Prevalence of asymptomatic COVID-19 infection using a seroepidemiological survey.

The prevalence of asymptomatic infection by coronavirus disease 2019 (COVID-19) as a critical measure for effectiveness of mitigation strategy has been reported to be widely varied. In this study, we aimed to determine the prevalence of asymptomatic infection using serosurvey on general population. In a cross-sectional seroprevalence survey in Guilan province, Iran, the specific antibody against COVID-19 in a representative sample was detected using rapid test kits. Among 117 seropositive subjects, prevalence of asymptomatic infection was determined based on the history of symptoms during the preceding 3 months. The design-adjusted prevalence of asymptomatic infection was 57.2% (95% confidence interval (CI) 44-69). The prevalence was significantly lower in subjects with previous contacts to COVID-19 patients (12%, 95% CI 2-49) than others without (69%, 95% CI, 46-86). The lowest prevalence was for painful body symptom (74.4%). This study revealed that more than half of the infected COVID-19 patients had no symptoms. The implications of our findings include the importance of adopting public health measures such as social distancing and inefficiency of contact tracing to interrupt epidemic transmission.

Burden of musculoskeletal disorders in Iran during 1990-2017: estimates from the Global Burden of Disease Study 2017.

Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause. PURPOSE: MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. METHODS: We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. RESULTS: In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. CONCLUSION: Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

1,000,000 cases of COVID-19 outside of China: The date predicted by a simple heuristic.

We forecast 1,000,000 COVID-19 cases outside of China by March 31st, 2020 based on a heuristic and WHO situation reports. We do not model the COVID-19 pandemic; we model only the number of cases. The proposed heuristic is based on a simple observation that the plot of the given data is well approximated by an exponential curve. The exponential curve is used for forecasting the growth of new cases. It has been tested for the last situation report of the last day. Its accuracy has been 1.29% for the last day added and predicted by the 57 previous WHO situation reports (the date 18 March 2020). Prediction, forecast, pandemic, COVID-19, coronavirus, exponential growth curve parameter, heuristic, epidemiology, extrapolation, abductive reasoning, WHO situation report.

Survival rate of colon and rectum cancer in Iran: A systematic review and meta-analysis.

Colorectal cancer is one of the deadliest cancers worldwide. Effective screening, surveillance and prevention can decrease its incidence, mortality and burden. This meta-analysis aims to provide a pooled estimation of 5-year survival rate for colorectal cancer based on topography codes and treatment in Iranian population. A systematic search for literature was done in international and national databases up to July 2018. Twenty-seven studies from 4929 articles met the eligible criteria. The overall pooled 5-year survival rates of colorectal cancer, colon, rectal and sigmoid were 56% (95% CI: 49, 63), 53% (95% CI: 41, 65), 52% (95% CI: 41, 62) and 38% (95% CI: 22, 55), respectively. In addition, 5-year survival rate of colorectal cancer after surgery was 64% (95%CI: 50, 78). Subgroup analysis by type of data source showed significantly higher rate of survival in oncology center (29%) than hospital-based (p=0.005). As a conclusion, low survival rate of colorectal cancer in Iran necessitates effective screening and surveillance strategies to find precancerous polyps and detect early-stage cases with lower stage risk of cancer.

Prevalence of tuberculosis treatment non-adherence in Ethiopia: a systematic review and meta-analysis.

Non-adherence to treatment is one of the challenges facing global tuberculosis (TB) control. In Ethiopia, an extremely variable and high magnitude of TB treatment non-adherence have been reported from different parts of the country. However, there has been no attempt to estimate the pooled prevalence of non-adherence from this heterogeneous data. To review the available literature and estimate the overall prevalence of treatment non-adherence among patients with TB on first-line treatment in Ethiopia. A systematic review and meta-analysis of published articles on TB treatment non-adherence. We included 26 studies, which contained data on 37 381 patients with TB. The crude prevalence of non-adherence reported by the studies included was extremely variable (range 0.2-35%). The overall pooled estimate of non-adherence prevalence was 10.0% (95%CI 8.0-11.0). The pooled prevalence of patients lost to follow-up alone was 5.0% (95%CI 4.0-6.0), while the pooled prevalence of intermittent non-adherence was 20.0% (95%CI 15.0-25.0). The rate of TB treatment non-adherence in Ethiopia remains too high to achieve target treatment success rates and prevent drug resistance. Implementing an effective patient retention scheme, along with the DOTS strategy, is critical to improving treatment adherence and preventing drug resistance. .

Sitagliptin vs. pioglitazone as add-on treatments in patients with uncontrolled type 2 diabetes on the maximal dose of metformin plus sulfonylurea.

AIMS: To compare the efficacy of sitagliptin versus pioglitazone as add-on drugs in patients with poorly controlled diabetes with metformin and sulfonylureas. METHODS: This is a randomized, open-label, parallel assignment clinical trial. Patients who had inadequate glycemic control [7% (53 mmol/mol) ≤ A1C < 11% (97 mmol/mol)] despite a minimum 6-month period of active treatment with metformin 2000 mg/day plus gliclazide 240 mg/day were enrolled in the study. HbA1C, fasting blood glucose (FBG), fasting plasma lipid parameters [total cholesterol (TC0, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C)], systolic and diastolic blood pressure (SBP, DBP), weight, waist circumference, and body mass index were measured at baseline and after 17, 34, and 52 weeks of treatment. Generalized estimating equation analysis was done to compare treatment groups for continuous efficacy parameters. RESULTS: No significant difference in HbA1C reduction was observed between the treatment groups during the study course. (P = 0.149, adjusted P = 0.434; coefficient - 0.11 ± 0.08). The FBG (P = 0.032; coefficient 7.44 ± 3.48), HDL-C (P = 0.001; coefficient - 2.69 ± 0.83), TG (P = 0.027; coefficient 12.63 ± 5.71) and SBP (P < 0.001; coefficient 5.43 ± 1.26) changes from baseline, and weight gain were greater in the pioglitazone group. The mean changes in LDL-C and TC from baseline to week 52 were greater in the sitagliptin group (P = 0.034; coefficient - 7.40 ± 3.50, P = 0.013; coefficient - 7.16 ± 2.88, respectively). CONCLUSION: Sitagliptin and pioglitazone were equally effective in improvement of HbA1C. There were some differences in terms of lipid indices, weight gain, and SBP. The current study confirmed that both sitagliptin and pioglitazone are effective treatment options and the decision should be made for each individual based on the baseline characteristics.

Infectious exposure, antibiotic use, and multiple sclerosis: A population-based incident case-control study.

BACKGROUND: The existing reports regarding the potential role of infections as well as antibiotic use in multiple sclerosis (MS) etiology are inconclusive. OBJECTIVES: We aimed to investigate the association of viral infections as well as antibiotic use and the risk of developing MS. MATERIALS & METHODS: This was a population-based incident case-control study of 547 incident cases and 1057 general population controls obtained from 22 municipality areas of Tehran (7/8/2013-17/2/2015). Multiple logistic regression models were used to determine the adjusted associations. RESULTS: Overall antibiotic use for ≥14 days during 3 years before the index date, significantly decreased the odds of MS OR 0.69 (95%CI: 0.53-0.91, P = .008). The results were consistent for different types of antibiotics, including penicillin OR 0.50 (95%CI: 0.34-0.75, P = .001) and cephalosporins OR 0.25 (95%CI: 0.12-0.50, P < .001). History of IM was associated with a more than 5fold increased risk of MS OR = 5.7 (95%CI, 1.28-25.37). There was no statistically significant association between any other single or cumulative number of viral infections with subsequent risk of MS (P > .05). CONCLUSIONS: Considering the possibility of reverse causation, the results of this large case-control study suggest that use of antibiotics may be associated with a decreased risk of MS. However, viral disease other than infectious mononucleosis was not associated with MS risk.

Prevalence and correlates of low physical activity in the Iranian population: National survey on non-communicable diseases in 2011.

To assess the prevalence and correlates of low physical activity among Iranian population aged 15-64 years. We used the data collected in National Surveillance of Risk Factors of Non-Communicable Diseases in Iran, 2011. Physical activity was categorized in 3 levels of low, moderate, and high based on a Persian version of Global Physical Activity Questionnaire. The multistage cluster sampling design was accounted for using complex survey analysis method. The sample included 10016 individuals; 41.7% (n = 4178) were men and 58.3% (n = 5837) were women. The mean (SD) age of participants was 38.8 (14.9) years also, and 69.8% (n = 6991) of the participants were from urban areas. The prevalence of low physical activity in the whole population was estimated to be 44.8% (95% CI: 41.7, 48.1). The odds of lower physical activity in the women were 3 times greater than men (OR = 3.14; 95% CI: 2.64, 3.57); in the wealthiest people was 25% lower than the poorest people (OR = 0.75; 95% CI: 0.60, 0.94). The odds of lower physical activity in the age groups 55-64 years were 44% greater than the youngest age groups 15-24 years (OR = 1.44; 95% CI: 1.23, 1.68). The odds of lower physical activity in the obese participants were 18% greater than normal-weight people (OR = 1.18; 95% CI: 1.01, 1.38).). The odds of lower physical activity in diabetic patients were 30% greater than healthy people (OR: 1.30; 95% CI: 1.07, 1.57). The prevalence of low physical activity in Iran, 2011 was high. The correlates of low physical activity in Iran are different to those of Western populations. The main associated factors with low physical activity were female gender, urban area, low socioeconomic status, obesity, diabetes, and older age. Public health policies should target the groups at highest risk of low physical activity.

Blood pressure and cardiovascular morbidity risk in type 2 diabetes with hypertension over a decade of follow-up: evidence for J-shaped phenomenon.

There is still debate on whether the relationship between blood pressure (BP) and risk of cardiovascular diseases (CVD) in patients with type 2 diabetes (T2D) is linear or not. Since these cardio-metabolic disturbances share interrelated complex pathogenic mechanisms, we aimed to assess the relationship of baseline systolic (SBP)/diastolic pressures with CVD and coronary heart disease (CHD) events in a cohort of Iranians with T2D during a median follow-up of 8.8 years. Of all 1009 eligible participants with T2D with a mean (s.d.) age of 54.4 (11.6) years and free of CVD at baseline, we primarily focused on 260 participants undergoing anti-hypertensive treatment. Multivariate Cox proportional hazard models were used to evaluate hazard ratios (HR) of BP categories for CVD and CHD events. Also, multivariable regression modelling was applied to obtain their risk curve. We detected a J-shaped phenomenon between the continuous baseline BP and risk of CVD events. Considering 130⩽SBP<140 mm Hg as reference, a SBP ⩾140 mm Hg was associated with increased CVD (HR [95% confidence interval (CI)]: 2.43 [1.23-4.82]) and CHD (HR [95% CI]: 2.05 [1.02-4.13]) risk. However, a SBP⩽120 mm Hg in those with drug-treated hypertension also showed higher risk for CVD (HR [95% CI]: 2.80 [1.24-6.34]) and CHD events (HR [95% CI]: 2.39 [1.03-5.57]). Our findings revealed that the risk for macrovascular morbidity events was inversely associated with BP reduction below the level of 120/80 mm Hg for those with diabetes. People with diabetes might benefit from a BP management to a moderate range of 120/80-140/90 mm Hg for CVD risk reduction.

Subclinical hypothyroidism and diabetic nephropathy in Iranian patients with type 2 diabetes.

PURPOSE: Association of subclinical hypothyroidism with type 2 diabetes and its complications has been previously documented. These reports were, however, inconclusive and mainly gathered from Chinese and East Asian populations. In this study, we aimed to determine the prevalence of subclinical hypothyroidism and its relationship with diabetic nephropathy in Iranian individuals with type 2 diabetes, drawn from a white Middle Eastern population with an increasing prevalence of diabetes. METHODS: In this cross-sectional study, 255 Iranian participants with type 2 diabetes and without history of thyroid disorders were included. Patients with TSH > 4.2 mIU/L and normal T4 were classified as having subclinical hypothyroidism. Diabetic nephropathy was diagnosed based on abnormal 24-h urinary albumin or protein measurements (24-h urinary albumin ≥30 mg/day or 24-h urinary protein ≥150 mg/day). Multivariate logistic regression was employed to obtain the OR for the relationship between subclinical hypothyroidism and diabetic nephropathy. RESULTS: We found that subclinical hypothyroidism and diabetic nephropathy were as prevalent as 18.1 and 41.2 %, respectively, among the participants. We also found that subclinical hypothyroidism was independently associated with higher rates of diabetic nephropathy, after multivariable adjustment (OR [95 % CI] 3.23 [1.42-7.37], p = 0.005). CONCLUSIONS: We found that the prevalence of subclinical hypothyroidism in Iranian diabetic population was among the highest rates reported to date. Our data supported the independent association of subclinical hypothyroidism with diabetic nephropathy, calling for further investigations to evaluate their longitudinal associations.

Socioeconomic status and prevalence of self-reported diabetes among adults in Tehran: results from a large population-based cross-sectional study (Urban HEART-2).

INTRODUCTION: Diabetes mellitus is an important public health challenge worldwide. The prevalence of type 2 diabetes varies across countries. The aim of this study is to estimate the prevalence of type 2 diabetes and to determine related factors including socioeconomic factors in a large random sample of Tehran population in 2011. METHODS: In this cross-sectional study, 91,814 individuals aged over 20 years were selected randomly based on a multistage, cluster sampling. All participants were interviewed by trained personnel using standard questionnaires. Prevalence and Townsend deprivation indexes were calculated. Principal component analysis (PCA) was used to construct wealth index. Logistic regression model was used in multivariate analysis. RESULTS: The estimated prevalence of self-reported diabetes was 4.98 % overall, 4.76 %in men and 5.19 % in women (P < 0.003). In multivariate analysis, age, marital status (married and divorced/widow) and BMI were positively associated with the prevalence of self-reported diabetes. Of the socioeconomic variables, educational level and wealth status were negatively and Townsend Index was positively associated with diabetes. CONCLUSION: Our study findings highlight low reported prevalence of diabetes among adults in Tehran. Subjects with low socioeconomic status (SES) had a higher prevalence of type 2 diabetes. Weight gain and obesity were the most important risk factors associated with type 2 diabetes. Wealth index and educational level were better socioeconomic indicators for presenting the inequality in diabetes prevalence in relation to Townsend deprivation index.

Prediction of different ovarian responses using anti-Müllerian hormone following a long agonist treatment protocol for IVF.

OBJECTIVE: The purpose of this study was to predict the poor and excessive ovarian response using anti-Müllerian hormone (AMH) levels following a long agonist protocol in IVF candidates. RESEARCH DESIGN AND METHODS: Through a prospective cohort study, the type of relationship and appropriate scale for AMH were determined using the fractional polynomial regression. To determine the effect of AMH on the outcomes of ovarian stimulation and different ovarian responses, the multi-nominal and negative binomial regression models were fitted using backward stepwise method. The ovarian response of study subject who entered a standard long-term treatment cycle with GnRH agonist was evaluated using prediction model, separately and in combined models with (ROC) curves. RESULTS: The use of standard long-term treatments with GnRH agonist led to positive pregnancy test results in 30% of treated patients. With each unit increase in the log of AMH, the odds ratio of having poor response compared to normal response decreases by 64% (OR 0.36, 95% CI 0.19-0.68). Also the results of negative binomial regression model indicated that for one unit increase in the log of AMH blood levels, the odds of releasing an oocyte increased 24% (OR 1.24, 95% CI 1.14-1.35). The optimal cut-off points of AMH for predicting excessive and poor ovarian responses were 3.4 and 1.2 ng/ml, respectively, with area under curves of 0.69 (0.60-0.77) and 0.76 (0.66-0.86), respectively. CONCLUSION: By considering the age of the patient undergoing infertility treatment as a variable affecting ovulation, use of AMH levels showed to be a good test to discriminate between different ovarian responses.

Predicting CCHF incidence and its related factors using time-series analysis in the southeast of Iran: comparison of SARIMA and Markov switching models.

Crimean-Congo haemorrhagic fever (CCHF) is endemic in the southeast of Iran. This study aimed to predict the incidence of CCHF and its related factors and explore the possibility of developing an empirical forecast system using time-series analysis of 13 years' data. Data from 2000 to 2012 were obtained from the Health Centre of Zahedan University of Medical Sciences, Climate Organization and the Veterinary Organization in the southeast of Iran. Seasonal autoregressive integrated moving average (SARIMA) and Markov switching models (MSM) were performed to examine the potential related factors of CCHF outbreaks. These models showed that the mean temperature (°C), accumulated rainfall (mm), maximum relative humidity (%) and legal livestock importation from Pakistan (LIP) were significantly correlated with monthly incidence of CCHF in different lags (P < 0·05). The modelling fitness was checked with data from 2013. Model assessments indicated that the MSM had better predictive ability than the SARIMA model [MSM: root mean square error (RMSE) 0·625, Akaike's Information Criterion (AIC) 266·33; SARIMA: RMSE 0·725, AIC 278·8]. This study shows the potential of climate indicators and LIP as predictive factors in modelling the occurrence of CCHF. Our results suggest that MSM provides more information on outbreak detection and can be a better predictive model compared to a SARIMA model for evaluation of the relationship between explanatory variables and the incidence of CCHF.

Age-specific serum anti-Müllerian hormone levels: estimates from a large population-based sample.

OBJECTIVE: Despite the wide use of anti-Müllerian hormone (AMH) measurement as a clinical marker for assessment of ovarian reserve, a population-based estimate for its reference values is not available. In this study, we have estimated age-specific AMH levels in a large sample of fertile women directly selected from a general population cohort. METHODS: All women who were naturally fertile and aged 18-50 years with regular menstrual cycles were selected from the Tehran Lipid and Glucose Study cohort and their blood levels of AMH were measured. Centiles for AMH distribution were estimated according to the exponential-normal 3-parameter model. We repeated the analysis after including a subgroup of women aged 40-50 years who met all the eligibility criteria except having entered natural menopause after age 40 years (n = 141). RESULTS: A total of 1015 women entered the study. The mean age was 36.7 years (standard deviation 7.5 years) and the mean body mass index was 27.0 kg/m(2) (standard deviation 4.6 kg/m(2)). A non-linear decline of serum AMH concentration with age was observed. Age-specific AMH levels for the 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were calculated. RESULTS: were reproduced after inclusion of 141 women aged 40-50 years who met all the eligibility criteria except having entered natural menopause after 40 years. CONCLUSION: In this study, we have presented a nomogram of age-specific estimates of anti-Müllerian hormone in a large sample of naturally fertile women within the general population. This could help clinicians in more accurate individual interpretation of serum AMH levels in healthy women.