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Background: An antimicrobial stewardship program can be defined as the set of actions performed in hospitals for the rational use of antibiotics. Early conversion from intravenous to oral antibiotics plays an important role in reducing the cost of treatment, shortening the length of hospital stay, and decreasing the workload of nurses. The purpose of this study was to evaluate the impact of the implementation of antimicrobial stewardship program on duration of hospitalization and medication costs. Methods: We performed an interventional study in Razi teaching hospital. All hospitalized patients aged 18 and older who met the inclusion criteria were included. This study comprised two groups. The interventional prospective group to assess the impact of intravenous to oral antibiotic conversion, and a retrospective group in which the intervention had not been applied, used as the comparator. Results: A total of 260 cases were enrolled; 47 in the interventional group and 213 in the retrospective one. The length of hospitalization was significantly shorter in the intervention group compared to the retrospective one (5.2 vs7.9 days, p

The Sputnik V COVID-19 vaccine, have shown excellent safety and efficacy against COVID-19 in phase 3 of the clinical trial. We provided independent evidence on side effects and immunogenicity following the administration of the Sputnik V COVID-19 in Iran. In this observational study, the healthcare workers who vaccinated with the Sputnik V COVID-19 vaccine within February and April 2021 were evaluated. Among a total of 13435 vaccinated healthcare workers, we received 3236 self-declaration reports of Sputnik V associated adverse events with the mean age 39.32±10.19 years old which 38.8% were men and 61.2% were women. The most common side effect was a pain in the injection site (56.9%), fatigue (50.9%), body pain (43.9%), headache (35.7%), fever (32.9%), joint pain (30.3%), chilling (29.8%) and drowsiness (20.3%). Side effects of the vaccine were significantly more frequent in females and younger individuals. Among a total of 238 participants, more than 90% after the first and second dose of vaccine had a detectable level of SARS-CoV-2 RBD antibody and SARS-CoV-2 neutralizing antibody. Although the overall the rate of adverse effects was higher than the interim results from randomized controlled trials, our findings support the manufacturer’s reports about the high humoral immunogenicity of vaccine against COVID-19.

Background: Nematodes of Trichostrongylus genus are mainly parasites of herbivores, although human infections in sporadic form ‎ have been reported worldwide‎. Herein we reported an outbreak of trichostrongyliasis in Qaemshar city in Mazandaran province, north of Iran from May to June 2020. Methods: The investigation was designed as a retrospective cross-sectional study on an outbreak occurred in Qaemshahr city in the north of Iran. The diagnosis of trichostrongyliasis cases was confirmed by hypereosinophilia and existence of Trichostrongylus ‎ eggs in the stool. Results: Trichostrongyliasis ‎ diagnosed in twelve patients. The age range of patients was ‎10-78 years old. 83.5% of the patients were female and ‎75% of them lived in the rural area. ‎ The most common ‎‏ ‏signs and symptoms of patients were abdominal pain‎ 91.6%, diarrhea 83.3%, ‎vomiting 41.6%, nausea 50%, anemia ‎‎‎‎8.3% and chill ‎ ‎16.6% respectively. ‎ These patients undertook a course of treatment consisting of antihelminth ‎drug ‎for adult ‎and albendazole for children.‎ Symptoms of trichostrongyliasis ‎ improved completely after therapy‎. Conclusions: Our study indicated that trichostrongyliasis may be a major parasitic aetiology for gastrointestinal symptoms such as abdominal pain among rural residents in endemic areas with outbreak presentations.

Background and Purpose: Cryptococcal meningitis (CM) is a serious fungal infection that especially affects patients with human immunodeficiency virus (HIV). In this regard, the present retrospective study aimed to analyze the clinical and laboratory features and therapeutic outcomes of patients with CM admitted to two teaching referral centers in the north of Iran during 2011-19. Materials and Methods: This study was performed on all the hospitalized patients diagnosed with CM in two therapeutic centers of infectious diseases in the north of Iran. The required data, such as demographic characteristics and clinical and paraclinical features of patients, were extracted and entered in the information forms. Finally, the collected data were analyzed in SPSS software (version 16). Results: For the purpose of the study, records of 12 confirmed CM patients were evaluated in this research. Based on the results, 75% of the patients were male. Moreover, the average age of the subjects was 40.33± 8.93 years old and 66.6% of them (n=8) were HIV-positive. Other underlying diseases among HIV-positive patients included infection with hepatitis C virus (25%) and a history of tuberculosis (25%). In total, three HIV-negative patients suffered from Hodgkin lymphoma (25%), sarcoidosis (25%), and asthma (25%) and one patient (25%) had no underlying disease. Headache (75%), weakness, and fatigue (75%) were the most common symptoms among the participants. The cluster of differentiation 4 (CD4) count in all HIV-positive patients was less than 100 cells/μl. There was no significant difference between symptoms in HIV-positive and HIV-negative patients. Besides, no significant difference was observed between the groups of HIV-positive and HIV-negative patients regarding the period between the onset of symptoms and diagnosis of CM, the length of hospital stay, and the duration of antifungal medication consumption. In total, three patients (25%) expired, and six patients recovered. The CM recurred in two HIV-negative and one HIV-positive subjects; the two HIV-negative patients were treated, while the HIV-positive patient expired due to this recurrence. Conclusion: Clinical features and cerebrospinal fluid parameters were not different in HIV-positive and HIV-negative participants. Despite the fact that CM is not common in Iran, due to the increasing number of immunosuppressive patients, the differential diagnosis of CM should be considered for patients with signs and symptoms of infection in the central nervous system.

The outbreak of (SARS-CoV-2) originated in Wuhan, China, and pneumonia induced by this virus is named coronavirus disease 2019 (Covid-19). By March 29, 2020, 737000 people were infected and 35000 died worldwide. To date, no effective medication is recommended to treat SARS-CoV-2 infection, and the drugs introduced are still in the clinical trial phase. Tocilizumab and Remdisivir are possible drugs to treat and improve the symptoms of the patients. We prescribed a combination of Remdisivir and Tocilizumab to treat three critical patients with Covid-19, and presented the results in this article. After the duration of treatment with this combination, one case was improved and discharged, but, unfortunately, two cases expired.

Empyema necessitans (EN) is a kind of empyema that diffuses to extrapleural space and can involve chest pain. Tuberculosis (TB) is the most common cause of EN. This disease can be found in both immunocompromised and immunocompetent individuals but is usually seen in the immunocompromised individuals. Because of long duration and ambiguous symptoms of the disease, diagnosis can be hard. The disease can be treated both medically and surgically. Missing the disease can lead to undesirable effects on patient’s condition and health care setting. This problem can be seen in endemic area in which controlling of TB is hard. Report of the disease in local health care center for desirable treatment and health maintenance is necessary. We explained a rare case of pulmonary TB in a patient that was healthy in other fields and just showed the minimum systemic symptoms. The patient came with a mass in lower part of back of chest cage, with a mild pain. The imaging survey showed EN. Smear and Ziehl-Neelsen stains from subcutaneous aspiration were positive for TB. This case showed importance of clinical view and awareness of this silent but serious disease in endemic area especially for TB.

Cutaneous anthrax has a mortality rate of 20% if no antibacterial treatment is applied. The clinical manifestations of cutaneous anthrax are obviously striking, but coinfection may produce atypical lesions and mask the clinical manifestations and proper laboratory diagnosis. Anthrax is known to be more common in the Middle East and Iran is one of the countries in which the zoonotic form of anthrax may still be encountered. We report a case of a 19-years-old male who used to apply Venetian ceruse on his skin. Venetian ceruse (also known as Spirits of Saturn) is an old cosmetic product used for skin whitening traditionally made from sheep’s spinal cord. The patient referred to the Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran, with atypical dermatosis, pronounced pain, and oedema of the affected tissue. It was confirmed by both conventional and molecular analysis that culture was a mixture ofBacillus anthracisandTrichophyton interdigitale. The patient was initially treated with ceftriaxone (1000 mg/day for two weeks), gentamicin (1.5–2 mg/kg/day), terbinafine (200 mg/week for one month), and 1% clotrimazole cream (5 weeks) two times per day which resulted in gradual improvement. No relapse could be detected after one-year follow-up. Anthrax infection might present a broader spectrum of symptoms than expected by clinicians. These unfamiliar characteristics may lead to delayed diagnosis, inadequate treatment, and higher mortality rate. Clinicians need to be aware of this issue in order to have successful management over this infection.

Background: Hepatitis C virus (HCV) infection is a major public health concern and the third most common cause of death from cancer worldwide. This infection is the most common risk factor for the progression of chronic liver disease, chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Hepatitis C virus infection is classified into six major genotypes and multiple subtypes. The distribution of HCV genotypes seems to vary in different areas around the globe. Objectives: In this study, we aimed to identify HCV RNA and perform genotyping in anti-HCV-positive patients through polymerase chain reaction (PCR). We compared the results of PCR and ELISA tests among patients referred to several healthcare centers of Mazandaran province, situated in North of Iran, during 2015 - 2016. Methods: A total of 157 patients with anti-HCV-positive specimens were enrolled in this study during 2015-2016. Hepatitis C virus-RNA was extracted from the serum samples, using pure link viral RNA Mini kit. Detection of HCV nucleic acids was performed by using the serum samples from anti-HCV positive specimens. The genotypes of the HCV genome were determined by PCR, using the RNA-PCR kit according to the specified protocol. Also, the PCR products (DNA fragments) from these samples were run on 1.5% agarose gel and visualized on a UV analyzer. All the samples were examined at the virology laboratory of Mazandaran University of Medical Sciences, Sari, Iran. Results: The mean age of the patients was 39 ± 14.3 years (range: 20 - 68 years). In total, 110 (70.06%) and 47 (29.94%) anti-HCV-positive patients were male and female, respectively. Hepatitis C virus–RNA was detected in 84 (53.50%) out of 157 patients with positive HCV antibodies. Based on the findings, the majority of HCV-RNA positive patients were intravenous drug users (46.43%). In this study, the 3a HCV genotype was predominant (59.52%), followed by the 1a/b genotype (40.48%). Conclusions: The present findings indicate that the 3a genotype is the most frequent HCV genotype, followed by 1a/b in the study region. The prevalence and incidence of HCV genotypes seem to vary in different areas, with each genotype showing a different response to interferon therapy. Therefore, it is essential to determine the predominant subtypes of HCV.

MicroRNAs are small non coding RNAs that are involved in gene expression regulation. Mir-122 was reported to inhibit hepatitis B virus (HBV), but little is known about the role of mir-122 polymorphisms on HBV infection development. This present study aimed to investigate the association between single nucleotide polymorphisms (SNPs) in mir-122 gene region with HBV infection. Study cases were HBV positive and negative individuals. 67 SNPs in mir-122 gene and its flanking regions were analyzed by sequencing method. mirVas software was used to assay the impact of polymorphisms on the secondary structure of mir-122 gene. 66 out of 67 studied SNPs were monomorphic and rs 17669 was the only polymorphic SNP in the studied population, with the T allele being four times more frequent than the C allele. However, there was no significant difference in alleles distribution between patient and control groups. Rs 17669 variant located near the mir-122 gene showed the highest impact for centroid, maximal expected accuracy, and minimal free energy structures in the arm, flank, and flank regions of mir-122, respectively. Therefore, rs17669 variant was predicted to exert an effect on mir-122 stability. The study of larger samples from different ethnicities may help to find a possible association between rs17669 genotype and HBV infection.

Background: Central nervous system infections are life-threatening in many cases. Infection etiology may be varied based on age, geographic region and comorbidities. Objectives: This study aimed to identify epidemiologic, clinical and laboratory features of patients with central nervous system infection in this area to facilitate rapid diagnosis and treatment. Patients and Methods: In a retrospective study, , data were collected by chart review of computerized medical records of hospitalized patients with CNS infection in Razi hospital, from March 2008 to March 2012 in Qaemshahr city, north of Iran. Results: During this period, of 16532 hospitalized patients with infectious diseases in Razi hospital, 66 were admitted with CNS infection diagnosis (0.4%). The average age was 26.3 ± 20.7 years. Male were more than females (81.2% vs. 18.8%), and 6.3% were younger than one year, and 35.9% aged between 11 - 20 years. Most patients were admitted in fall (32.8%) followed by summer. Eighty six percent of cases had meningitis, and encephalitis and brain abscess was occurred in 10.6% and 3%, respectively. Three cases of cryptococcal meningitis, and one rare case of H1N1flu meningitis and brucella meningoencephalitis were reported. Conclusions: Based on data collected about risk factors and epidemiologic, clinical, and laboratory features of CNS infections, we can help to prompt diagnosis and treatment of these patients.

Background Studies have shown that Mindfulness Based Stress Reduction (MBSR) has positive effect on physical and psychological dimensions of chronic illnesses. In this study for the first time we examine the effect of this new technique on quality of life and pulmonary function in chemically pulmonary injured veterans who have chronic pulmonary problem, psychological problems and low quality of life. Methods Forty male pulmonary injured veterans were randomly replaced in two groups with 20 participants (MBSR and control Wait List (WL)). Then MBSR group received 8-weekly sessions intervention. We evaluate quality of life (used SF-36 questionnaire) and Spirometry parameters two times; before and after intervention in two group. We used “mixed factorial analyses of variance” test for analyzing data in each dependent variables. Then if we have significant interactional effect, we used –paired- sample t-test” for comparing before and after intervention data of each group, and “Independent-Sample t-test” for comparing after intervention data of two groups. Results The MBSR compare to WL group improved SF-36 total score, (F (1, 38) =12.09, P=0.001), “Role limitations due to physical problems”(F(1,38)= 6.92, P=0.01), “Role limitations due to emotional problems”(F(1,38)= 7.75, P=0.008), “Social functioning”(F(1,38)= 9.89, P=0.003), “Mental health”(F(1,38)= 15.93, P=0), “Vitality”(F(1,38)= 40.03, P≤0.001), and “Pain”(F(1,38)= 27.60, P≤0.001). MBSR had no significant effect on “FEV1” (F (1, 38) = 0.03, P=0.85),”FVC” (F (1, 38) = 0.16, P=0.69) and “FEV1/FVC” (F (1, 38) = 2.21, P=0.14). Conclusion MBSR can improve individual’s quality of life but not lung function in chemically pulmonary injured veterans.

Background Iraq is a highly endemic area for the prevalence of hepatitis A and annually hosts a large number of Iranian pilgrims, most of whom are susceptible to infection with the hepatitis A virus (HAV). Objectives This study reports the health hazard of hepatitis A for Iranian pilgrims who go to holly Karbala from the Mazandaran province. Patients and Methods In this cross-sectional study, the data of all patients with acute hepatitis A admitted in the Razi teaching hospital from November 23, 2014 to January 24, 2015, with a history of recently returning from holly Karbala or being exposed to Karbala pilgrims, were registered. Results A total number of nine patients were registered. Seven patients were male and two were female. The mean age was 30.11 ± 10.09.Two patients were from the same family. All patients had typical symptoms of acute hepatitis A. None of the patients died nor did fulminant occur in any patients. In addition, all patients were treated with supportive treatment and subsequently recovered. Conclusions This number of pilgrim patients with acute hepatitis A from a single province compels us to conduct more evaluations and follow up monitoring on all persons travelling to Karbala and be sensitive to early diagnoses of the pilgrims. In the future, it is important to be mindful of administering the HAV vaccine and Ig.

Iraq used chemical weapons against thousands of Iranian militaries and civilians. This study aimed to compare the chronic cutaneous side effects of exposure to sulfur mustard (SM) with nerve agents (NA).The study enrolled 154 SM exposed cases and 175 (NA) exposed cases. Presence of any late cutaneous manifestations was evaluated by a dermatologist via prior history of acute cutaneous complications extracted from medical achieves.only 18.1% mustard exposed group was asymptomatic compared to 62.4% nerve agent exposures. Mustard and non-mustard scars, intertrigo, xerosis, cherry angioma, hyper pigmentation, pilar keratosis, poikiloderma, and malignant tumors were significantly more frequent in mustard exposed patients (p0.05). Nerve agent exposed patients experienced significantly more frequent occurrence of acne a seborrheic dermatitis and tinea versicolor.Mustard induced dermaltologic lesions were more common and specific than (NA) skin injuries. (NA) cause few psychocutaneous disorders like acne and seborrheic dermatitis in addition to psychological stress disorders.

Sulfur mustard (SM) exposure intensely causes lesions that range in severity from mild erythema to blister formation and necrosis. This review will discuss acute and long-term skin consequences due to exposure to SM and different kinds of medical prophylaxis and therapeutics against SM-induced skin lesions.Literature survey of medical case reports, clinical studies, and original articles was performed using PubMed, Medline, and the Cochrane Database (1917-2011 March). Key words included sulfur mustard, skin, toxicity, pathogenesis, cancer, treatment.SM-induced damage to the skin is characterized by edema, inflammation, and cell death mainly of the basal keratinocyte layer, with varying immunological and pathological changes in the acute phase. Also, xerosis, hypo or hyper pigmentation, scars, and rarely, skin cancers are long-term cutaneous effects. So far,the combination therapy of topical drugs and oral antihistamines, also iodine and antitumor necrosis factor alpha antibodies, are effective remedies in the treatment of skin lesions.The requirement for preparedness in the dermatological community concerning SM exposure is underlined. Novel treatments for prevention and therapeutics against SM toxicity and carcinogenicity are reviewed.

(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).

Background. Herpes zoster infection is a painful worldwide disease. Inappropriate and delayed treatment causes prolongation of the disease with debilitating symptoms and postherpetic neuralgia.Method. A cross-sectional study evaluated shingles cases admitted in a teaching hospital with one-year followup in north of Iran from 2007 to 2013.Results. From 132 patients, 60.4% were male. Head and neck involvement occurred in 78 people (59.1%), thoracoabdominal region in 37 cases (28%), and extremities in 16 cases (12.1%), and one case (0.8%) got multisites involvement. 54 cases (40.9%) had predisposing factors including diabetes mellitus in 26 cases (19.7%), malignancy in 15 (11.4%), immunosuppressive medication in 7 (5.03%), HIV infection in 3 (2.3%), radiotherapy in 2 (1.5%), and tuberculosis in one patient (0.8%). The most common symptoms were pain (95.5%), weakness (56%), fever (31.1%), headache (30.3%), ocular complaints (27.3%), itching (24.2%), and dizziness (5.3%). 21 cases (15.9%) had bacterial superinfection on blistering areas and overall 18 cases (13.6%) had opium addiction. 4 cases (3.03%) died during admission because of comorbidities. Postherpetic neuralgia was reported in 56 patients (42.5%) after three months and seven cases (5%) in one-year followup.Conclusion.Shortening interval between skin lesion manifestation and starting medication can accelerate lesion improvement and decrease disease course, extension, and complication.

Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such asCandida, Aspergillus, and Rhizopusspecies. We report one such rare case with calcaneal osteomyelitis caused byAspergillus ochraceusin a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus.Aspergillusspecies can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

Anthrax is an acute bacterial infection caused by Bacillus anthracis. Humans become infected under natural conditions by contact with infected animals or contaminated animal products. About 95% of human anthrax is cutaneous and 5% respiratory. Gastrointestinal anthrax is very rare, and has been reported in less than 1% of all cases. Anthrax meningitis is a rare complication of any of the other three forms of disease. We report three rare cases of anthrax (gastrointestinal, oropharyngeal and meningitis) arising from the same source. The three patients were from a single family and were admitted with different clinical pictures after the ingestion of half-cooked meat from a sick sheep. These cases emphasize the need for awareness of anthrax in the differential diagnosis in areas where the disease remains endemic.

Background: Albinos in Africa are at constant risk of developing skin cancer due to the damage caused by ultra-violet exposure. This study identifies the common skin conditions among albinos in Kenya as a country located along the equator. Methods: In this descriptive study on albino patients who were admitted to Mbagathi District Hospital in Nairobi, Kenya the census method was used for sampling and a total of 151 albinos were registered. All necessary data including age, gender, type, site and the number of skin lesions were recorded. Suspected patients with malignant and premalignant lesions were studied individually through skin biopsy and histopathological investigation. Finally, the collected data were analyzed using SPSS software. Results: Albinos with serious skin lesions were 121(80%) patients. Females were 64 (52.9%). The frequency of the following premalignant and malignant skin lesions including actinic-cheilitis, solar elastosis, actinic keratosis (AK), basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 17.88%, 11.92%, 37.08%, 7.94% and 5.29%, respectively. Hands (20.52%), face (19.20%), head (18.18%), shoulder (14.56%) and neck (7.94%) were the most affected areas by malignant and premalignant lesions. Conclusions: BCC was the most common type of cutaneous malignancy on the face and shoulders while AK was the most common cutaneous pre-malignancy on the hands and face in albinos in Kenya. Therefore, appropriate physical protection, avoiding any trauma when carrying sharp, heavy or rough instruments by the shoulder and hands, and finally urgent and quality treatment for any lesion even a small erosion and ulcer, especially on exposed areas in albinos, are recommended.

Brucellosis is an infectious disease caused by gram-negative bacteria of the genus Brucella. Involvement of the gastrointestinal, hepatobilliary, and skeletal systems has been reported frequently in the literature. Involvement of the nervous system is relatively uncommon and has been reported in only 3%-25% of cases of generalized brucellosis. Guillain-Barre syndrome is a prototypical postinfectious autoimmune disease. We report a case of Guillain-Barre syndrome in a 26-year-old woman as an uncommon presentation of neurobrucellosis.

Background: Acute bacterial meningitis is a medical emergency condition that requires prompt diagnosis and treatment and otherwise associated with serious morbidity and mortality. Aim: The aim of this study was to assess types, risk factors, clinical symptoms and diagnostic tests of meningitis in hospitalized patients of Mazandaran University of medical sciences hospitals during 2006-2012. Matherials and Methods: This is a retrospective descriptive study. Following approval of the ethics committee of Mazandaran University of Medical Sciences, records of adult patients diagnosed with acute meningitis from 2006 to 2012 were extracted from Mazandaran Provincial Health Center and patients attending hospitals affiliated to Mazandaran University of Medical Sciences. Statistical analysis: Data were analyzed with SPSS-16 using descriptive statistics (frequency, mean, standard deviation, and median). Results: In this study, of the 137 patients with meningitis, 73 (53.9%) were viral, 61 (46%) bacterial, 1 (0.7%) fungal, and 2 (1.4%) unknown. The majority of risk factors in patients were head trauma, upper respiratory infection, and drug addiction. The most common clinical signs were headache, fever, nausea and vomiting, and stiff neck. Conclusion: In this study, the incidence of meningitis was much lower than any other country. It could be due to geographic variation or incomplete recording of patient's data. It is recommended to perform a longitudinal study during the coming years on patients with meningitis.

Background. Mycobacterium tuberculosis (M.TB) causes a wide spectrum of clinical diseases. The prevalence of TB is different in various parts of Iran and throughout the world. The present study aimed to determine the clinical epidemiology and paraclinical findings of TB. Methods. A cross-sectional study was conducted from 2008 to 2013. Patient demographic, clinical, and radiologic characteristics, picked up from the TB patient’s files, were collected using a standard questionnaire format. Data was entered and analyzed using the SPSS version 16 statistical software and P value < 0.05 was considered statistically significant. Results. Out of 212 patients enrolled in this study 62% were male and the mean age was about 50 years old. 98.6% were Iranian, and 46.2% were rural. Prevalence of smear-positive TB was 66.4%. Prevalence of positive PPD was 50.7% with no significant difference between HIV-positive and -negative patients (P = 0.8). Prevalence of diabetes mellitus was 17%. 36% of the patients had history of smoking and about 29.3% were addicted to narcotics. Cough was the most common symptom (94.5%) and 84% had sputum. 15 cases (7%) had extrapulmonary TB. The mean time between the onset of symptoms and admission was 46.5 days. The delay for admission between urban and rural populations was not significantly different (P = 0.68); but for those who were in prison, the delay was significant (P = 0.02). About 46% of the patients had cavitary lesions in CXRs. Conclusion. Timely diagnosis of TB especially in prisoners by understanding its most important epidemiologic characteristics and clinical features can help to make an early treatment and prevent spread of mycobacteria and their complications.

Introduction: The hepatitis B virus infection is responsible for more than one million deaths all over the world. This study design is to compare the efficacy of Lamivudine (LAM), Adefovir Dipivoxil (ADV) or Tenofovir Disoproxil Fumarate (TDF) monotherapy in chronically infected hepatitis B patients. Methods: We design a prospective cohort study and select patients who were under treatment with TDF (300mg/day), ADV (10mg/day) and LAM (100mg/day). After matching patient's primary data and on base of our inclusion and exclusion criteria; 19, 20 and 19 patients were enrolled in TDF, LAM and ADV groups, respectively. Then, we evaluated patients at 6 and 12 month after treatment. Results: Patents primary data was closely matched. After 6 month medication, ALT level in 7 patients (36.8%), 12 patients (60%) and 6 patients (31.6%) of TDF, LAM and ADV groups were back to normal range, respectively (P>0.05). All drugs significantly decrease ALT level after 6 month therapy (P 0.05). Finally, response to treatment was observed in 5 patients (45.5%), 7 patients (35%) and 2 patients (10.5%) of TDF, LAM and ADV group, respectively (P>0.05).

Drug resistance (especially multiple drug resistance) in Mycobacterium tuberculosis makes global concerns in treatment and control of tuberculosis. Rapid diagnosis of drug resistant strains of the bacteria has vital importance in the prognosis of the disease. The aim of this study was to identify the mutations responsible for drug resistance in Mycobacterium tuberculosis strains derived from patients with tuberculosis using line probe assay (LPA) method which rapidly detect drug resistant strains and respective mutations. Sputum samples from tuberculosis patients were collected and cultured on Lowenstein– Jensen medium, and then the colonies of Mycobacterium tuberculosis from cultures of 54 bacterial positive cases were randomly chosen for DNA extraction. Bacterial DNA was extracted using standard Cetyl Trimethyl Ammonium Bromide (CTAB) method. In order to identify drug resistant strains and related mutations, LPA method was applied. Three subjects out of 54 investigated cases were resistant to quinolone (5.5%), and resistance to kanamycin/ amikacin, streptomycin, rifampin, and isoniazid were observed in 3 (5.5%), 4 (7.4%), 3 (5.5%), and 2 (3.7%) of the Mycobacterium tuberculosis strains, respectively. In the present study, 4 cases (7.4%) were detected to be resistant to more than one drug. Since LPA is a rapid method that simultaneously detects mutations involved in drug resistance, applying this method in the prediction of drug resistance and selecting appropriate treatment in tuberculosis patients is recommended.

Introduction: Mycobacterium marinum infection is the most common nontuberculous mycobacterial skin lesions. It results from skin injury and contact with contaminated water, fish, or shellfish; its infections have low frequency, nonspecific symptoms and lack of specific identification methods that can alter correct diagnosis.This study designed about cases that reported from Iran and comparing their presentation and clinical sign and symptom and outcome. Case Presentation: We find and evaluate three cases that have been reported in indexing sites (PubMed, Google scholar and Iranian indexing databases) since 1980 till end of 2012. Using combinations of the following keywords: “Mycobacterium marinum,” “Iran”, “atypical mycobacterium”, “Sporotrichoid presentation” and “fish tank granuloma”. Three new cases also described that infected with this organism and had Sporotrichoid presentation in 2012 in a referral hospital in north of Iran. Conclusions: Totally we evaluate six patients. Source of infection in all cases were aquarium and four of six cases were male (66.6%). Occurrence to treatment interval were between one month to one year (mean 3.07 months). Infection site in all of them were hands and dominantly in right hand (66.6 % of cases ) and 83.3 % of them had Sporotrichoid presentation and all of the patients finally cured. The only cause of infection with Mycobacterium marinum in Iran is aquarium and its presence in homes and offices increased during these years. Health workers and people should be informed and warned about this disease.

Background: Influenza A virus is the most virulent human pathogen and causes the most serious problem. Having epidemiological knowledge about this disease is important. The aim of this study was to determine the prevalence of influenza A/H3N2 virus infection in northern Iran from 2011 to 2013 using the real-time polymerase chain reaction (RT-PCR). Methods: In this cross-sectional study 57 samples were collected from patients with influenza-like illness (T≥ 38 °C and cough or sore throat. Influenza-RNA was extracted from the samples using PureLinkTM Viral RNA/DNA Kit. RT-PCR was one using SuperScript III Platinum, Quantitive Real Time PCR system from invitrogen with a specific type of primers and probs. All samples were examined in the Influenza laboratory of Mazandaran University of Medical Sciences. Results: The mean age of patients was 38.2±14.5 year, 278 (48.69%) were males and 293 (51.31%) females. A total number of 201 patients (35.2%) were diagnosed as influenza A1 H3 N2 infection. Conclusion: The results show that the prevalence of A/H3N2 in the North of Iran is considerable and needs more attention for preventive measures.

Background The relationship between compromised immune system and the development of malignancy, generalized dermatitis, and infection after sulfur mustard gas exposure has been established.

To investigate the prevalence rate of hepatitis B (HVB) and hepatitis C (HCV) co-infection in HIV positives in Mazandaran province.This descriptive cross-sectional study lasted from 2008 to 2010. The population of this study included 188 HIV positive persons confirmed to be infected by tests of ELISA I, II and western blood (WB) in the hospitals of Mazandaran University of Medical Sciences and Health Services. After getting permission, 5 cc venous blood samples were taken and drawn into a lab tube without citrate.Among the total of 188 HIV positive patients in Mazandaran province, only 80 patients were available, 62 had moved to other provinces, and 46 had died. Of the samples, 66 (82.5%) were males and 14 (17.5%) were females with the mean age of 37. Among the patients, nine (11.3%) were co-infected with HIV/ HBV, 27(33.8%) with HIV/HCV, while 20 (25%) were co-infected with HIV/HBV/ HCV. Only one patient had travelled abroad and eight of them stated that they had used shared syringes.The differences in the rate of HBV and HCV co-infection can be due to the epidemiologic conditions of viruses with different factors including different risk factors causing infection with these factors such as the rate of virus penetrating the body, the manner of penetration, patients' health condition, patients' culture, and their socio-economic condition, etc.

To determine the incidence and characteristics of measles, cases reported to the Health Center for Diseases Control 2000-2002 were reviewed. Demographics data, vaccination status and its relation to occurrence the disease were analysed. A total of 729 cases (270 women,162, 269, 298, over the 3 years) were reported. The annual incidence rates over the 3 years were 7.1, 11.9 and 12.7 for each 105 population. In full vaccinated subjects, 46.5% of the cases occurred and 39.9% of the cases had not been vaccinated. Because of the high incidence rate of measles both in vaccinated and unvaccinated individuals, paying more attention to proper shipping and storing of vaccine, and even catch-up immunization for increasing herd immunity are recommended.

Novel influenza A (H1N1) has created a major worldwide health problem within a short time after its emergence. This infection is often self-limited, but sometimes can cause severe and fatal complications. In this study, we present two rare complications of pandemic influenza A, who were referred to Razi University Affiliated Hospital in northern Iran. The first case was a 30-year-old man with severe headache and high fever accompanied with chills, generalized myalgia, and arthralgia. Cerebrospinal fluid analysis was consistent with aseptic meningitis. The second case, a 25-year-old pregnant woman with high fever, chills and severe fatigue and malaise, developed tachypnea, tachycardia, respiratory distress, cyanosis and loss of consciousness a few hours after admission. Echocardiography reported myopericarditis. The patient was transferred to the intensive care unit and mechanical ventilation was begun. The next day, the patient started vaginal bleeding which progressed to spontaneous abortion three days later. Diagnosis of novel influenza A (H1N1) was confirmed using real-time reverse-transcriptase PCR of a pharyngeal swab.