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The reported fatality rate of COVID-19 was significantly differ between different countries, provinces in a country, and hospitals in a province. It is important to find and analysed the source of variation in fatality rates to control future epidemics of infection disease. This study propose an approach to investigates the hospital quality of care and its impact on the in-hospital fatality rates of COVID-19 among over 30 years old patients in Iran. The study included 78,217 COVID-19 hospitalized patients over 30 years old from 34 hospitals in Razavi Khorasan province between January 20, 2020, and June 20, 2021. Attribute control charts were employed to evaluate the quality of care in hospitals during four peaks of COVID-19. To account for the impact of hospital quality on in-hospital fatality rates by adjusting on patient characteristics, two predictive models; Poisson and Binomial regression were utilized. The adjusted odds ratio of COVID-19 fatality in no quality confirmed (NQC) hospitals to the quality confirmed (QC) hospitals is 3.48 C.I.95% (2.38, 5.10) at the first peak among patients without other risk factors. The significant negative interactions with QC and peaks indicates that the provision of quality care serves to mitigate the risk of fatality in NQC hospitals during these peaks. The significant negative interaction between diabetes and QC demonstrated that the relative risk in NQC hospitals for no diabetes patient is higher than diabetic patients. There is no significant interaction between age, SaO2, and ARDS with QC; it means that the odds of fatality in NQC hospitals is not depends to these factors. The use of attribute control charts facilitated timely identification of trends and outliers, enabling proactive interventions to enhance patient care. This research underscores the critical role of hospital quality in managing patient outcomes during the COVID-19 pandemic and emphasizes the necessity for continuous monitoring and quality improvement initiatives in healthcare settings. The findings advocate for collaborative efforts among healthcare providers to implement best practices, particularly during surges in cases, to optimize resource allocation and improve overall quality of care. [ABSTRACT FROM AUTHOR]

Many studies have examined the impact of air pollution on cardiovascular hospitalization (CVH), but few have looked at the delayed effects of air pollution on CVH. Additionally, there has been no research on the spatial and temporal differences in how environmental pollutants affect CVH. This study seeks to identify spatial heteroscedasticity in the relation between PM2.5 and CVH by developing a Generalized Additive Distributed Lag (GADL) model. Data on hospitalization due to cardiovascular disease were collected from the Hospital Information System (HIS) of Mashhad University of Medical Science from 2017 to 2020. Air pollution data from 22 air quality monitoring (AQM) stations were obtained from the Environmental Pollution Monitoring Center of Mashhad administrates. Markov Random Field (MRF) smoother was utilized in the GADL model to account for spatial heteroscedasticity in the observations. This developed model is a Spatial Heteroscedastic Generalized Additive Distributed Lag (SHGADL) model. Our use of GADL allowed us to discover a significant relationship between PM2.5 exposures and the risk of CVH at lags 0 and 1 in all districts. Our results reveal heteroscedasticity in the Relative Risks (RR) of PM2.5 on CVH across different districts. After accounting for this spatial heteroscedasticity, we found that the RR of PM2.5 on CVH at lags 0 and 1 were 1.0102 (95% CI: 1.0034, 1.0170) and 1.0043 (95% CI: 1.0009, 1.0078) respectively. The central and southeastern districts showed higher RR for CVH. The developed SHGADL model provides evidence of a significant lagged effect of PM2.5 exposures on CVH, and identifies low- and high-risk districts for CVH in Mashhad. This finding can assist decision-makers in allocating resources and planning strategically, with a focus on local interventions to manage ambient air pollution and providing emergency care for CVH. [ABSTRACT FROM AUTHOR]

Introduction: According to the World Health Organization (WHO), breastfeeding is the best way to feed infants. Adoption of some inappropriate nutritional patterns along with breast milk, especially in infants older than 6 months, may lead to a delay in the child's growth. Therefore, the present study was conducted to investigate the relationship between breastfeeding and weight gain in children aged 6–24 months. Materials and Methods: This case-control study was conducted on 120 infants aged 6–24 months and their mothers recruited from health centers of Ahvaz, southwest of Iran. The data collection tool in the present study included a questionnaire to record demographic information and information in the child's medical records in health centers. Statistical analysis of the data was done by SPSS 23 using the Chi-square test and t-test. Results: No significant difference was observed between the control and case groups in terms of the infant's age (P = 0.741) and gender (P = 0.564) and the mothers' age (P = 0.614), her educational attainment (P = 0.389), and socioeconomic status of the infant's family (P = 0.563). The type of delivery (P = 0.650), mothers' opinion (P = 0.133), and the interval between breastfeeding and complementary feeding (P = 0.144) had no significant relationship with the infant's growth disorder. On the other hand, duration of breastfeeding per meal (P = 0.007) and frequent breastfeeding (dependency on the mother's breast) (P = 0.049) had a significant relationship with children's developmental disorders.Conclusion: According to the results of the present study, growth disorders in infants in the case group could be attributed to their mothers' inappropriate breastfeeding patterns. [ABSTRACT FROM AUTHOR]

Abstract Background In this exploratory study, the contribution of delivery type to the weight gain pattern for full-term infants with exclusive breastfeeding in the first month of infancy was determined. In addition, breastfeeding success among cesarean section (C-section) delivery mothers based on their neonate's weight gain at the end of the first month of infancy was evaluated. Methods A cohort of 92 neonates born in Shiraz, from July 10 to August 10, 2007 was followed longitudinally. The data were collected during the first month postpartum at three occasions: 3 to 7 days postpartum, 10-21 days postpartum and 24-31 days postpartum. Results Among 92 mothers in this study, 35 (38%) were delivered by C-section. Generalized estimating equation (GEE) showed that delivery type (p < 0.01), receipt of advice about breastfeeding (p = 0.03) and neonate's age (p < 0.01) significantly affected weight gain. GEE estimated the values of the parameters under study and the testing contribution of each factor to weight gain, leading to the conclusion that gender, parities and maternal education did not contribute to weight gain. The neonate's weight gain pattern for C-section deliveries lies below that of normal vaginal deliveries until 25 days postpartum, when weight gain for C-section deliveries became higher than that for normal vaginal deliveries. Conclusions Type of delivery contributes strongly to the weight gain pattern in the first month of infancy. In spite of greater weight loss among C-section birth neonates in the first days of life, at the end of the first month neonates showed a similar weight gain. Consequently, mothers with C-section delivery can successfully exclusively breastfeed.

This aim of this study was to determine the effect of 1540-nm nonablative fractional erbium on macular amyloidosis. This phase-II clinical trial study has been performed with parallel group with blinding of the evaluator. The skin lesions of the patients (15 patients and 30 lesions) with cutaneous macular amyloidosis were randomly assigned into laser and no-treatment groups. In the laser group, treatment was performed by 1540-nm nonablative fractional erbium laser. Thereafter, the patients' lesions were compared in terms of pigmentation, rippling, thickness, and subjective response. The lesions of the intervention group significantly improved in the three-month follow-up compared to the control group (in the control and intervention group, improved pigmentation was observed in 20 and 53.3% with p =.02, improved rippling in 6.7 and 60% with p =.007, diminished lichenification in 0 and 53.1% with p =.007, and overall lesion improvement in 20 and 60% with p =.03, respectively). In investigating the subjective response through patient global assessment, the patients in the intervention group had a greater satisfaction (p =.01). There was a considerable improvement of pruritus in the intervention group (p =.001). Use of 1540-nm nonablative fractional erbium laser offered a suitable efficacy to treat macular amyloidosis without significant complications. [ABSTRACT FROM AUTHOR]

Background: The exact etiology of premature hair graying (PHG) remains unknown; however, oxidative stress is shown to be involved. Selenium, as an antioxidant, is widely known for its antiaging potentials. Moreover, PGH is more prevalent among addicts and because Lead is a common impurity found in illegal drug. Aims: We evaluated the serum levels of lead and selenium in patients with PHG and compared it with a control group. Patients/Methods: In this cross‐sectional study, 60 patients referred to Dermatology Clinic of Imam‐Reza Hospital of Mashhad, Iran in 2015 were evaluated in two groups with and without PHG. Demographic information and disease characteristics, skin phenotype, and family history of PHG were recorded. Furthermore, 5 mL of brachial blood was drawn for measuring selenium and lead levels. Results: The mean patients' age was 28.1 ± 4.8 years. Age, sex, occupation, and skin phenotype in individuals with and without PHG were not significantly different (P >.05) but family history of PHG was significantly higher in the patients with PHG (P =.001). Similarly, the number of white hairs was significantly higher (P <.001), and the age of onset of hair graying was significantly lower in patients with PHG (P <.001). Serum levels of selenium and lead were not significantly different between two groups (P <.05). However, the serum levels of lead in the patients with PHG were slightly higher. Conclusions: The results of this study showed that there was no significant difference in lead and selenium serum levels in patients with and without PHG. [ABSTRACT FROM AUTHOR]