RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: In traditional Persian medicine (TPM), people often use herbal infusions as a dosage form to treat diseases related to hyperglycemia, known as 'dam-kardeh'. Traditionally, herbal preparations of Eryngium bungei Boiss. (E. b), Tragopogon buphthalmoides (DC.) Boiss. (T. b), Salvia hydrangea DC. ex Benth. (S. h), and Juniperus polycarpos K. Koch. (J. p) are used to manage diabetes in Iran. However, there is no evidence of their effectiveness in controlling glucose levels and their mechanisms remain unclear. AIM OF THE STUDY: This study aimed to investigate whether traditional doses of plant infusions can have hypoglycemic and/or anti-hyperglycemic effects during fasting and/or postprandial states and establish the basis for future research on their potential mechanisms of action. MATERIALS AND METHODS: The effects of traditional doses of herbal extracts on blood glucose levels in STZ-NA-induced hyperglycemic rats were investigated in 2-h acute tests during fasting and postprandial states (with a glucose load). In addition, the potential inhibitory effect in vitro of enzymes involved in relevant pathways, such as gluconeogenesis (fructose-1,6-bisphosphatase, FBPase and glucose-6-phosphatase, G6Pase), carbohydrate breakdown (intestinal α-glucosidases), and insulin sensitivity (protein tyrosine phosphatase 1B, PTP-1B) was evaluated. Acute toxicity tests were carried out and HPLC-SQ-TOF was used to analyze the chemical profiles of the plant extracts. RESULTS: In the fasting state, T. b, S. h, and E. b were as effective as glibenclamide in lowering blood glucose levels in hyperglycemic rats. Moreover, all three suppressed G6Pase and FBPase enzymatic activity by 90-97% and 80-91%, respectively. On the other hand, significant postprandial hypoglycemic efficacy was observed for E. b, S. h, and T. b. Based on the AUC values, T. b caused a reduction comparable to the therapeutic efficacy of repaglinide. When investigating the possible mechanisms of action involved in this activity, E. b, S. h, and T. b showed significant inhibition of PTP-1B in vitro (>70%). Finally, all plant extracts showed no signs of acute toxicity. Several compounds that may contribute to biological activities were identified, including phenolic acids and flavonoid glycosides. CONCLUSIONS: The present study supports the traditional use of T. b, E. b and S. h for the control of diabetes in the fasting and postprandial state. Moreover, these plants were found to be rich in bioactive compounds with hypoglycemic and antihyperglycemic activities. On the other hand, J. p, showed a modest effect only in the fasting state and after 90 min. Further studies are needed to expand these results by analyzing the chemical composition and using complementary experimental models.

Asunto(s)

Glucemia , Diabetes Mellitus Experimental , Ayuno , Hipoglucemiantes , Extractos Vegetales , Periodo Posprandial , Animales , Hipoglucemiantes/farmacología , Extractos Vegetales/farmacología , Extractos Vegetales/administración & dosificación , Extractos Vegetales/química , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Diabetes Mellitus Experimental/tratamiento farmacológico , Diabetes Mellitus Experimental/sangre , Masculino , Irán , Ratas , Medicina Persa , Ratas Wistar , Hiperglucemia/tratamiento farmacológico , Plantas Medicinales/química , Estreptozocina , Juniperus/química

RESUMEN

Purpose: In children under 20 years, refractive development targets a cycloplegic refractive error of +0.5 to +1.5D, while presbyopes over 40 years generally have non-cycloplegic errors of ≥ +1D. Some papers suggest these periods are separated by a period of myopic refractive error (i.e., ≤ –0.50D), but this remains unclear. Hence, this work investigates the mean cycloplegic refractive error in adults aged between 20 – 40 years. Methods: In 2002 a cross-sectional study with stratified cluster sampling was performed on the population of Tehran, providing cycloplegic and non-cycloplegic refractive error data for the right eyes of 3,576 participants, aged 30.6 ± 18.6 years (range: 1–86 years). After grouping these data into age groups of 5 years, the refractive error histogram of each group was fitted to a Bigaussian function. The mean of the central, emmetropized peak was used to estimate the mean refractive error without the influence of myopia. Results: The mean cycloplegic refractive error at the emmetropized peak decreased from +1.10 ± 0.11D (95 % confidence interval) to +0.50 ± 0.04D before 20 years and remains stable at that value until the age of 50 years. The non-cycloplegic refractive error also sees a stable phase at 0.00 ± 0.04D between 15 – 45 years. After 45 – 50 years both cycloplegic and non-cycloplegic refractive error become more hypermetropic over time, +1.14 ± 0.12D at 75 years. Conclusions: The cycloplegic refractive error in adults is about +0.50D between 20 – 50 years, disproving the existence of the myopic period at those ages.(AU)

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Visión Ocular , Pruebas de Visión , Errores de Refracción , Emetropía , Estudios Transversales , Irán

RESUMEN

INTRODUCTION: It is well known that peripheral artery disease (PAD) and coronary artery disease (CAD) coexist and therefore, patients diagnosed with PAD have an increased chance of developing concomitant CAD. CAD-related complications could be a leading cause of postoperative mortality in individuals with PAD undergoing vascular surgery. We present a case series of 48 patients who underwent coronary angiography before vascular surgery and an updated review of previous reports to determine the prevalence of concomitant CAD in a convenience sample of Iranian patients. METHODS: This cross-sectional study was performed on 48 patients with confirmed PAD admitted to Imam Ali Hospital, affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. A vascular surgeon diagnosed PAD based on the patient's symptoms, Doppler ultrasound, and CT angiography (CTA). All patients underwent coronary angiography to determine if they also had CAD. We defined significant CAD as a ≥70% luminal diameter narrowing of a major epicardial artery or a ≥50% narrowing of the left main coronary artery. RESULTS: Of 48 patients, 35 (72.9%) were male, 13 (27.1%) were female, and the mean age was 64.18±12.11 years (range, 30 to 100 years). The incidence of CAD in patients with PVD was 85.42% (41/48). The patients with CAD were more likely to be hypertensive than those without CAD (80.5 vs. 14.3, p-value<0.001). Of 41 patients with CAD, 9 (22.0%) had one-vessel disease, 10 (24.3%) had two-vessel disease, and 22 (53.7%) had three-vessel disease. CONCLUSION: Hypertension was a significant risk factor for CAD. Patients with hypertension and multiple major coronary risk factors scheduled for PVD surgery should be carefully evaluated for concomitant CAD.

Asunto(s)

Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Enfermedad Arterial Periférica , Humanos , Masculino , Femenino , Irán/epidemiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/epidemiología , Estudios Transversales , Prevalencia , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/complicaciones , Factores de Riesgo , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años

RESUMEN

Subtilase exhibits strong cytotoxicity that was first described in O113:H21 strain in Australia as a plasmid- encoded cytotoxin (subAB1). Subsequently, chromosomal variants including subAB2-1, subAB2-2, and subAB2-3 were described. We aimed to investigate the presence of subAB genes in a collection of Shiga toxin-producing Escherichia coli (STEC) strains (n=101) isolated from different sources in Iran. A collection of 101 archived STEC strains isolated from cattle (n=50), goats (n=25), sheep (n=15), wild captive animals (n=8: persian fallow deer, n=3; caspian pony, n=1; Macaca mulatta, n=4), and humans (n=3) during 2007-2016 were analyzed for the detection of different genes encoding the Subtilase variants, plasmidic and chromosomal virulence genes, phylogroups and serogroups. Overall, 57 isolates (56.4%) carried at least one variant of subAB. Most strains from small ruminants including 93% of sheep and 96% of caprine isolates carried at least one chromosomally encoded variant (subAB-2-1 and/or subAb2-2). In contrast, 12 cattle isolates (24%) only harbored the plasmid encoded variant (subAB1). STEC strains from other sources, including deer, pony and humans were positive for subAB-2-1 and/or subAb2-2. Our results reveal the presence of potentially pathogenic genotypes among locus of enterocyte effacement (LEE)-negative isolates, and some host specificity related to Subtilase variants and other virulence markers that may aid in source tracking of STEC during outbreak investigations.

Asunto(s)

Proteínas de Escherichia coli , Escherichia coli Shiga-Toxigénica , Subtilisinas , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Animales , Irán/epidemiología , Proteínas de Escherichia coli/genética , Subtilisinas/genética , Ovinos/microbiología , Humanos , Bovinos

RESUMEN

BACKGROUND: Cystic fibrosis (CF), an inherited autosomal recessive disorder, is linked with high morbidity and mortality rates due to bacteria, filamentous, yeast and black yeast-like fungi colonisation in the upper respiratory tract. Although Candida species are the most common fungi isolated from CF patients, azole-resistant Aspergillus fumigatus (ARAf) is a big concern for invasive aspergillosis. Notably, the exact prevalences of Aspergillus species and the prevalence of ARAf isolates among Iranian CF patients have yet to be previously reported and are unknown. We aimed to investigate the prevalence of ARAf isolates in CF patients among Iranian populations by focusing on molecular mechanisms of the mutations in the target gene. METHODS: The 1 year prospective study recovered 120 sputum samples from 103 CF patients. Of these, 55.1% (86/156) yielded Aspergillus species, screened for ARAf using plates containing itraconazole (4 mg/L) and voriconazole (1 mg/L). According to the CLSI-M38 guidelines, antifungal susceptibility testing was performed using the broth microdilution method. In all phenotypically resistant isolates, the target of azole agents, the cyp51A gene, was sequenced to detect any possible single nucleotide polymorphisms (SNP) mediating resistance. RESULTS: Of 120 samples, 101 (84.2%) were positive for filamentous fungi and yeast-like relatives, with 156 fungal isolates. The most common colonising fungi were Aspergillus species (55.1%, 86/156), followed by Candida species (39.8%, 62/156), Exophiala species (3.8%, 6/156) and Scedosporium species (1.3%, 2/156). Forty out of 86 (46.5%) were identified for section Fumigati, 36 (41.9%) for section Flavi, 6 (7%) for section Nigri and 4 (4.6%) for section Terrei. Fourteen out of 40 A. fumigatus isolates were phenotypically resistant. The overall proportion of ARAf in total fungal isolates was 9% (14/156). cyp51A gene analysis in resistant isolates revealed that 13 isolates harboured G448S, G432C, T289F, D255E, M220I, M172V, G138C, G54E and F46Y mutations and one isolate carried G448S, G432C, T289F, D255E, M220I, G138C, G54E and F46Y mutations. Additionally, this study detects two novel cyp51A single-nucleotide polymorphisms (I242V and D490E). CONCLUSIONS: This study first investigated ARAf isolates in Iranian CF patients. Due to a resistance rate of up to 9%, it is recommended that susceptibility testing of Aspergillus isolates from CF patients receiving antifungal treatment be a part of the routine diagnostic workup. However, extensive multicentre studies with a high volume of CF patients are highly warranted to determine the impact of ARAf on CF patients.

Asunto(s)

Antifúngicos , Aspergillus fumigatus , Azoles , Fibrosis Quística , Sistema Enzimático del Citocromo P-450 , Farmacorresistencia Fúngica , Proteínas Fúngicas , Pruebas de Sensibilidad Microbiana , Humanos , Fibrosis Quística/microbiología , Fibrosis Quística/complicaciones , Irán/epidemiología , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/genética , Aspergillus fumigatus/aislamiento & purificación , Farmacorresistencia Fúngica/genética , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Estudios Prospectivos , Prevalencia , Sistema Enzimático del Citocromo P-450/genética , Azoles/farmacología , Azoles/uso terapéutico , Proteínas Fúngicas/genética , Masculino , Femenino , Aspergilosis/microbiología , Aspergilosis/epidemiología , Aspergilosis/tratamiento farmacológico , Adulto , Niño , Adolescente , Polimorfismo de Nucleótido Simple , Adulto Joven , Esputo/microbiología , Itraconazol/farmacología , Voriconazol/farmacología , Voriconazol/uso terapéutico , Preescolar , Mutación

RESUMEN

Excessive internet usage can precipitate internet addiction (IA), negatively impacting lifestyle behaviors, especially during adolescence. These warrants investigating associations between IA and lifestyle factors. To examine the relationship between IA and health-promoting lifestyle dimensions among Iranian high school students. A cross-sectional study was conducted among 407 students from Sanandaj, Iran selected via cluster sampling. IA was assessed using the Young IA Test. Lifestyle was measured via the Health-Promoting Lifestyle Profile questionnaire. Regression analyses evaluated associations while adjusting for covariates. Approximately 25% of participants were at risk of internet addiction. Prevalence variations across groups lacked significance. Non-addicted students had significantly higher overall healthy lifestyle scores (p<0.05). Spiritual growth, health responsibility and nutrition scores significantly differed between addicted and non-addicted students. Regression analyses revealed a statistically significant negative correlation between IA and lifestyle even after adjustment (p<0.001). Nutrition and physical activity scores particularly declined for those at risk of addiction. IA was significantly associated with unhealthy dietary habits, sedentary behavior, and a lower healthy lifestyle. It may also hinder stress management and spiritual well-being. With rising internet integration, collaborative awareness programs between educational institutions, families, and communities are warranted to curb addiction risks and promote healthy lifestyles in youth. This study provides valuable insights, though longitudinal research is needed to establish causality.

Asunto(s)

Trastorno de Adicción a Internet , Estilo de Vida , Estudiantes , Humanos , Irán/epidemiología , Masculino , Femenino , Adolescente , Estudios Transversales , Estudiantes/psicología , Trastorno de Adicción a Internet/epidemiología , Trastorno de Adicción a Internet/psicología , Encuestas y Cuestionarios , Ejercicio Físico , Conducta Adictiva/epidemiología , Conducta Adictiva/psicología , Internet

RESUMEN

INTRODUCTION: HIV drug resistance (HIVDR) is an important challenge in the fight against HIV/AIDS and can threaten progress toward achieving the target of HIV elimination by 2030. Genotyping pretreatment HIVDR testing (DRT) has been proposed as a potential solution. However, the cost-effectiveness of this intervention needs to be evaluated to determine its feasibility and potential impact on healthcare systems. This study aimed to assess the cost-effectiveness of DRT among people living with HIV (PLHIV) in Iran. METHODS: 1000 hypothetical PLHIV were simulated in terms of cost and effectiveness based on quality-adjusted life Years (QALY). The Markov Model was developed to calculate incremental cost-effectiveness ratio (ICER) using TreeAge Pro 2020. Deterministic and probabilistic analyses were performed for sensitivity analyses. RESULTS: Results showed that compared to not performing pretreatment HIVDR testing, this intervention gained 0.035999 QALY with an incremental cost of 1,695.32 USD. The ICER was calculated as 47,093.53 USD, indicating that pretreatment DRT was not cost-effective. The probability of opportunistic infection (OI) in people with viral failure, the effectiveness of Dolutegravir in people without drug resistance, and the quality of life (QoL) of people in the AIDS stage were found to be the most important variables affecting ICER. With an increasing willingness to pay more than 53,000 USD, pretreatment DRT testing will become cost-effective. CONCLUSION: Based on our findings, pretreatment HIVDR testing is not currently cost-effective in Iran as it imposes high costs on healthcare systems with few benefits for People living with HIV (PLHIV). However, if resources are available, drug resistance testing can be a valuable tool in generating HIV molecular data and molecular surveillance of HIV.

Asunto(s)

Análisis Costo-Beneficio , Farmacorresistencia Viral , Infecciones por VIH , Años de Vida Ajustados por Calidad de Vida , Humanos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Infecciones por VIH/economía , Farmacorresistencia Viral/genética , Irán/epidemiología , Masculino , Femenino , Cadenas de Markov , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/economía , VIH-1/efectos de los fármacos , VIH-1/genética , Calidad de Vida , Adulto

RESUMEN

BACKGROUND: Parents of neonates with life-threatening conditions and professionals, bear the burden of making complex decisions. Parents may not be fully involved in decision-making, and there is a paucity of evidence regarding the influence of social context on parents' participation. We aimed to explore factors that extended beyond the healthcare system and impacted parents' participation in decision-making for neonates with life-threatening conditions. MATERIALS AND METHODS: This qualitative research was carried out in 2019 in four level-III Iranian NICUs, (neonatal intensive care units) where twenty-three face-to-face semi-structured interviews were conducted, transcribed, and analyzed using a conventional content analysis technique. Interviews were condensed into meaningful units during the coding phase, resulting in 206 open codes. These codes were then categorized into eleven categories based on commonalities and distinctions. This iterative process continued until 4 main subcategories were established. RESULTS: The main categories and sub-categories were "unmodified regulations according to the neonatology advances" (lack of regulations to modify ineffective treatments, lack of a legally documented do not resuscitate order, lack of a defined regional neonatal viability threshold, and lack of maternal guardianship of child medical care), "deficiencies of the health insurance system" (covering the cost of ineffective treatments and lack of insurance covering for palliative care services), "treatment-oriented culture in society" (expecting a miracle for medical science, difficult acceptance of neonatal death and difficult acceptance of home death), and "physician-oriented culture in society" (excessive respect for physicians' decision-making eligibility and social position of physicians). CONCLUSION: The findings revealed concepts surrounding parents' participation in decision-making for life-threatening conditions neonates are influenced by social, legal, cultural, and financial aspects. To bridge the gap between healthcare professionals' attitudes and cultural and religious beliefs, fatwas, and laws, a collaborative approach is necessary. To address the complex challenges of decision-making for these neonates, involving stakeholders like clinicians, legal experts, Islamic scholars, sociologists, jurists, judges, and medical ethicists is crucial for modifying laws to align with neonatology advancements.

Asunto(s)

Toma de Decisiones , Unidades de Cuidado Intensivo Neonatal , Padres , Humanos , Recién Nacido , Padres/psicología , Femenino , Masculino , Adulto , Irán , Investigación Cualitativa , Atención a la Salud

RESUMEN

Oil spills from pipeline accidents can have long-lasting health effects on residents of polluted regions. Assessing the potential health risk of these accidents is crucial for effective environmental health management. This study analyzed the concentration of 2-OHNAP in urine and hair as biomarkers of PAHs exposure among the people living in a region with frequent oil pipeline incident in Iran. Fifty pairs of hair and urine samples were collected from residents along with demographic information and dietary habits via a questionnaire. The concentration of 2-OHNAP was analyzed using high performance liquid chromatography coupled with fluorescence detector (HPLC-FLD). 2-OHNAP was detected in 100% of urine and 88% of hair samples. The mean concentration of 2-OHNAP in urine was 16.65 ± 21.98 µg/g creatinine and in hair was 8.16±7.62 ng/g dry weight (dw). However, there was no significant correlations between the levels of 2-OHNAP in urine and hair. The mean values of HQ and CR were below 1 and 10-6, respectively. Moreover, some simulated health risk indices were near the threshold levels, and the carcinogenic risk above 70% of the simulated CRs was above 10-6 as well. Therefore, the health risk attributed to the exposure to the parent compound of 2-OHNAP in the study area is currently acceptable, but it is not negligible and may be worsened in the future. This study provides a valuable scientific information for regional decision makers and stakeholders about human health programs and identification of environmental health priorities.

Asunto(s)

Cabello , Humanos , Irán/epidemiología , Cabello/química , Medición de Riesgo , Masculino , Femenino , Adulto , Contaminación por Petróleo/análisis , Exposición a Riesgos Ambientales/análisis , Persona de Mediana Edad , Biomarcadores/orina , Biomarcadores/análisis , Naftalenos/análisis , Naftalenos/orina , Monitoreo del Ambiente , Cromatografía Líquida de Alta Presión

RESUMEN

The declining fertility rate and increasing marriage age among girls pose challenges for policymakers, leading to issues such as population decline, higher social and economic costs, and reduced labor productivity. Using machine learning (ML) techniques to predict the desire to have children can offer a promising solution to address these challenges. Therefore, this study aimed to predict the childbearing tendency in women on the verge of marriage using ML techniques. Data from 252 participants (203 expressing a "desire to have children" and 49 indicating "reluctance to have children") in Abadan, and Khorramshahr cities (Khuzestan Province, Iran) was analyzed. Seven ML algorithms, including multilayer perceptron (MLP), support vector machine (SVM), logistic regression (LR), random forest (RF), J48 decision tree, Naive Bayes (NB), and K-nearest neighbors (KNN), were employed. The performance of these algorithms was assessed using metrics derived from the confusion matrix. The RF algorithm showed superior performance, with the highest sensitivity (99.5%), specificity (95.6%), and receiver operating characteristic curve (90.1%) values. Meanwhile, MLP emerged as the top-performing algorithm, showcasing the best overall performance in accuracy (77.75%) and precision (81.8%) compared to other algorithms. Factors such as age of marriage, place of residence, and strength of the family center with the birth of a child were the most effective predictors of a woman's desire to have children. Conversely, the number of daughters, the wife's ethnicity, and the spouse's ownership of assets such as cars and houses were among the least important factors in predicting this desire. ML algorithms exhibit excellent predictive capabilities for childbearing tendencies in women on the verge of marriage, highlighting their remarkable effectiveness. This capacity to offer accurate prognoses holds significant promise for advancing research in this field.

Asunto(s)

Aprendizaje Automático , Matrimonio , Humanos , Femenino , Adulto , Irán , Algoritmos , Máquina de Vectores de Soporte , Adulto Joven , Conducta Reproductiva

RESUMEN

BACKGROUND: Late-onset multiple sclerosis (LOMS), defined as the development of MS after the age of 50, has shown a substantial surge in incidence rates and is associated with more rapid progression of disability. Besides, studies have linked tobacco smoking to a higher chance of MS progression. However, the role of smoking on the risk of developing LOMS remains unclear. This study aims to evaluate the possible association between lifetime exposure to cigarette and waterpipe smoking, drug abuse, and alcohol consumption and the risk of LOMS. METHODS: This population-based case-control study involved LOMS cases and healthy sex and age-matched controls from the general population in Tehran, Iran. The primary data for confirmed LOMS cases were obtained from the nationwide MS registry of Iran (NMSRI), while supplementary data were collected through telephone and on-site interviews. Predesigned questionnaire for multinational case-control studies of MS environmental risk factors was used to evaluate the LOMS risk factors. The study employed Likelihood ratio chi-square test to compare qualitative variables between the two groups and utilized two independent sample t-test to compare quantitative data. Adjusted odds ratio (AOR) for age along with 95% confidence intervals (CI) were calculated using matched logistic regression analysis in SPSS 23. RESULTS: Totally, 83 LOMS cases and 207 controls were included in the analysis. The female to male ratio in the cases was 1.5: 1. The mean ± SD age of 83 cases and 207 controls was 61.14 ± 5.38) and 61.51 ± 7.67 years, respectively. The mean ± SD expanded disability status scale (EDSS) score was 3.68 ± 2.1. Although the results of waterpipe exposure had no significant effect on LOMS development (P-value: 0.066), ever cigarette-smoked participants had a significantly higher risk of developing LOMS than those who never smoked (AOR: 2.57, 95% CI: 1.44-4.60). Furthermore, people with a history of smoking for more than 20 years had 3.45 times the odds of developing MS than non-smokers. Drug and alcohol abuse were both associated with LOMS in our study; of which opioids (AOR: 5.67, 95% CI: 2.05-15.7), wine (AOR: 3.30, 95% CI: 1.41-7.71), and beer (AOR: 3.12, 95% CI: 1.45-6.69) were found to pose the greatest risk of LOMS, respectively. CONCLUSION: For the first time, we identified smoking, drug, and alcohol use as potential risk factors for LOMS development. According to the global increase in cigarette smoking and alcohol use, these findings highlight the importance of conducting interventional approaches for prevention.

Asunto(s)

Esclerosis Múltiple , Trastornos Relacionados con Sustancias , Humanos , Masculino , Femenino , Estudios de Casos y Controles , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/epidemiología , Irán/epidemiología , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/etiología , Edad de Inicio , Factores de Riesgo , Fumar/epidemiología , Fumar/efectos adversos , Anciano , Adulto

RESUMEN

BACKGROUNDS AND OBJECTIVE: Statins, inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase, are pivotal in managing hypercholesterolemia and reducing cardiovascular risk. While rosuvastatin demonstrates superior efficacy and tolerability compared to other statins, its safety profile in elderly patients older than 75 years old with acute coronary syndrome (ACS) remains underexplored. So, the objective of this study is to evaluate the frequency of adverse reactions and investigate the efficacy of high-dose rosuvastatin on lipid profiles in elderly patients aged over 75 with ACS. METHODS: In this observational study, 110 consecutive elderly ACS patients attending Modarres Hospital in Tehran, Iran, in 2019 were enrolled. The effects of high-dose rosuvastatin were assessed in elderly patients older than 75 years old by comparison of the adverse effects, lipid profile, cardiac function, and other biomarkers at the baseline and after 6 weeks of rosuvastatin therapy with a dose of 40 mg. RESULTS: Following 6 weeks of treatment, there was a significant reduction in total cholesterol (136.2 ± 24.3 to 115.5 ± 24.0, p = 0.001) and LDL levels (72.6 ± 17.5 to 50.9 ± 18.9, p = 0.001), accompanied by a notable increase in HDL levels (38.3 ± 7.1 to 47.2 ± 7.4, p = 0.001). Cardiac function, as measured by ejection fraction (EF), significantly improved from 43.4 ± 8.8 to 48.5 ± 8.5 (p = 0.001). Adverse effects such as cramps (N = 12, p = 0.001), weakness (N = 28, p = 0.001), and anorexia (N = 12, p = 0.001) were reported but did not warrant discontinuation of therapy. Notably, no cases of jaundice were observed. Two deaths occurred due to major adverse cardiac events (MACE) during the study period, unrelated to stroke or recurrent myocardial infarction. CONCLUSION: Totally, high-dose rosuvastatin therapy effectively improved lipid profiles, cardiac function, and liver enzyme levels in elderly ACS patients, with manageable adverse effects. These findings underscore the importance of rosuvastatin in optimizing cardiovascular health in this vulnerable population.

Asunto(s)

Síndrome Coronario Agudo , Biomarcadores , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Rosuvastatina Cálcica , Humanos , Rosuvastatina Cálcica/efectos adversos , Rosuvastatina Cálcica/administración & dosificación , Rosuvastatina Cálcica/uso terapéutico , Síndrome Coronario Agudo/tratamiento farmacológico , Síndrome Coronario Agudo/sangre , Síndrome Coronario Agudo/diagnóstico , Anciano , Masculino , Femenino , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/administración & dosificación , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Resultado del Tratamiento , Anciano de 80 o más Años , Irán , Biomarcadores/sangre , Factores de Tiempo , Factores de Edad , Dislipidemias/tratamiento farmacológico , Dislipidemias/diagnóstico , Dislipidemias/sangre , Lípidos/sangre , Estudios Prospectivos

RESUMEN

OBJECTIVE: Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This study aimed to shed light on the specific factors that contribute to the underlying causes of physical WPV in the prehospital context through direct experience and insight into the work of EMTs. METHODS: Sequential explanatory mixed methods were applied in five western provinces of Iran from 2022 to 2023. In total, 358 EMTs that met the criteria for the quantitative phase were selected using a multi-stage clustering method. In the quantitative phase, the researchers used a questionnaire on workplace violence in the healthcare sector. Based on the results of the quantitative phase, 21 technicians who had experienced physical violence in the past 12 months were invited for in-depth interviews in the qualitative phase. RESULTS: The average age of the EMTs was 33.96 ± 6.86 years, with an average work experience of 10.57 ± 6.80 years. More than half (53.6%) of the staff worked 24-hour shifts. In addition, most EMTs were located in urban bases (50.3%), and 78 (21.8%) reported having experienced physical violence. No significant correlations were found between the demographic characteristics of the technicians and the frequency of physical violence, except base location in the last 6 months. The qualitative study also created one theme (the complexity of WPV in the prehospital setting), four categories, and ten subcategories. CONCLUSION: The study's results emphasize the need for comprehensive WPV factors in the prehospital setting. These factors can lead to identifying and improving strategies such as organizational support, improving communication and collaboration between responders, and training in de-escalation techniques. In addition, it is crucial to address the root causes of WPV such as poverty and lack of education in the community to create a safer and more supportive environment for patients and staff.

Asunto(s)

Servicios Médicos de Urgencia , Auxiliares de Urgencia , Violencia Laboral , Humanos , Irán , Masculino , Adulto , Femenino , Violencia Laboral/estadística & datos numéricos , Auxiliares de Urgencia/psicología , Encuestas y Cuestionarios , Investigación Cualitativa

RESUMEN

AIMS: The impact of life-course different adiposity indices on diabetes mellitus (DM) is poorly understood. We aimed to do trajectory analysis with repeated measurements of adiposity indices in the development of DM among women across the lifespan. METHODS: This study prospectively investigated the 1,681 population of Tehran Lipid and Glucose Study. At baseline, all individuals were free of diabetes. Trajectory analysis was used to identify homogeneous distinct clusters of adiposity indices trajectories and assign individuals to unique clusters. RESULTS: Of the 1681 healthy women, 320 progressed to the DM. Three distinct body mass index (BMI) trajectories and 2 distinct trajectories of other adiposity indices (waist circumstance (WC), conicity index (C-index), and body roundness index (BRI)) were chosen as the best fitting of the latent class growth mixture model. In the adjusted model, total participants [HR (CI 95%): 2.83 (2.05, 3.91); p < 0.001], and menopause [1.35 (1.10, 2.11); p = 0.001] and reproductive-age women [2.93 (1.80, 4.78); p = 0.003] of the high BMI trajectory compared to the ones in the low trajectory of BMI were more likely to develop DM. The high BRI in menopause had a significantly higher risk of DM compared to the low trajectory. In menopause (1.80 (1.26, 2.58)) and reproductive-age women (4.32 (2.49, 7.47)) with high trajectory of C-index, the DM risk decreased after adjustment. CONCLUSIONS: The risk of DM was greater for high BMI, WC, C-index, and BRI trajectories than for lower trajectories. Hence, the development of general, abdominal, and visceral obesity trajectories in the prevention of DM should be considered by clinicians.

Asunto(s)

Adiposidad , Índice de Masa Corporal , Humanos , Femenino , Adiposidad/fisiología , Adulto , Persona de Mediana Edad , Irán/epidemiología , Estudios Prospectivos , Factores de Riesgo , Anciano , Diabetes Mellitus/epidemiología

RESUMEN

BACKGROUND: Geriatric assessment (GA) is a multidimensional process that disrupts the primary health care (PHC) referral system. Accessing consistent data is central to the provision of integrated geriatric care across multiple healthcare settings. However, due to poor-quality data and documentation of GA, developing an agreed minimum data set (MDS) is required. Therefore, this study aimed to develop a GA-MDS in the PHC referral system to improve data quality, data exchange, and continuum of care to address the multifaceted necessities of older people. METHODS: In our study, the items to be included within GA-MDS were determined in a three-stepwise process. First, an exploratory literature search was done to determine the related items. Then, we used a two-round Delphi survey to obtain an agreement view on items to be contained within GA-MDS. Finally, the validity of the GA-MDS content was evaluated. RESULTS: Sixty specialists from different health geriatric care disciplines scored data items. After, the Delphi phase from the 230 selected items, 35 items were removed by calculating the content validity index (CVI), content validity ratio (CVR), and other statistical measures. Finally, GA-MDS was prepared with 195 items and four sections including administrative data, clinical, physiological, and psychological assessments. CONCLUSIONS: The development of GA-MDS can serve as a platform to inform the geriatric referral system, standardize the GA process, and streamline their referral to specialized levels of care. We hope GA-MDS supports clinicians, researchers, and policymakers by providing aggregated data to inform medical practice and enhance patient-centered outcomes.

Asunto(s)

Técnica Delphi , Evaluación Geriátrica , Atención Primaria de Salud , Derivación y Consulta , Humanos , Atención Primaria de Salud/normas , Anciano , Evaluación Geriátrica/métodos , Irán , Derivación y Consulta/estadística & datos numéricos , Femenino , Prestación Integrada de Atención de Salud , Masculino , Anciano de 80 o más Años , Continuidad de la Atención al Paciente

RESUMEN

BACKGROUND: Knowledge networks, such as Communities of Practice (CoP), are essential elements of knowledge management. They play a crucial role in assimilating various knowledge domains and converting individual knowledge into collective knowledge. This study aimed to assess the concept of knowledge networks and identify facilitators and barriers influencing knowledge sharing in infectious diseases, according to Iranian experts. METHODS: This qualitative study employed content analysis and used purposive and snowball sampling. The data were collected via online or face-to-face interviews with 25 participants with diverse expertise in infectious diseases (both clinical and non-clinical), epidemiology, knowledge management, and knowledge-based business management in Iran. The thematic analysis technique was used to code the interviews, and the collected data were analyzed using MAXQDA 20 software. RESULTS: Thematic analysis of the interviews led to 437 codes. These codes were categorized into two groups: facilitators and barriers. The facilitators shaping the knowledge network for infectious diseases were classified into three main categories: individual factors, organizational factors, and communication mechanisms. Individual factors involved two themes: strengthening knowledge exchange between experts in infectious diseases and personal characteristics such as the criteria for network membership. Organizational factors comprised three themes: organizational and trans-organizational factors, management strategies, and interactions with non-governmental sectors. Communication mechanisms included two themes: the use of information technology and knowledge brokers. In addition, three important challenges were identified as barriers influencing the knowledge network: administration and policy-making, organizational and trans-organizational, and personal challenges. CONCLUSIONS: Several facilitators and barriers influence the formation of an infectious disease knowledge network, which must be addressed to ensure its effectiveness, development, and long-term sustainability. Addressing these factors will enable the network to effectively integrate diverse knowledge and contribute to advancing infectious disease management.

Asunto(s)

Enfermedades Transmisibles , Investigación Cualitativa , Humanos , Irán , Masculino , Femenino , Adulto , Gestión del Conocimiento , Entrevistas como Asunto , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud

RESUMEN

Considering the toxicological effects of some heavy metals (HMs) in which directly related to mortality and carcinogenicity in the population by their entrance from plants through livestock grazing, and medical skin cream, the rehabilitation of contaminated sites through phytoremediation by native plants might be quite challenging. Diplotaenia damavandica Mozaff. ex-Hedge & Lamond, is used as medical skin creams due to the existence of specific ingredients, which can be effective in treating skin disease. In the present study, the plant and associated soil sampling were performed around the boundary of D. damavandica. The concentration was measured using the Inductively coupled plasma mass spectrometry (ICP-MS). The results revealed the effect of existing endemic plants on reducing the average concentration of lead and zinc in soil by 40 and 60%, respectively, due to phytoremediation. EDX confirmed the presence of Pb and Zn in root and shoot tissues. Based on the results of this study, D. damavandica is an endemic perennial herbaceous plant with 60% biomass and prosperous root systems, which can grow in low contaminated areas of Pb in the southeast of Damavand Mt. Hence, the HMs pattern indicated less often in the aerial parts except for lead, which should be examined more carefully for skin cream uses.

Asunto(s)

Biodegradación Ambiental , Metales Pesados , Contaminantes del Suelo , Contaminantes del Suelo/análisis , Contaminantes del Suelo/toxicidad , Contaminantes del Suelo/metabolismo , Metales Pesados/análisis , Metales Pesados/metabolismo , Metales Pesados/toxicidad , Irán , Suelo/química , Plomo/toxicidad , Plomo/análisis , Plomo/metabolismo , Humanos , Zinc/análisis , Zinc/metabolismo , Zinc/toxicidad , Monitoreo del Ambiente/métodos , Raíces de Plantas/metabolismo , Raíces de Plantas/química

RESUMEN

BACKGROUND: Nosocomial infections are a global problem in hospitals all around the world. It is considered a major health problem, especially in developing countries. The increase in the patient's stay in hospitals has increased the mortality rate, and consequently, the costs drastically increase. The main purpose of using disinfectants in the hospital environment is to reduce the risk of nosocomial infections. Ethylene diamine tetra acetic acid (EDTA) causes lysis and increases susceptibility to antimicrobial agents in the planktonic form of bacteria. This substance affects the permeability of the outer membrane of bacteria. It also prevents the formation of biofilms by bacteria. MATERIALS AND METHODS: In the current study, 120 isolates of Acinetobacter baumannii (A. baumannii) were confirmed by phenotypic and genotypic methods. Antibiogram was performed and then the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of isolates against 5% sodium hypochlorite, ethanol %70, sayasept-HP 2%, chlorhexidine 2%, dettol 4/8% were evaluated. In addition, the disinfectant effect was re-evaluated with the mixture of EDTA solution. All isolates were examined for biofilm presence by crystal violet staining method in triplicates and repeated three times for each strain. Also for all isolates detection of efflux pump genes (Qac-E, qacE-Δ1, SUG-E) by PCR technique was done. RESULTS: Antibiogram results of A. baumannii showed that 6.7% were Multi-drug-resistant (MDR), and 89.2% were Extensively drug-resistant (XDR) isolates. The highest effect of disinfectants was related to 5% sodium hypochlorite, and the least effect was 70% ethanol. EDTA increases the efficacy of selected disinfectants significantly. The highest prevalence of the efflux pump genes was related to SUG-E (95%) and Qac-E (91.7%), and, the qacE-Δ1 gene with 12.5%. The biofilm production rate was 91.3% among all isolates. CONCLUSION: The best and safest way to disinfect hospital floors and surfaces is to choose the right disinfectants, and learn how to use them properly. In this study, a mixture of disinfectants and EDTA had a significant effect on bactericidal activity. it was found that improper use of disinfectants, especially the use of sub-inhibitory dilutions, increases the resistance of bacteria to disinfectants.

Asunto(s)

Acinetobacter baumannii , Biopelículas , Desinfectantes , Genotipo , Pruebas de Sensibilidad Microbiana , Fenotipo , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/fisiología , Acinetobacter baumannii/aislamiento & purificación , Desinfectantes/farmacología , Humanos , Irán , Ácido Edético/farmacología , Farmacorresistencia Bacteriana/genética , Antibacterianos/farmacología , Infecciones por Acinetobacter/microbiología , Hipoclorito de Sodio/farmacología , Infección Hospitalaria/microbiología , Clorhexidina/farmacología

RESUMEN

BACKGROUND: Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery. METHODS: A qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction. RESULTS: The analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources. CONCLUSIONS: Several approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.

Asunto(s)

Ambulancias , Parto Obstétrico , Servicios Médicos de Urgencia , Investigación Cualitativa , Humanos , Irán , Femenino , Embarazo , Servicios Médicos de Urgencia/organización & administración , Adulto , Partería , Auxiliares de Urgencia/psicología , Accesibilidad a los Servicios de Salud , Entrevistas como Asunto

RESUMEN

This research aims to create and evaluate an assessment tool termed Older Adults' First Aid Knowledge Scale, which measures the knowledge and attitude of Iranian grandparents about first aid. In accordance with COSIM guidelines, 485 individuals in southern Iran completed the instrument as part of a psychometric investigation. Rasch partial credit model (PCM), exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and receiver operating characteristic (ROC) analysis were used to analyze the results. The final version of OFAKS consisted of 18 items that were validated through EFA, CFA, and item response theory (IRT) analysis. All items showed measurement invariance and consecutive response groupings in the predictable order, and the instrument had strong internal consistency. Although Rasch's analysis demonstrated the significance of OFAKS, further investigations and testing in different settings are required to confirm the validity of the tool.

Asunto(s)

Psicometría , Humanos , Psicometría/métodos , Irán , Femenino , Masculino , Anciano , Análisis Factorial , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Encuestas y Cuestionarios , Abuelos/psicología , Reproducibilidad de los Resultados , Anciano de 80 o más Años