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

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

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

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

OBJECTIVES: Primary sclerosing cholangitis is an autoimmune illness affecting the intrahepatic and/or extrahepatic bile ducts that has a varying clinical history and no clear therapy. Recurrence of primary sclerosing cholangitis after transplantation can cause recurring liver failure, decreased survival, and the necessity for retransplant. Here, we explored the incidence of recurrence while also identifying the risk factors of primary sclerosing cholangitis. MATERIALS AND METHODS: In this retrospective cohort study, we collected demographic and clinical data from patients with a history of primary sclerosing cholangitis after liver transplant between 2011 and 2021. With SPSS software, we compared results in 2 groups of patients (with and without recurrent sclerosing biliary cholangitis) in terms of demographic and clinical variables. RESULTS: The study included 408 patients. Lower donor age and the occurrence of acute cellularrejection were shown to be key risk factors for recurrence of primary sclerosing cholangitis. Acute cellularrejection showed the best likelihood of predicting primary sclerosing cholangitis recurrence. As the number of acute cellular rejection episodes increased, so did the chance of primary sclerosing cholangitis. Death rate of patients with recurrence of primary sclerosing cholangitis was 40.8% (n = 20 patients) compared with 18.9% (n = 68 patients) in those without recurrence (significant at P < .001). CONCLUSIONS: The recurrence of primary sclerosing cholangitis had a detrimental effect on survival after liver transplant. Modifiable risk variables have the potentialto affecttherapies on care and prevention of primary sclerosing cholangitis recurrence. Donor age and acute cellular rejection were risk factors for decreased survival and higher primary sclerosing cholangitis recurrence. The use of mycophenolate (Cellcept) increased recurrence, but tacrolimus reduced mortality.

Asunto(s)

Colangitis Esclerosante , Inmunosupresores , Trasplante de Hígado , Recurrencia , Humanos , Colangitis Esclerosante/cirugía , Colangitis Esclerosante/mortalidad , Colangitis Esclerosante/diagnóstico , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/mortalidad , Factores de Riesgo , Estudios Retrospectivos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Inmunosupresores/efectos adversos , Factores de Tiempo , Medición de Riesgo , Irán/epidemiología , Adulto Joven , Incidencia , Factores de Edad , Adolescente , Rechazo de Injerto/mortalidad , Rechazo de Injerto/prevención & control , Rechazo de Injerto/diagnóstico , Rechazo de Injerto/inmunología

RESUMEN

BACKGROUND: In developing nations, myocardial infarction (MI) remains a significant contributor to deaths from sudden cardiac arrest, with diet playing a key role in its incidence through oxidative stress mechanisms. Although the connection between the Dietary Antioxidant Index (DAI) and cardiovascular diseases has been demonstrated in some studies, the relationship between DAI and MI has not been extensively explored. Therefore, this research aims to investigate this association. METHODS: We conducted a nested case-control study involving 156 MI cases and 312 healthy controls, utilizing data from the Fasa Adults Cohort Study (FACS), a population-based study of individuals aged 35-70 residing in Fasa, Iran, with 11,097 participants included at baseline. The DAI was determined by normalizing the intake values of six dietary vitamins and minerals, adjusting by subtracting the global mean, and then dividing by the global standard deviation. MI diagnosis was established by an experienced cardiologist using electronic medical records. Conditional logistic regression was employed to examine the association between DAI and MI. RESULTS: There were no significant differences between the case and control groups in terms of age (P = 0.96), gender distribution (P = 0.98), and education level (P = 0.38). In a multiple conditional logistic regression analysis, after adjusting for key variables-including body mass index (BMI), smoking status, education level, and serum levels of triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), fasting blood sugar (FBS), saturated fatty acids (SFA), and polyunsaturated fatty acids (PUFA)-an inverse association was found between DAI and the risk of myocardial infarction (MI) [adjusted Odds Ratio (Adj OR) = 0.88, 95% Confidence Interval (CI): 0.85-0.92; P < 0.001]. CONCLUSIONS: This study highlights the crucial role of the DAI in reducing the risk of myocardial infarction. Promoting diets rich in antioxidants presents a straightforward and effective strategy for MI prevention and the promotion of cardiovascular health, underscoring the novelty and significance of this research in dietary approaches to disease prevention.

Asunto(s)

Antioxidantes , Infarto del Miocardio , Factores Protectores , Humanos , Femenino , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/prevención & control , Infarto del Miocardio/sangre , Irán/epidemiología , Estudios de Casos y Controles , Anciano , Adulto , Antioxidantes/administración & dosificación , Medición de Riesgo , Dieta Saludable , Factores de Riesgo , Valor Nutritivo , Conducta de Reducción del Riesgo , Ingesta Diaria Recomendada

RESUMEN

BACKGROUND: Male factor infertility can affect spermatogenesis, sexual desire, and thus the quality of life of couples. The present study was conducted to investigate the relationship between spermogram parameters, and the score of sexual desire in infertile men. METHODS: This cross-sectional study was conducted on 315 infertile men referred to the Avicenna Infertility Center of Tehran (March 2022 to March 2023). The participants were selected based on the results of previous spermogram and hormonal tests recorded in their medical records. Eligible men completed the demographic information questionnaire and Hurlbert Index of Sexual Desire. A multivariable linear regression model was used to adjust the effect of variables on Hurlbert's score. RESULTS: There was no significant relationship among sperm parameters (count, morphology, motility, vitality, concentration and DNA Fragmentation Index) and with sexual desire of infertile men. Education level, age of men and their partners, the duration of the marriage and duration of infertility did not have a statistically significant effect on sexual desire. However, economic status had an inverse effect on men's sexual desire, with regression coefficients of 7.37 and 7.78 for medium and low socioeconomic levels compared with high (p<0.05). CONCLUSION: Male sexual desire is primarily influenced by social factors rather than organic ones. Further multicentre prospective studies are recommended for more accurate results.

Asunto(s)

Infertilidad Masculina , Libido , Humanos , Masculino , Estudios Transversales , Irán/epidemiología , Adulto , Infertilidad Masculina/psicología , Libido/fisiología , Centros de Atención Terciaria , Recuento de Espermatozoides , Análisis de Semen , Encuestas y Cuestionarios , Motilidad Espermática , Calidad de Vida

RESUMEN

Introduction: This study measures the COVID-19 vaccine effectiveness (CVE) against hospital admission and severe COVID-19. Methods: This study is a test-negative case-control design using data from eight provinces in April, 2021 until March, 2022. The individuals were classified as cases and controls based on the results of the RT-PCR test for SARS-CoV-2 and matched based on the timing of the test being conducted as well as the timing of hospital admission. The measure of association was an odds ratio (OR) by univariate and multiple logistic regression. The multiple logistic regression has been carried out to take confounding factors and potential effect modifiers into account. The CVE was computed as CVE = (1 - OR)*100 with 95% confidence interval. Results: Among 19314 admitted patients, of whom 13216 (68.4%) were cases and 6098 (31.6%) were controls, 1313 (6.8%) died. From total, 5959 (30.8%) patients had received the vaccine in which one, two, and booster doses were 2443 (12.6%), 2796 (14.5Ùª), and 720 (3.7Ùª), respectively. The estimated adjusted effectiveness of only one dose, two doses and booter vaccination were 22% (95% CI: 14%-29%), 35% (95% CI: 29%-41%) and 33% (95% CI: 16%-47%), respectively. In addition, the adjusted vaccine effectiveness against severe outcome was 33% (95% CI: 19%- 44%), 34% (95% CI: 20%- 45%) and 20% (95% CI: -29%- 50%) for those who received one, two and booster vaccinations, respectively. Conclusion: Our study concluded that full vaccination, though less effective compared to similar studies elsewhere, decreased hospital admissions and deaths from COVID-19 in Iran, particularly during the Delta variant period, with an observed decline during the Omicron variant dominance.

Asunto(s)

Vacunas contra la COVID-19 , COVID-19 , SARS-CoV-2 , Eficacia de las Vacunas , Humanos , COVID-19/prevención & control , COVID-19/inmunología , COVID-19/mortalidad , COVID-19/epidemiología , Irán/epidemiología , Vacunas contra la COVID-19/inmunología , Vacunas contra la COVID-19/administración & dosificación , Masculino , Femenino , Estudios de Casos y Controles , Persona de Mediana Edad , SARS-CoV-2/inmunología , Adulto , Anciano , Hospitalización/estadística & datos numéricos , Vacunación , Adulto Joven , Adolescente

RESUMEN

OBJECTIVE: Cardiovascular diseases (CVDs) are the most common cause of death worldwide. Diet plays an important role among many risk factors for CVDs. The present study aimed to investigate the relationship between carbohydrate quality index (CQI) and conventional risk factors of CVDs in Iranian adults. RESULTS: A higher CQI was related to a higher intake of energy, fiber, whole grains, fruits, vegetables, nuts, legumes, and dairy products. Additionally, a significant negative association was observed between CQI and triglycerides (TG) (odds ratio (OR) = 0.85; 95% confidence interval (CI): 0.73-0.98, highest versus the lowest tertile, p for trend = 0.026) and non-high density lipoprotein cholesterol (non-HDL-C) (OR = 0.85; 95% CI: 0.75-0.96, highest versus the lowest tertile, p for trend = 0.012). No significant correlation was shown between CQI and other cardiovascular risk factors. The findings indicate that the CQI is inversely associated with TG and non-HDL-C. Further studies are proposed to confirm these findings.

Asunto(s)

Enfermedades Cardiovasculares , Carbohidratos de la Dieta , Triglicéridos , Humanos , Irán/epidemiología , Masculino , Femenino , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/sangre , Adulto , Persona de Mediana Edad , Triglicéridos/sangre , Factores de Riesgo , Estudios Transversales , Factores de Riesgo de Enfermedad Cardiaca , Anciano , Dieta

RESUMEN

AIM: To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave. DESIGN: A cross-sectional study. METHODS: This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction. RESULTS: The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction. PATIENT OR PUBLIC CONTRIBUTION: None.

Asunto(s)

COVID-19 , Humanos , COVID-19/psicología , COVID-19/epidemiología , Femenino , Estudios Transversales , Adulto , Irán/epidemiología , Embarazo , SARS-CoV-2 , Satisfacción del Paciente , Periodo Posparto/psicología

RESUMEN

BACKGROUND: As the COVID-19 pandemic continues to unfold, there has been a substantial increase in the demand for prehospital services. Emergency medical service (EMS) providers have encountered a myriad of challenges that have had a discernible impact on their professional performance. This study was designed to explore the challenges faced by EMS providers during the initial phase of the COVID-19 pandemic. METHODS: This qualitative research was conducted using a content analysis approach at emergency medical centers affiliated with Hamadan University of Medical Sciences in Iran between April and August 2021. This study included the participation of 21 EMS personnel, which was conducted using purposive sampling and semistructured interviews, and continued until data saturation was reached. The conventional content analysis method, as outlined by Graneheim and Lundman, was applied for data analysis. RESULTS: The analysis of the interview data resulted in the identification of 219 primary codes, which were then organized into ten distinct categories. These categories were further consolidated into three overarching themes: personal safety challenges, professional-organizational challenges, and threatened mental health. CONCLUSIONS: EMS personnel play a critical role in healthcare during disasters and pandemics, facing challenges that can have negative effects. Managing these challenges can impact mental health and professional well-being, but awareness, support, resources, and services can help mitigate adverse consequences.

Asunto(s)

COVID-19 , Servicios Médicos de Urgencia , Investigación Cualitativa , Humanos , COVID-19/epidemiología , Irán/epidemiología , Servicios Médicos de Urgencia/organización & administración , Femenino , Masculino , Adulto , Pandemias , Auxiliares de Urgencia/psicología , SARS-CoV-2 , Entrevistas como Asunto , Persona de Mediana Edad

RESUMEN

BACKGROUND: Despite the severe impact of COVID-19 on cancer patients, data on COVID-19 outcomes in cancer patients from low- and middle-income countries is limited. We conducted a large study about the mortality rate of COVID-19 in cancer patients in Iran. METHODS: We analyzed data from 1,079 cancer (average age: 58.2 years) and 5,514 non-cancer patients (average age: 57.2 years) who were admitted for COVID-19 in two referral hospitals between March 2019 and August 2021. Patients were followed up until death or 31st August 2021. Multiple logistic regression models estimated the odds ratio (OR) and 95% confidence intervals (CI) of factors associated with ICU admission and intubation. The Cox regression model estimated hazard ratios (HRs) and 95% CI of factors associated with hospital and post-discharge 60-day mortalities. RESULTS: The cancer patients had higher ICU admission (OR = 1.65, 95% CI: 1.42-1.91; P-value 0.03) and intubation (OR = 3.13, 95% CI = 2.63-3.73, P-value < 0.001) than non-cancer patients. Moreover, hospital mortality was significantly higher in cancer patients than in non-cancer patients (HR = 2.12, 95% CI: 1.89-2.41, P-value < 0.001). HR for the post-discharge mortality was higher in these patients (HR = 2.79, 95% CI: 2.49-3.11, < 0.001). The hospital, comorbidities, low oxygen saturation, being on active treatment, and non-solid tumor were significantly associated with ICU admission (P-value < 0.05) in cancer patients, while only low oxygen saturation was associated with intubation. In addition, we found that old age, females, low oxygen saturation level, active treatment, and having a metastatic tumor were associated with death due to COVID-19 (P-value < 0.05). Only lung cancer patients had a significantly higher risk of death compared to other cancer types (HR = 1.50, 95% CI: 1.06-2.10, P-value = 0.02). CONCLUSION: Cancer patients are at a higher risk of ICU admission, intubation, and death due to COVID-19 than non-cancer patients. Therefore, cancer patients who are infected with COVID-19 require intensive care in the hospital and active monitoring after their discharge from the hospital.

Asunto(s)

COVID-19 , Mortalidad Hospitalaria , Neoplasias , Alta del Paciente , Humanos , COVID-19/mortalidad , COVID-19/complicaciones , COVID-19/epidemiología , Irán/epidemiología , Persona de Mediana Edad , Masculino , Femenino , Neoplasias/mortalidad , Neoplasias/complicaciones , Neoplasias/diagnóstico , Anciano , Alta del Paciente/estadística & datos numéricos , Unidades de Cuidados Intensivos/estadística & datos numéricos , SARS-CoV-2/aislamiento & purificación , Adulto , Hospitalización/estadística & datos numéricos , Factores de Riesgo

RESUMEN

BACKGROUND: The worldwide prevalence of type 2 diabetes mellitus in adults is experiencing a rapid increase. This study aimed to identify the factors affecting the survival of prediabetic patients using a comparison of the Cox proportional hazards model (CPH) and the Random survival forest (RSF). METHOD: This prospective cohort study was performed on 746 prediabetics in southwest Iran. The demographic, lifestyle, and clinical data of the participants were recorded. The CPH and RSF models were used to determine the patients' survival. Furthermore, the concordance index (C-index) and time-dependent receiver operating characteristic (ROC) curve were employed to compare the performance of the Cox proportional hazards (CPH) model and the random survival forest (RSF) model. RESULTS: The 5-year cumulative T2DM incidence was 12.73%. Based on the results of the CPH model, NAFLD (HR = 1.74, 95% CI: 1.06, 2.85), FBS (HR = 1.008, 95% CI: 1.005, 1.012) and increased abdominal fat (HR = 1.02, 95% CI: 1.01, 1.04) were directly associated with diabetes occurrence in prediabetic patients. The RSF model suggests that factors including FBS, waist circumference, depression, NAFLD, afternoon sleep, and female gender are the most important variables that predict diabetes. The C-index indicated that the RSF model has a higher percentage of agreement than the CPH model, and in the weighted Brier Score index, the RSF model had less error than the Kaplan-Meier and CPH model. CONCLUSION: Our findings show that the incidence of diabetes was alarmingly high in Iran. The results suggested that several demographic and clinical factors are associated with diabetes occurrence in prediabetic patients. The high-risk population needs special measures for screening and care programs.

Asunto(s)

Diabetes Mellitus Tipo 2 , Estado Prediabético , Modelos de Riesgos Proporcionales , Humanos , Estado Prediabético/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Irán/epidemiología , Adulto , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/mortalidad , Estudios Prospectivos , Anciano , Factores de Riesgo

RESUMEN

The global COVID-19 pandemic has disrupted daily routines and heightened stress levels worldwide, impacting various aspects of health, including sleep. This cross-sectional study conducted in Iran aimed to investigate the impact of Ramadan Intermittent Fasting (RIF) during the pandemic on sleep disturbances and associated risk factors in adults aged ≥ 18 years. Data was collected from Iranian participants observing RIF. A structured electronic questionnaire, translated into Persian, gathered information on sociodemographics, dietary habits, sleep parameters, physical activity, and more. The study assessed sleep quality, duration, and disturbances and conducted a thorough analysis to identify risk factors associated with sleep disruptions. The study revealed that 48% of the participants experienced sleep disturbances during RIF, with 21% reporting poor sleep quality and 46% having unusual sleep duration. Various factors were associated with an elevated risk of sleep disruptions, including body mass index, place of residence, income levels, cohabitation status, family history of obesity, hypertension, diabetes, heart disease, personal history of obesity, weight fluctuations, Shisha smoking, and unemployment. The results highlight the critical importance of health promotion strategies tailored to cultural contexts. This study advocates for enhanced health education initiatives focusing on sleep hygiene and stress management, especially during periods of significant lifestyle alterations like Ramadan amid a global pandemic. Such initiatives are vital in mitigating sleep disturbances and promoting overall well-being in populations facing unique health challenges.

Asunto(s)

COVID-19 , Ayuno , Islamismo , Humanos , COVID-19/epidemiología , Estudios Transversales , Masculino , Irán/epidemiología , Femenino , Adulto , Factores de Riesgo , Persona de Mediana Edad , Trastornos del Sueño-Vigilia/epidemiología , SARS-CoV-2 , Calidad del Sueño , Adulto Joven , Pandemias , Pueblos de Medio Oriente

RESUMEN

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a serious threat to global tuberculosis (TB) control efforts. This study aims to investigate the trend of MDR-TB prevalence in Iran over 20 years. METHODS: A systematic literature search was conducted in various databases, including PubMed, Embase, and Web of Science, from 1981 to 2023. Studies reporting the prevalence of MDR-TB in Iran were included in the meta-analysis. Statistical analysis was performed using Comprehensive Meta-Analysis software. RESULTS: A total of 58 studies from different provinces of Iran were included in the meta-analysis. The majority of studies were from Tehran (n = 33), Kermanshah (n = 5), Mashhad (n = 4), and Tabriz (n = 4) provinces. Overall, 1885 cases of MDR-TB were reported in Iran during the study period. The highest number of MDR-TB cases was reported in 2000 (582 cases) and the lowest in 2001 (1 case). An increasing trend in MDR-TB prevalence was observed, particularly between 2018 and 2019. The pooled prevalence of MDR-TB in Iran was 12.31% (95% CI: 11.83-12.80) using the fixed-effects model and 20.21% (95% CI: 15.70-26.01) using the random-effects model. No evidence of publication bias was found. CONCLUSION: The results of this comprehensive meta-analysis highlight the increasing trend of MDR-TB in Iran over the past two decades. This underscores the urgent need for strengthening TB control strategies, including improved surveillance, case detection, treatment, and management of MDR-TB in the country. Developing diagnostic and treatment approaches for MDR-TB should be prioritized by Iranian medical universities and public health authorities.

Asunto(s)

Tuberculosis Resistente a Múltiples Medicamentos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Irán/epidemiología , Humanos , Prevalencia , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/efectos de los fármacos

RESUMEN

BACKGROUND: To the best of our knowledge, no population-based studies have provided insights into the prevalence of hysterectomy and its risk factors among northern Iranian females. Thus, the present study aimed to investigate the prevalence and sociodemographic determinants of hysterectomy in a large cohort of northern Iranian females. METHODS: This cross-sectional study included data from the enrollment phase of the Tabari cohort study (TCS). The TCS consists of 10,255 adults (4,149 males and 6,106 females) aged 35-70 years who reside in Sari, Mazandaran, Iran, of which 6103 females were included in the study. Multiple logistic regression analysis was used to search for hysterectomy determinants. RESULTS: Our results revealed that the prevalence of hysterectomy among northern Iranian females was 9.7% (595/6103). Additionally, 50-59 (OR: 4.63, 95% CI: 3.57-6.01) and 60-70 (OR: 5.83, 95% CI: 4.28-7.95) age groups, higher socioeconomic levels (OR: 1.66, 95% CI: 1.13-2.42), a history of tubectomy (OR: 1.27, 95% CI: 1.05-1.53), and more gravida (OR: 5.35, 95% CI: 1.62-17.63) were found to increase the odds of hysterectomy, whereas living in mountainous areas (OR: 0.57, 95% CI: 0.43-2.75) and having a job (OR: 0.62, 95% CI: 0.45-0.86) were found to decrease the odds of hysterectomy. CONCLUSION: Older age groups, living in urban areas, higher socioeconomic levels, not having a job, a history of tubectomy, and more gravida were found to increase the odds of hysterectomy.

Asunto(s)

Histerectomía , Humanos , Femenino , Persona de Mediana Edad , Irán/epidemiología , Histerectomía/estadística & datos numéricos , Adulto , Estudios Transversales , Anciano , Prevalencia , Estudios de Cohortes , Factores de Riesgo , Masculino , Factores Socioeconómicos , Modelos Logísticos , Factores de Edad