Are chest X-rays valuable for patients presenting to emergency departments with acute abdominal pain?

BACKGROUND: Emergency department patients presenting with acute abdominal pain are often prescribed a chest X-ray; however, the value of chest X-rays in acute abdominal pain is poorly understood. The aim of this study was to assess the value of chest X-rays in acute abdominal pain. METHODS: A retrospective analysis of 944 chest X-rays performed for acute abdominal pain was conducted. Patient clinical information, radiology reports, and findings of other diagnostic investigations were also collected. MedCal® software was used to calculate diagnostic performance of chest X-rays. A Chi-Square test was used to assess the association between positive chest X-ray findings and both age and gender. RESULTS: Of the 944 chest X-rays identified as satisfying inclusion factors, only 10 cases (approximately 1%) demonstrated pathology that was likely to be the cause of the abdominal pain. Further analysis demonstrated the following performance metrics at 95%CI: sensitivity (12.8; 8.78-17.72); specificity (100; 98.4-100); positive predictive value (100%); negative predictive value (52.76; 51.54-53.98); accuracy (55.82; 51.17-60.40). CONCLUSION: Chest X-ray has limited sensitivity and diagnostic value in patients presenting to the emergency department with abdominal pain and does not appear to be a useful diagnostic investigation for abdominal pain.

Effect of climate change on spatial distribution of scorpions of significant public health importance in Iran

Objective: To establish a spatial geo-database for scorpions in Iran, and to identify the suitable ecological niches for the most dangerous scorpion species under different climate change scenarios. Methods: The spatial distribution of six poisonous scorpion species of Iran were modeled: Hemiscorpius lepturus, Androctonus crassicauda, Mesobuthus eupeus, Hottentotta saulcyi, Hottentotta zagrosensis, and Odontobuthus (O.) doriae, under RCP2.6 and RCP8.5 climate change scenarios. The MaxEnt ecological niche model was used to predict climate suitability for these scorpion species in the 2030s and 2050s, and the data were compared with environmental suitability under the current bioclimatic data. Results: A total of 73 species and subspecies of scorpions belonging to 19 genera in Iran were recorded. Khuzestan Province has the highest species diversity with 34 species and subspecies. The most poisonous scorpion species of Iran are scattered in the semi-arid climates, at an altitudinal range between 11 m and 2 954 m above sea level. It is projected that O. doriae, Androctonus crassicauda and Mesobuthus eupeus species would be widely distributed in most parts of the country, whereas the most suitable ecological niches for the other species would be limited to the west and/or southwestern part of Iran. Conclusions: Although the environmental suitability for all the species would change under the two climate change scenarios, the change would be more significant for O. doriae under RCP8.5 in the 2050s. These findings can be used as basis for future studies in the areas with the highest environmental suitability for the most dangerous scorpion species to fill the gaps in the ecology of scorpion species in these areas.

Climate change and potential distribution of zoonotic cutaneous leishmaniasis in Central Iran: Horizon 2030 and 2050

Objective: To investigate and predict the effects of climate change on the potential distribution of the main vector and reservoir hosts of the disease in Yazd province in the future. Methods: Distribution data for vector and reservoir hosts of zoonotic cutaneous leishmaniasis in Yazd province were obtained from earlier studies conducted in the area. MaxEnt ecological niche modeling was used to predict environmental suitability. BCC-CSM1-1(m) model and two climate change scenarios, RCP 4.5 and RCP 8.5 were used for horizons 2030 and 2050 climate projections. Future projections were based on data of a regional climate change model. Results: With both scenarios in 2030 and 2050, the results of jackknife test indicated that the mean temperature of wettest quarter and temperature annual range had the greatest effect on the model for the vector and the reservoir hosts, respectively. Conclusions: The climate conditions are the major determinants of zoonotic cutaneous leishmaniasis incidence rate in Yazd Province. These climate conditions provide favorable habitats for ease transmission of zoonotic cutaneous leishmaniasis in this endemic area. Habitats suitability for the vector and reservoir will be expanding in the coming years compared with the current conditions, such that, in horizon 2030 & 2050, the probability of the presence of the vector and reservoir within 38 580 and 37 949 km

Resistance status of main malaria vector, Anopheles stephensi Liston (Diptera: Culicidae) to insecticides in a malaria Endemic Area, Southern Iran

Objective: To evaluate the susceptibility of Anopheles stephensi (An. stephensi) Liston, the main malaria vector in southern Iran, to WHO recommended insecticides. Methods: Larvae of An. stephensi were collected from three different larval habitats in both urban and rural area of Bandar Abbas city and one rural area in Rudan county southern Iran. WHO standard method was used for evaluation of adult and larval mosquito susceptibility. Bendiocarb, permethrin, lambda-cyhalothrin, deltamethrin as insecticide and temephos and chlorpyriphos as larvicide were used at the diagnostic dosages recommended by WHO. Results: Findings of this study showed all larval populations of An. stephensi were completely susceptible to temephos and candidate for resistance to chlorpyriphos. Adult mosquitoes in rural areas of Bandar Abbas city were resistant to pyrethroid and carbamate insecticides. Conclusion: Comparison of the results of this survey with previous studies indicates that the resistance to pyrethroids and carbamates in this malaria endemic region is increasing. Wide use of pesticides in agriculture is certainly effective in increasing resistance. The inter-sectoral coordination and collaboration in health and agriculture seem to be necessary to manage insecticide resistance in malaria vectors.

Seasonal Activity of Adult Mosquitoes (Diptera: Culicidae) in a Focus of Dirofilariasis and West Nile Infection in Northern Iran.

BACKGROUND: Mosquito-borne arboviruses such as West Nile, dengue, Rift Valley fever, and Sindbis viruses and the nematode Dirofilaria are reported in Iran, but there is little information on the seasonal activity of their vectors in the country. We aimed to determine the seasonal activity of adult mosquitoes (Diptera: Culicidae) in a focus of dirofilariasis and West Nile infection in Guilan Province, northern Iran. METHODS: Collections were carried out using light traps in seven counties at least two times from random sites and every two weeks from a fixed site (Pareh Village, Rudbar County) during Aug-Dec 2015 and Apr-Oct 2016. RESULTS: Overall, 16327 adult mosquitoes comprising 18 species representing seven genera were identified. The most prevalent species were Cx. theileri (23.59%), Cx. tritaeniorhynchus (20.75%), Cx. pipiens (19.37%), Ae. vexans (18.18%), An. pseudopictus (10.92%) and An. maculipennis s.l. (5.48%). Aedes pulcritarsis and Cx. perexiguus were found for the first time in Guilan Province. The active season of adult mosquitoes extended from early May to early Oct in the fixed site. There was no significant regression between the abundance of adult mosquitoes and the meteorological data during active season in the fixed site (P> 0.05, R2= 0.31). CONCLUSION: Though no significant regression between the abundance of mosquitoes and the meteorological data was observed during active season, temperature and rice fields had a great influence in starting and ending active season in the region.

Spatial distribution of sand flies (Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Northwest of Iran

Objective: To determine spatial distribution of sand flies (Diptera: Psychodidae; Larroussius group), the vectors of visceral leishmaniasis in Ardabil province, Northwest of Iran. Methods: Sand flies were collected using sticky traps from the 30 selected points in Ardabil province, during May-November 2017. The MaxEnt model in GIS software was used for modeling. Results: A total of 2 794 specimens of sand flies were collected, of which 33% were Larroussius subgenus sand flies. Phlebotomus kandelakii and Phlebotomus wenyoni were the highest and lowest collected species respectively. Based on the modeling, four areas in the province were identified with more than 70% probability of the presence of Larroussius group vectors which were at risk of visceral leishmaniasis disease transmission. Conclusions: The distribution of Larroussius subgenus sand flies was observed in all parts of Ardabil. But the northern parts of the province (Germi and Bilesavar counties) as well as central part (Ardabil and Meshkinshahr counties) were of great importance in terms of the presence of Larroussius subgenus sand flies and the possibility of transmission of the visceral leishmaniasis.

Distribution and ecological aspects of sand flies (Diptera: Psychodidae) species in Northeastern Iran

Objective: To determine both the distribution and the ecological characteristics of sand flies in Golestan Province, northeast of Iran in 2016. Methods: In this study, 34 villages were selected based on their geographical conditions. Sticky paper traps were used for collecting the sand flies. Sampling was carried out in each of villages from May to November. In each village, 60 traps for indoors and 60 for outdoors were monthly installed. The species of all collected sand flies were determined using approved morphological keys. Pearson coefficient correlation was used to find the relationship between the number of collected Phlebotomus papatasi from different villages and incidence rate of zoonotic cutaneous leishmaniasis as well as the number of positive cases of the disease. The altitude of the studied villages was extracted from digital elevation model of the area using GIS and vegetation cover density index of the province was extracted from Modis satellite imagery and distribution map of sand flies drown up. Results: Overall, 5 428 sand flies were collected and identified, belonging to 18 species. Phlebotomus wenyoni was reported for the first time from the area in this study. The frequency of sand flies in the villages located in northeast of the Golestan province (the plateau area, lower altitude, arid and semi-arid climates, and lower vegetation cover density), were more than other villages in this province. There was a significant correlation between the number of collected Phlebotomus papatasi and incidence rate of the zoonotic cutaneous leishmaniasis cases in different villages (r=0.837, P=0.019) as well as the number of positive cases of the disease (r=0.688, P<0.001). Conclusions: In the northeaster areas of Golestan Province which is known as the endemic foci of zoonotic cutaneous leishmaniasis, the abundance of sand flies were more and the conditions for their growth and development were more appropriate.

Situation analysis of cutaneous leishmaniasis in an endemic area, south of Iran

OBJECTIVE@#To update current situation of the cutaneous leishmaniasis (CL) in Kazerun County, southwest of Iran and to analyse the epidemiological aspects of the disease during 2005-2015.@*METHODS@#Data on CL were obtained from the Health Center of Kazerun County, and then were analysed and mapped using SPSS and Arc GIS 10.3.@*RESULTS@#A total of 700 cases of CL were recorded during the study period with an overall decreasing trend from 2005 to 2015. More than 60% of the patients were inhabitants of rural areas and males were infected more than females. Although there was not a significant difference between gender, job categories, residence and CL infection (P > 0.05), age groups were significantly different (P  0.05). Most of the acute lesions were found to be present on the hand, leg and face, respectively. The average CL incidence in the study area was calculated as 24.9/100000 population. A hot spot for the disease was found in southern part of the area (P < 0.05).@*CONCLUSIONS@#This study revealed that CL is present in Kazerun country. Thus, effective monitoring and sustained surveillance system is crucial in counteracting the disease, and if possible, to eliminate it.

Situation analysis of cutaneous leishmaniasis in an endemic area, south of Iran

Objective To update current situation of the cutaneous leishmaniasis (CL) in Kazerun County, southwest of Iran and to analyse the epidemiological aspects of the disease during 2005–2015. Methods Data on CL were obtained from the Health Center of Kazerun County, and then were analysed and mapped using SPSS and Arc GIS 10.3. Results A total of 700 cases of CL were recorded during the study period with an overall decreasing trend from 2005 to 2015. More than 60% of the patients were inhabitants of rural areas and males were infected more than females. Although there was not a significant difference between gender, job categories, residence and CL infection (P > 0.05), age groups were significantly different (P  0.05). Most of the acute lesions were found to be present on the hand, leg and face, respectively. The average CL incidence in the study area was calculated as 24.9/100 000 population. A hot spot for the disease was found in southern part of the area (P < 0.05). Conclusions This study revealed that CL is present in Kazerun country. Thus, effective monitoring and sustained surveillance system is crucial in counteracting the disease, and if possible, to eliminate it.

Bio-ecology of malaria vectors in an endemic area, Southeast of Iran

OBJECTIVE@#To determine some bio-ecological aspects of malaria vectors in Jask County, where is targeted for malaria elimination in the national program.@*METHODS@#Mosquitoes were collected monthly during 2013-2014 using different collection methods. Subsequently, ELISA test was used to detect the human blood index of mosquitoes. The susceptibility status of Anopheles stephensi was evaluated against the diagnostic dosages of seven WHO recommended insecticides.@*RESULTS@#A total of 3650 female and 4736 Anopheles larvae were collected including Anopheles stephensi, Anopheles culicifacies s.l., Anopheles dthali, Anopheles fluviatilis s.l., Anopheles moghulensis and Anopheles turkhodi species. Anopheles stephensi was the dominant collected species on human baits and indoors with high rate of unfed and gravid specimens in internal and external window traps. Human blood index was calculated as 14.3% for this species. It was also found to be resistant to DDT and Dieldrin.@*CONCLUSIONS@#The collected species had a wide range of habitats, and resting behaviors. With regarding to the presence of most important malaria vectors in Jask, control of the disease may be so complicated; as based on the weather condition it can be transmitted during the whole year, expect for cold months. With this strong potential of transmission, existing population movements in the area may lead to imported cases of malaria and local outbreak(s). So, more specific studies on malaria vectors in high risk areas of Jask County are recommended.

Fauna and some biological characteristics of Anopheles mosquitoes (Diptera: Culicidae) in Kalaleh County, Golestan Province, northeast of Iran

Objective To determine fauna and some ecological aspects of Anopheles mosquitoes in northeast of Iran. Methods In this descriptive study, 3 villages in Kalaleh County were selected in different geographical zones. Anopheles mosquitoes were collected biweekly from May to October using standard dipping method for larvae, and hand catch, total catch, artificial pit shelter as well as night-biting collections on human and animal baits for adults. Results Totally 399 larvae and 2 602 adults of Anopheles mosquitoes were collected and identified as 2 species: Anopheles superpictus s.l. (An. superpictus s.l.) and Anopheles maculipennis s.l. The dominant species was An. superpictus s.l. (92.1%). Activity of these mosquitoes found to be started from middle of May and extended till September with two peaks of activity in July and August. Conclusions An. superpictus s.l. as one of the main malaria vectors in Iran as well as some other parts of the world is the dominant species in the study area. This species has high potential for transmission and possibility of establishing a transmission cycle with low abundance. Other species, Anopheles maculipennis s.l. also has introduced as a malaria vector in northern parts of Iran. As this Anopheles is a complex species, genetic studies are recommended to determine the members of this complex in the study area.

Knowledge, attitude and practice of healthcare workers concerning Crimean-Congo hemorrhagic fever in Western Iran

Objective: To determine the knowledge, attitude and practice of healthcare workers in Kermanshah Province about Crimean-Congo hemorrhagic fever (CCHF). Methods: This study was conducted in 2014 on healthcare personnel in different job categories including physicians, nurses, midwives, laboratory staff and network health staff of Kermanshah Province by direct interview. Results: A total of 367 respondents who had more than 5 years of experience in their jobs were interviewed. Among them 91% of physicians and nurses, 97% of midwives and health workers and 96% of laboratory staff stated that they had not been confronted with CCHF patients so far. Regarding knowledge, 76% of physicians, 78% of nurses, 77% of midwives and 58% of laboratory staff believed that the disease is remediable. Most of the interviewed participants stated that the disease pertains to people who are in close contact with domestic animals, but they did not consider their own occupations as one of the risk factors. More than 70% of the respondents believed that the disease may exist in the province or their work field. Generally, the knowledge about CCHF was inadequate, with nurses having the lowest level of knowledge. Conclusions: Knowledge of Kermanshah healthcare staff about CCHF was poor, especially nurses in a high risk job category. Therefore, it is necessary to conduct specific training programs for the disease identification, transmission, prevention, and treatment as well as the use of personal protection and safety devices.

Bio-ecology of malaria vectors in an endemic area, Southeast of Iran

Objective: To determine some bio-ecological aspects of malaria vectors in Jask County, where is targeted for malaria elimination in the national program. Methods: Mosquitoes were collected monthly during 2013-2014 using different collection methods. Subsequently, ELISA test was used to detect the human blood index of mosquitoes. The susceptibility status of Anopheles stephensi was evaluated against the diagnostic dosages of seven WHO recommended insecticides. Results: A total of 3. 650 female and 4. 736 Anopheles larvae were collected including Anopheles stephensi, Anopheles culicifacies s.l., Anopheles dthali, Anopheles fluviatilis s.l., Anopheles moghulensis and Anopheles turkhodi species. Anopheles stephensi was the dominant collected species on human baits and indoors with high rate of unfed and gravid specimens in internal and external window traps. Human blood index was calculated as 14.3% for this species. It was also found to be resistant to DDT and Dieldrin. Conclusions: The collected species had a wide range of habitats, and resting behaviors. With regarding to the presence of most important malaria vectors in Jask, control of the disease may be so complicated; as based on the weather condition it can be transmitted during the whole year, expect for cold months. With this strong potential of transmission, existing population movements in the area may lead to imported cases of malaria and local outbreak(s). So, more specific studies on malaria vectors in high risk areas of Jask County are recommended.

Molecular characterization, biological forms and sporozoite rate of Anopheles stephensi in southern Iran

<p><b>OBJECTIVE</b>To identify the biological forms, sporozoite rate and molecular characterization of the Anopheles stephensi (An. stephensi) in Hormozgan and Sistan-Baluchistan provinces, the most important malarious areas in Iran.</p><p><b>METHODS</b>Wild live An. stephensi samples were collected from different malarious areas in southern Iran. The biological forms were identified based on number of egg-ridges. Molecular characterization of biological forms was verified by analysis of the mitochondrial cytochrome oxidase subunit I and II (mtDNA-COI/COII). The Plasmodium infection was examined in the wild female specimens by species-specific nested-PCR method.</p><p><b>RESULTS</b>Results showed that all three biological forms including mysorensis, intermediate and type are present in the study areas. Molecular investigations revealed no genetic variation between mtDNA COI/COII sequences of the biological forms and no Plasmodium parasites was detected in the collected mosquito samples.</p><p><b>CONCLUSIONS</b>Presence of three biological forms with identical sequences showed that the known biological forms belong to a single taxon and the various vectorial capacities reported for these forms are more likely corresponded to other epidemiological factors than to the morphotype of the populations. Lack of malaria parasite infection in An. stephensi, the most important vector of malaria, may be partly due to the success and achievement of ongoing active malaria control program in the region.</p>

Environmental characteristics of anopheline mosquito larval habitats in a malaria endemic area in Iran

OBJECTIVE@#To determine the effects of environmental parameters of larval habitats on distribution and abundance of anopheline mosquitoes in Rudan county of Iran.@*METHODS@#This cross-sectional study was conducted during the mosquito breeding season from February 2010 to October 2011. The anopheline larvae were collected using the standard dipping method. The specimens were identified using a morphological-based key. Simultaneously with larval collection, environmental parameters of the larval habitats including water current and turbidity, sunlight situation, and substrate type of habitats were recorded. Water samples were taken from breeding sites during larval collection. Before collection of samples, the water temperature was measured. The water samples were analysed for turbidity, conductivity, total alkalinity, total dissolved solid, pH and ions including chloride, sulphate, calcium, and magnesium. Statistical correlation analysis and ANOVA test were used to analyze the association between environmental parameters and larval mosquito abundance.@*RESULTS@#In total 2 973 larvae of the genus Anopheles were collected from 25 larval habitats and identified using morphological characters. They comprised of six species: An. dthali (53.21%), An. stephensi (24.22%), An. culicifacies (14.06%), An. superpictus (4.07%), An. turkhudi (3.30%), and An. apoci (1.14%). The most abundant species was An. dthali which were collected from all of the study areas. Larvae of two malaria vectors, An. dthali and An. stephensi, co-existed and collected in a wide range of habitats with different physico-chemical parameters. The most common larval habitats were man-made sites such as sand mining pools with clean and still water. The anopheline mosquitoes also preferred permanent habitats in sunlight with sandy substrates. The results indicated that there was a significant relationship between mean physico-chemical parameters such as water temperature, conductivity, total alkalinity, sulphate, chloride, and mosquito distribution and abundance.@*CONCLUSIONS@#The results of this study showed a correlation between certain environmental parameters and mosquito larvae abundance, and these parameters should be considered in planning and implementing larval control programs.

Indication of pyrethroid resistance in the main malaria vector, Anopheles stephensi from Iran

OBJECTIVE@#To investigate insecticide resistance in target species for better insecticide resistance management in malaria control programs.@*METHODS@#The status of insecticide resistance to different imagicides in Anopheles stephensi (An. stephensi) including DDT 4%, lambdacyhalothrin 0.50%, deltamethrin 0.05%, permethrin 0.75%, cyfluthrin 0.15% and etofenprox 0.50% was performed according to WHO standard method.@*RESULTS@#The mortality rate to lambdacyhalothrin, permethrin, cyfluthrin, deltamethrin, etofenprox and DDT was (88.0 ± 3.2), (92.0 ± 2.7), (52.0 ± 5.0), (96.0 ± 2.2), (90.0 ± 3.0) and (41.0 ± 5.7) percent, respectively at diagnostic dose for one hour exposure time followed by 24 h recovery period.@*CONCLUSIONS@#These results showed first indication of pyrethroid resistance in An. stephensi in a malarious area, from southern Iran. There is widespread, multiple resistances in the country in An. stephensi to organochlorine and some report of tolerance to organophosphate insecticides and recently to pyrethroids. However, results of this paper will provide a clue for monitoring and mapping of insecticide resistance in the main malaria vector for implementation of any vector control.

Demonstration of malaria situation analysis, stratification and planning in Minab District, southern Iran.

OBJECTIVE: To demonstrate malaria situation analysis, stratification and planning for an endemic area in southern Iran. METHODS: Data on health system, population, meteorological parameters, malaria cases, anopheline vectors, and control activities during 2005-2007 was obtained from Minab Health Center, Minab Meteorological Station and published documents about malaria elements in the study area. A datasheet was created in excel 2003 for analysis. RESULTS: There were 644 health staff working in Minab District including 99 health staff in malaria control program. The health facilities are distributed as follow: 1 hospital with 96 beds, 23 health centers including private centers (10 in Minab city and 13 in rural area of Minab District) and 119 health houses in rural areas of Minab District. A nopheles stephensi was the dominant species in Minab District, however, Anopheles dthali, Anopheles superpictus, Anopheles fluviatilis, Anopheles multicolor, Anopheles pulcherrimus and Anopheles turkhudi can also be found in the area. Anopheles stephensi was reported susceptible to malathion, propoxur, primphos-methyl, lambda-cyhalothrin permethrin and deltamethrin, and resistant to DDT and dieldrin in the area. During the study period a total of 10 665 positive cases were reported, mainly due to local transmission (99.6%). Plasmodium vivax was the main causative agent followed by Plasmodium falciparum. There were reports about drug resistance of Plasmodium falciparum in the area. CONCLUSIONS: Using different parameters, Minab was classified into 3 strata. A plan was designed based on described goal, objectives and targets. The approaches of this plan were categorized into: health education, early detection and correct treatment, and vector control. Main constraints of these approaches are population movement between Iran, Pakistan and Afghanistan; vector control challenges at district, inadequate skilled medical staff in malaria case management and weak inter-sectorial coordination for malaria control, especially in urban areas.

Spatio-temporal distribution of malaria vectors (Diptera: Culicidae) across different climatic zones of Iran

Malaria is a main vector-borne public health problem in Iran. The last studies on Iranian mosquitoes show 31 Anopheles species including different sibling species and genotypes, eight of them are reported to play role in malaria transmission. The objective of this study is to provide a reference for malaria vectors of Iran and to map their spatial and temporal distribution in different climatic zones. Shape files of administrative boundaries and climates of Iran were provided by National Cartographic Center. Data on distribution and seasonal activity of malaria vectors were obtained from different sources and a databank in district level was created in Excel 2003, inserted to the shape files and analyzed by ArcGIS 9.2 to provide the maps. Anopheles culicifacies Giles s.l., Anopheles dthali Patton, Anopheles fluviatilis James s.l., Anopheles maculipennis Meigen s.l., Anopheles sacharovi Favre, Anopheles stephensi Liston, and Anopheles superpictus Grassi have been introduced as primary and secondary malaria vectors and Anopheles pulcherrimus Theobald as a suspected vector in Iran. Temporal distribution of anopheline mosquitoes is restricted to April-December in northern Iran, however mosquitoes can be found during the year in southern region. Spatial distribution of malaria vectors is different based on species, thus six of them (except for Anopheles maculipennis s.l. and Anopheles sacharovi) are reported from endemic malarious area in southern and southeastern areas of Iran. The climate of this part is usually warm and humid, which makes it favorable for mosquito rearing and malaria transmission. Correlation between climate conditions and vector distribution can help to predict the potential range of activity for each species and preparedness for malaria epidemics.