Economic evaluation of dialysis and comprehensive conservative care for chronic kidney disease using the ICECAP-O and EQ-5D-5L; a comparison of evaluation instruments.

BACKGROUND: Chronic Kidney Disease (CKD) patients often require long-term care, and while Hemodialysis (HD) is the standard treatment, Comprehensive Conservative Care (CCC) is gaining popularity as an alternative. Economic evaluations comparing their cost-effectiveness are crucial. This study aims to perform a cost-utility analysis comparing HD and CCC using the EQ-5D-5L and ICECAP-O instruments to assessing healthcare interventions in CKD patients. METHODS: This short-term economic evaluation involved 183 participants (105 HD, 76 CCC) and collected data on demographics, comorbidities, laboratory results, treatment costs, and HRQoL measured by ICECAP-O and EQ-5D-5L. Incremental Cost-Effectiveness Ratios (ICERs) and Net Monetary Benefit (NMB) were calculated separately for each instrument, and Probabilistic Sensitivity Analysis (PSA) assessed uncertainty. RESULTS: CCC demonstrated significantly lower costs (mean difference $8,544.52) compared to HD. Both EQ-5D-5L and ICECAP-O indicated higher Quality-Adjusted Life Years (QALYs) for both groups, but the difference was not statistically significant (p > 0.05). CCC dominated HD in terms of HRQoL measures, with ICERs of -$141,742.67 (EQ-5D-5L) and -$4,272.26 (ICECAP-O). NMB was positive for CCC and negative for HD, highlighting its economic feasibility. CONCLUSION: CCC proves a preferable and more cost-effective treatment option than HD for CKD patients aged 65 and above, regardless of the quality-of-life measure used for QALY calculations. Both EQ-5D-5L and ICECAP-O showed similar results in cost-utility analysis.

Effect of saffron supplementation on oxidative stress markers (MDA, TAC, TOS, GPx, SOD, and pro-oxidant/antioxidant balance): An updated systematic review and meta-analysis of randomized placebo-controlled trials.

Introduction: This study aimed to perform an updated systematic review and meta-analysis to evaluate the effectiveness of saffron supplementation on oxidative stress markers [malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), glutathione peroxidase (GPx), superoxide dismutase (SOD), and prooxidant/antioxidant balance (PAB)] in randomized controlled trials (RCTs). Methods: We searched PubMed/Medline, Web of Science, Scopus, Cochrane CENTRAL, and Google Scholar until December 2022. Trial studies investigating the effects of oral saffron supplements on MDA, TAC, TOS, GPx, SOD, and PAB concentrations were included in the study. To analyze the results, mean differences (SMD) and 95% confidence intervals (CI) were pooled using a random effects model. Heterogeneity was assessed using the Cochrane Q and I 2 values. Sixteen cases were included in the meta-analysis (468 and 466 subjects in the saffron and control groups, respectively). Results: It was found that saffron consumption caused a significant decrease in MDA (SMD: -0.322; 95% CI: -0.53, -0.16; I 2 = 32.58%) and TOS (SMD: -0.654; 95% CI: -1.08, -0.23; I 2 = 68%) levels as well as a significant increase in TAC (SMD: 0.302; 95% CI: 0.13, 0.47; I 2 = 10.12%) and GPx (SMD: 0.447; 95% CI: 0.10, 0.80; I 2 = 35%). Subgroup analysis demonstrated a significant reduction in MDA levels in studies with a saffron dosage of >30 mg/day, age of <50 years, and study duration of <12 weeks. Among the limitations of the study, we can point out that the studies were from Iran, the different nature of the diseases included, and were not considered of some potential confounders such as smoking, physical activity, and diet in the studies. Discussion: In summary, the results showed that saffron has beneficial effects on oxidative stress markers.

Using Multiple Logistic Regression to Determine Factors Affecting Delaying Hospital Arrival of Patients with Acute Ischemic Stroke.

Background: Early treatment of ischemic stroke patients who arrive at the hospital ≤4.5 hours after the onset of symptoms with recombinant tissue plasminogen activator is more beneficial and very important. Objective: This study is aimed to investigate the factors delaying the hospital arrival of patients with acute ischemic stroke by using multiple logistic regression analysis. Methods and Materials: This descriptive cross-sectional study was done on patients diagnosed with acute ischemic stroke who were referred to Ardabil city Training and Research hospital at 2018. All patients and/or patient relatives were interviewed and data were collected through a checklist including demographic and clinical data of patients to explore the involved factors delaying hospital arrival of patients and then analyzed using multiple logistic regression analysis. Results: Of all included patients, only 25.3% arrived at the hospital in ≤ 4.5 hours. By using multivariate logistic regression analysis, living in cities (P = 0.007), cigarette consumption (P = 0.032), having valvular heart disease (P = 0.008), and gender (P = 0.049) were factors associated with an early arrival to the hospital. Conclusions: Results showed that most of the patients had a considerable delay in arriving at the hospital in ≤ 4.5 hours. Thus, providing health promotion strategies to improve society awareness of early symptoms of stroke, training of local physicians about the importance of early arrival of stroke patients, and more extended ambulance services in all cities and rural areas are necessary for better management of acute stroke patients in this area.

Altered gene expression levels of IL-17/TRAF6/MAPK/USP25 axis and pro-inflammatory cytokine levels in lung tissue of obese ovalbumin-sensitized rats.

AIMS: The association between asthma and obesity has been shown but its accurate mechanism is unknown. In the current study, we sought to investigate the gene expression levels of IL-17/TRAF6/MAPK/USP25 axis and pro-inflammatory cytokine level (IL-6, IL-1ß, and TNF-α) in obese Ovalbumin (OVA)-sensitized female and male Wistar rats lung tissue. MAIN METHODS: Animals in both males and females were divided into eight groups (four groups in each sex) based on diet and OVA-sensitization: normal diet, a normal diet with OVA-sensitization, high-fat diet (HFD), and OVA-sensitization with an HFD. KEY FINDINGS: In both sexes, obese OVA-sensitized rats, the methacholine concentration-response curve shifted to the left and EC50 methacholine decreased. Increased pro-inflammatory cytokines as well as elevated IL-17/TRAF6/MAPK axis genes and decreased USP25 gene expression were identified in obese OVA-sensitized groups. SIGNIFICANCE: The results indicate that in obese OVA-sensitized rats, the IL-17 axis were involved in the pathogenesis of the disease and can be considered as a therapeutic target in subjects with obesity-related asthma.

Quality of work life and work-family conflict: a cross-sectional study among nurses in teaching hospitals.

BACKGROUND: The nursing profession is known to induce high levels of stress, and being simultaneously engaged in a stressful professional occupation and having a family life can lead to work-family conflict. Healthcare providers require recruitment and retention strategies that preserve nurses' quality of work-life and mitigate work-family conflict. AIM: To investigate the relationship between quality of work-life and work-family conflict among hospital nurses in Iran, as well as the relationships between work-family conflict and quality of work life, and between age, professional experience, type of employment, work shift and marital status. METHOD: This cross-sectional study was conducted among 378 nurses working in six Iranian teaching hospitals, who were selected using random quota sampling. Data on age, professional experience, type of employment, work shift and marital status was collected. The study questionnaire was based on the 53-item Quality of Work Life scale and the 18-item Work-Family Conflict scale. Correlations were established using Pearson's chi-squared and eta-squared tests. RESULTS: A total of 93% of participants experienced moderate or high levels of work-family conflict and 83% had a low or moderate quality of work life. On average, the levels of work-family conflict and quality of work life were moderate. Quality of work life decreased with increasing work-family conflict. CONCLUSION: Healthcare providers can use these results to inform their recruitment and retention strategies. Nurse managers can mitigate any adverse effects of work-family conflict on quality of work life by offering staff interventions such as short training courses on how to manage work-family conflict.

MEFV Gene Variant Alleles in Normal Population of Northwest of Iran, Which Is Near to Mediterranean Sea.

BACKGROUND AND OBJECTIVE: MEFV gene codes the pyrine protein that has major role in FMF as an autoinflammatory disorder. FMF is more often seen in the people of the Mediterranean area. Considering the significant role of MEFV gene in many rheumatologic diseases and even nonrheumatologic disorders, it is necessary to identify different variations of these mutations in the healthy and normal population of this area. METHODS: 224 healthy (unaffected or control) people based on the Cochran formula entered this study. The blood samples were screened for the 12 common MEFV gene variants polymorphisms according to manufacturer's instructions (FMF Strip Assay, Vienna lab, Vienna, Austria). They filled a questionnaire containing required information. All healthy control cases initially were evaluated for FMF symptoms and signs in themselves and their first-degree relatives based on clinical criteria. All data were analyzed by simple statistical method. RESULTS: Among 224 healthy control cases, 113 (50.4%) were male and 111 (49.6%) female. There were MEFV variants alleles in 57 patients (25%): 28 were male (49.1%) and 29 female (50.9%). The most frequent variants were E148Q (18.3%), followed by P369S (3.1%), V726A (2.2%), A744S (1.3%), and F479L, M694V, and R761H (0.8%), and eventually K695R (0.4%), respectively. Some variants such as M694I, M680I (G/C), M680I (G/A), and I692del were not seen in these samples. There were compound heterozygote variations of E148Q/P369S, E148Q/V726A, E148Q/P369S, and P369S/F479L in normal population without any findings in favor of FMF. CONCLUSION: Twenty-five percent of the normal populations of the northwest of Iran are carrying MEFV gene variants, and the most common mutation is E148Q (18.3%). The presence of M694I, M680I (G/C), M680I (G/A), I692del mutations in the normal population can be interpreted cautiously, while particular compound heterozygote mutations can be considered as normal variants.

The Incidence Rate, Risk Factors and Clinical Outcome of Acute Kidney Injury in Critical Patients.

BACKGROUND: Acute kidney injury (AKI) is the most common cause of organ dysfunction in intensive care unit (ICU) patients. There is no consensus definition of AKI in ICU patients. Therefore, we aimed to evaluate the incidence rate, risk factors and clinical outcome of AKI using the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) classification in ICU patients. METHODS: We performed a retrospective cohort study, on 900 patients admitted to the ICU during a one year period at Imam Khomeini Hospital in Ardebil, Iran from 2014 to 2015. AKI was defined by the consensus RIFLE criteria. RESULTS: The overall incidence rate of AKI was 37%. The patients with AKI were also classified according to RIFLE as follows: Risk (8.2%), Injury (13.4%), Failure (13.2%), Loss of kidney function (1.3%), and End-stage kidney disease (0.8%). The mortality rate was 58.3% for AKI patients, and 13.4% for non-AKI patients (P<0.001). Patients in RIFLE-R (Risk) had a mortality rate of 37.8% compared with 48.8% for those in RIFLE-I (Injury) and 76.5% for RIFLE-F (Failure) patients (P<0.0001). Significant risk factors to the development of AKI were included: age more than 60 yr, increased length of hospital stay, systolic blood pressure less than 100 mm Hg, requirement of mechanical ventilation, relevant comorbidities, anemia, thrombocytopenia, increased serum bilirubin and liver enzymes, and serum sodium abnormalities. CONCLUSION: The RIFLE classification is a useful and suitable clinical tool to evaluate the incidence and mortality rate of AKI. In ICU patients, AKI is associated with increased mortality rate.

Sodium intake, dietary knowledge, and illness perceptions of controlled and uncontrolled rural hypertensive patients.

Introduction and Objectives. Nutritional knowledge of the patients is important in dietary adherence. This study aimed to determine the relationship between illness perceptions and nutritional knowledge with the amounts of sodium intake among rural hypertensive patients. Methods. In a cross-sectional study, 671 hypertensive patients were selected in a multistage random sampling from the rural areas of Ardabil city, Iran, in 2013. Data were collected using a questionnaire consisting of four sections and were analyzed using Pearson correlation and multiple linear regressions by SPSS-18. Results. The mean of sodium intake in the uncontrolled hypertensive patients was 3599 ± 258 mg/day and significantly greater than controlled group (2654 ± 540 mg/day) (P < 0.001). Knowledge and illness perceptions could predict 47.2% of the variation in sodium intake of uncontrolled group. A significant negative relationship was found between knowledge and illness perceptions of uncontrolled hypertensive patients with dietary sodium intake (r = -0.66, P < 0.001 and r = -0.65, P < 0.001, resp.). Conclusion. Considering the fact that patients' nutritional knowledge and illness perceptions could highly predict their sodium intake, the importance of paying more attention to improve patients' information and perceptions about hypertension is undeniable, especially among the uncontrolled hypertensive patients.

Evaluating risk factors for protein-energy malnutrition in children under the age of six years: a case-control study from Iran.

INTRODUCTION: Protein-energy malnutrition is one of the most important public health problems in Iran. It not only accounts for more than half of child mortality but can also produce somatic and mental impairment in survivors. The main aim of this study was to identify risk factors for protein-energy malnutrition in children under 6 years of age in Namin city. METHODS: This was a population-based, multicenter case-control study. Seventy-six children with malnutrition and 76 children without malnutrition were randomly recruited for case and control groups. The prevalence of risk factors in the two groups was compared. Data were gathered from a health center database and interviews with mothers and health workers. The Wilcoxon signed-rank test and logistic regression were used for data analysis. RESULTS: Female gender, poverty, short maternal height, and use of unhygienic latrines in the home were significantly associated with childhood malnutrition (P < 0.05). CONCLUSION: The results of this study indicate four main factors (poverty, small maternal height, female gender, and absence of hygienic latrines in the home) as underlying factors in malnutrition of children under the age of 6 years.

Rhinosinusitis predispose asthmatic patients to severe bronchial asthma.

In this study, we evaluated the relationship between rhinosinusitis to the severity of asthma in asthmatic patients.This cross-sectional study was conducted on 90 patients with asthma referring to Imam Khomeini Hospital in Ardabil city. Asthma control stepping method was used for staging of asthma severity. Patients' clinical signs and paraclinical findings were individually evaluated and compared with particular attention to the presence or absence of rhinosinusitis. Chi square and t-test were used to analyze the data in SPSS15 software.Rhinosinusitis was found in 66 (73%) of the 90 patients. The Forced Expiratory Volume in 1 second (FEV1) was significantly lower in the patients who also had rhinosinusitis (P=0.002).Comparing severity of asthma, most of the patients with rhinosinusitis were in stage3 (42.4%) but most of the patients without rhinosinusitis were in stage1 (41.6%) (p=0.002).The results of this study confirm the correlation between asthma severity and rhinosinusitis in asthmatic patients. Therefore, in diagnosing asthma in patients, the possibility of the rhinosinusitis should be determined and treated.

Depression in mothers of children with thalassemia or blood malignancies: a study from Iran.

BACKGROUND: Several studies have found that parents of children with chronic diseases or disabilities have higher depression scores than control parents. Mothers usually take on the considerable part of the extra care and support that these children need and thus are at markedly increased risks of suffering from psychological distress and depression. The main aim of the present study was to investigate if mothers of children with thalassemia or blood malignancies have higher scores of depression compared with a group of control mothers. METHODS AND MATERIALS: In this cross - sectional study, 294 mothers were recruited in three groups and assessed using the Beck Depression Inventory (BDI): mothers of children with thalassemia, mothers of children with blood malignancies and a control group. SPSS version 11.5 with chi square, ANOVA, linear and logistic regression were used for statistical analysis. RESULTS: The only variable bearing a statistically significant relationship with the depression score of mothers was the child's disease: for thalassemia with OR of 2.17 (95% CI = 1.16-4.0, P = 0.015), for blood malignancies with OR of 2.71 (95% CI = 1.48-4.99, P = 0.001). DISCUSSION AND CONCLUSION: The results of this study can contribute to the development of a screening program for decreasing depression burden and promoting quality of life for mothers of children with thalassemia or blood malignancies.