Exploring the spatial pattern of animal bites in Iran (2021-2022).

OBJECTIVE: Knowledge of the spatial pattern of animal bites can be helpful for targeted resource allocation and to develop and deliver effective intervention programs. The aim of this study was to explore the spatial pattern of the animal bites in Iran during 2021-2022. METHODS: Animal bite cases from all provinces and counties in Iran were obtained from a nationally based registry. Global Moran's I was applied to check spatial autocorrelation. The spatially adjusted standardized incidence ratios (SIRs) were estimated using the Besag, York, and Mollie (BYM) model. Spatial clusters were identified by local indicators of spatial association (LISA) and purely spatial scan statistic. RESULTS: A total of 260,470 animal bites were registered during the study period. There was a positive spatial autocorrelation (global Moran's I=0.27, p-value=0.001). The majority of SIRs greater than 1.00 was found in counties in the northern belt of Iran (e.g., observed greater than expected animal bites). LISA found that approximately 7% of counties in the north and northeast, 18% in the west and south, and 3% in the central part of Iran were significant hot spots, cold spots, and spatial outliers (p-value≤0.05). Spatial scan statistic detected primary hot spot cluster in the counties in the Mazandaran and Alborz provinces (Relative Risk=2.56, p-value<0.001), while primary cold spot cluster involved counties in Kurdistan and Kermanshah province (0.37, <0.001). CONCLUSION: Animal bites were unevenly distributed in Iran. Further prevention and control programs as well as appropriately resource allocation are needed in order to reduce the observed animal bites spatial disparity.

The prognostic value of estimated glomerular filtration rate on admission for death within 30 days among COVID-19 inpatients using fractional polynomial and spline smoothing.

BACKGROUND: The common regression models included estimated glomerular filtration rate (eGFR) in the continuous and categorical form for predicting the mortality in COVID-19 inpatients. However, the relationship may be non-linear, and categorizing implies a loss of information. This study aimed to assess the effect of eGFR on admission on death within 30 days among COVID-19 inpatients using flexible and smooth transformations of eGFR and compare the results against the common models. METHODS: A retrospective study was conducted on hospitalized COVID-19 patients between April 2019 and July 2019 in Hamadan, Western Iran. The effect of eGFR on the death within 30 days was evaluated using different modeling: categorization, linear, unrestricted cubic spline (USC) with 4 knots, and fractional polynomial (FP). The results adjusted for older age and intensive care unit (ICU) admission. Discrimination power and model performance of the best-fitting model was evaluated using the area under the ROC (AUROC) and Brier score. RESULTS: In total, 2945 patients (median age 61 years; interquartile range 48-73 years) were included, of whom the mortality rate was 9.23%. The relationship between the eGFR and death within 30 days is non-linear, so the degree-2 FP with powers (- 2, - 1) is the best-fitting model. Using the FP model, the risk increased exponentially in eGFR < 45 and then increased linearly and slowly. The AUROC of the FP model involving eGFR, older age, and ICU admission was 0.92 (95% CI 0.90-0.93) with a Brier score of 0.09. CONCLUSION: There is a non-linear and asymmetric relationship between eGFR and death within 30 days among COVID-19 inpatients. Kidney function can be measured in COCID-19 patients on admission to know better understanding about prognosis of the patients.

Effects of Hypertension Alone and in Comorbidity with Diabetes on Death within 30 Days among Inpatients with COVID-19 Infection.

BACKGROUND: Hypertension and diabetes are common comorbidities in patients with COVID-19 and could be influencing the mortality of such patients. The present study aimed to evaluate the effects of hypertension alone and in comorbidity with diabetes on the death within 30 days among inpatients with COVID-19 in presence of well-known determinates of COVID-19 death. STUDY DESIGN: A case-control study. METHODS: Four groups of COVID-19 inpatients including controls, diabetes alone, hypertension alone, and hypertension and diabetes comorbidities were defined. Each study groups did not have underlying diseases other than hypertension and diabetes. Demographic and general characteristics, underlying diseases, and hospital course events were extracted from medical records. The outcome of interest was alive at discharge/ death within 30 days after admission. Multivariable binary logistic analysis was employed to estimate the effect measures. RESULTS: The number of death within 30 days among controls (n=1359), diabetes alone (159), hypertension alone (406) and hypertension and diabetes comorbidities (188) were 12.68%, 15.72%, 20.74% and 26.74%, respectively. According to three multivariable analyses after adjusting older age, hospital length of stay, and intensive care unit (ICU) admission separately, the odds of death within 30 days in COVID-19 patients with having hypertension and diabetes comorbidities was 1.58, 2.13 and 1.91 times of patients without such comorbidities, respectively (P<0.015). The effect of hypertension alone was also significant after adjusting hospital length of stay and ICU admission but not for older age. CONCLUSION: Our results suggest that comorbidities, such as hypertension and diabetes may be associated with COVID-19-related deaths independent of other underlying diseases, older age, and adverse hospital course events.