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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.

Background and Objective: The excessive use of broad-spectrum antibiotics will lead to drug resistance of microorganism and specially nosocomial organisms. Because of high incidence of antibiotic resistance in hospitals, we aimed to study antibiotic resistance to gram negative bacteria. Material and Methods: This cross-sectional study was conducted on the data of biological samples (2006-2008), with positive culture result. Using antibiogram, microbial resistance to isolated microorganism was determined, and after culturing the samples, bacteria were identified by using differential media and antiserum. Then, antibiotic resistance was performed by disk diffusion. Results: The most common gram-negative microorganism obtained from all cultures was E.coli with the lowest drug resistance to Nitrofurantoin. Conclusion: Based on the results, antimicrobial resistance pattern is not the same in different places and furthermore it is ever changing. Therefore, further research is needed to be done to have an accurate pattern of antibiotic resistance to provide effective treatment regimens. [ABSTRACT FROM AUTHOR]

Brucellosis continues to be a common infectious disease in some parts of the world. Although the disease has different presentations, but chest wall involvement, as a manifestation of brucellosis is rare. In this study, we report three cases of chest wall involvement as manifesting feature of Brucellosis in Iran. They presented with a history of parasternal masses revealed to a diagnosis of Brucellosis and responded well to the treatment. Brucellosis may present with strange and unpredictable manifestations and can be misdiagnosed with tuberculosis and malignancies, especially in endemic areas for both TB and brucellosis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Nosocomial infections, including drug-resistant Acinetobacter baumannii infections, continue to impact the health of hospitalized patients. This study sought to determine the prevalence of these infections and assess the associated risk factors and clinical outcomes in Gorgan, Iran., Methods: A retrospective cross-sectional study was conducted on 143 infected patients with Acinetobacter baumannii in two educational hospitals in Gorgan city, Iran between 2016 and 2018. Patient information including age, gender, reason and duration of hospitalization, background of diseases, type of sample culture, symptoms, laboratory findings, prescribed antibiotics, and antibiogram were collected and analyzed. The Logistic regression and survival statistical methods were used by software of SPSS 26., Results: A total of 37 patients (25.87%) died during hospitalization. The less than one year and 45-65 years age groups demonstrated more deaths (29.7%; p-value < 0.001). Being single (not being married) was found to be a risk factor in increasing the chance of death among patients (OR = 2.154, 95% CI: 1.02-4.53; p = 0.048). Hospitalization in intensive care units (ICUs) was a risk factor for the death of patients (OR = 4.655, 95% CI: 7.6-83.2). The resistance to carbapenems was reported to be an important risk factor for the death of patients., Conclusions: Acinetobacter baumannii infections, particularly those resistant to carbapenems, are a significant risk for patients in ICUs and can lead to higher mortality rates., (© 2024. The Author(s).)

Background: It is essential to constantly review the risk factors and treatment outcomes of tuberculosis (TB). This study evaluated some important risk factors of TB over five years., Methods: Between 2013 and 2018, all available information and possible risk factors related to TB patients were analyzed from the TB registry program of the health district of Gorgan, Iran., Results: Among 349 TB patients, 194 (55.59%) were males and 167 (47.85%) had at least a comorbidity. The death rate was higher in the age group more than 65 years (p < 0.001), the low-educated group (P = 0.012), and patients with underlying diseases, especially diabetes (p < 0.001). In total, univariate and multivariate statistical analyzes showed that having comorbidity (OR = 4.34; 95% CI 1.49 - 13.49), as well as, being jobless (OR = 3.07; 95% CI 1.19 - 8.59) were the main factors influencing the adverse events., Conclusion: According to the study, aging, underlying diseases, and cultural poverty include a higher share of the main risk factors for active TB and/or treatment outcomes. By considering these risk factors and training the medical staff continually, we can reduce the time of TB diagnosis, and prevent it from spreading., Competing Interests: The authors have no conflicts of interest to declare for this study., (© The Author(s).)

Background: COVID-19 has turned into a global public health crisis. This study intended to compare demographic characteristics, disease severity, treatment methods, and clinical outcomes in hospitalized patients with COVID-19 during the third and fourth waves of the pandemic in Golestan Province, Iran., Methods: In this cross-sectional study, the clinical epidemiology of all COVID-19 patients, who were hospitalized in two educational hospitals in Golestan Province for 30 days from the start of the third and fourth waves of the coronavirus pandemic in 2021-2022, was assessed. Their electronic medical records were used to collect their epidemiological, demographic, laboratory, and clinical information and treatment outcome., Results: In all, 930 electronic medical records of the hospitalized patients (351 in the third wave and 579 in the fourth wave) were studied. In the third and fourth waves, 29.06% and 13.13% of the patients had severe COVID-19, respectively ( P  = 0.001). The number of deaths in the third wave was larger compared to the fourth wave ( P  = 0.015). The mean duration of hospitalization was longer in the third wave than in the fourth wave ( P  = 0.001). The drugs administered most in these two waves were remdesivir, dexamethasone, and heparin, and the patients who received these drugs were compared in the third and fourth waves ( P  = 0.001)., Conclusion: The reduced rate of mortality in the fourth wave was compared to the third wave. This reduction can be attributed to the change in the national strategy adopted in terms of hospitalization criteria and treatment protocols taking into account the acquired experience, earlier hospitalization, and start of drug therapy., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Samira Eshghinia et al.)

Background: Considering the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, which causes coronavirus disease 2019 (COVID-19), we aimed to report the clinical features of 427 patients with COVID-19 and the outcomes after one-month admission to major teaching hospitals in the northeast of Iran., Materials and Methods: Data of patients hospitalized with COVID-19 from 20 February 2020 to 20 April 2020 was analyzed using the R software. The cases and their outcomes were monitored up to one month following their admission., Results: Among 427 patients with a median age of 53 years (50.8% male), 81 (19%) were directly admitted to the ICU ward, and 68 (16%) died during the study. The mean (SD) lengths of hospital stay were significantly higher in the non-survivors (6 (9) days) than survivors (4 (5) days) (P = 0.018). Ventilation need was reported in 67.6% of the non-survivors and 0.8% of the survivors (P < 0.001). Cough (72.8%), fever (69.3%), and dyspnea (64.0%) were the most common symptoms. There were more comorbidities in the severe cases (73.5%) and non-survivor (77.5%). Liver and kidney damage were significantly more common in non-survivors. Ninety percent of the patients had at least one abnormal chest CT scan finding, including crazy paving and consolidation patterns (27.1%), followed by the ground-glass opacity (24.7%)., Conclusion: Results showed that the patients' age, underlying comorbidities, levels of SpO 2 , and laboratory findings at the time of admission may predict the progress of the disease and can be considered mortality-related factors., (Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease.)

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.)

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 Ltd.)

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.