Trend of diseases among Iranian pilgrims during five consecutive years based on a Syndromic Surveillance System in Hajj.

BACKGROUND: Every year more than 2 million people depart from Iran to Saudi Arabia for Hajj ritual whichcan be faced with some different diseases. There are not much information about frequencies and trend of diseasesin Hajj. The main objective of this study was to determine the trend of prevalent diseases during five consecutiveHajj rituals among Iranian pilgrims. METHODS: We established a specific surveillance system for all Iranian pilgrims who had participated in Hajjfrom 2004 to 2008. We monitored the pilgrims' health status before departure, through their journey. The understudieddiseases were 19 selected types of diseases in the Hajj. The occurrences of diseases were recorded on aresearchers-made questionnaire. We used chi-square test for analysis with the alpha lower than 5% to reject thenull hypothesis. RESULTS: During 5 consecutive periods, a total of 254,823 of Iranian pilgrims were monitored for more commondiseases with this system. The most prevalent diseases were as follows: at least one type of respiratory involvement(71.26%), common cold like syndrome (47.15%), and musculoskeletal disorders (18.67%), The frequencyof respiratory involvement was lower in 2006 than other years (p <0.001).There were statistically significantdifferences between the numbers of hospitalization and patients who were referred back to Iran with theyear of Hajj (p <0.001). CONCLUSION: Health managers should be informed about trend and frequency of more prevalent diseases inHajj. Easy access to health information via such surveillance system can be possible.

Risk Factors for In-Hospital Mortality among Patients with Coronavirus-19 in Isfahan City, Iran.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13-3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09-5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42-6.55), Hb level <13 gr/L (aHR: 2.82; 95% CI: 1.34-5.93), bilateral pulmonary infiltrates (aHR: 2.02; 95% CI: 1.12-3.64) at admission, development of acute respiratory distress syndrome (ARDS) (aHR: 1.87; 95% CI: 1.01-3.47), and intensive care unit (ICU) admission (aHR: 2.09; 95% CI: 1.04-4.18) during hospitalization were risk factors for in-hospital mortality in patients with COVID-19. Conclusions: Multiple factors were found related to the severity and death among COVID-19 patients. We were found that older age (≥65 years) with COPD history, high level of WBC, low level of Hb (<13 g/L), bilateral pulmonary infiltrates at admission, development of ARDS, and ICU admission during hospitalization were identified as risk factors of death among COVID-19 patients. More related studies are needed in the future.

The efficacy of systemic corticosteroids in treatment of respiratory tract infections during hajj 2012.

BACKGROUND: Diagnosis and treatment of respiratory tract infections (RTI) in a mass-gathering situation such as hajj is a medical challenge that requires quick decision-making and considerable knowledge about its etiology and treatment methods. High prevalence of RTI during Hajj and tendency of caravan physicians to treat of patients quickly in such situation lead to prescription of parenteral steroids. Nonetheless, no study has focused on the short-term and long-term effects of systemic steroids in Hajj pilgrims with RTI. OBJECTIVES: This study focuses on efficacy of systemic consumption of corticosteroids in alleviating symptoms of RTI. PATIENTS AND METHODS: This clinical trial was included 1671 pilgrims in Hajj 2012 who had symptoms of RTI based on caravan physician's findings. The patients were divided to two groups to receive either parenteral corticosteroid or other drugs. Patients who received antibiotics for bacterial infections were excluded. This survey concentrated on general symptoms of RTI during Hajj such as fever, musculoskeletal pain, coryza, sore throat, cough, dyspnea, and hoarseness before, 24 hours after, and five days after drug consumption. For classification and analysis of data, SPSS 17 was used. Descriptive statistical and Chi square test were used to compare variables. RESULTS: In comparison to corticosteroid injection, treatment without systemic corticosteroids could reduce the fever more significantly within five days (P < 0.05), while it had no effect after 48 hours (P > 0.05). Although corticosteroids alleviated the symptoms during the first 48 hours (P > 0.05), they had no more effect after five days of consumption (P > 0.05). Treatment with medications other than corticosteroid had less effect on reducing coryza (P > 0.05) while corticosteroids had significant alleviating effect on coryza, cough, and musculoskeletal pain (P < 0.05). CONCLUSIONS: There is a need to conduct more comprehensive studies on effect of combination therapy with corticosteroids and antibiotics as well as their short-term and long-term adverse effects on the immune system. While injecting corticosteroids is commonly administered in patients with RTI, they are not recommended due to the lack of data on their long-term therapeutic and adverse effects.

Diseases Led to Refer Iranian Pilgrims From Hajj in 2012.

BACKGROUND: Some Iranian pilgrims are referred to Iran because of catching a new disease or exacerbation of their disease during the Hajj ceremony. These diseases need prolonged and specialized treatments. Investigation of the reasons led to their return to Iran is useful and effective in policy-making and planning of preventive health services. OBJECTIVES: This study aimed to investigate the causes of referring Iranian patients to Iran during Hajj in 2010. PATIENTS AND METHODS: In this cross-sectional study, all Iranian pilgrim cases in Hajj (2012) who referred to Iran were studied, and data analysis was performed. Demographic data and the causes of return to Iran during and after Hajj rituals were analyzed. RESULTS: A total of 106 cases were referred Iran during Hajj 2012. Psychiatric problems, with 26.4% allocated the highest rate of return to Iran during Hajj days, and significant difference was observed in the reasons before and after performing Hajj rituals (P = 0.001). CONCLUSIONS: Psychiatric, neurological, gastrointestinal, and respiratory diseases are the most frequent reasons of referring patients to Iran. More accuracy in screening and care of patients are recommended before Hajj in order to prevent references to Iran and its complications.

Health knowledge, attitude and practice among Iranian pilgrims.

BACKGROUND: Iran has the highest number of Umrah pilgrims among Islamic countries. Health care plays a major role in fulfilling the Umrah rites. Pilgrims' health situation depends on their health knowledge, attitude, and practice (KAP). OBJECTIVES: In this study, we aimed to determine the health KAP among Iranian Umrah pilgrims. PATIENTS AND METHODS: In this cross-sectional study, 157 Iranian Umrah pilgrims were randomly selected in Mecca, Saudi Arabia in June 2011. Data were collected using a questionnaire. The questionnaire consisted of demographic information (sex, age, degree of education, and resource of health knowledge), health knowledge (5 questions), health attitude (5 questions) and health practice (10 questions). RESULTS: Level of knowledge were very low in 12.1%, low in 25.2%, average in 38.1%, good in 20.4% and very good in 4.2% of respondents. Mean and standard deviation of attitude score was 18.58 ± 2.20 out of 25 (ranged between 13.00 and 25.00). The pilgrims were given 74.2 % out of total score. The Mean and standard deviation of practice score was 8.19 ± 1.32 out of 10 (ranged between 3 and 10). Although the old and low educated pilgrims had little knowledge of health tips, they had a good health attitude and practice. CONCLUSIONS: Educational strategy to improve knowledge regarding health-related problems and to develop health practices among pilgrims is needed.

Chief complaints and diagnosis of patients visited by caravan physicians during hajj 2010.

BACKGROUND: The primary data on the patient's status are articulated by the patient and consist of conditions that force the patient to seek treatment. Such data helps the physician effectively to make an appropriate list of differential diagnoses to establish a treatment protocol. OBJECTIVES: The objective of this study was to review the frequency of patients' chief complaints in Hajj to plan and develop medical protocols for expected problems in Hajj. PATIENTS AND METHODS: In this short-term past-oriented study, all medical files of the Hajj pilgrims were reviewed and all data regarding the diagnoses were extracted. RESULTS: In general, medical data of 107074 cases had been registered in this software. Cough with the frequency of 24083 (22.45%) was the most frequent complaints of the patients. Respiratory tract infections diseases with 66197 persons (61.82%) were the most frequently diagnosed diseases in times of annual Hajj of 2010. CONCLUSIONS: Respiratory disease, musculoskeletal pain, headache, and digestion problems were among the most important reasons of patients' referral to physicians in times of Hajj. The mentioned complications could be prevented through correct trainings and conforming to health recommendations in times of Hajj.