Abdolaziz Rastegar Lari

Epidemiology and mortality of burns in the South West of Iran

Burn injuries still produce a significant morbidity and mortality in Iran. This study was carried out to analyze the epidemiology, mortality, and current etiological factors of 2043 burn patients who were admitted to the burn centers in the Fars province during 4 years (1994-1998). There were two burn centers in the Fars province serving 3817036 people over an area of 124,000 km(2). The overall incidence rates of hospitalization and death were 13.4 and 4.6 per 100000 person-years. The mean age was 21.9 years, and 51% of patients were children under 19-years-old. The highest rates of hospitalization and death were observed in the elderly (80 years). Also young females (20-29 years) had a high rate of hospitalization. Thus, 55% of the patients had BBS less than 40%. Burn injuries were more frequent and larger with higher mortality in females than in males (P<0.0001). There was also statistically significant correlation between age groups, gender, and BBS with mortality rate (P<0.0001). Flame was the most common etiology of burns. There was also significant correlation between age groups and type of burns (P<0.0001). Suicide attempts for all the patients > or = 11 years were the cause of 41.3% (256/620) of the burns involving women and of 10.3% (40/388) of the burns involving men. The overall case fatality rate was 34.4%. The mortality rate was significantly higher for self-inflicted burns (78%) than for accidental burns (26.7%). Most of the lesions requiring hospital admission occurred during the winter months. Factors associated with an increase in mortality were suicidal burns, burn size, age, and flame burns. Most of the burn injuries were caused by domestic accidents and were, therefore, preventable.

Epidemiological study of 3341 burns patients during three years in Tehran, Iran

A retrospective study was conducted on 3341 burn patients hospitalized in a burn care center in Tehran, Iran during 1995-98. The mean age was 20.4 years, and 43.5% of patients were children under 15 years old. The mean body surface area burned was 30.6%. There were statistically significant correlations between age groups and total burn surface area (TBSA) burned with mortality rate (p<0.006). Flame was the most common etiology of burns. There was also significant correlation between age groups and causes of burns (p<0.0001). The mean hospital stay was 16.7 days. The overall mortality rate was 19.6. Most of the injuries requiring hospital admission occurred during the winter months. Parents can play an important role in prevention of burns in children who are most susceptible to burns. People with causes identified could be educated in burn prevention, through news and other media.

Nosocomial infections in an Iranian burn care center

Burn patients are obviously at high risk for nosocomial infections due to the immunocompromizing effects of burn injury. Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen in burn units. The aim of this study was to determine nosocomial infections in the Tohid Burn Center in Tehran, Iran. Materials of this study were samples of burn wounds and blood from 582 patients who required hospitalization during March 1996 and September 1998. Burn wound samples were taken on admission day, 3 and 7 days after admission. Frequency of culture positive on admission day, 3 and 7 days after admission were 15, 66, and 88%, respectively. Frequency of P. aeruginosa and Staphylococcus aureus on admission day were 35 and 34%, on the third day after admission 73 and 15%, and at the end of the first week of admission 87 and 9%, respectively. Frequency of blood culture positive was 36% (19/53) of which 89% were P. aeruginosa. Overall mortality rate was 18.5% (108/582). Of these patients, frequency of positive wound culture was 92% (99/108). In conclusion, our results show that P. aeruginosa is the leading cause of nosocomial infections in our burn center. It is also necessary to introduce urgent measures for restriction of the spread of P. aeruginosa infections in our burn center.

EPIDEMIOLOGY OF DERMATOPHYTOSES IN AN AREA SOUTH OF TEHRAN, IRAN

Dermatophyte infections have been considered to be a major public health problemin many parts of the world. The aim of this study was to identify the etiological andepidemiological factors of dermatophyte infections in an area south of Tehran. A totalof 1254 patients suspected to have dermatophytic lesions were examined over a periodof three years (1999-2001). Material collected from skin, hair, and nails was submittedto direct microscopic examination using KOH, cultured in Sabouraud dextrose agarand microscopically examined for colony morphology, in order to the identify the 169dermatophytes isolated. The prevalence of dermatophytoses was 13.5% (95% CI:11.7–15.5%). Their incidence was 10.6 per 100,000 person-years (95% CI: 8.5–13.2). Epiderophyton floccosum was the most frequent dermatophyte isolated (31.4%) followed by Trichophyton rubrum (18.3%), T. mentegrophytes (17.2%), T. violaceum (16.6%), Microsporum canis (6.5%), T. verrucosum (4.7%) and M. gypseum (4.1%). Epidermophytes floccosum was foundto be the most common isolated dermatophyte in age groups 20–29 (30.2%). Tinea corporis (31.4%) was the most common type of infection, followed by tinea cruris (20.7%), tinea manuum (15.4%), tinea capitis (12.4%), tinea pedis (10.6%), tineafaciei (7.1%), and tinea unguium (2.4%). The frequency rate of all of the types oftinea was higher in males than in females. The anthrophilic species E. floccosum was the most common dermatophyte as a causative agent of tinea. The most prevalent fungal infection was tinea corporis caused by E. floccosum.

Pediatric burn injuries in Tehran, Iran

The objective of this study was to identify the epidemiologic features of pediatric burn injuries in western Tehran. Study subjects included all children up to the age of 15 years who were treated as inpatients at the Tohid Burn Center in Tehran between April 1995 and March 1998. Among the 3341 burns admitted to the Center over the 3-year study period, 1454 (43.5%) occurred in children less than 16 years of age. The overall case fatality rate for children was 16%, while the annual burn incidence rates ranged from 22.7 to 17.8 burns per 100000 child-years. The overall gender ratio (boys/girls) was 2.6. Children less than 2 years of age had the highest burn incidence and burn mortality rates. These findings will be used as a basis for developing targeted preventive programs to protect Iranian children from burns.

Epidemiology of childhood burn injuries in Fars province, Iran.

Childhood burn injuries are a major environmental agent responsible for significant morbidity and mortality in Iran. Thus, the objective of this study was to analyze the epidemiology and current causative factors of hospitalized burn injuries among the approximately 1.6 million children between the ages of birth through 15 years residing in the Fars province of Iran. These data will be used as a basis for developing a targeted preventive program to protect children from burns. Epidemiologic data for 760 children, aged 0 to 15 years, admitted to the two burn centers of Shiraz University of Medical Sciences, over a 4-year period, 1994 to 1998, were collected and analyzed. The overall hospitalization rate was 11.8 per 100,000 person-years (PY). The sex ratio (boys/girls) was 1.38. About 60% were children aged 7 years or younger. Children aged 2 years had the highest burn incidence rate (36.9/100,000 PY). A total of 77.4% of the children had body surface area burns less than 40%. Scalds accounted for 46.2% of the burns, whereas 42.9% were caused by flame. Most of the burn injuries occurred at home (93%). There were 31 burns from suicide attempts among children aged 11 to 15 years (1.4/100,000 PY), showing a major public health problem for these children in our society. During the period of the study, 131 children died of the consequences of burns (2/100,000 PY). The epidemiology of childhood burn injuries in the Fars province is similar to that reported in other economically developing countries. It is suggested that a public health education campaign on this issue would help to reduce the incidence of childhood burn injuries in this region.

PREVALENCE OF INTESTINAL PARASITES IN A POPULATION IN SOUTH OF TEHRAN, IRAN

The aim of this study was to describe epidemiologic characteristics of intestinal parasites in a population in south of Tehran, Iran. A retrospective cross-sectional study of patients with suspicious intestinal parasitic infections referred to the Zakaria Razi Laboratory in Shahre-Ray, southern Tehran, Iran, was conducted from April 21, 2004 to October 20, 2005. All stool samples were examined and socio-demographic informations were retrieved. Of 4,371 referred patients, 466 (239 males and 227 females) were laboratory diagnosed with intestinal parasites, with a period prevalence of 10.7%. Blastocystis hominis (B. hominis) and Giardia lamblia (G. lamblia) were the most frequent intestinal parasites. More than half of patients aged (3) 18 years had a low level of educational attainment (e.g. illiterate, primary school, high school) (170/331, 54.1%). Further, majority of patients were homemakers (42.3%, 140/331) or workers (28.1%, 93/331) employed in various business settings such as food industry and construction. Findings of this study showed that intestinal parasitic infections are still a major public health challenge in Iran that needs to be addressed. We believe that public education, improving sanitation conditions of underdeveloped areas/communities, community involvement, and supporting evidence-based practice/programs are the major keys to success in preventing the spread of intestinal parasitic infections in Iran.

Epidemiology of suicide by burns in the Province of Isfahan, Iran

The aim of the study was to determine epidemiologic features and factors associated with suicidal behaviors by burns requiring hospitalization in the province of Isfahan, Iran. A prospective population-based study of all suicidal behaviors by burns requiring hospitalization was conducted in the province of Isfahan, Iran, from March 21, 2005 to March 20, 2006. Data were obtained from patients, family members, and/or friends through interviews during the course of hospitalization. A total of 89 patients ages 13 to 62 years with suicidal behaviors by burns were identified during the study period, representing an overall incidence rate of 2.9 per 100,000 persons-year (P-Y; 95% confidence interval 2.3–3.5 per 100,000 P-Y). Females (4.7 per 100,000 P-Y) had a higher rate of suicidal behavior by burns than males (1.2 per 100,000 P-Y; P < .001). The age-specific rate of suicidal behavior by burns peaked at age group 20 to 29 years (6.3 per 100,000 P-Y). Among the population aged 15 to 29 years, married women had a higher rate of suicidal behavior by burns (9.3 per 100,000 P-Y) than single women (6.6 per 100,000 P-Y). The highest rate of suicidal behavior by burns was found among the unemployed population (17.7 per 100,000 P-Y). The most frequent precipitating factor for suicidal behavior was a quarrel with a family member, relative, and/or friend (61.8%). Depression and anxiety disorders were the most frequent psychiatric comorbidities associated with suicidal behaviors. Mortality rate caused by suicidal behavior by burns was 1.4 per 100,000 P-Y. A high rate of suicidal behavior among young and mostly married women in the province of Isfahan is a tragedy and great concern. Social, cultural, and economical factors may contribute to suicidal behavior in Isfahan, and they need to be addressed through education, support, and commitment. Findings of this study can be used for implementation of a preventive program(s) to reduce the incidence of suicide among high risk groups.

Nosocomial Infections in Burned Patients in Motahari Hospital, Tehran, Iran

Burn patients are at high risk of developing nosocomial infection because of their destroyed skin barrier and suppressed immune system, compounded by prolonged hospitalization and invasive therapeutic and diagnostic procedures. Studies on nosocomial infection in burn patients are not well described. The objective of the present study was to identify the causative bacterial of nosocomial infection and to determine the incidence of nosocomial infection and their changing during hospitalization in burned patients admitted to in the Motahari Hospital, Tehran, Iran. During the second part of 2010, 164 patients were included in this study. Samples were taken the first 48 hours and the fourth week after admission to Motahari Burn hospital. Isolation and identification of microorganisms was performed using the standard procedure. Of the 164 patients, 717 samples were taken and 812 bacteria were identified, 610 patients were culture positive on day 7 while 24 (17.2%) on 14 days after admission. The bacteria causing infections were 325 Pseudomonas, 140 Acinetobacter, 132 Staphylococcus aureus, and 215 others. The percentage of mortality was 12%. All of patients had at least 1 positive culture with Pseudomonas and/or with Acinetobacter. Hospitals suggest continuous observationof burn infections and increase strategies for antimicrobial resistance control and treatment of infectious complications.

Suicidal Behavior by Burns in the Province of Fars, Iran

BACKGROUND While suicide by burns is a relatively uncommon form of suicide in developed countries, it is one of the most common methods of suicide in the Middle East region including Iran. AIMS To describe epidemiologic characteristics of suicidal behaviors by burns in the province of Fars, Iran. METHODS A prospective population-based study of all suicidal behaviors by burns requiring hospitalization was conducted in the province of Fars, Iran, from March 21, 2005 to March 20, 2006. Data were obtained from patients, family members, and/or significant others through interviews during the course of hospitalization. RESULTS A total of 125 patients with suicidal behavior by burns requiring hospitalization were identified during the study period, representing an overall incidence rate of 4.3 per 100,000 (95% Confidence Interval [CI]: 3.6-5.1). Females (6.2 per 100,000) had a higher rate of suicidal behavior by burns than males (2.4 per 100,000; p < .001). The age-specific rate of suicidal behavior by burns peaked at age 20-29 years (10.1 per 100,000). The rate of suicidal behavior by burns was higher among single (7.2 per 100,000) vs. married persons (4.2 per 100,000; p = 0.03). Single males aged 20-39 years and young married women aged 15-29 years were at greatest risk of suicidal behavior by burns. The most common precipitating factor (74.4%) for suicidal behavior was a quarrel with a family member, a relative, and/or a friend. CONCLUSIONS The high rate of suicidal behavior by burns among young/married women in Fars is of concern. Social, cultural, and economic factors may contribute to suicidal behavior and need to be addressed through education, support, and commitment.