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Background. Diabetic patients’ delay in visiting a specialist doctor can have significant effects on blood sugar factors. The present study aimed to determine the effects of delay in visiting a specialist doctor in type 2 diabetic patients on glycaemic factors. Material and methods. The patients’ demographic and clinical information included in medical records of 209 type 2 diabetic patients referred to diabetes clinics in Shiraz city, south of Iran, were analysed using logistic mix-model regression. Due to the occurrence of COVID-19 during the follow-up period, data analyses were done separately before and after the pandemic. Results. The mean age of the patients was 63.47 ± 8.89 years, and 67.94% of the type 2 diabetic patients were female. After COVID-19, haemoglobin A1C (HBA1C) of the patients who had delays of < 3, 3–6 and > 6 months in referring to a specialist increased by 1.81 (OR: 1.12–2.93), 2.56 (OR: 1.81–5.56) and 3.69 (OR: 1.79–7.63), respectively, compared to the group without delays. In this period, 2-hour Postprandial Glucose (2-hpp) of the patients with delays of 3–6 and > 6 months and the Fasting Blood Sugar (FBS) of the patients with delays of > 6 months had a significant increase of 1.92 (OR: 1.01–3.65), 2.14 (OR: 1.09–4.21) and 2.36 (confidence interval of 95%: 1.27–4.39), respectively, compared to the patients without delays in visits. The above trends had a non-significant increase before COVID-19, though. Conclusions. Healthcare providers should ensure the continuity of providing services to diabetes patients, especially during health crises, by taking appropriate measures. [ABSTRACT FROM AUTHOR]

Purpose: Iranians' worry over the number of older patients negatively impacted by COVID-19 surged dramatically throughout the 5 waves of the COVID-19 pandemic, which lasted from January 2020 to September 2021. The goal of this research was to assess the physical and mental health of Iranian older persons throughout the COVID-19 pandemic's major waves. Methods: The health condition of 507 older persons with a positive examination for COVID-19 illness was assessed before and throughout the 5 waves of coronavirus in south Iran in analytical and hybrid longitudinal research. Results: The primary consequences of COVID-19 incidence on frailty and mental health issues were revealed in this investigation. Using a linear mixed model, we found a reduction of 0.33 in loneliness (β = −.33, 95% CI −0.39 to −0.26) during the COVID-19 pandemic. The probabilities of becoming depressed, anxious, or frail rose 4.61 (95% CI: 3.77-5.63), 1.85 (95% CI: 1.52-2.24), as well as 1.42 (95% CI: 1.17-1.42) time, subsequently, with COVID-19 occurrence, according to the mixed logistic models. Furthermore, the influence of COVID-19 incidence on loneliness result differs by gender; for depression, it varies by education; and for anxiety, it changes by comorbidities and living independently. Conclusion: The COVID-19 pandemic significantly impacts the mental health and frailty of older persons with the positive COVID-19 situation, and this scenario is gender-based too. [ABSTRACT FROM AUTHOR]

Background: Standard regression modeling may cause biased effect estimates in the presence of time-varying confounders affected by prior exposure. This study aimed to quantify the relationship between declining in modified creatinine index (MCI), as a surrogate marker of lean body mass, and mortality among end stage renal disease (ESRD) patients using G-estimation accounting appropriately for time-varying confounders. Methods: A retrospective cohort of all registered ESRD patients (n = 553) was constructed over 8 years from 2011 to 2019, from 3 hemodialysis centers at Kerman, southeast of Iran. According to changes in MCI, patients were dichotomized to either the decline group or no-decline group. Subsequently the effect of interest was estimated using G-estimation and compared with accelerated failure time (AFT) Weibull models using two modelling strategies. Results: Standard models demonstrated survival time ratios of 0.91 (95% confidence interval [95% CI]: 0.64 to 1.28) and 0.84 (95% CI: 0.58 to 1.23) in patients in the decline MCI group compared to those in no-decline MCI group. This effect was demonstrated to be 0.57 (-95% CI: 0.21 to 0.81) using G-estimation. Conclusion: Declining in MCI increases mortality in patients with ESRD using G-estimation, while the AFT standard models yield biased effect estimate toward the null. [ABSTRACT FROM AUTHOR]

Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/<30 = 2.68, 95% CI = 1.38–5.19), gender (ORfemale/male = 0.62, 95% CI = 0.44–0.85), HIV/TB coinfection (ORyes/no = 1.98, 95% CI = 1.29–3.02), HIV/HBV coinfection (ORyes/no = 1.58, 95% CI = 1.07–2.38), and hemoglobin (OR = 0.89, 95% CI = 0.85–0.92) were directly associated with AHD in HIV/AIDS patients. As suggested by a linear regression model, factors including gender (B Female = 44.12, 95% CI:17.86, 70.38), older age (B ≥40 = −111.99, 95% CI:−174.70, −49.27), higher education level (B = 35.65, 95% CI:5.34, 65.97), WHO clinical stage (BIV = −254.53, 95% CI−298.82, −210.24), and hemoglobin (B = 5.23, 95% CI:0.25, 10.20) were significantly associated with CD4 count.The prevalence of AHD in patients was high in Iran. Our results suggested that several demographic and clinical factors are significantly associated with the baseline CD4 cell count and AHD. Targeted HIV testing, implementation of screening programs for early detection, and access to care services to assure early ART are recommended to improve the clinical status and quality of life of the patients. [ABSTRACT FROM AUTHOR]

In this study, we aimed to estimate the causal effect of normalized protein catabolic rate (nPCR) on mortality among end-stage renal disease (ESRD) patients in the presence of time-varying confounding affected by prior exposure using g-estimation. Information about 553 ESRD patients was retrospectively collected over an 8-year period (2011–2019) from hemodialysis facilities in Kerman, Iran. nPCR was dichotomized as <1.2 g/kg/day versus ≥1.2 g/kg/day. Then a standard time-varying accelerated failure time (AFT) Weibull model was built, and results were compared with those generated by g-estimation. After appropriate adjustment for time-varying confounders, weighted g-estimation yielded 78% shorter survival time (95% confidence interval (95% CI): −81, −73) among patients with a continuous nPCR <1.2 g/kg/day than among those who had nPCR ≥1.2 g/kg/day during follow-up, though it was 18% (95% CI: −57, 54) in the Weibull model. Moreover, hazard ratio estimates of 4.56 (95% CI: 3.69, 5.37) and 1.20 (95% CI: 0.66, 2.17) were obtained via weighted g-estimation and the Weibull model, respectively. G-estimation indicated that inadequate dietary protein intake characterized by nPCR increases all-cause mortality among ESRD patients, but the Weibull model provided an effect estimate that was substantially biased toward the null. [ABSTRACT FROM AUTHOR]

Objective: Oral clefting including cleft lip with or without cleft palate (CL/P), are considered as common congenital anomalies, particularly in Asia population. The aim of this study was to evaluate the incidence rate of CL/P according to ethnicity in Northern Iran. Materials and Methods: This cross-sectional, analytic study was carried out on 92 420 live newborns in Golestan province, the Northern Iran, from 2008-2011. The newborns were evaluated for the CL/P and recorded according to ICD10. Gender, ethnicity and parental consanguinity were filled out for each subject. The subjects grouped according to ethnicity into native Fars, Turkmen, and Sistani groups. Results: The rate of oral clefts was determined 0.72 per 1000 live newborns. The incidence rate of CL/P was 0.69 per 1000 in males and 0.75 per 1000 in females. The incidence of CL/P among native Fars, Turkmen and Sistani was 0.96, 0.61, and 0.57 per 1000 live births, respectively. Conclusion: The incidence rate of oral clefting was lower than in our previous study (1.05 per 1000), and it was higher in the native Fars population. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran.Methods: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates.Results: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model.Conclusions: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs. [ABSTRACT FROM AUTHOR]

We aimed to assess healthcare utilisation ( HU), its determinants, as well as its relationship with survival in colorectal cancer ( CRC) patients. This study was conducted on incident CRC cases from Northern Iran. Information on HU was collected using a valid questionnaire, considering eight diagnostic and four therapeutic services. The results were categorised as good and poor HU. Multivariate logistic regression analysis was used to assess the relationship between HU and other variables. Cox regression analysis was performed to determine major predictors of survival. In total, 227 new cases of CRC were enrolled. HU could be assessed in 218 subjects (96%). Living in rural areas was the strongest variable related to poor HU (adjusted OR, odds ratio = 2.65; CI, confidence interval: 1.30-5.40). The median survival time was 40.5 months. The 1-, 3- and 5-year survival rates were 71%, 52% and 44% respectively. Cox regression analysis showed a significant lower survival rate in patients with poor HU ( HR = 2.3; CI: 1.46-3.64). HU was an independent predictor of survival in our CRC patients. Patients' place of residence was a significant determinant of HU. Regarding its effects on patients' outcome, HU and its determinants should be considered in designing CRC controlling programmes in our region and similar high-risk populations. [ABSTRACT FROM AUTHOR]