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.

A randomised controlled trial on the effectiveness of an advanced wound dressing used in Iran.

OBJECTIVE: To compare the wound healing rate and incidence of infection in wounds treated with either a bioactive dressing (containing hydrophilic mucopolysaccharide, chitosan) or conservative treatment (gauze). METHOD: Eighty-five patients with diabetic foot ulcers, pressure ulcers or leg ulcers were randomised to receive either the bioactive study dressing (n=33 patients, 45 wounds) or the control dressing (n=52 patients, 53 wounds) for 21 days. Wound size, stage where appropriate and the presence of infection were recorded at each dressing change. Thirty-one of these 85 patients dropped out of the study during the three-month post-treatment follow-up, when wound size and grade were assessed on a monthly basis. Data were therefore analysed on 54 patients, of whom 32 (34 wounds) were in the treatment group and 22 (26 wounds) in the control group. RESULTS: In the control group, four pressure ulcers healed, but the remaining wounds all deteriorated and became infected, requiring antibiotics. In contrast, in the treatment group 29/34 wounds healed completely, and none became infected; the remaining five wounds healed during the follow-up period. The difference between the two groups in the number of wounds that healed was statistically significant (p<0.001), as was that for the number of healed pressure ulcers p<0.05. CONCLUSION: Use of a moist bioactive wound dressing significantly increased the healing rate when compared with the traditional dressings used in the participating hospitals. This will in turn bring significant cost savings.