Incidence of multiple sclerosis in Iran: a nationwide, population-based study.

OBJECTIVES: The incidence of multiple sclerosis (MS) is not well known in Iran. This study was conducted to estimate the trends in annual MS incidence in Iran from March 21, 2010, to March 20, 2016. STUDY DESIGN: Longitudinal study. METHODS: In this longitudinal study, data for all MS patients fulfilling McDonald criteria were obtained from a national registry, coordinated by the Ministry of Health (MOH). In Iran, all MS patients are eligible to receive public care and treatment services based on their records in this registry, and thus nearly all MS patients are registered in this database. The annual incidence rates were calculated based on year of diagnosis and were standardized using the World Health Organization (2000-2025) population as a standard. RESULTS: In this registry, 36,287 (8202 [22.6%] males and 28,085 [77.4%] females) confirmed MS cases were registered by the MOH between 2010 and 2016. The female-to-male ratio was 3.11. The mean age of patients was 31.6 ± 0.9 years at the time of diagnosis. It was 31.3 ± 0.8 and 32.3 ± 0.9 for females and males, respectively. Overall incidence rate was 6.7/100,000 population (95% confidence interval [CI]: 6.2-7.2); 10.5 and 3.0 in females and males, respectively. The age-adjusted incidence rates increased significantly from 4.4 (95% CI: 4.3-4.6) in 2010 to 5.8 (95% CI: 5.7-6.0) in 2016, with its peak at 6.5 (95% CI: 6.3-6.6) in 2014. CONCLUSIONS: This study revealed that Iran is a high-risk area for MS disease and that MS incidence and female-to-male ratio are more or less comparable with the dominant patterns in developed countries. Also, this study showed that the incidence trend of MS in Iran is similar to regional and global observed patterns.

Estimation of influenza and severe acute respiratory illness incidence (burden) in three provinces of the Islamic Republic of Iran, 2012 and 2013.

There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection (SARI) and influenza-associated SARI (F-SARI) in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza (F-SARI) over 12 months (seasonality), and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend (seasonality) of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique. The age groups most at-risk were children aged under 2 years and adults older than 50 years.

Estimation of influenza and severe acute respiratory illness incidence [burden] in three provinces of the Islamic Republic of Iran, 2012 and 2013

There are few estimates of influenza burden in the WHO Region for the Eastern Mediterranean. In this study we estimated the burden of severe acute respiratory infection [SARI] and influenza-associated SARI [F-SARI] in selected provinces of Islamic Republic of Iran, the trends of SARI and confirmed cases of influenza [F-SARI] over 12 months [seasonality], and the age groups most at risk. Using the electronic Iranian influenza surveillance system and data of cases in sentinel hospitals of 3 selected provinces, we estimated the monthly trend [seasonality] of incidence for SARI and F-SARI, overall incidence of SARI and F-SARI and their disaggregation by age with the aid using the Monte Carlo technique. The age groups most at-risk were children aged under 2 years and adults older than 50 years

Peu d'estimations sont disponibles sur la charge de la grippe dans la Région OMS de la Méditerranée orientale. Dans la présente étude, nous avons estimé la charge de morbidité due aux infections respiratoires aiguës sévères [IRAS] et aux IRAS associés à la grippe dans certaines provinces de la République islamique d'Iran, ainsi que les tendances des IRAS et des cas de grippe confirmés sur 12 mois [saisonnalité], et les groupes d'âge les plus exposés. En utilisant le système électronique iranien de surveillance de la grippe et les données relatives aux cas des hôpitaux sentinelles de trois provinces sélectionnées, nous avons estimé la tendance mensuelle [saisonnalité] de l'incidence des IRAS et des IRAS dus à la grippe, l'incidence globale des IRAS et des IRAS dues à la grippe et leur ventilation par âge grâce à la méthode de Monte Carlo. Les groupes d'âge les plus exposés au risque étaient les enfants de moins de 2 ans et les adultes de plus de 50 ans

Predicted Distribution of Visceral Leishmaniasis Vectors (Diptera: Psychodidae; Phlebotominae) in Iran: A Niche Model Study.

Visceral leishmaniasis (VL) is an important vector-borne disease in Iran. Till now, Leishmania infantum has been detected from five species of sand flies in the country including Phlebotomus kandelakii, Phlebotomus major s.l., Phlebotomus perfiliewi, Phlebotomus alexandri and Phlebotomus tobbi. Also, Phlebotomus keshishiani was found to be infected with Leishmania parasites. This study aimed at predicting the probable niches and distribution of vectors of visceral leishmaniasis in Iran. Data on spatial distribution studies of sand flies were obtained from Iranian database on sand flies. Sample points were included in data from faunistic studies on sand flies conducted during 1995-2013. MaxEnt software was used to predict the appropriate ecological niches for given species, using climatic and topographical data. Distribution maps were prepared and classified in ArcGIS to find main ecological niches of the vectors and hot spots for VL transmission in Iran. Phlebotomus kandelakii, Ph. major s.l. and Ph. alexandri seem to have played a more important role in VL transmission in Iran, so this study focuses on them. Representations of MaxEnt model for probability of distribution of the studied sand flies showed high contribution of climatological and topographical variables to predict the potential distribution of three vector species. Isothermality was found to be an environmental variable with the highest gain when used in isolation for Ph. kandelakii and Ph. major s.l., while for Ph. alexandri, the most effective variable was precipitation of the coldest quarter. The results of this study present the first prediction on distribution of sand fly vectors of VL in Iran. The predicted distributions were matched with the disease-endemic areas in the country, while it was found that there were some unaffected areas with the potential transmission. More comprehensive studies are recommended on the ecology and vector competence of VL vectors in the country.

Fabricating superhydrophobic surfaces via a two-step electrodeposition technique.

This work presents a template-free electrochemical route to producing superhydrophobic copper coatings with the water contact angle of 160 ± 6° and contact angle hysteresis of 5 ± 2°. In this technique, copper deposit with multiscale surface features is formed through a two-step electrodeposition process in a concentrated copper sulfate bath. In the first step, applying a high overpotential results in the formation of structures with dense-branching morphology, which are loosely attached to the surface. In the second step, an additional thin layer of the deposit is formed by applying a low overpotential for a short time, which is used to reinforce the loosely attached branches on the surface. The work also presents a theoretical analysis of the effects of the fabrication parameters on the surface textures that cause the superhydrophobic characteristic of the deposit.

Lessons learnt from malaria epidemics in the Islamic Republic of Iran.

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale (68.3% were < 100 cases) and short (51.7% lasted < 1 month). Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase.

Larval habitats and biodiversity of anopheline mosquitoes (Diptera: Culicidae) in a malarious area of southern Iran.

BACKGROUND & OBJECTIVES: Malaria is the most important mosquito-borne disease in Iran. It is endemic in south to southeastern part of the country. Knowledge about bio-ecology of vectors will support authorities for appropriate management of the disease. Bashagard district is one of the main endemic areas for malaria in south of Iran. This study was conducted to determine anopheline fauna, diversity and affinity in the area, characterization of larval habitats, and mapping their potential distribution across the district. METHODS: The potential aquatic habitats for Anopheles larvae were extracted from Indian Remote Sensing Satellite (IRS) image and digital elevation model of the area using GIS. Surface water bodies were sampled monthly during 2009­10 for anopheline larvae, while characteristics of their physical environment were recorded and water samples were analyzed. RESULTS: A total of 4511 Anopheles larvae were found during the year with the lowest and highest frequencies in February and April, respectively. Dominant species was Anopheles culicifacies. The Shanon diversity index ranged from 0.570­0.829 at fixed collection sites, while the affinity index was significant among some vector species. CONCLUSION: Riversides and riverbeds were the main breeding places which provided sandy, rocky, and clay beds for different species. The potential breeding places as well as distribution of collected species were mapped. Knowledge about ecology of malaria vectors provides information to health sector for effective control programs.

Spatial analysis and mapping of malaria risk in an endemic area, south of Iran: a GIS based decision making for planning of control.

Bashagard district is one of the important malaria endemic areas in southern Iran. From this region a total of 16,199 indigenous cases have been reported in recent years. The aim of this study was to determine the situation of the disease and provide the risk map for the area. ArcGIS9.2 was used for mapping spatial distribution of malaria incidence. Hot spots were obtained using evidence-based weighting method for transmission risk. Environmental factors including temperature, relative humidity, altitude, slope and distance to rivers were combined by weighted multi criteria evaluation for mapping malaria hazard area at the district level. Similarly, risk map was developed by overlaying weighted hazard, land use/land cover, population density, malaria incidence, development factors and intervention methods. Our results reveal that the disease mainly occurs in north and east of the study area. Consequently the district is divided into three strata. Appropriate interventions are recommended for each stratum based on national malaria policy. Malaria hazard and risk map, stratification based on relevant information and data analyzing provide a useful method preparedness and early warning system for malaria control, although regular updating is required timely.

Entomological and epidemiological attributes for malaria transmission and implementation of vector control in southern Iran.

Bashagard is an important malaria endemic area in south of Iran. An epidemiological and entomological survey was performed during 2002-2010. The aim of study was to determine malaria situation, species composition of anopheline mosquitoes and susceptibility status of main vectors to insecticides/larvicides. A total of 13,490 malaria cases were recorded, Plasmodium vivax (99.64%), P. falciparum (0.35%) and mix cases (0.01%). The highest and lowest Annual Parasite Incidence (API) were observed in 2007 (145.72/1000) and 2009 (6.29/1000), respectively. Anopheles culicifacies, An. dthali, An. stephensi, An. superpictus, An. fluviatilis, An. moghulensis, An. turkhudi and An. apoci were collected from the area. Two peak activities occur in April and October. The first five species were confirmed as malaria vectors in Iran. No indication of sporozoite in mosquitoes using molecular method was performed. Susceptibility tests using diagnostic dose of insecticides and larvicides showed only resistance of An. stephensi to DDT. Tolerance in An. stephensi to deltamethrin and bendiocarb is reported. The same phenomenon was observed in An. culicifacies to DDT, propoxur and deltamethrin, and in An. dthali to malathion and deltamethrin. Larvae of vectors were susceptible to all larvicides, except for An. stephensi that exhibited tolerance to fenthion. In conclusion it should be emphasized that malaria transmission is a complex process in Bashagard. This event is attributed to five proven vectors with different behaviors which are active in the area. Regarding tolerance of vectors to deltamethrin, resistance management is suggested by using new insecticide with novel mode of action.

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale [8.3% were < 100 cases] and short [51.7% lasted < 1 month]. Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase

Lessons learnt from malaria epidemics in the Islamic Republic of Iran

The Islamic Republic of Iran is in the pre-elimination phase of malaria control, but malaria epidemics are still a concern in the south of the country. This retrospective study presents the epidemiological characteristics and predisposing factors of 60 of the malaria epidemics reported in Sistan va Baluchestan province during 2005-09. A zero-truncated negative binomial model was used to investigate the relation between predictor variables and the total number of malaria cases. Malaria epidemics occurred mainly in the southern part of the province, mostly between July and October, peaking in August. Most malaria epidemics were small-scale [68.3% were < 100 cases] and short [51.7% lasted < 1 month]. Plasmodium falciparum was present in 46.7% of the epidemics. An increase in the rainfall rate as well as population movements were the most significant predisposing factors. The results may help inform an epidemic investigation and reporting system as the country approaches the malaria elimination phase

A histological study of pulp reaction to various water/powder ratios of white mineral trioxide aggregate as pulp-capping material in human teeth: a double-blinded, randomized controlled trial.

AIM: To compare the histological pulp reaction to various water/powder ratios of white mineral trioxide aggregate (MTA) as a pulp-capping material in healthy human teeth. METHODOLOGY: Twenty-nine disease-free maxillary and mandibular third molar teeth, scheduled for extraction, were exposed mechanically and then capped with 0.28, 0.33 and 0.40 water/powder ratios of white MTA (ProRoot; Dentsply Maillefer, Ballaigues, Switzerland) and restored with glass ionomer. After 30 days, the teeth were extracted, resected apically and immersed in 10% formalin. For histological processing, the teeth were sectioned buccolingually in 5-µm-thick slices, stained with Haematoxylin and Eosin and evaluated by a light microscope. Samples were evaluated for intensity and type of inflammation, presence of necrosis, as well as continuity, morphology and thickness of calcified bridges. The data were analysed by Kruskal-Wallis and Mann-Whitney tests. RESULTS: There were no significant differences in the diameter, morphology and continuity of the calcified bridges, intensity and type of inflammation or presence of necrosis (P > 0.05) in the pulps covered by MTA with various water/powder ratios. Two teeth failed to display a calcified bridge, and one had a pulp necrosis. CONCLUSION: Water-to-powder ratios of MTA had no significant influence on the histological outcome of direct pulp capping on healthy pulps.

Knowledge, attitudes and practices regarding malaria control in an endemic area of southern Iran.

Iran is in the malaria pre-elimination stage. In this situation community based strategies are important for malaria control. In order to intensify elimination activities we need to have a better understanding of the knowledge, attitudes and practices (KAP) of malaria prevention in the community. We carried out a KAP study in one malaria endemic district in southern Iran in 2009 using a structured questionnaire. Five villages with indigenous malaria cases during the previous year and a high potential for anopheline mosquito breeding were selected. All the households in each village were visited and the head of the household or other responsible adult was interviewed. Data were analyzed using SPSS 11.5. A total of 494 respondents from the five villages participated. More than 33% of people in the study area were living in sheds with poor facilities. The illiteracy level of the studied population was high (44.2%) and significantly affected the knowledge and practices of the respondents about malaria control (p<0.05). Descriptive analysis showed significant differences between sex, job and history of malaria infection of the respondents and their knowledge and practices about malaria control (p<0.05). Knowledge of the respondents about the route of transmission in malaria was good; 72.1% knew mosquitoes were the vector. Most people knew at least one symptom of the disease. The practices of respondents were 59.5% for bednet use and 9.3% for screening windows. The knowledge, attitudes and practices of respondents in this survey about malaria control were good in some cases, but in general needed to be improved with educational programs.

Prevalence of breast cancer in a defined population of iran.

BACKGROUND: Prevalence of breast cancer in Asian developing countries is much lower than western developed countries. The main aim of this study was to measure breast cancer prevalence in a defined population of Iran. METHODS: A total of 25201 women who were under coverage of "Imam Khomeini Relief Foundation (IKRF)", which is an organization for delivering supportive social and cultural services to the deprived and poor subgroups of the society, were involved in the study. The study was conducted during years 2007 and 2008. All subjects were interviewed for their socio-demographic features and underwent precise clinical and para-clinical breast examination. RESULTS: Mean age was 47 years with standard deviation 10 ranging from 11 to 88 years. Subjects were from deprived subgroups of the community; were mainly illiterate or had primary school education (86%) and majority of them (93%) had their first full-term pregnancy at age less than 26 years and also were multiparous. With confirmed diagnosis by breast biopsy, breast cancer prevalence was 0.15% (95%CI; 0.10-0.20). CONCLUSION: Compared with developed countries, Asian developing countries have been at a lower risk of breast cancer development. It is seen that more deprived subgroups are at much lower risk. The more industrialized life is accompanied with more hazards.

Comparative study of subcutaneous tissue responses to a novel root-end filling material and white and grey mineral trioxide aggregate.

AIM: To compare the subcutaneous tissue response to grey mineral trioxide aggregate (GMTA), white mineral trioxide aggregate (WMTA) and a new experimental cement (calcium enriched cement, CEM). METHODOLOGY: Thirty-six Wistar male albino rats each received three implants, containing one of the tested materials, and an empty tube as a control. Seven, 30 and 60 days after implantation, the animals were sacrificed. After histological preparation and H&E staining, the specimens were evaluated for capsule thickness, necrosis, and for the type, the severity, and the extent of inflammation. Kruskal Wallis and Chi-square tests were used for data analysis. RESULTS: After 1 week, CEM produced no necrosis compared to both types of WMTA and GMTA (P = 0.007). After 30 days, GMTA specimens had significantly less inflammation compared with WMTA and CEM (P = 0.011). After 60 days, less inflammation was associated with CEM specimens (P = 0.0001) compared to the other materials. Dystrophic calcifications in the connective tissue adjacent to all experimental material were detected. CONCLUSION: Histological observation illustrated that all materials were well tolerated by the subcutaneous tissues.

A comparative study of dental pulp response to several pulpotomy agents.

AIM: To examine the in vivo response of dental pulps in dogs to three pulp-capping agents: calcium hydroxide (CH), mineral trioxide aggregate (MTA) and a new endodontic calcium enriched mixture (CEM) cement. METHODOLOGY: Thirty-six second and third premolar teeth in six beagle dogs were randomly assigned to three experimental groups; CH, MTA or CEM cement. Following isolation and exposure, pulp tissues were removed with a fissure bur and haemostasis achieved. The pulps were dressed with appropriate materials, and the access cavity restored with amalgam. Histological analysis was performed 8 weeks after treatment; the samples were assessed by an independent observer for calcified bridge formation, pulp vitality and pulp inflammation. The data were analysed by Kruskal-Wallis, Mann-Whitney and one-way anova tests. RESULTS: The number of root canals that showed calcified bridge formation, pulp vitality and lack of inflammation was significantly higher for teeth capped with either MTA or CEM cement in comparison with CH (P < 0.05). No significant difference was found between the CEM cement and MTA in terms of calcified bridge formation, pulp vitality and lack of inflammation (P > 0.05). CONCLUSIONS: Mineral trioxide aggregate and CEM cement were associated with a similar favourable biological response to pulpotomy treatment and demonstrated a more effective induction of dentinal bridge formation compared to CH.

The interaction between physical activity and fasting on the serum lipid profile during Ramadan.

INTRODUCTION: The serum lipid profiles in Muslims change during the fasting month of Ramadan, but it is not clear whether this change is due to changes in their physical activities. In this study, we compared the patterns of the lipid profile changes in those who engaged in regular physical activity with those who did not. METHODS: In a randomised trial, we assigned 93 students who took a physical education course into two groups--those who had regular physical activity after Ramadan and those who had physical activity during Ramadan. Venous blood (5 ml) was taken just before, at the end, and 40 days after Ramadan, and the fasting glucose sugar and lipid profile were measured. RESULTS: Fasting with physical activity decreased body weight by 1.2 kg (p-value is 0.03). Fasting blood sugar also decreased by 7 mg/dL during Ramadan, but this drop was observed in both groups. Triglyceride decreased in both groups during Ramadan, but cholesterol levels dropped considerably during and after Ramadan for those who concurrently engaged in physical activity and fasted (-12.24 and -8.4 mg/dL, respectively). The patterns of changes in the high-density lipoprotein (HDL), low-density lipoprotein (LDL) and HDL/LDL values were more or less comparable in both groups (p is greater than 0.5). CONCLUSION: Usually, people are less physically active during Ramadan, but our findings show that physical activity alone cannot explain the variations in the lipid profile. Other factors, such as changes in the diet and sleeping hours, may have more important roles.

Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis.

We estimated the prevalence of type 2 diabetes in the Islamic Republic of Iran by systematic review of all available studies in the country between 1996 and 2004 and aggregation of the data using meta-analysis and meta-regression methods. In those > 40 years the prevalence was 24% and it increased by 0.4% with each year after 20 years of age. The risk of type 2 diabetes was 1.7% greater in women than men (P < 0.001). The prevalence of type 2 diabetes appears higher in the Islamic Republic of Iran than in other developing countries but because of differences in age pyramids, the crude prevalence is not an appropriate indicator and age-adjusted or age-specific prevalences should be used.

Common foot examination features of 247 Iranian patients with diabetes.

BACKGROUND: Iran is a Middle Eastern country with a 70 million population. There are 3 million Iranians with diabetes mellitus (DM) and there is a high incidence of non traumatic amputation in this population. Amputation is often preceded by foot deformity or ulceration. We evaluated the routine foot examination of persons with diabetes (PWD) attending an outpatient Diabetic Clinic to identify the clinical characteristics that might be early warning signs of individuals at a high risk of developing a foot ulcer or having a subsequent non traumatic amputation. METHODS: A prospective, descriptive, clinic-based study was conducted on 247 patients with diabetes mellitus in 2005. The objectives of the study were to define the abnormal features of the foot examination in PWD which could be risk factors for ulceration or amputation. RESULTS: The mean age of patients with diabetes was 52 +/- 12. The prevalence of callus in the enrolled patients was 12% and heel fissures were noted in 50%. There was a significant relationship between callus formation and the absence of tibialis posterior pulse (odds ratio 5), the presence of the hammer toe deformity (odds ratio 4), and foot ulceration (odds ratio 3). The prevalence of foot ulcers in PWD was 4%. CONCLUSION: A diabetic screening program identifying callus formation, absent pulses, and hammer toe are important early signs of individuals at an increased risk for foot ulcers. This program will facilitate early treatment to decrease the loss of limbs.

The effects of different drying methods and sun exposure on the concentrations of deltamethrin in nets treated with K-O Tab tablets.

The method used to dry bednets after they have been treated with an insecticide solution may affect the levels of insecticide and the uniformity of the insecticide deposits on the dry nets. In an attempt to see how the drying method may affect the insecticide deposits on the dry net, and to select the best drying method, laboratory and field studies have recently been carried out (in the U.K. and Iran, respectively). Conventional polyester nets were each treated with a deltamethrin solution (made with one K-O Tab tablet in 500 ml water) and then dried, either while hanging vertically or laid horizontally on the floor, in the sun or shade. The concentrations of deltamethrin in 25-cm2 samples cut from the dry nets (from the inner folds, surface folds, and top and bottom of each net dried vertically, and from the upper and lower surfaces of each net dried horizontally) were then determined using high-performance liquid chromatography (HPLC). Drying the treated nets in the sun or the shade did not make a significant difference to deltamethrin concentrations on the nets. Mean deltamethrin concentrations were, however, higher on the lower parts of the nets that had been hung to dry vertically than on the upper parts of these nets, and greater on the upper surfaces of nets dried horizontally than on the lower surfaces of such nets. In general, the layers and folds of the nets that had been on the outside of the drying nets contained more deltamethrin than the inner folds. These patterns are consistent with the hypothesis that deltamethrin tends to accumulate at the points where the water from the insecticide solution evaporates from the drying nets and also, in the case of nets dried vertically, at the lower points of the drying nets (as the result of gravity). In order to obtain an even and adequate distribution of insecticide, it is therefore not necessary to dry the net in the shade. To achieve a uniform deposit of deltamethrin, the drying net should be folded as little as possible and dried quickly.