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Identifying and determining the origin of the first human case of COVID-19, which has caused pandemic will be of great benefit in preventing and controlling next epidemics and pandemics. The first confirmed case of COVID-19 was reported in December 2019 in China. This article reports three cases of pneumonia compliant with COVID-19 admitted to Qaemshahr Razi Hospital in Mazandaran province, Iran before the first official report of confirmed case of the disease (November-December 2019). The pattern of radiological involvement was completely consistent with COVID-19 in all three patients. Two patients died of acute progressive respiratory failure despite supportive respiratory therapy and systemic corticosteroids, and the other patient recovered. Study of these cases highlights the fact that emerging and re-emerging diseases should be considered in management of patients with infection and unusual symptoms. [ABSTRACT FROM AUTHOR]

Background and purpose: Hepatitis B virus (HBV) is a major global health problem. The prevalence of HBV infection varies throughout regions of the world. More than 350 million people live with chronic HBV infection and many different clinical symptoms are associated with it. Long-term complications of HBV infection lead to cirrhosis of the liver and hepatocellular carcinoma. Consequently, 0.5-1.2 million death occurs every year. However, early diagnosis and appropriate treatment could reduce such complications. This study intended to investigate the correlation of serum concentrations of HBVDNA and HBeAg with liver enzymes. Materials and methods: In this cross-sectional study, serum samples of 146 chronic hepatitis B patients were studied. They referred to RaziTeaching Hospital, Qaemshahr, from 2007 to 2009. The subjects were assessed regarding HBV-DNA, HBeAg and ALT enzymes. The patients' serum was extracted and Real Time PCR test was performed using HBV RG Kit (Nov in Gene). Afterwards, the patients' medical records were studied and the data was analyzed using Pearson correlation coefficient and t-test in SPSS. Results: From the total of 146 patients, 94 were found negative HBeAg and 52 were HBeAg positive. No correlation was seen between HBV-DNA level and AST enzyme, while there was a significant relationship between HBV-DNA level and ALT enzyme. Conclusion: ALT enzyme is a reliable indicator for severity of liver involvement even in negative HBeAg stages and hidden period of the disease. Hence, the serum levels of HBV-DNA and ALT should be measured in such individuals before developing liver cirrhosis and thereby starting immediate antiviral therapy. [ABSTRACT FROM AUTHOR]

Acute rheumatic fever is an acute systemic disease due to autoimmune reaction against some of BHSA. Similarity between bacterial antigens and cardiaciovascular tissue, synovial membrane, joints and subcutaneous tissues and cerebral basal ganglions are the causes of autoimmune reactions and manifestation of the disease. Most of the ARF occur in children (5-14 years old) followed by streptococcal pharyngitis and the disease is very rare in adults. Sydenham's chorea is a late manifestation of ARF and one of the John's diagnostic criteria that is usually revealed when the other criteria are absent. There is often a long latent period between clinical manifestations of the ARF and the onset of chorea as an uncommon initial presentation of acute rheumatic fever. We report the clinical findings, investigations and the course of clinical development of a seventeen-year-old girl, who presented with acute onset of abnormal involuntary movements in her right hand for two days before her admission. She had sore throat and fever three weeks before development of these new problems. Her complaints disappeared with proper treatment. The considerable findings in this case report was co-incidence of Sydenham's chorea with erythema marginatum, fever, severe mitral valve insufficiency, arthralgia in an adult patient that is a very rare case. She was discharged after a 10-day treatment regime. [ABSTRACT FROM AUTHOR]

Background and purpose: This study evaluated the awareness of general practitioners (GP) in Mazandaran province on diagnosis, management and prevention of cholera. Materials and methods: In a prospective study, 156 GPs were randomly selected to complete a questionnaire containing 15 questions through face to face interviews. Results: The study population was 68 (43.6%) female and 88 (56.4%) male with the mean age of 42±7.8 and 40±5.8 years, respectively. Awareness level of GPs about cholera was moderate in 89 (57.1%) and good in 48 (30.8%). The awareness about diagnosis of cholera was good, moderate and poor in 23%, 69.9% and 7.1%, respectively. Also, 17.3%, 71.8%, and 10.9% of GPs had a good, moderate and poor (respectively) awareness level on treatment of cholera. The awareness level of GPs about prevention of cholera was good, moderate and poor in 26.3%, 59% and 14.7%, respectively Conclusion: Moderate level of awareness of GPs on cholera signifies the need for more planning to control such epidemic diseases. [ABSTRACT FROM AUTHOR]

Background and purpose: Leptospirosis is the most widespread zoonosis in the world which is endemic in Mazandaran province. Early diagnosis of leptospirosis based on clinical & laboratory findings is relatively difficult due to lack of characteristic pathogonomic features. General physicians are the first line of patients' admission. The main purpose of this study was to determine the level of awareness among general physicians on leptospirosis in Mazandaran province. Materials and methods: In a cross sectional study, 400 general practitioners including 281(70.25%) male and 119 (29.75%) female were chosen. They completed a questionnaire containing 15 questions within 30 minutes. Results: The level of awareness was found good among 66% of the subjects. No significant relation was observed between age and sex of the physicians and their knowledge of leptospirosis. The best information was about the routs of transmission and prevention of leptospirosis. Conclusion: This study demonstrated a low level of awareness among general practitioners, therefore, it is necessary to perform more re-education programs. [ABSTRACT FROM AUTHOR]

Background and purpose: Hepatitis C Virus (HCV), one major factor causing chronic liver disease, has been classified into six major genotypes based on the variation in the genome sequencing. Various genotypes of this virus are associated with the intensity of liver tissue changes in patients with hepatitis C. Therefore, this study aims to investigate the relationship between the HCV genotypes and liver damages. Materials and methods: This cross-sectional study was conducted on 86 HCV positive patients referring to Razi University Hospital in Qaemshahr from 2007 to 2010. Real time polymerase chain reaction (RT-PCR) test was employed in order to determine the genotypes of HCV. Moreover, histological activity index of the biopsy (Knodell score) was calculated through staining and the amount of ALT and AST Sera were measured. Results: Among the samples taken from the patients under study, 3a genotype was seen in 58.2% and 1a/b genotype existed in 41.8% of them. The mean serum levels of AST and ALT were 89.5 ± 60.8 and 103.7 ± 79.4 IU/lit, respectively. The histological activity index in 13.1% was at low level, in 41% at moderate level, and in 45.9% at high level. No significant difference was observed in the mean scores of Knodell in different HCV genotypes (P<0.05), while there was a positive correlation between AST and ALT level and the mean score of Knodell (P<0.05). Conclusion: The findings of this study indicated that there was no significant correlation between HCV genotype and histological activity index of the patients. However, the serum levels of AST and ALT increased with the increase in the histological activity index. [ABSTRACT FROM AUTHOR]

Background and purpose: Influenza is a respiratory infection that annually affects 5-15% of the global population. Influenza A/H1N1 is the most virulent human pathogens that results in a more severe disease and was first reported in 2009. The aim of this study was to investigate the epidemiology of influenza A/H1N1 in patients referring to several hospitals in North of Iran during 2009-2011. Materials and methods: This descriptive cross-sectional study was done on patients with symptoms of influenza using Real-Time PCR analysis. Results: The patients included 572 (41.97%) male and 791 (58.03%) female. The prevalence of influenza A/H1N1 was seen more in patients aged 21-30 (25%) years. In this study, 205 patients (15.4%) were diagnosed with influenza A/H1N1 including 94 (54.85%) male and 111 (54.15%) female. Influenza A/H1N1-associated death was seen in five patients (2.44%). Conclusion: Influenza A viruses are constantly evolving by mutation or by reassortment. The influenza virus evolves rapidly, and new strains quickly replace the older once, therefore, new vaccines should be developed for immunization against new strains of influenza. [ABSTRACT FROM AUTHOR]

Leptospirosis is a zoonotic disease in nearly all parts of the world, especially in tropical and subtropical areas and is prevalent in hot and humid areas. Particularly in the northern provinces of Caspian Sea in Iran by having mild and wet weather conditions, this disease is more spread to other parts of the country. Today, with evolution of the Leptospira, disease from traditional village that enhance its prevalence among farmers and fishing, modified to epidemics in urban communities that do not have good health. Thus the purpose of this review is epidemiology, prevention, diagnosis and treatment of leptospirosis. Prevalence of the disease in each zone depends on climate, geography, population, domestic and wild animals, and the abundance of surface water. Laboratory diagnosis of leptospirosis important and Micro Agglutination Test (MAT) in the diagnosis of disease is Valuable. Molecular tests such as PCR can be used in early detection of disease particularly when there are no specific antibodies. ELISA tests are also important in early screening. Disease prevention will be Possible by increasing awareness of the people at risk, regional health systems employees, and prevention from human contact with contaminated materials and vaccination of livestock and animals. [ABSTRACT FROM AUTHOR]

Background and purpose: Psychiatric disorders as a chronic illness lead to the exacerbation of physical symptoms and controlling them is very difficult. Respiratory chemical damaged veterans have many different psychiatric problems and low health-related quality of life. In this study, we evaluated the relations of spirometry parameters and health- related quality of life with mental health. Material and methods: This was a descriptive- co relational study done on 41 respiratory chemical veterans (Iran-Iraq war) selected with randomized available sampling in Tehran City. We used Spirometry test, St. George's Respiratory Questionnaire (SGRQ) & General Health Questionnaire (GHQ) for assessing the patients and Pearson's correlation matrix for analyzing the data. Results: There were significant negative correlations between the total score of GHQ and depression subscale with FVC & FEV1. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with total score of SGRQ. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with "symptoms" score of SGRQ. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with "impacts" score of SGRQ. Conclusion: Poor mental health condition with increased level of depression & anxiety leads to the decrease in FVC & FEV1 in spirometry and health-related quality of life, and increase in respiratory symptoms such as cough, breathless and sneezing. Totally, there were significant correlations between spirometry and health-related quality of life with mental health. It seems that in rehabilitation programs for mustard gas exposed veterans with chronic respiratory diseases, the psychological and psychiatric interventions should be considered. [ABSTRACT FROM AUTHOR]

Background and purpose: Hyponatremia is the most common electrolyte disorder in hospitalized patients and different report exists about its prevalence. This study aimed at determining the frequency of hyponatremia and its associated factors in hospitalized tuberculosis (TB) patients in Razi hospital, Iran. Materials and methods: This cross-sectional study was done using the existing data and the study population included all TB patients admitted in Razi Hospital during 2006 to 2011. TB was diagnosed based on clinical symptoms, positive sputum culture, positive radiographic finding and anti TB treatment. Variables included level of Na, age, sex, and drug regimen (standard / second line). Hyponatremia were sodium levels less than 135 in two consecutive tests. The data was analyzed by SPSS and Chi-square test. Results: The cases were 200 TB patients including 115 (57.5%) male. The mean age of patients was 51.2 ± 20.8 years. Hyponatremia was seen in 36(18%) patients (CI 95%: 12.6% -23.4%). Distribution of mortality was not significantly different in patients with and without hyponatremia (P>0.05). No significant difference was seen in frequency of hyponatremia according to the type of tuberculosis. Conclusion: Hyponatremia was considerably higher in patients with TB which should receive more attention for proper management and follow up. [ABSTRACT FROM AUTHOR]