The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis

Objectives@#This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. @*Methods@#We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. @*Results@#A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. @*Conclusion@#Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.

Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study / 한국역학회지

OBJECTIVES: This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran. METHODS: Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants. RESULTS: The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index. CONCLUSIONS: Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.

Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study / 한국역학회지

OBJECTIVES: This study aimed to measure the level and determinants of health-related quality of life (HRQoL) in adults in Kermanshah, a city in the western region of Iran.METHODS: Convenience sampling was employed to obtain a sample of 998 adults aged 18 years and older (646 males and 352 females) in the city of Kermanshah. A 2-part self-administered questionnaire was used to collect data over the period between March 1 and May 30, 2017. The first part was designed to collect information on socio-demographic characteristics, socioeconomic status, and lifestyle factors (10 items). The second part consisted of the EuroQoL 5-dimensions (EQ-5D) EuroQoL-3-level and the EuroQoL visual analog scale (EQ-VAS) questions. A multiple linear regression model was used to determine the factors associated with the EQ-5D index and EQ-VAS score among study participants.RESULTS: The mean values for the EQ-5D index and the EQ-VAS score were 0.74 (standard deviation [SD], 0.19) and 80.9 (SD, 16.5), respectively. The highest percentage of self-reported problems (‘some’ and ‘severe’ problems) across the 5 dimensions of the EQ-5D index were associated with the dimensions of anxiety/depression (35.3%) and pain/discomfort (32.9%). The percentage of self-reported problems for the dimensions of usual activities, mobility, and self-care were 19.0, 12.8, and 8.9%, respectively. Our regression analyses indicated that there were statistically significant positive associations between being physically active, monthly household income per capita, and post-secondary education and the EQ-5D index and EQ-VAS score. In contrast, negative associations were found between older age, being married, having a chronic disease, and smoking and the EQ-5D index and EQ-VAS score. A negative association was also found between being uninsured and the EQ-5D index.CONCLUSIONS: Our findings suggest that interventions aiming to improve physical activity, to prevent chronic diseases, and to reduce the smoking rate among adults living in the city of Kermanshah may improve their HRQoL.

Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran / 한국역학회지

OBJECTIVES: The aim of this study was to measure the health-related quality of life (HRQoL) and to evaluate the factors affecting HRQoL in individuals with health insurance in Tehran, Iran. METHODS: A cross-sectional analytical study was conducted using the 3-level EuroQol 5-dimensions (EQ-5D) questionnaire. In order to estimate the determinants of HRQoL, information about participants’ demographic, socioeconomic, and health status was gathered. The cluster sampling technique was used to collect data from May to June, 2016. The chi-square test and weighted least squares method were employed for data analysis. Data were analyzed using Stata version 11.0. RESULTS: A total of 600 Iranians with insurance completed the study, of whom 327 (54.5%) were male and 273 (45.5%) were female. The mean age of the participants was 41.48 years (standard deviation [SD], 14.60 years). Meanwhile, the mean duration of education was 12.36 years (SD, 4.68 years). The mean EQ-5D score was 0.74 (SD, 0.16). The most common health problems in the participants were anxiety/depression (42.3%), followed by pain/discomfort (39.2%). Sex, age, years of schooling, income, chronic disease, and body mass index had a significant effect on HRQoL (p<0.05). Healthy insured individuals, on average, had a HRQoL score 0.119 higher than that of people with a chronic disease, all else being equal (p<0.001). CONCLUSIONS: Among all determinants of HRQoL, chronic disease was found to be the highest priority for interventions to improve the health status of Iranians with insurance. This finding can help policymakers and health insurance organizations improve their planning to promote the HRQoL of individuals with insurance and society as a whole in Iran.

Comparison of toxicity of CdSe: ZnS quantum dots on male reproductive system in different stages of development in mice

Background: Quantum dots [QDs] are new types of fluorescent materials for biological labeling. QDs toxicity study is an essential requirement for future clinical applications. Therefore, this study aimed to evaluate cytotoxic effects of CdSe: ZnS QDs on male reproductive system

Materials and Methods: In this experimental study, the different concentrations of CdSe: ZnS QDs [10, 20 and 40 mg/kg] were injected to 32 male mice [adult group] and 24 pregnant mice [embryo group] on day 8 of gestation. The histological changes of testis and epididymis were studied by a light microscopy, and the number of seminiferous tubules between two groups was compared. One-way analysis of variance [one-way Anova] using the Statistical Package for the Social Sciences [SPSS, SPSS Inc., USA] version 16 were performed for statistical analysis

Results: In adult group, histological studies of testis tissues showed a high toxicity of CdSe: ZnS in 40 mg/kg dose followed by a decrease in lamina propria; destruction in interstitial tissue; deformation of seminiferous tubules; and a reduction in number of spermatogonia, sper-matocytes, and spermatids. However, there was an interesting result in fetal testis development, meaning there was no significant effect on morphology and structure of the seminiferous tubules and number of sperm stem cells. Also histological study of epididymis tissues in both groups [adult and embryo groups] showed no significant effect on morphology and structure of tubule and epithelial cells, but there was a considerable reduction in number of spermatozoa in the lumen of the epididymal duct in 40 mg/kg dose of adult group

Conclusion: The toxicity of QDs on testicular tissue of the mice embryo and adult are different before and after puberty. Due to lack of research in this field, this study can be an introduction to evaluate the toxicity of QDs on male reproduction system in different stages of development

Assessing the accessibility and degree of development in health care resources: evidence from the West of Iran

Introduction: health care is one of the most important sectors in the development of each country and disparities in their distribution will reduce the level of development. The aim of this study was to examine the access to healthcare and degree of development in health care resources in the west of Iran in 2011

Method: this was a cross-sectional and retrospective study. The study setting was 51 cities of five western provinces of Iran, including Kermanshah, Kurdistan, Ilam, Lorestan and Hamadan. For assessing these towns in terms of the degree of development in healthcare resources by the numerical taxonomy technique, 23 indicators of health resources were selected and obtained from the statistics yearbook. The data was analyzed by EXCEL software

Results: our study showed that the highest and lowest access to health care based on numerical taxonomy belonged to cities of Kermanshah [0.61] and Salas Babajani [1.07]. Also, most towns of Ilam, Lorestan and Kurdistan provinces are underdeveloped and developing, while the most towns of Kermanshah and Hamadan provinces were placed in the developed region

Conclusion: this study showed that there was a large gap between the cities of one province and also among the provinces in terms of the access to and degree of development in health care resources. Therefore, it is suggested that a higher priority in terms of health resource allocation should be placed on the developing and underdeveloped areas in order to reduce these disparities

Relationship between prooxidant-antioxidant balance and severity of coronary artery disease in patients of Imam Khomeini hospital of Tehran, Iran

The balance between reactive oxygen species production and antioxidant activity has an important role in oxidative stress associated diseases including coronary artery disease. In this study, the prooxidant-antioxidant balance [PAB] and its correlations with serum lipid levels, uric acid levels, and severity of coronary artery involvement were examined. The aim of this study was to determine the diagnostic value of PAB as a predictor in coronary artery disease [CAD]. Seventy two patients and 68 healthy subjects were selected. PAB was determined using standard solutions and ELISA. Triglyceride, total cholesterol, LDL- cholesterol, HDL-cholesterol and uric acid levels were measured by enzymatic method. Mean PAB was 66.4 +/- 2.84 [HK units] in healthy people, 77.37 +/- 33.51 [HK units] in patients with one vessel CAD, 63.76 +/- 29.47 [HK units] in patients with two vessel CAD and 68.59 +/- 24.51 [HK units] in patients with three or more vessel CAD. There was no significant difference between PAB values in different severity groups [P=0.41]. PAB significantly and indirectly correlated with uric acid level in two vessels CAD. The study shows that PAB can be a predictor of CAD associated with other risk factors, but not alone

[ effect of calcium and vitamin D consumption and combined training on parathyroid hormone and alkaline phosphatase of postmenopausal women]

The role of mechanical stress [sport] on bone under the effect of physical exercise in calcium and phosphorus metabolism was investigated first by RedHall [1999] 23. In this regard, the researches investigated the effect of various exercise on bone density and its markers. Thirty healthy postmenopausal women with mean age 54.85 years and 68.35 kg weight has been randomly selected from among retired employees in Kerman city. Their age range was 48-60 years were participating in this research and were divided into three groups. The first group included combined sport, the second group combined sport with calcium [1500 mg] and vitamin D [1600 IU] intake and the third group were taking calcium [1500 mg] and vitamin D [1600 IU]. The combined sport included some physical practices such as weight exercises, aerobic exercises, jump and agility exercises and they practice in 6 month, 3 sessions a week, and at least for 60 minutes.Evaluating the level of calcium, vitamin D, parathyroid hormone and alkaline phosphatase enzyme was done by blood test with enzyme synthetic method. After applying independent variable, the primary measurement was repeated again. With the test of kelmogrove-smirnov the analysis of one-way variance and post hoc test was used for checking the variables relationship. The amount of calcium, vitamin D, parathyroid hormone and alkaline phosphatase enzyme to arrange in sport - drug, drug and sport groups was significantly higher. The combined sport [excersice] caused an increase in bone reconstruction and increased alkaline phosphatase enzyme in post menopausal women. Increasing the process of involved enzymes in bone building, prevents delay of osteoprosis, and leads to improvement in nervo-muscular function

Temperature increase during different post space preparation systems: an in vitro study

The purpose of this study was to evaluate external root surface temperature rise during post space preparation using LA Axxess bur, Beefill pack System, and Peeso Reamer drill. The distal canals of forty-five extracted human permanent mandibular first molars were instrumented in crown-apical manner and obturated with lateral condensation technique. Teeth were then randomly divided into three groups according to post space preparation technique including: group 1. LA Axxess bur [Sybronendo Co., CA, USA], group 2 Beefill pack System [VD W Co., Munich, Germany] and group 3 Peeso Reamer drill [Mani Co., Tochigi-ken, Japan]. Temperature was measured by means of digital thermometer MT-405 [Comercio Co., Sao Paulo, Brazil] which was installed on the root surfaces. Data was collected and submitted to one-way ANOVA and Post hoc analysis. Root surface temperatures were found to be significantly higher [7.3 +/- 2.7 vs. 4.3 +/- 2.1 and 4 +/- 2.4,] in samples of Beefill pack System compared with the two other groups [P<0.02]. Using Beefill pack System during post space preparation may be potentially hazardous for periodontal tissues

[ clinical outcome of patients with acute coronary syndrome without critical stenosis in angiography: a prospective cohort study]

Previous studies were suggestive of a good prognosis in patients with acute coronary syndrome [ACS] and absence of any critical stenosis in coronary angiography but recent limited reports have revealed that patients with non-obstructive acute coronary syndrome are at a higher risk of future clinical coronary events. A concurrent prospective cohort study was designed and 146 male patients with ACS and non-obstructive coronary artery disease were regarded as the unexposed group, while 191 female patients with non-obstructive coronary artery disease were regarded as the exposed group. Coronary events were recorded within one year of follow-up. Prognostic factors were evaluated at baseline by using a standardized protocol. Of the 337 patients with ACS, 191 [56.6%] were female. Coronary events in female patients after one year of follow-up were: ST EMI 3 [1.6%], unstable angina pectoris 22 [11.5%], Q-wave MI 1 [0.5%] and no syncope. In male patients the outcomes were: ST EMI 4 [2.7%], unstable angina pectoris 29 [19.9%], Q-wave MI 1 [0.7%], and syncope 1 [0.7%]. Multivariate adjusted relationships revealed that physical inactivity [P=0.035], dyslipidemia [P=0.001], low ankle brachial index [P=0.024] and age between 40-50 years [P=0.004] were significantly associated with coronary events in women. In male patients, body mass index of 30-39.99 [P=0.011] was associated with a higher rate of ST-segment elevated MI. Prognostically, coronary events and clinical endpoints were significantly different between men and women with acute coronary syndrome. Persistence of symptoms over one year seems to relate to the development and progression of coronary atherosclerosis

Association between androgenic hormone levels and left ventricular ejection fraction

Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions [EF]. The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF=35-45%, EF=45-54%, and EF >/= 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone [fT], total testosterone [tT], and dehydroepiandrosterone sulfate [DHEAS]. To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF >/= 35%. There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes [p value < 0.001], coronary artery lesion [p value < 0.001], or high levels of C-reactive protein [CRP] [p value < 0.001]. As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF >/= 35% [5.82 +/- 2.73 pg/mL vs. 6.88 +/- 3.34 pg/mL, p value < 0.05]. A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately

Ablation of focal right upper pulmonary vein tachycardia using retrograde aortic approach

The use of diagnostic and therapeutic methods for assessing pulmonary vein due to its status as a main source of ectopic beats for the initiation of atrial dysrrythmias is strongly recommended. We report the case of a 13-year-old girl who was admitted to our hospital with the electrocardiogram manifestation of an ectopic atrial tachycardia. The focus of arrhythmia was inside the right upper pulmonary vein. The patient underwent successful ablation with a conventional electrophysiology catheter via the retrograde aortic approach. We showed that when the origin of atrial tachycardia is in the right upper pulmonary vein, it is possible to advance the catheter into this vein via the retrograde aortic approach and find the focus of arrhythmia. This case demonstrates that right upper pulmonary vein mapping is feasible through the retrograde aortic approach and it is also possible to ablate the arrhythmia using the same catheter and approach

Microbiologic assessment of non-surgical traumatic wound infections and surgical site infections in hospitalized patients

Surgical site infections [SSIs] are the most common nosocomial infections in surgical patients. Depending on the source of a traumatic wound, particular pathogens are expected to be present while their prevalence varies in different conditions. This study focused on determination of microorganisms in traumatic wound infection and the frequency of Staphylococcus aureus and other organisms in SSIs. A total of 116 patients were studied among whom 86 patients [18 females and 68 males] underwent microbiological assessment for non-surgical wound infections and 30 patients [all were males] had SSIs. Specimens were cultured on blood agar, MacConkey agar, and chocolate agar while direct examination and gram-staining were also achieved for each sample. Staphylococcus aureus [20.9%] was the most commonly isolated organism among non-surgical traumatic wound infections, however, Proteus mirabilis, Salmonella Arizona and streptococcus group A were less commonly isolated [1.1% each]. Similarly, S. aureus [40%] was the most prevalent isolated organism in SSIs while enterobacter Spp was found only in 4 cases [13.3%].Our results revealed that S. aureus is the most commonly isolated organism in non-surgical traumatic wound infections and SSIs, therefore, appropriate therapeutic approach and applying efficient preventive modalities are of utmost importance

Comparison of benefits from cardiac resynchronization therapy between patients with ischemic Cardiomyopathy and patients with idiopathic dilated cardiomyopathy

Cardiac resynchronization therapy [CRT] is an effective treatment for patients with moderate to severe heart failure. However, 20-30% of patients remain non-responders to CRT. We sought to identify which patients benefit the most from CRT in regard to the etiology of heart failure. Eighty-three consecutive patients [62 men] who had a biventricular pacemaker inserted at Tehran Heart Center between May 2004 and March 2007 were evaluated retrospectively. The inclusion criteria were comprised of New York Heart Association [NYHA] class III or IV, left ventricular ejection fraction<35%, and QRS>120ms. After 6 months, response was defined as being alive, no hospitalization for cardiac decompensation, and an improvement in NYHA class>1 grade. After 6 months, 60 patients out of the 83 patients were responders. Amongst the 83 patients, 48 had ischemic cardiomyopathy and 35 had non-ischemic cardiomyopathy. A cross-tabulation of response versus etiology showed no significant difference between ischemic versus non-ischemic cardiomyopathy with regard to response to CRT [P=0.322]. According to our study, there was no difference in response to CRT between ischemic versus non-ischemic cardiomyopathy at six months' follow-up

role of serum lipoprotien[a] in increasing the risk of thrombus formation in patients with atrial fibrillation

Atrial fibrillation [AF] is prevalent among cardiac patients; and as the risk of thromboembolism is high in this arrhythmia, discrimination of the effective risk factors in producing left atrial [LA] thrombosis is clinically important. The molecular structure of lipoprotein[a] [Lp[a]] is very similar to plasminogen, so it can be hypothesized that the high level of Lp[a] is a compromising factor for the prevention of fibrinolysis [thrombogenesis]. This case-control study was conducted in patients with chronic AF. Most of the subjects had mitral stenosis. LA thrombosis was confirmed by transthoracic and transesophageal echocardiography. The study group consisted of 50 chronic AF patients mostly with mitral stenosis. Half the patients had LA thrombosis [patient group or P] and the other half did not [control group or C]. The mean age of the control group [C] and patient group [P] was 45 +/- 11 y and 57 +/- 9 y, respectively. There was no significant correlation between sex and LA gradient and existence of LA thrombus. LA size was 49 +/- 5 mm [C] and 56 +/- 9 mm [P], respectively. Left atrial blood velocity was 12 +/- 2 cm/sec [C] and 5 +/- 3 cm/sec [P], and Lp[a] concentration was 30 +/- 6.7 mg / dl [C] and 55 +/- 2.75 mg / dl [P]. There was a significant correlation [p<0.001] between age, LA blood velocity, LA size, and serum concentration of Lp[a], which was confirmed by t-test. There has been a great deal of research into the classic risk factors of LA thrombosis in chronic AF, but the study on the effect of Lp[a], which is an atherosclerosis risk factor, on the formation of LA thrombosis is almost new. According to the results of the present study, Lp[a] should be measured in all chronic AF patients. We can assume that lowering Lp[a] serum level may decrease the risk of LA thrombosis in chronic AF patients

Coronary artery fistula with double outlet right ventricle: a case report

The majority of coronary artery fistulas [CAFs] are congenital. The anomaly accounts for 0.4% of congenital heart defects and approximately 50% of pediatric coronary vasculature anomalies. Twenty percent of people with congenital CAFs have other concomitant cardiac anomalies, most frequently aortic and pulmonary atresia and patent ductus arteriosus. It is worthy of note that CAF with the tetralogy of Fallot has also been reported. Here we describe a patient with a double outlet right ventricle in association with a coronary artery fistula