A retrospective analysis was conducted of human cases and outbreaks of tularemia in the Republic of Armenia from 1996 to 2012 utilizing geographic information system software. A total of 266 human cases of tularemia were recorded in Armenia from 1996 to 2012, with yearly incidence ranging from 0 to 5.5 cases per 100,000 people. Cases predominantly affected the male population (62.8%), 11-20 year age group (37.2%), agricultural workers (49.6%), and persons residing in rural areas (93.6%). In 2003, a waterborne outbreak involving 158 cases occurred in Kotayk Marz, and in 2007, a foodborne outbreak with 17 cases occurred in Gegharkunik Marz, attributed to exposure of food products to contaminated hay. Geospatial analysis of all cases showed that the majority were associated with the steppe vegetation zone, elevations between 1,400 and 2,300 m, and the climate zone associated with dry, warm summers, and cold winters. Characterization of these environmental factors were used to develop a predictive risk model to improve surveillance and outbreak response for tularemia in Armenia.
Introduction: We aimed to investigate the prevalence of liver involvement in pediatric patients with ARI using both routine tests of hepatic panel, and ornithine carbamoyltransferase (OCT) to identify the most sensitive indicators of early hepatic injury. Methodology: A prospective cohort study of 84 armenian children with ARI was conducted to evaluate the associated liver involvement. The diagnostic variables of interest were the signs of clinical disease severity, and enzymatic profile of the patients. Results: Serum levels of OCT were increased in 94% of patients versus routine tests of hepatic panel (AST in 41.7%, ALT in 15.5%, etc). Variance analysis by severity groups showed the serum levels of OCT (p < 0.001), ammonia (p < 0.001), phospholipides (p = 0.05), glucose (p = 0.01), TNF-α (p = 0.01), IL-8 (p < 0.001), AST (p < 0.001), and ALP (p < 0.001) were associated with the severity of underlying disease. Moreover, regression analysis revealed the serum activity of OCT (p value < 0.001, OR = 1.27) and ammonia (p value 0.002, OR = 1.1) significantly predict the severity of the disease. Conclusions: Using more sensitive marker of liver damage can detect more cases of ARI with hepatic manifestations. For evaluation of the liver involvement we are suggesting the testing of serum OCT levels as a more sensitive and specific marker. Pediatric patients with ARI and with higher serum OCT levels have 27% more chance to experience increased disease severity, which can affect on liver state and prolong hospitalization time and cost.
ObjectiveIn the spring of 2014, people from vulnerable households in all marzes of Armenia were examined with the aim of active surveillance. IntroductionBrucellosis is a serious disease caused by bacteria of the Brucella genus. It principally affects ruminants but may be transmitted to humans. Registration of cases in cattle farms causes considerable economic losses and creates favorable conditions for mass infection among humans. In Armenia the expansion of animal industries and urbanization are the main reasons for occurrence and development of brucellosis. MethodsBlood was sampled from people on farms reported as having infected animals. Blood samples were tested by the WrightHuddleston method. The standard case definition of brucellosis was used for diagnosis. A questionnaire-based interview was carried out among the population to identify the form of contact with animals and to analyze epidemiological links. During the investigation provisions were followed in governmental decree RA 19.01.2006 N480-N and brucellosis prevention, epidemiology, diagnosis, treatment, preventive measures. ResultsA total of 11160 people from 1054 households were enrolled in the study, of which 3625 (32.5%) underwent a laboratory examination. Nearly 6% (641) refused to be tested. Over 6% of those tested (226) were positive for antibodies to Brucellae. Of these, 129 (3.5%) had chronic brucellosis. Those testing positive for brucellosis were treated appropriately. These included 203 (90%) adults and 23 (10%) below 14 years old; 147 (65%) were male and 79 (35%) were female. Of those diagnosed with brucellosis, working in animal husbandry accounted for 46.6% (106), while those who harvested milk accounted for 37.6% (85) and those using raw milk made up 15.4% (35). ConclusionsCases were most frequently reported among people 20-55 years of age; the highest percentage of positives were among 41-45 year old males who had contact with infected animals. The main risk factor for acquiring brucellosis is animal husbandry.
Trends to improve international quality standards for medical education dictate the need for the proper application of methods for coordinating the results of the development of educational programs.The introduction of methodological approaches for coordinating the results of mastering educational programs, as well as the founding of two medical simulation training centers and their functional integration into the educational system of the Yerevan State Medical University after M. Heratsi served as a serious help for improving the quality of educational services.
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