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Background and aims: Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study, we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. Methods: This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory, and chest CT findings of identified COVID-19 patients were assessed. Results: The mean age of the patients was 55.21 ± 14.08 years, and 54 (53.47%) of them were male. With regard to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea, and fever, respectively. The right lower lobe was the most commonly and severely involved lope (69%), followed by left lower lobe, right middle lobe, and lingual segment; however, the anterior segment of upper lobes showed the least involvement with abnormality in the late course of the disease. The most common pattern was ground glass opacity (GGO), but atypical patterns such as round pneumonia, moderate to severe pleural effusion, and segmental lobar consolidation were seen without evidence of mediastinal adenopathy, cavitation, or nodular lesion. Chest X-ray (CXR) was not a sensitive method as the first-line imaging method because 34.65% of them were normal. Conclusion: CXR is not a sensitive method as the first-line imaging method (34.65% normal first CXR), but chest CT is a very sensitive and nonspecific modality for diagnosis of COVID-19. The lower lobe and posterior basal segments of the lungs are the most involved sites in most cases. About 12% showed atypical chest CT findings.

Background Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. Methods This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory and chest CT information of identified COVID-19 patients were assessed. Results Totally, 101 patients diagnosed with COVID-19 were included. The mean age of the patients was 55.21 ± 14.08 years and 54% (53.47%) of them were male. With regards to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea and fever, respectively and 44.5% had lymphopenia. The right lower lobe was the most common (69%) and severe involved lobe followed by left lower lobe, right middle lobe, and lingual; however, anterior segment of upper lobes showed least involvement with abnormality in the late course of disease. The most common pattern is ground glass opacity, but atypical patterns such as round pneumonia, moderate to severe plural effusion and segmental lobar collapse consolidation was seen without evidence of mediastinal adenopathy, cavitation or nodule. Chest X ray (CXR) was not sensitive method as a first line imaging because 34.65% of them were normal. Conclusion CXR is not sensitive method as first line imaging too (34.65% normal first CXR), but Chest CT is very sensitive and nonspecific modality for diagnosis of COVID – 19. Lower lobe and posterior basal predominance involvements were seen in most cases. About 12% showed atypical chest CT features.

Background: Brucellosis is endemic in Iran with a higher level of endemicity in western areas, including the Hamadan province. This study aims to define the seroprevalence of brucellosis and it,s risk factors in general the population of Famenin, Hamadan province, in western Iran. Methods: This survey was conducted on 2367 participants in Famenin and its villages from September to November 2016. After receiving written consent from subjects, demographic information was obtained through questionnaires and 10cc blood samples were taken from the participants. Blood samples were sent to the Core facility of Hamadan University of Medical Sciences and were tested using Wright and 2ME kits (Pasteur Institute, Iran) for serological detection of brucellosis. The seroprevalence of brucellosis was reported as percentage with 95% confidence interval (CI). Results: Totally, 2367 individuals with the mean age (SD) of 34.6 (20.9) (range: 2 to 95) years were enrolled. Of these, 1060 (44.8%) were men and 1610 (68.0%) lived in rural areas. The seroprevalence of brucellosis according to the Wright titer (equal to or greater than 1:80) was 6.6% (95% CI: 5.62%, 7.66%). The corresponding prevalence based on 2ME titers (equal to or greater than 1:40) in subjects with positive Wright test was 37.2% (95% CI: 29.5%, 44.84%). We saw a significant association between the incidence of brucellosis and occupation (P < 0.001) and type of contact with livestock (P = 0.009) as two important risk factors. Conclusion: The seroprevalence of brucellosis in Famenin population was considerable. Contact with livestock, animal husbandry, farming and history of brucellosis were risk factors for brucellosis infection.

Background Prisons can act as reservoirs of tuberculous infection. Previous studies have shown that the prevalence of latent tuberculous infection (LTBI) is high in prisons. Objective To investigate the prevalence and incidence rates of LTBI and contributing factors in a prison population in Iran. Methods In March 2013, inmates at the Hamadan Central Prison were invited to participate in a voluntary two-stage screening programme using the tuberculin skin test (TST). In the first stage, the standard TST was administered and read, and was repeated in negative cases to identify cases with delayed TST reactivity and boosted reaction. In the second stage, inmates with a true-negative TST underwent repeat screening 6 months later to identify incident LTBI. Information about risk factors was obtained using structured interviews. Results Among 1208 screened inmates, TST positivity was recorded in 756 cases (prevalence 62.6%). HIV-positive inmates and cigarette smokers were also more likely to have LTBI. In 380 inmates returning for a follow-up visit, the 6-month incidence rate was 7.6%. Two cases of pulmonary tuberculosis were identified during the period of study. Conclusions LTBI prevalence and incidence rates among Iranian prisoners are high. Comprehensive plans are needed to for effective TB control among prisoners.

IL-17is one of the most important inflammatory cytokines that stimulate immunity responses in humans infected with Brucella species, acting as a regulator that reduces release of γ-IFN, thus increasing resistance to brucellosis. Gene polymorphisms in the regulatory regions of cytokine-encoding genes affect the amountsof cytokines produced and play a fundamental role in infectious diseases. The aim of this study was to determine the association between IL-17 gene polymorphisms and susceptibility to brucellosis. In this case-control study, 86 patients with brucellosis and 86 healthy persons in Hamadan, western Iran, from September 2014 to September 2016, were included. IL-17 genetic variants at positions rs4711998 A/G, rs8193036 C/T, rs3819024 A/G, rs2275913 A/G, rs3819025 A/G, rs8193038 A/G, rs3804513 A/T, rs1974226 A/G and rs3748067 A/G were analyzed by restriction fragment length polymorphism-PCR. Serum IL-17 titers were measured by sandwich ELISA. GG genotypes at positions rs4711998 and rs3748067 were present significantly more frequently in patients with brucellosis than in controls (P < 0.05). The AA genotype at positions rs4711998, rs2275913 and rs3748067 and GG genotype at position rs19744226 were present significantly more frequently in controls than in the patient group. These results suggest that the AA genotype at positions rs3748067, rs3819025 and rs4711998 and GG genotype at position rs3819024 are likely protective factors against brucellosis, whereas the GG genotype at positions rs3748067, rs3819025 and rs4711998 and AA genotype at position rs3819024 may be risk factors against the disease. No significant relationships were found between serum IL-17 titers and genotypes of the single-nucleotide polymorphisms.

Background: Increased serum level of C-reactive protein (CRP) as a classic acute phase protein has commonly been reported in acute brucellosis. Hepcidin is also an acute phase protein and has a critical role in host defense. The aim of this study was to compare the level of hepcidin and CRP in patients with brucellosis. Methods: All patients with brucellosis referred to Sina Hospital during a 10-month period were included. Serum samples were checked for hepcidin levels in patients and also in the control group. Information on demographic and clinical characteristics was determined through completion of a questionnaire. Results: A total of 42 patients with brucellosis and 42 healthy controls were enrolled. The most common symptoms of brucellosis were fever (76) and arthralgia (69). The mean serum level of hepcidin in patients (42.6±11.7 pg/mL) was significantly higher than in the controls (17.3±4.2 pg/mL) (p

Brucellosis is a zoonotic disease caused by Brucella species via infected domestic animals. In endemic areas, certain occupations such as veterinarians, butchers, and slaughterhouse workers are considered high risk regarding brucellosis. We evaluated the seroprevalence of brucellosis in high-risk occupations in Hamadan, West of Iran.a cross-sectional study.Overall, 218 participants from 2014 to 2015 were enrolled. A questionnaire including demographic data, length of employment, and using personal protective equipment was completed for each of them. Then, blood samples were taken and sent to Hamadan Health Center to be tested by Wright or standard tube agglutination (STA). In addition, samples with positive Wright test were examined by 2-mercaptoethanol (2ME) test. Then, seropositive participants were evaluated for clinical manifestations of brucellosis. All collected data were analyzed by SPSS ver. 16.The mean age of the participants was 42.79±11.16 yr and all seropositive cases were male. Based on Wright ≥1/80 and 2ME ≥1/40, seroprevalence of brucellosis was 13.3% and 12.3%, respectively. The use of personal protective equipment was low among individuals with or without brucellosis. Myalgia, fatigue, back pain, joint pain, night sweats, fever, malaise, and headache were common symptoms in seropositive cases. Moreover, 20.6% of the seropositive participants were asymptomatic.High prevalence of brucellosis in these occupational groups and symptomatic disease in significant numbers of them, so periodic clinical examinations in these groups seems to be essential for brucellosis surveillance system.

Mojgan Mamani,1,2 Neda Muceli,2 Hamid Reza Ghasemi Basir,3 Maryam Vasheghani,4 Jalal Poorolajal5 1Brucellosis Research Centre, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Infectious Disease, Hamadan University of Medical Sciences, Hamadan, Iran; 3Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran; 4Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; 5Research Center for Health Sciences, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Background: Community-acquired pneumonia (CAP) is a common disease with significant morbidity and mortality. There is evidence that vitamin D deficiency can be associated with infectious diseases. The aim of this study was to compare the levels of vitamin D between patients with CAP and healthy controls. Methods: In a case-control study on 73 patients with CAP and 76 healthy controls, the serum concentration of 25-hydroxyvitamin D (25[OH]D) was measured. Severity and outcomes of disease and also duration of hospital stay were compared in patients with different levels of 25(OH)D. The severity of CAP was assessed using the CURB-65 score (confusion, uremia, respiratory rate, low blood pressure, age ≥65 years) and was also reflected by the length of hospital stay, admission to intensive care unit (ICU), and 30-day mortality. Results: In total, 81.2% of the study population had vitamin D levels

Tuberculosis (TB) is one of the oldest infections known to affect humans and in spite of the new treatment strategies and observations, it remains one of the most substantial causes of death, in the world. It is estimated that about one third of the world population has Mycobacterium tuberculosis infection.1 In 2010, there were 8.8 million new cases and 1.1 million deaths caused by TB in developing and industrialized countries.2 The World Health Organization (WHO) has developed the Global Plan to Stop TB by 2015 and 2050, which is defined as 50% reduction in the prevalence and mortality rates by 2015 and achieving towards less than 1 case per 1 million population per year by 2050. It indicates that TB control should be more effective than it is currently.3 Besides, the burden of disease and mortality, the long duration of treatment and the combination of treatment with several agents leading to changes in life structure. However, in spite of the most focus being directed towards mortality and incidence rate, the changes in morbidity and health status parameters have not been well considered.4 There are several methods for health status and disease management evaluation. The assessment of patient reported outcomes is a valuable method for this purpose and the quality of life (QOL) instruments have been developed to measure patients’ outcome in clinical research and practice.5 The QOL is defined as individuals’ perception of their physical and mental health in their daily lives which cover physical, psychological, economic, spiritual, and social functioning.6 It can reflect the impact of diseases and related morbidities on daily activities and functioning. This measurement is more necessary among patients with a chronic disease whose mental and social well-being as well as pure physical health are affected by the disease and its related long-term treatment.4 Therefore, it is required to investigate the QOL of TB patients to recognize appropriate actions for improvement of health status and the QOL among the patients.7 In addition, just the diagnosis of TB alone may lead to depression and anxiety or contribute to the worsening and persistence of disease symptoms, which follows with fear, frustration, and disappointment.8 Furthermore, most TB patients have no knowledge of disease progress and treatment which can cause more anxiety and feelings of frustration and decreases the QOL among the patients.9 Studies focusing on the QOL among TB patients are limited and no such investigation has been conducted among the Iranian population. Considering the fact that improvement in health-related QOL is an important factor for better response to treatment among TB patients, which may lead to better outcome in patients’ mental health, infection surveillance and prevention programs as well as location of Iran. On the other hand, as an endemic country for TB and no previous study on QOL of TB patients has been conducted in Iran, this study was designed to assess the QOL among TB patients living in Hamadan, a TB-endemic province, Western Iran, and compare the findings with the QOL among a healthy population taken as controls from the same area.

This study was designed to compare the efficacy of ciprofloxacin plus rifampin (CR) and ciprofloxacin plus doxycycline (CD) versus doxycycline plus rifampin (DR) in the treatment of brucellosis. A total of 178 patients with brucellosis who were referred to the Sina Hospital, Hamedan, Iran, were included. The responses to therapy were observed in 166 cases (93.7%) – 59 were in the DR group, 59 in the CR group and 48 in the CD group. No significant differences in the therapeutic responses were observed ( P = 0.09). Relapse was observed in 11.7% (DR 7.7%, CR 8.3% and CD 17.5%) after a six-month follow-up. No significant differences were also observed in relapse rates among the three groups ( P = 0.35). We concluded that DR is still the first choice regimen and CR or CD may be used as alternatives for treatment of brucellosis in adults.

Summary Objective To determine the frequency and clinical characteristics of osteoarticular complications of brucellosis in an endemic region in Iran. Methods In a prospective study we evaluated 245 patients with brucellosis diagnosed between January 2004 and December 2005. Patients included were those older than 8 years of age and who had clinical features suggestive of brucellosis and specific antibodies at significant titers, and/or positive blood or body fluid culture for Brucella species. A bone scan was performed in those with a clinical suspicion of osteoarticular involvement. Results Seventy patients (28.6%) had osteoarticular complications. Sacroiliitis was the most common complication (75.7%), followed by spondylitis (21.4%) and peripheral arthritis (8.6%). Spondylitis was the most common osteoarticular complication in the elderly. Relapses occurred in five (2%) patients, three of them with spondylitis. Conclusions Osteoarticular disease is the most common complication of brucellosis in Western Iran. Sacroiliitis is the most common form of osteoarticular complication. With the use of a proper treatment regimen, the prospect for recovery is good.

Summary Background Combination drug therapy of brucellosis leads to recovery of symptoms, shortening of symptomatic interval, and decrease in morbidity rate, but single drug therapy is associated with more relapse episodes and a higher rate of drug resistance. Different drug combinations have been evaluated in the treatment of brucellosis. Considering the failure of treatment and relatively high rate of relapse of the disease with the World Health Organization's (WHO) recommended therapeutic regimen, we evaluated a new regimen that we assumed would increase the success of treatment and decrease the rate of relapse. In this study we compare the standard regimen of the WHO, doxycycline–rifampin (DR), to triple therapy with doxycycline–rifampin–amikacin (ADR). Methods Two hundred and twenty-eight consecutive patients with brucellosis, who attended Hamedan Sina Hospital between 1999 and 2001, whether seen as outpatients or as inpatients, were enrolled in the study. The participants were randomly allocated to the DR group (receiving doxycycline 100mg twice a day and rifampin 10mg/kg body weight/day every morning, both taken orally for eight weeks) or the ADR group (receiving doxycycline 100mg twice a day and rifampin 10mg/kg body weight/day every morning, both taken orally for eight weeks, plus 7.5mg/kg amikacin intramuscularly twice a day for seven days). The patients were checked for the relief of symptoms, drug side-effects, and relapse of disease during the treatment and follow-up. Results Of the 228 patients enrolled, eight were withdrawn – four patients from the DR group and four from the ADR group. Of the remaining 220 participants (110 in the ADR group and 110 in the DR group), 107 were male (48.6%) and 113 were female (51.4%). Mean age was 35.7±17 years in the ADR group and 37±18.4 years in the DR group ( p =0.5). In the DR group, 97 (88.2%) and in the ADR group, 106 (96.4%) of the patients had relief of symptoms (a significant difference by Chi-square test ( p =0.04)). After completion of treatment, and at the sixth month follow-up, nine (9.3%) patients in the DR group and six (5.7%) in the ADR group experienced a relapse of the disease, with no significant difference ( p =0.4). Mild side-effects were found in only 10 patients, and none required discontinuation of the therapeutic regimen. Of these patients, four were from DR group and six from ADR group; no significant difference was observed ( p =0.7). Conclusions Given the fact that the ADR regimen had a higher efficacy and more rapid action in terms of relief of symptoms compared to the DR regimen, and that no significant difference in drug side-effects and disease relapse existed in the patients of either group, adding amikacin to the DR standard treatment regimen seems beneficial.

Background Hepatitis E virus (HEV) infection is a major public health problem in developing countries, which could progress to an acute self-limited hepatitis. Young adults and middle-aged people are more likely to be infected than children and elderly persons. The disease is usually mild in general population; severe infection is more seen among pregnant women and leads to a high rate of mortality in this population. Objectives This study aimed to assess seroprevalence of HEV infection and related risk factors among pregnant women referred to Fatemieh Hospital in Hamadan, Iran. Patients and Methods A total of 1050 pregnant women were included in this prospective cross-sectional study, conducted from 2010 to 2011. Anti-HEV specific IgG was measured with ELISA method. A questionnaire containing research purposes was also fulfilled for each participant. Results The mean age of pregnant women was 27.2 ± 5.6 years. The overall seroprevalence of anti-HEV was 7.4%. There was a significant association between anti-HEV seropositivity and age (P < 0.001), degree of education (P = 0.017), number of household members (P = 0.002), siblings (P = 0.005), and parities (P = 0.007). However, no significant relationship was observed between positive anti-HEV and variables such as place of residence, occupation, history of animal contacts, agricultural activities, type of drinking water, and the method of washing vegetables (P > 0.05). Conclusions According to the results, 92.6% of pregnant women were anti-HEV negative. However, there is no available effective vaccine for its prevention in human yet. Therefore, education about environmental and personal hygiene before and during pregnancy may be helpful for decreasing the rate of HEV infection in this high risk population.

Background Infectious complications among Injection Drug Users (IDUs) are associated with significant morbidity and mortality and place an enormous burden on the healthcare system. Objectives The present study aimed to describe the clinical and epidemiological characteristics of infectious complications in a sample of IDUs admitted to a hospital in Hamadan, Iran. Patients and Methods In a retrospective manner, medical records of IDUs admitted to an infectious diseases ward between 2007 and 2012 were reviewed. Data on patients’ demographic characteristics, reasons for admission, antibiotic treatment prior to admission, duration of hospital stay, mortality, and also the status of infection with hepatitis B, C, and HIV were recorded. Results Data for 100 IDUs lead to 115 admission episodes were available during the study. Bacterial infections accounted for 71% of all admissions. Among bacterial infections, skin and soft tissue infections, endocarditis, bone and joined infections emerged as the most common types. For 29% of cases, the reason for admission was due to viral pathogens, among which HIV/AIDS was the most common. The prevalence rates for hepatitis B, hepatitis C and HIV infection were 10.0%, 6.0% and 23.0%, respectively. The mean duration of hospital stay was 15.1 ± 0.9 days (range: 8 - 45 days). During the study period, 13 deaths were documented. Conclusions Despite implementation of community-level harm reduction strategies in Iran, infectious complications due to illicit drug use are frequent and often require care at the hospital. Introducing harm reductions services at an inpatient level may improve the quality of care provided and help reduce the burden of accrue from drug use.

Background Food-borne botulism is one of the potentially fatal forms of food poisoning, usually caused by ingestion of home-canned vegetables, fruits and fish products. Objectives The aim of this study was to report an outbreak of botulism due to homemade doogh in Hamadan, Iran. Patients and Methods During an outbreak, 10 members of a family referred to the hospital because of food poisoning. All patients had a history of consumption of doogh, a traditional drink. After careful physical examination, all of them were hospitalized. Botulism was suspected in all patients except for the first patient. Results The first patient was a 76-year-old man who died after 12 hours of admission due to respiratory distress. Nine subsequent patients were diagnosed as botulism with the following symptoms: diplopia (90%), dizziness (70%), nausea and vomiting (80%), ptosis (60%), symmetric weakness of extremities (60%), dysarthria (30%), chest discomfort (30%), mydriasis (20%), dysphasia (20%) and dry mouth (20%). All of the nine patients received botulinum antitoxin and improved during 5-15 days of hospitalization. Conclusions Immediate diagnosis based on careful history and physical examination are essential for management of botulism. People should be notified about proper food handling and preparation of traditional homemade foods.

Background Hepatitis B virus (HBV) is one of the most common pathogens associated with needle stick and sharp injuries (NSSIs) among healthcare workers. Objective The aim of this study was to evaluate HBV vaccination coverage and NSSIs among healthcare workers in Hamadan. Materials and Methods This cross-sectional study was performed on teaching hospitals personnel in 2010. A two-part questionnaire was designed for data collection. All participants completed the first part, which concerned demographic data, history of HBV vaccination, and hepatitis B surface antibody (HBsAb) testing. If a history of NSSI during the preceding year was noted, the second part was completed that consisted of data about characteristics of injury including time, place, and method as well as the measures taken after the injuries. Results Out of 700 healthcare workers, 585 had a complete course of HBV vaccination and only 45.7% had checked the titer of HBsAb. A total of 294 participants (42%) had positive results for HBsAb titer. The rate of accidental NSSI was 24.1% during the preceding year and 48.5% of NSSIs were during blood sampling or intravenous catheter insertion. Conclusion Hepatitis B vaccination of all nonimmune healthcare workers and measuring HBsAb after vaccination can reduce the risk of nosocomial transmission of HBV to medical staff. Furthermore, the risk of blood-borne disease transmission can be reduced by educating medical personnel on effective methods of reducing the risk of NSSIs as well as taking appropriate measures when NSSIs occur.

Escherichia coli is the main cause of community-acquired urinary tract infections (UTIs). The aims of the present study were to examine the susceptibility profile of E. coli causing UTIs and to identify factors associated with antimicrobial resistance. A cross-sectional study was conducted in Hamadan City, Iran, between 2012 and 2013. Patients referred to Farshchian or Shahid Beheshti Hospitals and diagnosed with UTI caused by E. coli were enrolled in the study. Susceptibility testing to commonly used antimicrobial agents was performed by the disk diffusion method. Relevant data were abstracted, and analysis was performed to identify factors associated with antimicrobial resistance. A total of 154 patients were enrolled in the study. Among the respective number of E. coli isolates, the highest susceptibility was observed to nitrofurantoin (94.1%) and gentamicin (86.4%) and the lowest to amoxicillin/clavulanic acid (35.1%), trimethoprim/sulfamethoxazole (38.3%) and ciprofloxacin (51.9%). Twenty-four isolates (15.6%) were susceptible to all antimicrobial tested, 31 (20.1%) were resistant to one agent and 99 (64.3%) exhibited resistance to at least two different classes of antibiotics [multidrug-resistant (MDR) phenotype]. Patients with prior use of antibiotics during the past 3 months and those who had an episode of UTI in the past 2 years were at higher risk of being infected with MDR E. coli ( P = 0.034 and P = 0.001, respectively). In conclusion, a substantial proportion of E. coli causing UTI exhibited a MDR phenotype. History of UTI and prior use of antibiotics were associated with increased risk of infection caused by MDR E. coli .

This study was undertaken in order to compare the frequency of bacterial agents of community-acquired pneumonia (CAP) and their antimicrobial resistance in the elderly and younger adults admitted to a teaching hospital in Hamedan, Iran. A total of 150 cases of CAP, including 81 elderly and 69 younger adults, were evaluated. The most frequently identified pathogens in younger adults were Moraxella catarralis (11.5%), Streptococcus pneumonia (10.1%) and Staphylococcus aureus (10.1%); while in the elderly the most frequent were S. pneumonia (12.3%), S. aureus (6.1%) and Pseudomonas aeruginosa (6.1%). No significant differences were observed between the frequency and antimicrobial resistance pattern of isolated pathogens in either age group. We concluded that the cause of CAP in the elderly follows the general trend of infection in the younger population. Increased resistance of isolated bacteria to the current antibiotics highlights the need for further investigation of newer antibiotics for the treatment of CAP.

Background: There is a high risk of tuberculosis (TB) infection among injecting drug users (IDUs). Objectives: This study aimed to determine the frequency of latent and active TB infection among IDUs. Materials and Methods: In a cross-sectional study between 2008 and 2009, IDUs referred to the methadone maintenance treatment (MMT) centers in Hamedan-Iran, undergone tuberculin skin test (PPD; purified protein derivative) were recruited. The participants with positive results for PPD test (> 5 mm and > 10 mm in HIV positive and negative cases), undergone other complementary procedures such as chest-X-ray and sputum smear test. Results: Overall, 268 IDUs between 18 and 70 (mean: 34.5 [8.2]) years were included in the study. PPD test had positive findings in 49 cases (18.3%). There was no significant difference of PPD positivity between HIV positive and negative participants (17.7% vs. 18.5%). An active TB was found among IDUs. Conclusions: The high prevalence of latent and active TB among IDUs indicates the need for TB screening tests among this population.

The increasing incidence of pertussis among adolescents and adults in recent years is an alarming factor in transmission of the infection to non-immune infants and children. Vaccination of pregnant women, immediately after delivery and before being discharged from the hospital may help to protect mothers and their newborns against the disease. Decision making process, regarding maternal immunization, requires credible information and knowledge about seroepidemiology of the infection in pregnant women. The aim of this study was to determine the seroprevalence of Bordetella pertussis antibody among admitted pregnant women in Hamadan, western Iran.In this cross-sectional study, 288 pregnant women admitted to the Fatemiyeh Hospital, Hamadan, western Iran, were enrolled into the study. After obtaining consent from every patient, serum samples were taken from patients and were kept frozen until testing. Serum level of B. pertussis antibody was measured using ELISA. Level of antibody higher than 24 U/ml was considered positive. The obtained data were analyzed using the statistical software SPSS.From 288 pregnant women, 126 (43.8%) were in their second trimester. Serological results in 103 patients (35.8%) were positive. The mean age of mothers with positive serology was 27.5±6 years old. Thirty-five percent of patients had a valid immunization record, and 1.57% of those with no vaccination record had a positive serology.The level of immunity against B. pertussis in pregnant women was low. Immunization before or during pregnancy can stimulate newborn's immune response and gives them required protection against pertussis infection.

Objectives The main goal of the treatment of the hepatitis C virus (HCV) infection is reduction and elimination of viruses as well as achieving high sustained viral response (SVR). The present study aimed to assess response to treatment of HCV infection by focusing on virological and biochemical aspects. Methods This study was performed in Hamadan, Iran on HCV infected patients who were referred between 2009 and 2013. All participants were under the treatment with Pegylated Interferon (PEG-IFN) and Ribavirin (RBV). The duration of treatment varied based on the HCV genotype as 24 weeks for genotypes 2 and 3, and 48 weeks for other genotypes. Results Of the 186 patients with HCV infection, 52.8% had a genotype of 3a and 35.6% had a genotype of 1a/b. Three months after treatment, 75 patients were willing to do quantitative PCR and early virologic response was observed in 58 cases (78.4%). Also, 112 patients were assessed after completing the treatment (75 patients in 24 weeks and 37 patients in 48 weeks treatment protocol) and the end-of-treatment response (ETR) was 94.7% and 86.5% respectively. Amongst the 103 patients with ETR, 76 were followed up six months after treatment and the PCR was negative in 71 cases (SVR = 93.4). With the progress and completion of the treatment, improvement is observed in liver function tests. Conclusions Even with the introduction of new drugs and interferon free protocols in treatment of hepatitis C infection it seems that the IFN-based treatment is still used in low/middle income countries for treatment-naive patients with HCV genotype 3.

Varicella is a highly contagious illness that is severe and associated with a greater risk of complications and death in adults than in children. The disease in pregnant women may result in congenital varicella syndrome. The aim of this study was to determine the immunity level against varicella-zoster virus among pregnant women in Hamedan, Iran. During a cross-sectional study, blood samples of 270 pregnant women who were referred to the Fatemieh hospital during a six-month period were taken after they filled out the relevant questionnaires and the agreements. The level of IgG against varicella-zoster virus was measured using ELISA method. The collected data was analyzed by SPSS 16. Out of 270 pregnant women, 210 (78.5%) had protective levels of IgG against varicella-zoster virus and 21.5% were not immune against it. Immunity development had no significant relationship with the place of residence, education, job and the history of infection with chickenpox in the examined person as well as, her maternal education and occupation. Our results seem to indicate that pregnant women in this region need special care when it comes to contacts with chicken pox patients, given the sensitivity of a significant portion of this group to the primary varicella infection. Key words: Varicella-zoster virus, seroepidemiology, pregnancy, immunity

Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in edu-cational hospitals of Hamadan, western Iran.During a 1-year period from April 2006 to March 2007, all patients with cul-ture-proven nosocomial infections from educational hospitals in Hamedan, west-ern Iran were included. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48h after admission in the hospital. An-timicrobial susceptibility testing of isolated bacteria was performed by disc dif-fusion method.A total of 170 cases of culture-proven nosocomial infections were diag-nosed. Most cases were in intensive care units (ICUs) (57.4%). The common sites of infection were lower respiratory tract (51.8%) and urinary tract (31.9%). Kleb-siella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens (32.7%, 22.9%, and 14.8% respectively). Most en-terobacteriacea isolates were resistant to third generation cephalosporins. The resis-tant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to cipro-floxacin. Among S. aureus isolates, 80% were methicillin-resistant.The patients in the ICUs are at a higher risk of nosocomial infec-tions. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs.

To study on the frequency of hepatitis B and C infections in chronic psychiatric patients in Day Night Patient Care Centres in Hamedan in 2006-2007.This is a cross sectional study done on 170 patients with chronic mental disorders admitted in patient care institutions of Hamedan in 2006-2007. Positive tests for HCV-Ab were confirmed by RIBBA test.Of 170 patients, 56% were males and 44% were females, (age range 15-71 years). Hepatitis B and C infection was found only in males, with Hepatitis B in 1.8% patients. All of Hepatitis B cases two thirds of Hepatitis C cases were institutionalized in one of the centers.Overall frequency of Hepatitis B and C infections in chronic psychiatric patients in care centers is more than the general population and centralization of these cases in one center causes transmission of infection if the standard precautions are not observed.

Article history: Received: 21 April 2010 Revised: 7 June 2010 Accepted: 19 June 2010 Available online: 24 June 2010 Background: Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in educational hospitals of Hamadan, western Iran. Methods: During a 1-year period from April 2006 to March 2007, all patients with culture-proven nosocomial infections from educational hospitals in Hamedan, western Iran were included. Nosocomial infections were defined as a cultureproven infection, which occurred more than 48h after admission in the hospital. Antimicrobial susceptibility testing of isolated bacteria was performed by disc diffusion method. Results: A total of 170 cases of culture-proven nosocomial infections were diagnosed. Most cases were in intensive care units (ICUs) (57.4%). The common sites of infection were lower respiratory tract (51.8%) and urinary tract (31.9%). Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens (32.7%, 22.9%, and 14.8% respectively). Most enterobacteriacea isolates were resistant to third generation cephalosporins. The resistant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to ciprofloxacin. Among S. aureus isolates, 80% were methicillin-resistant. Conclusion: The patients in the ICUs are at a higher risk of nosocomial infections. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs.

Summary Objective Brucellosis is a zoonosis of both public health and economic significance in most developing countries. Polymorphisms in Toll-like receptor-4 (TLR4) have been reported to be associated with a blunted immune response to microbial pathogens. Information regarding any association between genetic variation of TLR4 and susceptibility to brucellosis is not available in the literatures. The main purpose of this research is to evaluate the role of polymorphic alleles of TLR4 gene in susceptibility to brucellosis. Materials and methods In this case–control study, 198 patients with brucellosis and 111 healthy volunteers matched for sex, age and geographic area were evaluated by genotyping for polymorphism in TLR4 gene (Asp299Gly) using amplification refractory mutation system (ARMS)–PCR method. Results Allele 896G was more prevalent in patients with brucellosis compared to healthy controls (33.6% vs. 20.7%, P =0.000003). Also the frequency of G allele of TLR4 gene was significantly higher in male patients with brucellosis compared to the same sex in control group (36% vs. 21.7%, P =0.00005). Multiple logistic regression analysis demonstrated that male patients heterozygous at allele G gene had a significantly higher risk for brucellosis with an odds ratio of OR 2.89, 95% CI: 1.79–4.69, P Conclusion This study is the first to show an association between genetic polymorphism in TLR4 gene and susceptibility to brucellosis.

Although all newborns in Iran have been vaccinated against hepatitis B since March 1993, routine screening of pregnant women has not been conducted in prenatal care programs, yet transmission of hepatitis B via the maternal-fetal route is still a viable likelihood, which must be entertained.The subjects were divided into 2 groups. The exposed group comprised 97 vaccinated children whose mothers were seropositive for hepatitis B surface antigen (HBsAg) and had not received hepatitis immunoglobulin at birth. The unexposed group consisted of 87 vaccinated children whose mothers were seronegative for hepatitis B surface antigen. We compared these 2 groups to determine the efficacy of vaccine alone in high-risk children. This study was conducted in Tehran, Iran, from June 2002 to December 2002. All children were born after 1993.Chronic infection (HBsAg positivity) was detected in 14.3% of children in the exposed group. There were no instances of chronic infection in the unexposed group (relative risk [RR]=13.48, 95% confidence intervals [CI] 1.8-100.02). Previous infection of hepatitis B (HBcAb positivity) was found in 29 (29.9%) children in the exposed group, but only one (1.2%) in the unexposed group (RR=26.01, 95% CI: 3.61-186.95). Immunity (HBsAb positivity) in the exposed group measured 48 (49.5%) and unexposed group measured 56 (64.4%) (R.R=0.76, 95% CI: 0.59-0.99).Vaccination alone did not induce immunity against hepatitis B in high-risk children; it seems that routine screening of pregnant women is necessary for determining whether neonates need hepatitis B immunoglobulin after birth.

Introduction Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory and demyelinating disease of the central nervous system, resulting in various neurological symptoms. Usually, the disease appears following vaccination or systemic viral infections. In rare cases, the disease appears following pneumococcal infections. Case Presentation The patient was a 27 year-old man who was referred to the clinic following a few days of fever and cold with consciousness deficit and right hemiplegia. Based on the analysis of cerebrospinal fluid (CSF) and diagnosis of pneumococcal meningitis, he received suitable antibiotic treatment. Despite complete return of consciousness, good general condition, and negative smear and culture of CSF, fever continued and no considerable improvement was observed in the hemiplegia. Therefore, brain magnetic resonance imaging (MRI) was performed and according to the findings, treatment was started with the diagnosis of acute disseminated encephalomyelitis. Treatment with prednisolone at first obviated the fever and after a month brought about a complete hemiplegia cure. Following the status of the patient after three months, his MRI clearly showed considerable reduction in lesions. Discussion There is possible occurrence of ADEM following pneumococcal meningitis. Regarding the occurrence of neurological symptoms such as visual disturbance, hemiparesis or hemiplegia following bacterial meningitis, ADEM can be considered as one of the differential diagnoses to be accompanied by MRI. Acute disseminated encephalomyelitis should be treated using suitable dose of corticosteroids.

Background The risk of occupationally acquired tuberculosis (TB) remains a concern, even now that the infection has been under control to a great extent. Objectives The aim of this study was to ascertain the prevalence of latent TB infection and pulmonary TB, and to assess the risk factors for TB, among health care workers in Hamadan. Patients and Methods Tuberculin skin test was performed on 245 health care workers, in two educational hospitals. The reaction was considered as "positive" if the induration diameter was ≥ 10 mm. Individuals with a positive test > than 15 mm were encouraged to seek further medical evaluation, including a chest-x-ray and a smear and sputum culture of the sputum for acid-fast bacilli, in those with radiographic changes indicating TB. Results Out of 245 health-care workers included in this study, 92 (38%) had positive tuberculin test. There was a significant association between aging and tuberculin positivity. There was also a significant association between the length of employment and tuberculin positivity. Ward attendants had higher rates of positive test results, compared with other occupational groups. Conclusions It was concluded that latent TB infection is common among health-care workers in the studied region. Age, occupational group and employment length were found to be strongly associated with tuberculin positivity.

Background Hepatitis B is one of the most common chronic viral infections worldwide, especially in developing countries. The insufficient treatment of the disease increases the risk of cirrhosis and hepatocellular carcinoma, which impose heavy costs to the patient and the society. Different studies evaluated several protocols for the treatment of the disease. Objectives The aim of this study was to evaluate the response rate of the different treatments in patients with chronic hepatitis B (CHB). Patients and Methods In a cross-sectional study, 89 patients with CHB who were referred to Infectious Diseases Clinics during 2004 to 2009 were studied. Serological and biochemical outcomes to the different treatments were evaluated. The data were analyzed by SPSS 16. Results CHB was more frequent in men (74.2%) than women (25.8%). The mean age of the patients was 36 ± 1.36 years. Fifty-three patients (59.6%) had active CHB while 36 (40.4%) were asymptomatic carriers. Serologic and biochemical responses to the treatment were 50% and 69.44%, respectively. However, 50% of the patients with positive HBeAg showed serologic response to the treatment, 37.5% showed HBeAb as well as reduced amounts of HBeAg, and 12.5% just showed reduced amounts of HBeAg. Patients treated by lamivudine showed the highest serologic response rate (75%). Conclusions Serologic and biochemical response to the different treatments in the patients were better than other similar studies. Besides, it is recommended to begin antiviral therapy against CHB infection with lamivudine alone as a first-line therapy.

Objectives: The aim of this study was to ascertain the prevalence of latent TB infection and pulmonary TB, and to assess the risk factors for TB, among health care workers in Hamadan. Patients and Methods: Tuberculin skin test was performed on 245 health care workers, in two educational hospitals. The reaction was considered as "positive" if the induration diameter was ≥ 10 mm. Individuals with a positive test > than 15 mm were encouraged to seek further medical evaluation, including a chest-x-ray and a smear and sputum culture of the sputum for acid-fast bacilli, in those with radiographic changes indicating TB. Results: Out of 245 health-care workers included in this study, 92 (38%) had positive tuberculin test. There was a significant association between aging and tuberculin positivity. There was also a significant association between the length of employment and tuberculin positivity. Ward attendants had higher rates of positive test results, compared with other occupational groups. Conclusions: It was concluded that latent TB infection is common among health-care workers in the studied region. Age, occupational group and employment length were found to be strongly associated with tuberculin positivity.

Summary Background Traditional regimens for the treatment of brucellosis are associated with significant relapse rates. The aim of this study was to compare the efficacy of ofloxacin plus rifampin (OFX–RIF) versus doxycycline plus streptomycin (DOX–STR) and doxycycline plus rifampin (DOX–RIF) regimens in the treatment of brucellosis. Methods Two hundred and nineteen patients with brucellosis were enrolled in a randomized clinical trial; 28 cases were withdrawn because they did not attend the follow-up. Out of 191 patients with brucellosis, 64 received OFX–RIF, 62 received DOX–RIF, and 65 patients received DOX–STR regimens. All patients were assessed during the period of therapy in the second, fourth, and sixth weeks by clinical course and were also followed up clinically and serologically for 6 months after the cessation of therapy. Results The highest clinical response (95.4%) was observed in the DOX–STR group ( p =0.009). The results of multivariate analysis indicate that treatment with DOX–STR had the least therapeutic failures among the three groups ( p =0.033). Adverse reactions were seen in 16.8% of patients, but there was no significant difference among the three groups ( p =0.613). The lowest relapse rate (4.6%) was observed in the DOX–STR group ( p =0.109). Conclusions We conclude that the DOX–STR combination should remain the first-line regimen for the treatment of brucellosis in our region; we recommend DOX–RIF and OFX–RIF combinations as the second-line regimens.