Case fatality and mortality rates, socio-demographic profile, and clinical features of COVID-19 in the elderly population: A population-based registry study in Iran.

We aimed to investigate COVID-19 case fatality rate (CFR), mortality, and screening in the older population of East Azerbaijan Province. We conducted a population-based registry study from Death Registration System in the elderly population (N = 433 445) from the outbreak that emerged up to May 30, 2021 (before vaccination). We analyzed CFR and mortality rates due to COVID-19 as well as the case findings and characteristics in the elderly population. Logistic regression analysis was carried out for the association between COVID-19 mortality and effective factors. During the study, the province had 18 079 confirmed cases and 4390 deaths. The male to female CFR risk ratio was 3.2. The overall CFR and mortality rates were 24% and 1%, respectively. CFR and mortality ranged from 9.56% to 0.37% in the 60-64 age group to 70% and 2.6% in the age group ≥85 years, respectively. We found a significant trend in CFR and mortality of COVID-19 with advanced age. Male sex, advanced age, marital status, and living alone were associated with an increased risk of COVID-19 fatality. COVID-19 mortality measures were higher in the older population of this province. Advanced treatment supports and interventions are needed to reduce mortality rates of COVID-19 in the elderly population.

Ground Displacement in East Azerbaijan Province, Iran, Revealed by L-band and C-band InSAR Analyses.

Iran, as a semi-arid and arid country, has a water challenge in the recent decades and underground water extraction has been increased because of improper developments in the agricultural sector. Thus, detection and measurement of ground subsidence in major plains is of great importance for hazard mitigation purposes. In this study, we carried out a time series small baseline subset (SBAS) interferometric synthetic aperture radar (InSAR) analysis of 15 L-band PALSAR-2 images acquired from ascending orbits of the ALOS-2 satellite between 2015 and 2020 to investigate long-term ground displacements in East Azerbaijan Province, Iran. We found that two major parts of the study area (Tabriz and Shabestar plains) are subsiding, where the mean and maximum vertical subsidence rates are -10 and -98 mm/year, respectively. The results revealed that the visible subsidence patterns in the study area are associated with either anthropogenic activities (e.g., underground water usage) or presence of compressible soils along the Tabriz-Shabestar and Tabriz-Azarshahr railways. This implies that infrastructure such as railways and roads is vulnerable if progressive ground subsidence takes over the whole area. The SBAS results deduced from L-band PALSAR-2 data were validated with field observations and compared with C-band Sentinel-1 results for the same period. The C-band Sentinel-1 results showed good agreement with the L-band PALSAR-2 dataset, in which the mean and maximum vertical subsidence rates are -13 and -120 mm/year, respectively. For better visualization of the results, the SBAS InSAR velocity map was down-sampled and principal component analysis (PCA) was performed on ~3600 randomly selected time series of the study area, and the results are presented by two principal components (PC1 and PC2).

A 12-year trend analysis of the incidence of gastrointestinal cancers in East Azerbaijan: last updated results of an ongoing population-based cancer registry.

BACKGROUND: The most recent results of Global Cancer Statistics indicated that gastrointestinal cancers, including gastric, colorectal, esophageal, and liver cancers, are among the most commonly diagnosed cancers worldwide. Previous reports from cancer registries in East Azerbaijan have shown that there is a high incidence of gastrointestinal cancer in this region, so we performed a trend analysis to determine the pattern of change over the last decade. METHODS: In total, 12 years of cancer registry data were collected from different sources in East Azerbaijan, and a data quality check was performed to ensure clean data. Using the 2000 World Health Organization standard population, we then generated age-standardized incidence rates (ASRs) for different cancers, and for each year from 1383 to 1394 of the Persian calendar (i.e., 19 March 2004 to 20 March 2015). Annual percent changes (APCs) and Average annual percent changes (AAPCs) in the ASRs for esophageal, gastric, small intestine, colorectal, anal, liver, gallbladder, and pancreatic cancers were calculated using Joinpoint Software (Version 4.5.0.1, June 2017). RESULTS: An increase in most types of cancer was observed during the study period. The ASR for colorectal cancer increased from 2.9 to 13.6 per 100,000 women (APC, 9.7%) and from 2.2 to 17.8 per 100,000 men (APC, 10.2%). The ASR for gastric cancer showed a slight increasing trend from 10.5 to 13.5 per 100,000 women (APC, 1.3%) and from 3.1 to 29.9 per 100,000 men (APC, 3.2%). However, trend analysis showed a decreasing pattern for the ASR of esophageal cancer in both genders (APC,- 3%), with APCs of - 1.1% in females and - 0.4% in males. CONCLUSIONS: The latest results of the East Azerbaijan Population-Based Cancer Registry indicate that gastrointestinal cancers remain common, with significant increasing trends in their ASRs. Improved screening and early detection are needed in this region.

Evaluation of the health promotion standards in governmental and non-governmental hospitals in East-Azerbaijan.

Background: Considering the importance of assessing the program of health promotion hospitals (HPH) for elucidating the compliance with the standards, the present study aimed to evaluate the health promotion standards in governmental and nongovernmental hospitals of East-Azerbaijan. Methods: In the present cross-sectional study, all hospitals in East-Azerbaijan province in 2018 were recruited. The Persian validated World Health Organization (WHO) a self-assessment questionnaire was sent to the director of each hospital and invited to corporate with the study. Self-assessment questionnaire consists of 40 measurable elements that assess management policy, patient's assessment, patient information and intervention, promoting health work placed and continuity and cooperation. Independent sample ttest was conducted to compare the mean score of each standard across hospitals type, location, and size. A significance level of 0.05 was used. Results: Hospitals total HPH score was 56.06±21.27 (out of 100). Among five standards, Standard 3 had the highest score (66.85±18.80), and Standard 4 had the lowest score (47.79±19.12). The capital cities' hospitals had a significantly higher score in Standard 5 (p=0.02). Non-governmental hospitals had a significantly higher score in standard 4 (p=0.02). There were no significant differences in all five standards of HPH between hospitals with ≤200 and >200 beds (p>0.05). Conclusion: The hospitals in East-Azerbaijan-Iran had moderate compliance with HPH program, and they need to improve their performance especially in the field of providing healthy workplace and offering proper education and health-promoting services to patients after discharge.

A decadal analysis of road traffic accident-related mortality among women of reproductive age: A cross-sectional study in East Azerbaijan Province, Iran.

Background: Given the extensive impact of road traffic accidents (RTAs) consequences and their potential ramifications on the health of both current and future generations, this study examines the social and demographic factors that influence RTA-related mortality among women of reproductive age. Methods: The study population consisted of cases retrieved from the database of the Legal Medicine Organization, encompassing all women aged 15-49 who succumbed to road accidents between 2011 and 2021. Results: The mean age of women in the reproductive age group from East Azerbaijan province between 2011 and 2021 was 33.67 years, with a standard deviation of 9.18. RTAs on main roads accounted for the majority of incidents (395 cases, 50.8%), with 93.7% (728 cases) attributed to road traffic. In 54.4% of these cases, the affected organ was the head and neck, and the primary cause of death in 52.1% was head trauma. Across all age groups, injuries to the neck and head were the most common, followed by injuries to the abdomen, chest, back, and sternum. Conclusion: The higher incidence of road accidents in the 25-29 age group highlights the need for targeted interventions to address risky behaviors, inexperience, and peer influences in this demographic. Our observation of passengers experiencing the highest mortality rate emphasizes the vulnerability of road users, particularly pedestrians, in traffic accidents. Pedestrian violations in the 17-30 age group further emphasize the importance of education and awareness campaigns aimed at reducing risky behavior.

A GIS-based catastrophe approach for optimal site selection for installation of solar power plants, East Azerbaijan province case study, Iran.

Due to depletion of fossil fuels and environmental issues, renewable energy consumption is increasingly growing. Solar energy as the most abundant renewable energy source available is becoming more popular around the world. In the current study, the optimal sites for solar photovoltaic power plants in East Azerbaijan province, Northwest Iran, were investigated. A total of 17 variables were categorized into four groups: climatic, geomorphological, environmental, and access-economic. In order to integrate the variables, a model based on catastrophe theory in the context of GIS was applied. The relative importance and weight of the criteria are computed based on the internal mechanism of the catastrophic system, thus greatly reducing subjectivism and uncertainties of the decision-making process. Five optimal sites located in the western part of the province within the counties of Malekan, Bonab, Ajabshir, Shabestar, and Tabriz were identified as suitable sites for the construction of solar photovoltaic power plants, where there are ideal conditions in terms of many environmental-human variables such as high potential of solar energy, high sunshine hours, low relative humidity, suitable slope, poor vegetation, distance to protected areas, proximity to the population centers, excellent access to the roads and to the main power lines.

Public-private partnership in primary health care: an experience from Iran.

AIM: The aim of this paper is to introduce the experience of applying public-private partnership (PPP) in providing primary health care (PHC) in East Azerbaijan Province (EAP), Iran. BACKGROUND: Moving toward the Universal Health Coverage (UHC) involves using of all health-related resources. Certainly, one of the key strategies for achieving UHC is PPP. Since 2015, a PPP in PHC policy has begun in EAP as a major strategy for strengthening the health system and achieving UHC. METHODS: In this case study, data were collected through interviews with stakeholders, document analysis, reviewing of health indexes and published studies. The data were analyzed using content analysis. FINDING: PPP in PHC policy was designed and implemented in EAP with the aim of social justice, strengthening the health system and achieving UHC in the framework of health complexes (HCs). HCs provide a defined service package according to the contract. The reimbursement method is a combination of per capita, fee for services and bonus methods. Part of the payments is fixed and the other part is based on the pay for quality system and paid according to the results of monitoring and evaluation. According to the study results, the most important strength of the plan is to improve access to services, especially in marginalized areas. The main weakness is not providing infrastructures before the implementation of the plan, and the most important challenges are financial, political and organizational unsustainability and, sometimes, poor cooperation by the other organizations. The findings show that PPP in PHC in EAP is an effective strategy to provide social justice, implement family practice and achieve UHC.

The monitoring of Francisella tularensis in surface water of East Azerbaijan province, Iran.

BACKGROUND: Francisella tularensis could be disseminated through arthropod bites and exposure to infected animals, water, and aerosols. Water sources that are contaminated with rodent excrement could be a source of contamination; therefore, an analysis of water samples is an appropriate method to investigate the routes of dissemination. Since an outbreak occurred in one of the villages in East Azerbaijan. The current study aimed to investigate the Francisella isolation in the different water samples from East Azerbaijan, Iran. Sampling was carried out in East Azerbaijan province. Forty-six specimens of surface water were collected. Filtration, culture, and inoculation of the water sample into NMRI (Naval Medical Research Institute) inbreed mice were performed. DNA was extracted from filtered water samples, different organs of inoculated mice, and bacterial isolates and was tested by TaqMan real-time PCR by targeting ISFtu2 and fopA genes. Despite the unsuccessfulness in isolation of F. tularensis, molecular test results indicate the presence of bacteria in surface water. The highest rate of F. tularensis (ten from 46 water samples, 21.7%) was detected from injected mice based on molecular methods. Despite the high efforts of researchers to isolate Francisella spp. in Iran, in recent years, and also the evidence that shows the presence of this bacterium in different parts of the country, the culture was not successful again in this study and the molecular method still is recommended to identify the possible sources of Francisella spp.

Risk factors for transient and permanent congenital hypothyroidism: a population-based case-control study.

BACKGROUND: Congenital hypothyroidism (CH) is the most important cause of mental and physical retardation in newborns. The prevalence of CH has been reported high in East Azerbaijan province of Iran. However, the risk factors for CH are poorly understood. This study aimed to determine and compare risk factors for permanent and transient CH in East Azerbaijan, Iran. METHODS: A case-control study was conducted in the Iranian national screening program for CH. This study included 680 neonates: 340 neonates with confirmed CH and 340 matched healthy controls born at the same period and from the same residential area as the cases. Multiple logistic regression analyses were used to estimate the crude and adjusted odds ratios and 95% confidence intervals for the association between different risk factors and transient and permanent CH. RESULTS: Out of the 680 participants, 364 (53.53%) were male. Family history of CH (OR = 5.09, 95% CI: 1.66-15.63), neonatal jaundice (OR = 3.89, 95% CI: 2.36-6.43) and parental consanguineous relation (OR = 2.19, 95% CI: 1.51-3.17) were associated with an increased risk of permanent CH. Likewise, the use of Betadine in pregnancy (OR = 4.87, 95% CI: 1.45-16.28), family history of CH (OR = 5.98, 95% CI: 2.04-17.48), neonatal jaundice (OR = 2.81, 95% CI: 1.75-4.52), parental consanguineous relation (OR = 3.86, 95% CI: 1.92-5.74), and gestational age at birth (OR = 3.2, 95% CI: 1.90-5.41) were identified as risk factors for transient CH. CONCLUSION: Family history, neonatal jaundice, gestational age at birth, and Betadine usage in pregnancy are associated with CH.

Borrelia duttonii-like spirochetes parasitize Meriones persicus in East Azerbaijan Province of Iran.

In Iran, Borrelia persica and Borrelia microti/microti-like borreliae have been established as causative agents of tickborne relapsing fever (TBRF). However, the epidemiology of two previously described species, Borrelia balthazardi and Borrelia latyschewii (latychevi), has remained elusive for many years. We investigated Borrelia infection in various rodents and small mammals in the TBRF endemic East Azerbaijan Province, northwestern Iran, where B. perisca and B. balthazardi might coexist. Among trapped animals (n=210), a 16S real-time PCR detected Borrelia DNA in 11 Meriones persicus. Multilocus sequence analysis (MLSA) using six different loci, including four coding regions (flaB, glpQ, groEL, p66) and two non-coding (rrs, IGS) followed by phylogeny revealed considerable sequence identity between the borreliae detected, B. microti, and East African Borrelia duttonii, and Borrelia recurrentis. Our results indicate that B. microti and microti-like borreliae, including the specimens previously characterized in the south of Iran and the present study, are different ecotypes of B. duttonii, i.e., exhibiting a single species/entity or descendants of a recent common ancestor. Our findings also suggest that the species we had long coined as B. balthazardi and the microti-like borreliae detected herein might be the same.

Association of serum leptin with angiographically proven cardiovascular disease and with components of the metabolic syndrome: a cross-sectional study in East Azerbaijan.

BACKGROUND: Role of leptin is well documented in cardiometabolic diseases. The objective of this study was to investigate if the serum levels of leptin associates with the serum levels of markers related to cardiac and metabolic disorders in adults. MATERIALS AND METHODS: One hundred eighty subjects [120 cardiovascular disease (CVD) and 60 healthy controls] were enrolled in the study, to determine the association of the serum leptin (in quartiles) and cardiometabolic diseases [metabolic syndrome (MetS) and CVD] adjusted for other biological and physical examination. MetS was according to the WHO Clinical Criteria for MetS definition and CVD by angiography outcomes. The serum levels of leptin and OX-LDL were measured by ELISA. RESULTS: Leptin levels were significantly higher in patients with MetS and those with positive angiography compared with controls. After controlling for potential confounders, a significant association of the leptin levels with cardiometabolic diseases was proven, albeit there was a higher rate of significance between CVD and leptin in comparison with MetS. Additionally, receiver operating characteristic analysis revealed that the serum levels of leptin were a valuable biomarker of the cardiometabolic diseases. CONCLUSION: Our findings demonstrate that serum leptin levels are associated with components of the MetS and with CVD. Serum leptin may be a useful biomarker for CVD.

Data on microbiological quality of raw cow milk in East Azerbaijan province, Iran.

Microbial contamination of milk can lead to undesirable effects on texture, color, odor, or flavor that result in shorter shelf life. It may also cause serious illnesses in consumers if it contains over than standard limit of these parameters. In this data, we evaluate the total bacterial count (TBC) and somatic cell count (SCC) of raw milk in East Azerbaijan province using BactoScan and Fossomatic equipment, respectively. According to the 30 points selected in the province map, the 10,800 samples were collected during a one-year period. Microbiological results in this data show heavy contaminations of milk samples with TBC indicator (73.6%), while SCC in only 6.4% samples were over the recommended levels by the Iranian standard. Therefore, it is necessary to take attention in order to control of these microbial parameters especially TBC during of milk production to avoid the potential risk of high microbial contamination.

Distribution pattern of colorectal diseases based on 2300 total colonoscopies.

AIM: We conducted a cross-sectional study to estimate the prevalence of CRD in our area in East Azerbaijan, Iran. BACKGROUND: Colorectal diseases (CRD) include a broad spectrum that varies from benign lesions to malignant and cancerous masses. CRD can be investigated by colonoscopy. Some of these diseases are highly preventable with timely screening and appropriate planning by the healthcare system. METHODS: This is a hospital-based, cross-sectional study by the Gastroenterology Department on patients who underwent colonoscopy between June 2013 and March 2015 in outpatient clinics at private Shahriyar medical center and Imam Reza University Hospital in Tabriz, East Azerbaijan province, Iran. Chi-square analysis and bivariate Pearson correlation coefficient were applied in this study using SPSS 20. RESULTS: During the study period, we recruited 2300 patients (1230 men, 1070 women) with the mean and median (Standard Deviation=SD) age at presentation of 47.10 (0.338) and 47 (16.195) years. The duration of patients' symptoms ranged from 1 to 480 months, with mean and median (SD) values of 26.99 (0.902) and 12 (40.76) months, respectively. Despite at least 20 types of pathologies seen on colonoscopy, normal cases constituted the majority (32.7%).The most serious diseases in the study were IBD (10.9%), polyps (14.4%) and cancers (4.9%). Colonoscopic findings had a significant correlation with patients' age and gender; also, we detected a significant correlation between patients' chief complaint and colonoscopic findings as well as colonoscopic pathology samples. CONCLUSION: Despite the ongoing westernization of lifestyle in our country, the distribution of colorectal diseases in Iran is different from Western population. It is important to recognize the prevalence of these diseases in our area to determine exposure factors for management and planning correctly in health system policies.

Detection and Isolation of Mycoplasma capricolum Subspecies Capricolum from East Azerbaijan Sheep Flocks.

Mycoplasma capricolum subspecies capricolum (Mcc) is one of the causative agents of contagious agalactia (CA), which is an important disease in sheep and goats in the Mediterranean and Middle East countries. Mycoplasma agalactiae is the classic agent of CA in sheep and goats. Mycoplasma mycoides subspecies Capri (Mmc), Mycoplasma capricolum subspecies capricolum (Mcc), and Mycoplasma putrefaciens (Mp) produce a clinically similar disease, more often in goats. The aim of the present study was to detect Mcc in sheep flocks in East Azerbaijan Province of Iran. Milk, ear canal, and eye swab samples were collected from 49 sheep flocks with clinical signs of CA or a history of a disease. All the samples were examined using both culture and molecular methods. In the molecular method,positive samples for the Mycoplasma genus were tested for M. mycoides cluster and Mcc. From 272 samples, 67, 87, and 62 samples were shown to be positive using the culture method, polymerase chain reaction (PCR) method, and both culture and PCR methods, respectively. Mcc was detected in all the four M. mycoides cluster positive samples, including milk, ear canal, and eye swab samples. This is the first report of Mcc detection from East Azerbaijan. Our results showed that eye, milk, and ear canal samples could be suitable sources for Mcc detection in sheep flocks.

IL-18 gene polymorphism in patients with visceral leishmaniasis in East Azarbaijan, Iran.

Visceral leishmaniasis (VL) is a parasitic disease caused by Leishmania species. According to the important role of cellular immunity against VL, this study was directed to determine the frequency of -607A/C and -137G/C genotypes on promoter region of interleukin-18 gene. The study groups included 91 patients with confirmed history of VL, 106 healthy seronegative, and 79 healthy seropositive individuals. All three groups were analyzed by amplification refractory mutation system polymerase chain reaction (ARMS-PCR). The highest rate of -607/A, and -607/C alleles was observed in seronegative individuals (66/67 %) and in the patients (72/83 %). Allele frequency of -607/C is more than -607/A allele in all groups. In position of -137, frequency of -137/G allele in all groups was more than -137/C. Statistical analysis of distribution of genotypes, did not reveal any significant difference among groups. On the basis of the results, there was no significant association between VL and polymorphism of IL-18 promoter. The results of this study showed that IL-18 gene promoter polymorphisms at positions -607 and -137 are not associated with VL in East Azerbaijan, Iran.

Molecular Characterization of Pathogenic Acanthamoeba Isolated from Drinking and Recreational water in East Azerbaijan, Northwest Iran.

Acanthamoeba- related infections, such as amoebic keratitis and granulomatous amoebic encephalitis, can develop in high-risk population through contaminated water sources. Thus, surveying water resources, particularly those available for human use, is of the utmost importance. In the present study, 67 water samples were collected from water resources in East Azerbaijan, a province in northwestern Iran. Samples were cultured on enriched non-nutrient agar plates, and sequencing-based approaches were used for genotyping. The pathogenic potential of the isolates was determined using thermo- and osmo-tolerance tests. Acanthamoeba were detected in 17 (25.4%) of the 67 collected samples. Sequencing analysis revealed that the isolates belonged to the T3 (23.52%), mixed T3/T4 (5.88%), T4 (58.82%), T5 (5.88%), and T13 (5.88%) genotypes. Through thermo- and osmo-tolerance tests, 88.23% of isolates were resistant to 37 °C, 40 °C temperature, and 0.5 M and 1 M osmolarity; thus, these isolates had the potential for pathogenicity. These findings point toa serious public health concern in the studied region. This study is the first to report Acanthamoeba isolated from drinking and recreational water sources in East Azerbaijan and Acanthamoeba T13 isolated from tap water in Iran.

Rapid health needs assessment experience in 11 august 2012 East azerbaijan earthquakes: a qualitative study.

INTRODUCTION: In disasters, health care providers need to find out the essential needs of the affected populations through Rapid Health Needs Assessment (RHNA). In East Azerbaijan earthquakes, a rapid assessment was performed by the provincial health system. The main purpose of this study was to explore the RHNA challenges. METHODS: In this qualitative study (Grounded theory), data was collected through semi-structured interviews with purposely selected health care workers. The data collection process continued until data saturation. All interviews were recorded and then transcribed. The Colaizzi's descriptive method was used to analyze the data. RESULTS: The themes emerged from the analysis of the interviews were: 1) Logistic problems 2) Lack of RHNA tools 3) Inherent difficulty of RHNA in disaster situations 4) Lack of preparedness and 5) Lack of coordination between different organizations. These challenges result in inapplicable use of RHNA results. CONCLUSION: The most important challenge in this RHNA process was the lack of East Azerbaijan health center preparedness. Although they were familiar with the importance of RHNA, they did not have any plans for conducting RHNA.

Three new species from the subfamily Phyllocoptinae (Acari, Trombidiformes, Eriophyidae) in Iran.

Three new eriophyid species (Phyllocoptinae), Shevtchenkella denticulata sp. n., Notallus pestehae sp. n. and Echinacrus ruthenicus sp. n., were described from Eryngium thyrsoideum Boiss. (Apiaceae), Pistacia vera L. (Anacardiaceae) and Lycium ruthenicum Murray (Solanaceae), respectively. All the three new species were collected from southwest of the East Azerbaijan province, Iran in 2011. It is the first record of an eriophyoid mite collected from E. thyrsoideum and L. ruthenicum and the first record of Notallus from Anacardiaceae plant family.

A checklist of the flora of Shanjan protected area, East Azerbaijan Province, NW Iran.

The flora of protected Shanjan rangeland in Shabestar district, Azerbaijan Province, NW Iran was studied using a 1 m × 1 m quadrate in spring and summer 2011. The climate of this area is cold and dry. In this area 94 plant species belonging to 25 families were identified as constituting the major part of the vegetation. The families in the area are Amaryllidaceae, Boraginaceae, Campanulaceae, Caryophllaceae, Cistaceae, Compositea, Cruciferae, Cyperaceae, Dipesaceae, Euphorbiaceae, Geraniaceae, Hypericaceae, Linaceae, Melvaceae, Orobachaceae, Papaveraceae, Paronychiaceae, Plantaginaceae, Polygolaceae, Ranunculaceae, Resedaceae, Rubiaceae, Scrophulariaceae, Solanaceae and Valerianacea. Floristic composition is Irano-Turanian elements. Detailed analysis showed that Biennial plants were 3.19%, Annual 41.49% and Perennial 55.32%.