Determining endemic values of cutaneous leishmaniasis in Iranian Fars province by retrospectively detected clusters and receiver operating characteristic curve analysis

To determine the endemic values of cutaneous leishmaniasis in different cities of Fars province, Iran. Methods: Totally, 29201 cases registered from 2010 to 2015 in Iranian Fars province were selected, and the endemic values of cutaneous leishmaniasis were determined by retrospective clusters derived from spatiotemporal permutation modeling on a time-series design. The accuracy of the values was assessed using receiver operating characteristic (ROC) curve. SPSS version 22, ArcGIS, and ITSM 2002 software tools were used for analysis. Results: Nine statistically significant retrospective clusters (P<0.05) resulted in finding seven significant and accurate endemic values (P<0.1). These valid endemic scores were generalized to the other 18 cities based on 6 different climates in the province. Conclusions: Retrospectively detected clusters with the help of ROC curve analysis could help determine cutaneous leishmaniasis endemic values which are essential for future prediction and prevention policies in the area.

Establishment of an early warning system for cutaneous leishmaniasis in Fars province, Iran

Objective: To establish an early warning system for cutaneous leishmaniasis in Fars province, Iran in 2016. Methods: Time-series data were recorded from 29201 cutaneous leishmaniasis cases in 25 cities of Fars province from 2010 to 2015 and were used to fit and predict the cases using time-series models. Different models were compared via Akaike information criterion/Bayesian information criterion statistics, residual analysis, autocorrelation function, and partial autocorrelation function sample/model. To decide on an outbreak, four endemic scores were evaluated including mean, median, mean + 2 standard deviations, and median + interquartile range of the past five years. Patients whose symptoms of cutaneous leishmaniasis began from 1 January 2010 to 31 December 2015 were included, and there were no exclusion criteria. Results: Regarding four statistically significant endemic values, four different cutaneous leishmaniasis space-time outbreaks were detected in 2016. The accuracy of all four endemic values was statistically significant (P<0.05). Conclusions: This study presents a protocol to set early warning systems regarding time and space features of cutaneous leishmaniasis in four steps: (i) to define endemic values based on which we could verify if there is an outbreak, (ii) to set different time-series models to forecast cutaneous leishmaniasis in future, (iii) to compare the forecasts with endemic values and decide on space-time outbreaks, and (iv) to set an alarm to health managers.

Does prospective permutation scan statistics work well with cutaneous leishmaniais as a high-frequency or malaria as a low-frequency infection in Fars province, Iran?

Objective: To determine whether permutation scan statistics was more efficient in finding prospective spatial-temporal outbreaks for cutaneous leishmaniasis (CL) or for malaria in Fars province, Iran in 2016.Methods: Using time-series data including 29177 CL cases recorded during 2010-2015 and 357 malaria cases recorded during 2010-2015, CL and malaria cases were predicted in 2016. Predicted cases were used to verify if they followed uniform distribution over time and space using space-time analysis. To testify the uniformity of distributions, permutation scan statistics was applied prospectively to detect statistically significant and non-significant outbreaks. Finally, the findings were compared to determine whether permutation scan statistics worked better for CL or for malaria in the area. Prospective permutation scan modeling was performed using SatScan software.Results: A total of 5359 CL and 23 malaria cases were predicted in 2016 using time-series models. Applied time-series models were well-fitted regarding auto correlation function, partial auto correlation function sample/model, and residual analysis criteria (Pv was set to 0.1). The results indicated two significant prospective spatial-temporal outbreaks for CL (P<0.5) including Most Likely Clusters, and one non-significant outbreak for malaria (P>0.5) in the area.Conclusions: Both CL and malaria follow a space-time trend in the area, but prospective permutation scan modeling works better for detecting CL spatial-temporal outbreaks. It is not far away from expectation since clusters are defined as accumulation of cases in specified times and places. Although this method seems to work better with finding the outbreaks of a high-frequency disease;i.e., CL, it is able to find non-significant outbreaks. This is clinically important for both high- and low-frequency infections;i.e., CL and malaria.

Spatiotemporal clustering of cutaneous leishmaniasis in Fars province,Iran

Objective: To assess the spatiotemporal trait of cutaneous leishmaniasis (CL) in Fars province, Iran. Methods: Spatiotemporal cluster analysis was conducted retrospectively to find spatio-temporal clusters of CL cases.Time-series data were recorded from 29 201 cases in Fars province,Iran from 2010 to 2015,which were used to verify if the cases were distributed randomly over time and place. Then, subgroup analysis was applied to find significant sub-clusters within large clusters.Spatiotemporal permutation scans statistics in addition to subgroup analysis were implemented using SaTScan software. Results: This study resulted in statistically significant spatiotemporal clusters of CL (P<0.05).The most likely cluster contained 350 cases from 1 July 2010 to 30 November 2010. Besides, 5 secondary clusters were detected in different periods of time. Finally, statistically significant sub-clusters were found within the three large clusters(P<0.05). Conclusions: Transmission of CL followed spatiotemporal pattern in Fars province, Iran.This can have an important effect on future studies on prediction and prevention of CL.

The Effect of Mefenamic Acid and Naproxen on Heavy Menstrual Bleeding: A Placebo-Controlled Study

Background. Heavy menstrual bleeding is a common complaint. Various therapeutic approaches have been suggested.Aim. To compare the efficacy of mefenamic acid and naproxen in reducing heavy menstrual bleeding.Methods. Women referred to an outpatient centre for treatment of heavy menstrual bleeding were recruited. Participants who met the inclusion criteria were evaluated for 6 menstrual cycles. During 3 control cycles they recorded the amount of their bleeding on the Pictorial Blood Assessment Chart to confirm that their menstrual bleeding was heavy. One hundred and twenty participants were then randomly assigned to receive mefenamic acid; naproxen or placebo; and asked to fill in the same questionnaires during 3 intervention cycles. The data were analysed using SPSS version 15 for Windows.Results. Participants receiving mefenamic acid experienced a marked decrease in bleeding during the 3 months of intervention; an initial sharp decrease being followed by a further lesser decrease (p0.05 within group). Bleeding lessened dramatically in the first month of the intervention in participants receiving naproxen; and dropped still further in the second and third months (p0.05 within group). In the placebo group there were slight changes in bleeding during the intervention (p0.05 within group). However; the total decrease in bleeding was greatest in the naproxen arm; and the differences between the groups were statistically significant (p0.05 between groups).Conclusion. All three interventions had positive effects on the mean amount of bleeding; although naproxen was more effective than mefenamic acid and much more effective than placebo