شکرالله سلمان زاده

In June 2018 , 537 residents of a rural area in Khuzestan Province presented to the regional Comprehensive Health Service Center for gastroenteritis symptoms. This study was designed to determine the extent and cause of the outbreak.

A case-control study was performed after random selection of the case and control groups (80 cases and 88 controls). Clinical and water samples were analyzed for parasitic, bacterial and viral pathogens in local, provincial and national laboratories. Odds ratios with corresponding 95% confidence intervals were used to assess the relationship between disease and exposure.

The odds ratio of rural plumbing water consumption as a risk factor was 3.3 (95% CI: 1.7-6.2). Using in vitro methods, Shigella sonnei was isolated in clinical samples and enterohemorrhagic Escherichia coli and enteropathogenic Escherichia coli were isolated from both clinical samples and water samples taken from the intake basin of water supply facilities.

Consumption of rural plumbing water Since 26 June 2018 as well as the water stored in domestic tanks at certain water-shut-off times is associated with gastroenteritis outbreak. To prevent similar outbreaks, continuous chlorination of drinking water during distribution through rural pipelines should be done. To prevent secondary outbreaks after the epidemic phase, educating and informing people about personal hygiene is essential.

Sulfur dioxide is one of the important pollutants that at the present time cause irreparable damage to environment and human health. The aim of present study was to study and comparison the effects of SO2 on respiratory and cardiovascular deaths in Bushehr city.
This analytical study was conducted in Bushehr city during 2011. In the first stage data were collected from Bushehr department of the environment. The concentration of SO2 was measured by using BUBK portable device. After processing data by EXCEL software, data were converted as input file to the model and health effects of SO2 pollutant were measured by using statistical analysis and the World Health Organization model (Air Q model).
The results showed that concentration of SO2 pollutant with an annual average was 44 µg/m3 in Bushehr city. In the study area, increasing the concentration of sulfur dioxide per 10 µg/m3 than before values increased risk of cardiovascular death (0.8%) and respiratory deaths (1%).
The local comparison results showed that the number of respiratory and cardiac cases death which is attributable to the sulfur dioxide pollutant has been low in Bushehr city health endpoint can result due to continued and this situation could be justified by the low concentration of sulfur dioxide in the air of Bushehr city.

Background and Particulate matter less than 10 microns (PM10) is one of the main pollutants that cause irreparable damage to the environment and human health. The aim of this study was to estimate the health effects of PM10 on human health.
This analytic study was conducted in Bushehr, 2013. PM10 data were obtained from Bushehr Meteorological organization and Department of environment. PM10 concentration was measured by GRIMM. Raw data processing was done in Excel (instruction set correction of averaging and coding), then the impact of meterological parameters was considered and the data was converted into the Air Q model.
The results showed that the annual average concentrations of PM10 in Bushehr was 251.35 µg/m3. Total number of cardiovascular diseases attributed to PM10 was 130 cases. The total cumulative number of respiratory diseases in a year was 346. 52 of which 52% were attributed to PM10 concentration less than 150 µg/m3. In areas studied per 10 µg/m3 increased concentrations of PM10, the risks of cardiovascular death and respiratory deaths increased by1.8% and 2.1%, respectively.
High rates of these two diseases could be due to higher average PM10 or continued days of high PM10 concentration in Bushehr.

The emergency ward at the time of a disaster is the most important ward for providing therapy service to the injured. The purpose of this research study was to study of the effects of increasing the capacity of admission in emergency ward in increasing the rate of patient acceptance at the time of crisis at Razi Educational Hospital, Ahvaz, Iran.
The present interventional study was performed to determine role of the increase of capacity to emergency ward in increase rate of patient acceptance at the time of disaster. After one year a re-evaluation of the capacity of the emergency department was conducted. Data were analyzed using descriptive statistics.
The results of this study showed that the capacity to accept patients was 16 injured in time of disasters at the emergency ward before reform measures. After performing reforms, this capacity increased to 42 patients. The findings also showed that the implementation of appropriate capacity building increased 2.6 times, thus led to increasing the readiness and service delivery in times of crisis and emergency department of the disaster.
Based on the findings, it could be concluded that planning and action to be carried out in hospital emergency departments by the crisis committee increased the admission capacity of the injured during the crisis.

High density of industries and phenomena of dust make Ahvaz as one of the most polluted cities in Iran. The aim of current study was determination of cardiovascular death and hospital admissions respiratory disease of particulate matter less than 10 microns (PM10) on human health in Ahvaz, during 2010-2012. This descriptive study was conducted in Ahvaz, during 2010-2012. Pollutant concentrations of PM10 were measured by using GRIMM. Evaluation the effects attributed to PM10 on health was used by statistical analysis and the World Health Organization model (Air Q model). The findings showed that, the total cumulative number of cardiovascular death which can be attributed to exposure with PM10 during 2010-2012 were 714, 898 and 1055 persons, respectively. Also, based on results cumulative number of Hospital Admissions Respiratory Disease which can be attributed to exposure with PM10 during 2010-2012 were equal 2028, 2277 and 2675 persons. The high number of cardiovascular deaths and hospital admissions respiratory disease can be result of dust phenomenon, higher average and continued days with high PM10 concentration in Ahvaz.

Statistical-epidemiological models are mostly used to determine the health effects. These models combine the air quality data at intervals of concentrations with epidemiological parameters such as relative risk, baseline incidence and attributable proportion and display the results as morbidity and mortality. The purpose of this study was to evaluate the cardiovascular and respiratory deaths attributed to sulfur dioxide in Kermanshah, Iran. This analytical study was conducted in Kermanshah in 2011. First, SO2 data were obtained from Kermanshah department of environment and meteorology organization. Then, after processing by EXCEL software, the data were converted into input file to the Air Q model, and health effects were evaluated. The results of this study showed that the annual mean of SO2 concentration in Kermanshah was 103 µg/m3. According to the research findings, the total cumulative number of cardiovascular and respiratory deaths attributed to exposure to SO2 was 295 and a total of 48 persons died due to respiratory diseases. The high rate of deaths due to cardiovascular and respiratory diseases can be attributed to high concentration of SO2 or perhaps continued high-concentration days in Kermanshah city.

According to the estimates of W.H.O., approximately 150000 persons are annually affected by early death of cardiovascular, respiratory disease, and lung cancer resulted from air pollution in south Asia. The short-term and long-term effects are reported as hospital admission, consulting with a physician, number of special disease, death and years of life lost (YOLL). The purpose of this paper is to discuss the effects of PM10 pollution on human health. AirQ 2.2.3 (Air Quality Health Impact Assessment) Model was used to evaluate adverse health effects caused by PM10 exposure in Ahvaz during 2009. Long-term exposure with suspended particulates are expressed as decreasing personal life. The prevalence of bronchitis and reduced lung function in children and adults, even at annual average concentrations of particulate matter below 20 μg/m3 (PM2.5) and 30 μg/m3 (PM10) have been observed. Major sources of emissions resulting from human intervention in particulate matter are road traffic (25-10%), stationary combustion (55-40%), and industrial processes (30-15%). First, PM10 data was collected from Ahvaz Environment Protection Organization and Meteorological Organization. Then, raw data were processed by Excel software.. Finally, data processed were inputted to AirQ model. This model proved to be a valid and reliable tool to estimate the potential short-term effects of air pollution. This software is provided by the World Health Organization and is used to quantify the health effects of air pollution. This model consists of four input screens (Supplier, AQ data, Location, Parameter) and two output screens (Table, Graph). The highest and lowest PM10 concentration was reported for Headquarter and Naderi stations respectively. Moreover, the annual, summer, and winter means and 98 decimal of this pollutant in Ahvaz City was measured as 261, 376, 170, and 1268 μg/m3 respectively. Total death toll contributed to PM10 was estimated as 1165 cases in 2009. Using data processing in Excel, AirQ software calculates relative risks, attributable proportion, and baseline incidence and the final output would be displayed in the form of death toll. It is noteworthy that there is no model that can estimate the effect of all pollutants together and simultaneously. In addition, it was found that the annual PM10 emission mean, the summer mean, winter mean, and 98 percentile were 261, 376, 170, and 1268 μg/m3 in Ahvaz City. Cumulative number of persons for total number of deaths attributed to PM10 exposure was 1165 in 2009; Out of which, 44% has occurred in the days with concentrations lower than 250 μg/m3. It should be noted that 62% of this value is corresponded to the days with concentrations below 350 μg/m3. The total cumulative number of cardiovascular death attributed to the exposure with PM10 during one year of monitoring was 612 persons. On the other hand, 52% of these cases have occurred in days with PM10 levels not exceeding 300 μg/m3. Cumulative number of Hospital Admissions Respiratory Disease attributed to exposure with PM10 during one year of monitoring was 1551 persons; Out of which, 36 % occurred in days with PM10 levels not exceeding 200 μg/m3.

From human- made pollutants, SO2 has been widely studied. This research aims to estimate the respiratory deaths and COPD related to SO2 pollutant in 2011. Firstly, the concentration of SO2 pollutant was measured by GRIMM device in 2011 in five stations in Tabriz. The data were processed by Excel software and fed to AIR Q model. The result showed that the maximum concentration of pollution was in Namaz square station as 33.79 µg/m3 and the minimum was in Baghshomal station at 6.57 µg/m3. The results of model showed that in 2011, 13 cases of respiratory deaths in Tabriz were ascribed to SO2. The cumulative number of COPD related to SO2 was 9. The analysis and comparison of means and maximum concentration of SO2 in five stations in Tabriz during 24 hrs with air pollution index showed that there was no problem of air pollution in terms of SO2 in 2011. The relative risk of estimated medium limit with low certainty means an increase of 1% in respiratory death risk for each 10 µg/m3 increase of SO2 concentration. It is evident that for each increase of 10 µg/m3 in SO2 concentration, the risk of COPD increases 0.44%.

Tuberculosis is still one of the main causes of mortality and disability in developing countries. Despite of socio-economic development of communities and controlling majority of communicable diseases, With respect to importance and high incidence of Tuberculosis in marginal provinces, the present study was aimed to assess the epidemiology of Tuberculosis. In this Descriptive-Analytical Retrospective Study, documents of 6363 patients diagnosed with TB in the beginning of March 2005 to the end of the September 2012 in Khuzestan province, Iran, by used census sampling size, were used. Demographic variables and other necessity data were recorded by TB-Register software and then these data were analyzed by SPSS 16.0 software and Chi-square and independent t-tests with a significance level of less than 5%. For comparison Tuberculosis incidence in consecutive years used by Poisson tests (with a significance level of less than 5%). mean age of patients and median age of patients were 39.3±18 and 35±6.5 years, for women mean age was older 2.1 years than men and there was significant relationship to age (P=0.0001). Of all patients 75.7% were pulmonary tuberculosis, 2.7% were infected with HIV and 91.2% were new cases. Cumulative incidence in province was 148.84/100,000. Most prevalent in Non-pulmonary TB was Lymphatic glands. Poisson test showed that changing trends of TB incidence in study years was statistically significant (P<0.05). Increasing concurrent of HIV infection and TB and decreasing patients mean age (39.3±18) and median (35±6.5) in southwest of Iran has high prevalence. Screening, training and preventive activities for controlling of disease is highly recommended for the whole country and in margin provinces in particular.

Pulmonary tuberculosis (TB) is the most common form of the tuberculosis in HIV infected patients that can affect on progression of HIV infection. The aim of this study was to investigate the impact of HIV infection on the clinical presentation of tuberculosis. Subjects and We extracted the information of admitted patients in infectious ward of Razi hospital with pulmonary tuberculosis diagnosis from 2004 – 2009. Outcome of this stage was 204 patients. Then we divided these patients in two groups، group 1 patients with HIV (34 cases) and group 2 without HIV infection (170 cases). Finally، we compared the clinical manifestations between these two groups. Data analysis with Chi square test and SPSS software was done. Tuberculosis was more common in men in both groups (p<0. 001). The mean age of HIV positive patients was lower than HIV negative patients. (31. 85±8. 52 vs. 44. 33±10. 34)، (p = 0. 001). Fever، weakness and hemoptysis were more frequent in HIV positive patients (%94. 11 vs. %81. 17، %58. 82 vs. %50. 58 and %20. 58 vs. %7. 05)، (p=0. 07، p=0. 23، p=0. 01). Whereas chronic cough، sputum، weight loss and night sweating were more prominent in HIV negative patients. (%95. 29 vs. %73. 52، %87. 64 vs. %70. 58، %71. 17 vs. %38. 23 and %61. 76 vs. %41. 17)، (p= 0. 03، p= 0. 04، p=0. 009، p= 0. 04). According to the study in these two groups it is important to consider tuberculosis in differential diagnosis of every HIV infected patient not only with cough and sputum but also with fever and constitutional symptoms.

Toxocariasis is a worldwide zoonosis caused by the acaridae of dogs and rarely cats. Seroprevalance of toxocariasis vary with geographic regions. In this study, the sera of school children aged between 6 to 15 years were examined for the presence of anti T.canis antibodies. Subjects and In this descriptive cross-sectional study the sera of 203 randomly selected school children aged between 6 to 15 years from urban and rural regions in Ahvaz, south western of Iran from 2007 to2008 was examined by means of ELISA with excretory- secretary antigen of infectious larva stage. CBC was performed for the presence of eosinophilia or hypereosinophilia. A short questionnaire was fulfilled to obtain data of age, sex, history of pica, contact with dogs and living area (urban or rural). Of total 203 students 90 (44.3%)were female and 113 (55.7%) were male. 86(42.9%) were rural and 114(57.1%) were urban, 67 (33%) had contact with dogs,35(17%)had history of recent cough,5 (2.5%)had pica, on had hypereosinophilia but 21(10.3%)had eosinophlia, 4 (2%) had positive ELISA for T.canis IgG, of them one was male and three were female, two were urban and two were rural, non had history of contact with dogs, pica, chronic cough or asthma, and also non had hypereosinophilia but all had eosinophilia. Our study showed that toxocariasis is present in the school children of Ahvaz, but it is lower than was expected and also lower than similar tropical regions.