Prevalence of pulmonary tuberculosis before and after soil dust in Khuzestan, southwest Iran.

BACKGROUND: Soil dust has been debated about its effects on public health and the challenge is brought about tuberculosis (TB). The purpose of this study was to investigate the influence of soil dust on pulmonary tuberculosis (PTB) prevalence and its control indices. METHODS: The medical files of patients in Khuzestan Health Center were reviewed. The control group included the PTB patients registered from 2005 to 2006 (before soil dust), and case group consisted of PTB patients who were registered from 2007 to 2010 (after soil dust exposure). The diagnosis of tuberculosis was based on National Tuberculosis Program (NTP). RESULTS: The mean age of control and case group was 42 (18-80) years and 40 (13-99) years, respectively. The prevalence of pulmonary TB in the control and case group was 537 (12.5 per 100000 population) and 465 (11.0 per 100000 population), respectively. Exposure to dust did not increase the prevalence of TB. The prevalence was higher in women than men (298, 41.8% vs. 336, 48.2%), in children than adult group (31, 4.3% vs. 53, 7.3%), in urban than rural inhabitants (448, 63% vs.496, 71.1%) and in family contacts than solitary contamination (60, 8.4% vs. 97, 13.9%). The rate of treatment failure, TB relapse, and MDR-TB in controls and cases were (1.4%, 1.4%, 1%) and (7%, 5.5%, 4.6%), respectively. Dust exposure had significant effect on treatment outcome. CONCLUSION: Although soil dust exposure had no significant effect on TB prevalence, but significantly affected the prevalence of TB respecting to age, sex, residential area and closed contact. In addition resulted in more treatment failure, development of MDR TB and relapse.

Comparison of epidemiological, clinical, laboratory and radiological features of hospitalized diabetic and non-diabetic patients with pulmonary tuberculosis at razi hospital in ahvaz.

BACKGROUND: Diabetes mellitus (DM) due to suppressive effect on cellular immunity can impact on progression of tuberculosis (TB). OBJECTIVES: The aim of this study was to investigate the impact of DM on the epidemiological, clinical and para clinical aspects of pulmonary TB. PATIENTS AND METHODS: The information of 148 admitted pulmonary TB patients in infectious ward of Razi hospital in Ahvaz from 2009 to 2010 was extracted from their medical files. The patients were divided into two groups as TB with DM (n = 36) and TB without DM (n = 112). The related data on epidemiology, signs, symptoms, radiology and sputum smear examination in both groups were compared in SPSS 16 by using chi squared test. RESULTS: The mean age of TB with DM patients was higher TB without DM patients (56.6 ± 12.7 vs. 44.8 ± 18.3; respectively, P = 0.006). Whereas cough, night sweating, fever and weigh loss was not statistically different, sputum, hemoptysis and dyspnea was more prominent in TB with DM (69.4%, 33.4%, 44.5% vs. 36.6%, 9.8%, 20.5%; P = 0.005, P = 0.001, P = 0.005, respectively). In chest x-ray, cavitation and reticulonodular pattern was more frequent in TB with DM (55.5%, 22.2% vs. 31.2%, 8% - P = 0.008, P = 0.02, respectively). The rate of sputum smear positivity in TB with DM and TB without DM was 66.6% and 47.3%, respectively (P = 0.03). CONCLUSIONS: According to the results of this study, in approach to every DM cases suffering of respiratory symptoms such as productive cough, hemoptysis and dyspnea in association with cavitation or miliary mottling in chest x-ray, pulmonary TB should be considered at the top of the differential diagnosis list.

Bacterial sepsis: challenges of diagnosis and treatment in a teaching hospital southwest of iran.

BACKGROUND: Management of bacterial sepsis as a common cause of hospitalization and a life threatening clinical syndrome is a challenge. In previous studies, incorrect diagnosis of sepsis and unnecessary treatment have been frequently reported. OBJECTIVES: The aim of this study was to evaluate the diagnosis and treatment of cases with a primary diagnosis of sepsis. PATIENTS AND METHODS: Of 410 medical files of patients with primary diagnosis of bacterial sepsis, 187 fulfilled our criteria and were enrolled in the study. The study was conducted in Razi Hospital of Ahvaz, southwest Iran, from 2009 to 2011. Data included demographic characteristics, underlying disease, clinical symptoms, laboratory and imaging findings, administrated antibacterial drugs, and nurses and doctors-analyzed notes. For evaluation of the diagnosis, patients were divided to two groups, sepsis group and pseudosepsis group, and for evaluation of the treatment, patients were categorized in appropriate and inappropriate treatment groups and compared using SSPS software version 16 by chi-square and fisher exact tests. P-values less than 0.05 were considered significant. RESULTS: Out of 187 cases, 61 were in the intensive care unit (ICU), 98 in the infectious disease ward, and 28 in the internal medicine ward. Correct diagnosis of sepsis in the ICU, internal and infectious diseases wards were made in 16 (26.2%), 4 (14.3%) and 71 (72.4%) cases, respectively. Appropriate treatments for sepsis in the ICU, internal and infectious wards were applied in 12 (19.7%), 3 (10.7%) and 61 (78.2%) cases, respectively. Ninety-one patients (48.6%) were diagnosed correctly (true sepsis) and 76 (40.6%) were treated with proper regimes. CONCLUSIONS: Inappropriate and unnecessary use of antibiotics by patients with preliminary diagnosis of sepsis in our hospital, similar to other parts of the world, was high.

A comparative study on the prevalence and risk factors of tuberculosis among the prisoners in khuzestan, South-west iran.

BACKGROUND: High prevalence of Tuberculosis (TB) among prisoners is reported as an alarming public health problem in the world, especially in the developing countries. OBJECTIVES: Since there is almost no information from TB in this population in Khuzestan province, the current study aimed to assess the prevalence and identify risk factors of TB among the prisoners of this region. PATIENTS AND METHODS: In a retrospective study, medical files of patients with Tuberculosis in Khuzestan Health Center (KHC), from 2005 to 2010, were studied. Patients with Pulmonary TB were placed in two groups as the Inmate Prison (IP) and Non-Inmate Prison (NIP) groups. Data extracted from the patients' records in the two groups were compared by SPSS software system using Chi square and Fisher exact tests. P-value was considered less than 0.05. RESULTS: From the reported 4562 patients with Tuberculosis, 363 (7.9%) were prison inmates at the time of TB diagnosis. Prevalence of TB cases among the prison inmates was 403.3 per 100'000.The annual TB case rate in the general population during this period was 16.4 per 100,000. Among the TB risk factors close contact [odds ratio (OR), 95% confidence interval (CI), 19.4, 8.9-41.8, P < 001] especially in the recent 2 years, injection drug use (IDU) [OR, 95% CI, 4.61, 1.7-12.4, P = 006], and Human Immunodeficiency Virus (HIV) infection [OR, 95% CI, 2.4, 1.1-5.0, P = 025] were more frequent in the prisoners than in the general population with TB. CONCLUSIONS: In the region under study the prevalence of TB among the prisoners was higher than the general population. The main risk factors for Pulmonary TB in this population were close contact, IDU and HIV infection.