Résumé
Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.
Résumé
Introduction: Reports of reinfection in immunocompromised patients increased concern regarding multiple sclerosis (MS) patients since they are mostly on immunosuppressant agents. Objective(s): to compare the risk of reinfection between multiple sclerosis (MS) patients and a control group without MS. Aim(s): Measure the rate of possible reinfection among MS patients and control, protection against reinfection, odd of reinfection among those who previously tested positive;and effect of rituximab on the protection Method: In thisretrospective study, data of all SARS-CoV-2 tests (n=793,301) and almost all MS patients (n=10639) in Isfahan province were collected from January 01, 2020 to August 22, 2021. Of the 2196 MS patients and 793,301 persons from the general population who had been tested at least once, 3 control for each MS patient were identified, leaving 1560 MS patients and 4680 controls without MS. We compared the risk of reinfection after 90 days of a primary infection between those with and without a previous positive COVID-19 test. Result(s): 736 (48.2%) MS patients and 2013 (43.0%) control individuals had at least one positive test. A total of 17 (2.3%) and 22 (1.1%) possible reinfections in MS and control groups were observed. The adjusted risk ratio (RR) of infection among previously infected patients compared to uninfected persons in all MS patients was 0.318 (95%CI: 0.188, 0.538), MS patients on rituximab was 0.426 (95%CI: 0.169, 1.070), MS patients on DMTs rather than rituximab was 0.280 (95% CI: 146, 0.537), and control individuals was 0.179 (95%CI: 0.115, 0.279). The estimated protection against reinfection in all MS patients, MS patients on rituximab, MS patients on DMTs rather than rituximab, and controls were 68.2% (46.3%, 81.2%), 57.4% (-0.1%, 83.5%), 71.5% (45.5%, 85.2%), and 82.1% (72.1%, 88.5%), respectively. We found no statistically significant difference in estimated protection (p=0.123) and odd of reinfection (adjusted OR: 2.01 [0.98, 4.08]) between all MS patients and control group.Two patients were hospitalized at first infection but none required hospitalization at reinfection event. Conclusion(s): Prior SARS-CoV-2 infection is protective against reinfection in MS patients. Those on rituximab may be at a greater risk of reinfection. We found no evidence regrading increased risk of severe reinfection compared to the primary infection Further studies are required to assess the risk of the second reinfection among the MS population.