Risk factors for mortality of 557 adult patients with COVID 19 in Babol, Northern Iran: a retrospective cohort study.

BACKGROUND: This study was aimed to investigate the risk factors for mortality in patients with COVID-19. METHODS: For this retrospective cohort study, we included 121 deceased and 436 discharged cases with COVID-19 in Babol, Northern Iran. The cases were between March 1 to April 1, 2020. RESULTS: Multivariate Poisson regression analysis revealed that older age (aRR: 1.03, 95% CI: 1.01, 1.05, p < 0.001), hospital length of stay (aRR: 0.94, 95% CI: 0.90, 0.97, p = 0.003), ICU admission (aRR: 4.34, 95% CI: 2.95, 6.37, p < 0.001), cerebrovascular disease (aRR: 1.96, 95% CI: 1.20, 3.19, p = 0.007), ventilator-associated pneumonia (VAP) (aRR: 2.09, 95% CI: 1.22, 3.55, p = 0.006), septic shock (aRR: 2.98, 95% CI: 1.44, 6.19, p = 0.003), acute respiratory distress syndrome (ARDS) (aRR: 3.80, 95% CI: 2.28, 6.31, p < 0.001), acute kidney failure (AKF) (aRR: 1.45, 95% CI: 1.12, 3.76, p = 0.021), acute heart failure (AHF) (aRR: 1.63, 95% CI: 1.01, 2.62, p = 0.043) and lymphocyte count (aRR: 3.01, 95% CI: 1.99, 4.57, p < 0.001) were associated with mortality. CONCLUSION: Findings showed that elderly with comorbidities such as cerebrovascular diseases had an increased risk of death. Some complications such as: pneumonia, septic shock, ARDS, AHF, and AKF played crucial roles as well death (Tab. 2, Ref. 25).

Burden of musculoskeletal disorders in Iran during 1990-2017: estimates from the Global Burden of Disease Study 2017.

Musculoskeletal diseases (MSDs) are the leading cause of disability and facing them demands updated reports on their burden for efficient policymaking. We showed Iran had the highest female-to-male ratio and highest increase in the burden of musculoskeletal diseases, in the past three decades, worldwide. We further confirmed the role of population aging as the main cause. PURPOSE: MSDs comprise most of the top causes of years lived with disability (YLDs) worldwide and are rapidly increasing in lower- and middle-income countries. Here, we present disability and mortality due to MSDs in Iran at the national level from 1990 to 2017. METHODS: We used Global Burden of Disease (GBD) 2017 Study data and standard methodology and presented the burden of MSDs in rates of years of life lost (YLLs), YLDs, and disability-adjusted life years (DALYs) during 1990-2017, for population aged ≥ 5 years old. We further explored attributable risk factors and decomposed the changing trend in DALYs to assess underlying causes. RESULTS: In Iran, MSDs were responsible for 1.82 million (95%uncertainty interval [UI] 1.3-2.4) DALYs, in 2017. During the past 28 years, with 1.75% annualized percentage change (APC), Iran had the highest percentage increase in the all-ages MSD DALYs rate worldwide, while the age-standardized DALYs APC was negligible. Low back pain was the greatest contributor to DALYs and caused 4.5% of total DALYs. The female population is experiencing considerably higher burden of MSDs, with 115% and 48% higher all-ages YLLs and YLDs rates per 100,000, respectively (YLLs 28.7; YLDs 2629.1), than males (YLLs 13.2; YLDs 1766.1). However, due to wide UIs, difference was not significant. Only 17.6% of MSD YLDs are attributable to assessed risk factors. CONCLUSION: Despite that MSDs are rising as an important cause of disability in Iran, these conditions are not sufficiently addressed in health policies. There is urgent need for cross-sectoral engagement, especially addressing the MSDs in females.

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

Vitamin D status in preschool children: should vitamin D supplementation, preventing vitamin D deficiency be continued in children over 2 years?

BACKGROUND: The aim of this study was to determine the prevalence of vitamin D deficiency among preschool children in rural and urban areas of Northern Iran and need for continuing vitamin D supplementation after 2 years of age. METHOD: A sample of 406 children aged 30-72 months was selected from health centres. Serum levels of 25-hydroxyvitamin D (25OHD), demographic data, anthropometric characteristics and total body surface area, were evaluated. RESULTS: Subnormal vitamin D levels were found in 68.94% (269) of children. In multiple logistic regression models, season (P = 0.001) and residency (P = 0.006) were significantly correlated with vitamin D deficiency. Multiple linear regression analysis revealed that age (ß = -0.18, P < 0.001), body mass index (ß = -1.1, P < 0.001) and sun exposure (ß = 0.4, P < 0.001) were significantly associated with 25OHD level. CONCLUSION: Owing to the high prevalence of subnormal vitamin D levels in preschool children, it is recommended that vitamin D deficiency prevention programs are continued in this age group.

Effect of Simulated Mastication on the Surface Roughness and Wear of Machinable Ceramics and Opposing Dental Enamel.

OBJECTIVE:: Computer aided design-computer aided machining (CAD-CAM) ceramic crowns are replacing ceramo-metal ones due to newly developed mechanical properties and esthetics. To obtain knowledge about their interactions due to polishing and occlusal contacts with the opposing dental enamel specimen, including surface roughness and wear, the three-body wear simulation was investigated. METHODS AND MATERIALS:: The surface roughness (RA) and wear rate (mm) of four CAD-CAM blocks with different compositions including Vita Mark II, e.max, Suprinity, and Enamic, after two surface treatments of glazing and polishing, and their opposing enamel specimens, were investigated using a mastication simulator and atomic force microscope. RESULTS:: The roughness of all ceramic and to a greater extent enamel samples, with the exception of enamel opposing polished Enamic samples, was decreased after wear. No significant difference in wear was evident for the ceramic samples between the glazed and polished treatments. Lower wear rates were recorded only for polished Vita Mark II and polished Enamic in comparison to the glazed ones. CONCLUSION:: The newly developed polishing systems for CAD-CAM ceramics can be good alternatives to reglazing, because the roughness and wear rate of both the ceramic and the opposing enamel will either not change or decrease.

Time to seroconversion of HBsAg to anti-HBs in individuals who lost HBsAg during follow-up.

To determine the time to appearance of antibody against hepatitis B surface antigen (anti-HBs) after clearance of hepatitis B surface antigen (HBsAg) in chronically infected individuals, we followed up 3963 cases with positive antibody against hepatitis B e antigen (anti-HBe) from 1991 to 2014. Of these, 101 (67 males, 34 females) lost HBsAg. These serocleared cases were checked every 6-month interval regarding HBsAg, anti-HBs, liver function tests, and liver sonography. Hepatitis B virus DNA was assessed at the time of seroclearance or the appearance of anti-HBs. The mean age of these patients at entry to this study was 34·4 ± 13 years. The mean follow-up duration until seroclearance of HBsAg was 6·6 ± 4·3 years. After the mean follow-up of 43·7 ± 45 months, anti-HBs appeared in 64 (63·4%) cases. The cumulative probabilities of anti-HBs appearance for 2, 5 and 10 years were 24·3%, 58% and 78·2%, respectively. The appearance of anti-HBs was associated with age ⩾35 years and seroclearance of HBsAg (hazard ratio 1·96, 95% confidence interval 1·32-3·38, P = 0·016) but not with sex. The results show that anti-HBs may develop in 78·2% of cases within 10 years of HBsAg clearance. Age ⩾35 years at HBsAg loss was associated with earlier development of anti-HBs.

Comparative evaluation of antimicrobial activity of two root canal sealers: MTA Fillapex and AH 26.

AIM: Even after a complete root canal therapy, reinfection may occur as a result of incomplete seal and activation of residual bacteria. Thus, antimicrobial activity is an important characteristic of root canal sealers. MTA Fillapex is a newly developed MTA-based sealer. It has been subjected to various studies evaluating its physical and chemical properties. In this study, we aimed to compare the antimicrobial activity of this sealer to the commonly known widely accepted sealer, AH26. METHODS: MTA Fillapex and AH 26 were exposed the bacterial suspension of Enterococcus faecalis, Escherichia coli, Streptococcus mutans, and Candida albicans after setting. After incubation and complete evaporation, BHI was added to microtubes. 24 hours later, the liquid content was placed in agar diffusion plate and bacterial count was performed. ANOVA followed by Tukey test, and t-Test were performed to analyze the data. RESULTS: With regard to all four bacterial groups, the bacterial count was significantly lower in MTAFillapex group comparing to AH 26 group. CONCLUSION: Newly developed MTA Fillapex sealer, has better antimicrobial properties in comparison to the widely accepted AH26 sealer.

Comparison of total antioxidant capacity in saliva of children with severe early childhood caries and caries-free children.

Oxidative stress may play an important role in the onset and development of oral inflammatory and dental decay diseases. The aim of this study was to compare total antioxidant capacity (TAC) levels in the unstimulated whole saliva of children with severe early childhood caries (S-ECC) and caries-free children. In this case-control study, 80 children aged 3-5 years from nursery schools in Babol, northern Iran were the subjects of the study. The S-ECC group contained 40 children with dmfs ≥4 (age 3), ≥5 (age 4) or ≥6 (age 5) and the control group contained 40 caries-free children (dmfs = 0). Out of consideration for growth pattern and general health, the clinical examinations of the chosen children were conducted by a physician. These two groups were age and sex matched. TAC was measured by the FRAP (ferric-reducing antioxidant power) method and total protein in unstimulated whole saliva was evaluated spectrophotometrically. According to the normal distribution of data, statistical tests including the t test and Pearson's correlation test were used; p < 0.05 was considered significant in the difference between the two groups. TAC levels and salivary total protein increased in children with S-ECC compared with caries-free children (p = 0.025 and p = 0.033, respectively). Moreover, salivary TAC showed a significant positive correlation with total protein concentration and dmfs in the S-ECC group (p < 0.001, r = 0.685 and r = 0.902, respectively). The significant increment of salivary TAC in S-ECC may represent a compensatory mechanism against oxidative stress in S-ECC.

Chronic diseases among older people in Amirkola, northern Islamic Republic of Iran.

This descriptive cross-sectional study was undertaken to describe the prevalence of noncommunicable diseases and their risk factors in elderly people in Amirkola, Islamic Republic of Iran. A total of 1019 people aged 60+ years were assessed using a standard questionnaire and a review of medical records. The most common chronic diseases were cardiovascular disease (29.5%), digestive disorders (28.5%), hypertension (23.6%) and diabetes mellitus (23.5%), while 44.4% of subjects were overweight or obese. Overall, 83.0% of the sample reported at least 1 chronic disease and 64% had 2 or more diseases. In age-adjusted logistic regression analysis, hypertension (OR 3.94, 95% CI: 2.87-5.40) and diabetes mellitus (OR 1.83, 95% CI: 1.32-2.55) were associated with cardiovascular disease, but sex, smoking, overweight and lack of walking were not. The study provides valuable data for planning appropriate health services for elderly people in this area of the Islamic Republic of Iran.

Chronic diseases among older people in Amirkola, northern Islamic Republic of Iran

This descriptive cross-sectional study was undertaken to describe the prevalence of noncommunicable diseases and their risk factors in elderly people in Amirkola, Islamic Republic of Iran. A total of 1019 people aged 60+ years were assessed using a standard questionnaire and a review of medical records. The most common chronic diseases were cardiovascular disease [29.5%], digestive disorders [28.5%], hypertension [23.6%] and diabetes mellitus [23.5%], while 44.4% of subjects were overweight or obese. Overall, 83.0% of the sample reported at least 1 chronic disease and 64% had 2 or more diseases. In age-adjusted logistic regression analysis, hypertension [OR 3.94, 95% CI: 2.87-5.40] and diabetes mellitus [OR 1.83,95% Cl: 1.32-2.55] were associated with cardiovascular disease, but sex, smoking, overweight and lack of walking were not. The study provides valuable data for planning appropriate health services for elderly people in this area of the Islamic Republic of Iran

Comparison of the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks versus streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis: a randomized clinical trial.

OBJECTIVES: To compare the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks with streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis. METHODS: In each arm of the study, 82 patients older than 10 years randomly received 5 mg/kg gentamicin once daily for 5 days plus 100 mg of doxycycline twice daily for 8 weeks or 1 g of streptomycin intramuscularly for 2 weeks plus the same dose of doxycycline for 45 days. Therapeutic failure and relapse in these two treatment groups were compared. This study was registered in the Iranian Registry of Clinical Trials (www.irct.ir) with registration number ID: IRCT138708191441N1. RESULTS: The clinical manifestations in these two groups were similar. Therapeutic failure was seen in two (2.4%) patients in the gentamicin/doxycycline group and in four (4.9%) patients in the streptomycin/doxycycline group [relative risk (RR) = 0.5, 95% confidence interval (CI) 0.09-2.66, P = 0.68]. Relapse was seen in two (2.4%) cases in the gentamicin/doxycycline group and in five (6.1%) cases in the streptomycin/doxycycline group (RR = 0.4, 95% CI 0.08-2, P = 0.44). The efficacy with the gentamicin/doxycycline regimen was 95.12% and that with the streptomycin/doxycycline regimen was 89% (RR = 1.07, 95% CI 0.98-1.17, P = 0.25). Cox regression analyses showed no differences among the two treatment groups for patients who had relapse or therapeutic failure and those who had not regarding baseline covariates such as sex, duration of disease before diagnosis, positive blood culture and focal disease. CONCLUSIONS: The results show that the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks is not superior to that of streptomycin for 2 weeks plus doxycycline for 45 days.

Follow-up standard agglutination and 2-mercaptoethanol tests in 175 clinically cured cases of human brucellosis.

BACKGROUND: The standard agglutination (SAT) and 2-mercaptoethanol (2-ME) tests are usually used in the follow-up of treated cases of human brucellosis. The purpose of this study was to monitor the levels of these tests, two years after clinical cure in cases of brucellosis. METHODS: From April 2003 to September 2008, 175 clinically cured cases of brucellosis (103 males, 72 females) were evaluated. Diagnosis of brucellosis was established with a SAT of > or =1:320 and a 2-ME of > or =1:80, with clinical symptoms and signs compatible with brucellosis. SAT and 2-ME were retested at the end of therapy and at 3-monthly intervals for two years. Serologic cure was considered in the event of a SAT titer decrease to < or =1:160 or a 2-ME decrease to<1:80. RESULTS: The mean age of study patients was 31 +/- 13.5 years. At 6, 12, 18, and 24 months after treatment, SAT titers > or =1:320 were seen in 41 (23.4%), 22 (12.6%), 7 (4%), and 6 (3.4%) cases, respectively, whereas 2-ME titers > or =1:80 were seen in 51 (29.1%), 24 (13.7%), 12 (6.9%), and 8 (4.6%) cases, respectively. The probability of serologic cure for patients with SAT titers < or =1:640 was higher than for those >1:640 (95% confidence interval (CI) 2.5-3.47, p=0.023). The probability of serologic cure for patients with 2-ME titers < or =1:320 was higher than for those >1:320 (95% CI 2.48-3.5, p=0.04). CONCLUSIONS: SAT and 2-ME may be found in significant titers in less than 5% of clinically treated cases after two years. Serologic cure for both tests with lower titers were higher than with higher titers.

Prevalence of hepatitis A IgG in individuals with chronic hepatitis B infection in Babol.

To determine the prevalence of previous hepatitis A virus (HAV) infection in people chronically infected with hepatitis B virus (HBV), we assessed the prevalence of anti-HAV IgG in 392 patients. The study was carried out in Babol, northern Islamic Republic of Iran from September 2004 to March 2005. Prevalence in those aged 10-19 years was 59.4% and was significantly lower than that in those aged 20-29 years (89.8%) and those over 29 years (97.5%). There was no significant difference in prevalence according to sex or place of residence. A significant proportion of Iranian adolescents and young adults with chronic HBV infection are at risk of contracting HAV infection.

Prevalence of hepatitis A IgG in individuals with chronic hepatitis B infection in Babol

To determine the prevalence of previous hepatitis A virus [HAV] infection in people chronically infected with hepatitis B virus [HBV], we assessed the prevalence of anti-HAV IgG in 392 patients. The study was carried out in Babol, northern Islamic Republic of Iran from September 2004 to March 2005. Prevalence in those aged 10-19 years was 59.4% and was significantly lower than that in those aged 20-29 years [89.8%] and those over 29 years [97.5%]. There was no significant difference in prevalence according to sex or place of residence. A significant proportion of Iranian adolescents and young adults with chronic HBV infection are at risk of contracting HAV infection