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Development of the first Iranian clinical practice guidelines for the diagnosis, treatment, and secondary prevention of acute coronary syndrome
No full textBackground: This article introduces the first national guidelines for the management including diagnosis, treatment, and secondary prevention of acute coronary syndrome (ACS) in Iran. Materials and Methods: The members of the guideline development group (GDG) were specialists and experts in fields related to ACS and were affiliated with universities of medical sciences or scientific associations in the country. They carefully examined the evidence and clinical concerns related to ACS management and formulated 13 clinical questions that were sent to systematic review group who developed related evidence using Grade method. Finally the GDG developed the recommendations and suggestions of the guideline. Results: The first three questions in the guideline focus on providing recommendations for handling a patient who experience chest pain at home, in a health house or center, during ambulance transportation, and upon arrival at the emergency department (ED) as well as the initial diagnostic measures in the ED. Subsequently, the recommendations related to the criteria for categorizing patients into low, intermediate and high-risk groups are presented. The guideline addressed primary treatment measures for ACS patients in hospitals with and without code 247 or having primary percutaneous coronary intervention (PCI) facilities, and the appropriate timing for PCI based on the risk assessment. In addition, the most efficacious antiplatelet medications for ACS patients in the ED as well as its optimal duration of treatment are presented. The guideline details the recommendations for therapeutic interventions in patients with ACS and acute heart failure, cardiogenic shock, myocardial infarction with nonobstructive coronary arteries (MINOCA), multivessel occlusion, as well as the indication for prescribing a combined use of anticoagulants and antiplatelet during hospitalization and upon discharge. Regarding secondary prevention, while emphasizing the referral of these patients to rehabilitation centers, other interventions that include pharmaceutical and nonpharmacological ones are addressed, In addition, necessary recommendations for enhancing lifestyle and posthospital discharge pharmaceutical treatments, including their duration, are provided. There are specific recommendations and suggestions for subgroups, such as patients aged over 75 years and individuals with heart failure, diabetes, and chronic kidney disease. Conclusion: Developing guidelines for ACS diagnosis, treatment and secondary prevention according to the local context in Iran can improve the adherence of our health care providers, patients health, and policy makers plans
Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey
No full textBackground: One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran. Methods: We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household’s capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE. Findings: : The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP. Conclusion: The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status househol
Developing and validating a risk assessment method for noise-induced hearing loss in workers
No full textVarious risk factors can affect noise-induced hearing loss (NIHL) among employees. This research sought to establish and validate a risk assessment method for NIHL using these risk factors. This cross-sectional research was carried out with 220 workers from a steel manufacturing facility. At first, their demographic characteristics and information related to the studies’ items were gathered by the researcher-made questionnaire. In the next step, the noise exposure values of the participants were measured by the sound pressure level meter based on the ISO 9612 standard. Moreover, a pure tone audiometric test of bone and air conduction was used to measure hearing loss in people. Ultimately, a new index for risk assessment was created. Indirect effect coefficients of individual factors such as work experience, age, smoking, and effective diseases were 0.266, 0.227, 0.056, and 0.064, respectively. The coefficients of noise exposure items including occupational noise and leisure noise were obtained as 0.687 and 0.660. The personal protective equipment (PPE) items including use of PPE, noise reduction rating of PPE, and awareness of PPE were 0.194, 0.147, and 0.127, respectively. These coefficients were utilized to create a new index. The overall score of the index was divided into four categories using optimal cut-off values of 4.85, 6.84, and 7.59. According to the findings, the OHLRA methods were able to account for 74 percent of the hearing loss values. The results showed that the novel index for risk assessment had proper validity in the prediction of NIHL
Evaluation of an Epidemiological Skills Laboratory Course Using a Direct Teaching and Online Flipped Classroom Method in Iran: An Interventional Study
No full textBackground and aims: The epidemiological skills laboratory (ESL) course has been incorporated into the curriculum for Master of Science students in epidemiology. However, it has not been implemented and evaluated in Iran so far. The present study was conducted to compare two teaching methods and the implementation of an ESL lesson. Methods: All MSc students (N = 9) in epidemiology at Shahrekord University of Medical Sciences were included in the study during two academic semesters in 2019-2020 using a census sampling method. Three levels of Kirkpatrick’s pyramid were used to evaluate direct teaching and electronic flipped classroom (FC) groups. The Chi-square test, Fisher’s exact test, paired t-test, and independent t-test were used in Stata software with a significance level < 0.05. Results: The means ± standard deviations (SD) of scores of pre-and post-instructional interventions were 42.1 ± 8.4 and 96.6 ± 2.1 in the intervention group with the FC method and 41.3 ± 3.2 and 77.3 ± 4.7 in the direct teaching group. The means ± SDs of satisfaction scores of pre-and post-instructional interventions were 67.8 ± 1.6 and 97.6 ± 5.6 in the intervention group with the FC method and 45.3 ± 5 and 87.3 ± 4.5 in the direct teaching group. Conclusion: Under the conditions of the coronavirus disease 2019 epidemic, mainly the virtualization of students’ education and easy access to virtual education systems to convey instructional content, it is a pleasurable opportunity to use the electronic FC method to teach students. The FC method could improve the students’ epidemiological skills and increase their satisfaction
Lamiaceae plants improve serum cholesterol, triglyceride, and LDL in patients with metabolic syndrome: A systematic review and meta‐analysis of randomized clinical trials
No full textThe Lamiaceae plant family has a positive impact on metabolic diseases. This study meta-analyzed the data of different clinical trial studies on the impacts of these plants on blood lipid biomarkers including cholesterol, triglyceride, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). A comprehensive search was conducted using PubMed, Scopus, ISI Web of Science, ProQuest, Scientific Information Database, MagIran, and Google Scholar to identify relevant published research up to December 20, 2023. The meta-analysis revealed that the Lamiaceae family significantly reduced cholesterol (p 8 weeks) only LDL level is improved in the blood (p <.05). In addition, Lamiaceae plants specifically decreased LDL and cholesterol levels in diabetic patients and only LDL levels in the individuals who were hyperlipidemic or overweight/obese. Within the Lamiaceae family, the genera Satureja and Coleus had the most significant effects in decreasing triglyceride and LDL/cholesterol levels, respectively. Origanum was the only genus within the Lamiaceae family that significantly improved three lipid parameters (cholesterol, LDL, and HDL). The meta-analysis confirmed that Lamiaceae plants could improve the levels of lipid parameters (triglyceride, cholesterol, and LDL) in patients with metabolic syndrome
Cardiac magnetic resonance imaging in repaired tetralogy of Fallot: A longitudinal midterm follow-up study
No full textBackground Biventricular dysfunction is frequent in patients with repaired tetralogy of Fallot, necessitating routine imaging to monitor for worsening conditions and determine whether procedures like pulmonary valve replacement (PVR) are needed. This study aimed to highlight the parameters of cardiac magnetic resonance imaging (CMR) and their association with adverse outcomes in the midterm follow-up of these patients. Methods This longitudinal study recruited all patients with a history of tetralogy of Fallot total correction (TFTC) who had two CMR images at a minimum three-month interval at Rajaie Center from 2007 through 2017. Results Fifty-six patients at a mean age of 15.23 ± 11.66 years at TFTC and a 1:1 gender distribution were assessed. Regarding adverse events, PVR was done on 18 patients (32%). Right and left ventricular dysfunction occurred in 43 (76.8%) and 18 (32.1%) patients, respectively. Death did not occur in the present study. RVOT fibrosis was present in 47 (92.2%). The stroke volume of both ventricles increased during the follow-up (P <0.05), although end-diastolic volume indices, end-systolic volume indices, ejection fractions, strain parameters, and ventriculoarterial coupling did not change significantly. Patients requiring PVR had a significantly higher end-systolic volume index in both ventricles (P <0.05) and a lower right-sided ejection fraction (P <0.01) and coupling ratio (P <0.05). The ejection fraction in the left ventricle correlated with global circumferential strain (P <0.01), while in the right ventricle, it correlated with global longitudinal strain (P <0.05) and the right-sided coupling ratio (P <0.01). Conclusion Myocardial strain and ventriculoarterial coupling parameters could underscore personalized-approached therapy and follow-up to improve outcome
Characterizing the Impact of Dysregulated Micrornas on CRISP3 Isoforms in Male Infertility
No full textmicroRNAs (miRNAs) have a serious and dynamic function in spermatogenesis. These molecules have been recognized as crucial parts of the control of gene activity, and their involvement in the regulation of target genes has been extensively studied. This research aimed to determine the expression of CRISP3 and miR-493-5p, miR-204-5p, and miR-182-5p in the seminal plasma fluid and spermatozoa and to examine the relationship between CRISP3 and the mentioned miRNAs in 57 infertile men with Asthenozoospermia (AZ) (n = 19), Teratoasthenozoospermia (TAZ) (n = 19), and Normozoospermia (NZ) (n = 19). The selection of these three miRNAs, miR-493-5p, miR-204-5p, and miR-182-5p, was conducted using computational prediction algorithms. These miRNAs were nominated as CRISP3-associated miRNAs that can target CRISP3. We performed the quantitative real-time polymerase chain reaction (qRT-PCR) method to determine the levels of the studied miRNA expression. In the following stage, the expression of two protein isoforms of CRISP3, targeted by these miRNAs, was quantified using western blotting. The results demonstrate significant differences in the levels of miR-182-5p, miR-204-5p, miR-493-5p, and CRISP3 isoforms among the patient groups. In TAZ individuals, miR-182-5p and miR-204-5p expression decreased, while miR-493-5p expression increased compared to the control samples. Additionally, significant differences were observed in the expression levels of unglycosylated and glycosylated CRISP3 isoforms between the AZ and NZ groups. Correlation analysis revealed associations between miRNA expression and the expression of CRISP3 isoforms in the patient groups. Additionally, there were correlations between the expression of CRISP3 isoforms and sperm motility and morphology. These results offer valuable insights into the underlying molecular processes associated with male infertility
The association between soft drinks consumption and risk of mental disorders among Iranian adults: The LIPOKAP study
No full textObjective: With rising demand for soft drinks (SDs) in low-income countries, studies examining mental disorders in relation to SDs are rather scarce. Therefore, we aimed to explore this association in a sample of Iranian adults. Methods: This cross-sectional study was carried out within the framework of the multi-centric LIPOKAP project, with 1970 Iranian healthy adults. Dietary intake and symptoms of depression and anxiety were collected using validated, Persian versions of a food frequency questionnaire and a Hospital Anxiety and Depression Scale (HADS), respectively. Artificial juices were considered fruit-flavored carbonated sugar beverages, sugar-sweetened beverages (SSB) included fruit-flavored carbonated sugar beverages and carbonated colas, and soft drinks included SSB and drinks containing non-nutritive sweeteners. Results: The mean age of the participants was 39.8 ± 13.9 years. Compared to lower intake, higher intake of SDs (OR = 1.30, 95 % CI: 1.01, 1.69; P = 0.041), SSBs (OR = 1.30, 95 % CI: 1.00, 1.67; P = 0.045) and artificial juice (OR = 1.63, 95 % CI: 1.24, 2.13; P < 0.001) was associated with higher risk of depression in adjusted model. These associations were sex-specific and more evident in males. No significant association was found between any of the drinks and anxiety risk except for artificial juice in men which was directly associated with anxiety risk (OR = 1.66, 95 % CI: 1.06, 2.61; P = 0.028). Conclusion: This study found a positive association between SDs, SSBs and artificial juice and depression, but not anxiety. These associations varied between men and women. Prospective cohort studies are warranted to confirm our results and reveal the causal relationshi
Bone loss and fracture in people with multiple sclerosis: A systematic review and meta-analysis
No full textBackground: People with multiple sclerosis (PwMS) exhibit reduced bone mineral density (BMD) across several anatomical regions. Studies have indicated that PwMS are at a heightened risk of fractures due to decreased BMD and increased prevalence of osteopenia and osteoporosis. This study aimed to investigate the prevalence and risk of osteopenia, osteoporosis, and fracture among PwMS. Methods: Relevant studies were identified through comprehensive searches of databases (PubMed/MEDLINE, Scopus, Embase, and Web of Science) from January 1, 2000, to January 21, 2024. R software version 4.4.0 and random-effects models were employed to estimate the pooled prevalence, odds ratio (OR), and risk ratio (RR) of osteopenia, osteoporosis, and fracture among PwMS, along with their respective 95 % confidence intervals (CIs). Results: From a total of 2039 articles, 51 studies with 1,503,785 PwMS met our inclusion criteria. The pooled prevalence of osteopenia, osteoporosis, and overall fracture among PwMS was 41.41 % (95 % CI: 36.14% to 46.69 %, I2=97 %), 14.21 % (95 % CI: 10.75 % to 17.68 %, I2=99 %), and 12.84 % (95 % CI: 8.49 % to 17.19 %, I2 = 100 %), respectively. The likelihood of osteopenia (OR=2.02, 95 % CI: 1.46 to 2.8, p-value<0.01, I2=17 %) and osteoporosis (OR=1.71, 95 % CI: 1.27 to 2.31, p-value<0.01, I2=74 %), as well as the probability of overall fracture (RR=1.86, 95 % CI: 1.61 to 2.14, p-value<0.01, I2=74 %) were significantly higher in PwMS than healthy controls (HCs). Conclusion: PwMS were at a substantially increased risk of developing osteopenia (2-fold), osteoporosis (1.7-fold), and overall fractures (1.9-fold). Well-designed studies are needed to explore these associations further
Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021
No full textBackground: Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. Methods: Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). Findings: In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311–0·414) per 100 000. Mortality rates ranged from 1·01 (0·895–1·13) per 100 000 in central Latin America to 0·054 (0·0464–0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174–274) per 100 000, corresponding to 17 million (13·8–21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286–475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9–109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. Interpretation: Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. Funding: Bill and Melinda Gates Foundation