javad moazen

Antimicrobial stewardship studies are essential to prevent microbial resistance, ensure proper antimicrobial use, and reduce treatment costs. This study aimed to examine the prescription trends of eight costly antimicrobial agents, including carbapenem (imipenem/meropenem), voriconazole, vancomycin, liposomal amphotericin B, colistin, linezolid, teicoplanin, and caspofungin, at Ganjavian hospital in Dezful.

This cross-sectional study collected prescription forms for the eight targeted antimicrobials from March 2018 to March 2020. The recorded data included patient information, microbiological findings, infection sites, and details of antimicrobial use.

The analysis of 200 patients revealed that the most common infection sites were the bloodstream (41%), respiratory system (24.5%), and unidentified sources (13%). The majority of patients were admitted to internal wards (29.5%), general intensive care units (25.5%), and neonatal intensive care units (13%). The predominant bacterial isolates were Escherichia coli (19.5%), Acinetobacter baumannii (14.5%), Pseudomonas aeruginosa (12.5%), and Staphylococcus aureus (11.5%). Multidrug-resistant (MDR) bacteria caused 53% of infections, and 33.5% were caused by bacteria resistant to all tested antimicrobials.

MDR bacteria pose a significant challenge, underscoring the critical need for nosocomial infection control, antimicrobial stewardship, and continuous monitoring of antimicrobial resistance patterns in this medical center.

 Staphylococcus aureus ranks among the leading causes of serious nosocomial infections. One critical route for the spread of this bacterium within hospitals is via asymptomatic carriers, particularly healthcare providers. Staphylococcus aureus can exist as part of the normal skin flora and within the anterior nostrils of individuals, making healthcare providers a significant vector for transmission. Several genes associated with virulence, such as toxic shock syndrome toxin-1 (tsst-1), alpha-toxin (hla), and panton-valentine leucocidin (pvl), play pivotal roles in the pathogenicity and severity of infections caused by S. aureus.

 This study aimed to characterize S. aureus nasal carriage among healthcare providers in an intensive care unit (ICU), with a particular focus on antibiotic resistance profiles and the prevalence of virulence genes.

 Nasal swabs were collected from 120 healthcare workers in the ICU of Ganjavian hospital, Dezful, Iran. Standard microbiological procedures were employed for S. aureus detection. Antibiotic susceptibility testing was conducted using both disk diffusion and minimum inhibitory concentration methods. Polymerase chain reaction (PCR) was employed to identify the presence of the mecA gene and the virulence genes hla, tsst-1, and pvl. A statistical analysis was performed to evaluate the data.

 The study revealed that 12.5% of healthcare providers were carriers of S. aureus, with 26.6% of them harboring methicillin-resistant S. aureus (MRSA) strains. Antibiotic resistance patterns varied, with a notable resistance to erythromycin and penicillin. The hla gene was detected in 66.6% of S. aureus strains; nevertheless, the tsst-1 and pvl genes were not identified. The study suggests a potential association between high expression of the hla and mecA genes and antibiotic resistance.

 This study underscores the prevalence of S. aureus nasal carriage, antibiotic resistance patterns, and the distribution of virulence genes among healthcare providers in an ICU setting. The findings emphasize the significance of continuous surveillance and infection control strategies to mitigate the transmission of S. aureus and associated infections within healthcare facilities. The study recommends routine screening of ICU healthcare providers for asymptomatic S. aureus carriers and appropriate interventions to eliminate colonization.

 Although the COVID-19 pandemic is over, the disease remains a public health threat. Contracting and transmitting SARS-COV-2 among individuals under 18 is significant.

 This study aims to identify potential side effects and symptomatic reinfections among 12-18-year-olds after receiving COVID-19 vaccines.

 In this longitudinal study conducted in 2021 - 2022 in Dezful, Iran, 1,000 vaccinated individuals were followed up for 6 months. Side effects and symptomatic reinfections of the first and second doses of PastoCovac and Sinopharm vaccines and a history of prior SARS-COV-2 infection were recorded.

 Only 7.6% received the PastoCovac vaccine, while 92.4% received the Sinopharm vaccine. The most common side effect for both vaccines was local pain at the injection site, while the least common was skin rash. Side effects were 1.9 times more prevalent with the PastoCovac vaccination. Women had a 2.3 times higher chance of experiencing side effects after the first dose and a 1.9 times higher chance after the second dose compared to men. Over the 6-month follow-up period, 11.6% and 14.3% of individuals experienced re-infection after the first and second vaccine doses, respectively. It seems with the passage of time and the decrease in the level of immunity, the possibility of re-infection increases.

 Both vaccines were considered safe for 12-18-year-olds. However, receiving two doses does not guarantee protection against reinfection.

Fatigue is the most common symptom described by patients undergoing hemodialysis. Foot reflexology and then aromatherapy, among the types of complementary medicine, are the most frequently used intervention to control fatigue in patients undergoing hemodialysis.

The purpose of the present study is to compare the effect of aromatherapy with geranium essential oil and foot reflexology on Fatigue and daily activities of patients undergoing hemodialysis referred to the Hemodialysis Centers of Dezful University of Medical Sciences in 2019.

This randomized controlled clinical trial was conducted on 90 patients (30 patients in the geranium essential oil aromatherapy intervention group, 30 patients in the foot reflexology intervention group, and 30 patients in the control group). After the consent form was completed by the patient, Visual Analogue Fatigue Scale (VAFS), Piper Fatigue Scale (PFS) and Nottingham Extended Activities of Daily Living (NEADL) scale were completed for patients before the intervention and then four weeks after the intervention. Data analysis was carried out using descriptive statistics (prevalence, mean and standard deviation) and inferential statistics (one-way analysis of variance and least significant difference (LSD) post hoc test, t test) in SPSS version 16.

There was a statistically significant difference between the pre-test and post-test PFS and NEADL scores in the foot reflexology group. After foot reflexology, the mean fatigue scores decreased significantly (P < 0.001) and the mean activities of daily living (ADL) scores increased significantly (P < 0.001). There were no changes in fatigue and ADL scores in the geranium essential oil aromatherapy and the control groups after the intervention (P > 0.05).

Foot reflexology can be used as an effective nursing intervention to reduce fatigue and increase ADLs of patients with chronic kidney failure and undergoing hemodialysis treatment.

Areas with a higher prevalence of vitaminDdeficiency have reported a higher frequency of severe coronavirus disease 2019 (COVID-19) infections.

This study aimed to assess the possible association between vitamin D and COVID-19.

This study examined the vitamin D status, hepatic, serologic, and hematologic parameters of COVID-19 patients who tested positive upon admission to a major referral center in southwest Iran. A total of 50 cases and 50 controls were enrolled in the study after obtaining informed consent. The patients did not receive a vitamin D supplement during their hospitalization.

Patients with insufficiency and deficiency of vitamin D3 had a longer hospitalization time, a higher likelihood of ICU admission, and a greater risk of death compared to cases with sufficient levels of vitamin D.

The results of this study showed that vitamin D deficiency is associated with increased severity and mortality rates. Therefore, using a vitamin D supplement may help reduce the severity of COVID-19.

 About a year after the start of the coronavirus disease 2019 (COVID-19) pandemic, the results of the studies conducted to investigate the effectiveness of interferon (INF) compounds in this disease were contradictory.

 This study was carried out to examine the safety and efficacy of a treatment protocol containing INF-β-1b, hydroxychloroquine, and Kaletra (lopinavir/ritonavir) in patients with severe COVID-19.

 In this open-label, randomized controlled trial, severe cases of COVID-19 were included. Patients were eligible if they had epidemiological and radiological evidence compatible with COVID-19 or a positive polymerase chain reaction result and their disease was severe. They were randomly allocated into a control group that received the standard regimen (hydroxychloroquine and Kaletra) and an intervention group that received INF-β-1b treatment and the standard treatment regimen. Then, the two groups were compared in terms of in-hospital mortality, intubation, length of hospital stay, oxygen saturation, and lactate dehydrogenase before and after the intervention.

 A total of 91 cases of severe COVID-19 were enrolled for analysis [intervention (n = 47) and control (n = 44)]. The length of hospital stay in the intervention group was significantly longer than in the control group (13.21 ± 6.88 vs. 10.52 ± 5.77 days; P = 0.047). The mortality rate did not significantly differ between the intervention and control groups (19.15% and 13.64%, respectively; P = 0.509). The intubation rate did not significantly differ between the intervention and control groups (12.76% and 11.36%, respectively; P = 0.838).

 The use of INF-β-1b-containing treatment regimens does not reduce mortality and intubation rates among patients with severe COVID-19. Furthermore, it might even increase the severity of the disease and the length of hospital stay for some patients; therefore, it is not recommended to use INF-β-1b in severe cases of COVID-19.

 Due to the increase in microbial resistance, nosocomial multidrug resistance infections, including ventilator-associated pneumonia (VAP), are presently one of the main causes of death in hospitals since they are difficult to treat.

 This study aimed to investigate the bacterial etiology of VAP and their microbial resistance pattern in Dezful Hospital, southwest of Iran.

 In this cross-sectional study, 131 bacterial isolates were isolated from the respiratory secretions of the patients with VAP in ICU wards. Antibiotic susceptibility testing (AST) of all isolates was carried out after the identification. Then the extended-spectrum beta-lactamases (ESBLs), carbapenemase, and metallobetalactamase were identified by phenotyping and genotyping.

 The most frequent isolates were Staphylococcus aureus (30.5%), Acinetobacter baumannii (25.2%), and Klebsiella pneumoniae (24.4%). All strains of S. aureus were sensitive to vancomycin, ticoplanin, quinupristin-dalfopristin, and linezolid. Escherichia coli and Klebsiella showed high resistance to cephalosporins. More than 93% of Acinetobacter isolates were resistant to carbapenem and quinolones. The overall prevalence of ESBLs and carbapenemase producing bacteria were 80.43% and 73.6%, respectively. The most frequent ESBLs gene was blaCTX-M gene (78.3%) followed by blaAMP-C gene (67.5%), blaSHV gene (64.8%), and blaTEM gene (54%).

 In sum, there was a possibility that the treatment of nosocomial multidrug resistant infections such as VAP would become a major challenge. Therefore, it was recommended that AST results should always be considered when selecting the appropriate treatment regimen. Furthermore, it was found important to emphasize the principles of antibiotic stewardship and to constantly monitor the pattern of microbial susceptibility.

Fever of unknown origin (FUO) is one of the clinical challenges in medicine. Most causes of FUO include infectious diseases, malignancies, non-infectious inflammatory causes, and unknown factors, but this prioritization may change under the influence of various factors such as geographic area, age, and access to laboratory-diagnostic facilities. The aim of this study was to determine the frequency of causes of FUO in this area in order to suggest a better clinical approach to achieve a faster diagnosis in patients with fever of unknown origin.

In this cross-sectional, descriptive study, we studied all files of patients who admitted to Dezful General Hospital with an initial diagnosis of FUO during 2018-2019. In descriptive statistics, for qualitative variables, frequency table (percentage) and graph and for quantitative variables, central and dispersion indices including mean and standard deviation were used.

The most common causes of FUO were infectious agents (50%), non-infectious (26.1%), unknown (13%) and malignancies (10.9%). Among the infectious agents, the highest frequency was related to the diagnosis of pneumonia, sepsis and extra pulmonary tuberculosis. About 71% of patients are diagnosed with non-invasive methods. No significant relationship was found between the four main causes of FUO and other variables during the analysis using Chi-Square Tests.

Although the pattern of causes of FUO in this study is compatible with most medical sources, but we suggest that in order to achieve a faster diagnosis of patients admitted with FUO in this area, always common and endemic diseases such as tuberculosis and thyroiditis and unusual clinical manifestations of some syndromes should be considered.

We are witnessing the increasing use of antibiotics and the upward trend of resistant nosocomial infections. Therefore, identifying pathogens and determining the local patterns of antibiotic resistance are the health system’s priorities in any region.

The current study aimed to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Intensive Care Unit (ICU) and Non-ICU wards, the toxic shock syndrome toxin-1 (TSST-1), alpha-toxin (Hla), and pantone-valentine leucocidin (PVL) genes in S. aureus strains, and antibiotic resistance patterns to provide a clinical guide for clinicians in Southwest Iran.

Staphylococcus aureus was isolated from clinical specimens between 2018 and 2020. Methicillin-resistant S. aureus was detected by cefoxitin screening. Then, the antimicrobial resistance of all isolates was tested with the disk diffusion (DD) and the minimuminhibitory concentration (MIC) methods. Virulence genes, including TSST-1, Hla, and PVL, were evaluated by the PCR method.

Of 186 S. aureus strains isolated from various specimens, 51 (27.4%) were MRSA, with a 26.8% rate in the ICU. All isolates were susceptible to vancomycin, teicoplanin, linezolid, daptomycin, andquinupristin-dalfopristin. The penicillin-resistant S. aureus proportion was 93.5% (174/186), and more than 50% of all S. aureus isolates were resistant to fluoroquinolones. The incidence rates of virulence factors, including TSST-1, Hla, and PVL genes in MRSA, were 3.9%, 39.2%, and 2%, respectively.

It is recommended to start empiric treatment against MRSA in case of severe infections in the ICU with either quinupristin-dalfopristin, daptomycin, vancomycin, teicoplanin, or linezolid until the culture and antibiotic susceptibility test results are available. Nevertheless, following the antibiotic resistance pattern is necessary to start treatment for other infections.

Schistosomiasis, after malaria, is the second most important parasitic disease in the world in terms of morbidity and mortality and is one of the 14 neglected tropical diseases. In 2016, about 206.4 million people needed preventive treatment for the disease.

This study evaluated schistosomiasis’s incidence rate and spatial-temporal cluster distribution in the north of Khuzestan province, Iran.

This cross-sectional study collected data from January 1977 to December 2001. The data of 1,390 definitive patients with Schistosoma haematobium in the north of Khuzestan province, Iran, were analyzed for the disease incidence in rural districts over five-year periods. Also, the changes in median age and sex were examined. Spatial scan statistics were used to diagnose and evaluate the spatial clusters of S. haematobium cases. The pure retrospective temporal analysis and retrospective spatial-temporal analysis were carried out to identify the temporal clusters and spatial-temporal clusters of schistosomiasis with high rates, respectively, using the discrete Poisson model.

The schistosomiasis incidence decreased over the years, with the last case reported in 2001. Using Kulldorff’s spatial scan method, spatial clustering showed nine high-risk areas in the north of Khuzestan province from 1977 to 2001. Besides, S. haematobium was not randomly distributed in this area. Spatial-temporal clusters identified three high-risk areas during the study period. Temporal clusters decreased from 17 months and five days to one day, and they mainly occurred in the winter and summer.

The study indicated a zero incidence and vanishing S. haematobium endemicity in the northern region of Khuzestan province of Iran in 2002. Due to snail vectors of the disease resident in this region, the disease surveillance still needs continuation.

Dezful and its suburbs, as the second city in Khuzestan Province, southwest of Iran, has been an endemic area of cutaneous leishmaniasis (CL) with a low incidence rate since the last decades. However, the disease incidence has rapidly increased, and now is considered as a re-emerging parasitic disease in the area.

The aim of this study was to identify the most prevalent CL species in Dezful Region.

A total of 196 microscopically confirmed slides from CL patients referred to Dezful Health Center were randomly collected in the period of 2015 - 2016. After DNA extraction from microscopically positive slides, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was carried out on 61 eligible specimens using ribosomal internal transcribed spacer 1 (ITS1) gene. The HaeIII restriction enzyme was used for the identification of species.

Samples were randomly collected from 196 acute CL cases, including 110 (56.2%) males and 86 (43.8%) females. Most infections were seen in the age range of 2 - 7 years (65/196, 33.1%). Totally, 60.1% of the cases had only one lesion, and half of the lesions appeared on hands. Furthermore, 162 (82.7%) cases were referred to Dezful Health Center in the cold seasons (autumn and winter). Results of PCR-RFLP on 61 eligible isolates showed that 60 (98.4%) isolates were Leishmania major, and only 1 (1.6%) isolate was Leishmania tropica.

Our findings indicated that L. major is the main agent of re-emerged CL in Dezful and its suburbs, and the disease is a zoonosis.

Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1.5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran. In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100,000 individuals in each county was determined for the past five years. Reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model. The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’s I analysis from 2011 to 2015. Local Moran’s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015. Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

Socioeconomic status (SES) is one of the main determinants of health-related quality of life (HRQoL), where people with lower SES experience more health problems, have a lower quality of life, and are exposed to have a greater number of health-related risk factors.
This study aimed to examine the relationships between HRQoL, SES, and several demographic factors among the residents of the city of Ilam (located at the West of Iran).
This cross sectional study was conducted on 400 households from 3 districts of the city of Ilam in 2015. The participants were selected on the basis of the multistage sampling method. The second version of the 12-item Short-Form Health Survey (SF-12v2) questionnaire and the Wealth Index were used to measure HRQoL and SES, respectively.
The mean scores of the physical component summary (PCS) and the mental component summary (MCS) were 46.32 ± 9.69 and 42.12 ± 9.11, respectively. The findings indicated that PCS (P = 0.01) and MCS (P = 0.01) were significantly related to SES (wealth index). The demographic variables of age, gender, education level, marital status, job status, and home ownership (P HRQoL is directly related to SES, in that HRQoL is higher in families with higher SES. Similarly, HRQL is higher in younger people, men, and those with a university degree. A decrease in socio-economic inequalities and the gap between the rich and the poor can enhance the individuals’ health status and HRQoL within a community.

Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS..
This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection..
Patients and In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don’t have such sore in their genital area..

Almost one-third of the world''s population is infected with Mycobacterium tuberculosis, but only 10% of them develop tuberculosis. TNF-α/IL-10 balance has key roles in controlling latent/activation stages of tuberculosis.. The objective of this study was to determine an association between polymorphic variants of the TNF-α and IL-10 genes and tuberculosis..Patients and This case-control study was performed on 100 patients with tuberculosis (TB) and 194 healthy blood donors. There was no significant difference among the groups regarding gender and race (P > 0.05). The patients were diagnosed at Boo-Ali Hospital in Sistan-Baluchestan province, Iran. Polymerase chain reaction (PCR) was performed using commercially available CTS-PCR-SSP Tray Kit (University Clinic Heidelberg) for single nucleotide polymorphisms (SNPs) at IL-10 -1082 A/T, -819 C/T and -592 A/C; TNF-a-308 G/A and -238 G/A. Analysis of the specific amplicons was done by electrophoresis on 2% agarose gel containing 0.5 μg/mL ethidium bromide. Results were analyzed using the statistical software package SPSS 17.0 for Windows (SPSS Inc.).. A total number of 100 patients (50 with pulmonary TB [PTB] and 50 with extrapulmonary TB [EPTB]) and 194 healthy blood donors were genotyped. The results showed significantly increased frequency of AA genotype of IL-10 (C/A-592). Also, polymorphism was observed in EPTB patients compared to normal human subjects (NHS) and PTB patients (P = 0.05). The genotype frequency of IL-10 (C/T-819), IL-10 (G/A-1082) TNF-α (G/A-308) and TNF-α (G/A-238) did not show any significant difference. Frequency of high producing IL-10 (-819) T allele was significantly over-represented in EPTB group in comparison to both healthy blood donor and PTB groups (47.7% vs. 36.9%, P = 0.035; 47.7% vs. 31.8%, P = 0.03; respectively). Frequency of IL-10(-592) A allele was significantly increased in EPTB patients compared to NHS and PTB patients (51% vs. 37%, P = 0.01; 51% vs. 33%, P = 0.01; respectively).. Results of the present study showed IL-10 gene polymorphism (C/T –819, C/A –592) plays a key role in susceptibility to or protection against EPTB development in the Iranian population..