Isfahan Province Research Articles

Causative Agents and Antibiotic Resistance in Nosocomial Sepsis: A Cross-Sectional Multicenter Study from Isfahan Province, Iran

Background: Nosocomial sepsis is a leading cause of morbidity and mortality worldwide. Understanding the antibiotic susceptibility patterns of pathogens specific to each geographic region is essential for effective patient management. Methods: This cross-sectional study aimed to investigate the microorganisms causing nosocomial sepsis and their antibiotic sensitivity in patients admitted to three referral hospitals in Isfahan, Iran. Clinical information and blood culture results were obtained from hospital records. Results from patients without signs of sepsis, as well as contaminants and community-acquired isolates, were excluded. Stratification was conducted based on sex and age (< 20 and > 20 years) categories. Results: In this study, 267 patients with hospital-acquired sepsis were identified, with gram-negative bacteria accounting for 77.2% of infections. The most common pathogens included Klebsiella spp. (35.2%), Acinetobacter spp. (21.7%), Enterococcus spp. (13.5%), Escherichiacoli (8.6%), Pseudomonasaeruginosa (8.6%), and Staphylococcusaureus (8.2%). The highest resistance among gram-negative bacteria was observed with cefepime (80.3%), ceftazidime (76.5%), cefotaxime/ceftriaxone (70.0%), trimethoprim-sulfamethoxazole (68.6%), ciprofloxacin (68.2%), meropenem (60.0%), and amikacin (50.3%). All gram-negative isolates were sensitive to colistin. Among gram-positive bacteria, the highest resistance was to ciprofloxacin (77.3%), ampicillin (75.7%), clindamycin (74.4%), vancomycin (64.9%), and gentamicin (30.0%). All gram-positive isolates in this study were sensitive to linezolid. Conclusions: The study indicates a high level of resistance among bacterial agents causing nosocomial sepsis in the studied area. Consequently, treatment may necessitate the use of last-line antibiotics, such as linezolid and colistin.

Bovine brucellosis, associated risk factors and preventive measures in industrial cattle farms

Effective management of brucellosis in human populations is closely tied to controlling the disease in domestic livestock. This study focused on identifying determinants of brucellosis prevalence in mixed industrial dairy and beef cattle farms within Isfahan Province, Iran. Employing a case control design, we compared 32 ranches with documented brucellosis within the previous year (12 months) to 38 farms with no brucellosis during the same timeframe. The comparison examined the farms' adherence to health protocols for raising cattle. Utilizing multivariable logistic regression, the study identified several significant risk factors linked to brucellosis prevalence. These included cleaning milking accessories with a water and chlorine solution (OR 0.25, 95%CI 0.06 to 0.99), cleaning water troughs daily (OR 0.20, 95%CI 0.04 to 0.89), the cows' density per square meter (OR 0.14, 95%CI 0.03 to 0.75), being within 2000 m of another cattle ranch with brucellosis (OR 4.02, 95%CI 1.09 to 14.84) and ovine farms situated within a 500-m radius (OR 8.43, 95%CI 1.66 to 42.70). No meaningful difference was observed in vaccination frequency between infected and non-infected farms (P = 0.645). While vaccination is essential for preventing bovine brucellosis, robust biosecurity measures are crucial for effective disease management.

Cancer and mortality risks among people with multiple sclerosis: A population-based study in Isfahan, Iran.

Multiple sclerosis (MS) and cancer present substantial global health challenges. Understanding cancer patterns among people with MS (PwMS) is crucial due to potential variations across demographics and geographic regions. Isfahan province in Iran, known for its high MS incidence ratio, offers a significant population for comprehensive studies on MS. In this study, we aim to investigate the association between risk of cancer and MS. Data on PwMS were collected utilizing the National Multiple Sclerosis Registry System of Iran (NMSRI), with diagnoses confirmed using McDonald criteria by neurologists specialized in MS. Cancer incidence was investigated using the Iranian National Population-Based Cancer Registry (INPCR) data, collected following international protocols. Descriptive statistics and regression analyses were employed to assess factors associated with cancer and mortality risks among PwMS. Survival analysis was conducted using Kaplan-Meier curves. Out of 10,049 PwMS, 123 were diagnosed with cancer, with an mean age at the time of cancer diagnosis being 40.41 years and a mean MS duration of 6.76 years. The majority had relapsing-remitting MS (81.2%), and Interferon-β was the most common disease-modifying therapy (DMT) (42.4%). Cancer incidence was 125.6 per 100,000 person-years, peaking at ages 60-64 (677.9 per 100,000 person-years). Receiving monoclonal antibody medications and older age were significantly associated with higher cancer risk (OR:1.542 (1.009-2.357), OR:1.033 (1.015-1.051), respectively). Female breast cancer had the highest incidence ratio among PwMS (40.17 per 100,000 person-years), followed by thyroid (18.38 per 100,000 person-years) and digestive system cancers (17.36 per 100,000 person-years). Breast cancer was the predominant cancer in women, while digestive system cancers were most common among men. Being male and having longer MS duration were linked to higher cancer mortality risk (HR: 2.683, 1.087, respectively). Cancer incidence among 10,049 people with multiple sclerosis was significant, especially in older individuals, with breast cancer being the most common. Male gender and longer MS duration were linked to higher cancer mortality risk.

Assessment of Managerial Skills Among Healthcare Provider Managers

The primary objective of this research is to assess the managerial skills of managers working in healthcare and hospital centers (primary healthcare) within Isfahan province. This cross-sectional study was carried out in 2023, encompassing a sample size of 1,420 healthcare providers operating in these healthcare and hospital centers. The research utilized the Cameron and Whetten questionnaire, which employs a Likert scale for measurement. Data analysis was conducted using Pearson correlation coefficient and linear regression tests. The findings revealed that 53.4% of managers demonstrated effective skills in writing, oral communication, and listening. Additionally, 62.8% of managers exhibited proficiency in time management. However, only 39.12% were adept at avoiding troublesome decisions, 30.2% were skilled in persuading higher-level individuals, and 30.8% showed competence in planning. A significant relationship was identified between the ability to persuade higher-level individuals to perform tasks and teamwork among managers with more work experience. The results also highlighted a higher incidence of troublesome decision-making among women and individuals with extensive managerial experience. In conclusion, the study suggests that managers of healthcare providers in healthcare and hospital centers (primary healthcare) in Isfahan province require more focused attention and training in certain key managerial skills to enhance their effectiveness. This includes improving their abilities in decision-making, persuasion, and planning, which are crucial for their roles. Therefore, targeted training programs and interventions are recommended to address these gaps and improve the overall managerial capabilities within these healthcare settings.

The isolation and serotyping of foot-and-mouth disease virus in Iran during 2019-2022.

Foot-and-mouth disease (FMD) is a significant transboundary animal disease that has a considerable economic impact on livestock systems worldwide. In order to determine the presence and type of FMD virus in Iran, a total of 90 samples of vesicular fluid and epithelial tissue were collected from the tongues, tooth pads, and hooves of clinically suspect cattle on 40 vaccinatedfarms in 9 provinces of Iran. These samples were collected duringfour years, from January 2019 to December 2022, and the vaccine was a locally produced polyvalent inactivated vaccine. The collected samples were analyzed using ELISA and isolation methods to identify and characterize the FMD virus. The results of the ELISA tests revealed that 66.66% of the samples were positive for FMD, and the serotypes of the virus were determined. Considering ELISA reslut, 62% of the samples were assigned to serotype O, 33% to serotype A, and 5% to serotype Asia-1. Furthermore, 90% of the positive samples were inoculated onto monolayer cultures of pig kidneys (IB-RS2) for isolation and antigen detection by serotype-specific ELISA kit. The great majority of detected serotype Oviruses were from Esfahan province, while the most detectedserotype Aand serotype Asia-1 viruses were from Qom and Tehran provinces, respectively. These findings indicate that the ELISA and isolation methods are suitable for identifying and typing FMD viruses. The vaccination program in Iran, which includes three serotypes (O, A, and Asia-1), appears to be effective in controlling the spread of the disease. However, the continued circulation of these serotypes in most provinces suggests that ongoing surveillance and vaccination efforts are necessary.

Phenol identification and mapping of rangeland species at laboratory and landscape scales using PRISMA hyperspectral data

ABSTRACT Secondary metabolites have high ecological and economic values. Measuring the amounts of these metabolites in plants through laboratory analysis is time-consuming and expensive. On the other hand, the laboratory results cannot be generalized to a wide area of rangelands with diverse climates, topography, and soil. Therefore, the present study aims to evaluate the potential of PRISMA hyperspectral data to estimate the rangeland phenol concentration at landscape scale in western Isfahan province, Iran. Phenol concentration and spectral signatures were extracted from 42 plant individuals, including Astragalus adscendens, Astragalus verus, Daphne mucronata, Anabasis aphylla, and Phlomis olivieri using laboratory methods and spectroscopy in the range of 350 to 2500 nm. Phenol-sensitive bands were identified by establishing a relationship between phenol concentration and all spectral bands by the Partial Least Square Regression (PLSR) method. The map of phenol spatial changes was then produced with the Bayesian Regularized Artificial Neural Network Model (BRNN), Random Forest (RF), Generalized Linear Model (GAM), Generalized Additive Model (GLM), and Gaussian Process Regression (GPR) in rangelands. The results showed that the phenol concentration in different individuals was between 3.65 and 20.13 (mgGAE/gDW), and species spectral absorptions ranged from 1.650 to 1.660. The very high coefficient of determination of phenol concentration with spectral data (R2 = 0.94) confirmed the use of these data in phenol mapping at the landscape scale. The maximum estimated phenol concentration by GLM, GAM, RF, BRNN, and GPR models was 36.40, 26.76, 18.07, 22.74, and 32.92 GAE/g DW, respectively; which RF model had the highest (R2 = 0.955) and GLM had the lowest accuracy (R2 = 0.816). The findings show that hyperspectral data can estimate secondary metabolites at the landscape scale and can supplement laboratory methods in managing rangeland plants.

The spectrum of clinical, hormonal findings in children with congenital adrenal hyperplasia in Isfahan province; a 20-year review.

Congenital adrenal hyperplasia is an autosomal recessive disorder caused by complete or partial defects in one of the several steroidogenic enzymes involved in synthesizing of cortisol from cholesterol in the adrenal gland. Prompt and proper treatment of the disease would reduce symptoms and the level of androgens in patients. The present study aimed to evaluate the demographic characteristics and clinical findings of these patients. This retrospective investigation was conducted in 146 patients with congenital adrenal hyperplasia participated. Their clinical and paraclinical findings were accurately recorded in the file and extracted from the records. Among all 146 patients, 119(81.5 %) was 21-OH Deficiency type;11-OH Deficiency type was 13(8.9 %), 10(6.8 %) was 3β-HSD type, StAR was 2(1.4 %) and 17 alpha(α)-hydroxylase Deficiency was 2(1.4 %). The mean age of disease onset in these patients was 2.45±1.16 years. Macropenis was the most frequent clinical finding in 39 cases of 64 boys (60.9 %), and Clitoromgaly was the most clinical presentation in 40 cases of 82 girls (48.7 %). The levels of testosterone, dehydroepiandrosterone sulfate, and 17-OHP significantly decreased in the last visit compared to the initial diagnosis. Based on the clinical findings in every infant or child with ambiguous genitalia, macropenis, clitoromegaly, hirsutism, and premature pubarche, we should consider congenital adrenal hyperplasia. Prompt and proper treatment and disease control would reduce symptoms and the level of androgens in patients.

Effectiveness of a Health Belief Model-based Educational Intervention on Treatment Adherence Among Type 2 Diabetic Patients: Insights from a Randomized Controlled Trial in Iran

Background: Diabetes is a significant and costly health problem worldwide, requiring effective interventions to improve adherence. The aim of this study was to increase treatment adherence in patients with type 2 diabetes using constructs from the Health Belief Model (HBM). Methods: An educational intervention consisting of four sessions was conducted on 100 patients with type 2 diabetes referred to the Diabetes Clinic affiliated with the Social Security Organization in Mobarakeh, Isfahan province, Iran. The mean difference before and after the intervention in HBM constructs and self-efficacy activities was compared using independent t-tests. The association between self-care behaviors before and after the educational intervention in both groups and the expected value of a part of the HBM was examined using linear regression. The threshold for statistical significance was P<0.05. Results: After the intervention, the mean difference scores for all components of the HBM and self-efficacy increased significantly in the intervention group. In linear regression analysis, perceived vulnerability was the only variable that showed a direct and significant relationship with self-care in the intervention group. Conclusion: The results of the study suggest that patient education improved all HBM constructs related to treatment adherence. This underscores the importance and effectiveness of self-care education in controlling blood glucose levels in diabetic patients.

Continued Increase in Incidence of Kidney Cancer in Iran and its 31 Provinces

Background: Kidney cancer in adults includes malignant tumors originating from the parenchyma and pelvis and is the most lethal urogenital cancer. Available data in Iran indicate that the incidence and pattern of this cancer are changing. Objectives: Our study aimed to present an updated incidence rate of kidney cancer in Iran and its 31 provinces and their trends, and climate zones distribution of the disease. Methods: In this study, the age standard incidence rate (ASIR) of kidney cancer based on provinces, age groups, and gender has been calculated using the available data in the national cancer registration system of the Ministry of Health from 2003 to 2016. Results: Overall ASIR of kidney cancer was 1.28 per 100,000 from 2003 to 2016. ASIR of this cancer in men has increased from 0.96 in 2003 to 3.66 in 2016 and similarly, reached from 0.61 in 2003 to 2.24 in 2016 in Iran. Fars, Yazd, Tehran and Isfahan provinces had the highest ASIR in Iran. Hot climate zones are associated with a higher incidence of kidney cancer while moderate climate is linked to lower incidence rates in Iran. Conclusions: Although the incidence rate of kidney cancer in Iran and its provinces is low, the increasing trend is concerning particularly among men. Therefore, it is crucial to develop cost-effective screening tests and implement control and prevention programs in the high-incidence provinces.

Exploring paramedics’ lived experiences in confrontation with patients’ death during missions: a phenomenological study

BackgroundEmergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients’ Deaths during their missions in 2023.MethodsThis study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith’s approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran.ResultsSeventeen emergency personnel with the age range of 24–60 (average = 39) years and with a history of confronting patients’ deaths during their services were interviewed. Their lived experiences of being exposed to patients’ deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes.ConclusionWhile emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.

Comparison of the calculated frost event return period based on copula models under climate change: a case study of Chadegan region in Isfahan province- Iran

Comparison of the calculated frost event return period based on copula models under climate change: a case study of Chadegan region in Isfahan province- Iran

The Effect of Eight-Week Kegel Exercise on Quality of Life in Postmenopausal Females with Urinary Incontinence

Introduction: Urinary incontinence (UI) is the leakage of urine which is often uncontrollable and can negatively impact on the quality of life (QoL). The aim of this study was to determine the effects of an eight-week of Kegel exercise as a complementary therapy on QoL in postmenopausal females with UI. Methods: The study design was a quasi-experimental pre-test post-test with a control group trial. The participants were Iranian women aged between 60 to 95 years with UI problems referring to medical centers in Najafabad city in Isfahan Province, Iran. Twenty four female UI patients were recruited and randomly divided into Kegel exercise (n = 12) and control group (n = 12). The Kegel group received exercise three times a week for eight-week, and the control group continued their routine life. The Questionnaire for Urinary Incontinence Diagnosis and the World Health Organization Quality of Life questionnaire were used for data collection. The variables were measured before and after the Kegel protocol in both groups. Descriptive statistics and analysis of covariance were used to assess variable differences between groups (p < 0.05). Results: The mean age of UI patients was 70.83 ± 7.61 years old. Analysis of variance demonstrated a significant decrease in stress urinary incontinence symptoms (F = 61.88, p = 0.01), urge urinary incontinence symptoms (F = 111.56, p = 0.01), and UI symptoms (F = 88.20, p = 0.01), and significant increase in physical health (F = 28.93, p = 0.01), psychological health (F = 15.35, p = 0.01), social relationships (F = 18.83, p = 0.01), environment health (F = 155.51, p = 0.01), QoL (F = 132.07, p = 0.01) in Kegel exercise group. Conclusion: Kegel exercise can be an effective complementary therapy for improving QoL in postmenopausal female suffering from UI. Healthcare providers should consider recommending Kegel exercise as part of comprehensive treatment approach for postmenopausal female with UI to help alleviate symptoms and enhance their overall QoL.

The biochemical properties of Satureja species affected by micronutrients, genotype, and locations in drought stress conditions

Medicinal plants, as important sources of secondary metabolites, are used for treating different diseases. It is accordingly pertinent to find methods, which may improve their growth and quality in different conditions including variable stresses. It was hypothesized micronutrients use and suitable genotypes may improve Satureja growth and quality in drought stress conditions. The objective of this study was to investigate the effects of drought stress (irrigating plants each 3 (A1), 6 (A2) and 9 days (A3)), micronutrients (Mn and Cu at 0 (M1), 20 (M2) and 40 mgL−1 (M3)), and field location (Isfahan (F1) and Golpayegan (cooler) (F2), Isfahan province, Iran) on the biochemical properties of different Satureja species including S. bakhtiarica, S. khuzestanica and S. mutica. The experimental treatments significantly affected the measured parameters including nodule number, essential oil, antioxidant activity, proline, Mn and Cu contents, and relative water content. Although Cu and Mn, enhanced plant biochemical properties, especially in M2, in some cases, the two micronutrients, unfavorably affected plant properties in M3. The responses of genotypes were different in the two research fields and S. bakhtiarica performed better in F2. The highest essential oil was resulted by A2. The two micronutrients improved plant responses in drought stress by increasing nodule number (148 %), and essential oil yield (143 %) and decreasing plant relative water content and conserving plant water. The use of Mn and Cu is recommendable for planting Satureja species in drought stress conditions, as the two nutrients may enhance plant tolerance by increasing proline production and antioxidant activities.

Numerical comparison of streamflow drought index (SDI) and standardized streamflow index (SSI) for evaluation of Isfahan drought status

ABSTRACT Hydrological droughts are the most serious and alarming variation of droughts due to their numerous long-term negative impacts on natural ecosystems, agricultural capacities, and the water regime of a specific region. Isfahan province, in Iran, is highly prone to this type of drought, and its arid climate has already made the efficient water management in this area a challenging task. Due to the lack of a uniform method for drought evaluation, various indices have been suggested by different researchers over the last few decades. The streamflow drought index (SDI) and standardized streamflow index (SSI) are the two primary hydrological drought indices that have been used in many regions with similar climatic conditions to Isfahan province. Their reliability in previous case studies and the easy computational process have made them suitable drought measurement tools for Isfahan. In this study, these two indices are calculated based on the obtained data from 10 hydrometric stations in Isfahan, for the timeframe (1988–2018). The analysis of SSI and SDI in this region shows consistent and station-specific drought patterns, with moderate drought conditions prevailing. These findings offer valuable insights for regional water resource management and climate adaptation, guiding policies to mitigate the impact of droughts.

Characterization of bacteria expectorated during forced salivation of the Phlebotomus papatasi: A neglected component of sand fly infectious inoculums.

The infectious inoculum of a sand fly, apart from its metacyclic promastigotes, is composed of factors derived from both the parasite and the vector. Vector-derived factors, including salivary proteins and the gut microbiota, are essential for the establishment and enhancement of infection. However, the type and the number of bacteria egested during salivation is unclear. In the present study, sand flies of Phlebotomus papatasi were gathered from three locations in hyperendemic focus of zoonotic cutaneous leishmaniasis (ZCL) in Isfahan Province, Iran. By using the forced salivation assay and targeting the 16S rRNA barcode gene, egested bacteria were characterized in 99 (44%) out of 224 sand flies. Culture-dependent and culture-independent methods identified the members of Enterobacter cloacae and Spiroplasma species as dominant taxa, respectively. Ten top genera of Spiroplasma, Ralstonia, Acinetobacter, Reyranella, Undibacterium, Bryobacter, Corynebacterium, Cutibacterium, Psychrobacter, and Wolbachia constituted >80% of the saliva microbiome. Phylogenetic analysis displayed the presence of only one bacterial species for the Spiroplasma, Ralstonia, Reyranella, Bryobacter and Wolbachia, two distinct species for Cutibacterium, three for Undibacterium and Psychrobacter, 16 for Acinetobacter, and 27 for Corynebacterium, in the saliva. The abundance of microbes in P. papatasi saliva was determined by incorporating the data on the read counts and the copy number of 16S rRNA gene, about 9,000 bacterial cells, per sand fly. Both microbiological and metagenomic data indicate that bacteria are constant companions of Leishmania, from the intestine of the vector to the vertebrate host. This is the first forced salivation experiment in a sand fly, addressing key questions on infectious bite and competent vectors.

CO2 emission from the electricity sector in Iran; calculation, prediction and reduction policies

Fossil fuel power plants produce a significant amount of CO2 emissions, and this pollutant causes global warming, respiratory and heart diseases, and other significant issues. Electricity interprets as a primary and rising demand in each energy system; thus, in this paper, carbon dioxide (CO2) emission reduction was selected as the objective value for 2025. Power plant fuel consumption was surveyed to calculate the CO2 emission caused by each fuel. Also, Esfahan province (an industrial province in Iran) was investigated as the study case. Forecasting the fuel consumption for 2025 was run by two parameters: population and Gross Domestic Production (GDP), which were forecasted by the report of the Iran Statics Center and the Gaussian Process Regression (GPR) method, respectively. The CO2 emission of power plants was obtained using the coefficients of each fuel. Based on Iran's commitment to the Paris Agreement, a 4% reduction of CO2 emissions is the main objective. Thus, this study aims to reach this goal by implementing four scenarios: a) adding renewable energies, b) adding renewable energies and improving the generation efficiency, c) adding renewable energies and decreasing the grid losses, and d) combining the three scenarios mentioned above. According to these scenarios, reformation strategies compensated 10.5% of the required power, which was satisfied by renewable energies, and finally, this province can gradually satisfy a 4% reduction until 2025.

Association analysis of MnSOD-Ala16Val genetic variation and the risk of preeclampsia: A case-control study and in silico analysis

BackgroundPreeclampsia, a main contributor to maternal mortality worldwide, impacts women beyond 20 weeks of gestation, presenting with elevated blood pressure and proteinuria. The role of oxidative stress in the development of preeclampsia is considerable due to the increased oxygen requirement of placenta. The aim of this study is to evaluate the association between MnSOD-Ala16Val genetic variation and the risk of preeclampsia in a group of pregnant women in accompanying a bioinformatics analysis. Materials and methodsIn this case-control study, 136 pregnant women with preeclampsia vs. 173 healthy women without any history of known diseases as control group, were selected from cases who have referred to the Shahid Beheshti hospital of Kashan (Isfahan province, Iran). After sampling and DNA extraction, MnSOD-Ala16Val polymorphism was evaluated using PCR-RFLP for genotype assessment. Eventually, some bioinformatics tools were used for evaluation of the above-mentioned polymorphism on gene function. ResultsOur data illustrate the association between CT heterozygote genotype of MnSOD-Ala16Val polymorphism with enhanced risk of susceptibility to preeclampsia (OR = 1.865, 95%CI = 1.03–3.37, p = 0.039). Indeed, bioinformatics analysis demonstrated the significant impact of the above mentioned polymorphism on the structure of protein (Score: 49, Expected accuracy: 71%) and RNA (Distance: 0.1815, p-value: 0.1676; A p-value <0.2 is significant). ConclusionsAs a preliminary study, our findings suggest a potential association between the MnSOD-Ala16Val polymorphism and the risk of preeclampsia. However, more investigations with a larger sample size and in different ethnicities are essential for achievement of more precise outcomes.

Hospital safety index: evaluation of the readiness and safety of hospitals in Isfahan province, Iran

Objective: Hospitals play a vital role in disaster management and their function must be maintained during crises. Isfahan province is susceptible to major crises and disasters at any time of the year. The study aimed to investigate the hospital safety index (HSI) in hospitals in Isfahan province. Methods: This cross-sectional study was conducted using the HSI questionnaire of the world health organization. The safety of all 55 hospitals in Isfahan province was evaluated with the Persian version of the questionnaire from 2017 to 2022. In this study, all hospitals were evaluated by a group of experts from the emergency operations center (EOC) of Isfahan University of Medical Sciences, and the checklists were completed with the cooperation of the hospital disaster committee, visiting the hospitals, and interviewing the personnel. Results: The safety level of hospitals has improved from 2017 to 2022 so in 2022, 38 hospitals (69.09%) had a high safety level, and 17 hospitals (30.91%) had a medium safety level. This increase in safety has happened in all three components of safety (functional, non-structural, and structural safety). There was no significant difference in the overall hospital safety score between academic-educational, non-academic governmental, social security and military, and private and charity hospitals (P&lt;0.05). Conclusion: Although the safety in the hospitals of Isfahan province has improved due to the continuous disaster prevention and preparedness activities, hospitals still need to improve to achieve higher levels of safety. The HSI shows how well a hospital can maintain its organization and performance during disasters. This index will be useful for decision-making and policy-making to prioritize administrative and civil interventions.

Adaptation of Clinical Practice Guideline for Assessment of Liver Fibrosis in Patients with Non Alcoholic Fatty Liver Disease in Isfahan Province.

Non-alcoholic fatty liver disease (NAFLD) refers to the presence of hepatic steatosis (accumulation of fat in the liver to over 5% of its weight) in the absence of secondary causes of fat accumulation in the liver such as excessive alcohol use. NAFLD is divided into two types: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Therefore, in this clinical guideline, we sought to determine general and important policies for this disease and modify its managment approaches. We adapted this guideline for the management of NAFLD in Isfahan Province. This guideline was developed by clinical appraisal and review of the evidence, available clinical guidelines, and in consultation with members of the Isfahan Chamber of the Iranian Association of Gastroenterology and Hepatology. Biopsy is recommended as the most reliable method (gold standard) to diagnose steatohepatitis and fibrosis in patients with NAFLD. NAFLD fibrosis score (NFS) and fibrosis-4 (FIB-4) are recommended as the test with the highest predictive value for advanced fibrosis in patients with NAFLD compared to other serologic tests. Among the noninvasive methods used to assess liver fibrosis, transient elastography (TE) is preferable to other methods.

Benefits of applying hourly resolution in the assessment of the climate aptitude to manage tourist activities in arid regions

The availability of reliable information on local climatic-tourism conditions is a growing need due to the influence it exerts on the quality of the organizational strategy of tourist destination’s, and travel experience. Evaluations of the tourism potential of the climate have been carried out on a daily or monthly resolution, thus limiting the collection of detailed information that makes it possible to fine-tune tourism management and operational decision-making on an intraday scale. This research is the first case study to analyse the climatic suitability for nature tourism, using the weather types method at hourly resolution. The study applies to arid tourist destinations in Isfahan province (Iran). The detailed resolution has made it possible to identify the time slots favourable to the development of nature tourism in those periods of the year recognized as critical in the daily resolution analyses. In the same way, the hourly resolution has also identified critical bands in those periods indicated as favourable in the evaluations to daily resolution. The hourly resolution provides detailed information that can allow tourists and also tourism managers to establish intraday adaptation strategies that make it possible to develop the activity even in places with extreme climates.