فهرست مطالب علی مجید پور

Salmonella is considered as a main cause of community-acquired diarrhea in humans, however, sources of the multi-drug resistant (MDR) strains and their link with the disease are not well known.

This study aimed to investigate the frequency, serogroup diversity, and antimicrobial susceptibility patterns of Salmonella strains in poultry meat and stool samples of patients with community acquired diarrhea in Tehran.

We compared the frequency of non-typhoidal Salmonella serogroups, the similarities of their resistance patterns to 10 antimicrobial compounds, the prevalence of extended spectrum β-lactamase (ESBL) and ampicillinase C (AmpC) genetic determinants, and class 1 and 2 integrons in 100 chicken meat and 400 stool samples of symptomatic patients in Tehran during June 2018 to March 2019.

Salmonella was isolated from 75% and 5.5% of the chicken meats and human stool samples, respectively. The chicken meat isolates mainly belonged to serogroup C (88%, 66/75), while the human stool isolates were mainly related to serogroup D (59.1%, 13/22). The MDR phenotype and the most common rates of resistance to antibiotics, including tetracycline, trimethoprim/sulfamethoxazole (TS) and azithromycin, were detected in 4.5% and 45.3%, 59% and 13.6%, 43% and 9.1%, 42% and 9.1% of the human stool and chicken meat samples, respectively. Carriage of blaCTX, blaSHV, and blaPER genes in the meat isolate with ESBL resistance phenotype and blaACC, blaFOX, and blaCMY-2 among the 7 meat strains with AmpC resistance phenotype was not confirmed using polymerase chain reaction (PCR). High prevalence of class 1 and 2 integrons was characterized and showed a correlation with resistance to TS and chloramphenicol.

These findings showed a lack of association between chicken meats and human isolates due to discrepancy between the characterized serogroups and resistance phenotypes.

Pathogenic species of Campylobacter, in addition to diarrhea and gastrointestinal diseases, could cause debilitating auto-immune and chronic diseases in humans. Investigation of the existence of this bacterium in food sources and clinical samples, and detection of antibiotic resistance could be helpful in the control of its spread and treatment procedures. The aim of this study was to evaluate the frequency and antibiotic resistance of Campylobacter isolates isolated from poultry meat.

In this study, a total of 100 poultry meat samples were collected from 22 districts of Tehran from July 2018 until March 2019. Accordingly, standard enrichment of the collected samples and their culture in selective medium was done. The isolates were characterized biochemically and by polymerase chain reaction for genus and species specific primers for C. jejuni, C. coli, C. upsaliensis, and C. lari. Antimicrobial susceptibility of the isolates to 7 antibiotics were done using E-test and disk diffusion methods. Moreover, resistance to three or greater classes of antibiotics was determined as multiple drug resistance phenotype (MDR) and the results were statistically analyzed using SPSS16 software.

Campylobacter was isolated from 35% of the poultry meat samples. C. jejuni (23%), C. coli (1%), and C. lari (1%) were among the Campylobacter isolates from these samples. Highest resistance phenotype and the lowest ones were detected against tetracycline (62.8%), and ampicillin and clindamycin (17.1%, each one), respectively. The MDR phenotype was detected among 42.8% of the isolates.

Our results showed high level of contamination with Campylobacter in the poultry meat samples which proposed increased risk of the infection with MDR strains among the consumers in Tehran. Further studies on human clinical samples could better determine this correlation.

Asthma is one of the most common chronic diseases in the world and Iran. Despite appropriate treatment, recent researches indicate that asthmatic patients have poor asthma control. The aim of this study was to determine the correlation between educational level of asthmatic patients and asthma control indices. This retrospective cross-sectional study was performed on 80 asthmatic patients admitted to Shahid Labbafinejad hospital. ESMAA questionnaire was used to collect data to assess the level of asthma control, according to ACT (Asthma Control Test) and 2016 GINA (the Global Initiative for Asthma) guidelines. Patient medication compliance was evaluated based on Morisky medication adherence scale (MMAS). ANOVA test (Regression and Pearson correlation) and Chi-Square test were used for analysis of quantitative and qualitative variables, respectively. The P - value less than 0.05 was considered statistically significant. Eighty asthmatic patients with an average age of 54.65 were entered to this study that of them 32 patients were at primary school level, 26 patients at high school level and 22 patients at university state. According to ACT test, 52.5% and 47.5% of patients were in control and uncontrolled state, respectively.
According to GINA classification, 30% of patients were in control, 45% in partially control and 25% in uncontrolled state. According to MMSA scale, 20% of patients were high adherent to medicine, 40% were moderate adherent and 40% were low adherent. In this study, there was no significant correlation between the asthma control in terms of ACT and patients' educational level. Also, there was no significant relationship between sex, asthma control and medication adherence. In addition, there was no significant relationship between educational level and drug adherence. The results suggest that there was no relationship between asthma control indices and patient's educational level. Perhaps other factors, other than education, affect the asthma control indices and medication adherence which requires more studies.

Enterococci are among the normal microbial flora in human and animals digestive tract. The nosocomial pathogenicity of enterococci has emerged in recent years and has caused great concern due to developing resistance to many antimicrobial agents. The aim of this study was to investigate and identify the prevalence of VRE (vancomycin resistant enterococcus) within Enterococci isolates obtained from different parts of the hospital. Putative Enterococci (n=120) were isolated on Membrane Filter Enterococcus Selective Agar Medium and supplemented with 2, 4 and 8 µgr/ml vancomycin in medical samples. A total isolates passed the standard biochemistry tests for the genus and species as well as their specific primers. The antibiotic susceptibility was determined by the disc diffusion method for 8 antibiotics. Microbiologically-influenced corrosion (MIC) of vancomycin was also done using Agar-dilution assay by CLSI recommendations. Results showed that 38 and 84 of the isolates were E. faecium and E.faecalis, respectively. According to antimicrobial susceptibility tests 45, 88, 103, 42, 83, 73, 54 and 95 of the isolates were resistant to vancomycin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin, penicillin, ampicillin and erythromycin, respectively. MIC test on 70% of the isolates was>256 µgr/ml. Despite the fact that the prevalence of VRE strains belongs to two species, E. faecium had high resistance to a broad range of antibiotics. The results of this study indicate the important role of medical samples as reservoirs of resistance elements. Early detection of VRE with their virulence trait will help in preventing the spread of vancomycin resistant enterococcus species and urgent infection control is required in hospital setting

Wound infection is a predominant cause of death in burned patients who are clearly at increased risk of nosocomial infections. Pseudomonas aeruginosa is the most common cause of burn infections and is difficult to treat because of having high level of resistance to antibiotics. The aim of this study was to perform isolation, identification and determination of antibiotics resistance pattern of P. aeruginosa strains isolated from wounds of hospitalized burn patient. Biochemical and molecular tests were used for identification of the P. aeruginosa and antibacterial susceptibility test was performed using disk diffusion (Kirby- Bauer) methods. Then, the minimum inhibitory concentration (MIC) was performed for four representatives of different groups of antibiotics. Among 94 evaluated strains of P. aeruginosa, 83 isolates (88.3%) were multi drugs resistant. Based on Kirby-Bauer method, the most resistance was seen to cefepime (89.5 %) and among the antibiotics studied to determine the MIC, the most resistance was observed to ciprofloxacin (89 %). These results indicate high range of resistance to different antibiotics among strains of P. aeruginosa isolated from burn wounds of patients. So, the fast and accurate measurement and evaluation of antibiotic resistance for appropriate antibiotic therapy of burned patients is imperative.

Osteomyelitis is a bone infection that is caused by pyogenic bacteria، Mycobacterium tuberculosis، or fungus. This study has performed to determine the best experimental antibiotic treatment of chronic osteomyelitis due to Staphylococcus aureus infection. This cross-sectional study was conducted، on 145 war veterans with osteomyelitis from 2007 to 2011. T test method was used to find the sensitivity and antibiotic resistance in patients with Staphylococcus aureus. Our findings were classified to 3 categories: sensitive، resistant and moderately susceptible. The most effective antibiotic on S. aureus was Vancomycin that wasn’t resistance in none of the cultures، 36% of the cultures were sensitive to vancomycin. On the second category there was Ticoplanin with 5. 0% resistance. The most ineffective antibiotic was Cotrimoxazole that 73% of cultures were resistant to it. In 54. 8 percent of cultures staphylococcus were as reported resistance to Meticilin. In 107 % of Staphylococcus aureus resistant species were sensitive to cotrimoxazole. According to taking the culture is different at least from 24 hours to 15 days، prepared specimens in smear were observed from positive cocci. Vancomycin or Ticoplanin can be used to the time of preparation of culture results. To decide selecting each of these antibiotics many factors such as Cost، availability of medication، discharge، and drug side effects are important.

Establishing Counseling Centers for Behavioral Illnesses (CCBIs) is a practical solution for preventing AIDS, sexually-transmitted diseases, and drug abuse in countries that have successfully implemented prevention programs. More efficient management models can help such centers better achieve their goals using the inevitably limited existing resources. The main goal of this study was to design a domestic model for resource management at CCBIs. In this descriptive-comparative study, a form was designed to gather relevant data from countries being studied. Based on the study goals, gathered data were organized into comparative tables, based on which the primary model was designed. A questionnaire was used to test and validate the primary model. The model was finalized by collecting the opinions of 30 experts, faculty members, and managers from the Ministry of Health and Universities of Medical Sciences using the Delphi technique. All countries studied had used their resources for managing prevention and treatment programs for AIDS and other behavioral diseases despite existing challenges. In most countries studied, the clinics were decentralized and counseling and contraception services were also provided in rural areas. Besides, such services were often integrated with primary care clinical services. Occasionally, internet-based, online counseling was also used. The present investigation showed participation of non-governmental organizations, provision of all services free of charge, integration of services into primary care clinics, continuing education for the personnel of CCBIs, establishing special centers for high-risk groups such as sex workers, school-based health education, launching educational websites, and absorbing international aid can all contribute to improvement of resource management and performance at CCBIs.

Acquired immunodeficiency syndrome (AIDS) with a history of only three decades, has turned into a threatening pandemic disease world wide giving rise to 3.1 million deaths in 2005. Since there is no distinctive treatment or effective vaccine for AIDS, its epidemiology is similar to non-communicable and behavioral diseases. Since accurate knowledge and attitude is necessary for a healthy behavior, we conducted this study on high school students of Ardabil to determine their sources of acquiring information on AIDS as well as to find out their attitude and knowledge about this disease. This descriptive and cross-sectional study was conducted on 800 students in Ardabil high schools during the year 2002 using cluster random sampling method. A questionnaire with 4 groups of questions including demographic information, source of information used for AIDS and the amount each source is used as well as attitude and knowledge of the participants regarding AIDS was distributed in the school. The collected data were analyzed using SPSS. 378 (47.2%) out of 800 students were girls and the rest of them were boys. The media used for getting informed about AIDS was determined to be: 84.5% TV, 51.4% newspapers and magazines, 49.6% papers and books and 30.6% radio. 89% of the girls and 67% of the boys used TV. The difference was statistically significant(p<0.001). Sources of information in interview form were found to be health care workers with 17.7%, teachers with 10.2%, friends with 9.5%, religious authorities with 8.6%, family members with 8% and other relatives with 5.6%. A combition of the above-mentioned methods plus other souces formed 41.3% of the information source of the students about AIDS. Only 46.3% of the students had a proper insight in their interaction with role-playing patients of AIDS. 44% of the participants had weak and 56% had moderate knowledge about transmission ways of HIV and no one had good knowledge in this regard. There was no significant difference between age, sex and knowledge. The highest percentage of moderate knowledge score was seen in student studying experimental sciences. Only TV had a significant correlation with knowledge (p=0.001). This study entails that more attention must be paid to education through effective use of TV broadcasting. Films, pictures, teachers, clergymen, radio, books and papers had not an effective educational role among high school students regarding AIDS.

Authorities and scholars believe that determining cigarette smoking status of individuals and groups and finding reasons of smoking plays an important role in manipulating and facing with this dirty habit. The present study is an attempt to determine the rate of prevalence and the causes inducing smoking among students of Ardabil university of medical sciences. This survey was a descriptive and cross-sectional study. Of 1300 medical sciences students, 1106 ones volunteered to participate in this study. The data were collected using a questionnaire and were analyzed in SPSS. 154 students (13.9%) had experienced cigarette smoking previously and 82 students (7.2%) were already a smoker. Intimacy with smokers, self-gratification and acquiring enjoyment, educational failures, vague future career and smoking for entertainment were the most important factors inducing smoking. Cigarette smoking prevalence rate in this study was relatively low in comparison with similar studies. However, regarding the critical social status of these students, some serious measures should be taken to inform them about the dangers of smoking and at the some time some facilities should be provided for students, which can be of great help in this regard.

Regarding the high prevalence of hyperlipidemia in the world especially in Iran, finding suitable and effective treatment seems justified. Metronidazole is the only drug that is used as an antiparasital and antiprotozoal agent. Researchers have found that oral dose of 750 mg/day has a suitable absorption, is widely distributed in the tissues and reaches to a blood level of 4-6 mg/ml. Despite its suitable efficiency, a few clinical trial have been conducted in this regard. This study was designed as such to examine the effect of metronidazole on lowering blood lipids. The present research was performed as a clinical trial without control, on 50 patients. All the patients filled out a special form (to show their satisfaction) as well as a questionnaire. Metronidazole was given with a daily dose of 750 mg for a week. 20 patients with no complaint continued their drug consumption for another seven days. Lipid parameters such as plasma total lipid, total cholesterol, and triglyceride were measured in both groups. The data were collected and analyzed with SPSS software using t-test. Measuring the serum level of lipids indicated that the mean total plasma lipid and total cholesterol decreased significantly compared to their level before taking the drug (p<0.01). The findings also showed a similar decrease in plasma TG level (p<0.001). In the patients who continued the drug consumption in the second week, the serum level of lipids under study showed more decrease compared to their levels in the first week which was statistically significant (p<0.01). Liver tests indicated that the functioning of liver has not changed during drug consumption. Using 750 mg of metronidazole per day exerts a significant decrease in lipids fractions in a short time. Most cases of hyperlipidemia require a long-term treatment, hence metronidazole can be effectively used in the treatment of short-term hyperlipidemia.

Ardabil province is the main area of Iran affected by relapsing fever (RF) for which Borrelia Persica is the most common cause. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region in order to take necessary measures to decrease it is incidence and increase awareness about the characteristics of this disease. In this study a total of 391 patients who were diagnosed to have been effected by tick borne relapsing fever were investigatated in terms of clinical epidemiology between 1998 and 2001. The kind of Borrelia as well as the clinical characteristics of the disease were observed. The kind and prevalence of Borrelia infection was determined in 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests. The most prevalent clinical manifestations were fever, chills and headache. Other findings included nausea, vomiting, sweating, abdominal pain, arthralgia, cough, photophobia, eosinophilia, hematuria, jaundice, petechiae and sclera congestion. Laboratory tests performed on 60 patients showed leukocytosis, high erythrocyte sedimentation rate (ESR) and anemia. Of the 1,421 ticks collected, 45.9%, 40.3% and 13.8% were infected by Ornithodoros lahorensis Ornithodoros tholozani and Argas persicus species, respectively. The prevalence of ticks was highest in Khanadabil village. The ticks collected from three villages were found to be infected with Borrelia. The clinical manifestations were similar to those reported in other studies. Petechiae occurred less frequently in our study compared to louse-borne RF. The high frequency of anemia in this region, which was not stated in other reference articles, requires further investigation.

Animal bites are considered to be an important threat to human health. Ardabil province in north-western Iran has the highest incidence rate of animal bites in Iran. This study was an attempt to investigate the epidemiological features of animal bites in Ardabil province during a one-year period from April 1999 to April 2000. In this descriptive study a special questionnaire was filled for all cases of animal bites reported during a one year period in Ardabil province. The questionnaire included questions regarding rabies, age, sex, job, etc. The data were analyzed using SPSS software (release 9). Descriptive statistics was used in the form of frequency tables and graph in order to summarize the data. The total number of exposed persons to animal bites were 4331. Males comprised 75% of cases (3259) and 1072 persons (25%) were females. The highest incidence rate was seen among 30-50 year-olds. Animal bites were more common in summer. In 3078 cases (17%), legs were the main site of bite. Dog bite was the most common type (95%). This study confirms that animal bite such as dog bite is an important public health problem in Ardabil province. Regarding the importance of this issue it is necessary to take serious measures in order to control and prevent this health thereat.

Nutritional status of individuals and community are influenced by different factors. Investigating nutrition and food problems as well as determining dietary pattern play a crucial role in determining nutrition programs and policies, preventing food deficiency, improving nutrition level and preventing malnutrition diseases. The aim of this study was to determine calorie and nutrients intake, food habit and dietary pattern in rural areas of Ardabil. In this cross-sectional study 250 families from 15 rural areas of Ardabil were selected using simple random method. Nutrition status of all the individuals was studied using 24 hour recall and food frequency. Data were analyzed using SPSS and Food processor. This study showed that intake of some nutrients (Zinc, Selenium, Folic acid and Vitamin B2) in the subjects were significantly less than Recommended Dietary Allowance (RDA) of WHO (P<0.001), but intake of protein, iron and calcium was more than the RDA of WHO (P<0.001). Calorie intake of 20% of rural people was less than 75% of RDA(mostly seen among men). The findings of food frequency showed that main foods of rural individuals in Ardabil were local bread (Lavash), potato, egg, milk, biscuit, yogurt, garlic, onion, vegetable fat, butter and tomato. This study showed unsuitable intake of some nutrients. In order to improve the nutritional status of these people, regular intake of different groups of foods should be instructed.