Actinomycosis may be presented in unusual organs: A report of two cases

Actinomycosis is a chronic granulomatous suppurative disease characterized by direct extension to the contagious tissue with the formation of multiple drainage sinus tracts through which tiny colonies of organisms called sulfur granules are discharged. Here, we report 2 cases of actinomycosis from Iran. One of them had actinomycosis on the hand and the other on the foot. Samples of tissue biopsy showed sulfur granules associated with colonies of actinomyces, thus confirming the diagnosis in both cases. The response to curettage and penicillin therapy was satisfactory in our patients. The chronic and indolent course of actinomycosis resembles tuberculosis, fungal infection and malignancy. So, increasing awareness among the clinicians and clinical microbiologists will help in the early diagnosis of the disease and in the initiation of early and proper treatment

Pulmonary tuberculosis and some underlying conditions in Golestan Province of Iran, during 2001-2005

Context: Pulmonary tuberculosis has been a major health problem in Golestan province of Iran. Aims: This descriptive cross-sectional study was performed to evaluate the frequency of coexisting medical conditions and their effects on some epidemiologic factors in patients with pulmonary tuberculosis. Setting and Design: This was a descriptive cross-sectional study. Methods and Material: Demographic information, time of admission in the hospital and coexisting medical conditions (diabetes, chronic renal failure/hemodyalysis, corticosteroids consumption and malignancies) were extracted from the patient's file. Statistical analysis used: Chi-square test was used to assess the relationship between variables. Results: Two hundred forty three patients with pulmonary tuberculosis during 5 years were studied. Out of all, 162 cases (66.7%) did not have any co-morbidities. Diabetes mellitus was found to be the most prevalent condition (23.05%) followed by chronic renal failure, corticosteroid consumption and malignancy ranking second, third and forth in the list (5.8%, 2.5% and 2 respectively). The mean age of the patients was 50.15±19 years old. In the group without co morbidities, male/ female ratio was 1.41/1, but co morbidity with diabetes was significantly more prevalent in females (p<0.05). Conclusions: We suggest screening of tuberculosis in patients with chronic renal failure and diabetes mellitus in our area. Also for patients with pulmonary tuberculosis, diabetes screening should be considered essential

Leptospirosis in Golestan province in Iran (Reports of twelve cases)

Background&Objective: Leptospirosis is one of the most common zoonosis in the world,fatality rate of the disease is sometimes high in endemic regions and is transmitted through direct or indirect contact with urine of animals that are carrier of leptospirosis. We studied incidence of leptospirosis in Golestan province in 2004. Materials&Methods: According to coordination with province health center, 20 suspicious patients for leptospirosis were diagnosed by general practioners and referred to 5th Azar hospital. Patients with at least 4 constitutional symptoms (fever, sever headache, conjunctival suffusion, myalgia, arthralgia, icter, malaise) and history of working ir rice farm, exposure to wild or domestic animals or stagnant water were included and MAT for leptospirosis were requested. other causes were ruled out with wright, widal, VDRL, peripheral blood smear. Results: Out of 20 suspicious patients, 12 cases reported. All of them were farmer, had titer>1/100 in MAT. Fever chills, headache were found in nearly all of them. Conjunctival suffusion and increased CPK up to 2 fold than normal was seen in %75 and %66.4 respectively. They were treated by ampicillin or amoxicillin sussessfully. Conclusion: According to the results of this study we suggest to all physician of the area to be concentrated to the disease as an occupational disease in rice farmers. So early diagnosis can prevent many complications of the disease in this group of farmers

Prevalence of infectious diseases in patients with end stage renal disease in Gorgan City in Iran

Background: The mortality rate of sepsis and pneumonia is higher in end-stage renal disease (ESRD) patients than in the general population. Bacterial infections are the most common cause of hospitalization in dialysis patients and the most common source of bacteremia is vascular access in these patients. The aim of this study was to determine the prevalence of infectious causes of hospitalization in patients with endstage renal failure in Gorgan. Methods: This cross-sectional study was performed on patients with ESRD who were admitted to the 5 Azar Medical Education Center of Gorgan City during 2014 to 2016. Patients' information was collected through their clinical records and analyzed statistically. Results: The prevalence of infectious diseases in ESRD patients during the 3 years was 12.7, out of 100 hospitalized patients with ESRD and infectious causes, the most common type of infectious disease was catheter infection (43) and sepsis (18), urinary tract infection (11) and pneumonia (8) were the next. The most common infectious causes leading to hospitalization in men with the ESRD were catheter infection, sepsis, and pneumonia, respectively, and in women, catheter infection, sepsis, and urinary tract infection. The highest incidence of catheter infection was in the age group of 66-70 years (30.2), 71-75 (25.6), and above 71 years (25.6), respectively. The highest incidence of sepsis occurred in the age group of 75-71 years (38.9) and also the highest incidence of urinary tract infections in the age group of less than 65 years. Age (P=0.003), sex (P=0.01), duration of disease (P=0.009), addiction (P=0.01), and diabetes (P=0.01) were the most common risk factors for infectious diseases in patients with ESRD. Conclusion: The results of this study showed that catheter infection is the most common cause of infection in patients with end-stage renal disease (ESRD). Therefore, avoiding multiple vascular manipulations, disinfection of the catheter, timely replacement, and training of dialysis staff are effective in reducing catheter infections. © 2020 Tehran University of Medical Sciences. All rights reserved

Frequency of Beta-Lactamase Antibiotic Resistance Genes in Escherichia Coli and Klebsiella pneumoniae

Background: This cross-sectional study was performed on isolates of Klebsiella pneumoniae, and E.coli from clinical specimens of patients admitted to Sayyad Shirazi Hospital by census sampling method in 2019. Antibiogram testing was performed using the disk diffusion method as defined by the Clinical and Laboratory Standards Organization for performing this test. Finally, the abundance of genes was evaluated by PCR using specific primers. Frequency, percentage, mean±SD were used to describe the data. Chi-square and Fisher's exact tests were used to compare the presence and absence of the studied genes alone and in the presence of each other. Result: This study was performed on 130 positive samples, isolated from 32 (24.6) males and 98 (65.4) females with a mean age of 43.78 ± 21.72. From the total number of 130 isolates, 84 (64.6) consisted of E.coli, and 46 (35.4) were Klebsiella. Most of the cultures were urine and vaginal (61.5). The highest antibiotic resistance in isolates was cephalexin and cefazolin (67.9 in E.coli & 63 in Klebsiella). Colistin was identified as the most effective antibiotic (100) in both. AMPC extendedspectrum β-lactamase genes were present in 40 (30.8) isolates. The highest frequency about the gene pattern of AMPC positive β-lactamase bacteria was correlated to DHA, FOX, and CIT genes, while none of the samples contained the MOX β-lactamase gene. E.coli and Klebsiella beta-lactamase-producing AMPC isolates were also significantly correlated with antibiotic resistance to the cephalosporin class (P <0.05). Conclusion: This study indicated a high percentage of resistance to third and fourth generation cephalosporins. Hence, careful antibiogram tests and prevention of antibiotic overuse in infections caused by AMPC-producing organisms and screening of clinical samples for the resistance mentioned above genes and providing effective strategies to help diagnose and apply appropriate treatments and change antibiotic usage strategies can partially prevent the transmission of this resistance. © 2021 Roghieh G.Ayele, et al

The epidemiology of skeletal tuberculosis in northeast of Iran: A review of 229 cases

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1 of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3 were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8) were from the rural areas and most were diagnosed by the private healthcare system (63.8). The highest rate of skeletal TB was seen in 2013 (15.3). Spinal TB (81.2) scored the highest rate and pain (96.9) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed. © 2018, Shiraz University of Medical Sciences. All rights reserved

The epidemiology of skeletal tuberculosis in northeast of Iran: A review of 229 cases

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1 of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3 were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8) were from the rural areas and most were diagnosed by the private healthcare system (63.8). The highest rate of skeletal TB was seen in 2013 (15.3). Spinal TB (81.2) scored the highest rate and pain (96.9) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed. © 2018, Shiraz University of Medical Sciences. All rights reserved

Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran

Objective: To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. Methods: Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. Results: Among 2280 TB records, 609 (26.71) were EPTB. They were mostly female patients (53.7) and residents in rural areas (56.5) with a mean age of 40.55 years ±16. The average age of female patients (37.55 years ±16.99) was lower than of male patients (44.07 years ±20.59). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). Conclusion: Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB. © 2020 John Wiley & Sons Lt

Prevalence of medicinal drug interactionsin medicinal prescriptions in the Golestan province, Iran (2012)

Background and Objective: Medicinal drug interactions are one of the problems caused by irrational drug prescription. It eigher change the therapeutic effect or cause drug toxicity. This study was performed to determine the prevalence of medicinal drug interactions in medicinal prescriptions in Golestan province, north of Iran. Methods: In this descriptive study, 1100000 medicinal prescriptions under contract with the Golestan province health insurance organization were assessed for drug interactions during 20 March- 20 September 2012. Results: Drug interactions frequency was 6262 (0.66%). 35.5%, 63.1% and 1.4% of prescriptions were severe, moderate and mild interactions, respectively. The most common severe, moderate and mild drug interactions related to Atorvastatin-Gemfibrozil (13.67%), Ceftriaxone- Gentamicin (9.05%) and Lithium Carbonate-Haloperidol (2.56%). Conclusion: In view of moderate and severe medicinal drug interactions in physicians' prescriptions, health system should plan a comprehensive program to improve awareness and effective monitoring to reduce medicinal drug interactions