فهرست مطالب shahla afrasiabian

Q fever is a contagious zoonotic disease which is caused by a gram-negative and intracellular Cocco-bacillus known as Coxiella burnetii ticks play a role in its transmission. Endocarditis is the most common consequence of chronic Q fever.

Here we report a case of endocarditis caused by Q fever. The patient is a 67-year-old, and she had coronary artery bypass graft (CABG) and aortic valve replacement surgery.

The result of echocardiography showed a suspicious mass (Vegetation) on the implanted valve. Based on la-boratory and clinical assessments, endocarditis caused by C. burnetii was the final diagnosis.

Q fever is a tick-transmitted pathogen that has been known as an important cause of culture-negative en-docarditis in Iran, and more attention needs to be paid to this disease in Iran by the healthcare system and physicians.

 The emergence of antimicrobial-resistant pathogens in intensive care units (ICU) makes treatment of these infections very difficult.

 This study aimed to survey the resistance phenotype, risk factors, and possible treatment options for hospital-acquired infections (HAI) at ICUs in a referral university hospital.

 Samples were prepared from ICU patients with HAIs. Pathogens were isolated, and the resistance phenotype, prescribed antibiotics, mortality rate, associated risk factors, and clonal relationship of the isolates were assessed.

 From 100 patients admitted to ICUs, 76 (76%) showed clinical symptoms of HAIs. The most common sources of infection were lung secretions (51.8%). The isolated bacteria were Gram-negative (77, 90.6%) and Gram-positive (9.4%). The most common isolated microorganism was the Acinetobacter baumannii complex (63.5%). The most effective antimicrobials were colistin (96.1%) and linezolid (100%) for Gram-negative and Gram-positive isolates, respectively. An extensively drug-resistant (XDR) phenotype was documented in all isolates of A. baumannii, Pseudomonas aeruginosa, and Serratia marcescens. The XDR phenotype was a significant risk factor only for mortality. A. baumannii had the highest mortality rate (66.6%) among all the isolates. While A. baumannii strains had limited diversity, the other species were highly divergent.

 The results revealed a high mortality rate for Gram-negative isolates, especially in adenosine triphosphate-binding cassette (ABC). The high genetic similarities of ABC strains might be an indication of neglecting infection control prevention. The use of cotrimoxazole and colistin instead of carbapenems can be promising for mortality reduction in the studied ICUs.

The neutrophil-to-lymphocyte ratio (NLR), obtained from a peripheral blood sample, is considered an indicator of subclinical inflammation. The aim of this study was to determine the NLR pattern in the deceased and survivor patients with coronavirus disease 2019 (COVID-19) during hospitalization.

This was a cross-sectional analytical study that was performed in TohidHospital in Sanandaj, Iran, from March to July 2021. In our study, 30 patients had received the treatments for COVID-19 and did not need to be admitted to the intensive care unit (ICU). They were discharged from the hospital and considered "Group A". Besides, 21 patients who were admitted to the ICU but were discharged were considered "Group B". Finally, 40 patients with COVID-19 who were hospitalized in the ICU and died were considered "Group C". Complete blood count (CBC) test was performed for all patients at 3 different times (at the time of admission, mid-hospitalization, and the last day of hospitalization). In the end, the data were analyzed by one-way analysis of variance (ANOVA) and the Kruskal-Wallis H test.

91 patients were included in this study. The NLR index during hospitalization in Group C was significantly higher than in Group B and in Group B was significantly higher than in Group A. On the other hand, in Group C, the NLR was significantly increased at three consecutive times during hospitalization; however, in Group B and Group A, at the end of hospitalization, this ratio was lower than in mid-hospitalization.

The NLR was an important indicator in predicting patients' prognoses. Pulmonary inflammation in patients with COVID-19 will be accompanied dominantly by neutrophils; thus, the NLR parameter could be important in the progress of the clinical status.

Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures.

CASE REPORT:

We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died.

All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall

Anthrax is a zoonotic infectious disease that is still considered as a health problem in developing countries. Therefore, the aim of this study was to investigate the incidence and geographical distribution of anthrax using the Geographic Information System (GIS) and predict its incidence in Iran in 2021.

This study is descriptive analytical study. Information on anthrax was obtained from the Center for Communicable Diseases Control during 2010-2015. In the next step, ArcGIS 9.3 was used to prepare geographic maps of the disease incidence and frequency. Therefore, using the Raster Calculator tool, the disease prediction map was drawn.

The highest incidence of anthrax during 2010-2015 was observed in the provinces of Kurdistan, North Khorasan, and Chaharmahal and Bakhtiari, respectively. The trend of the incidence of anthrax in Iran had increased from 2010 to 2013, while its incidence decreased in 2014. Based on the results of modeling in Iran, the provinces of Kurdistan, West Azarbaijan, Tehran, and Zanjan, respectively, with 37.16%, 33.83%, 16.78%, and 10.49% of their area (km²) had the highest risk of anthrax disease in the country in the year 2021.

Since the provinces of Kurdistan, West Azerbaijan, Tehran, and Zanjan are among the high-risk areas in the country in the coming years, the cooperation between the veterinary organization and the health care system and the vaccination of livestock in these areas can significantly help to control and prevent the disease.

Brucellosis is a zoonotic disease that is caused by the Brucella species. This disease is common in Iran and its incidence is increasing .This study measures serum vitamin D levels in patients with brucellosis and healthy people.

This research was conducted as a case-control study at Tohid Hospital, Sanandaj, Iran. The calculated sample size included 90 patients in the case group and 90 patients in the control group. The measurement of vitamin D levels in the case and control groups were performed by ELISA.

The mean serum vitamin D level was 19.91 ng/ml in the case group and 22.87 ng/ml in the control group. (Serum vitamin D level <10 ng/mL is accepted as deficiency, 10-30 ng/mL as insufficiency, 30-100 ng/mL as sufficiency, and >100 ng/mL as toxicity).

There was no significant difference between the two groups in terms of vitamin D deficiency (p-value=0.097).

Extended-spectrum β-lactamases (ESBL) is present in drug-resistant enterobacteriaceae that is causing many epidemics in hospitals of developing countries; it remarkably limits therapeutic options and increases the rate of motility and morbidity. In order to choose the most appropriate treatment for urinary tract infections (UTI), it is necessary to know its risk factors. The aim of the present study is assessment of risk factors, and antibiotic resistance pattern of Escherichia coli (E. Coli) with ESBL (ESBL-EC) in the patients with UTI in west of Iran.

This case-control study was conducted on patients with UTI referred to Sanandaj Tohid Hospital in Iran during March 2015 to March 2017, who had positive E. coli culture.they were divided into two groups of case (posetive ESBL-EC) and control (negative ESBL-EC) . Demographic data and risk factors findings were compared in the two groups. Using disk diffusion method. Antibiogram test was performed. SPSS software version 21 was used to analyze the data and p ˂0.05 was considered as the significant level.

98 patients with UTI and positive E. coli cultures (49 case and 49 control) were evaluated . Risk of UTI induced ESBL-EC was increased 3.33 times in patients with urinary catheterization in the last 12 months (OR = 3.33; 95% CI: 1.33 – 8.35; p = 0.010).

Based on the findings of this study, urinary catheterization in the last 12 months increased the risk of UTI induced ESBL-EC and cotrimoxazole and ciprofloxacin should not be administered for treating E. coli-induced UTI in Sanandaj.

Zinc deficiency can increase the risk of infectious diseases. Given that recurrent urinary tract infection is a common complication, this study examines the association between serum zinc levels and recurrent urinary tract infections.

In this case-control study, serum zinc levels for 48 patients with recurrent urinary tract infections were compared with the serum zinc levels of the same number of people in the control group who were matched in terms of location and age. Using SPSS ver. 18, univariate analysis was performed through t-test, correlation coefficient; and multivariate analysis was carried out through multiple regression tests. Significant level was considered as less than 0.05.

There was a weak correlation between age and serum zinc level (r=-0.205, p=0.045). Mean serum zinc level of the test group and the control group were 96.83 (±11.25) and 76.72 (±17.06) microgram/deciliter (p=0.001), respectively. Level of zinc reduced with aging; in addition, the group with recurrent UTIs had lower zinc levels than the control group (p=0.010, R2=0.377).

According to the results of this study, serum zinc levels of people with recurrent urinary tract infections were lower than that in the control group. It seems that zinc levels are a risk factor for recurrent urinary tract infections.

The aim of this study was to evaluate the status of the appropriate use of antibiotics by type, dosage, and length of treatment and the route of administration in Tohid teaching hospital, Sanandaj, Iran.
In a retrospective descriptive study, 400 patients were systematically selected from patients receiving antibiotics hospitalized in Tohid hospital from March 2016 to March 2017. Demographic characteristics, hospitalization ward, diagnosis, antibiotic prescribed, dosage, length of treatment, the route of administration, and prescribing physician were recorded. The treatments were compared with standard treatment based on Harrison reference. The data were analyzed using STATA software.
Out of total patients, 54% were men and 46% were women with a mean age of 57.87 ± 9.87 years. The mean duration of hospitalization was 6.37 ± 2.69 days. More and less numbers of patients were admitted in the internal medicine ward (23.75%) and intensive care unit (ICU) (1.00%), respectively, The highest antibiotics were administered by internal medicine specialists (40.25%), the most commonly prescribed antibiotic was ceftriaxone (34.59%), and the most common cause of antibiotic therapy was pneumonia (20.50%). Out of 595 antibiotics prescribed, 28.50% of the administrations were inappropriate. In addition, the objective for the prescription of the first and second antibiotic was inappropriate in 27.50% and 33.70% of cases, respectively. Dosage, route of administration, and the length of treatment of the prescribed antibiotic was inappropriate in 9.00%, 0.50%, and 41.00% of cases, respectively. The highest and lowest rate of inappropriate antibiotic prescription was observed in surgical (51.31%) and infectious diseases (12.90%) wards.
Due to the increase inappropriate administration of antibiotics, it is necessary to train the specialists about the planning, appropriate medical consultations for antibiotic therapy, and limitation of the new antibiotics prescription.

Pneumococcal endocarditis is an uncommon disease. Here, we describe a case of endocarditis caused by Streptococcus pneumoniae in a young man following a nose trauma. In traumas that involve the respiratory system and the mucous membrane, bacterial complications such as colonization and bacteremia and end-organ involvement should be considered by physicians.

Kikuchi-Fujimoto disease is an uncommon, benign, autoimmune condition characterized by lymphadenopathy, fever, and neutropenia. It is a self-contained condition of unidentified etiology. A 38-year-old female of Iranian Kurdish origin referred to us with multiple neck swellings, fever, and generalized arthropathy. There was no weight loss and no history of tuberculosis, medication intake, or allergy. Clinical examination revealed bilateral large, mobile, and tendercervical lymphadenopathy. Cardiovascular, respiratory, and neurological examination was normal. The patient had leucopenia and thrombocytopenia.Kikuchi-Fujimoto disease must be considered in the differential diagnosis of a female patient with fever and cervical lymphadenopathy.

Human Brucellosis still challenges many physicians, especially in developing countries where it is still a very common, but sometimes ignored disease. Its reemergence in developed countries and its status as a class B bioterrorist agent has recently attracted much interest. Having over 500,000 new cases annually, Brucellosis is known as one of the most common zoonotic infections in the world and “the great imitator” because of many clinical and hematological manifestations. Brucellosis is still endemic in many developing countries and remains under-diagnosed and sometimes missed reported. Although this province (Kurdistan, Iran) is a Brucella endemic area with a very high prevalence and incidence rate, except for very few and negligible case reports, we did not find any reports or epidemiological study regarding this zoonotic infection. This is the first reported case of Brucellosis with pancytopenia from this western province of Iran which has been neglected. Our case was a 16-year-old girl referred with protracted fever during the last month and undetermined diagnosis. She also suffered from generalized pain, pale skin, sweating, anorexia, and weight loss. After clinical surveying, taking history, and physical examination, Brucella infection was suspected. Diagnosis confirmed by standard tube agglutination test (STA), 1/640. The patient was successfully treated with doxycycline, rifampicin, and ceftriaxone.

Leprosy is an infectious disease causing irreversible disability if unnoticed. A 69-year-old man with undetected leprosy from 30 years ago referred to us with claw hand and Madrosis (Milphosis). The patient complained of non-healing and painless ulcers on the extremities as well as numbness in the right leg. He told the medical team that he could not feel his feet in his shoes. The patient had blurred vision and lacrimation two weeks before admission. He had a history of recurrent foot ulcers from 25 years ago although he referred to medical staff about 5 years ago with infected wound on the hands and multiple scars of pervious ulcers. The disabilities were mainly in consequence of late visit to healthcare centers, misdiagnosis, difficult access to medical centers and patient''s unawareness. The case showed the significance of medical education and public awareness for signs and symptoms of leprosy to be recognized and treated on time. In conclusion detecting leprosy should not be delayed just because of a decrease in the number of cases especially in an endemic area like Kurdistan, Iran.

In some studies, the level of adenosine deaminase (ADA) in sputum and effusion liquids was used for the diagnosis of tuberculosis (TB). But it is not always possible to access these materials. The goal of this study is to assess the diagnostic value of serum ADA levels in pulmonary TB patients. In this study, 40 sputum smear-positive TB patients who were hospitalized and 40 non-TB patients who referred for surgeries were selected. A serum sample was collected and serum ADA level was measured by ADA kit. The average (SD) of serum ADA in TB and non-TB patients were 20.88 (±5.97) and 10.69 (±2.98) U/L, respectively (P value < 0.05). The best cut-off point was 14 U/L. The calculated area under the receiver operating characteristic (ROC) curve was 0.955 (95% CI, 0.914-0.995); sensitivity was 92.7% (95% CI, 84.7-100) and specificity was 88.1% (95% CI, 78.3-97.8) (P < 0.001). Serum ADA level may be proposed as a proper index for TB diagnosis.