Infective Endocarditis in North Africa and the Middle East, 1990‒2019: Updates from the Global Burden of Disease Study 2019.

BACKGROUND: Infective endocarditis (IE), a severe and economically impactful condition, lacks substantial epidemiological data in the North Africa and Middle East (NAME) region. This study focused on analyzing the trends and burden of IE in NAME from 1990 to 2019, taking into account factors like age, gender, and socio-demographic index (SDI). METHODS: The Global Burden of Disease data from 1990 to 2019 was retrieved from the Institute for Health Metrics and Evaluation (IHME) website. RESULTS: Between 1990 and 2019, the age-standardized rates (ASR) for IE incidence increased by 59%, and prevalence and years lived with disability (YLDs) rose by 12% and 9%, respectively, while the ASRs for deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) saw reductions of 22%, 34%, and 34% in the NAME region. Death rates among children under five declined by 72%. Gender and the SDI did not significantly influence these changes. Saudi Arabia witnessed the most significant increase in ASR of IE incidence since 1990, while Turkey had the highest rates in 2019. The year 2019 also saw the highest death rate among those aged 70 and over, with over 91000 DALYs from IE. DALYs decreased by 71.5% for children under five from 1990 to 2019 but remained stable for individuals in their seventies. Jordan showed the most notable decrease in ASRs for deaths, DALYs, and YLLs among children under five. CONCLUSION: This study highlights the changing epidemiology of IE in the NAME region, recommending the establishment of multidisciplinary IE registries, antibiotic prophylaxis guidelines for healthcare-associated IE, and strategies to control antimicrobial resistance as key mitigation measures.

Assessment of Hemoglobin A1c Management and Prescription Cost Due to Polypharmacy Among Patients With Diabetes in Iran Based on the STEPS Iran 2016 Survey and a Prescription Database: A Multi-level, Cross-sectional National Study.

BACKGROUND: Diabetes frequently results in the need for multiple medication therapies, known as 'Polypharmacy'. This situation can incur significant costs and increase the likelihood of medication errors. This study evaluated the prescriptions of patients with diabetes regarding polypharmacy to assess its effect on the control of hemoglobin A1c (HbA1c) levels and prescription costs. METHODS: A cross-sectional national study was conducted based on data from linking the Iranians Health Insurance Service prescriptions in 2015 and 2016 with the STEPS 2016 survey in Iran. The association of the individual and sociodemographic factors, as well as polypharmacy, as independent variables, with control of HbA1c levels and the cost of the prescriptions were assessed among diabetic patients using logistic and linear regression, respectively. RESULTS: Among 205 patients using anti-diabetic medications, 47.8% experienced polypharmacy. The HbA1c of 74 patients (36.1%) was equal to or less than 7, indicating controlled diabetes. HbA1c control showed no significant association with gender. However, prescription costs were notably lower in females (ß=0.559 [0.324‒0.964], P=0.036). No significant correlation was found between the area of residence and prescription costs, but HbA1c was significantly more controlled in urban areas (OR=2.667 [1.132‒6.282], P=0.025). Prescription costs were significantly lower in patients without polypharmacy (ß=0.211, [0.106‒0.423], P<0.001), though there was no significant association between polypharmacy and HbA1c levels. CONCLUSION: Our results demonstrated that diabetics with polypharmacy paid significantly more for their prescriptions without experiencing a positive effect on the control of HbA1c levels.

Omicron-specific and bivalent omicron-containing vaccine candidates elicit potent virus neutralisation in the animal model.

Omicron variant (B.1.1.529) is able to escape from naturally acquired and vaccine-induced immunity, which mandates updating the current COVID-19 vaccines. Here, we investigated and compared the neutralising antibody induction of the ancestral variant-based BIV1-CovIran vaccine, the Omicron variant-based BIV1-CovIran Plus vaccine, and the novel bivalent vaccine candidate, BBIV1-CovIran, against the Omicron and ancestral Wuhan variants on the rat model. After inactivating the viral particles, the viruses were purified and formulated. Bivalent vaccines were a composition of 2.5 µg (5 µg total) or 5 µg (10 µg total) doses of each ansectral-based and Omicron-based monovalent vaccine. Subsequently, the potency of the monovalent and bivalent vaccines was investigated using the virus neutralisation test (VNT). The group that received three doses of the Omicron-specific vaccine demonstrated neutralisation activity against the Omicron variant with a geometric mean titer of 337.8. However, three doses of the Wuhan variant-specific vaccine could neutralise the Omicron variant at a maximum of 1/32 serum dilution. The neutralisation activity of the Omicron-specific vaccine, when administered as the booster dose after two doses of the Wuhan variant-specific vaccine, was 100% against the Omicron variant and the Wuhan variant at 1/64 and 1/128 serum dilution, respectively. Three doses of 5 µg bivalent vaccine could effectively neutralise both variants at the minimum of 1/128 serum dilution. The 10 µg bivalent vaccine at three doses showed even higher neutralisation titers: the geometric mean of 388 (95% CI 242.2-621.7) against Omicron and 445.7 (95% CI 303.3-655.0) against Wuhan. It is shown that the candidate bivalent and Omicron-specific vaccines could elicit a potent immune response against both Wuhan-Hu-1 and Omicron BA.1 variants.

Predicting Iran's achievement to Sustainable Development Goal 3.2: A systematic analysis of neonatal mortality with scenario-based projections to 2030.

BACKGROUND: Sustainable Development Goal 3.2 (SDG 3.2) is to reduce Under-5 and neonatal mortality rates (U5MR and NMR), two major health systems' performance indicators, globally by 2030. We aimed to report Iran's U5MR and NMR status during 2010-2017 and its achievement of SDG 3.2 by 2030, using scenario-based projection. STUDY DESIGN: To estimate the national and subnational levels of U5MR and NMR, we applied an Ensemble Bayesian Model Averaging (EBMA) with Gaussian Process Regression (GPR) and Spatio_temporal models. We used all available data sources including: 12-year data from the Death Registration System (DRS), two censuses, and a demographic and health surveys (DHS). This study employed two approaches, Maternal Age Cohort (MAC) and Maternal Age Period (MAP), to analyze summary birth history data obtained from censuses and DHS. In addition, we calculated the child mortality rate directly from DHS using the complete birth history method. National and subnational NMR was projected up to 2030 with a scenario-based method using average Annual Rate of Reduction (ARR) introduced by UN-IGME. RESULTS: In 2017, national U5MR and NMR were 15·2 (12·4-18·0) and 11·8 (10·4-13·2), with an average ARR of 5·1% (2·1-8·9) and 3·1% (0·9-5·8) during 2010-2017, respectively. According to our projection scenarios, 17 provinces have not fulfilled SDG 3.2 for NMR yet, and the current trend (the current trend of NMR improvement in Iran) will not result in reaching SDG for some provinces by 2030; However, if each province has the same neonatal mortality annual reduction rate as the best-performing province in the same region, besides achieving SDG, the national NMR will be reduced to 5·2, and almost 92,000 newborn lives will be saved. CONCLUSIONS: Iran has achieved SDG3.2 regarding U5MR and NMR; however, there are provincial inequalities. For all provinces to reach SDG3.2, health policies should focus on reducing provincial inequalities by precise planning for neonatal health care.

National and Provincial Prevalence of Cigarette Smoking in Iran; A Systematic Analysis of 12 Years of STEPS Experience.

BACKGROUND: Smoking is a modifiable risk factor for six of the eight leading causes of death. Despite the great burden, there is lack of data regarding the trend of cigarette smoking in Iran. We described the national and provincial prevalence of cigarette smoking and its 12-year time trend utilizing six rounds of Iranian stepwise approach for surveillance of non-communicable disease (STEPS) surveys. METHODS: We gathered data from six STEPS surveys done in 2005, 2007, 2008, 2009, 2011, and 2016 in Iran. To estimate the data of missing years, we used two separate statistical models including the mixed model and spatio-temporal analysis. RESULTS: The overall prevalence rate of cigarette smoking was 14.65% (12.81‒16.59) in 2005 and 10.63% (9.00‒12.57) in 2016 in Iran. The prevalence of cigarette smoking in 2005 and 2016 was 25.15% (23.18‒27.11) and 19.95% (17.93%‒21.97%) for men and 4.13% (2.43‒6.05) and 1.31% (0.06-3.18) for women, respectively. The prevalence of smoking in different provinces of Iran ranged from 20.73% (19.09‒22.47) to 9.67% (8.24‒11.34) in 2005 and from 15.34% (13.68‒17.12) to 6.41% (5.31‒7.94) in 2016. The overall trend of smoking was downward, which was true for both sexes and all 31 provinces. The declining annual percent change (APC) of the prevalence trend was -2.87% in total population, -9.91% in women, and -2.08% in men from 2005 to 2016. CONCLUSION: Although the prevalence of smoking had a decreasing trend in Iran, this trend showed disparities among sexes and provinces and this epidemiological data can be used to modify smoking prevention programs.

Burden of thyroid cancer in North Africa and Middle East 1990-2019.

Background: Thyroid cancer is the leading cause of mortality and morbidity among cancers of the endocrine system. We aimed to describe the trends of thyroid cancer burden in North Africa and Middle East for 1990-2019. Methods: Data on burden of thyroid cancer in North Africa and Middle East from 1990 to 2019 were obtained from the Global Burden of Disease (GBD) Study 2019. Decomposition analysis was used to estimate the effects of population growth, aging, and change in incident numbers on overall change of thyroid cancer incidence. Also, we used the comparative risk assessment framework of GBD to determine the burden of thyroid cancer attributable to a high body mass index (BMI). Results: In 2019, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of thyroid cancer were 3.5 (2.9-4) and 0.5 (0.5-0.7) per 100,000, respectively. The highest age-standardized incidence, deaths, and disability-adjusted life year (DALY) rate were in Lebanon, Afghanistan, and United Arab Emirates, respectively. The ASIR of thyroid cancer in region was about 2.5 times higher among women, which had a positive association with increasing age. In 2019, the age-standardized deaths attributable to a high BMI was 16.7% of all deaths due to thyroid cancer. In 1990-2019, the overall change in thyroid cancer incident cases was a 396% increase which was mostly driven by the increase in disease-specific incidence rate (256.8%). Conclusions: Women, the elderly above about 60 years old, and countries with a higher sociodemographic index showed higher incidence rates of thyroid cancer. Regarding our findings, it is recommended to establish preventive plans by modification in life style like weight reduction programs.

The burden of prostate cancer in North Africa and Middle East, 1990-2019: Findings from the global burden of disease study.

Background: Prostate cancer (PCa) is the second most prevalent cancer among men worldwide. This study presents estimates of PCa prevalence, incidence, death, years-of-life-lost (YLLs), years-lived-with-disability (YLDs), disability-adjusted-life-years (DALYs), and the burden attributable to smoking during 1990-2019 in North Africa and Middle East using data of Global Burden of Diseases (GBD) Study 2019. Methods: This study is a part of GBD 2019. Using vital registration and cancer registry data, the estimates on PCa burden were modeled. Risk factor analysis was performed through the six-step conceptual framework of Comparative Risk Assessment. Results: The age-standardized rates (95% UI) of PCa incidence, prevalence, and death in 2019 were 23.7 (18.5-27.9), 161.1 (126.6-187.6), and 11.7 (9.4-13.9) per 100,000 population. While PCa incidence and prevalence increased by 77% and 144% during 1990-2019, respectively, the death rate stagnated. Of the 397% increase in PCa new cases, 234% was due to a rise in the age-specific incidence rate, 79% due to population growth, and 84% due to population aging. The YLLs, YLDs, and DALYs of PCa increased by 2% (-11.8-23.1), 108% (75.5-155.1), and 6% (-8.9-28.1). The death rate and DALYs rate attributable to smoking have decreased 12% and 10%, respectively. The DALYs rate attributable to smoking was 37.4 (15.9-67.8) in Lebanon and 5.9 (2.5-10.6) in Saudi Arabia, which were the highest and lowest in the region, respectively. Conclusions: The PCa incidence and prevalence rates increased during 1990-2019; however, the death rate stagnated. The increase in the incidence was mostly due to the rise in the age-specific incidence rate, rather than population growth or aging. The burden of PCa attributable to smoking has decreased in the past 30 years.

National, sub-national, and risk-attributed burden of thyroid cancer in Iran from 1990 to 2019.

An updated exploration of the burden of thyroid cancer across a country is always required for making correct decisions. The objective of this study is to present the thyroid cancer burden and attributed burden to the high Body Mass Index (BMI) in Iran at national and sub-national levels from 1990 to 2019. The data was obtained from the GBD 2019 study estimates. To explain the pattern of changes in incidence from 1990 to 2019, decomposition analysis was conducted. Besides, the attribution of high BMI in the thyroid cancer DALYs and deaths were obtained. The age-standardized incidence rate of thyroid cancer was 1.57 (95% UI: 1.33-1.86) in 1990 and increased 131% (53-191) until 2019. The age-standardized prevalence rate of thyroid cancer was 30.19 (18.75-34.55) in 2019 which increased 164% (77-246) from 11.44 (9.38-13.85) in 1990. In 2019, the death rate, and Disability-adjusted life years of thyroid cancer was 0.49 (0.36-0.53), and 13.16 (8.93-14.62), respectively. These numbers also increased since 1990. The DALYs and deaths attributable to high BMI was 1.91 (0.95-3.11) and 0.07 (0.04-0.11), respectively. The thyroid cancer burden and high BMI attributed burden has increased from 1990 to 2019 in Iran. This study and similar studies' results can be used for accurate resource allocation for efficient management and all potential risks' modification for thyroid cancer with a cost-conscious view.

Twenty-Six-Year Trend of Mortality Rate Due to Ischemic Heart Diseases (IHDs) in Iran: 1990-2015.

Background: Ischemic Heart Diseases (IHDs) are the main causes of deaths all over the world. Since there is no comprehensive study on IHDs mortality rate in Iran, the present study aimed to estimate age-standardized IHDs mortality rate by sex, age, geography, and time trends at both national and sub-national levels in Iran. Methods: We used the Death Registration System (DRS) data from 1990 to 2015 collected by the Iranian Ministry of Health and Medical Education across the country, Tehran, and Isfahan main cemetery, not included in the DRS. Utilized death distribution methods to overcome the incompleteness of data. Statistical models including Spatio-temporal and Gaussian-Process Regression models were used to extrapolate all-cause and cause-specific mortality rates. Results: Age-standardized IHDs mortality rate in Iran almost doubled from 1990 to 2015. Forty-nine deaths per 100.000 population in 1990, which increased to 91.6 deaths per 100.000 in 2015). Male to female age-standardized mortality rate increased from 1.07 to 1.32 during the studied period. Aging was associated with an increase in age-standardized IHDs mortality rate in both sexes, all provinces, and all of the years. The range of age-standardized IHDs mortality rate for both sexes was from 58 to 136.2 deaths per 100,000 across provinces in 2015. Conclusion: Due to the increase in age-standardized IHDs mortality rate in Iran, it seems necessary to design and implement appropriate public health interventions by health authorities to prevent and control this group of diseases.

Level and trend of total plasma cholesterol in national and subnational of Iran: a systematic review and age-spatio-temporal analysis from 1990 to 2016.

Purpose: We aimed to estimate the level and trend of plasma cholesterol and raised total cholesterol (TC > 200 mg/dl) prevalence at national and subnational level of Iran. Methods: Nine national surveys and 27 studies, encompassing 3,505 unique points on over 500,000 adults, aged > 25 years with a report of laboratory measurement of TC were found. Age-spatio-temporal model and Gaussian Process Regression were used to estimate mean TC for each sex, 5-year age groups, and 31 provinces from 1990 to 2016. Results: At national level, age-standardized prevalence of TC > 200 mg/dL has decreased from 57·2%(53·3-61·1) to 22·4%(20·5-24·3) in women and 53·2%(49·1-57·3) to 18·0%(16·4-19·6) in men. TC distribution presented a condensation between 170-200 mg/dL. At subnational level, decreasing and converging patterns of raised TC prevalence were detected. Conclusion: The decrease in raised TC is likely the result of statin widespread use, food industry improvements, and the expanded primary health care. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01052-w.

A pilot study using financial transactions' spatial information to define high-risk neighborhoods and distribution pattern of COVID-19.

BACKGROUND: Development of surveillance systems based on big data sources with spatial information is necessitated more than ever during this pandemic. Here, we present our pilot results of a new technique for the incorporation of spatial information of transactions and a vital registry of COVID-19 to evaluate the disease spread. METHODS: We merged two databases of laboratory-confirmed national COVID-19 registry of Iran and financial transactions of point-of-sale devices from February to March 2020 as our training data sources. Spatial information was used for the visualization of maps and movements of sick individuals. We used the point-of-sale devices-related guild to check for the dynamics of financial transactions and effectiveness of quarantines. FINDINGS: In the study period, 174,428 confirmed cases were in the COVID-19 registry with accompanying transactions information. In total, 13,924,982 financial transactions were performed by them, with a mean of 1.2 per day for each person. All guilds had a decreasing pattern of "risky" transactions except for grocery stores and pharmacies. The latter showed a decreasing pattern by impose of lockdowns. Different cities were the hotspot of disease transmission as many "high-risk" transactions were performed in them, among which Tehran (mainly its central neighborhoods) and southern cities of Lake Urmia predominated. Lockdowns indicated that the disease gradually became less transmissible. INTERPRETATION: Financial transactions can be readily used for epidemics surveillance. Semi real-time results of such iterations can be informative for policy makers, guild owners, and general population to prepare safer commuting and merchandise spaces.

Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021.

BACKGROUND: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present. METHODS: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey. RESULTS: By amending the required changes, we could include a total of 27874 individuals in the first step of the survey. This number was 27745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants. CONCLUSION: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.

A Report on Statistics of an Online Self-screening Platform for COVID-19 and Its Effectiveness in Iran.

BACKGROUND: The most recent emerging infectious disease, coronavirus disease 2019 (COVID-19), is pandemic now. Iran is a country with community transmission of the disease. Telehealth tools have been proved to be useful in controlling public health disasters. We developed an online self-screening platform to offer a population-wide strategy to control the massive influx to medical centers. METHODS: We developed a platform operating based on given history by participants, including sex, age, weight, height, location, primary symptoms and signs, and high risk past medical histories. Based on a decision-making algorithm, participants were categorized into four levels of suspected cases, requiring diagnostic tests, supportive care, not suspected cases. We made comparisons with Iran STEPs (STEPwise approach to Surveillance) 2016 study and data from the Statistical Centre of Iran to assess population representativeness of data. Also, we made a comparison with officially confirmed cases to investigate the effectiveness of the platform. A multilevel mixed-effects Poisson regression was used to check the association of visiting platform and deaths caused by COVID-19. RESULTS: About 310 000 individuals participated in the online self-screening platform in 33 days. The majority of participants were in younger age groups, and males involved more. A significant number of participants were screened not to be suspected or needing supportive care, and only 10.4% of males and 12.0% of females had suspected results of COVID-19. The penetration of the platform was assessed to be acceptable. A correlation coefficient of 0.51 was calculated between suspected results and confirmed cases of the disease, expressing the platform's effectiveness. CONCLUSION: Implementation of a proper online self-screening tool can mitigate population panic during wide-spread epidemics and relieve massive influx to medical centers. Also, an evidence-based education platform can help fighting infodemic. Noticeable utilization and verified effectiveness of such platform validate the potency of telehealth tools in controlling epidemics and pandemics.

Safety and potency of BIV1-CovIran inactivated vaccine candidate for SARS-CoV-2: A preclinical study.

The development of effective and safe COVID-19 vaccines is a major move forward in our global effort to control the SARS-CoV-2 pandemic. The aims of this study were (1) to develop an inactivated whole-virus SARS-CoV-2 candidate vaccine named BIV1-CovIran and (2) to determine the safety and potency of BIV1-CovIran inactivated vaccine candidate against SARS-CoV-2. Infectious virus was isolated from nasopharyngeal swab specimen and propagated in Vero cells with clear cytopathic effects in a biosafety level-3 facility using the World Health Organization's laboratory biosafety guidance related to COVID-19. After characterisation of viral seed stocks, the virus working seed was scaled-up in Vero cells. After chemical inactivation and purification, it was formulated with alum adjuvant. Finally, different animal species were used to determine the toxicity and immunogenicity of the vaccine candidate. The study showed the safety profile in studied animals including guinea pig, rabbit, mice and monkeys. Immunisation at two different doses (3 or 5 µg per dose) elicited a high level of SARS-CoV-2 specific and neutralising antibodies in mice, rabbits and nonhuman primates. Rhesus macaques were immunised with the two-dose schedule of 5 or 3 µg of the BIV1-CovIran vaccine and showed highly efficient protection against 104 TCID50 of SARS-CoV-2 intratracheal challenge compared with the control group. These results highlight the BIV1-CovIran vaccine as a potential candidate to induce a strong and potent immune response that may be a promising and feasible vaccine to protect against SARS-CoV-2 infection.

The levels of BMI and patterns of obesity and overweight during the COVID-19 pandemic: Experience from the Iran STEPs 2021 survey.

Background: Obesity and its increasing burden have become an urgent health problem all over the world. Benefiting from a national representative sample, the present study aimed to estimate the distribution of body mass index (BMI) levels and its association with metabolic and lifestyle risk factors in an Iranian adult population by sex, age, and geographical distribution. Methods: This study involves a national survey of noncommunicable disease risk factor surveillance (STEPs) in Iran. Through systematic random sampling, in compliance with safety considerations during the COVID-19 pandemic, of the 28,520 adults who gave voluntary consent and included in the study, 27,874 participants completed the questionnaires (step 1), 27,745 individuals were anthropometrically measured (step 2), and 18,119 individuals completed laboratory evaluation (step 3). Anthropometric measurements followed based on standard protocols and by using calibrated instruments. Results: In 2021, the national prevalence of normal weight, obesity, and overweight/obesity in ≥18-year-old Iranian adults was estimated at 33.61% (95% CI: 32.99-34.23), 24.96% (24.39-25.53), and 63.02% (62.39-63.65), respectively. Compared to women, Iranian men had a lower mean BMI [25.54 (24.95-26.13 vs. 27.6 (27.07-28.12) kg/m2] (p < 0.001). There was also a significant difference in the national prevalence rate of overweight/obesity [women: 66% (61-71), men: 53% (46-60) (p < 0.001)]. The prevalence of obesity was significantly higher in participants suffering from metabolic and lifestyle risk factors. The study of the geographical extent of obesity and overweight shows that compared to national levels, the highest prevalence of being underweight was seen in the southeastern provinces. On the other hand, the highest prevalence of obesity belonged to the northeastern and central provinces. The highest provincial prevalence of obesity was almost 2.5-fold higher than the lowest provincial prevalence. Conclusion: The study reveals a significant difference between the prevalence of obesity in male and female participants and between different regions of the country. These findings will help policymakers, clinicians, and researchers to more accurately estimate the obesity/overweight problem and to implement more effective interventional programs to promote strategies of prevention and control of weight gain.

Red flags of poor prognosis in pediatric cases of COVID-19: the first 6610 hospitalized children in Iran.

INTRODUCTION: COVID-19 clinical course, effective therapeutic regimen, and poor prognosis risk factors in pediatric cases are still under investigation and no approved vaccinehas been introduced for them. METHODS: This cross-sectional study evaluated different aspect of COVID-19 infection in hospitalized COVID-19 positive children (≺18 years oldwith laboratory confirmed COVID-19 infection, using the national COVID-19 registry for all admitted COVID-19 positive cases from February 19 until November 13,2020, in Iran. RESULTS: We evaluated 6610 hospitalized children. Fifty-four percent (3268) were male and one third of them were infants younger than 1 year. Mortality rate in total hospitalized children was 5.3% and in children with underlying co-morbidities (14.4%) was significantly higher (OR: 3.6 [2.7-4.7]). Chronic kidney disease (OR: 3.42 [1.75-6.67]), Cardiovascular diseases (OR: 3.2 [2.09-5.11]), chronic pulmonary diseases (OR: 3.21 [1.59-6.47]), and diabetes mellitus (OR: 2.5 [1.38-4.55]), resulted in higher mortality rates in hospitalized COVID-19 children. Fever (41%), cough (36%), and dyspnea (27%) were the most frequent symptoms in hospitalized children and dyspnea was associated with near three times higher mortality rate among children with COVID-19 infection (OR: 2.65 [2.13-3.29]). CONCLUSION: Iran has relatively high COVID-19 mortality in hospitalized children. Pediatricians should consider children presenting with dyspnea, infants≺ 1 year and children with underlying co-morbidities, as high-risk groups for hospitalization, ICU admission, and death.

Insulin pen use and diabetes treatment goals: A study from Iran STEPS 2016 survey.

BACKGROUND: Frequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology. METHODS: In this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling. RESULTS: There were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels. CONCLUSION: Results showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.

Liver cirrhosis mortality at national and provincial levels in Iran between 1990 and 2015: A meta regression analysis.

BACKGROUND: Liver cirrhosis mortality number has increased over the last decades. We aimed to estimate the liver cirrhosis mortality rate and its trends for the first time by sex, age, geographical distribution, and cause in Iran. METHOD: Iranian Death Registration System, along with demographic (Complete and Summary Birth History, Maternal Age Cohort and Period methods) and statistical methods (Spatio-temporal and Gaussian process regression models) were used to address the incompleteness and misclassification and uncertainty of death registration system to estimate annual cirrhosis mortality rate. Percentages of deaths were proportionally redistributed into cirrhosis due to hepatitis B, C and alcohol use based on the data from the Global Burden of Disease (GBD) 2010 study. RESULTS: Liver cirrhosis mortality in elder patients was 12 times higher than that in younger patients at national level in 2015. Over the 26 years, liver cirrhosis mortality in males has increased more than that in females. Plus, the percentage of change in age adjusted mortality rate at provincial levels varied between decreases of 64.53% to nearly 17% increase. Mortality rate has increased until 2002 and then decreased until 2015.The province with highest mortality rate in 2015 has nearly two times greater rate compare to the lowest. More than 60% of liver cirrhosis mortality cases at national level are caused by hepatitis B and C infection. The rate of hepatitis B mortality is four times more than that from hepatitis C. CONCLUSION: This study demonstrated an increasing and then decreasing pattern in cirrhosis mortality that could be due to national vaccination of hepatitis B program. However monitoring, early detection and treatment of risk factors of cirrhosis, mainly in high risk age groups and regions are essential. Cirrhosis mortality could be diminished by using new non-invasive methods of cirrhosis screening, hepatitis B vaccination, definite treatment of hepatitis C.

An Approach Towards Reducing Road Traffic Injuries and Improving Public Health Through Big Data Telematics: A Randomised Controlled Trial Protocol.

OBJECTIVE: Deaths due to road traffic accidents (RTAs) are a major public health concern around the world. Developing countries are over-represented in these statistics. Punitive measures are traditionally employed to lower RTA related behavioural risk factors. These are, however, resource intensive and require infrastructure development. This is a randomised controlled study to investigate the effect of non-punitive behavioural intervention through peer-comparison feedback based on driver behaviour data gathered by an in-vehicle telematics device. DESIGN, SETTING, AND PARTICIPANTS: A randomised controlled trial using repeated measures design conducted in Iran on the drivers of 112 public transport taxis in Tehran province and 1309 inter-city busses operating nationwide. Driving data is captured by an in-vehicle telematics device and sent to a centrally located data centre using a mobile network. The telematics device is installed in all vehicles. Participants are males aged above 20 who have had the device operating in their vehicles for at least 3 months prior to the start of the trial. INTERVENTION: The study had three stages: 1- Driver performance was monitored for a 4-week period after which they were randomised into intervention and control groups. 2- Their performance was monitored for a 9-week period. At the end of each week, drivers in the intervention group received a scorecard and a note informing them of their weekly behaviour and ranking within their peer group. Drivers in the control group received no feedback via short messaging service (SMS). 3- Drivers did not receive further feedback and their behaviour was monitored for another 4 weeks. PRIMARY AND SECONDARY OUTCOME MEASURE: Primary outcome was changes in weekly driving score in intervention and control groups during stage 2 of intervention. Taxis and busses were analysed separately using generalised estimating equation analysis. FUNDING AND ETHICAL APPROVAL: This project was funded by the National Institute for Medical Research Development (Grant No.940576) and approved by its ethics committee (Code: IR.NIMAD.REC.1394.016). This trial was registered at www.irct.ir as IRCT20180708040391N1.