Hospital In Zahedan Research Articles

Paraclinical Evolutions Regarding Liver and Renal Abnormalities of Kawasaki Disease in the Southeast of Iran

Background: Kawasaki disease (KD) is a vasculitis affecting multi-organ systems including liver and kidneys. KD is diagnosed by some clinical criteria including sterile pyuria, microscopic hematuria, proteinuria due to renal involvement, liver abnormalities manifesting as abnormal liver function tests, gallbladder hydrops, and hypoalbuminemia. Objectives: The aim of the study was to determine the frequency of liver and renal abnormalities in patients with KD, hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013. Materials and Methods: Paraclinical findings including serum and urine tests as well as gallbladder ultrasonography of 47 patients with KD hospitalized in Ali-Ebne-Abitaleb Hospital of Zahedan during 2006 - 2013 were reviewed retrospectively. Results: Liver abnormalities were found in 22 (46.8%) cases and impaired liver function tests were more common than other liver abnormalities in this cross-sectional study. The incidence of abnormal liver function tests in this study was about 42%. Gallbladder hydrops were found in 6 (12.7%) patients and 18 (38.3%) had renal involvement. Sterile pyuria was the most common urine abnormality with incidence of 36.2%. Microscopic hematuria and proteinuria were rarely found; in addition, serum urea nitrogen and creatinine had normal levels in all patients. Conclusions: The possibility of KD should be considered in any infants or children with abnormal results in liver or renal function tests. Paraclinical findings of liver and renal involvements of all patients were partly similar to the previous studies.

Acute Q fever among febrile patients in Zahedan, southeastern Iran.

So far, few studies have been conducted on Q fever in Iran. The objective of this study was to determine the frequency of acute Q fever in febrile patients admitted to Boo-Ali Hospital in Zahedan (southeastern Iran). In this study, 105 febrile patients suspected ofhaving brucellosis were examined using indirect immunofluorescent assay kit for the detection of Coxiella burnetii IgM and IgG phase antibodies in their serum. Serum with a phase II IgG titer of > or =256 and a phase II IgM titer of > or =50 was predictive for acute Q fever. Additionally, a 4-fold rise in antibody titers was considered diagnostic of Q fever. Results were analyzed using SPSS 17.0 for Windows. Among 105 patients (male: 52, female: 53), 35.2% (37/105) febrile patients had a positive serology test for acute Q fever. The prevalence of acute Q fever in women and men was 17/37 (45.9%) and 20/37 (54%), respectively. There was serological evidence of past infection in 36 (34.3%) patients. According to the results of our study, acute Q fever is highly prevalent in this province. Thus, it is necessary to pay attention to this disease to prevent its transmission in this region.

Intra Uterine Fetal Death And Some Related Factors: A Silent Tragedy In Southeastern Iran

Objective: To determine the incidence, and some causes of intra uterine fetal death (IUFD). Methods: This was a prospective observational study of all stillbirths over a 2 years from April 2011 to April 2013 at the Imam Ali University Teaching Hospital of zahedan,Iran The variables studied were the following: demographic characteristic, fetal factors and maternal factors. Data was collected prospectively by directly interviewing the pregnant women and from the medical chart .Data were analyzed using SPSS (Statistical Package for the Social Sciences) statistical package. Results: The incidence of IUFD at our hospital was 88.7 per 1000 total births. The intra uterine fetal rate had been increased in maternal ages under 20 years and above 35 years that showed a significant difference between this group and other groups(P=0.001).There was a significant trend in parity of 1 and parity of 10 and above. The rate of IUFD tended to decreased with increasing gestational age .There were 437 (54.1%) macerated and 370 (45.8%) fresh death fetus. Unexplained’ IUFD, Major congenital malformations, PROM, and preeclampsia were the three main causes of intra uterine fetal death. Discussion: Unfortunately, in our study the incidence of IUFD was very high. The main risk factors identified were lack of antenatal care. Despite the difficulty in predicting IUFD occurrence, it appears that carefully implemented antenatal care, family planning, genetic counseling and timely management of at risk patients may contribute to its prevention.

Spiritual intelligence, resiliency, and withdrawal time in clients of methadone maintenance treatment.

Background:Reports show an increasing interest in spirituality. It has been revealed that people with spiritual tendencies, can better deal with a trauma, manage the stressful situations, and have greater improvement in their health condition.Objectives:Our aim was to examine the relationship between spiritual intelligence and resiliency, and the relation of these two variables with the withdrawal time of individuals treated with methadone.Materials and Methods:This research was conducted on patients referred to the addiction center of Baharan Psychiatric Hospital in Zahedan, Iran. Our sample included 100 referrals; they were provided with questionnaires and asked to answer them honestly. King’s spiritual intelligence questionnaire and resilience questionnaires were used.Results:There were significant positive correlations between resiliency and scores of spiritual intelligence as well as with subscales of spiritual intelligence. In addition, there were significant positive correlations between withdrawal time and scores of spiritual intelligence as well as with subscales of spiritual intelligence as well as with resiliency.Conclusions:Relationships between the spiritual intelligence and resiliency parameters with withdrawal time show that these parameters can have a role in relapse protection among addicted people.

Prevalence and Molecular Characterization of AmpC-Producing Clinical Isolates ofEscherichia colifrom Southeastern Iran

AmpC in Escherichia coli is noninducible but is regulated by promoter and attenuator mechanisms and can be expressed at high levels as a result of a mutation. This study was undertaken to characterize the AmpC hyperproducing clinical isolates of E. coli. E. coli isolates recovered from three major hospitals in Zahedan, South Eastern Iran, were selected on the basis of resistance phenotype to the third-generation cephalosporins and cefoxitin. Phenyl boronic acid as an inhibitor and cefoxitin were used to confirm the overexpression of AmpC. The presence of genes encoding ACC, FOX, MOX, DHA, CIT, and EBC was detected using multiplex PCR. The existence of mutations in the regulatory region of the chromosomal ampC gene was assessed using PCR and sequencing. Thirteen of 392 E. coli isolates were selected as high-level AmpC producers. Eleven of the 13 isolates contained the blaCMY-2 gene; 12 of the 13 AmpC hyperproducing strains harbored changes in the promoter/attenuator region, which could explain the increased expression of the chromosome-encoded AmpC enzyme. In 10 of the 13 strains, we found both chromosomal- and plasmid-mediated mechanisms responsible for AmpC production. AmpC hyperproducing E. coli isolates exhibit significant resistance to cephalosporins. This work showed that strains hyperproducing chromosomal AmpC could be as frequent as strains with plasmid-mediated AmpC hyperproduction.

Djinnati: Dissociation and Possession Trance Disorder in Baluchistan, Iran

This article covers the presentation of djinnati as a culture-bound syndrome and a possession trance disorder. Three studies conducted in Baluchistan, Iran, are presented and reviewed. The first study was of ten patients (one male and nine female, with one female being from Pakistan) who presented as having a discrete identity or entity known as djinn. The symptoms of djinnati are delineated, along with the treatment by local healers. The second study concerned the prevalence of djinnati at the inpatient ward of Baharan Psychiatric Hospital in Zahedan, Iran. The subjects were 150 inpatients (61 male and 89 female) chosen from an admissions pool of 773 patients. Psychodiagnostic interviews by a psychiatrist and a psychologist revealed that 32 of the 150 inpatients had djinnati symptoms. There was also a significant difference between the Dissociative Experiences Scale (DES) scores for nondjinnati patients (23.85) and the scores of those patients identified as having djinnati symptoms (38.89). Prevalence of djinnati among admitted patients in the hospital during a six-month period was 4 percent. The authors of this study also noted that a history of child abuse had a direct relationship to djinnati presentation in these patients. In addition, gender was an important variable, as more women than men were diagnosed with djinnati symptoms. The third study, on the epidemiology of djinnati, was a cross-sectional study conducted in the Baluchistan rural area using clustering as the method of sampling of 4,000 subjects. The rate of djinnati was about 0.5 percent in the general population and 1 percent among women, with no male djinnati patients found. No significant relationship was found between djinnati presentation and age group or education level. The DES average was significantly higher in patients than in the normal population. Dissociation, possession trance state, culture-bound syndrome, and cross-cultural considerations were considered.

Safe Delivery Posts: An intervention to provide equitable childbirth care services to vulnerable groups in Zahedan, Iran

Backgroundrecently, there has been a shift towards alternative childbirth services to increase access to skilled care during childbirth. Objectivethis study aims to assess the past 10 years of experience of the first Safe Delivery Posts (SDPs) established in Zahedan, Iran to determine the number of deliveries and the intrapartum transfer rates, and to examine the reasons why women choose to give birth at a Safe Delivery Post and not in one of the four large hospitals in Zahedan. Designa mixed-methods research strategy was used for this study. In the quantitative phase, an analysis was performed on the existing data that are routinely collected in the health-care sector. In the qualitative phase, a grounded theory approach was used to collect and analyse narrative data from in-depth interviews with women who had given birth to their children at the Safe Delivery Posts. Settingwomen were selected from two Safe Delivery Posts in Zahedan city in southeast Iran. Participantsnineteen mothers who had given birth in the Safe Delivery Posts were interviewed. Findingsduring the 10-year period, 22,753 low-risk women gave birth in the Safe Delivery Posts, according to the records. Of all the women who were admitted to the Safe Delivery Posts, on average 2.1% were transferred to the hospital during labour or the postpartum period. Three key categories emerged from the analysis: barriers to hospital use, opposition to home birth and finally, reasons for choosing the childbirth care provided by the SDPs. Key conclusion and implications for practiceimplementing a model of midwifery care that offers the benefits of modern medical care and meets the needs of the local population is feasible and sustainable. This model of care reduces the cost of giving birth and ensures equitable access to care among vulnerable groups in Zahedan.

The Effect of Educating Self-Care Behaviors to Patients With Heart Failure in Hospitals of Zahedan

Background: Heart failure is a chronic disease in the elderly. Self-care education has a significant role in preventing the disease, its progress, and complications. Objectives: The present study aimed to assess the effect of training on self-care behaviors among patients with heart failure in hospitals of Zahedan City in 2012. Materials and Methods: The present study had a quasi-experimental interventional design with control group, and was conducted in CCU and post-CCU wards in hospitals affiliated to Zahedan University of Medical Sciences in 2012. There were 140 hospitalized patients in two equal groups of case (70 people) and control (70 people). The case group received an educational package including a pamphlet, an educational CD, and educational footage for their cell phone. After one month, they took the posttest. The data were analyzed by SPSS statistical software ver. 18. Results: After training, the mean scores of awareness, attitude and practice among patients in the case group were respectively 8.93 ± 2.32, 47.69 ± 2.21, and 66.04 ± 3.44 (P < 0.0001). The mean score difference of attitude in the intervention group was 17.78 ± 7.0, and 3.30 ± 6.85 in the control. The mean score difference of practice in the intervention group was 26.57 ± 6.37, and 2.08 ± 7.16in the control group (P < 0.0001). Conclusion: The results of the present study showed that self-care behaviors in patients with heart failure were influenced by awareness, and their practice improved with increasing their knowledge. Therefore, it is recommended to give an educational pamphlet video to patients with heart failure.

Can serum ferritin level predict disease severity in patients with crimean-congo hemorrhagic Fever?

Crimean-Congo hemorrhagic fever (CCHF) is an acute viral disease. Several factors have already been suggested to explain the pathogenesis as well as predict the disease severity. In our study we aim to investigate the role of serum ferritin level as a possible predicting factor of disease severity in these patients. We evaluated all patients with laboratory confirmed diagnosis of CCHF who were admitted to Boo-Ali Hospital of Zahedan from May 2011 to June 2012. Confirmation of the disease determined using the presence of anti- CCHFV IgM in the serum by enzyme-linked immunosorbent assay (ELISA) or by polymerase chain reaction(PCR). After ethical approval, patients were categorized into two groups of mild and severe disease according to disseminated intravascular coagulation (DIC) severity using the scoring system of International Society on Thrombosis and Hemostasis (ISTH). Serum ferritin levels were evaluated and compared between these two groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the optimal cutoff value of serum ferritin for predicting the disease severity. A total of 42 patients (36 men, 6 women, age range: 17-78 years) were included in this study, of whom 38% had Persian and 62% had Baloch ethnicity. According to DIC severity score, 54.7% of the patients had severe disease and 45.3% had mild disease. The area under the ROC curve was 0.896 and 95% CI was 0.801-0.991 (p<0.0001). A cut-off point of 1060 ng/dL, had a sensitivity of 78.9%, a specificity of 87%, a positive predictive value of 6% and a negative predictive value of 100%. Positive and negative likelihood ratios for this serum ferritin level were 6.05 and 0.24, respectively. Increased serum ferritin level has a significant positive correlation with disease severity in patients with CCHF and can evaluate the prognosis of these patients with a high sensitivity and specificity.

Clinical, Epidemiological and Laboratory Characteristics of Patients with Febrile Convulsion

Background: Febrile convulsion (FC) is the most common type of seizure that occurs in children aged 6-60 months. It occurs in two forms including simple and complex febrile seizure. Objectives: The purpose of this study was to determine the clinical, epidemiologic and laboratory features of patients admitted to Ali-ebne-Abitaleb hospital of Zahedan with febrile seizure in 2010-2011. Patients and Methods: In this cross-sectional study, the patients with diagnosis of febrile seizure were the target population. We obtained patient’s data based on clinical examination, history and information registered in hospital medical files including demographic, clinical and laboratory findings. Results: During the study period, 160 children with febrile seizures and mean age of 26.2 ± 19.5 months were studied. Male to female ratio was 1.2:1. Ninety-nine (61.9%) children had simple seizures and 61 (38.1%) children had complex seizures. Thirty-one (19.4%) of the patients had family history of febrile seizures and family history of epilepsy was positive in 6.3% of cases. Ninety one percent of cases were born with normal vaginal delivery. Also, only 5 patients (3.1%) had less than 37 weeks of gestational age at birth. The mean rectal temperature of the patients was 38.5 ± 0.67 ºC. Gastroenteritis was the most common cause of fever in our patients. Conclusions: The highest frequency of FC was seen in younger than 20-month-old children. Except for the lower incidence of positive history of prematurity and higher prevalence of gastroenteritis, results of the present study are relatively similar to other studies.

Efficacy of high-dose methylprednisolone in patients with Crimean-Congo haemorrhagic fever and severe thrombocytopenia

Crimean-Congo haemorrhagic fever (CCHF) is an acute viral haemorrhagic disease that is now endemic in south eastern Iran. The most important factor associated with mortality is a platelet count of less than 50,000/mL. The purpose of this study is to compare treated cases with severe thrombocytopenia using ribavirin with high-dose methylprednisolone (HDMP) with patients receiving ribavirin without HDMP. A clinical trial was conducted for confirmed patients with CCHF and severe thrombocytopenia (platelet count less than 50,000/mL) admitted to Boo-Ali Hospital in Zahedan between January 2010 and October 2011. The intervention group was given oral ribavirin, supportive managements and HDMP and the controls were treated with ribavirin and supportive management. Following HDMP therapy in hospitalized patients with severe thrombocytopenia, the platelet count increased within 36 h and the leukocyte count within 48 h of the beginning of treatment. Fewer in the intervention group required a transfusion of blood products than in the controls (P < 0.001). No one in the intervention group died. It seems that high-dose methylprednisolone is effective in the treatment of patients with CCHF. The increased platelet count and reduction of blood product requirement for severe CCHF patients after receiving HDMP are promising results. Further investigation is necessary in order to determine the efficacy of corticosteroid and its effect on outcome.

Prevalence of Alloimmunization against RBC Antigens in Thalassemia Major Patients in South East Of Iran

Background: Thalassemia major is a lifelong transfusion dependent disease. Continuous blood transfusion can causes alloimmunization against RBC antigens and complicate further treatment in these patients. The purpose of this study was to determine the frequency of RBC allo and auto antibodies, the types of these antibodies and the factors that affect alloimmunization in patients with thalassemia. Material and methods: This descriptive study was performed on 221 males and 164 females with thalassemia major referred to Ali Asghar hospital in Zahedan, Iran. Initially information sheet about age, gender, race, age on first blood transfusion, history of splenectomy and ABO & Rh blood group were filled out. For alloantibody screening, patients serum were tested in three phases (Salin, 37°C with LISS and Anti Human Globulin ) by pooled cells of Biorad. In case of a positive screen, antibody identification was performed by using panel cells prepared by Iranian Blood Transfusion Organization. Finally obtained results were analyzed by SPSS software. Results: Out of 385 patients (221 male &164 female; mean age, 13.8 years; range, 1-45 years), 69 cases (17.9%) had been alloimmunized. Majority of alloantibodies were directed against Rh and Kell systems. 21(5.5%) patients were positive for autoantibodies. Conclusion: The relatively high prevalence of alloantibodies (17.9%) in our studied patients indicated the importance of cross matched blood from the beginning of transfusion in thalassemia major patients.

Serotype distribution and antimicrobial resistance of invasive Streptococcus pneumoniae isolates from children in Zahedan, Iran

Streptococcus pneumoniae is the leading cause of death among children worldwide. This study was conducted to evaluate the antibiotic resistance patterns and seroepidemiology of invasive S. pneumoniae isolates in children of Zahedan. Invasive isolates of S. pneumoniaewere obtained from normal sterile sites (blood, cerebrospinal fluid, pleural fluid, joint aspirate, peritoneal fluid and pericardial fluid) of pediatric patients (aged ≤14 years) from 3 large hospitals in Zahedan, Iran. The serotyping was carried out by latex agglutination test and the minimum inhibitory concentrations (MIC) of penicillin, as well as other commonly used antibiotics were determined by broth dilution method. During February 2008 to November 2010, a total of 1265 children with suspected invasive bacterial disease were recruited, of whom 75 (5.9%) were identified to have S. pneumoniae as the causative agent of invasive disease. The leading serotypes were 23F, 6B, 3, 19F and 14 (70.7% of all isolates). Intermediate- and high-level resistance, were observed in 37.3 and 45.4% of isolates respectively. Resistance was also demonstrated against erythromycin (90.7%), cotrimoxazole (80.0%), tetracycline (66.6%), cefuroxime (62.7%), imipenem (17.3%) and amoxicillin/clavulanate (9.2%). All the isolates were susceptible to vancomycin and levofloxacin. Multiple drug resistance was observed mostly in types 19F, 23F, 6B and 14. The application of heptavalent pneumococcal conjugate vaccine (PCV7) covered 68.0% of all IPD cases, 42.7% of the penicillin-nonsusceptible S. pneumoniae (PNSSP), and 48.0% of the multiple drug resistant (MDR) isolates. The highest PNSSP prevalence and highest PCV7 coverage were in children aged <2 years. Antibiotic resistance was common among invasive isolates of S. pneumoniae in Zahedan. The present study suggests that the introduction of anti-pneumococcal conjugate vaccines into immunization programme would likely lead to a significant reduction of IPD- associated morbidity among children in Zahedan. Key words: Antimicrobial resistance, invasive pneumococcal disease, serotype, Streptococcus pneumoniae.

Satisfaction of mothers with the performance of health care providers in postpartum wards of hospitals in Zahedan

Background and aim The main goal of health care providers is to gain satisfaction of patients. Accordingly, one of the criteria in assessing quality of maternity care is satisfaction of mothers. The aim of this study was to determine satisfaction of mothers with the performance of health care providers in postpartum wards of selected hospitals at Zahedan. Materials and methods In this descriptive study, 72 women with normal vaginal delivery were selected via quota sampling method in two hospitals. A questionnaire completed by interview from mothers in 4 parts including demographics and satisfaction with the performance of physicians, nurses as well as other staff was used to collect data. Its validity was determined by content method and its reliability by internal consistency. Data were analyzed by SPSS 15. Findings Mean age of the subjects was 23.65±5.49. Mean amounts of satisfaction with the performance of physicians, nurses and staff were 68.32%, 60.81% and 68.40% respectively. The highest means of satisfaction were related to the knowledge and skills of physicians as well as nurses and the lowest to the conduct of physicians and responsiveness of nurses. Conclusion With respect to the proper satisfaction of mothers with the competency of clinical staff which cannot be authentically cited due to their limited information regarding professional medical services, the conduct and responsiveness should be well attended. Keywords: Satisfaction of mothers, Postpartum care, Nursing care, Staff performance. * Corresponding Author: Torkzahrani, SH. Dept. of Community Health Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences & Health Services , Tehran, Iran E-mail: zahranishahnaz@yahoo.com

Analysis of trauma outcome at a university hospital in Zahedan, Iran using the triss method

To evaluate validity of TRISS (Trauma score and injury severity score) method in trauma outcome analysis and compare trauma care at a university hospital, with the standards reported in the Major Trauma Outcome Study (MTOS). Analytical and descriptive study. Khatam-ol-anbia University Hospital in Zahedan, Iran, from March 22, 1997 to March 21, 1998. Seven hundred and sixty eight consecutive patients with multiple trauma were included in the study. Survival analysis was completed for all of the patients. The majority of patients were men (82%), and the average age was 23 years. Seven hundred and one patients (91%) sustained blunt trauma, with road traffic accidents being the most common (59%). The predicted mortality was 3.1% and the observed mortality was 8%. The M-statistics was 0.91. In developing countries the same as developed countries, the TRISS methodology is an acceptable method for evaluation of the difference between predicted and observed mortality. This study shows that our mortality is significantly more than universal standards and there are weak points in our trauma care system.