The impact of the COVID-19 pandemic on the provision of HIV/AIDS-related services in Iran: a qualitative study.

BACKGROUND: Providing services to people living with HIV (PLWH) faced many challenges during the COVID-19 pandemic. This study aimed to examine the impact of the COVID-19 pandemic on providing HIV/AIDS-related services in Iran. METHODS: In this qualitative study, the participants were included by purposive sampling between November 2021 and February 2022. Virtually focused group discussion (FGD) meetings were conducted with the first group including policymakers, service providers, and researchers (n = 17), and the interviews were conducted telephonic and face-to-face using a semi-structured guide with the second group including people who received services (n = 38). Data were analyzed by content analysis using the inductive method in MAXQDA 10 software. RESULTS: Six categories were obtained, including mostly affected services, ways of the effect of COVID-19, healthcare systems reaction, effects on social inequality, opportunities created by the pandemic, and suggestions for the future. In addition, people who received services believed the COVID-19 pandemic has affected their life in several ways, including getting COVID-19, mental and emotional problems during the pandemic, financial problems, changes in the care plan, and changes in high-risk behaviors. CONCLUSION: Considering the level of community involvement with the issue of COVID-19 and the shock caused by the pandemic, as mentioned by the world health organization, it is necessary to improve health systems' resilience for better preparedness for similar conditions.

Barriers and facilitators of access to HIV prevention, care, and treatment services among people living with HIV in Kerman, Iran: a qualitative study.

BACKGROUND: Low access to HIV prevention, care, and treatment services among people living with HIV (PLWH) is a barrier to the control of the epidemic worldwide. The present study aimed to assess the barriers and facilitators to HIV services among PLWH in Kerman, Iran. METHODS: In this qualitative study, a convenience sample of 25 PLWH who had received HIV prevention, treatment, or care services, and six PLWH who had not yet received services were recruited between August-October 2020. Data were collected using a semi-structured, face-to-face interview. Data were examined by inductive content analysis using MAXQDA 10 software. RESULTS: Nine categories of facilitators and 11 categories of barriers to HIV services were identified. Facilitating factors included: maintaining health status, feeling scared, trust in the health system, how they were treated by service providers, provision of suitable hours by the service provider center, changing attitudes towards HIV in society, acceptance of the disease by the patient's family, hope for the future and feeling the need for consulting services. Barriers included financial problems, side effects and belief in efficacy, distance and transportation problems, fear of being recognized, stigma towards PLWH, organization of services, improper treatment by service providers, unsuitable hours by the service provider center, lack of trust in the health system, lack of family support, and inadequate or low-quality service. CONCLUSION: Many facilitators and barriers to HIV prevention, treatment, and care are amenable to change and better management by healthcare and service providers. Addressing these factors is likely to increase the willingness to use services by those who have never previously accessed them.

Exploration of the Impact of Coronavirus Disease 2019 on People Living With HIV in Kerman, Iran: A Qualitative Study.

ABSTRACT: We explored the impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with HIV (PLWH) in Kerman, Iran. A convenience sample of 18 PLWH from a voluntary counseling and testing (VCT) center (August-October 2020) were invited to participate in face-to-face interviews. Inductive content analysis was performed with MAXQDA software. Six themes were identified: COVID-19-related knowledge and preventive practices, misconceptions about COVID-19, fear of seeking health care services, psychosocial effects, limited or inconvenient access to health care services, and the impact of COVID-19 on socioeconomic status. Although participants generally understood COVID-19 preventative measures, some held misconceptions. COVID-19 negatively affected PLWHs' mental health, financial stability, and use of and access to health care services. Our findings support expansion of services related to HIV care/treatment and mental health to promote health and well-being during the COVID-19 pandemic.

Prevalence of Depression among Iranian Patients with Beta-Thalassemia Major: A Systematic Review and Meta-analysis.

BACKGROUND: Patients with beta-thalassemia (BT) are susceptible to psychological disorders such as depression. The present study was conducted to estimate the pooled prevalence of depression among patients with BT in Iran. METHODS: Domestic and international databases were searched for relevant articles published from 1991 until June 2019. We searched international databases such as Scopus, ISI, and Embase; Iranian databases such as SID, Magiran, and IranDoc; and Google Scholar and PubMed search engines. The MeSH keywords used were "depression", "mental health", "depressive disorder", "thalassemia", "beta-thalassemia major", "prevalence", "epidemiology", and "Iran". Relevant cross-sectional or cohort studies were included in the analysis. Cochran's Q test and the I2 index were used to assess heterogeneity. The pooled prevalence and its 95% confidence interval (CI) were calculated using "metaprop" commands in Stata 14. In cases, where the I2 statistic was greater than 50%, the random-effects model was used. RESULTS: Eighteen eligible studies were included. The pooled prevalence of depression was 42% (95% CI: 33% to 52%), whereas the pooled prevalence of mild, moderate, severe, and extremely severe depression was 16% (95% CI: 11% to 22%), 13% (95% CI: 9% to 18%), 13% (95% CI: 9% to 17%), and 3% (95% CI: 0% to 8%), respectively. The pooled prevalence of depression in moderate- and high-quality studies was 45% (95% CI: 29% to 61%), and 39% (95% CI: 27% to 51%), respectively. CONCLUSION: The high prevalence of depression highlights the urgent need for the establishment of interventions for the prevention, early detection, and treatment of depression among Iranian patients with BT.

Isokinetic Analysis of Fe41Co7Cr15Mo14Y2C15B6 Bulk Metallic Glass: Effect of Minor Copper Addition.

In the present study, (Fe41Co7Cr15Mo14Y2C15B6)100-xCux (x = 0, 0.25 and 0.5 at.%) amorphous alloys were prepared by copper-mold casting. To clarify the effect of the minor addition of copper on the mechanism of nucleation and growth during the crystallization process, an isokinetic analysis was performed. The activation energies (E) of the various crystallization stages were calculated by using theoretical models including Kissinger-Akahira-Sunose (KAS), Flynn-Wall-Ozawa (FWO), Augis-Bennett and Gao-Wang methods. In addition, Augis-Bennett, Gao-Wang and Matusita methods were used to investigate the nucleation and growth mechanisms and to determine other kinetic parameters including Avrami exponent (n), the rate constant (Kp) and dimensionality of growth (m). The obtained results revealed that the activation energy-as well as thermal stability-was changed with minor addition of copper. In addition, the obtained Avrami exponent values were confirmed by Johnson-Mehl-Avrami-Kolmogorov (JMAK) method. The research findings demonstrated that the value of Avrami exponent is changed with minor addition of copper, so that the Avrami exponents of all crystallization stages, except the second peak for copper-free amorphous alloy, were equal to integer values ranging from two to four, indicating that the growth mechanisms were controlled by interface. Moreover, the kinetic parameters of n and b for all peaks were increased by an increase in crystallization temperature, which can be attributed to the increase in the nucleation rate.

Rubella Immunity in Pregnant Iranian Women: A Systematic Review and Meta-Analysis.

Rubella infection within the first trimester of pregnancy may lead to adverse pregnancy outcomes. The present study was conducted to evaluate the immunity against rubella among the pregnant Iranian women. The steps of meta-analyses were conducted based on the MOOSE protocol and results were reported according to the PRISMA guideline. To review the associated English and Persian literature, a comprehensive search was conducted among the international databases such as Scopus, PubMed/Medline, Science Direct, Embase, Cochrane library, Web of Science and Google Scholar search engine as well as Iranian databases, until April 1, 2018 using the following medical subject headings (MeSH) keywords: 'Pregnant', 'Gestational', 'Prenatal care', 'Complications of pregnancy', 'Pregnancy', 'Rubella infection', 'Prevalence, 'Epidemiology', 'Immunity', 'Immunization', 'Antibody', 'Immunogenicity' and 'Iran'. Cochran's Q test and I2 index were used to investigate heterogeneity in the studies. Random effects model was used to estimate the rate of rubella immunity. The obtained data were analyzed using Comprehensive Meta-Analysis Ver.2. Fifteen studies constituting 7,601 pregnant Iranian women met the inclusion criteria. The overall pooled rubella immunity rate was 90.1% [95% confidence interval (CI): 86.1-93.1]. Rubella immunity rates were respectively 88.6% (95% CI: 80.6-93.6) and 91.5% (95% CI: 88.1-93.9) before and after national vaccine program. Rubella immunity rates were 91.4% (95% CI: 87.8-94.0) and 87.2% (95% CI: 74.3-94.1) based on the enzyme-linked immunosorbent assay (ELISA) and haemagglutination-inhibition (HAI) methods, respectively. There was no significant association between rubella immunity and vaccination program (P=0.398), diagnostic methods (P=0.355), geographic regions (P=0.286), quality of the studies (P=0.751), occupation (P=0.639), residence (P=0.801), and year of the studies (P=0.164), but it was significantly associated with age (P<0.001). Despite high rubella immunity among the pregnant Iranian women, anti-rubella antibody screening is recommended for all women of childbearing age.

The etiology and prevalence of urinary tract infection and asymptomatic bacteriuria in pregnant women in Iran: a systematic review and Meta-analysis.

BACKGROUND: Urinary tract infection (UTI) is a common clinical problem in pregnant women. Bacteriuria in pregnancy without antibiotic treatment could result in complications. This study aims to investigate the etiology and prevalence of UTI and asymptomatic bacteriuria (ASB) in pregnant women in Iran. METHOD: This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To avoid bias, all steps of the study were carried out independently by two researchers. We conducted a comprehensive search on all the related literature in national databases, including IranDoc, SID, Barakat Knowledge Network System, RICST, Magiran, Iranian National Library and international databases, including Scopus, Embase, Science Direct, PubMed/ Medline, Cochrane Library, Web of Sciences, EBSCO, as well as Google Scholar search engine until June 2018. After considering the inclusion/exclusion criteria and qualitative evaluation, studies were analyzed based on random effects model using Comprehensive Meta-Analysis Software Version 2. RESULTS: In 31 studies with a sample size of 20,309, the prevalence of ASB in pregnant Iranian women was estimated to be 8.7% (95%CI: 7.2-10.4). The lowest and highest prevalence of ASB were observed in the third trimester (6.1% [95%CI: 2.1-16.4]) and first trimester (11.7% [95%CI: 7.9-16.9]), respectively. Subgroup analysis of the prevalence of ASB based on geographical region (P = 0.002) and province (P <  0.001) was significant but for the quality of studies (P = 0.51) was not significant. In 17 studies including 48,731 pregnant women, the prevalence of UTI was estimated to be 9.8% (95%CI: 7.6-12.5). The test for subgroup differences of prevalence of UTI for province (P <  0.001) was significant but for geographical region (P = 061) and quality of studies (P = 0.11) was not significant. Meta-regression model for the prevalence of UTI and ASB in pregnant women in Iran based on year of the studies was significant (P <  0.001). The most common microorganism involved in the etiology of UTI (61.6% [95%CI: 51.6-70.7]) and ASB (63.22% [95%CI: 51.2-73.8]) was E. coli. CONCLUSION: UTI and ASB are prevalent in pregnant women in Iran. Therefore, UTI screening is essential in pregnant women. The most common microorganism involved in the etiology of UTI and ASB in pregnant women in Iran is E.coli.

Prevalence and risk factors of retinopathy of prematurity in Iran: a systematic review and meta-analysis.

BACKGROUND: Retinopathy of prematurity (ROP) refers to the developmental disorder of the retina in premature infants and is one of the most serious and most dangerous complications in premature infants. The prevalence of ROP in Iran is different in various parts of Iran and its prevalence is reported to be 1-70% in different regions. This study aims to determine the prevalence and risk factors of ROP in Iran. METHODS: This review article was conducted based on the preferred reporting items for systematic review and meta-analysis (PRISMA) protocols. To find literature about ROP in Iran, a comprehensive search was done using MeSH keywords in several online databases such as PubMed, Ovid, Science Direct, EMBASE, Web of Science, CINAHL, EBSCO, Magiran, Iranmedex, SID, Medlib, IranDoc, as well as the Google Scholar search engine until May 2017. Comprehensive Meta-analysis Software (CMA) Version 2 was used for data analysis. RESULTS: According to 42 studies including 18,000 premature infants, the prevalence of ROP was reported to be 23.5% (95% CI: 20.4-26.8) in Iran. The prevalence of ROP stages 1, 2, 3, 4 and 5 was 7.9% (95% CI: 5.3-11.5), 9.7% (95% CI: 6.1-15.3), 2.8% (95% CI: 1.6-4.9), 2.9% (95% CI: 1.9-4.5) and 3.6% (95% CI: 2.4-5.2), respectively. The prevalence of ROP in Iranian girls and boys premature infants was 18.3% (95% CI: 12.8-25.4) and 18.9% (95% CI: 11.9-28.5), respectively. The lowest prevalence of ROP was in the West of Iran (12.3% [95% CI: 7.6-19.1]), while the highest prevalence was associated with the Center of Iran (24.9% [95% CI: 21.8-28.4]). The prevalence of ROP is increasing according to the year of study, and this relationship is not significant (p = 0.181). The significant risk factors for ROP were small gestational age (p < 0.001), low birth weight (p < 0.001), septicemia (p = 0.021), respiratory distress syndrome (p = 0.036), intraventricular hemorrhage (p = 0.005), continuous positive pressure ventilation (p = 0.023), saturation above 50% (p = 0.023), apnea (p = 0.002), frequency and duration of blood transfusion, oxygen therapy and phototherapy (p < 0.05), whereas pre-eclampsia decreased the prevalence of ROP (p = 0.014). CONCLUSION: Considering the high prevalence of ROP in Iran, screening and close supervision by experienced ophthalmologists to diagnose and treat the common complications of pre-maturity and prevent visual impairment or blindness is necessary.

Perihepatic Packing versus Primary Surgical Repair in Patients with Blunt Liver Trauma; an 8-year Experience.

OBJECTIVE: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability. METHODS: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients' hospital medical records during the study period. The patients' outcome was compared between those who underwent perihepatic packing or primary surgical repair. RESULTS: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room  due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002). CONCLUSION: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more  than  1000 milliliters hemoperitoneum  and  more  than  1600 milliliters of intra-operative  estimated blood  loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.

Comparison of conservative management and laparotomy in the management of stable patients with abdominal stab wound.

INTRODUCTION: The management of the hemodynamically stable patients with penetrating abdominal stab wounds is a problematic issue among trauma surgeons. METHODS: In a retrospective study, we analyzed stable patients with anterior abdominal stab wound from August 2009 to 2010. The patients who were hemodynamically unstable or had developed peritonitis were excluded. In our center, the patients are treated through conservative or operative management depending on the protocol of management of the stable penetrating abdominal stab wound in our center. We compared the effectiveness, mean duration of hospital admission, and the time of starting diet in 2 groups. RESULTS: There were 99 cases including 47 patients in the conservative group and 52 in the laparotomy group. The laparotomy was negative in 73% and positive in 27% of the patients. In the conservative group, all the patients remained asymptomatic and stable except for 6 patients who needed subsequent laparotomy. The maximum period between admission and delayed laparotomy in these 6 patients was 17 hours. The mean length of hospital stay and the time of starting diet were 70.4 vs 43 hours and 42.3 vs 30.6 hours in the operative group and conservative group, respectively. P < .05 was considered significant. CONCLUSION: Our study showed that conservative management of asymptomatic and stable patients with anterior abdominal stab wound with physical examination can decrease the rate of normal laparotomy and the length of hospitalization and help to start diet earlier. This study made this hypothesis that after 17 hours of observation, diet can be started for the stable asymptomatic patients.