roghieh golsha

It is essential to constantly review the risk factors and treatment outcomes of tuberculosis (TB). This study evaluated some important risk factors of TB over five years.

Between 2013 and 2018, all available information and possible risk factors related to TB patients were analyzed from the TB registry program of the health district of Gorgan, Iran.

Among 349 TB patients, 194 (55.59%) were males and 167 (47.85%) had at least a comorbidity. The death rate was higher in the age group more than 65 years (p < 0.001), the low-educated group (P = 0.012), and patients with underlying diseases, especially diabetes (p < 0.001). In total, univariate and multivariate statistical analyzes showed that having comorbidity (OR = 4.34; 95% CI 1.49 – 13.49), as well as, being jobless (OR = 3.07; 95% CI 1.19 – 8.59) were the main factors influencing the adverse events.

According to the study, aging, underlying diseases, and cultural poverty include a higher share of the main risk factors for active TB and/or treatment outcomes. By considering these risk factors and training the medical staff continually, we can reduce the time of TB diagnosis, and prevent it from spreading.

Improper prescription of the type, dose, and duration of antibiotics imposes a financial burden on the health system, can cause many side effects for the patient, and can lead to the emergence of drug-resistant bacteria. This study aimed to determine the profile of prescribing antibiotics in different wards of a hospital and compare it with references.

This study was conducted on the recorded information of 342 patients in the emergency, infectious diseases, pulmonary, and surgical wards of Sayad Shirazi Hospital in Gorgan (north of Iran) in 2019-2020. The type, dose, and duration of the prescribed antibiotics were extracted from each patient's file and compared with references. The compatibility and inconsistency of the prescribed antibiotics were identified and analyzed accordingly.

A total of 13 types of antibiotics were prescribed for the patients. There was a 43.7% inconsistency in antibiotic prescription with the references. The most prescribed antibiotic was ceftriaxone (25.6%). Ceftriaxone (11.26%), followed by cefazolin (8.30%), had the most inconsistency in prescription. The most inconsistency in total was respectively observed in the pulmonary (47.9%), general surgery (44.8%), emergency (44.4%), and infectious diseases wards (40.6%). No significant difference was observed between the wards in terms of the total inconsistency of prescribed antibiotics with the references (P = 0.692).

The most prescribed antibiotic was ceftriaxone. A high percentage of its prescriptions are without indication and are actually prescribed as empiric. Therefore, it is necessary to monitor the prescription of antibiotics in medical centers based on the indications and available evidence.

Hemoptysis is defined as the expectoration of blood from the lower respiratory tract. Bronchiolitis, bronchogenic carcinoma, and bronchiectasis are the most common causes of hemoptysis in developed countries, while infections caused by Mycobacterium tuberculosis are the most common cause in endemic countries. This study was conducted to determine the frequency of causes of hemoptysis and some related factors.

This descriptive-analytical study was done on 68 patients (37 men and 31 women, average age 56.85±17.27 years) who were referred to the Shahid Sayyad Shirazi Hospital in Gorgan, north of Iran during 2014-16 with the complaint of hemoptysis. Demographic information, cause of hemoptysis and history of illness or drug abuse were extracted from the patients’ records.

Based on the results, 42.6%, 45.6%, and 17.6% of the patients had a history of smoking, drug abuse, and diabetes, respectively. The most frequent causes of hemoptysis were bronchiectasis (25%), pneumonia (20.6%), tuberculosis, and lung cancer (16.4%). Gender was determined as an independent risk factor for hemoptysis (P<0.05). The most common causes of hemoptysis were bronchiectasis, lung cancer and pneumonia in men, and tuberculosis and bronchiectasis in women. Age, drug abuse, smoking, and diabetes had no significant association with the occurrence of hemoptysis.

Bronchiectasis, tuberculosis, and lung cancer are the main causes of hemoptysis, and gender is an independent risk factor for hemoptysis in the study area.

Considering the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, which causes coronavirus disease 2019 (COVID-19), we aimed to report the clinical features of 427 patients with COVID-19 and the outcomes after one-month admission to major teaching hospitals in the northeast of Iran. Data of patients hospitalized with COVID-19 from 20 February 2020 to 20 April 2020 was analyzed using the R software. The cases and their outcomes were monitored up to one month following their admission. Among 427 patients with a median age of 53 years (50.8% male), 81 (19%) were directly admitted to the ICU ward, and 68 (16%) died during the study. The mean (SD) lengths of hospital stay were significantly higher in the non-survivors (6 (9) days) than survivors (4 (5) days) (P = 0.018). Ventilation need was reported in 67.6% of the non-survivors and 0.8% of the survivors (P < 0.001). Cough (72.8%), fever (69.3%), and dyspnea (64.0%) were the most common symptoms. There were more comorbidities in the severe cases (73.5%) and non-survivor (77.5%). Liver and kidney damage were significantly more common in non-survivors. Ninety percent of the patients had at least one abnormal chest CT scan finding, including crazy paving and consolidation patterns (27.1%), followed by the ground-glass opacity (24.7%). Results showed that the patients’ age, underlying comorbidities, levels of SpO2, and laboratory findings at the time of admission may predict the progress of the disease and can be considered mortality-related factors.

Hepatitis B virus (HBV) is one of the most common viral infections and amongst the top health priorities worldwide. Due to frequent exposure, medical students are at high risk of developing HBV infection. This study was conducted to evaluate serum level of anti-HBV surface antigen (HBsAg) 18 years after HBV vaccination in students of the Golestan University of Medical Sciences (Gorgan, Iran).

In this cross-sectional study, 241 students (18-20 years old, 137 women) who had been vaccinated at infancy were enrolled. After recording demographic data, blood sample was taken to measure HBsAg, HBs anti-body (HBs-Ab) and HBc antibody (total HBcAb) using commercial enzyme-linked immunosorbent assay kits. Data were analyzed by the chi-square test using SPSS 16 and at significance of 0.05.

HBsAb titer of less than 10 mlU/ml was found in 167 (69.3%) participants (89 females and 78 males). Positive HBsAg and anti-HBcAb were not observed in the subjects. There was no significant relationship between antibody titer and sex, body mass index, place of residence and ethnicity (P>0.05).

The high number of medical students with seronegative antibody levels is a cause for concern. In this regard, more attention should be paid to high risk students in medical school of the Golestan Province.

Currently, due to an increase in the number of individuals with immune deficiency, long-term chemotherapy, and underlying diseases, an appropriate situation has been provided for the development of opportunistic infections, including fungal infections. This study was conducted with the aim of evaluating clinical symptoms, laboratory findings, and the treatment outcome of mucormycosis in diabetic individuals.

In this cross-sectional retrospective study, all recorded cases of mucormycosis in the health centers of Gorgan city, northeast of Iran, in diabetic individuals were extracted during 15 years from 2002 to 2016. All information was extracted from patient-related records and then was analyzed. In the period from 2002 to 2016, 12 diabetic individuals with mucormycosis were referred to health centers.

There were statistically significant differences in the categories of sex, residence, education, taking drug, addiction, diabetes status, methods of diagnosis, involved area with mucormycosis, treatment type of mucormycosis, and treatment outcome of mucormycosis. Furthermore, no statistically significant difference was observed in the categories of age, underlying diseases (other than diabetes), hospitalization, and diagnostic time.

Due to the rareness or lack of an appropriate diagnostic method, and in addition, due to lack of an appropriate treatment, attention should be paid to invasive mucormycosis in individuals with immunodeficiency.

Educational appraisal plays a pivotal role in determining and promoting the educational quality and ensuring its continuous improvement. The performance of faculty members, characterized as the major building blocks of universities, makes significant contribution to the output of an educational system. Thus, the current study sets out to compare the results of the faculty members’ self-assessment and the students’ assessment of their educational performance in Golestan University of Medical Sciences, Iran.

This cross-sectional, descriptive-analytical study was performed in academic years 2011-14 on faculty members and students at school of medicine in Golestan University of Medical Sciences, Iran. Data were collected using two questionnaires. Mean scores of educational performance were compared using the Mann-Whitney test. The Kappa and ICC agreement coefficient were used to assess the agreement between the professors and the students’ views. All statistical analyses were performed in SPSS 18 at significance of 0.05.

Overall, 191 completed questionnaires related to 49 professors were collected. In addition, 109 self-assessment questionnaires were collected from 48 faculty members. Of 191 professors, 34.6% were women, 65.4% were men, and 78.8% were assistant professors. In addition, the mean work experience was 12.3 ± 6.88 years. By comparing the highest and lowest self-assessment scores of the professors, of 191 professors, 31 (16.23%) assessed themselves with the highest score, which determined their strengths in explicit expression and full explanation of the content of the course, the perfect use of class time for educational activities, proper communication with colleagues, and responsibility for carrying out organizational tasks. Moreover, 25 (13.08%) of the professors assessed themselves with the lowest score mainly due to lack of research activities. A partially significant convergence was observed between the students and the faculty members’ assessment scores.

The convergence between the students’ ideas and that of the faculty members questions the practical value of evaluation programs and highlights the necessity to deliver the resulting outcome to the faculty members.

The mortality rate of sepsis and pneumonia is higher in end-stage renal disease (ESRD) patients than in the general population. Bacterial infections are the most common cause of hospitalization in dialysis patients and the most common source of bacteremia is vascular access in these patients. The aim of this study was to determine the prevalence of infectious causes of hospitalization in patients with end-stage renal failure in Gorgan.

This cross-sectional study was performed on patients with ESRD who were admitted to the 5 Azar Medical Education Center of Gorgan City during 2014 to 2016. Patients' information was collected through their clinical records and analyzed statistically.

The prevalence of infectious diseases in ESRD patients during the 3 years was 12.7%, out of 100 hospitalized patients with ESRD and infectious causes, the most common type of infectious disease was catheter infection (43%) and sepsis (18%), urinary tract infection (11%) and pneumonia (8%) were the next. The most common infectious causes leading to hospitalization in men with the ESRD were catheter infection, sepsis, and pneumonia, respectively, and in women, catheter infection, sepsis, and urinary tract infection. The highest incidence of catheter infection was in the age group of 66-70 years (30.2%), 71-75 (25.6%), and above 71 years (25.6%), respectively. The highest incidence of sepsis occurred in the age group of 75-71 years (38.9%) and also the highest incidence of urinary tract infections in the age group of less than 65 years. Age (P=0.003), sex (P=0.01), duration of disease (P=0.009), addiction (P=0.01), and diabetes (P=0.01) were the most common risk factors for infectious diseases in patients with ESRD.

The results of this study showed that catheter infection is the most common cause of infection in patients with end-stage renal disease (ESRD). Therefore, avoiding multiple vascular manipulations, disinfection of the catheter, timely replacement, and training of dialysis staff are effective in reducing catheter infections.

Animal bite is a public health problem worldwide. The aim of this study was to investigate frequency of animal bites in Golestan province, northeast of Iran, between 2011 and 2012.
This descriptive cross-sectional study was done by collecting data from medical records of animal bite victims referred to the health centers in the Golestan province, in 2011-12. Information collected included species of animals, gender, age, occupation, location of residence, type of treatment, and type of injury. The data were analyzed by SPSS (version 16).
Overall, there were 10,810 incidents of animal bites in the province in 2011-12. Of these cases, 8125 (75.48%) were men and most cases were 5-24 years of age. Dog bites accounted for 9885 (91.44%) cases of animal bites. Most incidents occurred in rural areas (82.27%). Most vulnerable individuals were students (n=2370, 21.92%) and homemakers (n=1722, 15.93%). The most common site of animal bites was lower limb (62.53%). Moreover, treatment with anti-rabies serum and vaccine was done for 9610 (89.9%) and 9068 (83.89%) cases, respectively.
According to our results, animal bites are more frequent in young men, residents of rural areas, and students. In addition, dog bites account for 91% of all cases of animal bites in the province. These results highlight the need for education programs on animal bites and rabies to increase knowledge and awareness of the individuals at risk.

Resistance to anti-tuberculosis (TB) drugs is reported to be a global problem. Previous studies showed that the prevalence rate for primary MDR-TB was higher and has been increasing. The purpose of this study is to determine the primary drug resistance strains isolated from patients with smear-positive of the new cases to anti-TB drugs.
In this cross-sectional study, 266 smear positive pulmonary TB Iranian patients were enrolled during the April 2011 and March 2012. Drug Susceptibility Testing (DST) of M. tuberculosis isolates to the first-line drugs: Isoniazid, Rifampicin, Ethambutol and Streptomycin were performed by the proportion method using the conventional Lowenstein-Jensen (L-J) medium.
The average age was 48.4 ± 21.3 years and 56.5 percent were male. In this study, out of 266 pulmonary TB suspects studied, susceptibility testing was performed for 189 isolates. Resistance to at least one drug was 11.1% (21/189). Resistance among newly diagnosed patients was most common for streptomycin and MDR prevalence rates (resistant to ISONIAZID and RIFAMPIN) among these patients were 2.1%.
Our finding suggests that the incidence of MDR tuberculosis in high TB burden setting stresses the need for drug susceptibility testing to be done for every patient who is culture positive for Mycobacterium tuberculosis.

WHO and other organizations recommend fixed-dose combination formulations (FDCs) as a further step to facilitate the optimal drug treatment of TB. No study has been done in this regard so far In Iran. The purpose of this study is comparison of the Treatment Outcome of a Fixed-Dose Combination (FDC) regimen with separate drugs for treatment of pulmonary and extra pulmonary tuberculosis in Gorgan, Iran. This study is a quasi-experimental study in 528 patients with tuberculosis during the 2012-2013. In line with the national implementation of the care and treatment of tuberculosis, Patients were divided into two groups Fixed-Dose Combination (n=257) regimen compared with separate drugs (n=271) and treatment outcome in the two groups were compared. The data was analyzed by multinomial logistic regression using SPSS16 software. Of the 528 patients assessed for eligibility, 257 satisfied the inclusion/exclusion criteria and were assigned to a Fixed-Dose Combination regimen group (51% male, mean age of 19.6 years); 271 patients (52.4% male, mean age of 20.3 years) in the separate drugs group. There were no significant differences in Age, sex, living place and status of imprisonment between groups (P>0.05). Difference between the treatment outcome in the fixed-dose combination group and the separate drugs group (P<0.001). International standards for the treatment of tuberculosis are recommended to use Fixed-Dose Combination regimen of drugs. Findings suggest that Fixed-Dose Combination of anti-TB drugs have a more favorable treatment outcome than the separate drugs.

The symptoms of infections caused by Toxoplasma gondii range from asymptomatic or mild to severe infection in pregnant women, which results in severe congenital infection, abortion or fetal still birth. The aim of this study was to assess the risk factors and seroepidemiology of toxoplasmosis in pregnant women in their first trimester in Bandar Abbas. This cross-sectional study was conducted on 600 pregnant women who were in their first trimester. Demographic data and risk factors were collected using a questionnaire. Also, blood samples were taken from each subject to detect IgM and IgG antibodies by ELISA method. Data was entered into the SPSS 16 software and descriptive statistics, chi-square and t- test were used for analysis. The mean age of the participants was 26.7± 5.89 years. IgG seropositivity was 41.93%. No significant difference was seen in housewives and working women (p=0.221). No significant relation was seen between seropositivity and parity (p=0.06). No significant relation was seen between gardening, owning a cat and consumption of raw or undercooked meat and seropsitivity (p>0.05), and only raw eggs consumption was significantly related to serpositivity (p=0.032). No significant correlation was seen between abortion and seropositivity (p=0.138), however, still birth had a significant correlation with seropositivity (p=0.049). According to the results, public education about toxoplasmosis transmission and lab testing before pregnancy may be effective in preventing congenital toxoplasmosis.