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Injection drug use is the primary driver of the HIV epidemic in Iran. We characterized people who inject drugs (PWID) living in Iran who had never received opioid agonist therapy (OAT) and examined barriers to OAT uptake. We recruited 2684 PWID with a history of drug injection in the previous 12 months using a respondent-driven sampling approach from 11 geographically dispersed cities in Iran. The primary outcome was no lifetime uptake history of OAT medications. The lifetime prevalence of no history of OAT uptake among PWID was 31.3%, with significant heterogeneities across different cities. In the multivariable analysis, younger age, high school education or above, no prior incarceration history, and shorter length of injecting career were significantly and positively associated with no history of OAT uptake. Individual-level barriers, financial barriers, and system-level barriers were the main barriers to receiving OAT. PWID continue to face preventable barriers to accessing OAT, which calls for revisiting the OAT provision in Iran. [ABSTRACT FROM AUTHOR]

Drug use is common among people who live in prisons (PWLP) worldwide. This systematic review and meta-analysis aimed to summarize the prevalence of drug use among PWLP in Iran. We searched PubMed, Embase, Web of Science, Scopus, PsycINFO, as well as Farsi-language databases including Iran Psych Magiran, IranMedex, Scientific Information Database (SID), and Irandoc for studies published from January 2003 to January 2021. We included studies that reported the prevalence of drug use among PWLP. We performed a random-effects meta-analysis to pool prevalence estimates. Point estimates and 95% confidence intervals (CI) are reported. Among 1107 publications and reports screened, 16 studies reported the prevalence of drug use and were included. The pooled prevalence of lifetime non-injection drug use was 73.8% (95% CI 70.9, 76.6). The pooled prevalence of lifetime injection drug use was 16.0% (12.6, 19.7). Needle/syringe sharing among those with a lifetime injection drug use history was 14.0% (6.4, 24.0). Non-injection and injection drug use was found to be prevalent among PWLP in Iran. Continued evidence-based prevention, harm reduction, and treatment programs should address drug use among this population. [ABSTRACT FROM AUTHOR]

Background: There is no systematic review on the prevalence of HIV drug resistance (HIVDR) in Iran. We aimed to estimate the prevalence of HIVDR among people living with HIV (PLHIV) in Iran. We assessed HIVDR prevalence in antiretroviral therapy (ART) naïve PLHIV (i.e., those without a history of ART) and PLHIV receiving ART. Method: We systematically searched Scopus, PubMed, Web of Science, Embase, Iranian databases (Iranian Medical Research Information System, Magiran, and Scientific Information Database), the references of studies, and Google Scholar until March 2023. A random-effects model was used to calculate a point estimate and 95% confidence interval (95% CI) for the prevalence of HIVDR in PLHIV. Results: Among 461 potential publications, 22 studies were included in the meta-analysis. The pooled prevalence of acquired HIVDR in PLHIV receiving ART was 34% (95% CI: 19, 50) for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), 27% (95% CI: 15, 41) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 9% (95% CI: 3, 18) for protease inhibitors (PIs). The pooled prevalence of acquired HIVDR in treatment failure PLHIV was 50% (95% CI: 31, 69) for NRTIs, 49% (95% CI: 29, 69) for NNRTIs, 11% (95% CI: 2, 24) for PIs, and 1% (95% CI: 0, 4) for integrase inhibitors (INIs). The pooled prevalence of transmitted HIVDR in ART-naïve people was 3% (95% CI; 1, 6) for NRTIs, 5% (95% CI: 2, 9) for NNRTIs, and 0 for PIs and INIs. Conclusion: The prevalence of HIVDR was relatively high in both ART-naïve PLHIV and those receiving ART. Without universal pretreatment HIVDR testing and more frequent routine HIV viral load testing among PLHIV who are on ART, the HIVDR prevalence might increase in PLHIV in Iran. [ABSTRACT FROM AUTHOR]

We characterized suicidal ideation and suicide attempts among incarcerated people in Iran. We recruited a multistage random sample of 5785 incarcerated people from 33 prisons across Iran. Eligible participants were those aged ≥ 18 years who had been incarcerated for at least one week at the time of the study. Lifetime suicidal ideation and suicide attempts were estimated at 38.2% and 20.5%, respectively. Of participants who reported suicide attempts, 57.6% reported attempts prior to incarceration, 31.5% while incarcerated, and 10.9% both before and during incarceration. Suicide attempt was significantly associated with a younger age, being a woman, being widowed/divorced, a longer period of incarceration, convictions for violent crimes, HIV sero-positivity, lifetime non-injection, and injection drug use. The primary reasons reported for suicide attempts were feeling empty/hopeless and living with substance use disorders. Prison health services should provide a comprehensive, integrated mental health programme, including mental health screening upon arrival and continued care during incarceration. [ABSTRACT FROM AUTHOR]

Purpose: Nowadays, complementary and alternative medicine (CAM) is used by cancer patients all over the world. The aim of this study was to investigate the prevalence of CAM use in patients with cancer in Iran. Methods: This descriptive-analytical study was conducted on 320 cancer patients in Arak. For gathering information, a researcher-made questionnaire was used. This questionnaire was consisted of two parts: demographic and clinical information; and patient's attitude toward using complementary and alternative medicine treatments and their effectiveness, as well as how much they used different kinds of these treatments. The data were analyzed using SPSS software version 16. Results: Our findings showed that average age of participants was 55.11 ± 15.58. Most of them had leukemia (25.9%) and underwent chemotherapy (55%), and 141 (44.3%) of individuals were using CAM. Majority of patients (73.2%) were using CAM to improve physical conditions, 61.4% were using it simultaneously with conventional medical treatments, and 25% to reduce pain. Participants have reported visiting holy places, yoga, prayer therapy, and using medicinal plants and special diets, respectively. Conclusion: Considering the high number of patients using CAM treatments, proper planning and implementation to educate professional members of health team, especially doctors and nurses about CAM treatments is essential. The most important CAM treatments to be educated are spiritual therapies, yoga, medicinal plants, and diet therapy. Moreover, support and education about using these kinds of treatment should be considered in the supportive care program for patients with cancer. [ABSTRACT FROM AUTHOR]

The present study aimed to assess the effectiveness of mindfulness-based stress reduction (MBSR) intervention on cognitive emotion regulation and cognitive reactivity in patients suffering from epilepsy. The study employed a quasi-experimental design in which 24 epilepsy patients, administered by the Isfahan Epilepsy Society in Iran, were recruited through the convenient sampling method in 2015. The participants were randomly assigned into two groups of experimental (N = 12) and control (N = 12). The control group was as waitlist. In addition to the demographic information, Garnefski's Cognitive Emotion Regulation Questionnaire (2001), Beck's Depression (1979), Dysfunctional Attitudes (1978), and Automatic Thoughts (1980) were administered to the patients in three stages encompassing pretest, posttest, and the follow-up period (75 days). The collected data were then analyzed with repeated measurement of variance ANOVA. Results showed that MBSR intervention significantly increased the use of positive strategies and decreased the implementation of negative strategies in cognitive emotional regulation (p < 0.05). Moreover, the intervention led to a significant decline in depression, dysfunctional attitudes, and negative automatic thoughts. The results support the idea that mindfulness could positively affect the patient's cognitive emotion regulation and cognitive responsiveness. [ABSTRACT FROM AUTHOR]

Background: Considering the new Coronavirus outbreak and limited data about this pandemic in Iran, this study aimed at assessing the demographic characteristics, clinical symptoms, paraclinical findings, and radiological features of hospitalized patients with COVID-19 according to their hospital records. Methods: In this descriptive-cross-sectional study, the required data were collected from the Health Information System (HIS) and the records of the patients who had been hospitalized following positive COVID-19 Polymerase Chain Reaction (PCR) and lung Computed Tomography (CT) scans, in some hospitals of Markazi Province, Iran from February 20, 2020, to April 20, 2020. The selected hospitals were affiliated with the Iranian Social Security Organization. Clinical follow-up was continued until April 26, 2020. During this period, 260 records were assessed. The collected data included demographic characteristics, clinical symptoms, as well as the paraclinical findings and radiological features of the patients. The obtained data were analyzed by SPSS. Results: Among 260 confirmed cases of COVID-19, 161 (61.9%) cases were men and 99 (38.1%) were women. The Mean±SD age of the explored patients was 58.78±16.44 years. Besides, 221 (85%) patients were hospitalized in the general ward and 39 (15%) cases in the Intensive Care Unit (ICU). Hypertension and diabetes were the most prevalent medical histories (comorbidities). Fever, fatigue, cough, anorexia, myalgia, dyspnea, oliguria, taste impairment, and smell deficiency were the most frequent clinical symptoms. Neutrophilia, lymphopenia, low blood glucose level, and increased BUN, ALP, CRP, and ESR were among the critical laboratory findings. Almost 30% of the studied patients presented acidosis in arterial blood gases analysis and 55% had normal blood gasses. Decreased PaO2 was observed in 80% of the investigated patients. Most of the patients had received oxygen therapy, lopinavir, and hydroxychloroquine. Additionally, 11.2% of the patients were under invasive mechanical ventilators. Concerning the lung CT scan, 42.7% of the patients had ≥5 involved lobes. In terms of density, 51.9% of the subjects had mixed opacity. Most lung damages (41.5%) were in the central part of the lungs. In 55.8% of cases, these damages were patchy lesions, and 40% had an airbronchogram. According to the Chi-squared test data, there was a significant relationship between the location of the lesions and the patient's need for suction (P<0.001). Besides, patients with central lung lesions required the highest percentage of suction (26%). In this study, 15% of the explored patients were hospitalized in the ICU, 84% were discharged by April 26, and 8.07% died. Conclusion: The current research results provide the health team with beneficial information about the assessment and care of patients with COVID-19 and the prediction of treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Leukemia is among the major causes of mortality and disability and the seventh most prevalent cancer worldwide. It has various effects on the biopsychosocial, reproductive, and economic performance of individuals. This study compared the Quality of Life (QoL) of hospitalized patients with different leukemia. Methods: This was a descriptive cross-sectional study. In total, 100 adolescent patients with leukemia hospitalized in Ayatollah Khansari Hospital in Arak City, Iran, were selected by purposive sampling method. The samples were evaluated for six months in 2018. The required data were collected by EORTC-QLQ-C30 Quality of Life questionnaire and analyzed by descriptive statistics (Mean±SD and frequency) and Chi-squared test, Fisher's exact test, and t-test in SPSS. P=0.5 was considered as significant. Results: The overall QoL Mean±SD score was 62.2±12.59, which was at a relatively appropriate level. The Mean±SD scores of life quality were 60.10±14.31 for chronic lymphocytic leukemia, 59.51±12.83 for acute lymphocytic leukemia, 66.61±10.94 for chronic myeloid leukemia, and 62.84±6.33 for acute myeloid leukemia. There were significant differences between the total QoL and its dimensions in different leukemia types (P<0.05). There was also a significant relationship between age, residency, and marital status of the patients, and their total QoL (P<0.05). Conclusion: Patients with myeloid leukemia had a better QoL, compared to those with lymphocytic leukemia. The patients had better performance in the physical area and weaker performance in social domain. The knowledge of nurses and other healthcare members about these findings could be used to promote care and improve the QoL of patients with different leukemia types. [ABSTRACT FROM AUTHOR]

Background: One of the most common orthopedic problems is the incidence of pressure ulcer followed by immobility. This study aimed to investigate the effect of Aloe Vera gel on the prevention of pressure ulcer in patients hospitalized in the orthopedic ward. Method: This study is a randomized, triple-blind clinical trial which was done on 80 purposefully selected patients in orthopedic ward in Arak town, Iran, 2016. Patients were randomly assigned into two intervention and control groups based on blocking sampling method. In each group the routine daily cares to prevent bed sores were performed by nurses. In the intervention group in addition to routine nursing care to prevent bed sores, twice a day (hours of 9 and 21) pure Aloe Vera gel on the areas of hip, sacrum and heel were rubbed, but in the control group placebo (gel of water and starch) were used. Then sacral, hip and heel of both groups on days 3, 7 and 10 for of signs of pressure ulcers was evaluated. Results: The mean age of patients in the control group was (42.34 ± 12.19) and in the intervention group Was (41.71 ± 11.50) years, respectively. In the intervention group 1 patient afflicted with sore of hip and two people with sacral pressure ulcer. In the control group 3 patients affiliated with sore of hip, 8 people with sacral pressure ulcer, and 1 person had pressure sore of heel. Analysis of the data showed that both groups had statistically significant differences in the incidence of pressure ulcers (P = 0.047). This means that Aloe Vera gel could prevent the occurrence of pressure ulcers in the intervention group. Conclusion: Due to the effect of Aloe Vera gel to prevent a rise in temperature, non-blanchable redness, swelling and pain of the skin of regions under study in hospitalized patients in the orthopedic ward, applying of it toward the prevention of pressure ulcers in patients at risk of pressure ulcer development is recommended. Trial registration: This study was registered in Iranian Registry of Clinical. Trials in 07/09/2016 with the IRCT ID: IRCT2016051027825N1. [ABSTRACT FROM AUTHOR]

Introduction: HIV drug resistance (HIVDR) is an important challenge in the fight against HIV/AIDS and can threaten progress toward achieving the target of HIV elimination by 2030. Genotyping pretreatment HIVDR testing (DRT) has been proposed as a potential solution. However, the cost-effectiveness of this intervention needs to be evaluated to determine its feasibility and potential impact on healthcare systems. This study aimed to assess the cost-effectiveness of DRT among people living with HIV (PLHIV) in Iran., Methods: 1000 hypothetical PLHIV were simulated in terms of cost and effectiveness based on quality-adjusted life Years (QALY). The Markov Model was developed to calculate incremental cost-effectiveness ratio (ICER) using TreeAge Pro 2020. Deterministic and probabilistic analyses were performed for sensitivity analyses., Results: Results showed that compared to not performing pretreatment HIVDR testing, this intervention gained 0.035999 QALY with an incremental cost of 1,695.32 USD. The ICER was calculated as 47,093.53 USD, indicating that pretreatment DRT was not cost-effective. The probability of opportunistic infection (OI) in people with viral failure, the effectiveness of Dolutegravir in people without drug resistance, and the quality of life (QoL) of people in the AIDS stage were found to be the most important variables affecting ICER. With an increasing willingness to pay more than 53,000 USD, pretreatment DRT testing will become cost-effective., Conclusion: Based on our findings, pretreatment HIVDR testing is not currently cost-effective in Iran as it imposes high costs on healthcare systems with few benefits for People living with HIV (PLHIV). However, if resources are available, drug resistance testing can be a valuable tool in generating HIV molecular data and molecular surveillance of HIV., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mirzaei et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Supervised injection facilities (SIFs) have not yet been integrated into Iran's harm reduction programs. This study aimed to report the extent to which people who inject drugs (PWID) in Iran are willing to use SIFs., Methods: Participants were recruited from 11 major cities using respondent-driven sampling. Willingness to use SIFs was defined as a three-level categorical variable: low, moderate, or high., Results: Of 2,490 PWID, 52.8% and 23.8% reported high and moderate willingness to use SIFs, respectively. PWID with a history of homelessness (relative-risk ratio (RRR): 2.22, 95% CI: 1.76-2.80), incarceration (1.86 [1.48-2.35]), hepatitis C infection (1.49 [1.13-1.97]), and non-fatal overdose (2.30 [1.69-3.13]) were more likely to be willing to utilize SIFs. Willingness to use SIFs was also higher among PWID who reported recent public injecting (2.24 [1.70-2.97]), daily injection (1.82 [1.35-2.45]), stimulants injection (2.39 [1.41-4.07]), syringe sharing (3.09 [1.23-7.74]), harm reduction services utilization (2.80 [2.13-3.68]), and food insecurity (8.28 [5.43-12.63])., Conclusion: The majority of PWID in Iran expressed willingness to use SIFs, in particular, those who were involved in higher-risk injection practices, dealing with structural risks, and had experienced drug-related harms. SIFs represent critical opportunities to deliver comprehensive harm reduction services to improve the health and well-being of PWID in Iran., Competing Interests: Declarations of Interest The authors have confirmed they have no potential conflicts of interest to declare., (Copyright © 2021 Elsevier B.V. All rights reserved.)