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Background: Although the incidence of leukemia's is not high, many of these cancers lead to death over a short period. This is a cross-sectional study on leukemia deaths in southern Iran. Methods: All deaths due to leukemia in the Fars province were obtained from the population-based electronic death registration system (EDRS). Crude and age-standardized mortality rate (ASMR), YLL, and YLL rate data were calculated, and joinpoint regression was used to examine the trend. Results: Totally, 3141 deaths from leukemia occurred in the Fars province during the study period (2004-2019). Of these, 61.5% (1933 cases) pertained to men. The crude mortality rate was 6.1 (95% CI: 5.8 to 6.4) in men and 3.9 (95% CI: 3.7 to 4.2) in women. Also, ASMR was 6.6 (95% CI: 6.3 to 6.9) and 4.2 (95% CI: 4.0 to 4.4) in men and women, respectively. The total YLLs due to leukemia were 32 804 in men and 23 064 in women. The joinpoint regression analysis demonstrated that the trend of YLL rate due to premature mortality was stable: the annual percent change (APC) was -1.2% (95% CI: -2.5 to 0.2, P = 0.090) for males, and -1.0% (95% CI: -2.9 to 0.9, P = 0.274) for females. Conclusion: The mortality and YLL due to leukemia had a stable trend. However, this trend has been decreasing or increasing in some age groups. Determining and controlling essential risk factors, especially the environmental factors of leukemia, may reduce its burden in the Fars province. [ABSTRACT FROM AUTHOR]

Background: During the past three decades, neonate, infant, and child mortality declined in North Africa and Middle East. However, there is substantial heterogeneity in mortality rates across countries. Methods: This study is part of the Global Burden of Diseases study (GBD) 2019. We report the number as well as mortality rates for neonates, infants, and children by cause across 21 countries in the region since 1990. Results: Between 1990 and 2019, the neonate mortality rate in the region declined from 31.9 (29.8, 34.0) to 12.2 (11.1, 13.3) per 1000 live births. Respective figures for under 5 mortality rates (U5MRs) were 79.1 (75.7, 82.7) in 1990 and 24.4 (22.3, 26.7) per 1000 live births in 2019. The majority of deaths among children under 5 years were due to under 1 year deaths: 75.9% in 1990 and 81.8% in 2019. Mortality rates in males were higher than females. The mortality rate among neonates ranged from 2.4 (2.1, 2.6) per 1000 live births in Bahrain to 25.0 (21.6, 28.4) in Afghanistan in 2019. Similarly, in 2019, the U5MR ranged from 5.0 (4.2-6.0) per 1000 live births in United Arab Emirates to 55.3 (47.9-63.5) in Afghanistan. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of neonate, infant, and child mortality in almost all countries in the region. Conclusion: In 2019, most countries in this region have achieved the SDG targets for neonate and child mortality. However, there is still substantial heterogeneity across countries. [ABSTRACT FROM AUTHOR]

Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Methods: This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Results: Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6--171.2) to 94.3 (73.4--121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3--6.8) in Kuwait to 502.9 (375.2--655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0--6.4) in Kuwait to 269.9 (195.8--368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion: MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries. [ABSTRACT FROM AUTHOR]

Background: Since 1990, maternal mortality ratio (MMR) has significantly decreased in Iran. However, estimates for mortality and morbidity by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 31 provinces of Iran from 1990 to 2019. Results: Since 1990, MMR declined from 44.5 (95% UI: 38.6-50.1) to 15.9 (14.7--17.3) per 100 000 live births in Iran. In 1990 MMR ranged from 18.5 (11.2--26.4) to 76.9 (38.4--114.7) per 100 000 live births across provinces. Respective figures for 2019 were 7.1 (5.2--9.3) to 34.0 (25.1--44.7) per 100 000 live births. In 2019, MMR was higher in young women (aged 10 to 14) and older women (aged 45 or more). Percentages of deaths under 25 years was 24.8% in 1990 and 16.0% in 2019. There was remarkable decline in years lost due to premature death (YLL) rates from 1990 to 2019. While the decline was modest for years lived with disability (YLD) rates. Indirect maternal deaths and other maternal deaths ranked first or second in almost all provinces. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic Index (SDI) from 1990 to 2019 in all provinces and an evident convergence across provinces. Conclusion: MMR has declined to levels much lower than Sustainable Development Goals in all provinces. Although there was a convergence in trends, there are still disparities across provinces. The decline in disabilities caused by maternal disorders is not as significant as mortality, which needs further actions. [ABSTRACT FROM AUTHOR]

Background: Since 1990, neonatal, infant, and child mortality has substantially decreased in Iran. However, estimates for mortality by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report the number and rates of neonate, infant, and child deaths by cause across provinces of Iran from 1990 to 2019. Results: Between 1990 and 2019, the neonatal mortality rate per 1000 live births decreased from 31.8 (95% UI: 28.1--35.5) to 6.8 (6.1--7.4). The child mortality rates decreased from 71.2 (63.6--79.1) to 11.1 (10.2--12.0) per 1000 live births. Mortality rates among neonates per 1000 live births ranged from 3.1 (2.6--3.7) to 10.0 (9.2--10.8) across provinces in 2019. Child mortality rate per 1000 live births ranged from 5.5 (4.6--6.5) to 17.9 (16.4--19.4) across provinces in 2019. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of mortality in almost all provinces of Iran. The majority of neonatal disorders were due to neonatal preterm birth and neonatal asphyxia, trauma, and infections. The trends of mortality across provinces from 1990 to 2019 were converging and decreased along with increase in sociodemographic index (SDI). Conclusions: All provinces achieved the Sustainable Development Goal 3.2 of neonatal mortality less than 12 and child mortality less than 25 per 1000 live births. However, disparities still exist across provinces, specifically in low-SDI provinces. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major public health concern with diversity in epidemiological aspects and applied methods. In this study, we estimate years of life lost (YLLs) related to completed suicidal in the Fars province, southern Iran. Methods: Our study included data of all mortality events during 2011-2018 from Fars Suicide Surveillance System (FSSS). The validity of qualitative and quantitative variables was assessed through contrasting data between different sources and phone call justification. Case-fatality rates, age-specific and gender-specific mortality rates, ASR (age standardized rate), and YLLs through WHO's 2015 "YLL template" were calculated. Results: During the study period, 2384 mortalities with a mean age of 32.73 ± 15.65 had been registered. Most of them were males (male: 70.05% vs. female: 29.95%; male-female ratio: 2.33), hanging was the most frequent method (29.94%), and an increasing pattern in successful suicidal attempts was observed. The total YLLs were calculated to be 58 669 years (14.71 per 1000 persons). Regardless of year or gender, suicide had the largest YLLs amongst those aged 15-29 years. Conclusion: Regarding the increasing trend in YLLs and observing the highest rate of successful suicidal attempts amongst active and productive members of community, a comprehensive inter organizational reaction is demanded. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). Methods: The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. Results: Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91 000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. Conclusion: This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures. [ABSTRACT FROM AUTHOR]

Background: Cancer, a common disease in adulthood, is a rare albeit slowly increasing condition among children. Currently, limited data are available on the incidence, prevalence, and mortality of these diseases in many regions, including developing countries. Herein, we are reporting national and sub-national estimates on deaths due to childhood cancers between 2000 and 2015 in Iran. Methods: Cancer mortality rates were estimated using the national death registration system's data after addressing its incompleteness and misclassification, using demographic (complete birth history and summary birth history) and statistical analysis (spatiotemporal, Gaussian process regression, and generalized linear mixed models). We included data from cemeteries of two cities (Tehran and Isfahan) that were not included in the death registration system. We used census data and household expenditure and income surveys for data on population and other covariates used in the modeling. Results: The overall age-standardized death rate (ASDR) of childhood cancers have decreased by 69.52% (80.67-49.71) in Iran (equal to an annual percent change of -3.63 [-4.53- -2.24]), declining from 12.24 (95% UI: 10.52-14.49) in 2000 to 3.73 (2.8-5.29) deaths per 100 000 in 2015. This decrement was equal to an annual percent change of 4.35% over these years. Leukemia, brain, and nervous system malignancies accounted for about 66% of all cancer-related mortalities among children and adolescents in 2015, which had a 10% increase compared to 2000. Moreover, trends at the sub-national level showed that the highest and lowest ASDR of childhood cancers ranged from 2.12 to 4.99 across provinces of Iran in 2015. Conclusion: Although the overall mortalities have decreased, there is still inequality in the distribution of the recorded deaths. This inequality should be addressed with the improvement of the quality of care and better access to pediatric hospitals and oncologists in these areas. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B infection is the major risk factor for liver cancer in Iran. There is no comprehensive population-based study on the prevalence of hepatitis B by regional distribution. Moreover, systematic reviews of hepatitis B prevalence lack knowledge of some regions. We aimed to estimate the prevalence of hepatitis B and its temporal trends over 17 years by sex, age and geographical distribution. Methods: We used the Iranian Blood Donors data in addition to systematic reviews on population-based studies at national and provincial levels and statistical methods (A two-stage spatio-temporal model and crosswalk approach) to address the missing points of hepatitis B prevalence among the general population. The direct age-standardized approach was applied using Iran's national population in 2016. Results: At national level, age-standardized hepatitis B prevalence in Iran decreased from 3.02% (95% uncertainty interval; 2.26 to 3.96) in 2000 to 1.09% (95% uncertainty interval; 0.85 to 1.37) in 2016, with a total -64.84% change. Hepatitis B prevalence was more than 1.3 times greater in males than females in 2016. Overall, the prevalence of hepatitis B increased with increasing age. At provincial level, in 2016, the province with the highest prevalence had a nearly 11-time greater rate compared to the lowest prevalence. The declining annual percent change (APC) of the prevalence trend varied between -11.53% to -0.5% at provincial level from 2000 to 2016. Only one province did not witness a downward trend in which the APC was 0.5% (95% UI:0.47-0.54). Conclusion: The downward trend in prevalence of hepatitis B infection indicates the effectiveness of strategies and preventive measures adapted in Iran. Nevertheless, we need to eradicate this infection. In this regard, re-evaluating preventive measures, especially in high-risk age groups of the population, is recommended. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) which is the most common sleep disorder breathing (SDB), imposes heavy costs on health and economy. The aim of this study was to provide models based on data mining approaches (C5.0 decision tree and logistic regression model [LRM]) and choose a top model for predicting OSA without polysomnography (PSG) devices that is a standard method for diagnosis of this disease, to identify patients with this syndrome payment. Methods: In this cross sectional study, data was extracted from the medical records of 333 patients with sleep disorders who were referred to sleep disorders research center of Kermanshah University of Medical Sciences during the years 2012-2016. All patients underwent one night PSG. A stepwise LRM was fitted and its performance was compared with C5.0 decision tree with use of the criteria of accuracy, sensitivity and specificity. Results: For C5.0 decision tree, accuracy was obtained 0.757 with 95% confidence interval (0.661, 0.838), sensitivity was 0.66 and specificity was 0.809. For LRM, these items were obtained 0.737 (0.639, 0.820), 0.693 and 0.78 respectively. Conclusion: C5.0 decision tree showed better performance than LRM in diagnosis of OSA. So this model can be considered as an alternative approach for PSG. [ABSTRACT FROM AUTHOR]

The article offers an overview of the effective policies that Iran should consider to reduce smoking prevalence especially in young and low-income individuals. These include the tobacco price policies and taxation, the implementation of more practical and executable strategies and laws banning the advertisement of tobacco products, and the ratification of comprehensive smoke-free air laws that cover all indoor work places, restaurants and coffee shops.

This paper presents a systematic literature review of studies that shed light on the health of migrants in Iran from the perspective of social justice. A systematic search was conducted in PubMed and Iranian databases, including IranMedex, Magiran, and SID, in June 2012. All studies that were published until June 2012 describing the health status of migrants-including refugees-in Iran were included. The search results were categorized according to an adapted version of the six dimensions of well-being in Madison Powers'and Ruth Faden's theory of social justice in health. They consisted of access to health care, health, respect, self-determination and attachment, personal security, and social determinants of health. The majority of papers mentioned issues related to infectious diseases (100 papers, 60.2%). Only a few papers mentioned socioeconomic status and access to health services, education, and work. Infectious diseases and high population growth among migrants and the problematic image of migrants as "threat" to the Iranian population's health appear to be the most prominent results in our search. It is imperative to combat the high numbers of infectious diseases among migrants in Iran while simultaneously making efforts to change the public image of migrants as a health and social service threat to Iran. Data concerning social and ethical issues of migrants' health in Iran is scarce, and thus, future research is necessary using other methods and sources. [ABSTRACT FROM AUTHOR]

Background: Alzheimer and Parkinson diseases (AD and PD) are the two most important neurodegenerative disorders. This paper aims to determine the possible molecular linkage between these two common neurodegenerative diseases by a combination of computational investigations. Methods: According to our aim, common sets of identified proteins from the KEGG database were further analyzed based on Gene Ontology (GO) annotation and sequence similarities by the agglomerative hierarchical clustering. Proteins possessing same characteristics were categorized based on biological features in distinct clusters using the R programming software. In addition to this, by the use of DAVID Program and PPI network analysis, more insight can be achieved. Results: The results of this study indicated that 23 proteins are common between these two diseases. Their ontology evaluations by application of clustering methods showed that proteins belonging to a specific cluster indicate discrete properties that are different from other clusters. Furthermore, PPI network analysis confirms that the proteins with similarity ontology and sequence are also in close relationship. Conclusion: In conclusion, assessment of protein features supported the idea that mitochondria are the main malfunction compartment in AD and PD. Some of these common properties are apoptosis and mitochondria oxidation pathways that can be used for drug targeting. Moreover, examination of other neurodegenerative diseases can be helpful for comprehensive understanding of the origin of these diseases. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from the Global Burden of Disease study 2010, by sex and age in Iran from 1990 to 2010. Methods: The Global Burden of Disease Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD 2010 data, produce new graphs, and explain the results for Iran in greater detail. Results: Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1 % in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and cerebrovascular diseases, respectively. Conclusion: Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for death and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the and disease burden attributed to tobacco smoking. [ABSTRACT FROM AUTHOR]

Background: Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Diseas study 2010 (the GBD study 2010). Methods: The GBD study 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD study 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of the GBD study 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. Results: Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1 % to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. Conclusion: Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the burden of hemoglobin disorders, it is necessary to perform a national and sub-national study of hemoglobinopathies using multiple national and sub-national surveys. [ABSTRACT FROM AUTHOR]

Background: Tobacco smoking and exposure to second-hand smoke in the indoor environment are major public health risks worldwide. The aim of this paper is to report and critique a global assessment of smoking prevalence, smoking-attributable deaths, and disability adjusted life years (DALYs) extracted from the Global Burden of Disease study 2010, by sex and age in Iran from 1990 to 2010. Methods: The Global Burden of Disease Study 2010 estimated the distributions of exposure and relative risks per unit of exposure by systematically reviewing and analyzing published and unpublished data. These assessments were used, together with estimates of death and DALYs due to specific risk factors, to calculate the attributed burden for each risk factor exposure compared with the theoretical-minimum-risk exposure. Uncertainties in the distribution of exposure, relative risks, and relevant outcomes were incorporated into estimates of attributable mortality and burden. In this study, our aim was to reformulate the GBD 2010 data, produce new graphs, and explain the results for Iran in greater detail. Results: Between 1990 and 2010, the prevalence of tobacco smoking at all ages increased by 1 % in men and declined by 2% in women in Iran, but the overall prevalence in the general population was unchanged (12%). A reduction was observed in the age-standardized death and DALY rates (per 100,000 population) attributed to tobacco smoking, including second-hand smoke. The attributed DALY rate was greater for Iranian men than for Iranian women. The highest rates of DALYs because of tobacco smoking were found in smoker men and women aged 70+, but exposure to second-hand smoke had the most significant burden in children under 5 years old. In 1990, the three leading disease burdens attributed to tobacco smoking, including second-hand smoke, were ischemic heart disease; communicable, maternal, neonatal, and nutritional disorders; and chronic respiratory diseases. In 2010, three leading burden of diseases attributed to tobacco smoking belonged to ischemic heart disease, chronic respiratory disease, and cerebrovascular diseases, respectively. Conclusion: Despite a reduction in the rate of tobacco smoking, including second-hand smoke, since 1990, smoking exposure remained the fifth leading risk factor for death and DALYs in Iran in 2010. Overall, our data clearly show the need for new efforts in Iran to reduce the and disease burden attributed to tobacco smoking. [ABSTRACT FROM AUTHOR]

Background: Hemoglobinopathies are known as the most common genetic disorders in Iran. The paper aims to provide global estimates of deaths and disability adjusted life years (DALYs) due to hemoglobinopathies in Iran by sex and age during 1990 to 2010 and describe the challenges due to limitations of the Global Burden of Diseas study 2010 (the GBD study 2010). Methods: The GBD study 2010 estimates of the numbers of deaths and years of life lost (YLLs) due to premature mortality were calculated using the Cause of Death Ensemble model (CODEm). Years of life lost due to disability (YLDs) were computed by multiplication of prevalence, the disability weight for occurrence of sequelae, and the duration of symptoms. Prevalence was estimated through a systematic search of published and available unpublished data sources, with a Bayesian meta-regression model developed for GBD study 2010. Disability weights were produced using collected data from population-based surveys. Uncertainty from all inputs was incorporated into the computations of DALYs using simulation methods. We aim to prepare and criticize the results of the GBD study 2010 and provide some recommendations for reaching better conclusions about the burden of hemoglobinopathies in Iran. Results: Between 1990 and 2010, the overall deaths attributed to hemoglobinopathies decreased from 0.51% to 0.36% of total deaths, with the corresponding burden declining from 1 % to 0.82% of total DALYs. There was a reduction in deaths and DALYs rates for all ages and the rates attributed to all ages followed the same pattern in Iranian men and women. The highest DALYs for hemoglobinopathies, thalassemia, sickle cell disorder, and glucose-6-phosphate dehydrogenase deficiency (G6PD-D) were found in those aged less than 5 years. The collective burden of all of these hemoglobin disorder was lower in 2010 than in 1990. Conclusion: Although the screening programs in Iran have been very successful in reducing the number of thalassemia patients between 1990 to 2010, in order to provide a better estimation of the burden of hemoglobin disorders, it is necessary to perform a national and sub-national study of hemoglobinopathies using multiple national and sub-national surveys. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to evaluate and compare the prediction accuracy of two data mining techniques, including decision tree and neural network models in labeling diagnosis to gastrointestinal prescriptions in Iran. METHODS: This study was conducted in three phases: data preparation, training phase, and testing phase. A sample from a database consisting of 23 million pharmacy insurance claim records, from 2004 to 2011 was used, in which a total of 330 prescriptions were assessed and used to train and test the models simultaneously. In the training phase, the selected prescriptions were assessed by both a physician and a pharmacist separately and assigned a diagnosis. To test the performance of each model, a k-fold stratified cross validation was conducted in addition to measuring their sensitivity and specificity. RESULT: Generally, two methods had very similar accuracies. Considering the weighted average of true positive rate (sensitivity) and true negative rate (specificity), the decision tree had slightly higher accuracy in its ability for correct classification (83.3% and 96% versus 80.3% and 95.1%, respectively). However, when the weighted average of ROC area (AUC between each class and all other classes) was measured, the ANN displayed higher accuracies in predicting the diagnosis (93.8% compared with 90.6%). CONCLUSION: According to the result of this study, artificial neural network and decision tree model represent similar accuracy in labeling diagnosis to GI prescription. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study aimed to evaluate and compare the prediction accuracy of two data mining techniques, including decision tree and neural network models in labeling diagnosis to gastrointestinal prescriptions in Iran. METHODS: This study was conducted in three phases: data preparation, training phase, and testing phase. A sample from a database consisting of 23 million pharmacy insurance claim records, from 2004 to 2011 was used, in which a total of 330 prescriptions were assessed and used to train and test the models simultaneously. In the training phase, the selected prescriptions were assessed by both a physician and a pharmacist separately and assigned a diagnosis. To test the performance of each model, a k-fold stratified cross validation was conducted in addition to measuring their sensitivity and specificity. RESULT: Generally, two methods had very similar accuracies. Considering the weighted average of true positive rate (sensitivity) and true negative rate (specificity), the decision tree had slightly higher accuracy in its ability for correct classification (83.3% and 96% versus 80.3% and 95.1%, respectively). However, when the weighted average of ROC area (AUC between each class and all other classes) was measured, the ANN displayed higher accuracies in predicting the diagnosis (93.8% compared with 90.6%). CONCLUSION: According to the result of this study, artificial neural network and decision tree model represent similar accuracy in labeling diagnosis to GI prescription. [ABSTRACT FROM AUTHOR]

Meningioma is one of the most common central nervous system tumors derived from meningothelial (arachnoid cap) cells. This paper identified the network-based Protein-Protein Interactions (PPI) for meningioma compared to healthy controls. Gene expression data, including 384 gene or protein names, were extracted from a number of previous investigations. Out of these 384 proteins, 176 were found to be exclusively expressed in meningiomas and 208 proteins were down-regulated. The networks of related differentially expressed genes were explored using cytoscape and the PPI analysis methods such as MCODE and ClueGO. The results introduced a number of hub proteins and 27 clusters (protein complex) with distinctive seed genes. Identified ClueGO Pathways based on subnetworks mined by MCODE was composed of positive regulation in RBC homeostasis, dysregulation of transport from ER to Golgi, disruption regulation of cell cycle and antigen processing and presentation of exogenous peptide antigen and neutralization of exogenous dsRNA. Combination of over-expression of TCEA1, UBE2E1, XRCC5, IFIT1, IFIT-3, MCM2, and MCM7 and under-expression of CDC25A, SEC31A, and CDK6 can serve as a diagnostic biomarker panel for meningiomas. These proposed network-based biomarkers for the meningioma patterns may be helpful in diagnosis, prognosis and treatment processes, although biomarker validation is necessary. [ABSTRACT FROM AUTHOR]

Meningioma is one of the most common central nervous system tumors derived from meningothelial (arachnoid cap) cells. This paper identified the network-based Protein-Protein Interactions (PPI) for meningioma compared to healthy controls. Gene expression data, including 384 gene or protein names, were extracted from a number of previous investigations. Out of these 384 proteins, 176 were found to be exclusively expressed in meningiomas and 208 proteins were down-regulated. The networks of related differentially expressed genes were explored using cytoscape and the PPI analysis methods such as MCODE and ClueGO. The results introduced a number of hub proteins and 27 clusters (protein complex) with distinctive seed genes. Identified ClueGO Pathways based on subnetworks mined by MCODE was composed of positive regulation in RBC homeostasis, dysregulation of transport from ER to Golgi, disruption regulation of cell cycle and antigen processing and presentation of exogenous peptide antigen and neutralization of exogenous dsRNA. Combination of over-expression of TCEA1, UBE2E1, XRCC5, IFIT1, IFIT-3, MCM2, and MCM7 and under-expression of CDC25A, SEC31A, and CDK6 can serve as a diagnostic biomarker panel for meningiomas. These proposed network-based biomarkers for the meningioma patterns may be helpful in diagnosis, prognosis and treatment processes, although biomarker validation is necessary. [ABSTRACT FROM AUTHOR]

Background: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. Methods: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. Results: By amending the required changes, we could include a total of 27 874 individuals in the first step of the survey. This number was 27 745 and 18 119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. Conclusion: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources. [ABSTRACT FROM AUTHOR]

Background: On a global scale, approximately 350 million are affected by hepatitis B, and 71 million by hepatitis C. People in custody face elevated risks for these infections. The prevalence and risk factors in Iranian prisons are insufficiently documented. The principal objective of this study was to ascertain the prevalence of hepatitis B and C, coupled with the identification of pertinent influencing factors, within the confines of Zahedan central prison, situated in the southeastern region of Iran. Methods: In 2019, we conducted an analytical cross-sectional study involving 407 people in custody, using stratified random sampling. To definitively diagnose hepatitis C virus (HCV) infection (P < 0.05), a checklist developed by the researchers, along with enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) techniques, were employed. Results: This study comprised 406 participants (96.3% male) with a median age of 32 years (27-38). Approximately 62% were married, and a substantial proportion of the participants had low education levels (47%), unemployment (64%), and belonged to the Baloch ethnicity (64%). The overall prevalence of hepatitis C and B infections was 2.7% and 10.6%, respectively. Tattooing (adjusted odds ratio [AOR]: 2.07, 95% CI: 1.9-4.5) and marriage (AOR: 1.78, 95% CI: 1.05-3.04) were identified as risk factors for hepatitis B. Moreover, hepatitis C showed a statistically significant association with a family history of hepatitis B and C (AOR: 3.31, 95% CI: 3.93-24.64) and intravenous (IV) drug use (AOR: 7.01, 95% CI: 1.52-32.78) according to the multivariable logistic regression analysis. Conclusion: The prevalence of hepatitis B and C was higher among people in custody in Zahedan central prison. Consequently, targeted interventions are vital to address and reduce viral hepatitis burden in custodial settings. [ABSTRACT FROM AUTHOR]

Clinical immunology and its subset topics are rather newly emerging medical fields in Iran as well as other developing countries. Primary immunodeficiency diagnosis and treatment were revolutionized in the late 1970s; a period of time that coincided with the establishment of the Division of Clinical Immunology and Allergy at the Children's Medical Center, Tehran. Subsequently, the launch of fellowship training programs (in 1988), the development of a national Iranian Primary Immunodeficiency Diseases Registry (in 1999), the inauguration of Research Center for Immunodeficiencies (in 2009), and recently, the national primary immunodeficiency network (in 2016) significantly changed the picture of disease management during the last 40 years. In this review, we seek to elucidate the most important past events, current challenges and future directions regarding the field of primary immunodeficiency. [ABSTRACT FROM AUTHOR]

Pulmonary lymphangioleiomyomatosis (LAM) is an uncommon disease principally affecting women during childbearing years and eventually leading to progressive respiratory failure. Lung transplantation is a viable option for patients with end-stage disease. LAM-related complications remain common, but recurrence of LAM following allograft transplantation is rare. We present a 25-year-old woman who presented with progressive dyspnea five years after bilateral lung transplantation for end-stage LAM. Histological examination of transbronchial lung biopsy sample confirmed recurrent LAM. We changed cyclosporine to sirolimus and she is currently being considered for re-transplantation. [ABSTRACT FROM AUTHOR]

Background: Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys. Methods: We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis. Results: The overall prevalence rate of cigarette smoking was 14.65% (12.81-16.59) in 2005 and 10.63% (9.00-12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18-27.11) and 19.95% (17.93%-21.97%) for men and 4.13% (2.43-6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09-22.47) to 9.67% (8.24-11.34) in 2005 and from 15.34% (13.68-17.12) to 6.41% (5.31-7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016. Conclusion: Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs. [ABSTRACT FROM AUTHOR]

Background: The ability of stem cells to differentiate into different cell types makes them a key component of healing damage in regenerative medicine. As human umbilical cord Wharton's jelly (HUCWJ) is available non-invasively, HUCWJ does not raise any ethical issues with higher differentiation potential compared to adult stem cells. With the ability to express embryonic stem cell markers, HUCWJ can be considered as a good candidate in regenerative medicine applications. The objective of this study was to find if these cells form cell aggregates with the same features as that formed by embryonic stem cells (embryoid body) and could form three germ layers. Methods: Eighteen umbilical cords were of healthy infants with parent permission. The umbilical cords were cut into small pieces and the explants were cultured. At the third passage, 1000, 5000 and 10 000 cells/ 20 µL were cultured in hanging drops for 3 days. Then, they were incubated for additional 3 days in non-adhesive dishes. As the center of cell aggregates formed from 5000 and 10 000 cells were darker than those formed from 1000 cells, this study focused on the aggregates formed by 1000 cells for further assessments. The immunocytochemistry and flowcytometry were performed using 3 color antibodies to detect the markers for three germ cell lineages. Results: The immunohistochemistry data showed that the embryoid-body-like aggregates expressed a low amount of ectodermal and endodermal markers and most of the cells expressed mesodermal markers. The flowcytometry percentage of the cells in each aggregate that expressed ectodermal marker Otx2 was17.1% and endodermal marker, Sox 17 was 5.49%. The frequency of cells expressing mesodermal marker Brachyury was high (75.0%). Flowcytometry also showed the percentages by mathematical evaluation and we did this three times for our result accuracy. Conclusion: These aggregates mainly kept their mesenchymal state and showed a poor differentiation potential toward ectoderm and endoderm identity. [ABSTRACT FROM AUTHOR]

Background: Reduction in the level of tissue decorin is a hallmark of many types of cancer including breast carcinoma. However, reduced decorin expression has also been reported in several types of benign tumors to the extent that it has been proposed as a tissue marker to differentiate malignant from benign tumors. The aim of this study was to investigate the potential role of plasma decorin to distinguish breast cancer from fibroadenoma, the second most common type of benign tumor, after fibrocystic disease. Methods: From 35 patients recruited in this study, 24 were affected with invasive ductal carcinoma, either grade II (n = 14) or grade III (n = 10). The other 11 patients had fibroadenoma lesions in their breasts. Tissue decorin mRNA and protein levels were assessed with real-time qPCR and Immunohistochemical analysis. ELISA was employed to measure plasma levels of decorin. Results: The mean plasma decorin in cancer patients was measured to be 5.42 ± 1.83 ng/mL while fibroadenoma patients had an average of 4.22 ± 1.17 ng/mL decorin in their plasma. The difference was not significant. However, the mean expression level of decorin mRNA calculated by the 2-ΔΔCt method was 5.6-fold lower in the biopsied tissue specimens of IDC patients versus fibroadenoma, as expected. Consistent reduction in protein abundance was observed in the studied tissue sections. Conclusion: We have shown that tissue decorin is a reliable marker, unaffected by patient disease stage, to differentiate IDC from fibroadenoma. However, plasma decorin does not seem to have diagnostic value in this regard. [ABSTRACT FROM AUTHOR]

Objective: Deaths due to road traffic accidents (RTAs) are a major public health concern around the world. Developing countries are over-represented in these statistics. Punitive measures are traditionally employed to lower RTA related behavioural risk factors. These are, however, resource intensive and require infrastructure development. This is a randomised controlled study to investigate the effect of non-punitive behavioural intervention through peer-comparison feedback based on driver behaviour data gathered by an in-vehicle telematics device. Design, Setting, and Participants: A randomised controlled trial using repeated measures design conducted in Iran on the drivers of 112 public transport taxis in Tehran province and 1309 inter-city busses operating nationwide. Driving data is captured by an in-vehicle telematics device and sent to a centrally located data centre using a mobile network. The telematics device is installed in all vehicles. Participants are males aged above 20 who have had the device operating in their vehicles for at least 3 months prior to the start of the trial. Intervention: The study had three stages: 1- Driver performance was monitored for a 4-week period after which they were randomised into intervention and control groups. 2- Their performance was monitored for a 9-week period. At the end of each week, drivers in the intervention group received a scorecard and a note informing them of their weekly behaviour and ranking within their peer group. Drivers in the control group received no feedback via short messaging service (SMS). 3- Drivers did not receive further feedback and their behaviour was monitored for another 4 weeks. Primary and Secondary Outcome Measure: Primary outcome was changes in weekly driving score in intervention and control groups during stage 2 of intervention. Taxis and busses were analysed separately using generalised estimating equation analysis. Funding and Ethical Approval: This project was funded by the National Institute for Medical Research Development (Grant No.940576) and approved by its ethics committee (Code: IR.NIMAD.REC.1394.016). This trial was registered at www.irct.ir as IRCT20180708040391N1. [ABSTRACT FROM AUTHOR]

The authors reflect on the report "Strengthening US-Iranian Relations through Public Health," by K. Alaei and others, published in the September 2015 issue of the "Lancet Global Health Journal." They explain the importance of knowledge acquisition in Iran manifested in the increase of university enrollees and academic papers. They also emphasize the influence of diplomatic relations in the exchange of ideas and experiences about medical sciences, research, and service delivery.

Background: Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify the incidence of the most common complications of PICC implantation and evaluate the risk factors of each complication. Methods: This historical cohort study was conducted on 2500 neonates with birth weights (BWs) ≥ 500 g and gestational age (GA) > 24 weeks who had a history of PICC inserted in three NICUs between August 2015 and August 2018. Data were collected by reviewing medical records. Demographic data and indices of catheter placement, duration of catheter placement, and common complications were recorded. Data analysis was done using SPSS-21. Results: The median cubital vein had the most PICC placement (43%). The most common complication was tip malposition (48.2%). The incidence rates (95% CI) of the main complications such as malposition, edema/occlusion, and PICC migration were 0.0356 (0.0337-0.0377), 0.0134 (0.0122-0.0147), and 0.0088 (0.0079-0.0099), respectively. PICC insertion position was the strongest predictor of malposition for the cephalic vein. Besides, the incidence of malformation in the cephalic vein was about six times higher than in the median cubital vein. Independent risk factors for non-technical complications included BW (OR = 0.59, 95% CI 0.44-0.79), administration of hyperosmolar medications (OR = 3.43, 95% CI 2.62-4.51), position (OR = 2.43, 95% CI 1.92- 3.08), and duration of catheter presence (OR = 1.02, 95% CI 1.01-1.03) (P < 0.001). Conclusion: The most common complication was malposition related to catheter placement in an emergency. Moreover, BW, administration of hyperosmolar medications, and duration of catheter presence were the most critical risk factors for nontechnical complications. Therefore, it is recommended to educate the PICC insertion team to reduce tip malposition and replace long-term catheters. [ABSTRACT FROM AUTHOR]

Background: Global real-time monitoring of SARS-CoV-2 variants is crucial to controlling the COVID-19 outbreak. The purpose of this study was to set up a Sanger-based platform for massive SARS-CoV-2 variant tracking in laboratories in low-resource settings. Methods: We used nested RT-PCR assay, Sanger sequencing and lineage assignment for 930-bp of the SARS-CoV-2 spike gene, which harbors specific variants of concern (VOCs) mutations. We set up our platform by comparing its results with whole genome sequencing (WGS) data on 137 SARS-CoV-2 positive samples. Then, we applied it on 1028 samples from March-September 2021. Results: In total, 125 out of 137 samples showed 91.24% concordance in mutation detection. In lineage assignment, 123 out of 137 samples demonstrated 89.78% concordance, 65 of which were assigned as VOCs and showed 100% concordance. Of 1028 samples screened by our in-house method, 78 distinct mutations were detected. The most common mutations were: S:D614G (21.91%), S:P681R (12.19%), S:L452R (12.15%), S:T478K (12.15%), S:N501Y (8.91%), S:A570D (8.89%), S:P681H (8.89%), S:T716I (8.74%), S:L699I (3.50%) and S:S477N (0.28%). Of 1028 samples, 980 were attributed as VOCs, which include the Delta (B.1.617.2) and Alpha (B.1.1.7) variants. Conclusion: Our proposed in-house Sanger-based assay for SARS-CoV-2 lineage assignment is an accessible strategy in countries with poor infrastructure facilities. It can be applied in the rapid tracking of SARS-CoV-2 VOCs in the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a chronic inflammatory airway disease caused or worsened by environmental factors in genetically vulnerable people. The study of national and sub-national burden of asthma aims to provide a quantitative method and valid estimates for the prevalence, incidence, and economic burden of asthma disease in Iran from 1990 to 2013 and this papers explains measures, data sources, methods, and challenges that we will use in the study. METHODS: In order to conduct this study, we will use all available unpublished data sources, including claim databases and data collected by the food and drug organization (FDO). Moreover, we will devise and run a systematic review of all studies and literature published about asthma epidemiology in Iran, which includes all cross-sectional, cohort and case-control studies with asthma epidemiology focus that are population based. In this study, we will use two statistical models, including spatio-temporal and multilevel autoregressive models to estimate mean and uncertainty intervals for the parameters under study by gender, age, year, and province. All programs will be written in R statistical packages (version 3.0.1). CONCLUSION: This study helps to obtain information concerning the variation among regions and provinces, and in general among sub-national divisions. Our study can be contribute to better allocation of resources, since it helps policymakers to recognize inequalities between regions and provinces and consequently help them to allocate resources more efficiently. [ABSTRACT FROM AUTHOR]

BACKGROUND: Asthma is a chronic inflammatory airway disease caused or worsened by environmental factors in genetically vulnerable people. The study of national and sub-national burden of asthma aims to provide a quantitative method and valid estimates for the prevalence, incidence, and economic burden of asthma disease in Iran from 1990 to 2013 and this papers explains measures, data sources, methods, and challenges that we will use in the study. METHODS: In order to conduct this study, we will use all available unpublished data sources, including claim databases and data collected by the food and drug organization (FDO). Moreover, we will devise and run a systematic review of all studies and literature published about asthma epidemiology in Iran, which includes all cross-sectional, cohort and case-control studies with asthma epidemiology focus that are population based. In this study, we will use two statistical models, including spatio-temporal and multilevel autoregressive models to estimate mean and uncertainty intervals for the parameters under study by gender, age, year, and province. All programs will be written in R statistical packages (version 3.0.1). CONCLUSION: This study helps to obtain information concerning the variation among regions and provinces, and in general among sub-national divisions. Our study can be contribute to better allocation of resources, since it helps policymakers to recognize inequalities between regions and provinces and consequently help them to allocate resources more efficiently. [ABSTRACT FROM AUTHOR]

Background: The limitations of antipsychotics for treatment of schizophrenia have led to investigation of the usefulness of pharmacological augmentation strategies. Clinical studies have provided evidence for glutamate abnormalities in schizophrenia. Topiramate is an anticonvulsant drug with alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor antagonist properties; therefore, the objective of the present study was to explore the therapeutic efficacy of topiramate as an adjunctive medication in schizophrenia. Methods: A17 week, double-blind, placebo-controlled clinical trial was performed on 80 patients (25 - 65 years) from 2005 - 2007. All were hospitalized in Mashhad psychiatric hospitals with chronic DSM-IV-TR-diagnosed schizophrenia. All participants received up to 300 mg/day of clozapine. In addition, participants randomly received either topiramate (200 - 300 mg/day) or placebo gradually added to their ongoing treatment. Efficacy of medication was measured by administering Positive and Negative Syndrome Scale at baseline and weeks 4,8,12, and 17. Results: During the study, 5 patients from the placebo group and 12 participants from topiramate group were excluded. Clozapine and topiramate group showed significant decreases in all three subscales of PANSS values from baseline, with the maximum efficacy in week 12.- However, after tapering topiramate, the general psychopathology sign was the only subscale that showed a significant difference. The clozapine and placebo group showed a significant decrease in all three subscales of PANSS values compared to baseline. The significant efficacy for all subscales was obtained at the end point. No significant differences in PANSS scores from baseline to end point were noted between case and control groups. Conclusion: Augmentation of clozapine and topiramate did not significantly decline patterns in any of the three subscales of PANSS compared to the clozapine and placebo group. Irct ID: IRCT138904014236N1 [ABSTRACT FROM AUTHOR]

Background: A limited number of headache disability indices exist that can evaluate and manage different disabilities related to headache among Iranian patients. Objective: This study aimed to translate and validate the Persian version of the Henry Ford headache disability inventory (HDI). Methods: The original questionnaire was translated and culturally adapted to the Persian setting. A total of 250 patients with chronic headache were enrolled in this study. The questionnaire's face validity, content validity, and convergent validity with Short-Form Health Survey (SF-36) were evaluated and a confirmatory factor analysis (CFA) was conducted. Its internal consistency was also assessed and its short- and long-term test-retest reliability were examined by intraclass correlation coefficient (ICC). Results: The content validity indices were 0.85, 0.99, and 0.97 for simplicity, relevance, and clarity, respectively. The content validity ratio was calculated as one for all items. The findings of CFA confirmed that this index had a good fit. Cronbach's alpha was 0.91, 0.82, and 0.86 for the entire questionnaire as well as its functional and emotional subscales, respectively. The ICC was also calculated as 0.97 for the total inventory. The convergent validity showed significant negative correlations between HDI and short-form health survey items. Conclusion: The validity and reliability of the Persian version of the HDI were confirmed. This questionnaire can explore the disabilities of Persian-speaking people with headache disorders. [ABSTRACT FROM AUTHOR]

Background: Pain control methods after cesarean section may interfere with infant breast-feeding. The aim of this study was to evaluate the effect of pethidine on breast feeding of infants born via cesarean section with spinal anesthesia. Methods: In this randomized double-blind clinical trial, we evaluated 116 infants born via cesarean section in Gerash Amiralmomenin hospital (Southern Iran) in 2017. The subjects were selected through purposive sampling and randomly by permuted block randomization and assigned to intervention and control groups. The test group received 100 mg of pethidine as intravenous infusion and the control group received only routine cares. Infants' breast feeding behavior in both groups was recorded within 48 hours of hospitalization, using the standard tool for rapid assessment of infant feeding behavior, which consists of 4 main components of breastfeeding, including readiness to feed, rooting, latching, and sucking with a score range of 0 to 3 for each component evaluated at 1, 6, 12, 24, 36, and 48 hours postnatally. Data were analyzed using independent t tests and chi-square test. Results: The highest score of breast-feeding behavior pertained to sucking reflexes in the control group and the lowest score to breast feeding readiness in the pethidine group. Readiness for feeding in the control group (2.09 ± 0.53) was significantly higher than the pethidine group (1.81 ± 0.61) (95% CI: 0.0552, 0.5092 and P = 0.015). Sucking reflex (95% CI: -0.1461, 0.2208 and P = 0.687), latching (95% CI: -0.3012, 0.0345 and P = 0.118) and rooting reflexes (95% CI: -0.1685, 0.2342 and P = 0.747) were almost equal in the control group (2.54 ± 0.49, 2.52 ± 0.38, 2.5 ± 0.48, respectively) and pethidine groups (2.51 ± 0.43, 2.65 ± 0.45, 2.46 ± 0.53, respectively). The total score of feeding behavior in the control group (9.66 ± 1.04) was higher than that of the pethidine group (9.44 ±.69) (95% CI: -0.2032, 0.6412 and P = 0.306). There was no significant difference between the infants' feeding frequency (95% CI: -0.269, 1.930 and P = 0.137) and duration of feeding (95% CI: -3.2067, 0.4597 and P = 0.14). Conclusion: Evaluation of infants in the first 48 hours after birth showed that those babies whose mothers received pethidine were less willing to start breast-feeding. However, other components of breast-feeding behaviors were similar. [ABSTRACT FROM AUTHOR]

Background: The pathogenesis of the COVID19 pandemic, that has killed one million nine hundred people and infected more the 90 million until end of 2020, has been studied by many researchers. Here, we try to explain its biological behavior based on our recent autopsy information and review of literature. Methods: In this study, patients with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) result were considered eligible for enrollment. Histopathological examinations were done on 13 people who were hospitalized in Afzalipour hospital, Kerman, Iran. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry and electron microscopy. Results: The most frequent co-morbidity in the patients was cardiovascular disease. The common initial symptoms of COVID-19 infection were dyspnea and cough. In all cases, the number of white blood cells was higher than the normal range. Common histopathological findings were variable degrees of vasculitis as degenerative to necrotic changes of endothelium and trafficking of inflammatory cells in the vessel wall with fibrinoid necrosis. Tissue damage included interstitial acute inflammatory cells reaction with degenerative to necrotic changes of the parenchymal cells. CD34 and Factor VIII immunohistochemistry staining showed endothelial cell degeneration to necrosis at the vessel wall and infiltration by inflammatory cells. Electron microscopic features confirmed the degenerative damages in the endothelial cells. Conclusion: Our histopathological studies suggest that the main focus of the viral damage is the endothelial cells (endotheliopathica) in involved organs. Also, our findings suggest that degeneration of leukocytes occurs at the site of inflammation and release of cytokines (leukocytoclastica) resulting in a cytokine storm. [ABSTRACT FROM AUTHOR]

Background: To evaluate ultrasound (US) characteristics and BI-RADS (Breast imaging-reporting and data system) of malignant breast masses in women <40 years and to compare with older patients. Methods: In a retrospective, descriptive-analytical study, we assessed the US images and BI-RADS category of 78 malignant masses with a final pathology of invasive ductal carcinoma (IDC, NOS type). Results: Overall, the most frequent US descriptors of IDC were indistinct margin (45%), irregular shaped (63.5%), posterior shadowing (38.8%), heterogeneous internal echogenicity (56.3%) and non-parallel orientation (76.3%). In this study, most malignant masses of young patients were categorized as BI-RADS 4a while in the older patients (over 40), they were mostly BI-RADS 4b and 5 with P = 0.03 and odds ratio (OR) of 2.57 (95% confidence interval (CI), 0.74-8.8). In addition, the mean dimension of the mass in young cases was greater (18.3 mm) compared with older patients (13.2 mm) with P value of 0.04 and OR of 3.8 (95% CI, 1.1-13.4). Conclusion: Similar to previous studies, malignant masses were diagnosed in greater dimensions in younger cases which may be due to the delay in diagnosis, the rapid growth of the tumor and the absence of routine screening guidelines. Radiologists should be aware of the possibility of malignancy in palpable slightly suspicious masses (BI-RADS 4A) in young cases. [ABSTRACT FROM AUTHOR]

Background: Raised blood pressure is a serious risk factor for several non-communicable diseases (NCDs) in Iran. In this study, we aimed to estimate the mean of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and subsequently, the prevalence of hypertension by sex, age, province, and year in Iran. Methods: We conducted a systematic review using PubMed, Web of Science, and Scopus databases through December 2017. We also used individual level data from eight national surveys, aggregated data from seven subnational population-based studies, and extracted data reported in 52 published studies. We used a two-stage model including Age-Spatio-Temporal and Gaussian process regression (GPR) to estimate mean systolic and diastolic blood pressure and used a crosswalk model to estimate the prevalence of hypertension by sex, age, province, and year. Results: The number of hypertensive adults increased in Iran from 1.8 million (882 thousand in women) in 1990 to 13.6 million (7.2 million in women) in 2016. The national age-standardized prevalence of hypertension increased from 8.7% (7.8--9.7) to 28.8% (27.7--30.0) in women and from 8.0% (7.2--8.9) to 24.2% (23.1--25.3) in men from 1990 to 2016. Mean systolic and diastolic blood pressures show a similar increasing trend. Conclusion: During the past 27 years, we observed an increase in the age-standardized prevalence and mean levels of blood pressure. If the current trend in levels of blood pressure and prevalence of hypertension continue in the coming years, Iran will not achieve the sixth target of the Global Action Plan by 2020 and the Sustainable Development Goals (SDGs) by 2030. Keywords: Epidemiology, Hypertension, Iran, Public Health [ABSTRACT FROM AUTHOR]

Background: Since December 2019, the world has been facing one of the most critical health threats of the last decades. In March 2021, the official number of deaths passed 2.6 million worldwide. Most countries have developed policies to control the disease. Nevertheless, countries have experienced different outcomes related to their various adapted policies. Complementing our first report, in this article, we report our findings of comparing the policies adopted to combat coronavirus disease 2019 (COVID-19) in Iran, with those from nine selected countries, including China, Japan, South Korea, Singapore, Germany, the United States, the United Kingdom, Spain, and Italy, to draw evidence-informed policy lessons. Methods: This is a qualitative study conducted based on document analysis related to COVID-19 policies in Iran and nine selected countries. Using a deductive approach, data were extracted and analyzed based on the components of the WHO Building Blocks Framework. Finally, we compared the Iranian policies with the nine selected countries. Results: Documents analysis revealed a spectrum of policies, which have led to a variety of outcomes. Based on our findings, three main strategies (widespread testing, comprehensive contact tracing, and timely measures) were the most effective directions to combat COVID-19. Conclusion: The experience of the first and second waves of COVID-19 showed that the risk of coronavirus is serious and will continue until a vaccine or decisive treatment is achieved. Therefore, countries are required to adopt appropriate and tailored policies to deal with this crisis effectively. Applying the experiences from the previous waves is essential for more efficient performance in the likely upcoming waves. INSET: 260. [ABSTRACT FROM AUTHOR]

Neurotrauma (NT) is one of the common causes of mortality and morbidity. Investigating the role of people who had an impact on the development of knowledge of NT is reasonable. Our aim is to investigate the role of Bizhan Aarabi, professor of Neurosurgery, on the knowledge development in NT. Accordingly, we searched the Scopus database for Bizhan Aarabi on August 8, 2020 and selected papers with at least 10 citations, investigating his impact on NT and details of his publications. He has published 168 papers including original articles, reviews, conference papers, letters, and editorials according to the Scopus databases. There are 112 papers with 10 or more citations. Thirty-eight out of 112 papers (33.9%) were in the first and the highest rank journal: 29 in Neurosurgery and 9 in the Journal of Neurotrauma. Twenty-four papers have the level of evidence (LOE) of "1". Bizhan Arabi developed knowledge in NT especially in the cervical spine/spinal cord trauma and brain injury and his publications are references for spine/neurosurgeons.e [ABSTRACT FROM AUTHOR]

Background: The scientific evidence concerning pathogenesis and immunopathology of the coronavirus disease 2019 (COVID-19) is rapidly evolving in the literature. To evaluate the different tissues obtained by biopsy and autopsy from five patients who expired from severe COVID-19 in our medical center. Methods: This retrospective study reviewed five patients with severe COVID-19, confirmed by reverse transcription-polymerase chain reaction (RT-PCR) and imaging, to determine the potential correlations between histologic findings with patient outcome. Results: Diffuse alveolar damage (DAD) and micro-thrombosis were the most common histologic finding in the lung tissues (4 of 5 cases), and immunohistochemical (IHC) findings (3 of 4 cases) suggested perivascular aggregation and diffuse infiltration of alveolar walls by CD4+ and CD8+ T lymphocytes. Two of five cases had mild predominantly perivascular lymphocytic infiltration, single cell myocardial necrosis and variable interstitial edema in myocardial samples. Hypertrophic cardiac myocytes, representing hypertensive cardiomyopathy was seen in one patient and CD4+ and CD8+ T lymphocytes were detected on IHC in two cases. In renal samples, acute tubular necrosis was observed in 3 of 5 cases, while chronic tubulointerstitial nephritis, crescent formation and small vessel fibrin thrombi were observed in 1 of 5 samples. Sinusoidal dilation, mild to moderate chronic portal inflammation and mild mixed macro- and micro-vesicular steatosis were detected in all liver samples. Conclusion: Our observations suggest that clinical pathology findings on autopsy tissue samples could shed more light on the pathogenesis, and consequently the management, of patients with severe COVID-19. [ABSTRACT FROM AUTHOR]

Background: Current and daily smoking prevalence rates have been have investigated in several cross-sectional studies. However, analyses in terms of age-period-cohort (APC) have not been carried out. We assessed daily smoking dynamics over a 25-year period using the APC model. Methods: In our analyses, we used data from 214,652 people aged 15 to 64 years, collected by national health surveys conducted in 1990-1991, 1999, 2005, 2007, 2011 and 2016. The Intrinsic Estimator model was used to analyze the impact of APC on daily smoking prevalence. Results: Males were found to exhibit a higher prevalence of smoking compared to females (26.0% against 2.7%). Prevalence of smoking increased by age, peaking at the age groups of 40-44 in men and 45-49 in women, followed by a decreasing trend. The 1990 period had the highest prevalence in both genders, and the 2016 period had the lowest. The coefficients of birth cohort effects showed different patter19s of fluctuations in the two genders with the maximum and minimum coefficients for men calculated in the 1966-1970 and 1991-95 birth cohorts, and for females the 1931-1935 and 1971-1975 birth cohorts, respectively. Conclusion: We showed the impact of APC on daily tobacco smoking prevalence, and these factors should be considered when dealing with smoking. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels. Methods: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death). Results: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20). Conclusion: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for longterm cardiac complications of this infection. [ABSTRACT FROM AUTHOR]

Background: The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic broke out in December 2019 and is now characterized as a pandemic. Effective control of this infectious disease requires access to diagnostic techniques, for both case finding and epidemic size estimation. The molecular technique is routinely used worldwide. Although it is the "standard" case detection and management method, it has its own shortcomings. Thus, some easy-to-use rapid serological tests have been developed. Methods: One hundred and fourteen positive RT-PCR-diagnosed patients were tested by VivaDiag Kit, a brand of rapid serological kits available in hospitals affiliated to Tehran University of Medical Sciences (TUMS), Tehran, Iran. Frozen serum specimens taken from healthy people in summer and fall 2019 were also tested as negative controls. Results: Test sensitivity was 47.9% (95% confidence interval [CI]: 38.8-56.9) for IgM and 47.0% (95% CI: 38.0-56.0) for IgG. There was no difference between IgG and IgM seropositivity except in one case. Specificity was calculated as 99.0% (95% CI: 96.4--99.9) for IgM and of 100.0% (95% CI: 0.98.2--100.0) for IgG. Sensitivity was higher in men and older participants. Conclusion: This test can be used for epidemiological investigations, especially for the estimation of the level of infection in the community, after it is properly corrected for sensitivity and specificity. The low sensitivity could be attributed to the technical limitations of the kit or low levels of antibodies after infection. The different sensitivity in age and sex groups supports the hypothesis that different people show different immune responses to this virus. [ABSTRACT FROM AUTHOR]

Background: There is a possible association between celiac disease (CD) and juvenile idiopathic arthritis (JIA). Our aim was to evaluate the serological incidence of CD in patients with JIA. Children under 16 years of age with JIA who did not respond adequately to routine treatment, who referred to the pediatric centers of Tehran University of Medical Sciences (2017-2019), were enrolled in this study. Manifestations of CD were also evaluated. CD-related serological screening tests were measured. Seventyeight patients were enrolled in the study. Their mean age was 7.9 ± 3.9 (1.6-16) years. Three patients with oligoarticular JIA had Anti-TTG-Ab levels above normal (prevalence = 3.8%). None of them had symptoms of CD. There were no significant statistical differences in terms of growth disorders, sex distribution, and different subtypes of JIA (P value > 0.05) between the groups (seropositive vs. sero-negative). In one case, CD was confirmed by pathology and the gluten-free diet was recommended. The absence of CD symptoms in patients with JIA does not rule out concomitant CD. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is one of the most preventable causes of death worldwide. We aimed to determine the trend of mortality due to appendicitis by sex and age at national and provincial levels in Iran during 26 years. Methods: Data were collected from Iran Death Registration System (DRS), cemetery databanks in Tehran and Esfahan, and the national population and housing censuses of Iran. The estimated population was determined for each group from 1990 to 2015 using a growth model. Incompleteness, misalignment, and misclassification in the DRS were addressed and multiple imputation methods were used for dealing with missing data. ICD-10 codes were converted to Global Burden of Disease (GBD) codes to allow comparison of the results with the GBD study. A Spatio-Temporal model and Gaussian Process Regression were used to predict the levels and trends in child and adult mortality rates, as well as cause fractions. Results: From 1990 to 2015, 6,982 deaths due to appendicitis were estimated in Iran. The age-standardized mortality rate per 100 000 decreased from 0.72 (95% UI: 0.46-1.12) in 1990 to 0.11 (0.07-0.16) in 2015, a reduction of 84.72% over the course of 26 years. The male: female ratio was 1.13 during the 26 years of the study with an average annual percent change of -2.31% for women and -2.63% for men. Among men and women, appendicitis mortality rate had the highest magnitude of decline in the province of Zanjan and the lowest in the province of Hormozgan. In 1990, the lowest age-standardized appendicitis-related mortality was observed in both women and men in the province of Alborz and the highest mortality rate among men were observed in the province of Lorestan. In 2015, the lowest mortality rates in women and men were in the province of Tehran. The highest mortality rates in women were in Hormozgan, and in men were in Golestan province. Conclusion: The mortality rate due to appendicitis has declined at national and provincial levels in Iran. Understanding the causes of differences across provinces and the trend over years can be useful in priority setting for policy makers to inform preventive actions to further decrease mortality from appendicitis. [ABSTRACT FROM AUTHOR]

Background: Projection of mortality rates is essential for policy making and planning of health services. Premature mortality, as an important index, commonly refers to deaths occurring before 70 years of age. This study was conducted to estimate the trend of premature deaths from 2006-2015 and to project premature deaths for the 2016-2030 period. Methods: We used national mortality data collected by the Ministry of Health and Medical Education's Deputy of Health, and population data from the Statistical Center of Iran. Mortality and population data were categorized based on sex and 5-year age groups. The Bayesian hierarchical model was used to project future premature mortality rates through 2030. Results: Age-standardized all-cause premature mortality declines from 414.3 per 100 000 persons in 2010 to 300.3 per 100 000 persons in 2030 (27.5%) for men, and from 230.6 per 100 000 persons in 2010 to 197.2 per 100 000 persons in 2030 (14.5%) for women. In all age groups, the percent reduction of premature mortality was greater for men than women. Conclusion: Overall, it is projected that premature mortality will witness a declining trend in both sexes in Iran. Accordingly, we would expect to achieve less than a third reduction in premature mortality by 2030, which is one of the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is now of global concern due to its rapid dissemination across the globe. The rapid spread of this viral infection, along with many of its unknown aspects, has posed new challenges to the health care systems. The main challenging effects of COVID-19 are rapid dissemination through close contact and varying clinical severity among different individuals. Furthermore, the medical staff in endemic areas are becoming exhausted and deal with a considerable level of job burnout, which can negatively affect their medical decision making. Also, due to the variable pulmonary manifestations of COVID-19, some physicians may misdiagnose patients. To overcome these issues, we proposed a web-based software to aid physicians in detecting possible COVID-19 cases through online consultation with different specialists and educate the not-well experienced physicians. Our results demonstrated that this software could improve the diagnostic rate for not-well experienced physicians. [ABSTRACT FROM AUTHOR]