Cutaneous leishmaniasis in Bam: a comparative evaluation of pre- and post- earthquake years [1999-2008]

The recent devastating earthquake of December 26 in Bam, 2003 created various risk factors; caused a sharp increase in incidence of anthroponotic cutaneous leishmaniasis [ACL] cases and reached to an epidemic proportion. The objective of this study was to evaluate the status of ACL cases five years before the earthquake compared to the cases occurred five years after the earthquake [1999-2008]. Status of disease was assessed retrospectively for the five years before the earthquake and prospectively for the five years after the earthquake. Identification was confirmed by smear and polymerase chain reaction [PCR]. The mean annual incidence of ACL for the period from 1999 to 2003 was 1.9 per 1000 comparing to post earthquake period, which was 7.6 per 1000. Most of the infection was in individuals of <20 years, more frequently in females before the earthquake, whilst in contrast, there was a progressive rise in the number of cases, significantly in male individuals of >20 years [P< 0.0001] in post earthquake era. The anatomical distribution of lesions considerably changed during the two periods. Most of the cases were limited to three zones within the city prior to the earthquake, whereas it was spread throughout different zones after the earthquake. PCR indicated that the CL was due to Leishmania tropica in the city. The results strongly suggest that in natural disasters such as earthquakes various precipitating factors in favor of disease will be created, which in turn provide a suitable condition for propagation of the vector and the transmission of the parasite

[Evaluation of the cost - effectiveness of cutaneous leishmaniasis treatment after the earthquake in Bam]

Cutaneous leishmaniasis [CL] is a vector - borne disease and at present it is one of the important health problems in tropical and sub - tropical countries including Iran. Due to imposed expenses to the people and government, this study was performed to evaluate the cost - effectiveness of cutaneous leishmaniasis treatment in the years after the earthquake in Bam/Iran. In a descriptive cross-sectional study data about treatment costs CL-patients during 2006-7 were collected. Overall, 100 recovered patients were randomly selected and their treatment costs were analyzed. For 5320 CL patients about 2570 million rials was spend by the government that was equal to per capita cost of 483676 rials. In addition, 1150 million rials were spent by the patients themselves in private clinics which increase the per capita cost to 216320 rials. Overall, 3% of the patients referred to private sectors that had 2 million rials costs and 25% referred to both governmental and private sectors which has led to a per capita cost of 550000 rials. In total, over 90% of the costs were direct and 10% were indirect costs. The per capita treatment cost in this study shows a significant difference with those by other national and international reports. The establishment of CL Treatment Center after the earthquake in bam has reduced the disease costs and provided an efficient, free and easy accessible service for the patients. This experience could be a suitable model to be used nationally as well as globally

[ epidemic of cutaneous leishmaniasis in baft district in Kerman province and its probable causative risk factors]

In Iran, cutaneous leishmaniasis [CL] as a health problem is increasing and presenting two epidemiological forms; Zoonotic CL [ZCL] and anthroponotic CL [ACL]. The objective of the present study was to introduce the CL epidemic in Baft district, Kerman province. This study was conducted in 3 villages; Soltanabad, Vakilabad and Shahmaran as a census between spring and autumn of 1998 in Orzoeihe region, Baft district. Various epidemiological aspects of this epidemic including prevalence and related demographic factors, diagnosis by direct smears, identification of the causative species by immunological and biological methods were determined. Population of the 3 villages was 13721; mean 21.8 +/- 13.9 years, 50.7% males and 49.3% females. The prevalence rate of 12.3% with mean age of 16.3 +/- 12.1 years was infected. Most of the cases were in 10-20 years of age and in Soltanabad [30.6%]. The mean number of lesions was 2.58, majority with >/= 2 lesions, frequently located on the legs and hands. No previous history of CL scar was observed. All 100 IFAT, 30 ELISA tests and 18 inoculated mice showed L.major as the overall causative agent. This is the first epidemic of CL occurred in the southern villages of Baft district with high severity in all age and sex groups in a new agricultural region. Probably the source of infection was the new comers who arrived the region from endemic areas for agricultural purposes and infecting the gerbils. Thus, this new agricultural development has created an extraordinary suitable condition for propagation of rodents and sand fly populations, then the occurrence of the new epidemic in rural residence, consequently

[Frequency of contact dermatitis in patients with chronic dermatitis referring to dermatology clinics in Kerman]

Allergic and irritant compounds are frequent in nature, and the environmental allergic factors which can induce or exacerbate eczema are different and often unknown in different areas. The aim of this study was to determine the frequency of contact dermatitis in patients with chronic dermatitis referring to dermatology clinics in Kerman. In this descriptive study, standard patch test containing 24 allergens was done for 156 cases [56 males and 69 females] with confirmed chronic dermatitis who had been referred to Afzalipoor Hospital Dermatology Clinics. Evaluation of the results was done for every case 24, 48 and 72 hours after application of the patch test. In whole, 153 positive patch tests were seen in 66 [52.8%] cases of 125 patients who had been examined. The most common allergic agent was nickel sulfate detected in 20 [13.1%] patients [17 females and 3 males]. The hypersensitivity reaction to this agent was significantly more common in females than males [P<0.05]. Potassium dichromate with frequency of 11.1% [12 males and 5 females] was the second common allergic agent and males showed significantly more positive reaction to this agent than females [p<0.05]. There was no statistically significant difference according to the age and sex between groups with positive and negative patch test results [P>0.05]. As the causative agents of contact dermatitis are different in various areas, by doing patch test in each area the allergic agents can be detected for more appropriate preventive measures and treatment strategies. In this study, the first and second common allergens were respectively Nickel and Chrome compounds. Thiorum, Cobalt, benzocaine and theazolin compounds were in the third rank

Creatinine, blood urea nitrogen and thyroid hormone levels before and after haemodialysis

A study was carried out on 57 patients with chronic renal failure in a hospital in Kerman city, Islamic Republic of Iran. Blood samples were taken before and after haemodialysis to measure blood urea nitrogen and serum creatinine, triiodothyronine [T3] and thyroxine [T4] levels. Findings revealed that before dialysis T4 in 11 cases and T3 in 29 cases were lower than the normal range, but after haemodialysis only 3 cases for T4 and 15 cases for T3 were lower than normal levels. The remaining cases reverted to normal state. We suggest that a feedback relationship exists between the major end catabolic products [creatinine and blood urea nitrogen] and thyroid hormone serum levels