Lactational Exposure of Human Infants to Metal (loid)s: A Comparison of Industrial and Urban Inhabitants in North of the Persian Gulf.

In this study, postnatal metal (loid)s (MLs) exposure was compared between the petrochemical and gas area of Asaluyeh (PGA) and urban area of Kaki (UA) in Bushehr province, Iran. Two hundred human breast milk (BM) samples from the industrial and urban areas were analyzed for MLs using Inductivity Coupled Plasma-Optical Emission Spectrometry (ICP-OES). Boron (B), copper (Cu), iron (Fe), and nickel (Ni) were found at the highest levels in both study areas. Adjusted multiple linear regression models revealed that the mean concentration of total MLs in BM samples collected from the PGA was statistically significantly greater than that of the UA (655.85 vs. 338.17 µg/L). Also, the mean concentrations of all detected MLs in BM samples collected from the PGA were statistically significantly higher than those collected from the UA. The hazard index (HI) of combined MLs in the PGA and UA illustrated non-cancer risk for infants. Lead (Pb) and chromium (Cr) in the PGA and Cr in the UA showed the risk of cancer. So it can be concluded that nursing infants from an industrial area are most at risk for MLs exposure during entire lactation course than those from an urban area.

Vaccination effects on reducing COVID-19 complications in pregnancy: A large-scale report from Iran.

OBJECTIVE: The objective of this study was to evaluate the effects of maternal coronavirus disease 2019 (COVID-19) vaccination on preventing severe complications of COVID-19 in pregnant women. METHODS: A retrospective study was conducted in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and/or for up to 6 weeks postpartum between September 1, 2021, to January 30, 2022. The data was retrieved from a national database. The pregnant women were divided into two groups of vaccinated and unvaccinated. The proposed outcomes (the need for hospitalization, intensive care unit admission, and mechanical ventilation and products of conception complications) were compared between the two groups. RESULTS: Approximately 90 000 pregnant women infected with COVID-19 were included in the study. The data of the vaccinated (19 922) and unvaccinated (70 147) groups were analyzed and compared. Pregnant patients in the vaccinated group had a significantly lower rate of hospitalization (21.2% vs 29.4%) (odds ratio [OR], 0.648 [95% confidence interval (CI), 0.625-0.673], P = 0.0001) and intensive care unit admission (3.7% vs 7.8%) (OR, 0.453 [95% CI, 0.382-0.535], P = 0.0001). The need for mechanical ventilation was also lower, although not statistically significant, in the vaccinated group than in the unvaccinated group (30 of 155 [19.4%] vs 418 of 1597 [26.2%]) (OR, 0.677 [95% CI, 0.448-1.024], P = 0.063). Cesarean section (54.3% vs 58.1%) (OR, 0.856 [95% CI, 0.751-0.977], P = 0.021) and stillbirth (0.4% vs 3.6%) (OR, 0.097 [95% CI, 0.026-0.252], P = 0.0001) were also significantly lower in the vaccinated patients. Most pregnant women in the vaccinated group (18 484-96.14%) received Sinopharm BIBP COVID-19 inactivated vaccine. No significant differences were seen in the effect of different types of COVID-19 vaccines on reducing COVID-19 complications in infected pregnant patients. CONCLUSION: Maternal COVID-19 immunization is effective in reducing COVID-19 complications in infected pregnant women.

Management goal achievements of diabetes care in Iran: study profile and main findings of DiaCare survey.

Aim: This paper presented the methodology and main findings of a population-based survey to determine diabetes care status among type 2 diabetic subjects in Iran. The current study assessed treatment goal achievements in type 2 diabetics, diabetes care service utilization, prevalence of diabetes complications, and psychological effects of diabetes in a representative sample of Iranian population in urban and rural areas. Materials and Methods: This nationwide study was conducted between 2018 and 2020 as the observational survey entitled "Diabetes Care (DiaCare)". We studied a representative sample of participants with type 2 diabetes, aged 35-75 years, living in urban and rural areas in all thirty- one provinces of Iran. Data were collected by an interviewer in a form of a questionnaire that includes demographic and socioeconomic status, family and drug history, lifestyle, and self-reported psychological status according to a Patient's Health Questionnaire (PHQ). Management goal achievements, diabetes care service utilization, diabetes complications and psychological effects of diabetes were also assessed. Physical measurements were measured based on standard protocol. Fasting blood glucose (FBG), HbA1c, lipid profile, and also urine albumin to creatinine ratio were obtained from all participants of the study. Results: Overall, 13,334 people with type 2 diabetes in 31 provinces of Iran completed the survey (response rate: 99.6%). In total 13,321 participants, 6683(50.17%) women and 6638(49.83%) men were included in our analysis. Thirteen recruited patients refused after the consenting process and did not respond. The mean age (SD) of total participants was 54.86 ± 9.44 years and 71.50% were from the urban areas. 13.66% of diabetic patients had achieved the triple target of management [controlled HbA1c, blood pressure, and Low-Density Lipoprotein-Cholesterol (LDL-C)] in the whole country. While 28.74% of people had controlled HbA1c and 33.40% of them had controlled FBG. Diabetic subjects living in rural areas had less controlled HbA1c (23.93 vs. 29.48), controlled FBG (29.50 vs. 34.20) and controlled triple targets (10.45 vs. 14.32) than those living in urban areas. Diabetic neuropathy and diabetic foot were more common in women than men, while end-stage of renal disease (ESRD) was more common in men than women. Conclusions: This population-based study provided representative information about diabetes care in Iran. The high prevalence of diabetes and low proportion of diabetes control in Iran implies that it is necessary to identify factors associated with poor treatment goal achievements. Besides, general improvements in management and care of diabetes are mandatory.

A comparative monitoring of maternal and cord serum polychlorinated biphenyls levels from Iranian pregnant women between industrial and urban areas.

The aim of this study was to compare maternal and fetal exposure to PCBs in pregnant women from a petrochemical and gas area (PGA) and an urban area (UA), by the analyses of serum samples from mother (MS) and cord (CS). After liquid-liquid extracting, samples were analyzed for 12 PCBs congeners by gas chromatography mass spectrometer. Adjusted multiple linear regression models showed the mean levels (µg/L) of total PCBs in the MS and CS samples from the PGA (1.70 ± 0.81 and 1.19 ± 0.43) were significantly higher than those from UA (1.64 ± 0.75 and 1.07 ± 0.38). PCB 44 was predominant in both MS and CS serum samples, and in both PGA (0.80 ± 0.70 and 0.76 ± 0.67) and UA (0.79 ± 0.39 and 0.67 ± 0.34). A negative correlation was found for PCB 52 as one-unit increase in the cord serum levels was associated with 0.024 g decrease in newborn weight. Similarly, one-unit increase in the maternal serum PCB 18 concentrations were associated with 0.09 and 0.086 cm decrease in newborn height and head circumference. The serum levels of PCB 18 and 52 in the mothers who consumed meat and milk at least 1 meal/week were higher than these who consumed meat and milk never or less than 1 meal/month. The findings in this study indicated that higher maternal exposure to PCBs, as result of living in an industrialized area, leads to higher PCBs accumulation in cord blood, which consequently passes to the developing fetus. These events may cause harmful effects on both them in-utero and afterbirth growth and development.

Iranian Multi-center Osteoporosis Study (IMOS), 2021-2022: the study protocol.

BACKGROUND: This paper presents the protocol of the 4th round of Iranian Multi-center Osteoporosis Study (IMOS), a national survey with the primary objective of estimating the prevalence of osteoporosis and sarcopenia and their risk factors in a representative sample of urban and rural populations. METHODS: The target population of the survey is all individuals ≥ 50 years in Iran. A multi-stage random sampling method has been used in the study. We stratified the 31 provinces of the country into 5 strata based on the distribution of their potential risk factors for osteoporosis and randomly selected one or two provinces from each stratum. Then, we invited 2530 people aged ≥ 50 years recruited in the 8th National Survey of None Communicable Diseases (NCD) Risk Factors (STEPs-2021) in the selected provinces to participate in IMOS. Body composition measurements including bone mineral density, muscle mass, and fat mass are measured through Dual-energy X-ray Absorptiometry (DXA) method using HOLOGIC (Discovery and Horizon) devices; and Trabecular Bone Score (TBS) is measured on the DXA scans using iNsight software. Anthropometric measurement and physical examinations are made by a trained nurses and other required information are collected through face-to-face interviews made by trained nurses. Laboratory measurements are made in a central lab. The prevalence of osteoporosis and sarcopenia will be estimated after applying sampling design, non-response, and post-stratification weights to the data. DISCUSSION: IMOS will provide valuable information on the prevalence and determinants of osteoporosis and sarcopenia at the national level, and the results can be used in evaluating health system interventions and policymaking in the field of musculoskeletal diseases.

Socioeconomic difference in physical activity in children and their parents: The childhood and adolescence surveillance and prevention of adult noncommunicable disease study.

Background: As a health-related behavior, physical activity (PA) differs according to individual's socioeconomic status (SES). This study aimed to assess the socioeconomic difference in leisure-time PA among Iranian students and their parents at national and regional levels. Study Design: Nationwide cross-sectional study. Methods: This study was conducted as part of a national survey conducted in 2015 among 14400 Iranian students and their parents. Total PA level was measured as the average hours spent on PA per week. Nonlinear principal component analysis was used to construct the households' SES based on household's assets, type of house ownership, occupation of fathers and the educational levels of fathers and mothers. Concentration index was applied to measure the inequality in the PA level in parents and students. Results: Complete data of 13313 students and their parents were available. At the national level, students spent more hours of PA per week (3.753 h per week [h/w]) as compared to their parents. Moreover, PA h/w was higher in fathers (3.488 h/w) as compared to mothers (2.763 h/w). The lowest means of mother's and student's PA were found in the highest SES region. At national level, the concentration indices (CI) of father's and mother's PA were -0.050 (95% CI = -0.067 ~ -0.030) and -0.028 (95% CI = -0.044 ~ -0.012), respectively, indicating pro-poor inequality, but the CI value of student PA was non-significant (CI = -0.007, 95% CI = -0.023-0.008). Conclusions: Given that the mother's and student's PA level was low in the high SES regions, it is suggested that focused PA planning may further increase the level of PA across higher SES regions and might be effective in reducing the PA inequality.

Thoracic Sarcoma: A New Glance at the Epidemiological Characteristics of Disease in Iran from 2009 to 2014.

Background: The heterogeneity, high rate of mortality and lack of comprehensive diagnostic methods have categorized primary sarcomas of the thorax as a malignancy with dismal outcomes and unknown etiology. Given the fundamental role of epidemiological analysis in establishing management strategies, we designed a study with focus on the epidemiological characteristics of primary thoracic sarcomas in Iran. Methods: This national population-based cancer study was conducted on patients with histologically confirmed sarcoma of the thorax referred to the Iranian National Cancer Registry between 2009 and 2014. The incidence was calculated as number of cases per 100,000 person-years and was age-adjusted by the direct method using the weight of the 1960 world standard population. Results: Over a 6-year period, 1477 cases with pathologically confirmed thoracic sarcomas were registered in Iran, of which 896 were male and 581 were female. Khuzestan Province had the highest incidence of thoracic sarcomas as compared to other provinces. Malignant mesothelioma was the most common histological subtype (20.85%). Moreover, the age-standardized incidence rate (ASR) of the disease was 1.94 per 100,000 which was more common in males than females with the highest incidence rate in men aged more than 65 years. Conclusion: Our study provided valuable epidemiologic data on characteristics of thoracic sarcomas. This data can be used for strategizing preventive measures.

Maternal and fetal exposure to metal (loid)s, maternal nutrition status, and impact on prenatal growth in an energy rich zone and an urban area along the Persian Gulf.

The main purposes of the study were to determine whether maternal and cord blood (MB and CB) levels of metal (loid)s (MLs) are different between industrial and urban areas. Subjects were derived from the petrochemical and gas area (PGA) of Asaluyeh County and the urban area (UA) of Bushehr County in Iran. Adjusted models revealed significant differences between the PGA and UA for maternal Fe, Cu, Mg, Cd, Zn, Ni, V and Pb levels, likewise cord Cu, V, Pb and Ni levels, which were higher in the PGA. Unadjusted models revealed there were decreases in neonatal weight and head circumference by 16.550 g and 0.059 cm, respectively for each Ln unit increase in maternal Cr levels. The mean blood levels of MLs significantly associated with food consumption frequency. The MLs were detected at higher levels in the body's fetuses and their mothers who resided in the PGA than those from the UA. So, the fetuses of mothers living in an industrial areas may be at higher risk from anthropometric measures. The impact of prenatal exposure to MLs on prenatal growth should be considered for better understanding in the further studies.

Primary Health Care Model for Non-Communicable Diseases Management during COVID-19 Pandemic in the Islamic Republic of Iran.

Background: Given the importance of appropriate response to prevent and manage Non-Communicable Diseases (NCDs), this study aimed to analyze the state of NCDs services at the level of the PHC system during the COVID-19 pandemic and to determine the main strategies. Methods: In this qualitative study, first, the circulars and guides in Iran's PHC system from the beginning of the pandemic to the end of September 2020 were retrieved manually and by searching the internal websites of the Ministry of Health. All documents about decision-making or governance and coordination mechanisms for the provision of NCDs services were enrolled and analyzed. In the second phase, the status of service delivery for major NCDs was presented in a model, and finally, SWOT analysis was used to analyze the situation and determine the main strategies. Results: 25 out of 199 circulars and guides were eligible and analyzed. In the crisis phase, most risk assessment, screening, and diagnosis services for NCDs have been suspended, and follow-up and care of patients with major NCDs were done by telephone. In the reopening phase, the general strategies and strategies to increase capacity and provide delayed care were adopted, and the PHC model of the provision of essential services for the major NCDs was developed in low-risk, intermediate and high-risk pandemic conditions. Finally, 16 main strategies were determined with the approach of integrating and focusing on essential services, considering vulnerable groups and the use of E-health technologies. Conclusion: The results indicate on interruption of NCDs services in the crisis phase while adopting strategies for responding to the pandemic. Revision of the COVID-19 guides with a particular focus on NCDs is recommended.

Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021.

BACKGROUND: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS: By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

The Iranian National Blood Pressure Measurement Campaign: What Do the Process and Output Evaluation say?

BACKGROUND: The Iranian National Blood Pressure Measurement Campaign (INBPMC) was conducted all over the country to raise awareness in different groups of people regarding the importance of blood pressure and persuading them to manage their blood pressure. The present research aimed at assessing the process and output of this campaign. METHODS: For process evaluation, 31 universities/faculties were selected. Experts from the Ministry of Health and Medical Education assessed the documentation of the campaign implementation using the designed checklist. The output was assessed by including 8274 people and through a telephone survey using the designed instructions. RESULTS: The response rate of the telephone interviews was 82.74% (8274 people). It was found that 79% of the selected groups were aware of the INBPMC. Among them, 64% remembered the messages, 99% of the participants who remembered the messages agreed with those messages, and 89% of the participants who agree with the messages went for a measurement of their blood pressure. In the telephone interviews, 30% of the participants stated that they were diagnosed with hypertension, 97% of these participants received the required consultations for subsequent care, and 86% of them went to the health service centers to receive care. The process evaluation of the INBPMC indicated that the universities of medical sciences obtained 97% of the score of the checklist. CONCLUSION: The INBPMC was successful and accomplished its objectives.

The detection of SARS-CoV-2 RNA in indoor air of dental clinics during the COVID-19 pandemic.

In the indoor environment of dental clinics, dental personnel and patients are exposed to a risk of infection because of the transmission of SARS-CoV-2 via particles or droplets. This study investigated the presence of SARS-CoV-2 RNA in indoor air of dental clinics in Tehran, Iran. Air sampling was done (n = 36) collecting particulate samples on PTFE filters at flow rates of 30 to 58 L/min. The samples were analyzed with novel coronavirus nucleic acid diagnostic real-time PCR kits. Only 13 out of 36 samples were positive for SARS-CoV-2 RNA. Logistic regression showed that sampling site's volume, PM2.5 concentration, number of people, and number of active patient treatment units were significantly positively related with the presence of SARS-CoV-2 RNA. Thus, strategies to control the spread of COVID-19 should include reducing the number of infected people in dental clinics, adding filtration systems, and/or improving ventilation conditions.

The Effect of the COVID-19 Pandemic on Non-Communicable Disease Prevention and Management Services in the Primary Health Care System of Iran.

Background: The COVID-19 pandemic has caused significant disruptions in the provision of non-communicable disease (NCDs) prevention and control services in many countries, and there is a concern that it would lead to long-term complications of the diseases. The aim of this study is to assess the changes in the provisions of selected NCD services before and after the COVID-19 epidemic in Iran's primary healthcare system. Methods: In this descriptive-analytical retrospective study, the number of eight NCD services provided during the first 10 months of the COVID-19 pandemic from Feb 2020 to Dec 2020 were compared with the same period in the previous year using the data from the Iranian integrated electronic health record system (SIB) and also the association between the number of deaths due to COVID-19 and a sample of NCD services were assessed using cross-correlation analysis. The statistical analysis was performed in Stata Software v.14. Results: The NCD services have decreased by an average of 18.89% compared to the same period in the previous year; this decline was much more severe at the beginning of the epidemic period (up to 75% in some services) and was greater in physician-provided services than in non-physician services. Also, examining the course of the selected services during this period, a gradual compensation was evident after the initial reduction. Conclusion: The general trend of the selected services of prevention and control of NCDs in the PHC system of Iran within 10 months after the onset of COVID-19 showed a sharp decline and subsequent gradual compensation. Although the process of compensation in some services may be considered somewhat reassuring, in the case of some essential services, more effort and attention to the implementation of programs or compensatory policies seem necessary.

Annual incidence of osteoporotic hip fractures in Iran: a systematic review and meta-analysis.

BACKGROUND: Osteoporosis (OP) is progressively becoming a global concern with the aging of the world's populations. Osteoporotic fractures are associated with significantly increased mortality rates and a financial burden to health systems. This Meta-analysis aims to estimate the annual incidence of osteoporotic fractures in Iran. METHODS: A comprehensive systematic literature search was performed through Medline (PubMed), Embase, Scopus, Web of Science, and Google Scholar to identify studies which contain an investigation of the incidence of osteoporotic fractures in Iran up to December 3rd 2020, with no time and language restriction. For the risk of bias assessments of studies, the Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used. The pooled estimation of the incidence of osteoporotic fractures in population aged≥50 years was calculated using random-effects meta-analysis, and the heterogeneity of included studies was quantified with the I2 statistic. RESULTS: In all, 6708 papers were initially retrieved from the electronic databases, among which seven studies were included in the meta-analysis. The pooled standardized annual cumulative incidence of hip fractures was estimated as 138.26 (95% CI: 98.71-193.65) per 100,000 population and 157.52 (95% CI: 124.29-199.64) per 100,000 population in men and women, respectively. CONCLUSION: This study showed a high incidence rate of osteoporotic hip fractures in Iran. Early detection and treatment of individuals with higher risks of primary fragility fractures at primary health care as well as implementing fracture liaison services to prevent secondary fractures are highly recommended. The results suffer from the following limitations: first, a low number of studies that were eligible for inclusion; second, the lack of population-based studies; and presence of highly heterogeneous studies despite the use of a random effect model.

Routine COVID-19 testing may not be necessary for most cancer patients.

Cancer patients are at risk for severe complications or death from COVID-19 infection. Therefore, the need for routine COVID-19 testing in this population was evaluated. Between 1st August and 30th October 2020, 150 cancer patients were included. Symptoms of COVID-19 infection were evaluated. All eligible individuals went through RT-PCR and serological tests for COVID-19. At the same time, 920 non-cancer patients were recruited from a random sample of individuals who were subject to routine molecular and anti-body screening tests. Of 150 cancer patients, 7 (4.7%) were RT-PCR positive. Comorbidity made a significant difference in the RT-PCR positivity of cancer patients, 71.4% positive versus 25.8% negative (P-value = 0.02). The average age for negative and positive groups was 53.3 and 58.2 respectively (P-value = 0.01). No significant difference was observed between cancer and non-cancer patients regarding COVID-19 antibody tests. However, cancer patients were 3 times less likely to have a positive RT-PCR test result OR = 0.33 (CI: 0.15-0.73). The probability of cancer patients having a positive routine test was significantly lower than non-cancer patients, and the concept that all cancer patients should be routinely tested for COVID-19 may be incorrect. Nevertheless, there may be a subgroup of patients with comorbidities or older age who may benefit from routine COVID-19 testing. Importantly, these results could not be subjected to multivariate analysis.

Effect of short-term exposure to air pollution on COVID-19 mortality and morbidity in Iranian cities.

Purpose: The association between air pollutant (PM2.5, PM10, NO2, and O3) concentrations and daily number of COVID-19 confirmed cases and related deaths were evaluated in three major Iranian cities (Tehran, Mashhad, and Tabriz). Methods: Hourly concentrations of air pollutants and daily number of PCR-confirmed cases and deaths of COVID-19 were acquired (February 20th, 2020 to January 4th, 2021). A generalized additive model (GAM) assuming a quasi-Poisson distribution was used to model the associations in each city up to lag-day 7 (for mortality) and 14 (for morbidity). Then, the city-specific estimates were meta-analyzed using a fixed effect model to obtain the overall relative risks (RRs). Results: A total of 114,964 confirmed cases and 21,549 deaths were recorded in these cities. For confirmed cases, exposure to PM2.5, NO2, and O3 for several lag-days showed significant associations. In case of mortality, meta-analysis estimated that the RRs for PM2.5, PM10, NO2, and O3 concentrations were 1.06 (95% CI: 0.99, 1.13), 1.06 (95% CI: 0.93, 1.19), 1.15 (95% CI: 0.93, 1.38), and 1.07 (95% CI: 0.84, 1.31), respectively. Despite several positive associations with all air pollutants over multiple lag-days, COVID-19 mortality was only significantly associated with NO2 on lag-days 0-1 and 1 with the RRs of 1.35 (95% CI: 1.04, 1.67) and 1.16 (95% CI: 1.02, 1.31), respectively. Conclusion: This study showed that air pollution can be a factor exacerbating COVID-19 infection and clinical outcomes. Actions should be taken to reduce the exposure of the public and particularly patients to ambient air pollutants. Supplementary Information: The online version contains supplementary material available at 10.1007/s40201-021-00736-4.

COVID-19 in patients with diabetes: factors associated with worse outcomes.

Purpose: Diabetes is one of the major comorbidities associated with COVID-19. We aimed to determine the clinical and epidemiological factors associated with the mortality of COVID-19 in diabetic patients in Iran, and also the impact of prescribed antiviral and antibiotics on patients' status. Methods: In this study, we used the national registry of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) Symptoms with diabetes from February 18, 2020, to December 22, 2020. Demographic, clinical features, treatments, concurrent comorbidities, and their associations with mortality and severity outcomes were assessed using logistic regression. Results: 78,554 diabetic in-patients with SARS symptoms were included from 31 provinces of whom 37,338 were PCR positive for COVID-19. Older age and male gender are associated with COVID-19 mortality in diabetic patients. CVD is the most frequent comorbidity (42%). CVD, kidney disease, liver disease, and COPD are associated comorbidities which increased the risk of mortality. The mortality rate is higher in diabetic patients comparing to patients with no comorbidities, particularly in younger age groups. The frequency of antiviral, and antibiotics in COVID-19 positive patients was 34%, and 31%, respectively. Antibiotic treatment has no association with mortality in COVID-19 patients. Conclusions: Diabetic patients indicate higher mortality comparing to patients without any underlying comorbidities. Restrict strategies on increasing effective health care utilization must be considered in diabetic patients, especially in those with parallel underlying comorbidities. Regarding the antibiotic resistance issue and the noticeable use of antibiotics in diabetic patients, it is recommended to prioritize an antibiotic guideline prescription in COVID-19 patients for better stewardship by countries.

Bladder Cancer Incidence in Iran: Results of the Iranian National Population-Based Cancer Registry from 2014 to 2016.

PURPOSE: Bladder cancer is a common cancer in the world with the highest rates in Southern and Western Europe, North America, and Western Asia. It imposes a high economic burden to the health care system globally. The objective of this study is to provide the incidence of bladder cancer and its geographic distribution in Iran in 2014, 2015 and 2016. RESULTS: We registered 5817, 5662 and 6630 new bladder cancer cases in 2014, 2015 and 2016, respectively with men counting 82% of cases in every year. The ASR of bladder cancer in total Iranian population was 8.50 (95% CI: 8.28-8.72), 8.05 (95% CI: 7.83-8.27) and 8.74 (95% CI: 8.52-8.96) per 100,000 in those years. The male to female ratio was 5 every year. Kerman has the highest ASR in each of the years, respectively 15.49, 13.07 and 12.46, and Ilam has the lowest ASR during 2014 to 2015, respectively 4.27 and 3.50, and Sistan and Baluchestan has the lowest rate in 2016 (ASR:3.56) in both sexes. CONCLUSION: The highest incidence of bladder cancer was observed in Central, southern and northwestern parts of Iran. Through the analysis of the incidence patterns and the identification of risk factors associated with it, steps can be taken towards prevention and control measures.

Incidence of Hematopoietic Sarcoma in Iranian Population.

BACKGROUND: The heterogeneous nature of hematopoietic sarcoma has restricted the diagnosis and treatment of this disease to the extent that annually, several patients lose their lives. Given the lack of comprehensive epidemiologic information on the incidence of hematopoietic sarcoma in the Iranian population, we designed the present study to evaluate the distribution pattern of this disease. METHODS: In this national population-based cancer registry study, we collected data from patients diagnosed with hematopoietic sarcoma who were registered in the Iran National Cancer Registry (INCR) between 2009 and 2013. For each patient, the variables of age, sex, province, year of diagnosis, site of involvement and morphology were collected. RESULTS: In 45 cases from 18 provinces of Iran, we found that the incidence rate of the disease was 0.60 (95% CI: 0.44-0.80) per million persons. Among all provinces, Ilam had the highest incidence of hematopoietic sarcoma with a rate of 2 (95% CI: 0.05- 11.14) per million persons, while Isfahan had the lowest incidence with a rate of 0.21 (95% CI: 0.01-1.16) per million persons. The incidence rate of the disease increased with age and the disease was slightly more common in men (0.63 [95% CI: 0.41-0.94] vs. 0.56 [95% CI: 0.35-0.86] per million persons). The frequency of hematopoietic sarcoma in connective and soft tissues was higher than other anatomical sites and we found that myeloid morphology was the most prevalent morphology. CONCLUSION: The resulting data provided a valuable perspective on the distribution pattern of hematopoietic sarcoma in Iran; however, further studies are required to confirm these results.

Mobile Spine Osseous Sarcoma: Descriptive Epidemiological Analysis Based on a National Population-Based Study.

BACKGROUND: Primary osseous sarcomas of the mobile spine are rare bony tumors. Ewing sarcoma, chondrosarcoma, chordoma and osteosarcoma constitute the majority of primary bone sarcomas of the spine; however, other rare sarcoma tumors may also affect the spine. In order to perform an epidemiological study of theses tumors, national registries may help to evaluate data for populations with similar characteristics. METHODS: A population-based study was designed based on data from the Iran National Cancer Registry (INCR). All morphology codes (M-Code) of primary osseous sarcomas of the mobile spine (C-code 41.2) were derived and analyzed. RESULTS: Among 186 patients with primary osseous sarcomas of the mobile spine, 67.2% were men and 32.8% were women. The median (IQR) age was 37.0 (20.0-59.0) years and the age-standardized incidence rate (ASIR) was 0.37 per million. The majority of cases of Ewing sarcoma (29.5%) were observed in the age group 20-25 years. Among male patients with chondrosarcoma, the median age was 39.0 (30.0-50.0), while females showed a median age of 56.0 (50.0-59.0). The median age of patients with chordoma was 54.0 (47.0-63.0) years. The crude incidence rate of mobile spine osteosarcoma was 0.04 per million. CONCLUSION: Ewing sarcoma was the most frequent primary osseous sarcoma of the mobile spine. A male predilection was observed among all major sarcomas of the mobile spine. Ewing sarcoma in Iran affects the mobile spine in slightly older ages compared to other studies. Myxoid chondrosarcoma is the most frequent subtype of the mobile spine chondrosarcoma. Chordoma affects male in older ages compared to females. In contrast with other studies which showed a bimodal distribution of osteosarcoma of the spine including young adult and older age groups, 86% of cases in Iran were in the age group of 10-40 years.