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Background and purpose: In late December 2019, pneumonia originating from nCOV-2019 spread rapidly around the world, and in March 2020, the World Health Organization officially declared it a pandemic and chose the name "COVID-19" for the resulting disease. A significant proportion of COVID-19 patients experience severe pulmonary complications and life-threatening conditions that necessitate respiratory support and admission to the intensive care unit (ICU). Since the detection of the first case of COVID-19 in Iran, the country has experienced several waves, with different strains of the coronavirus prevailing in each wave. According to the studies conducted in this field, in the first wave, the alpha strain (B.1.1) 7), the second wave of the beta strain (B.1.351), the third wave of the gamma strain (P.1), the fourth wave of the delta strain (B.1.617.2) and in the fifth wave the Amicron strain (B.1.1.529) of the strain were dominant in patients. This study aims to evaluate the clinical and paraclinical findings, as well as the outcomes, of COVID-19 patients admitted to the intensive care units at a referral teaching hospital in northern Iran during the first through fifth waves of the pandemic. Materials and methods: This research is a descriptive-analytical retrospective study that was conducted on all patients with COVID-19 who were hospitalized in the ICU of Razi Qaemshahr Hospital (Infectious Diseases Referral Center of Mazandaran Province) in first to fifth waves. Personal information, underlying diseases, time from the onset of symptoms to a hospital visit, laboratory tests, and length of stay of the patient in the intensive care unit was collected through dossier reading and spss25 software was used for statistical analysis. Results: Out of the 304 patients admitted to the ICU during the first through fifth waves of the COVID-19 outbreak, 50.3% were male. The age range of the patients was from 22 years to 98 years with an average of 65.14±15.08. 244 patients had at least one underlying disease. So 41% of the patients had diabetes and 50% had blood HTN. Among 244 patients with underlying disease, only 28 patients recovered and 216 patients died, which difference was significant (P=0.01). The second wave had the highest number of patients (25.7%), while the third wave had the lowest (16.4%). The average hemoglobin level differed significantly between the second and fourth waves, being 1.37 units lower in the fourth wave. The mortality rates varied significantly across the different waves (P

Background and purpose: Although various vaccines have been produced to provide immunity against COVID-19, these vaccines do not provide lifelong immunity, and over time, their level of immunity diminishes. Considering that at least 50% of the population must be immune to prevent the chain of transmission of COVID-19, we conducted this study to measure the level of immunity against this virus after at least 6 months of the third dose injection among the employees of Razi Hospital, Qaimshahr. Materials and methods: In this analytical observational study, the blood samples of 88 volunteers were used to determine the SARS-Cov-2 RBD antibody. The 18-item self-report questionnaire of the side effects of the COVID-19 vaccine was provided to the participants. Statistical analysis was done with SPSS software (version 0.24). Results: The mean age of the participants was 41 years, and men and women accounted for 36.36% and 63.63% of the samples, respectively. The youngest participant was 23 years old, while the oldest was 72 years old. Comorbidities were found in 21% of the participants. Among the 88 participants, 98.86% had antibody levels higher than the cut-off, which was 5 (RU/ml). Systemic side effects of the third dose included fever (46.5%), myalgia (25%), as well as local reactions of pain (29.5%) and redness (6%). The systemic side effects of the fourth dose were fever (22%), myalgia (12%), and the local reactions were injection site pain (42%) and redness (4%). Conclusion: No significant relationship was found between the investigated variables and the antibody level. However, it was observed that humoral immunity against COVID-19 was present in most of the injectors after 6 months from the third dose injection.

Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Materials and methods: In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Results: A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13±22.63 years old. The mean time of symptom onset to hospital admission was 15.13±30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients’ outcomes, only underlying diseases were significantly associated with death. Conclusion: Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Materials and methods: In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Results: The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion: COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.

Background and purpose: Violet is a plant that has received interest in complementary medicine due to its anti-inflammatory, antipyretic, and antimicrobial effects. Fever is one of the major symptoms of COVID-19. This study was conducted to determine the effect of violet extract in the form of syrup on fever in patients with COVID-19. Materials and methods: In this randomized clinical trial, 52 patients with COVID-19 were studied in Intensive Care Unit in Amol Imam Khomeini Hospital (2021). In intervention group in addition to an injection of acetaminophen, 5 cc of violet extract syrup prepared from the aqueous extract of the plant was taken. The temperature was recorded after 30 and 60 minutes and four hours. The follow-up of the patients continued for three days and the temperature was recorded every six hours. Results: There was a significant difference between the intervention group (36.84±0.37) and control group (37.13±0.62) in mean temperature at second time in second day of follow-up (P=0.04). Also, the mean temperature was found to be significantly different between the two groups at 30 (P=0.001) and 60 minutes (P=0.05) after the intervention. At other groups, there was no significant difference between the intervention and control groups. Conclusion: The aqueous extract of violet plant in the form of syrup reduces fever in patients with COVID-19 causing no complication. Due to the ease of access to this herbal product, it can be used to prevent problems caused by fever. (Clinical Trials Registry Number: IRCT20150916024047N6)

Background and purpose: The COVID-19 pandemic resulted in an uncontrolled disease burden on healthcare workers (HCWs) worldwide. We aimed to investigate the prevalence and severity of COVID-19 in HCWs of selected hospitals in Mazandaran province and examine the association between COVID-19 and missed opportunities of HCWs. Materials and methods: In this retrospective descriptive-analytical study, 1105 HCWs in Qaemshahr Razi Hospital and Sari Fatemeh-Zahra Hospital were studied between February 2020 and June 2020. In order to evaluate the frequency and severity of the disease, clinical and paraclinical manifestations were recorded by a trained HCW. Data were analyzed in SPSS V18. Results: The frequency of COVID-19 was 16.19% among HCWs. The patients included 113 (63.13%) nurses, 47(26.26%) service providers and administrative personnel, and 19(10.61%) physicians. Duration of sick leave was found to be significantly associated with severity of COVID-19 (P=0.006). This length was also significantly associated with the job and was longer in nurses (P=0.013). Our findings revealed a significant relationship between the level of adherence to personal protective equipment (PPE) and the severity of COVID-19 (P=0.001). Conclusion: COVID-19 could exert remarkable impact on the quality of work in HCWs, especially among nurses. Effective training of HCWs regarding PPE instructions results in suitable protection against severe forms of the disease.

Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Materials and methods: In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Results: A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13±22.63 years old. The mean time of symptom onset to hospital admission was 15.13±30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients’ outcomes, only underlying diseases were significantly associated with death. Conclusion: Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.

Background and purpose: Violet is a plant that has received interest in complementary medicine due to its anti-inflammatory, antipyretic, and antimicrobial effects. Fever is one of the major symptoms of COVID-19. This study was conducted to determine the effect of violet extract in the form of syrup on fever in patients with COVID-19. Materials and methods: In this randomized clinical trial, 52 patients with COVID-19 were studied in Intensive Care Unit in Amol Imam Khomeini Hospital (2021). In intervention group in addition to an injection of acetaminophen, 5 cc of violet extract syrup prepared from the aqueous extract of the plant was taken. The temperature was recorded after 30 and 60 minutes and four hours. The follow-up of the patients continued for three days and the temperature was recorded every six hours. Results: There was a significant difference between the intervention group (36.84±0.37) and control group (37.13±0.62) in mean temperature at second time in second day of follow-up (P=0.04). Also, the mean temperature was found to be significantly different between the two groups at 30 (P=0.001) and 60 minutes (P=0.05) after the intervention. At other groups, there was no significant difference between the intervention and control groups. Conclusion: The aqueous extract of violet plant in the form of syrup reduces fever in patients with COVID-19 causing no complication. Due to the ease of access to this herbal product, it can be used to prevent problems caused by fever. (Clinical Trials Registry Number: IRCT20150916024047N6)

Background and purpose: Recently, due to the reduction of hepatitis A in Iran there are people with low or no Hepatitis A Virus- Antibody (HAV-Ab), therefore, people at Arbaeen Pilgrimage are at risk for hepatitis A. This study aimed at examining HAV-Ab in pilgrims traveling from Mazandaran province, Iran to Karbala in 2018. Materials and methods: This cross-sectional study was performed in 200 people selected from 40,000 pilgrims in Mazandaran province. Serum samples were evaluated for presence of HAV-Ab and data for demographic characteristics and history of hepatitis A immunity were recorded. Data analysis was performed in SPSS V16. Results: The participants were 137 (68.5%) males and 63 (31.5%) females. Positive and negative HAV-Ab were seen in 156 (78%) and 44 (22%), respectively. Mean ages of people with positive and negative HAV-Ab were almost similar (50 years and 47 years, respectively). HAV-Ab status was found to be significantly associated with job (P0.05). Conclusion: Twenty-two percent of people who were travelling to Karbala had no HAV-Ab, which is significant because the risk of developing fulminant hepatitis increases in adults, therefore, vaccination of Karbala pilgrims for hepatitis A virus is suggested.

Background and purpose: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that was first reported in December 2019 in China and spread rapidly around the world. The aim of this study was to compare clinical and laboratory findings and disease outcome between survived and deceased COVID-19 patients admitted to Qaemshahr Razi Hospital, Iran. Materials and methods: In this retrospective study, demographic, clinical, paraclinical, and treatment information of hospitalized COVID-19 patients were analyzed. Logistic regression analysis was performed using SPSS V25. Results: Among 1013 COVID-19 patients, 145 (14.3%) died. Mortality rate was significantly higher in patients older than 65 years of age (54.5%) (P= 0.0001). Comorbidities was seen in 631 patients (62.4%). Mortality rate was significantly higher in patients with hypertension (P= 0.005), diabetes (P 250 (U/L) (P

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.

Background and purpose: This research aimed at investigating the effect of herbal medicine on reduction of pulmonary complications in patients with Coronavirus disease 2019 (COVID-19). Materials and methods: Forty patients with COVID-19 infection older than 18 years of age (60% men) with the average age of over 55 years old enrolled in this study. Written consent was obtained and participants with the following symptoms were divided into experimental group and control group: body temperature higher than 38℃, lymphocyte counts of less than 1200, positive CRP, respiratory symptoms, and pulmonary involvement in lung CT scan. The control group was treated with 400 mg Kaletra® and 200 mg hydroxychloroquine oral every 12 hours, and the experimental group, in addition to this regimen, received 5 ml of a herbal medicine (consisting of Satureja hortensis L., Hypericum perforatum L. and Foeniculum vulgare L.) three times a day. Statistical analysis was done in SPSS applying Chi-square test and t-test. Results: The herbal medicine was found to be significantly effective in decreasing the time of hospitalization and recovery from the disease (8.5 days in control group vs. 5 days in experimental group, (P

BackgroundIvermectin which was widely considered as a potential treatment for COVID-19, showed uncertain clinical benefit in many clinical trials. Performing large-scale clinical trials to evaluate the effectiveness of this drug in the midst of the pandemic, while difficult, has been urgently needed.MethodsWe performed two large multicenter randomized, double-blind, placebo-controlled clinical trials evaluating the effectiveness of ivermectin in treating inpatients and outpatients with COVID-19 infection. The intervention group received ivermectin, 0.4mg/kg of body weight per day for 3 days. In the control group, placebo tablets were used for 3 days.ResultsData for 609 inpatients and 549 outpatients were analyzed. In hospitalized patients, complete recovery was significantly higher in the ivermectin group (37%) compared to placebo group (28%; RR, 1.32 [95% CI, 1.04–1.66]; p-value = 0.02). On the other hand, the length of hospital stay was significantly longer in the ivermectin group with a mean of 7.98 ± 4.4 days compared to the placebo receiving group with a mean of 7.16 ± 3.2 days (RR, 0.80 [95% CI, 0.15–1.45]; p-value = 0.02). In outpatients, the mean duration of fever was significantly shorter (2.02 ± 0.11 days) in the ivermectin group versus (2.41 ± 0.13 days) placebo group with p value = 0.020. On the day seventh of treatment, fever (p-value = 0.040), cough (p-value = 0.019), and weakness (p-value = 0.002) were significantly higher in the placebo group compared to the ivermectin group. Among all outpatients, 7% in ivermectin group and 5% in placebo group needed to be hospitalized (RR, 1.36 [95% CI, 0.65–2.84]; p-value = 0.41). Also, the result of RT-PCR on day five after treatment was negative for 26% of patients in the ivermectin group versus 32% in the placebo group (RR, 0.81 [95% CI, 0.60–1.09]; p-value = 0.16).ConclusionOur data showed, ivermectin, compared with placebo, did not have a significant potential effect on clinical improvement, reduced admission in ICU, need for invasive ventilation, and death in hospitalized patients; likewise, no evidence was found to support the prescription of ivermectin on recovery, reduced hospitalization and increased negative RT-PCR assay for SARS-CoV-2 5 days after treatment in outpatients. Our findings do not support the use of ivermectin to treat mild to severe forms of COVID-19.Clinical Trial Registrationwww.irct.ir IRCT20111224008507N5 and IRCT20111224008507N4.

Background and purpose: Acute viral hepatitis is one of the world's health problems today. An outbreak of hepatitis A virus occurred in a rural area in ​​Mazandaran province, north of Iran, 2019. This research aimed at examining this outbreak in detail in order to study the epidemiological and economic burden, and the possible source of pollution. Materials and methods: This descriptive case report study presents the cases of seven members of a family of nine with acute symptoms of hepatitis. Results: In this family, seven members were found with clinical and laboratory symptoms of acute hepatitis, all of whom were positive for HAV Igm serology tests. According to the short incubation period and contamination of common origin, the most probable route of transmission, considering the health condition and residence of the people studied, was contaminated water. Conclusion: According to the investigation on water plumbing system and location of the residential building (at the end of the village), contamination entered the water plumbing system through sewage and drinking water is regarded as the main cause of the disease.

Background and purpose: AIDS, can cause psychological and social problems in patients and affects their quality of life. Therefore, infected people need more care. This study was conducted to investigate the effect of different care methods in quality of life of HIV+ patients. Materials and methods: HIV-positive patients in Mazandaran were divided into two groups of intervention (n=34) and control (n=17). Patients in intervention group received medical and social care for one year. Quality of life was assessed in both groups before and after the intervention using WHOQOL-Brief and a researcher-made questionnaire. Results: The study population included 49 patients including 56.67% males and 43.33% females. Before the intervention there was no significant difference in quality of life between the two groups. But after the intervention, satisfaction from personal relationships decreased significantly while social-occupational worries and concerns about the disease showed significant increase in intervention group. Compared to the control group, after one year, satisfaction from current treatment (P=0.02), concerns about the disease (P=0.0009), and quality of social life (P=0.02), showed significant increases in the intervention group. Conclusion: The participants in this study had low levels of quality of life and physical and mental health care could be of great benefit in improving quality of life of HIV+ patients. In designing care protocols for these patients, all aspects of life should be considered.

Background and purpose: Tuberculosis is a contagious disease caused by mycobacterium tuberculosis. Approximately 30% of the world's population is infected, 5-10% of whom develop active tuberculosis. The aim of this study was to determine the tuberculin skin test conversion. Materials and methods: A cross-sectional study was conducted in 114 staff working in Qaemshahr Razi Hospital, 2015-2017. Demographic characteristics and the results of tuberculin skin test (TST) were recorded in a checklist. Data analysis was done in SPSS V20. Results: The participants included 15.8% males and 84.2% females (mean age: 29.42±5.03). Among the subjects, 33% had latent tuberculosis. TST was positive in 11.4% in first evaluation and 36.84% had positive TST in the second assessment. TST seroconversion was observed in 25.44%, in 61.4% the working experience was more than 10 years, and 61.5% worked in infectious department. There were significant associations between the positive result of TST and age, gender, and working experience (P=0.002, P=0.021, and P=0.01, respectively). We observed significant differences in the results of TST between the first and second evaluation (P

Background and purpose: Studying the different diagnostic aspects of hydatid cysts (HC) plays a major role in early diagnosis and treatment. This study was conducted to evaluate the clinical and laboratory characteristics of HC cases operated in educational hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: In this descriptive study, the records of all cases with HC (n=95) who underwent surgical treatment in two educational hospitals within 11 years (2004-2015) were studied and analyzed. Results: The patients were found to be 53.7% females, 67.4% living in rural areas, and 28.4% were aged 51-60 years old (P

Background and purpose: Tuberculosis (TB) is an infectious disease that is lethal in many cases. The aim of this study was to evaluate the clinical and laboratory findings in patients hospitalized with tuberculosis. Materials and methods: A cross-sectional study was carried out in 61 patients with tuberculosis in Razi Qaemshahr Hospital , Iran 2014-2015. We compared paraclinical and clinical findings in patients, those who died, individuals with recurrent TB, and patients with underlying diseases. Data was analyzed in SPSS V19. All P values less than 0.5 were considered significant. Results: Significant differences were seen in ALP, RBC count, and hemoglobin in patients who had relapsed serum and new cases. Also, there were significant differences between alive and dead patients in levels of ALT, ALP, PPD, FBS, and creatinine levels. The HCT level, FBS, RBC, MCHC, platelet count, and serum ferritin differed significantly in patients who were HIV-positive and negative. Moreover, we found significant differences in MCV, WBC, MCH, MCHC, and AST between TB patients with and without liver disease. In TB patients with and without diabetes the levels of ALT and BS were significantly different. Conclusion: Comparison of paraclinical outcomes in TB patients with and without underlying diseases, proves the importance of early diagnosis of clinical disorders in these patients. Therefore, elimination of these causes can lead to faster recovery and better treatment response in these patients.

Background and purpose: The main purpose of this study was determination of different genotypes and phenotypes of N-acetyltransferase 2 gene and its relationship with drug-induced liver injury among patients in Mazandaran province, Iran, which was done for the first time. Materials and methods: A total of 65 newly diagnosed unrelated pulmonary tuberculosis patients (47 men, 18 women) was enrolled in the study. A combination of polymerase chain reaction -restriction fragment length polymorphism method was used to investigate different allels of N-acetyltransferase-2. The patients were followed for occurrence of antituberculosis induced hepatotoxicity during the course of treatment. Relationship between N-acetyltransferase-2 phenotypes and antituberculosis induced hepatotoxicity was evaluated. Results: Frequency of slow, intermediate and fast acetylator genotypes in patients were 34%, 60% and 6%, respectively. Hepatotoxicity was diagnosed in 13.64% of slow acetylators, in 2.56% of intermediate acetylators and interestingly in none of the fast acetylators. The Chi-Square Test showed no significant difference between different acetylation phenotypes and risk of hepatotoxicity (P = 0.1086). Conclusion: These results could improve treatment profile, prevent from drug-related adverse effects such as hepatotoxicty and lead to better outcomes in tuberculosis patients.

Background and purpose: H1N1 influenza circulate worldwide and affects the world population in case of pandemic. The aim of this study was to evaluate the awareness of urban family physicians in Mazandaran province, Iran about H1N1 influenza. Materials and methods: In a descriptive study, 373 urban family physicians were questioned. A standard questionnaire including different items were completed by participants. The items included epidemiology (7 questions), treatment (5 questions), virology and diagnosis (5 questions), clinical manifestations (6 questions), and prevention (4 questions) of H1N1 influenza. Data was then coded and analyzed in SPSS V18 applying Chi-square, t-test, and Fisher's exact test. Results: The participants were 47.5% females and 52.5% males. The levels of knowledge about H1N1 influenza were poor in 0.8%, fair in 11.3% and good in 60.3%. Also, 27.6% of the participants had excellent levels of knowledge on this type of influenza. The average scores of participants for epidemiology, virology and diagnostics, clinical manifestations, prevention, and treatment were 4.30, 3.38, 4.59, 2.79, and 3.67, respectively. The mean scores for knowledge in epidemiology and treatment were found to be higher in female physicians compared to those of their male counterparts. Our results indicated a direct correlation between experience and knowledge on virology, diagnosis, clinical symptoms, and prevention and treatment, while it was inversely related with knowledge on epidemiology of H1N1 influenza. Conclusion: This study showed a relatively high level of knowledge among urban family physicians in Mazandaran province about H1N1 influenza. But they are strongly recommended to participate in continues education programs that increase their awareness and enhance their knowledge.

Background and purpose: Viral hepatitis is a systemic infection that mainly affects the liver. We studied the prevalence of skin lesions and infectious diseases including hepatitis A and B virus infection in patients attending Qaemshahr Razi Teaching Hospital, Iran 2013-2015. Materials and methods: In this retrospective descriptive study, records of patients diagnosed with hepatitis were investigated for skin lesions and other simultaneous infectious diseases. Results: There were 188 patients with viral hepatitis in whom skin lesions were observed in 16 and 35 were diagnosed with other simultaneous infections. Conclusion: In current study, the incidence of skin lesions in patients with hepatitis B was higher than that of other hepatitis. High rate of infections such as pneumonia and bronchitis among patients with viral hepatitis indicates a decreased ability of their immune system in protecting against other infectious agents.

(Received 14 July, 2009 ; Accepted 23 December, 2009)AbstractBackground and purpose: Leptospirosis (also known as Weil's disease, 7-day fever and many more) is a bacterial zoonotic disease caused by spirochetes of the genus Leptospira that affects humans and a wide range of animals, including mammals, birds, amphibians, and reptiles. It was first described by Adolf Weil in 1886 when he reported an "acute infectious disease with enlargement of spleen, jaundice and nephritis". Leptospira was first observed in 1907 from a post mortem renal tissue slice. It is recognized as the world's most common zoonoses. This disease continues to have a major impact on people living in urban and rural areas of developing countries with inestimable morbidity and mortality. The disease is an occupational hazard.People in Mazandaran province in the North of Iran, are mostly involved in agricultural fields or animal husbandry and leptospirosis is common in this area. In this study we tried to find seroepidemiology of leptospirosis in workers that were involved in 5 group of high risk jobs (farmers, mine workers, abattoir workers, animal farm workers, anglers).Materials and methods: This is a descriptive case- series study. Our target population was 500 people that were involved in one of fore-mentioned high risk occupations for leptospirosis, 100 of each one, selected them by cluster sampling. They were screened for the presence of serum Leptospira immunoglobulin G. IgG was tested with a commercially available immuno florescent assay (IFA) method.Results: Serologic study showed that 29.5% of farmers, 18% of fishers, 12.5% of mine workers, 6% of animal farm workers and 4% of abattoir workers were positive (IFA ≥ 1/10).Conclusion: Our data emphasize the importance of occupational exposure to leptospirosis among people who have exposure with infected water or soil in Northern Province Mazandaran-Iran. Thus, it is clear that contact with water and soil are risk factors of getting infected with Leptospira.J Mazand Univ Med Sci 2009; 19(73): 11-15 (Persian).

(Received 5 February, 2009 ; Accepted 13 Jan, 2010)AbstractAcute 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.Key words: Acute rheumatic fever, sydenham's chorea, erythema marginatumJ Mazand Univ Med Sci 2009; 20(74): 91-97 (Persian).