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Background: Smear‑positive pulmonary tuberculosis (SPPTB) is a significant public health concern in Iran. This registry‑based study aimed to investigate the incidence rates of SPPTB in Iran from 2018 to 2022. Methods: The study analyzed SPPTB cases using the Spatial Lag Model to investigate the spatial distribution of SPPTB incidence rates, income inequality, and delayed diagnosis across the provinces of Iran and mapped the results using GIS maps. Results: The study found that SPPTB is prevalent among older individuals and males. The analysis identified significant spatial variation in the distribution of SPPTB incidence rates, income inequality, and delayed diagnosis across the provinces. The highest incidence rate of SPPTB was found in Sistan and Baluchestan Province and Golestan provinces. The study found a positive association between income inequalities, measured by the Gini index, and SPPTB incidence rates, indicating that provinces with higher income inequality may have higher incidence rates of SPPTB. The negative correlation with delayed diagnosis implies that predominantly, SPPTB cases are identified in the early months. Conclusions: The study highlights the need to address socioeconomic disparities in health outcomes and implement targeted interventions in areas with higher income inequality to reduce the burden of SPPTB in Iran. Despite decreased SPPTB incidence rates in Iran over the past decade, some regions, such as Sistan and Baluchestan, still have high incidence rates. The Iranian government has implemented policies and programs to reduce income inequality and delayed diagnosis within the country, which can contribute to reducing the burden of SPPTB. [ABSTRACT FROM AUTHOR]

Cutaneous Leishmaniasis (CL) is one of the world's neglected diseases which is caused by Leishmania spp. The aim of this study was to assess molecular profile and antimony resistance of Leishmania isolated from human and rodent hosts. Samples were collected from suspected CL patients referred to health centres and wild rodent's traps in Gonbad-e-Qabus region, north-eastern Iran. Smears were subjected to PCR-RFLP to identify Leishmania species. In addition, ITS1-PCR products were sequenced for phylogenetic analysis. Clinical isolates and rodent samples were subjected to MTT assay to determine IC50 values and in vitro susceptibilities. Expression levels of antimony resistance-related genes were determined in CL isolates. Out of 1,949 suspected patients with CL and 148 rodents, 1,704 (87.4%) and 6 (4.05%) were positive with direct smear, respectively. Digestion patterns of BusRI (HaeIII) endonuclease enzyme were similar to what expected for Leishmania major. Phylogenetic analysis revealed that the highest interspecies similarity was found between current L. major sequences with L. major obtained from Russia and Uzbekistan. Out of 20 L. major samples tested, 13 (65%) were resistant to meglumine antimoniate (MA) treatment, with an activity index (AI) exceeding 4. The remaining 7 samples (35%) responded to MA treatment and were classified as sensitive isolates, with a confirmed sensitive phenotype based on their AI values. The comparison expression analysis of three major antimony resistance-associated genes in unresponsive clinical isolates demonstrated significant fold changes for TDR1 (4.78-fold), AQP1 (1.3-fold), and γ-GCS (1.17-fold) genes (P < 0.05). Herein, we demonstrate genetic diversity and antimony resistance of L. major isolated from human and reservoir hosts in north-eastern Iran, which could be the basis for planning future control strategies. [ABSTRACT FROM AUTHOR]

Background: Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. Methods: This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. Results: Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO = 1.07), access rate to EMS (PO = 0.78), arrival time (evening shift vs. day shift, PO = 0.09), and sequelae variables (PO = 9.20) had a significant association with the odds of in-hospital stroke mortality (P < 0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. Conclusion: Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of Candida species in cancer patients with candidemia around the world, and to identify related risk factors and their antifungal resistance, with an emphasis on non-albicans Candida species (NACs). Methods: The published papers related to the subject were systematically searched in databases of MEDLINE (including PubMed), Web of Science, Scopus, Science Direct, and Google Scholar between the 1st January 2000 and 21st April 2021. Candida (C.) parapsilosis was the most frequently isolated organism followed by C. tropicalis and C. glabrata. In addition, the therapeutic usage of antibiotics was found as the most common risk factor, accounting for 85% (95% CI 81%-89%) and central venous catheter accounting for 69% (95% CI 62%-77%). Conclusions: The incidence of Candida bloodstream infections among cancer patients is a growing concern, especially when the etiologic agents of candidemia tend to shift towards NACs. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis (CL), caused by Leishmania tropica, is the main causative agent of CL in the Herat province, western Afghanistan. In CL patients, one of the most important indicators for reducing the amount of body damage and the choice of treatment is the number of dermal lesions, but there is no strong evidence in this regard. Therefore, using count regression models, the main objective of this historical cohort study was to identify the distribution of the number of dermal lesions and determine the associated factors among CL patients referring to leishmaniasis reference laboratory in Herat province, from January 2012 to December 2013. In a total of 4,127 clinically suspected CL cases, 50.20% were female and 49.80% male. Based on the results of ZINB model, which is the best model suggested by goodness‐of‐fit criteria, age variables (IRR = 1.007), duration of lesion (6–12 weeks compared to < 6 weeks with IRR = 1.36 and >12 weeks with IRR = 1.39 compared to <6 weeks), type of lesion(both nodule and ulcer compared to papule with IRR = 2.03), location of lesion (trunk with IRR = 1.90, upper with IRR = 1.66, lower with IRR = 1.61 and mix with IRR = 10.35 compared to head/neck/ears) and type of lesion (ulcer compared to papule with IRR = 0.50, nodule and lupoid, respectively, as IRR = 0.72 and IRR = 0.51 compared to papule) had a significant effect on the mean number of dermal lesions (p <.05). Also, our results showed that among four models used, the ZINB model represented a better performance to determine the associated probable factors about the number of dermal lesions in ACL patients. Moreover, there was a direct association between age and number of dermal lesions; in addition, duration of lesion, type of lesion and location of lesion had a significant effect on the number of dermal lesions. Therefore, a comprehensive planning is necessary for controlling and reducing the number of dermal lesions. [ABSTRACT FROM AUTHOR]

Background: The similarity in the mechanism of action between paracetamol and ibuprofen can cause similar side effects. However, in preterm neonates with feeding intolerance, intravenous (IV) paracetamol has replaced oral ibuprofen. Therefore, a comparison of the effectiveness and side effects is essential. Methods: In this retrospective cohort study, the data of 118 preterm infants with a definite diagnosis of patent ductus arteriosus (PDA), including 59 patients who received oral ibuprofen and 59 patients who received IV paracetamol were analyzed. Laboratory evaluations of serum total and direct bilirubin, hemoglobin, and creatinine levels before and seven days after treatment were made. Using analysis of covariance (ANCOVA) and multiple multinomial logistic regression models, the effect of two treatment groups on the post-treatment variables as well as their efficacy comparison were evaluated. Results: In both pre- and post-treatment periods, there was no significant association between echocardiography variables with treatment groups. The results from the ANCOVA model showed that the paracetamol and ibuprofen were followed by a significant decrease in the mean total bilirubin and Hct variables after treatment by 1.38 and 1.65 units, respectively. In addition, results from the Mann-Whitney U test revealed that the median Hb and K differences after and before treatment had a significant difference between the two treatment groups. Furthermore, based on the multiple multinomial logistic model results, the odds of complete arterial duct closure with IV paracetamol was 1.27 times higher than with oral ibuprofen, while in the oral ibuprofen group, the odds of closing was 1.44 times higher than the IV paracetamol group, but there was no statistically significant difference between the two groups. Conclusion: Intravenous paracetamol has equal efficacy compared to oral ibuprofen in the treatment of PDA. Also, it seems to be associated with a lower risk of hyperbilirubinemia following the treatment. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal parasitic infection (IPIs) is one of the most important health problems in the developing countries. Study on the prevalence of IPIs in various communities is a prerequisite for the development of appropriate control strategies. The aim of this study was to evaluate the prevalence of intestinal parasites among the general population in Mazandaran province, northern Iran. Methodology: This study was conducted on 4,788 specimens collected from 17 urban areas (2,515 samples) and 34 rural areas (2,273 samples) within January-December 2016. Fecal specimens were examined by direct wet mounting, formalin-ether concentration, modified Ziehl-Neelsen, and trichrome staining methods. Results: The overall infection rate of intestinal parasite was 14.2% (680/ 4,788). Blastocystis hominis and Giardia lamblia were identified as the most frequent parasites. Protozoa, helminths, and polyparasitism (co-infections with two or more parasite species) were observed in 12.3%, 1.03%, and 0.85% of the specimens, respectively. Furthermore, IPIs showed a significant association with household income, place of residence, washing of vegetables, exposure to soil and season (p < 0.05). Conclusions: Based on the findings, parasitic infections are still a major public health concern in the north of Iran that requires special attention. Therefore, the major key to success in the prevention of IPIs is the execution of some interventions, including patient screening and treatment, public education, and improvement of sanitary conditions. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) remains a major public health issue in Iran, especially smear-positive pulmonary tuberculosis (SPPTB), due to its high transmission rate. Examining the effective reproduction number( R t ) of SPPTB and patient characteristics is crucial for crafting targeted TB control measures. This study aimed to assess the R t of SPPTB in Iran from 2011 to 2021 and profile SPPTB patient demographics, initial smear bacilli density, diagnosis delays, and spatial distribution. Study Design: This is a historical cohort study., Methods: A time-dependent method was used to estimate R t , and monthly data from the national TB registry were scrutinized from 2011 to 2021., Results: A decline was observed in SPPTB incidence rates of 50909 SPPTB cases in Iran from 2011 to 2021. Approximately 29.1% of the cases were diagnosed within a month, while 44.5% experienced a one to three-month delay in diagnosis. The analysis revealed substantial heterogeneity in TB transmission dynamics across various provinces of Iran. Provinces such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi exhibited the highest effective reproduction numbers. Additionally, there was a decreasing trend in the effective reproduction numbers across all provinces from 2011 to 2020., Conclusion: Effective reproduction numbers declined in most provinces from 2011 to 2020 but increased moderately after the COVID-19 pandemic, highlighting the need for targeted public health interventions. Although SPPTB incidence rates are declining nationally, elevated incidence rates and effective reproduction numbers in regions such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi signify the need for persistent TB management efforts in Iran., (© 2024 The Author(s); Published by Hamadan University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: The effects of a high protein diet in combination with chronic resistance training (RT) on skeletal muscle adaptation responses in untrained older ex-military men is unknown. Therefore, we compared the effects of 8 weeks of RT in combination with either a high (1.6 g/kg/d) or low protein diet (0.8 g/kg/d) on body composition [skeletal muscle mass (SMM) and body fat percentage (BFP)], muscular strength, power, and endurance (upper and lower body), markers of liver [alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT)] and kidney (creatinine and urea) function, and lipid profile low-density lipoprotein (LDL), high-density lipoprotein (HDL), and cholesterol levels in a cohort of healthy, untrained older ex-military males., Methods: Forty healthy untrained older ex-military males (age: 61 ± 2 yr, body mass index: 23.2 ± 1.3 kg.m -2 ) performed 8 weeks (three sessions·w -1 ) of RT with either 1.6 g/kg/d (RHP; n  = 20) or 0.8 g/kg/d of protein (RLP; n  = 20). Body composition (assessed by Inbody 720), muscular strength (1-RM for chest and leg press), power (Wingate test), endurance (75% 1-RM for chest and leg press), and markers of liver and kidney function (biochemical kits) were assessed pre and post-intervention., Results: SMM and muscular strength (upper and lower body) increased post-intervention in both groups and were significantly greater in RHP compared to RLP, while muscular power increased to the same extent in both groups ( p < 0.05) with no between-group differences ( p > 0.05). In contrast, there were no post-intervention changes in muscular endurance, HDL, and BFP remained in either group ( p > 0.05). ALT and creatinine significantly increased in RHP compared to RLP while GGT, AST, and urea only increased in the RLP group ( p < 0.05). LDL and cholesterol significantly decreased in both groups ( p < 0.05)., Conclusion: A daily intake of 1.6 g/kg/d protein was superior to 0.8 g/kg/d (current recommended daily intake) for promoting greater improvements in SMM and muscle strength and thus may be a more suitable level of intake for promoting such adaptive responses. Notwithstanding observed between-group differences in ALT and creatinine and the fact that levels remained within normal ranges, it is feasible to conclude that this daily protein intake is efficacious and well tolerated by healthy, untrained older ex-military males., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bagheri, Shakibaee, Camera, Sobhani, Ghobadi, Nazar, Fakhari and Dutheil.)

Background: The similarity in the mechanism of action between paracetamol and ibuprofen can cause similar side effects. However, in preterm neonates with feeding intolerance, intravenous (IV) paracetamol has replaced oral ibuprofen. Therefore, a comparison of the effectiveness and side effects is essential., Methods: In this retrospective cohort study, the data of 118 preterm infants with a definite diagnosis of patent ductus arteriosus (PDA), including 59 patients who received oral ibuprofen and 59 patients who received IV paracetamol were analyzed. Laboratory evaluations of serum total and direct bilirubin, hemoglobin, and creatinine levels before and seven days after treatment were made. Using analysis of covariance (ANCOVA) and multiple multinomial logistic regression models, the effect of two treatment groups on the post-treatment variables as well as their efficacy comparison were evaluated., Results: In both pre- and post-treatment periods, there was no significant association between echocardiography variables with treatment groups. The results from the ANCOVA model showed that the paracetamol and ibuprofen were followed by a significant decrease in the mean total bilirubin and Hct variables after treatment by 1.38 and 1.65 units, respectively. In addition, results from the Mann-Whitney U test revealed that the median Hb and K differences after and before treatment had a significant difference between the two treatment groups. Furthermore, based on the multiple multinomial logistic model results, the odds of complete arterial duct closure with IV paracetamol was 1.27 times higher than with oral ibuprofen, while in the oral ibuprofen group, the odds of closing was 1.44 times higher than the IV paracetamol group, but there was no statistically significant difference between the two groups., Conclusion: Intravenous paracetamol has equal efficacy compared to oral ibuprofen in the treatment of PDA. Also, it seems to be associated with a lower risk of hyperbilirubinemia following the treatment., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Aging is a major challenge not only for high-income countries but also for middle- and low-income countries. The length of stay (LOS) in hospitals is one of the major concerns of elderly patients, which should be taken into consideration. We aimed to investigate the factors affecting LOS of elderly patients admitted to a referral hospital of northeast of Iran. Methods: A relatively large population of 7130 hospitalized elderly patients (over 65 years old) who referred to Ghaem hospital (Mashhad, Iran) from March 20, 2016 to March 19, 2017 were selected. The demographic and medical records data of patients were extracted from the hospital database. Univariate analyses as well as count regression models, including poisson regression and negative binomial regression, were conducted to assess the influential factors on the LOS and the number of admissions considered for potential confounders using SAS software. In this study α =0.05 was considered as statistically significant. Results: The mean age of participants was 76.57±7.29 years, and 54.8% were male and 45.2% were female. The mean LOS was 8.11±13.97 days and the mean number of admissions 1.5±1.73 times. The negative binomial regression model had better fitness than Poisson's model. Findings indicated that emergency hospitalization (RR: 0.21), admission to the CCU (RR: 0.33), and male gender (RR: 0.92) were statistically reducing factors for LOS among elderly patients, respectively. Discharge status (deceased, RR: 1.50), patients with diagnosis of injuries and poisoning (RR: 1.34), and native residence (RR: 1.10) were factors that statistically increased the length of stay among hospitalized elderly patients. Conclusion: LOS in hospitals is affected by multiple factors and the negative binomial regression model is a better statistical method for estimating the influencing factors., (© 2021 Iran University of Medical Sciences.)

Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), and pulmonary TB is the most prevalent form of the disease worldwide. One of the most concrete actions to ensure an effective TB control program is monitoring TB treatment outcomes, particularly duration to cure; but, there is no strong evidence in this respect. Thus, the primary aim of this study was to examine the possible spatial variations of duration to cure and its associated factors in Iran using the Bayesian spatial survival model. All new smear-positive PTB patients have diagnosed from March 2011 to March 2018 were included in the study. Out of 34,744 patients, 27,752 (79.90%) patients cured and 6992 (20.10%) cases were censored. For inferential purposes, the Markov chain Monte Carlo algorithms are applied in a Bayesian framework. According to the Bayesian estimates of the regression parameters in the proposed model, a Bayesian spatial log-logistic model, the variables gender (male vs. female, TR = 1.09), altitude (>750 m vs. ≤750 m, TR = 1.05), bacilli density in initial smear (3+ and 2+ vs. 1-9 Basil & 1+, TR = 1.09 and TR = 1.02, respectively), delayed diagnosis (>3 months vs. <1 month, TR = 1.02), nationality (Iranian vs. other, TR = 1.02), and location (urban vs. rural, TR = 1.02) had a significant influence on prolonging the duration to cure. Indeed, pretreatment weight (TR = 0.99) was substantially associated with shorter duration to cure. In summary, the spatial log-logistic model with convolution prior represented a better performance to analyze the duration to cure of PTB patients. Also, our results provide valuable information on critical determinants of duration to cure. Prolonged duration to cure was observed in provinces with low TB incidence and high average altitude as well. Accordingly, it is essential to pay a special attention to such provinces and monitor them carefully to reduce the duration to cure while maintaining a focus on high-risk provinces in terms of TB prevalence.