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  ABSTRACT

 Background and Aim: Nosocomial Infections are nearly the most important health problem in the world. The high costs of treatment, the great number of patients with high mortality and morbidity rates and also increased incidence of these infections are suggestive of the importance of these infections. The aim of this study was to assess the epidemiologic status and the rate of acquired infections together with their related factors in ICU and post ICU patients at Tohid Hospital, in Sanandaj.

 Material and Methods: This is a cross sectional descriptive study. The sample size included 160 patients who had been admitted to ICU and post ICU during a period of 6 months. Demographic data and prevalence rate of nosocomial infections and results of clinical and para-clinical measures were recorded. The data were analyzed by means of SPSS-win software.

 Results: In our study the prevalence rate of nosocomial infections was 15.6%. The most frequent infections were pneumonia (68%), UTI (19.2%), bed sore (7.8%), sepsis (3.8%) and infections of unknown origin (3.8%). The most frequent isolated microorganisms were Klebsiella Pneumonia (47.05%), Ecoli (17.64%), and Entrobacter spp (17.64%). There was an important relationship between the duration of hospitalization and the prevalence rate of the infections (p=0.000). But there was no significant linkage between age, intubation or tracheostomy with the prevalence rate of the infections

 Conclusions: The results of our study supported previous data concerning nosocomial infections. In order to decrease the rate of nosocomial infections, assignment of one nurse for one patient and proper hand washing should be emphasized.

  Key words: Nosocomial infections, ICU, Post ICU

 

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ABCTRACT Background and Aim: Cytomegalovirus (CMV) and toxoplasmosis are the most common and serious opportunistic infections in AIDS patients. Despite recent advances in the treatment of these infections, they still remain as challenging problems for physicians. The aim of this study was to determine the frequency of cytomegalovirus and toxoplasma infections in HIV-positive patients in HIV/AIDS counseling and care center in Kurdistan in 1385. Material and Methods: This was a cross-sectional descriptive, analytic study. The sample size included all accessible patients referring to Sanandaj behavioral and STD diseases consultation center (64 participants). ELISA test was performed for all individuals, IgM and IgG anti CMV and Toxoplasma titers were determined. Data were introduced into SPSS 13 Soft ware and analyzed by one way ANOVA test. Results: This study included 64 patients, 98/4% of them were male. The mean age of the patients was 32.1±6.73 years. Anti cytomegalovirus IgM was negative and anti cytomegalovirus IgG was positive in all of the patients (100%). Anti Toxoplasma IgM and anti Toxoplasma IgG were positive in 10.9% and 46.9% of the patients respectively. There was no significant relationship between the level of IgG and mean time duration of being HIV positive, age and CD4 cell count. But a significant relationship was noticed between the level of CMV and toxoplasma IgM and CD4 cell count (p<0.05). There was a significant relation between positive toxoplasmosis IgM and history of keeping a pet in house (p=0.019). Conclusion: In this study 100% of HIV positive participants were negative for anti cytomegalovirus IgM which can be explained by presence of CD4 cell count above 100 in all of the patients. But 53% of HIV positive participants had negative anti toxoplasma antibody who will be at risk of acute toxoplasmosis in their clinical course. Educational plans and regular follow up of theses patients are recommended for proper prophylaxis and treatment. Key words: HIV/AIDS, Toxoplasma Gondeii, Cytomegalovirus, Serology. Conflict of Interest: Nill Received: May 15, 2008 Accepted: June 18, 2008

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Background and Aim: Excessive use or misuse of antibiotics leads to important consequences such as increased cost of treatment, bacterial resistance, treatment failure, drug toxicity and increased morbidity and mortality. Use of guidelines can result in increased knowledge of the physicians and decreased prescription of antibiotics with resultant change in the attitudes of the physicians towards this policy. 

Materials and Methods: This cross-sectional study included 356 physicians and was conducted in Sanandaj in 2015. The sampling method was census. The final questionnaire included 7 questions to assess knowledge, 18 questions to measure attitudes, (by means of a 5-point Likert Scale from very strong agreement to very strong disagreement), and 12 questions to assess performance. The reliability of the questionnaire was 54%. Using SPSS20 software, frequency and mean score of the questions were calculated.

Results: Among 356 questionnaires, 44.2% were filled out by specialists and 45.2% by the physicians who had graduated more than seven years ago. 56% of the physicians chose the correct answer for the questions on knowledge, and 25% of the physicians had knowledge about antibiotic resistance.  97.3% of the physicians agreed that antibiotics in our country have been used in excess. In this study, 233 (65.5%) physicians had high knowledge and self-confidence and 19.7% expressed low or lack of self-confidence about antibiotic prescription. WHO guideline and antibiotic guideline had been considered useful by 56% and 54.5% of the participants respectively. 49.9% of the physicians had not participated in any training course on antibiotic prescription. The highest and lowest frequency rates about sources of knowledge on antibiotic prescription belonged to internet (63.2%) and information provided by pharmaceutical companies (30.3%) respectively.

Conclusion: Considering the average level of knowledge of the doctors on antibiotic prescription and lack of participation of half of the subjects in training courses on antibiotic prescription after, attention to training courses<span dir="RTL" style="font-family: " b="" zar";="" font-size:="" 12pt;="" mso-bidi-language:="" fa;="" mso-ascii-font-family:="" "times="" new="" roman";="" mso-hansi-font-family:="" roman";"=""> with proper planning is recommended.

Keywords: Knowledge, Attitude, Practice, Doctors, Antibiotics, Sanandaj.

 

Received: May 23, 2016      Accepted: Dec 21, 2016

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Background and Aim: In recent decades, the emergence of resistant strains of staphylococcus aureus, pneumococci, enterococcus and intestinal gram-negative bacteria due to the inappropriate use of antibiotics has emphasized the necessity of proper use of antibiotics. The aim of this study was to evaluate the appropriate antibiotic administration by general practitioner in the emergency department of a teaching hospital (Tohid Hospital) in Sanandaj, Iran.

Material and Methods: In this prospective descriptive study we evaluated the prescriptions for 170 patients who had been referring to the emergency department of Tohid Hospital in Sanandaj from May 2013 to May 2014. We selected 14 to 15 patients every month in a period of one year. After examination and writing prescriptions by the general practitioner, the patients were re-examined by an infectious diseases specialist. Finally, general practitioners and infectious diseases specialist's prescriptions data were recorded and compared with each other in regard to age, gender and prescribed drugs. Using spss v.18  software the data were analyzed by descriptive statistics.
Results: Among 170 patients, 52.4% (89) were male and 47.6% (81) were female with an average age of 39.86 ± 15.44 years. According to the results of this study, 11.18% of patients who had received antibiotics prescribed by the general practitioner did not require antibiotics. The exact compatibility and similarity of the prescribed antibiotics by the general practitioner and infectious diseases specialist for a specific patient was 7.8%. The mean numbers of the drugs prescribed by general practitioner and infectious diseases specialist was 2.08 and 2.21, respectively. The most common prescribed antibiotics by the infectious diseases specialist and general practitioner were ciprofloxacin (13.3%) and azithromycin (13.3%). Ciprofloxacin (21.3%) and cefixime (12%) were the most common antibiotics prescribed by the general practitioner.
Conclusion: The findings of this study showed necessity of educational programs for general practitioners about antibiotic prescription.
Keywords: Antibiotic administration, General practitioner, Infectious diseases specialist.
 
Received: Feb 5, 2018     Accepted: May 22, 2018

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Background and Aim: Considering the importance of sepsis and its complications in the mortality of the patients admitted to different parts of hospital and the importance of early diagnosis and timely and appropriate treatment in the patients' survival, we investigated the value of procalcitonin serum level for the differential diagnosis between infectious and non-infectious SIRS in the patients referring to Tohid Hospital in Sanandaj.
Material and Methods: In this descriptive analytical (case-control) study, we measured procalcitonin level in SIRS positive patients who had been referring to Tohid Hospital in Sanandaj.
After obtaing the results of the lab.tests the patients were divided into two groups of infectious SIRS (case group) and non-infectious (control group) based on the final diagnosis made by our infectious diseases specialist. Patients with  history of antibiotic intake within the last 48 hours, mechanical trauma, heat stroke, recent surgery, cancer and severe burn were excluded from the study. Each group consisted of 30 patients. Using SPSS software, data were analyzed by independent T-test to compare the quantitative data between the two groups. We also used Pearson correlation test to investigate the relationship between procalcitonin serum level and variables related to vital signs and blood markers. P<0.05 was considered significant.
Results: Mean procalcitonin serum level in the case group was significantly higher than that in the control group, and the patients with higher respiratory rate and higher WBC counts had significant increase in procalcitonin serum level. Results of this study showed that the sensitivity, specificity and accuracy of procalcitonin test at the threshold of 0.52 ng / ml were 70%, 94% and 81.7%, respectively, and positive and negative predictive values were 75.7% and 91.3%, respectively.
Conclusion: According to the results, procalcitonin level had a significant sensitivity and specificity in the differential diagnosis between infectious and non-infectious SIRS and can be considered as a diagnostic test along with other clinical and paraclinical criteria in the early stages of these disorders. This can be helpful in making early diagnosis and timely administration of medications.
Keywords: Procalcitonin, Systemic inflammatory response syndrome, Sepsis.
 
Received: Feb 17, 2018     Accepted: May 22, 2018

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Background and Aim: Genital wart is the most common sexually transmitted infection and its role in cervical cancer has been confirmed. The aim of this study was to determine the presence of human papillomavirus (HPV) and the frequency of its genotypes in the patients with genital lesions referring to the clinics in Sanandaj, Iran.
Material and Method: This descriptive analytical study included 50 women with genital lesions referring to the clinics in Sanandaj City from February 2016 to February 2017. Biopsy samples were examined for four genotypes (HPV 16, 18 (high risk) and HPV 11, 6 (Low risk)) by PCR. Demographic information and risk factors were recorded in a questionnaire for every patient. Using spss v.20 software, data were analyzed by descriptive statistics. Fischer test was used to investigate the relationship between the risk factors and HPV infection.
Results: The results showed that 28 cases (56%) were HPV positive. Among the four genotypes of HPV, HPV 6 was the most frequent (32%), followed by the types of 18 (12%), 16 (6%) and 11 (2%). Co-infection of HPV-16 and 18 were found in 2 cases (7.1%).The mean age of the patients with HPV infection  was 34.07 ± 8.7 years and the mean age of the first sexual contact was 21.22 ± 4.8 years. No significant association was found between the risk factors and HPV infection (P> 0.05).
Conclusion: Considering the high prevalence of HPV infection and its asymptomatic course in many cases, early detection and treatment of the genital warts, especially HPV16 and 18, can lead to prevention of cervical cancer.