Legionellosis is the generic term used to describe infections caused by different varieties of Legionella spp., including Legionnaires’ disease (LD), a severe and potentially fatal form of pneumonia, and Pontiac fever, a self-limited flu-like illness. Legionellosis is usually acquired through inhalation or aspiration of aerosols containing Legionella spp. These bacteria can cause acute consolidating pneumonia in susceptible patients who are at an advanced age, have underlying debilitating diseases, or are immunodeficient. The main natural reservoir for Legionella is water and this pathogen colonizes many different natural and man-made freshwater environments such as water networks, cooling towers, and water systems in buildings and hospitals. In recent years, various laboratory diagnostic tests for Legionella infections have changed significantly. Although the sequencing method is nowadays considered the fastest and most reliable method for differentiation and detection of different Legionella species, the isolation of these bacteria from clinical specimens is the golden standard for diagnosis of Legionnaires’ disease. Today the urinary antigen test as the most rapid and inexpensive method is routinely used for diagnosis of LD caused by Legionella pneumophila serogroup 1. The macrolides and fluoroquinolones are still the mainstays for the treatment of Legionella infections. For the prevention of spreading the contaminated water aerosols and controlling Legionella infections, an effective water treatment procedure is necessary. This review describs and summarizes the latest available information about all aspects of Legionella and Legionnaires’ disease.

Objective: To determine the effect of rehabilitation education on pain, knee stiffness and performance difficulty in patients undergoing knee replacement surgery. Methods: This randomized clinical trial study was performed on 96 patients undergoing knee replacement surgery, who were randomly divided into two groups: the control group and the intervention group, with 48 patients in each group. In the intervention group, the patients received educational intervention in four stages (one day before surgery, 24 h and 48 h later, upon discharge from the hospital. In the control group, only the routine of the hospital was performed. Questionnaires were completed before and 6 weeks after the intervention. Results: The mean scores of pain, knee stiffness and performance difficulty were significantly decreased in the intervention group (P=0.01). Compared to the control group, the intervention group had a better outcome of the illness, including pain, knee stiffness and performance difficulty (P=0.001). Conclusion: Rehabilitation education could be a suitable way to improve the surgical outcomes of patients undergoing total knee replacement.

Objective: To assess the preparedness for handling injuries by female primary school teachers based on their knowledge, attitude, practice and their willingness to learn first aid. Methods: A cross-sectional questionnaire on first aid was provided to female primary school teachers, and the knowledge, attitude, practice and their willingness to learn first aid were investigated. Data were analyzed using SPSS version 23. Quantitative data were analyzed by one-way ANOVA, categorical variables were analyzed by the Chi-square test. The level of significance was set at P<0.05. Results: In total, 464 teachers of different age groups and education responded. The mean knowledge score was low but the mean attitude score was high. Parental consent was sought by one-fourth of the teachers, and 25.6% of teachers documented the health status of children. Most of the teachers desired to have a first aider, and they were keen on training (62.3%) and educating children (88.1%) on first aid. Knowledge scores were significantly impacted by age (P<0.05) and experience (P<0.01), while specialization impacted mean practice scores (P<0.001). Teachers’ qualification (P<0.05), first action to be taken at the accident site (P<0.05), and frequency of training (P<0.05), were significantly associated with the need of a first aider. Conclusions: Based on the paucity of awareness and expertise, on priority basis, it is important to strengthen teachers’ skills. Child safety is an important public health issue and can be improved by educating and training teachers.

Objective: To determine the prevalence of the recurrent stroke and its risk factors in the city of Ahvaz, Iran. Methods: The present study investigated the medical records of 389 ischemic stroke patients admitted to the Department of Neurology, Ahvaz Hospitals from March 2015 to January 2016. Patients’ information was collected. Patients who suffered recurrent stroke but survived were followed up for at least 12 months after the first attack, and their medical records were collected. Results: The incidence rate of recurrent stroke was 14.91% (n=58). There was a significant relationship between the incidence rate of recurrent ischemic stroke with atrial fibrillation (OR=2.012, P<0.05) and ischemic heart disease (OR=1.695, P<0.05). However, there was no significant relationship between recurrent stroke and age, sex, dyslipidemia, diabetes, hypertension, and cigarette smoking (P>0.05). Conclusions: Patients with a history of atrial fibrillation and ischemic heart disease were at a higher risk of recurrent ischemic stroke. The incidence can be reduced by better treatment of atrial fibrillation and active follow-up.

Objective: To study the prevalence of HHV-8 infection in patients undergoing hemodialysis. Methods: In this study, blood samples of 89 patients undergoing hemodialysis were collected. DNA was extracted from peripheral blood mononuclear cells and HHV-8 DNA was evaluated by nested-PCR. Results: Of total 89 patients, 51 (57.3%) were males and 38 (42.7%) were females. The patients’ age ranged from 24 to 90 years and the mean age was (57.5±1.4) years. HHV-8 DNA was found in 9 of 89 (10.1%) peripheral blood mononuclear cell samples, 8/51 (15.7%) in males and 1/38 (2.6%) in females (P=0.07). All patients who were positive for HHV8-DNA were more than 50 years old. Conclusions: This study shows high prevalence of HHV-8. Since hemodialysis patients are candidates for kidney transplantation and due to the possibility of HHV8-reactivation and its serious complications in immunocompromised patients, routine screening for detection of the virus should be implemented for all hemodialysis patients.

Objective: To identify the biodiversity of Nocardia species isolated from the environments of Tehran hospitals via phenotypic and PCR molecular methods. Methods: A total of 236 samples were collected from the transplantation and cancer centers of five Tehran hospitals, and the presence of Nocardia was identified by using standard protocols. Conventional tests were used for preliminary identification, and PCR amplification of the 598 bp amplicon of the 16S rRNA and sequence analysis of 16S rRNA were performed for genus and species identification. Results: From the 236 soil samples, 16 samples were identified as positive based on the culture tests, while 8 samples showed positive results based on the molecular method. The phylogenetic tree showed that the most frequent genus of Nocardia was related to Nocardia cyriacigeorgica. Conclusion: The hospital environment is a potential reservoir of a diverse range of Nocardia species. Due to the strong capability of survival, these bacteria bring a threat to the health of patients. Its identification can help physicians to implement treatments and is important for healthcare centers.

Objective: To investigate the prevalence of snakebites and associated epidemiologic factors in Khorram-shahr County, Iran, between 2013 and 2017. Methods: This was a cross-sectional descriptive-analytical study. Information was collected and recorded via questionnaires. Snakebite data included gender, age, occurrence regions, bite site, time of being bitten, month and season. Data were analyzed by Chi-square and t-tests with SPSS version 18. Results: A total of 102 cases of snakebites occurred in Khorram-shahr County of Khuzestan Province, southwestern Iran. There were 75 men (73.5%) and 27 women (26.4%), without significant difference in incidence. The highest frequency of snakebites was observed in the age group of 41-50 years with 28 cases (27.4%). In total, 58 cases (56.9%) occurred in urban areas and 44 cases (43.1%) in rural areas. No statistically significant difference was observed between the age groups or residential areas. Snakebites occurred in May with 19 cases (18.6%), spring with 45 (44.1%) and summer with 45 (44.1%). The results showed significant difference among different seasons and months of the year. Snakebites were in feet in 62 cases (60.8%) and hands in 36 cases (35.3%) which were bitten more than other organs, respectively, with significant difference among different bite sites in the body. The highest and lowest frequencies of snakebites were observed between 18:00 and 24:00 with 43 cases (42.2%) and between 6:00 and 12:00 with 14 cases (13.7%), with a significant difference among different hours of the day. Conclusions: Useful information about snakebites, venomous snakes, their hazards, prevention of bites and the importance of early hospital referral and treatment of victims should be provided to people using different educational tools.

Objectives: To investigate the epidemiology of animal bites and associated factors in Abadeh district (central Iran) from 2012 to 2018. Methods: In this cross-sectional study, 1 407 individuals with animal bites who were referred to the Abadeh Rabies Treatment Center were investigated by using the census method from 2012 to 2018. The variables included the victim’s demographic information (age, gender, occupation), the type of biting animals (dog, cat, and other animals), the domesticated and wild animals, the time of biting based on year and month, the residence location (urban or rural), the treatment status, and the anatomical location of the wounds. Results: The annual incidence rate of animal bites was 189.62 per 100 000 population. Totally 83.4% of the victims were male. The average age was (33.66±18.97) years and individuals in the age range of 36-50 years were greater at risk. Most of the animal bites were from dogs (77.8%). About two thirds (62.1%) of the bites were from household animals. A total of 57.1% of individuals lived in urban areas. Most victims were engaged in farming and animal husbandry. The highest prevalence of animal bites (37.4%) happened in the summer. None of the patients had any clinical signs of rabies. Conclusions: To reduce the incidence of animal bites, high-risk groups including farmers and ranchers should be educated about bite prevention, and it should be ensured that they are managed correctly.