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Background : Contradictory opinions exist regarding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in patients with hypertension, which is the most common comorbidity associated with COVID-19. Herein, the effects of ACEIs and ARBs on outcomes of COVID-19 patients were evaluated. Methods: In this cross-sectional study, the outcomes of COVID-19 patients were compared between patients who received pretreatment ACEIs or ARBs and those who did not. Results: The incidence of moderate and severe forms of COVID-19 was significantly higher in patients taking ACEI/ARB drugs (P-value = 0.012). Also, patients taking ACEI/ARB drugs (P-value = 0.034), patients with hypertension (P-value = 0.011), and patients with dyslipidemia (P-value = 0.011) experienced more severe forms of COVID-19. There was an association between increased length of hospital stay and dyslipidemia (P-value = 0.033) and the use of ACEI/ARB drugs (P-value = 0.041), while no correlation was found between other parameters in univariate linear regression analysis as well as multivariate linear regression. There was an association between increased mortality of patients with increasing age (P-value < 0.001), BMI greater than 30 kg/m2 (P-value = 0.02), asthma (P-value = 0.003), and dyslipidemia (P-value = 0.045). Conclusions: ACEI/ARB drugs put COVID-19 patients at high risk for moderate to severe forms of COVID-19 and higher length of hospital stay. Although, it is notable that these drugs did not significantly affect specific adverse outcomes of COVID-19, such as the need for admission to the intensive care unit (ICU), length of ICU stay, ventilation, and mortality. [ABSTRACT FROM AUTHOR]

Abstract Background Brucella epididymoorchitis(BEO) is a focal complication of human brucellosis and has been reported in 2-20% of patients with brucellosis. Brucellosis is an endemic disease in Iran. The incidence of the disease in this country is 34 per 100 000 per year. Methods In a retrospective study, we identified 30 cases of Brucella epididymoorchitis in two teaching hospitals in the north of Iran during 1997-2009. Findings Epididymoorchitis occurred in 11.1% of male patients with brucellosis. The average age was 25.5 ± 12.43 years. Pain and scrotal swelling (100%) and fever (96.7%) were the most common symptoms. Different treatment regimens were administered including doxycycline plus rifampin (60%), doxycycline plus rifampin plus aminoglycoside for the first two weeks (36.6%) and doxycycline plus cotrimoxazole(3.4%). Ten percent of the patients did not respond to antibiotic therapy and required surgical drainage or orchiectomy. Conclusions In brucellosis endemic areas, clinicians who encounter patients with epididymoorchitis should consider the likelihood of brucellosis. A careful history and physical examination and an immediate laboratory evaluation help to make a correct diagnosis. Generally, classical therapy of brucellosis is adequate for the treatment of epididymoorchitis.

Identifying and determining the origin of the first human case of COVID-19, which has caused pandemic will be of great benefit in preventing and controlling next epidemics and pandemics. The first confirmed case of COVID-19 was reported in December 2019 in China. This article reports three cases of pneumonia compliant with COVID-19 admitted to Qaemshahr Razi Hospital in Mazandaran province, Iran before the first official report of confirmed case of the disease (November-December 2019). The pattern of radiological involvement was completely consistent with COVID-19 in all three patients. Two patients died of acute progressive respiratory failure despite supportive respiratory therapy and systemic corticosteroids, and the other patient recovered. Study of these cases highlights the fact that emerging and re-emerging diseases should be considered in management of patients with infection and unusual symptoms. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis is a soil-transmitted helminth (STH) widespread in various part of the world. A 78-yr-old peasant diabetic female from Mazandaran Province northern Iran, was admitted to Infection Department of the Razi Hospital in city of Qaemshahr, north of Iran complaining about abdominal skin rash, pruritus, itching, anorexia, nausea, vomiting, dysuria and cough. This patient had cutaneous migration effects of S. stercoralis larvae in her abdominal skin (larva currents and urticaria). Lung CT without contrast demonstrates bilateral diffuse ground glass opacity draws attention. Upper gastrointestinal endoscopy revealed gastro esophageal reflux with antral gastritis. Duodenal endoscopy showed unusual mucosa and a biopsy from it sent to the pathology laboratory. Histopathology of duodenal bulb and duodenum biopsy showed mild villous atrophy and S. stercoralis infection. The patient was treated with albendazole and clinical sings improved completely after treatment. Strongyloidiasis should be carefully considered by clinicians who practice in endemic areas. Clinicians must keep a high level of skepticism for patients from endemic area. [ABSTRACT FROM AUTHOR]

We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician's attention toward the possibility of invasive fungal infection in the immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Background: Icterohemorrhagic form of leptospirosis has a high mortality rate. In this study, the clinical manifestations, epidemiologic and laboratory findings and outcome of Weil's disease were investigated. Methods: A descriptive cross-sectional study was conducted on 66 consecutive patients with icterohemorrhagic leptospirosis who were admitted to Razi Hospital (The Therapeutic Center of Infectious Diseases in the North of Iran) in 2013. The inclusion criteria were as follows: All patients who had clinical and epidemiological data suggestive of leptospirosis and displayed icterohemorrhagic form at the time of admission or during hospitalization. All patients were visited on admission, one, two and six weeks later. Demographic data, clinical, laboratory features and complications were evaluated, and statistical analysis was performed using SPSS version 13.0. Results: Among 66 patients, 89.4% (n = 59) were male, 60% (n = 40) were farmers and 9.1% (n= 6) had a history of swimming in rivers. The most common complaints were fever and jaundice, respectively. The most common clinical symptoms were fever (90.9%), myalgia (75.8%), chills (70.8%) and headache (65.1%). Hyponatremia and hypernatremia were seen in 7.6% and 72.8% of the participants, respectively. Also, hypokalemia was observed in two patients (3%). Approximately, half of the cases had leukocytosis and 90% had thrombocytopenia. Rise of AST, ALT, ALP and bilirubin were seen in 95.2%, 93.6%, 76.2% and 100% of the patients, respectively. Of the patients, 42.4% experienced complications of icterohemorrhagic leptospirosis including acute renal failure (30.3%) pneumonia (25.8%), pancreatitis (4.5%), subarachnoid hemorrhage (1.5%) and gastrointestinal bleeding (1.5%). Three cases (4.5%) died, 42 cases (63.7%) were discharged with residual effects and 52 patients (78.8%) had positive serology. Conclusion: The most significant biochemical abnormalities were thrombocytopenia, hyperbilirubinemia, hyponatremia and hypernatremia and azotemia and the latter remained stable in 2% of the patients at least until the end of the 6-week period. [ABSTRACT FROM AUTHOR]

An efficient catalytic system using 1-benzyl-4-aza-1-azoniabicyclo[2.2.2]octane chloride ((BeDABCO)2Pd2Cl6) was developed for the Hiyama of various aryl halides with triethoxy(phenyl)silane. The substituted biaryls were produced in excellent yields in short reaction times using a catalytic amount of this catalyst in NMP at 100 °C. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and purpose: Brucellosis is a zoonotic disease with worldwide distribution. Humans are usually infected through contact with infected animals or unpasteurized dairy products. We observed contradictory diagnostic value of ELISA and Standard tubal agglutination test (wright) in other studies. Therefore, we designed this study to compare the diagnostic value of ELISA and Standard tubal agglutination test (wright) in patients with positive PCR brucellosis. Material and Methods: We designed a diagnostic study and selected 59 suspected patients and 45 healthy individuals during March 2012 to March 2013 in Razi Hospital at Ghaemshahr City. We did all the tests including: PCR, 2-Mercaptoethanol, Wright, Coombs and Wright and Elisa for all patients and healthy subjects. Clinical manifestation and laboratory data were collected. Data were analyzed by SPSS version 16. Results: The patients' mean age was 37.98±13.79 years and 71.2% were males. All patients had previous exposure to risk factors. The most common signs were fever (86.4%), sweating (71.2%) and arthralgia (71.2%). On the base of PCR, sensitivity, specificity, positive predict value (PPV), negative predict value (NPV) and the overall accuracy of Wright test was 94.73%, 63.63%, 60%, 95.45% and 75%, Elisa IgM test 57.89%, 77.27%, 59.45%, 76.11% and 70.19% and Elisa IgG test 78.94%, 71.21%, 61.22%, 85.45% and 74%. Conclusion: In our study, Wright test has higher sensitivity, NPV and overall accuracy in comparison with ELISA. In ELISA test, ELISA IgG has higher sensitivity, PPV, NPV and overall accuracy in comparison with ELISA IgM. [ABSTRACT FROM AUTHOR]

Background and purpose: Annually outbreak of cholera is reported in our country. Awareness of the general population about cholera is the cornerstone of disease prevention. The aim of this study was to assess the awareness of general population in Mazandaran province about cholera. Materials and methods: This cross-sectional study was carried out in April 2013. The study population included 425 people of general population attending health centers in Mazandaran province who were randomly selected. They completed a questionnaire containing 10 questions about cholera in the presence of researcher. SPSS ver. 16 was used to analyze the data. Results: The participants were 222 (52.2%) female and 203 (47.8%) male with the mean age of 34±11.50 years. The awareness level were, 27.5% poor (score≤3), 33.2% moderate (score 4 and 5), 34.8% good (score 6 and 7) and 4.5% very good (score≥8). We observed low levels of awareness among those aged under 20 and over 60 years old. However, no significant difference was seen in two genders. Conclusion: This study revealed a low level of awareness among general population on cholera. Therefore, educational programs are recommended to enhance the knowledge of people on cholera. [ABSTRACT FROM AUTHOR]

Tuberculosis could involve every organ. CNS involvement occurs in 10-15% of patients with extra pulmonary tuberculosis. This paper presents an unusual case of tuberculoma. A 36- year-old man was referred to Qaemshahr Razi hospital with decrease in consciousness level and paraparesia. His brain MRI revealed small and multiple hyperatenuated lesions in pons, hypothalamus and temporal lobes. Analysis of CSF fluid was consistent with TB meningitis. Anti-TB drugs and prednisolone was started for the patient. His status improved and his brain MRI involvement resolved by the end of treatment. In an endemic area, tuberculosis should be considered as a differential diagnosis for patients with fever, decrease in consciousness level and neurological deficit. [ABSTRACT FROM AUTHOR]

An efficient catalytic system using (BeDABCO)2Pd2Cl6 was developed for the Stille cross-coupling reaction. The substituted biaryls were produced in excellent yields in short reaction times using a catalytic amount of this catalyst in DMF at 120 °C. The ionic character of homogeneous catalyst and microwave irradiation and also DMF as microwave-active polar solvent gave higher yields and shorter reaction times than conventional heating. Benzyl DABCO as an efficient ligand and also a quaternary ammonium salt had an efficient stabilizing effect on the Pd(0) species. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An Aspergillus fungal ball is a rare cause of ureteral obstruction attributed to indwelling catheters, stents, antibiotics, anastomotic leaks, obstruction, and immunosuppressive therapy and other immunocompromised states. We describe a case of unilateral ureteral obstruction caused by Aspergillus terreus following ureteroscopic lithotripsy and ureteral stenting in a 45-year-old diabetic man. The patient was successfully treated with endoscopic removal of the fungal mass and oral voriconazole. We also review briefly the clinical features, treatment, and outcome in 9 previously reported diabetic patients with ureteral obstruction due to aspergillosis. Obstructive uropathy related to Aspergillus mass may be suspected in diabetic patients with a history of manipulation, impaired kidney function, and persistent passage of a soft mass in urine. Direct microscopy and culture of multiple urine and ureteral washing are necessary for early diagnosis. Antifungal therapy and endoscopic removal of the mass are needed to reduce morbidity. [ABSTRACT FROM AUTHOR]

Background and purpose: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. Pulmonary involvement is common in these patients but it often has few clinical symptoms. In some cases however, pulmonary leptospirosis can develop a severe respiratory involvement with high mortality. The aim of this study was to investigate the frequency of lung involvement in leptospirotic patients. Materials and methods: In a cross-sectional study, the records of leptospirotic patients hospitalized in a third class hospital were investigated from April 2009 to April 2010. Leptospirosis diagnosis was done based on clinical symptoms and positive serology (IFA>1/180). Results: A total of 107 patients with confirmed leptospirosis were recruited in the study. Among them 64.7 % were males and 82.4% were farmers. The chief complaint in 105 patients was fever and in 2 was jaundice. Among the patients, 15.9% had abnormal chest X-ray and the most common radiographic finding was bilateral reticular infiltration. The mean age of patients with pulmonary involvement was significantly higher than that of the patients with normal chest X-ray (P<0.05), while no significant differences were found (P>0.05) between the two groups regarding their gender, occupation and laboratory findings (except CPK). The level of CPK was significantly higher in the patients with pulmonary involvement than in normal patients (P<0.05). Conclusion: Patients with leptospirosis can infrequently develop severe pulmonary involvement and respiratory symptoms and this involvement is mostly seen in higher ages. [ABSTRACT FROM AUTHOR]

Background and purpose: Iran has a notable rank in the world with 300 thousand injecting drug users (IDUs) among 3.5 million drug users. Infections of IDUs have brought about various challenges to physicians. Thus, this study aims at studying the infections related to injection drug abuse in the IDUs. Materials and methods: In a cross-sectional descriptive study, 88 IDUs, hospitalized at Razi Hospital in Ghaemshahr and Imam Khomeini Hospital in Sari from October 2007 to October 2009, were studied. Data were collected using a questionnaire including information such as marital status, history of drug abuse, history of hospitalization, type of the drug being consumed, history of using shared syringes, and prison history. Results: The mean age of patients was 35.01 ± 11.53 years and most of them aged between 20-40 years (72.5%). Thirty of IDUs used 2 or more injecting drugs simultaneously and 24 used crack injection. The most frequent viral diseases were HIV and hepatitis C (10 people) and the most common complication leading to hospitalization was cellulitis (27.3%); endocarditis and sepsis were in the next rank. Conclusion: Our study showed that the most cases of endocarditis happened in crack users which is probably due to the injection of contaminated drugs with impurities in our country. [ABSTRACT FROM AUTHOR]

Introduction. Staphylococcus aureus is currently the most common cause of infection in hospitalized patients. Patients on hemodialysis are at increased risk due to their immunocompromised state. The present study was designed to determine the frequency of S aureus nasal carriage in patients on hemodialysis. Materials and Methods. This study was undertaken in 2 dialysis centers to establish the frequency of S aureus nasal carriage at teaching hospitals of Mazandaran University of Medical Sciences, in the north of Iran. Standardized nose swabs were rotated into the anterior nares of the patients, and the samples were cultured on a blood-agar medium. Having grown the colony, gram stain, catalase, manitol, DNAase, and coagulase tests were all performed. Pattern of antibacterial sensitivity was determined by using the disc diffusion method. Also, agar dilution method was used to determine minimal inhibitory concentration of oxacillin and vancomycin. Results. Of 84 patients on hemodialysis, 31 (36.9%) were nasal carriers of S aureus, of whom 23 (74.2%) were resistant to methicillin. Of the methicillin-resistant S aureus isolates, 3 (13.0%) were resistant to vancomycin and 7 (56.5%) had reduced susceptibility to vancomycin in agar dilution method. Resistance frequencies to clindamycin, ciprofloxacin, and trimethoprim-sulfamethoxsazole were 12.9%, 9.7%, and 19.3%, respectively. However, all microorganisms were sensitive to rifampicin. Conclusions. Patients on hemodialysis are at an increased risk of S aureus infections; thus, screening of these susceptible patients should be considered as a health priority. Meanwhile, microbial sensitivity tests should be ordered for all cases in order to optimize treatment options. [ABSTRACT FROM AUTHOR]

Background: Animal bites are potentially harmful for people. The prophylaxis approach is effective and safe, however, it is expensive and sometimes may be used without clear indication. Prophylaxis programs depend on local epidemiology. The aim of this study was to survey the animal bites and rabies epidemiology in northern Iran. Patients and methods: We performed a descriptive study on all animal bites and rabies in the Mazandaran Province during 2001 to 2005. Initial data including age, sex, site of bite, incidence, type of animal, geographical distribution, number of vaccinations and death by rabies were gathered and analyzed by SPSS soft ware. Results: Annual frequency of animal bites was between 3,174 and 4,670 in the Mazandaran Province. One hundred sixty bites per 100,000 persons occur annually, with a cost of approximately US $0.5 million in health care expenditures and loss of income. Twenty thousand animal bites occurred during the year of 2001 to 2005. Behshar, with 302.88 cases per 100,000 persons was the most prevalent city. We found that the majority of bites are from dogs (84.87%), especially stray dogs. Men are frequently bitten by dogs (79.62%), while adolescence is the most frequent victims of dog bites, especially in rural areas. Dog bites resulted in 2 deaths, both of which had bites on their faces. Conclusion: Exposure to dogs, especially stray dogs in Mazandaran Province, reported the majority of cases of human bites and post-exposure prophylaxis. [ABSTRACT FROM AUTHOR]

Background: The annual risk of tuberculosis (TB) in Iran is about 0.5% with annual incidence rate of 23/100000 (16322 cases). Different factors have been postulated as TB predisposing factors. Several studies have linked smoking with pulmonary tuberculosis as the TB incidence in their adult men was 2.4 times higher than women. In Iran, however, this ratio is equal and somewhere the ratio in women is greater. We decided to carry out a case control study in order to evaluate the effect of cigarette smoking on pulmonary TB. Patients and methods: A case-control study was achieved in health care centers of Mazandaran province (affiliated to Mazandaran University of Medical Sciences). Participants were men aged 15 years and older who were enrolled in health care centers with the diagnosis of active pulmonary tuberculosis. One hundred men (aged 15-85 years) with bacteriological TB (smear or culture positive) were selected as cases and 300 age-matched men without TB were selected randomly as controls. Information on smoking status, quality of tobacco smoked and duration of cigarette smoking and also the age at which smoking was first commenced were collected by a questionnaire. Results: Smokers were 2.1 times more likely to develop pulmonary TB (OR=2.10, 95% confidence interval (CI):1.33- 2.33, p<0.04). The age adjusted odds ratio was 1.804 (95%CI:1.66-2.5, p<0.05). Quantity of cigarette smoking and duration of smoking had positive association with pulmonary TB. The ORs for mild (1-10 cigarette/day), moderate (11- 20/day) and heavy (>20/day) smoking were 1.68, 2.46, and 2.56, respectively (p<0.05). The ORs for duration of smoking with <10 years, 11-20 years and >20 years of smoking were 0.91, 2.48, and 2.9, respectively (p< 0.001). Conclusion: We conclude that smoking may increase the risk of pulmonary TB in men. Further studies should be conducted to investigate this association and to establish whether smoking reduction strategies contribute to tuberculosis control. [ABSTRACT FROM AUTHOR]

Background and purpose: This study evaluated the awareness of general practitioners (GP) in Mazandaran province on diagnosis, management and prevention of cholera. Materials and methods: In a prospective study, 156 GPs were randomly selected to complete a questionnaire containing 15 questions through face to face interviews. Results: The study population was 68 (43.6%) female and 88 (56.4%) male with the mean age of 42±7.8 and 40±5.8 years, respectively. Awareness level of GPs about cholera was moderate in 89 (57.1%) and good in 48 (30.8%). The awareness about diagnosis of cholera was good, moderate and poor in 23%, 69.9% and 7.1%, respectively. Also, 17.3%, 71.8%, and 10.9% of GPs had a good, moderate and poor (respectively) awareness level on treatment of cholera. The awareness level of GPs about prevention of cholera was good, moderate and poor in 26.3%, 59% and 14.7%, respectively Conclusion: Moderate level of awareness of GPs on cholera signifies the need for more planning to control such epidemic diseases. [ABSTRACT FROM AUTHOR]

Background and purpose: Leptospirosis is the most widespread zoonosis in the world which is endemic in Mazandaran province. Early diagnosis of leptospirosis based on clinical & laboratory findings is relatively difficult due to lack of characteristic pathogonomic features. General physicians are the first line of patients' admission. The main purpose of this study was to determine the level of awareness among general physicians on leptospirosis in Mazandaran province. Materials and methods: In a cross sectional study, 400 general practitioners including 281(70.25%) male and 119 (29.75%) female were chosen. They completed a questionnaire containing 15 questions within 30 minutes. Results: The level of awareness was found good among 66% of the subjects. No significant relation was observed between age and sex of the physicians and their knowledge of leptospirosis. The best information was about the routs of transmission and prevention of leptospirosis. Conclusion: This study demonstrated a low level of awareness among general practitioners, therefore, it is necessary to perform more re-education programs. [ABSTRACT FROM AUTHOR]

Background: The antibiotic resistance of nosocomial organisms is rapidly increasing. The purpose of this study was to determine the frequency of bacterial agents isolated from patients with nosocomial infection., Methods: This study was performed in the different wards of teaching hospitals of Mazandaran University of Medical Sciences (northern Iran). The study population consists of the patients with the symptoms of nosocomial infection admitted in these hospitals in 2012. The patient data (including age, sex, type of infection, type of isolated organisms and their antibiotic susceptibility) were collected and analyzed., Results: The total number of hospitalizations was 57122 and the number of nosocomial infection was 592. The overall prevalence of nosocomial infection was 1.03% that was mostly in Burn unit and intensive care unit. The most common nosocomial infection was wound infection (44.6%) and the most common organisms were Pseudomonas aeruginosa and Acinetobacter., Conclusion: Given the increasing numbers of nosocomial infection in this region, especially infection with Pseudomonas aeruginosa, it is necessary to make a precise reporting and improve the procedures of infection control in hospitals.

Unlabelled: Background : Cefepime was used as empirical treatment in ventilator-associated pneumonia (VAP) induced by gram-negative and gram-positive bacteria. This study aimed to determine the antimicrobial susceptibility pattern of cefepime against microorganism causing VAP in Mazandaran, North of Iran., Methods: This study was performed on VAP patients diagnosed with clinical pulmonary infection score (CPIS) scores in ICU of two hospitals. For each patient suspected of having VAP, quantitative culture of endotracheal aspiration (QEA) was performed and MIC was determined by micro dilution test. Data were collected and analyzed., Results: Thirty- five cases of enterobacteriaceae were isolated orderly including E coli 13, P. aeruginosa 11, Enterobacter 7 and K. pneumonia 4 cases. All the isolated E. coli, Enterobacter and Klebsiella, 54.5% of P. aeruginosa isolated were fully resistant to cefepime., Conclusion: The results of this study show that cefepime is not a reasonable choice for empirical treatment of nosocomial pneumonia and VAP.

Background: The clinical manifestations and outcome of influenza infection differ between various patients in the world. The purpose of this study was to assess the clinical manifestations of patients with confirmed or suspected novel H1N1 flu infection in Sari, North of Iran., Methods: From September 2009 to January 2010, the patients' data were collected by retrospective chart review of medical records. Laboratory confirmation included a positive RT-PCR (reverse transcriptase-polymerase-chain-reaction assay) from a nasal or pharyngeal swab sample., Results: Nearly 80% of established patients were in age group of 15-45 years. Approximately 14.6% of female cases were pregnant There was no significant difference in clinical and laboratory characteristics of patients with confirmed H1N1 virus infection to total cases with Influenza Like Illness (ILI). Thirty nine (95.1%) of the established patients had a combination of fever plus sore throat or cough. Relative lymphopenia was reported in 36.6%. Pneumonia was the most common complication. Acute pericarditis evolved in one case and aseptic meningitis was reported in another., Conclusion: Precise collecting information of clinical manifestations, risk factors and other characteristics of flu, can help to the early infection detection, timely treatment of patients and proper preventive measurements.