samples were sterilized and fermented with Lactobacillus acidophilus LA-5 as probiotics. Then, they were kept at C for 14 days. Microbial count, titratable acidity, pH, syneresis, color parameters and sensory evaluation were performed during the storage time. Results showed that all the samples possessed minimum effective dose of LA-5 on day 14, although a significant decrease in LA-5 was observed in the sample with 60% soymilk. In each experimental day, there was a noticeable decrease in the pH of the samples. Addition of soymilk to milk also significantly increased syneresis, particularly in samples with 60% soymilk. Sensory evaluations showed that scores of texture, mouth sense, aroma, and flavor of the samples with 40% and 60% soymilk were significantly lower than other samples. With respect to color, "L" value decreased significantly in the fermented product with 60% soymilk and the decrease was more pronounced with longer storage times. In conclusion, addition of 20% soymilk did not substantially alter physicochemical and sensory characteristics of milk while providing an appropriate growth culture for LA-5. The mixture of milk-20% soymilk can be introduced as a good probiotic product with lower lactose content and additional nutritional benefits. Key words: Probiotics, Milk, Soymilk, Lactobacillus acidophilus

Antifungal activity of commercial disinfectants: formaldehyde, glutaraldehyde, microten, alcohol 70 and savlonalcohol on isolated saprophytic fungi from hospital environments

Nosocomial infections are one of main causative agents of mortality among hospital patients. This study was done for the determination of efficacy of commercial disinfectants such as: formaldehyde, glutaraldehyde, microten, the alcohol 70 and savlonalcohol on isolated saprophytic fungi from hospital environments. This descriptive study was done on 33 isolated fungi from teaching hospitals of Tehran during 2009-10. The identified samples were randomly chosen. Stock fungal suspensions were supplied from each fungus with cells ranging 0.5-5_10[4] microg/cfu in 1ml with spectrophotometer at the wavelength of 530 nm. For evaluation of antifungal activity of commercial disinfectants formaldehyde, glutaraldehyde, microten, alcohol 70 and savlon-alcohol disinfectants, 0.25cc stock solutions were mixed with 3.75 cc disinfectants solutions and the new diluted samples held at 25c for 15, 30 and 60 min. The culture medium was checked for growth of fungi until 8 weeks. Following specific period isolated fungi were including Aspergillus spp with 39.4%, Penicillium spp with 36.4%, Fusarium spp with 12.1%, Rhizopus with 6.1%, Alternaria and Circinella with 3%. Formaldehyde 8% and glutaraldehyde 8% with activity against 63.6% and 39.3% were effective disinfectants at 15 min. Formaldehyde 8% with activity against 74.8% of fungi, was effective disinfectant at 30 min. Glutaraldehyde 8% and formaldehyde 8% with 100% prevention of growth were effective disinfectants at 60 min. According to this study formaldehyde 8% and glutaraldehyde 8% showed to have the highest antifungal activities. Synergetic fungicidal activity of comenercial disinfectants, dependent on time and concentration

Prevalence of hepatitis C virus genotypes in Mashhad, Northeast Iran

Hepatitis C is a disease with significant global impact. The distribution of hepatitis C virus [HCV] genotypes in Mashhad [the Northeast and the biggest city after the capital of Iran] is unknown. The purpose of this study was to determine the prevalence of HCV genotypes among HCV seropositive patients, and to study the relationship between types, virologic and demographic features of patients in Mashhad. Three hundred and eighty-two clinical specimens obtained from HCV-infected patients referred to Ghaem Hospital in Mashhad during a period of 2009 to 2010 were selected. HCV genotype was determined by Nested PCR amplification of HCV core gene using genotype specific primers. Totally, 299 patients were male [79.9%]. The most common HCV genotype was genotype 3a, with 150 [40%] of subjects. Genotype 1a was the other frequent genotype, with 147[39.2%] subjects. Frequency of genotypes for 1b, 5 and 2 was 41[10.9%], 13[3.4%] and 9[2.4%], respectively. Mix genotype including 1a+1b in 4 [1.04%], 1a+3a in 3 [0.8%] was found in 7 patients. Four percent out of these samples had an undetermined genotype. Among the hemophilia patient, there were 13[48.1%] genotypes as 1a, 3[11.1%] 1b and 10[37%] 3a, respectively. The dominant HCV genotype among patients living in Mashhad was 3a. This study gives added evidence of the predominant HCV genotypes in Iran

[Fungus paranasal sinusitis in non-immunocompromised patients in Tehran, Iran [2006-07]]

Incidence of fungal infections particularly fungal sinusitis is increasing in Iran and identification of causative agents is essential for its control and treatment. This study was carried out to determine the fungus paranasal sinusitis in non-immuno-compromised patients in Tehran, Iran. This cross-sectional study was done on 108 patients [73 males, 35 females] with chronic sinusitis ranged from 9 to 68 years, admitted to Amir Alam and Emam Khomeini hospitals in Tehran, Iran during 2006-07. Sinusitis in patients confirmed by radiologic images. Complementry information were obtained using questionnaires which including gender, job, presence of disposing disease diabetes and consumption immunocompromised drugs. Sinus samples were collected by washing and biopsy were carried out by two methods of fenestration and Cald-wel luc operations. Subsequently they were cultured on Sabouraud dextrose agar [SDA], SDA+chloramphenicol and blood agar [BA] media at 30 C and 37 C. Direct examination and fixative sample for histhologic evaluation was done and for colonies confirmation the slide culture method also was used. 8 cases [7.4%] were positive for fungal sinusitis with following sub type: 6 cases [Alternaria Spp], 1 case [Paecilomyces] and 1 case [Aspergillus flavus]. The most fungal sinusitis [5 cases] were observed in 30-39 years patients. Considering the prevalence of 7.4% fungal sinusitis and isolation of paecilomyces which is a rare subtype complematry investigation is recommended, in the field of research

Molecular study of coagulation factor XIII-A among patients with inherited factor XIII-A deficiency

Factor X[1] is the last enzyme in the clotting cascade. The gene of A chain is located on chromosome 6. Deficiency of factor XIII in autosomal recessive conditions occurs at a frequency of 1 in 2 million general population. The aim of this study was to detect the mutations of subunit A in both patients and carriers. In this study we have investigated the molecular basis of inherited FXIII deficiency among patients from 21 unrelated Iranian families. Mutation were detected by amplifying each exon. Those exons exhibiting the presence of hetero duplex formation sensitive gel electrophoresis, were selected for direct sequencing. After sequencing, detected mutation was carried out by restriction fragment length polymorphism [RFLP]. All patients having entered the study had mutations. Twelve patients had homologues substitution of TGG->CGG in exon 4, 1 insertion mutation occurring in exon 7 triple G, 2 patients demonstrated mutation exon 9 ATG-> AAG, 3 patients had substitution of CGG-> CAG in exon 10, and 3 patients showed a homologue subsituation mutation in exon 15 GCC->GTC. Our findings suggest that the activity of enzyme is highly dependent on the core domain. Changes in charge, amino acid tail and conformation lead to decreased enzyme activity. Also tetrameric structure is calcium related. It seems that changes of amino acid sequence convert enzyme stability

[ effect of glucose and glutamine supplementation on some serum growth factors in non-athlete males during four weeks exhausting endurance-intermittent training]

The aim of the present study was to investigate the effect of glucose and glutamine supplementation on two serum growth factors, GH and IGF-I, in non-athlete males during four weeks of exhaustive endurance - intermittent training that causes glycogen depletion. 20 non-athlete healthy males were selected and randomly assigned into four groups including: glucose supplementation with glycogen depletion training group [n=5, supplement 1], glutamine supplementation with glycogen depletion training group [n=5, supplement 2], glycogen depletion training group [n=5, placebo], and a group without any treatment [n=5, control]. The blood samples were collected at the onset of the training protocol, and 48 hours after final training session from anticubital venous. Serum GH and IGF-I concentration were determined by ELISA technique. The main and interaction effects of variables were determined using TWO WAY ANOVA compeleted with Tukey post-hoc test. The significant level was chosen as alpha =0.05. The results showed the significant effect of training variable for serum IGF-I concentration, [p<0.01]. Post-hoc test showed the significant difference between supplement 1 with control groups [p<0.01], and placebo with control [p<0.01]. The effect of training variable was not significant for serum GH concentration. In addation, the effect of supplementation variable was not significant neither for serum IGF-I, nor serum GH concentration. Also, the interaction effect between the two variables was not significant. The results suggested that glucose or glutamine supplementation does not have significant effects on serum GH and IGF-I concentration after four weeks, but four weeks glycogen depletion training causes an increase on the serum IGF-I

[Pattern of physical activity and the promoters among adolescent girls of Isfahan]

Technology development has brought about the society with a sedentary life style and an increase in number of chronic diseases. Therefore, to change the pattern of physical activity in adolescents, the recognition of factors affecting such activities is of crucial importance. The aim of this research was to investigate the relationship between the pattern of physical activity in adolescent girls and their mothers' physical activities, attitudes, and some demographic characteristics. This cross-sectional stud was carried out on adolescents 226 girls aged 11-18 years in 2010. The study population was chosen using a cluster sampling method. Data were collected using a questionnaire of three sections including demographic data, adolescent's physical activity pattern, and attitude and pattern of physical activity in mother. Data were analyzed using chi-square test and Pearson correlation coefficient. Of 226 girls, 50% found to have 2.07 hours of moderate to strong physical activity while 26.5% with a sedentary life style. A significant relationship between the adolescents' physical activity pattern and the mother's physical activity and regular exercise was demonstrated [p<0.005]. Also, there was a significant relationship between the adolescents' regular exercise and the mothers' exercise. Statistically, a significant correlation between the mothers' attitude and educational degree and the level of physical activity was shown. According to our results, a sedentary life style among female adolescents is higher than expected which is associated with mother's pattern of physical activity and affected by the attitude and educational level of mothers. Therefore, it is recommended that part of the educational programs to increase the level of daily physical activity in adolescent girls to be focused on mothers

[Detection of drug resistance gene in trichomonas vaginalis by PCR]

Trichomoniasis is a worldwide protozoan parasitic disease. Considering the importance of the disease in public health and the controversial ideas about the prevalence of drug resistance, this study was designed to determine the prevalence of metronidazole resistance gene in trichomonas vaginalis [T. vaginalis] with PCR-RFLP method in Tehran and in Kashan. In this descriptive study 140 samples of T. vaginalis in patients with T. vaginalis infections were collected and assessed microscopically. Then they were isolated and examined by culturing in dorset's medium, DNA extraction and PCR amplification. The PCR products were analyzed using RFLP and suspected samples were sequenced. All but 7 samples were T. vaginalis positive by PCR. Sixty-two samples [44.4%] were examined by microscopic, culture and PCR techniques; 12 samples [8.5%] by microscope and PCR, 56 samples [40%] by culture and PCR and other 3 samples [2.1%] were positive only by PCR. Two samples [1.5%] were also examined for detection of mutation in 18S rRNA gene with RFLP in Tehran. This study shows that T. vaginalis infections in the female population living in Tehran are metronidazole-resistant. Since metronidazole is considered as the drug choice for T. vaginalis infections, more studies are recommended for identification of the drug resistance mechanisms and prevention of the disease

[Determination of slimness, low weight and low growth rates in rural and urban schoolboys in Golpayegan]

Malnutrition is one of the causative agents of death in children. So, this study was done for assessment of anthropometric indices of students and malnutrition status in Golpayegan, Iran. This research was done as a descriptive - analytical [inferential] study. Sampling was done as clusters and multistage. In order to collect data, the standard questionnaire of anthropometric indicators standards [ANIS] pattern was used. Low and low height was used based on Z score. Collected data was analyzed by Epi-info and SPSS software. Of 1062 schoolboys, 550 were male and 512 were female. Anthropometric indicators including age [month], weight [kg] and height [Cm] showed significant differences [P < 0.05]. The mean of malnutrition index was 5.4% [WAZ<-2] and 3% [WAZ<-2] in our study. The significant difference between prevalence of slimness, low weighting and low growth in rural and urban Schoolboys is an indicator of the undesirable situation in rural areas. Therefore, nutritional planning should be considered in rural children

[Congenial insensitivity to pain with anhydroses [CIPA]: a case report]

Introduction: Autonomic neuropathy is a rare disorder inherited as insensitivity to pain and temperature. It has been divided into five groups, the fourth of which named congenital insensitivity to pain with anhydrosis, [CIPA] is the most common type of this disorder. CIPA is a recessive inherited condition with courses of idiopathic fever, reduction of sweat glands secretion despite having normal glands, insensitivity to pain and temperature changes, and mild mental retardation. Oral symptoms due to their severe abuse in these patients are considerable. Gas shock tongue, lips and other oral mucosa have been reported

Case Report: Examination of a 15 month old boy revealed severe oral ulcers and burns in the fingers of both hands due to contact with the heater. Pathological studies and special attention to specific aspects of the patient revelead that he was insensitive to pain and thermal stimulation and was diagnosed as a possible case of CIPA

Conclusion: CIPA is a autosomal recessive disorder which is very rare in childhood, as insensitivity to pain or the incidence of abuse and lack of objective response to pain in people with peripheral and central nervous system are normal. Tyrosine gene defect related to gene code provided membrane tyrosine has been identified in these patients. Mutation in this gene results in insensitivity to pain, anhydrosis, self abuse, and mental retardation and is associated with cancer. More than half of the patients die before the age of three. Oral manifestations of this syndrome are the characteristics of the disorder and can help to make an early diagnosis

Poultry diseases in Iran: an epidemiological study on different causes of mortality in broilers

Understanding the distributions of poultry diseases will help planning for disease control and prevention more effectively. Studies on poultry diseases in Iran are scarce. We investigated the incidence of mortality in broiler chicken flocks in Iran as part of a national project. Specifically, documents from September 2004 to November 2005 related to the mortality of broilers that were covered by the national insurance scheme were analyzed retrospectively. Of the 439,188,406 broiler chickens that were covered by insurance services, 188,680,459 chickens were exposed to different diseases. The most common diseases [in descending order] were infectious bursal disease [IBD], infectious bronchitis [IB], chronic respiratory disease [CRD], colibacillosis and avian influenza [AI; subtype H9N2]. The mean mortality rate in broilers was 7.89%. Mortality rates were higher during chicks between the third to sixth weeks of age. AI [H9N2] produced the highest mean mortality rate of 26.1%, followed by IB with a mean mortality rate of 22.1%. Most of the mortalities were recorded from the southern provinces of Iran. The distributions of diseases were differed in different regions which could be related to regional conditions and management parameters