Etiology and Prognosis in Burning of Children and Adolescents During 2009-2019.

Introduction: This study aimed to evaluate the etiology and prognosis in burn children and adolescents referred to Shahid Motahari Trauma and Burn hospital. Materials and Methods: This cross-sectional study was conducted on burn children and adolescents who were hospitalized in Shahid Motahari Burns Hospital between 2009 and 2019 due to burns. Results: In this study, 3,520 patients were studied; of which 2,151 subjects were boys (61.1%) and 1,369 subjects were girls (38.9%). The mean age of the subjects was 2.84 ± 3.66 years. 138 (3.9%) patients died in the study. The relationship between mortality and gender was not statistically significant (P value = 0.336). The highest percentage of burns was 10 to 19% in 1284 patients (36.63%) and the lowest was 80 to 89% burns in 7 patients (0.19%). In terms of burn site, the most areas related to the trunk, lower limbs except the legs and upper limbs except the hands with 22.56%, 18.95%, and 18.45%, respectively, and the lowest related to the legs and the whole body with 6.39% and 8.46%. Also, the highest cause of burning was boiling water in 1915 patients (56.12%). Conclusion: The study showed that boys were more likely to be the victim of burns. Also, the highest percentage of burns was less than 20% and most of the areas are related to the trunk, limbs. The mortality rate was 3.9%. In addition, these evaluations showed that the most common cause of burns was boiling water.

The concurrent accuracy of the modified telephone interview for cognitive status and mini-mental state examination tools in detection of cognitive impairment among older adults / A acurácia concorrente da entrevista telefônica modificada para o estado cognitivo e as ferramentas de miniexame do estado mental na detecção de comprometimento cognitivo em idosos

ABSTRACT. Due to the need for face-to-face administration of many cognitive screening tests, it is not always feasible to screen large-scale samples. Objective: This study aimed to assess the discriminant validity of the Persian version of Telephone Interview for Cognitive Status (P-TICS-m) and Mini-Mental State Examination in the middle-aged Iranian population. Methods: The P-TICS-m and MMSE were administered to 210 randomly selected middle-aged community-dwelling adults who had been registered in the Neyshabur Longitudinal Study on Ageing. Participants also underwent psychological examination by two neurologists to assess cognitive impairment based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. To evaluate the discriminant validity of P-TICS-m and MMSE with DSM-V criteria, the sensitivity, specificity, positive and negative predictive values (PPV and NPV), and positive and negative likelihood ratios (LR+ and LR−) were calculated. Results: The mean age of the participants was 59.6±6.8 years. The TICS and MMSE were highly correlated (r=0.635, p<0.001). The sensitivity, specificity, PPV, NPV, LR+, and LR− to discriminate cognitive impairment were, respectively, 83%, 92%, 68%, 96%, 10, and 0.182 for MMSE and 100%, 13%, 19%, 100%, 1.16, and 0 for TICS-m. The receiver operating characteristic curve analysis results showed no statistically significant differences between P-TICS-m and MMSE. Conclusions: Our findings indicate that the TICS-m test can be used as a screening tool instead of the MMSE. Due to the low specificity and low PPV of the TICS-m compared to MMSE, the diagnosis should be confirmed using definitive diagnostic tests when a subject is classified as having cognitive impairment.

RESUMO. Diante da necessidade de administração face a face de muitos testes de triagem cognitiva, nem sempre é viável rastrear amostras em grande escala. Objetivo: O objetivo deste estudo foi avaliar a validade discriminante da versão persa do Telephone Interview for Cognitive Status (TICS-m) e do Miniexame do Estado Mental (MMSE) na população iraniana de meia-idade. Métodos: A versão persa do TICS-m (P-TICS-m) e do MMSE foi administrada a 210 adultos de meia-idade residentes na comunidade e selecionados aleatoriamente, que haviam sido registrados no Neyshabur Longitudinal Study on Ageing. Os participantes também foram submetidos a exame psicológico por dois neurologistas para serem avaliados quanto ao comprometimento cognitivo com base nos critérios do Manual de Diagnóstico e Estatística de Transtornos Mentais (DSM-V). Para avaliar a validade discriminante do P-TICS-m e do MMSE com os critérios do DSM-V, foram calculados a sensibilidade, a especificidade, os valores preditivos positivo e negativo (PPV e NPV) e a razão de verossimilhança positiva e negativa (LR+ e LR-). Resultados: A média de idade dos participantes foi de 59,6±6,8 anos. O TICS e o MMSE foram altamente correlacionados (r = 0,635, p <0,001). A sensibilidade, a especificidade, o PPV, o NPV, a LR+ e a LR- do MMSE para discriminar comprometimento cognitivo foram 83, 92, 68, 96%, 10, 0,182; e, para TICS-m, foram 100, 13, 19, 100%, 1,16 e zero, respectivamente. Os resultados da análise da curva característica de operação do receptor (ROC) não mostraram diferenças estatisticamente significativas entre P-TICS-m e MMSE. Conclusões: Nossos achados mostram que o teste TICS-m pode ser utilizado como ferramenta de triagem em vez do MEEM. Por causa da baixa especificidade e do baixo PPV do TICS-m em relação ao MMSE, o diagnóstico deve ser confirmado por meio de testes diagnósticos definitivos quando um indivíduo é classificado como portador de comprometimento cognitivo.

The inverse correlation between serum levels of anti-pneumococcal and ferritin after pneumococcal vaccination in splenectomised beta thalassemia major

Splenectomy is necessary in beta thalassemia major patients when the spleen becomes hyperactive, leading to extreme destruction of erythrocytes. This study assessed the ferritin effect on serum pneumococcal antibody response following pneumococcal vaccination, in patients with beta thalassemia major after splenectomy. In this case series study, convenience sampling was used to recruit 347 splenectomised beta thalassemia patients under the auspices of Jahrom University of Medical Sciences. Demographic data such as age, sex, and time after splenectomy were recorded by a questionnaire. All participants had been splenectomised and received a dose of Pneumovax1 23 vaccine 14 days before surgery. The IgG antibody responses to pneumococcal vaccine and levels of serum specific ferritin were determine by commercial enzyme immunoassay kits. For the analysis, SPSS software version 16 was used. A p-value less than 0.05 was considered statistically significant. Most of the participants (63.4 percent) were hypo-responders to pneumococcal vaccine. Also, serum anti-pneumococcal IgG antibody was related to post splenectomy duration and serum ferritin (p 0.05). An important result was a relation of serum anti-pneumococcal IgG antibody to serum ferritin according to post splenectomy duration groups. Therefore, in three groups of post splenectomy duration, the serum ferritin was higher in hypo-responder than in good responder subjects. Our results indicate that serum anti-pneumococcal IgG antibody decreased with increment of serum ferritin and post splenectomy duration. Thus, there is a need to re-address the approach towards revaccination in this immune-compromised group of patients by administering a booster pneumococcal vaccination in an attempt to recover immunity and reduce morbidity(AU)

La esplenectomía es necesaria en pacientes con beta talasemia mayor cuando el bazo se vuelve hiperactivo, lo que lleva a una destrucción extrema de los eritrocitos. Este estudio evaluó el efecto de la ferritina sobre la respuesta de anticuerpos antineumocócicos en suero después de la vacunación antineumocócica, en pacientes con talasemia beta mayor a los que se les realizó esplenectomía. En este estudio de serie de casos, se utilizó un muestreo de conveniencia para reclutar a 347 pacientes con beta talasemia esplenectomizados bajo los auspicios de la Universidad de Ciencias Médicas de Jahrom. Los datos demográficos como la edad, el sexo y el tiempo después de la esplenectomía se registraron mediante un cuestionario. Todos los participantes fueron esplenectomizados y recibieron una dosis de la vacuna Pneumovax® 23, 14 días antes de la cirugía. Las respuestas de anticuerpos IgG a la vacuna neumocócica y los niveles de ferritina sérica específica se determinaron mediante estuches comerciales de inmunoensayo enzimático. Para el análisis se utilizó el programa SPSS versión 16. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. La mayoría de los participantes (63,4 por ciento) resultaron hiporrespondedores a la vacuna antineumocócica. Además, el anticuerpo sérico antineumocócico IgG se relacionó con la duración de la esplenectomía y la ferritina sérica (p0,05). Un resultado importante fue la relación del anticuerpo sérico IgG antineumocócico con la ferritina sérica según los grupos de duración postesplenectomía. Por lo tanto, en tres grupos de duración posterior a la esplenectomía, la ferritina sérica fue mayor en los sujetos con hiporrespuesta que en los sujetos con buena respuesta. Nuestros resultados indican que el anticuerpo sérico IgG antineumocócico disminuyó con el incremento de la ferritina sérica y la duración posterior a la esplenectomía. Por lo tanto, existe la necesidad de volver a abordar el enfoque hacia la revacunación en este grupo de pacientes inmunocomprometidos mediante la administración de una vacunación antineumocócica de refuerzo en un intento por recuperar la inmunidad y reducir la morbilidad(AU)

The economic burden of esophageal cancer in Iran

Background: Studies on economic burden demonstrate the impacts of some diseases and provide invaluable information for specifying priorities and resource needs when designing cancer control strategies. The current study aimed to estimate the cost of esophageal carcinoma (EC) in Iran in 2018. Methods: This study was conducted on the prevalence approach to estimate the economic burden of EC in Iran from a social perspective. The direct cost was estimated by summing the diagnosis, treatment, follow-up, terminal care, and transport costs. Additionally, a human capital approach was adopted to estimate productivity losses. Various resources were used for data collection, including the GLOBOCAN 2018 report, and the medical record in the Cancer Institute of Iran. Also, data such as exchange rates, employment, and housekeeping rates were extracted from the Central Bank of Iran Statistics. Results: The economic burden of EC in Iran was $69.2 million in 2018, of which $38.7 million is caused by indirect costs and $30.5 million by direct costs. The mortality cost accounted for 49% of the economic burden, followed by 34% direct medical cost, 10% direct non-medical cost, and 7% morbidity cost. Conclusions: Mortality and medical cost appeared to be the main contributor to the economic burden. Therefore, policy-makers are recommended to adopt early detection and effective treatment as a highly cost-effective strategy for controlling costs

The optimization of PpSP15 purification from salivary glands in Iranian wild Phlebotomus papatasi (Diptera Psychodidae)

Background & objectives: Sand fly saliva contains proteins that modulate the host immune system and it plays an important role in both blood feeding and the outcome of Leishmania infections. The profile of the salivary proteins was examined and analyzed from an endemic focus of zoonotic cutaneous leishmaniasis by wild P. papatasi to find local and suitable antigens as potential proteins for developing Leishmania vaccine alongside the development of a new extraction technique. Methods: Specimens were caught from Bojnord, using funnel and CDC traps. Different methods of protein extraction were employed and a new technique was developed. The proteins were extracted from the salivary glands tissues with a lysis buffer. Purification was performed using RP-HPLC, with a linear gradient protocol from 0-60 % of acetonitrile. PpSP15 was characterized by SDS-PAGE. Results: The concentration of extracted protein content was 0.5 and 0.03 ?g/?l in chemical and physical methods, respectively. PpSP15 was isolated at a weight of 15kDa in 80–85 min of run time. SDS-PAGE was able to characterize PpSP15. The crude extract of the chemical method, revealed 15 separated bands, ranging from 11–100 KDa. Tajima D index was positive. Interpretation & conclusion: PpSP15 was characterized from Iranian specimens; it is a very highly hydrophobic protein of salivary glands among SP15- like proteins. The chemical method of extraction was found to be more effective than physical methods (P < 0.05). For developing a vaccine against leishmaniasis, depending on the location, choosing suitable proteins should be considered and an efficient extraction method should be used.

Tuberculous meningitis and miliary tuberculosis in Iran: A review

In recent years, the number of cases of extrapulmonary tuberculosis in Iran has increased. The goal of this study was to determine the epidemiological status, clinical symptoms, diagnostic methods, and treatment strategies of extrapulmonary tuberculosis in Iran, with a focus on tuberculosis meningitis and miliary tuberculosis. Between January 1, 2000 and June 1, 2021, 1 651 cases of tuberculosis meningitis and miliary tuberculosis were discovered in Iran. The prevalence of tuberculosis meningitis was higher in Sistan and Baluchestan, South Khorasan, and Mazandaran compared with other provinces. The most prevalent symptoms of tuberculous meningitis were fever, anorexia, headache, neck stiffness, loss of consciousness, and vomiting. The most commonly used procedures for diagnosing tuberculous meningitis were polymerase chain reaction and cerebrospinal fluid culture. The most prevalent clinical symptoms of miliary tuberculosis were fever, lethargy, weariness, and anorexia. In 70% of chest radiographs, a miliary pattern was visible. Bone marrow biopsy was used to diagnose miliary tuberculosis in 80% of patients, while bronchoalveolar lavage was used in 20% of cases. The conventional 6-month treatment approach for tuberculous meningitis and miliary tuberculosis was used for all of the participants in the investigations. Given the high prevalence of extrapulmonary tuberculosis patients in Iran and the devastating consequences of the disease, the researchers recommend that further study be done to prevent extrapulmonary tuberculosis in the general population.

Years of Life Lost (YLLs) due to drug-related deaths in the Islamic Republic Of Iran (2014-2017): a temporal and geographic pattern / Anos de Vida Perdidos (AVP) devido a mortes relacionadas a drogas na República Islâmica do Irã (2014-2017): um padrão temporal e geográfico

Abstract The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.

Resumo O presente estudo teve como objetivo medir a carga de mortalidade causada por morte prematura por abuso de substâncias em diferentes regiões do Irã de 2014-17. Neste estudo transversal serial, os dados relacionados aos indivíduos que morreram por abuso de drogas foram coletados primeiramente em duas fontes (Ministério da Saúde e Educação Médica do Irã e Organização de Medicina Legal do Irã). Em seguida, usando o método de captura-recaptura, estimou-se o número de mortes relacionadas a drogas. Os anos de vida perdidos (AVP) para todas as províncias do Irã foram calculados com base na idade, sexo e ano. Durante quatro anos, o número total de óbitos foi de 12029. A média de idade dos indivíduos foi de 37,3±14,1. A média de idade dos mortos foi constante em mulheres e homens ao longo desse período; entretanto, a média de idade das mulheres mortas por abuso de substâncias foi menor do que a dos homens. O AVP médio por pessoa morta foi de 70131,3329 anos para homens e 9321,1125 anos para mulheres. Os anos potenciais de vida perdidos (APVP) apresentaram tendência ascendente, sendo mais forte nas mulheres do que nos homens. É necessário realizar mais análises regionais para encontrar diferenças no número de AVP devido ao abuso de substâncias.

Association of VDR gene Apal polymorphism with obesity in Iranian population / Asociación del polimorfismo Apal del gen receptor de vitamina D con la obesidad en una población iraní

Abstract | Introduction: Identifying obesity risk factors as a health problem facing communities is crucial given its complexity. The vitamin D receptor gene has been reported as a possible cause of this disease. Objective: To study the association of the VDR gene ApaI, BsmI, and Ta qI polymorphisms with obesity in an Iranian population. Materials and methods: We analyzed the genotypes of 348 obese (BMI≥30 kg/m2) and 320 non-obese people (BMI: 18.5-24.9 kg/m2) using PCR-RFLP. We measured FBS, TG, total cholesterol, and HDL and LDL cholesterol levels in an automatic biochemical analyzer. Results: We found significantly higher BMI, FBS, and TG levels in the obese group compared to the control. In the obese individuals, the frequency of genotype AA was 47.1% and that of the combined Aa+aa genotype, 52.9% while in the control group they were 30% and 70%, respectively (p=0.024, 95% confidence interval (CI)=1.100-3.933, odds ratio (OR)=2.08). A and a alleles frequencies for the ApaI polymorphism were statistically significant in the two groups (allele A vs. a; p=0.017). No significant relationship was observed between Ta qI genotypes and alleles in the control and obese subjects. Conclusion: We found that VDR ApaI (rs7975232 C/A) polymorphism appeared to be a risk factor for obesity. Especially, the A allele and the AA genotype in ApaI were associated with the obesity phenotypes.

Resumen | Introducción. La determinación de los factores de riesgo de la obesidad en la población iraní como problema de salud de la comunidad es crucial dada su complejidad. El gen receptor de la vitamina D (VDR) se ha mencionado como posible causante de dicha enfermedad. Objetivo. El objetivo del estudio fue investigar la asociación de los polimorfismos Apal, Bsml y Ta ql, con el gen VDR y la obesidad en una población iraní. Materiales y métodos. Se analizaron genotipos de 348 individuos obesos (BMI≥30 kg/m²) y 320 no obesos (BMI: 18,5-24,9 kg/m²) mediante reacción en cadena de la polimerasa y polimorfismos de longitud de fragmentos de restricción (PCR-RFLP). Para medir los niveles de glucemia en ayunas, tiroglobulina (TG), colesterol total, colesterol HDL y colesterol LDL, se utilizó un analizador bioquímico automático. Resultados. Los índices de masa corporal, glucemia en ayunas y TG fueron significantemente más elevados en el grupo de los obesos que en el de control. En los individuos obesos, la incidencia del genotipo AA fue de 47,1 % y la del genotipo combinado Aa+aaa fue de 52,9 %, en tanto que en el grupo de control estas cifras fueron, respectivamente, de 30 y 70 % (p=0,024; IC95% 1,100-3,933; la razón de probabilidades (OR) fue de 2,08. La frecuencia de los alelos "A" y "a" para el polimorfismo Apal en ambos grupos fue estadísticamente significativa (alelo A Vs. A; p=0,017). No se observó ninguna relación significativa entre los genotipos Ta ql y los alelos en los sujetos obesos y, tampoco, en los controles. Conclusión. El polimorfismo Apal del gen VDR (rs 7975232C/A) sería un factor de riesgo para la obesidad. El alelo y el genotipo AA en dicho polimorfismo se asociaron con los fenotipos de obesidad.

Relationship between Spiritual Intelligence and Professional Self-concept among Iranian Nurses / Relación entre la inteligencia espiritual y el autoconcepto profesional entre las enfermeras iraníes / Relação entre inteligência espiritual e autoconceito profissional entre enfermeiras iranianas

Objective. To determine the relationship between spiritual intelligence (SI) and professional self-concept (PSC) among Iranian nurses. Methods. This is a correlation study. A convenience sampling method was used and 344 nurses were selected from hospitals of Jahrom University of Medical Sciences. Data collection standard tools included two validated scales: Cowin's Nurse Self-Concept Questionnaire (36 items scored ranged from 1 to 8; Maximum score=288; 6 subcategories: General Nurse Self-Concept, Knowledge, Care, Communication, Staff Relation and Leadership) and Abdollahzadeh's SI Questionnaire (29 items scored ranged from 0 to 5; Maximum score=145; 2 subcategories: Relying on the inner core and Understanding and communicating with the origin of the universe. Results. The mean total score of PSC was 220.3±30.61 and 120.67±16.13 for SI. There was a significant statistical correlation between PSC (r=0.348, p<0.0001) and almost all subcategories and SI. The results of the regression analysis showed that SI predicts 13.3% of the variance of PSC (p<0.0001). Conclusion. Considering the correlation of SI and PSC among Iranian nurses, it is suggested that strategies be used to train and promote the SI of nurses.

Objetivo. Determinar la relación entre la inteligencia espiritual y el autoconcepto profesional entre las enfermeras iraníes. Métodos. Se trata de un estudio correlacional. Se utilizó un método de muestreo por conveniencia y se seleccionaron 344 enfermeras de los hospitales de la Universidad de Ciencias Médicas de Jahrom. Los instrumentos de recolección de los datos incluían dos escalas validadas: Cuestionario de autoconcepto de la enfermera de Cowin (36 ítems con puntuaciones que van de 1 a 8; puntuación máxima=288; 6 subcategorías: Autoconcepto enfermero general, Conocimiento, Cuidados, Comunicación, Relación con el personal y Liderazgo) y el Cuestionario de Inteligencia Espiritual de Abdollahzadeh (29 ítems puntuados de 0 a 5; Puntuación máxima=145; 2 subcategorías: Apoyarse en el núcleo interno y Comprender y comunicarse con el origen del universo). Resultados. La puntuación total media del Autoconcepto Profesional fue de 220.3±30.61 y de 120.67±16.13 para Inteligencia Espiritual. Hubo una correlación estadística significativa entre el puntaje total de la escala Autoconcepto Professional (r=0.348, p<0.0001) y de casi todas sus subcategorías, con la Inteligencia Espiritual. Los resultados del análisis de regresión mostraron que la Inteligencia Espiritual predice el 13.3% de la varianza del autoconcepto profesional (p<0.0001). Conclusión. Existe correlación entre la Inteligencia Espiritual y el Autoconcepto Profesional entre las enfermeras iraníes. En este sentido, se sugiere que se utilicen estrategias para formar y promover la Inteligencia Espiritual de las enfermeras.

Objetivo. Determinar a relação entre inteligência espiritual e autoconceito profissional entre enfermeiras iranianas. Métodos. Este é um estudo correlacional. Um método de amostragem de conveniência foi usado e 344 enfermeiras foram selecionadas dos hospitais da Jahrom University of Medical Sciences. Os instrumentos de coleta de dados incluíram duas escalas validadas: Questionário de autoconceito do enfermeiro de Cowin (36 itens com pontuação variando de 1 a 8; pontuação máxima = 288; 6 subcategorias: Autoconceito geral de enfermagem, Conhecimento, Cuidado, Comunicação, Relacionamento com a equipe e Liderança) e o Questionário de Inteligência Espiritual de Abdollahzadeh (29 itens pontuados de 0 a 5; Pontuação máxima = 145; 2 subcategorias: Baseando-se no núcleo interno e entendendo e se comunicando com a origem do universo. Resultados. A pontuação total média para o profissional do autoconceito foi de 220.3 ± 30.61 e 120.67 ± 16.13 para Inteligência Espiritual, houve correlação estatisticamente significante entre a pontuação total da escala de Autoconceito Profissional (r = 0.348, p <0.0001) e quase todas as suas subcategorias, com Inteligência Espiritual. Os resultados da análise de regressão mostraram que a Inteligência Espiritual prediz 13.3% da variância do autoconceito ou profissional (p <0.0001). Conclusão. Existe uma correlação entre Inteligência Espiritual e Autoconceito Profissional entre os enfermeiros iranianos,

Relação entre níveis de chumbo e cádmio no sangue e a prisão de ventre crônica refratária entre crianças iranianas / Relationship between lead and cadmium levels in blood and refractory chronic constipation among iranian children

ABSTRACT BACKGROUND: There is limited research examining reasons causing refractory chronic constipation (RCC) in children. The effects of lead (Pb) and cadmium (Cd) exposures on this condition have been even less clear. However, some related factors may contribute to evaluation of blood lead levels (BLLs) and blood cadmium levels (BCLs). OBJECTIVE: The present study aimed to examine the relationship between Pb and Cd exposures and RCC in children living in the city of Ahvaz, Khuzestan Province, in Southwestern Iran. METHODS: This study was performed on a total number of 48 children aged 2-13 years, including 36 medically-diagnosed RCC cases and 12 controls referring to a pediatric clinic in the city of Ahvaz. Their BLLs and BCLs were then determined using a graphite furnace atomic absorption spectrophotometer. The data from the researcher-designed questionnaire were also recoded and the related risk factors were analyzed through Spearman's correlation and logistic regression analysis. RESULTS: The findings revealed that the geometric means of Pb and Cd in blood samples in the control group were 58.95 µg/dL and 0.45 µg/dL; respectively. These values in the case group were equally 45.26 µg/dL and 0.26 µg/dL; respectively. A significant difference was additionally observed between BCLs in the case and control groups (P<0.01). All children in both groups also had BLLs greater than the permissible limit endorsed by the World Health Organization (WHO) (≤10 µg/dL). On the other hand, 8.3% of the individuals in the case group and 33.3% of those in the control group had BCLs higher than the acceptable range mentioned by WHO (≤0.5 µg/dL). CONCLUSION: Pb and Cd exposures due to environmental pollution and susceptibility to heavy metals may not be associated with RCC in children living in the city of Ahvaz. Although this research was the first one providing data on BLLs and BCLs in children with RCC, the findings could be useful for designing future epidemiologic studies.

RESUMO CONTEXTO: Há limitadas pesquisas que procuram razões que causem constipação crônica refratária (CCR) em crianças. Os efeitos das exposições de chumbo (Pb) e cádmio (Cd) nesta condição têm sido ainda menos claros. No entanto, alguns fatores relacionados podem contribuir para a avaliação dos níveis de Pb no sangue (NPbSs) e dos níveis de Cd no sangue (NCdSs). OBJETIVO: O presente estudo teve como objetivo examinar a relação entre as exposições de Pb e Cd e a CCR em crianças residentes na cidade de Ahvaz, província de Khuzestan, no Sudoeste do Irã. MÉTODOS: Este estudo foi realizado em um número total de 48 crianças de 2 a 13 anos, incluindo 36 casos de CCR diagnosticados clinicamente, e 12 controles encaminhados a uma clínica pediátrica na cidade de Ahvaz. Seus NPbSs e NCdSs foram então determinados usando um espectrógrafo de absorção atômica do forno de grafite. Os dados do questionário projetado pelo pesquisador também foram recodificados, e os fatores de risco relacionados foram analisados por meio da análise de correlação e regressão logística de Spearman. RESULTADOS: Os achados revelaram que as médias geométricas de Pb e Cd em amostras de sangue no grupo controle foram de 58,95 μg/dL e 0,45 μg/dL; respectivamente. Esses valores no grupo constipação foram igualmente 45,26 μg/dL e 0,26 μg/dL; respectivamente. Observou-se diferença significativa entre os NCdSs nos grupos de caso e controle (P<0,01). Todas as crianças de ambos os grupos também apresentaram NPbSs maiores do que o limite permitido endossado pela Organização Mundial da Saúde (OMS) (≤10 μg/dL). Por outro lado, 8,3% dos indivíduos no grupo de casos e 33,3% dos do grupo controle apresentaram NCdSs superiores à faixa aceitável mencionada pela OMS (≤0,5 μg/dL). CONCLUSÃO: As exposições de Pb e Cd por poluição ambiental e suscetibilidade a metais pesados podem não estar associadas à CCR em crianças residentes na cidade de Ahvaz. Embora esta pesquisa tenha sido a primeira a fornecer dados sobre NPbSs e NCdSs em crianças com CCR, os achados poderiam ser úteis para a concepção de futuros estudos epidemiológicos.

Reasons of under-representation of Iranian women in blood donation

The under-representation of women in blood donation can lead to blood shortages. We aimed to determine the factors, which encourage or impede blood donations in women. The findings can help us in designing effective recruitment strategies that could encourage women to donate blood to cover the patients' needs. This cross-sectional study was conducted in Shiraz, Iran, from the 1st of January 2017 to the 1st of August 2017 on women aged 18-60 years old. The demographic characteristics of the participants, the reasons that motivate blood donors and the factors that discourage non-donors were surveyed. Reasons for lapses in donors were also mentioned. The most frequent reasons for blood donation were altruistic causes (94.4%), moral and personal obligations (89.1%), the feeling of responsibility (82.7%), and awareness of the positive effects on their health (77.4%). The most common deterrents in non-donors were fear of developing anemia (68.4%) or weakness and dizziness (66%), unsuitability due to certain medical conditions (62.4%), and lack of a situation in which they were asked to donate blood (61.8%). Although altruistic reasons are the chief motivating factors for women to donate blood, the overall female contribution in blood donation remains low. Therefore, it is necessary to take measures aiming at informing women about the importance of blood donation and to reduce fears based on misinformation. Confidence in the blood donation organization must be a major consideration in future recruitment strategies to reassure women about the safety of blood donation.

Validation of a brief sex addiction screening instrument (PATHOS) and prediction of sex addiction in the Iranian population

Abstract Introduction Sex addiction is a major psychiatric disorder in which a person is compelled to participate in sexual activities despite negative consequences. This study was conducted to localize a brief sex addiction screening instrument (PATHOS) for use in the Iranian population and to determine variables predictive of sex addiction in the general Iranian population. Methods In this study, we evaluated the psychometric properties of PATHOS in a sample of 443 Iranians in 2018. Data were analyzed using exploratory factor analysis (Factor 10.8.04 software). Simple and multiple linear regression analyses were used to investigate construct validity and variables predictive of addiction. Results Exploratory factor analysis identified two factors in this dichotomous questionnaire and reported the questionnaire's test-retest reliability in the target population. Prognostic variables for sexual addiction in the Iranian population were determined to be female gender, higher education, viewing pornographic videos, having multiple sex partners, having difficulty interacting in sex, and history of masturbation. Conclusion The Persian version of the brief sex addiction screening instrument (PATHOS) has sufficient reliability and validity in the Iranian population. The predictive variables of sex addiction are indicative of the presence of risk of this disorder in Iranian samples and more studies are needed in order to enable prevention and treatment.

Predicting cutaneous leishmaniasis using SARIMA and Markov switching models in Isfahan, Iran: A time-series study

Objective: To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average (SARIMA) models and Markov switching model (MSM). Methods: This descriptive study employed yearly and monthly data of 49 364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province, located in the center of Iran from January 2000 to December 2019. The data were provided by the leishmaniasis national surveillance system, the meteorological organization of Isfahan province, and Iranian Space Agency for vegetation information. The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics. Results: The minimum relative humidity, maximum relative humidity, minimum wind speed, and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags (P<0.05). Comparing SARIMA and MSM, Akaikes information criterion (AIC), and mean absolute percentage error (MAPE) in MSM were much smaller than SARIMA models (MSM: AIC=0.95, MAPE=3.5%; SARIMA: AIC=158.93, MAPE:11.45%). Conclusions: SARIMA and MSM can be a useful tool for predicting cutaneous leishmaniasis in Isfahan province. Since cutaneous leishmaniasis falls into one of two states of epidemic and non-epidemic, the use of MSM (dynamic) is recommended, which can provide more information compared to models that use a single distribution for all observations (Box-Jenkins SARIMA model).

Prevalence of cryptosporidiosis in animals in Iran: A systematic review and metaanalysis

Objective: To review the prevalence of cryptosporidiosis among animal population of Iran. Methods: Data were systematically gathered from 1 January 2000 to 1 January 2020 in the Islamic Republic of Iran from the following electronic databases: PubMed, Springer, Google Scholar, Science Direct, Scopus, Web of Science, Magiran, and Scientific Information Database (SID). According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 88 eligible studies were obtained. Results: The pooled prevalence of cryptosporidiosis using random and fixed effects model according to heterogeneity among animals was as follows: rodents 18.8% (95% CI 12.6%-25.0%), camels 17.1% (95% CI 8.6%-25.7%), cattle 16.8% (95% CI 13.4%-20.1%), goats 14.1% (95% CI 5.2%-23.0%), horses 12.2% (95% CI 8.3%- 16.2%), birds 10.5% (95% CI 7.6%-13.4%), sheep 9.9% (95% CI 2.4%-4.9%), cats 8.8% (95% CI 4.8%-12.8%) and dogs 3.7% (95% CI 7.0%-12.8%). Conclusions: Cryptosporidiosis has been reported and present in a wide range of animals in Iran over the years and has a high prevalence in most of these species.

Antibacterial resistance patterns of Acinetobacter baumannii complex: The results of Isfahan Antimicrobial Resistance Surveillance-1 Program

Objective: To determine the antibiotic resistance patterns of the Acinetobacter (A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source (hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS. Results: From 254 patients who had confirmed A. baumannii complex infection, 158 (62.20%) cases were male, 27 (10.63%) were less than 20 years old, 172 (67.72%) had healthcare-Associated infections and 96 (37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections (111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics (more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline (20, 44.44%) and colistin (0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance (MDR) were significantly different between males and females. In patients with healthcare associated infection (HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses. Conclusions: In our study, a high level of antibiotic resistance was detected in both community-Acquired and healthcare-Associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

Spatio-Temporal history of H9N2 viruses in Iran and neighbor countries by Bayesian analysis and molecular characterization

Objective: To delineate the H9N2 influenza virus circulation within Iran and its neighboring countries, the potential source of the epidemic in these countries, and its date of origin. Methods: We obtained all hemagglutinin (HA) and neuraminidase (NA) nucleotide sequences of influenza H9N2 available up to December 25, 2020 from Iran and its neighboring countries (i.e., Pakistan, Afghanistan, Turkmenistan, Armenia, Azerbaijan, Turkey, and Iraq). We also performed a Bayesian Markov chain Monte Carlo method to infer the evolutionary dynamic and the most recent common ancestor for the HA and NA sequences. Results: H9N2 epidemic may have started in Iran and Pakistan much earlier than the other investigated countries in the region, and an ongoing bidirectional dispersion of the virus between the investigated countries was also observed. The mean time of the most recent common ancestor of H9N2 viruses was 1988 for HA, and 1992 for NA. Conclusions: Strains from investigated countries rooted in Pakistan and Iran. Regular surveillance of H9N2 viruses, especially in the live bird markets, enhancing the biosecurity of poultry industry and screening newly arriving immigrants and tourists from neighboring countries at border should be considered to control spread of the virus. Furthermore, surveillance of viral molecular evolution should be initiated for effective prevention of epidemic and pandemic spreads.

Prediction of malaria cases in the southeastern Iran using climatic variables: An 18-year SARIMA time series analysis

Objective: To predict future trends in the incidence of malaria cases in the southeast of Iran as the most important area of malaria using Seasonal Autoregressive Integrated Moving Average (SARIMA) model, and to check the effect of meteorological variables on the disease incidence. Methods: SARIMA method was applied to fit a model on malaria incidence from April 2001 to March 2018 in Sistan and Baluchistan province in southeastern Iran. Climatic variables such as temperature, rainfall, rainy days, humidity, sunny hours and wind speed were also included in the multivariable model as covariates. Then, the best fitted model was adopted to predict the number of malaria cases for the next 12 months. Results: The best-fitted univariate model for the prediction of malaria in the southeast of Iran was SARIMA (1,0,0)(1,1,1)12 [Akaike Information Criterion (AIC)=307.4, validation root mean square error (RMSE)=0.43]. The occurrence of malaria in a given month was mostly related to the number of cases occurring in the previous 1 (p=1) and 12 (P=1) months. The inverse number of rainy days with 8-month lag ( =0.329 2) and temperature with 3-month lag ( =-0.002 6) were the best predictors that could improve the predictive performance of the univariate model. Finally, SARIMA (1,0,0)(1,1,1)12 including mean temperature with a 3-month lag (validation RMSE=0.414) was selected as the final multivariable model. Conclusions: The number of malaria cases in a given month can be predicted by the number of cases in the prior 1 and 12 months. The number of rainy days with an 8-month lag and temperature with a 3-month lag can improve the predictive power of the model.

Prevalence of non-tuberculosis mycobacteria among samples deposited from the National Tuberculous Reference Laboratory of Iran (2011-2018)

Objective: To investigate the prevalence of non-tuberculosis mycobacteria (NTM) among the samples deposited from the National Tuberculosis Reference Laboratory of Iran between 2011 and 2018. Methods: The study evaluated the prevalence of NTM among specimens from patients with pulmonary tuberculosis symptoms (n=15 771) deposited at the National Tuberculosis Reference Laboratory of Iran from 2011 to 2018. Detection of Mycobacterium (M.) tuberculosis was based on presence of a 190-bp amplicon from IS6110 insertion sequence using Tb1 and Tb2 primers, and amplicon-negative specimens were tested for NTM and M. tuberculosis (refractory to IS6110 amplification) using restriction fragment length polymorphism PCR of hsp65 amplicon fragment. Results: A total of 7 307 (46.33%) M. tuberculosis and 658 (4.17%) NTM specimens were found, the latter mainly comprising M. abscessus (10.18%), M. avium (2.28%), M. chelonae (8.97%), M. intracellulare (10.49%), M. kansasii (4.71%), and M. simiae (56.08%). Conclusions: As treatment for NTM differs from that for M. tuberculosis, accurate detection of Mycobacterium sp. is of public health significance.

Tick-borne pathogens in Iran: A meta-analysis

Objective: Different studies have been performed on the prevalence of tick-borne pathogens in different areas of Iran; however, as far as our knowledge, there is no regional meta-analysis available for consideration and estimation of tick species infected with different pathogens in Iran. Methods: In this review, among different databases, a total of 95 publications were included, and the infection of different tick species to different tick-borne pathogens was determined; furthermore, presence of pathogens (with 95% confidence intervals) in tick vectors was calculated separately for each province, using Comprehensive Meta-Analysis version 2 (Biostat, USA). Results: Totally, among all 95 studies, 5 673 out of 33 521 investigated ticks were positive according to different detection methods. Overall estimated presence of pathogens in tick vectors in Iran was 8.6% (95% CI 7.0%-10.6%, P 0.001). Of all 46 species of ticks in 10 genera in Iran, 28 species in 9 genera, including Alveonasus, Argas, Boophilus, Dermacentor, Haemaphysalis, Hyalomma, Ixodes, Ornithodoros, and Rhipicephalus were infected with at least 20 pathogens in 10 genera including Aegyptianella, Anaplasma, Babesia, Borrelia, Brucella, Orthonairovirus [CrimeanCongo hemorrhagic fever virus (CCHFV)], Coxiella, Ehrlichia, Rickettsia and Theileria in 26 provinces of Iran. The presence of pathogens in ticks collected in western Iran was more than other regions. Hyalomma anatolicum (20.35%), Rhipicephalus sanguineus (15.00%), and Rhipicephalus bursa (14.08%) were the most prevalent infected ticks for different pathogens. In addition, most literatures were related to CCHFV and Theileria/Babesia spp. Conclusions: Public health and veterinary professionals should be aware of diagnosing possible diseases or outbreaks in vertebrates.

Identification of climatic and environmental factors associated with incidence of cutaneous leishmaniasis in Central Iran using satellite imagery

Objective: To determine the effect of climatic and environmental factors on the incidence of cutaneous leishmaniasis in Qom province in 2018. Methods: In this cross-sectional study, the data on cutaneous leishmaniasis incidence were collected from the Disease Control and Prevention Center in Qom province. Climatic and environmental data including Normalized Difference Vegetation Index (NDVI), Land Surface Temperature (LST), and soil moisture were extracted using satellite images. Data of altitude and sunny hours were provided based on shuttle radar topography mission digital elevation model and hemispherical viewshed algorithm, respectively. The associations of climatic and environmental variables with the incidence of the disease were analyzed by Pearson correlation method. The ArcGIS 10.3 software was used to determine the geographical distribution of these factors. Results: There were positive correlations between cutaneous leishmaniasis incidence and the two climatic factors: LST and sunny hours per day (P=0.041, P=0.016), and it had weak negative correlations with the digital elevation model (P=0.27), soil moisture (P=0.54), and NDVI (P=0.62). The time delay analysis showed that in one-, two-, and three month periods, the correlations increased with a 95% confidence interval. Accordingly, the correlation with the three-month time delay was positive and relatively strong between the cutaneous leishmaniasis incidence and LST and sunny hours (P=0.027, P=0.02); nevertheless, there were negative correlations between the cutaneous leishmaniasis incidence and the soil moisture (P=0.27) and NDVI (P=0.62). Conclusions: As Qom is located in one of the semi-arid climate zones, topography and solar energy are important factors affecting the incidence of cutaneous leishmaniasis in autumn. Therefore, appropriate disease control programs are recommended.