Cost-effectiveness analysis of diagnostic strategies for COVID-19 in Iran.

BACKGROUND: Since 2020, COVID-19 has become a global public health issue and has caused problems worldwide. This infection can lead to a fever and respiratory problems. Asymptomatic carriers of the virus are a significant part of the spread of the disease, so early screening and diagnosis of suspected cases of COVID-19 are essential. Generally, standard diagnostic methods include lung imaging (CT), polymerase chain reaction (PCR), and corona antibody (IgM&IgG) testing. However, the costs of the above tests for the healthcare system cannot be ignored, and evaluating the incremental costs against the additional benefit is necessary. Therefore, this study aimed to determine the cost-effectiveness of diagnostic methods for COVID-19 patients. MATERIALS AND METHODS: In this research, an economic evaluation analysis was conducted to reveal the cost-effectiveness of the diagnostic strategies for COVID-19 from the service provider's perspective. Basic information about the costs of CT, serology (IgG&IgM), and molecular (PCR) tests were collected from the Ministry of Health of Iran. The effectiveness data were calculated according to the sensitivity and specificity of the diagnostic tests for COVID-19. In this study, the incremental cost-effectiveness ratio (ICER) of the diagnostic strategies for COVID-19 was estimated, and the most cost-effective diagnostic strategy was determined. In calculating ICER and analyzing the sensitivity of the results, Treeage software was used. RESULTS: According to the calculated incremental effectiveness cost ratio for scenarios with 5, 10, and 50% prevalence of COVID-19 and according to the threshold defined by the World Health Organization, in the study, PCR, PCR, and IgG&IgM strategies are the most cost-effective diagnostic methods of the corona. Also, the results were not sensitive to the desired parameters based on the results of one-way sensitivity analysis. CONCLUSION: Nowadays there are various tests with different levels of accuracy in the diagnosis of COVID-19. In general, PCR tests are more cost-effective for low prevalence of Covid-19, while IgM&IgG tests are more cost-effective for high estimated prevalence. The results of this research can help policymakers and health system managers to validate the most accurate diagnostic method for COVID-19, considering the prevalence of the disease.

Investigation of the Effect of PEG Detoxification on Diphtheria Vaccine.

Immunization has been considered a successful global health program that saves many persons' lives each year. The vaccines reduce the risk of getting the disease by building immunity in the body. Therefore, the constant availability of essential vaccines is an important factor in community health. One of the most important vaccines is the diphtheria vaccine, which is usually used as Multivalent diphtheria-tetanus-pertussis (DTP) combination vaccines. The production of this vaccine takes about 45 days, from the initial bacterial culture to the end of toxin production. However, the production of this vaccine can be optimized in case the production stages are carried out under normal conditions. In this study, a significant amount of impurities was removed after washing with phosphate buffer saline, and the toxin was then purified by Sephadex G-50. In this method, the toxin was concentrated to be stored in a smaller space (this removes the concerns for the provision of a suitable space). Another problem with the diphtheria vaccine is that it is reversible after detoxification of the toxin using formaldehyde. For this reason, it is suggested to use MPEG for detoxification, which will produce more stable covalent bonds between PEG and the first type of amine groups in the toxin chain. Tests were performed to evaluate factors, such as in vivo cytotoxicity, lack of edemas formation, the neutralizing activity of serum from guinea pigs immunized with the diphtheria toxoid inactivated with MPEG, and the immunogenic activity of the purified and modified toxin. Comparison of this PEG detoxification toxoid with the standard toxoid produced in Razi Vaccine and Serum Institution, Karaj, Iran, showed that washing with PBS and purification with Sephadex G-50 was an efficient method. The stability and reversibility of the toxoid approved by MPEG were acceptable. Therefore, the results of animal tests showed that the obtained product was stable and caused no wound or necrosis in the tested animals.

Anhedonia symptoms: The assessment of brain functional mechanism following music stimuli using functional magnetic resonance imaging.

PURPOSE: This study aimed to investigate the effect of music stimulation on the brain functional mechanism of depressed patients with anhedonia symptoms using functional magnetic resonance imaging (fMRI). METHODS: Participants in this study included 20 healthy subjects as the control group, 25 subjects with depression and no anhedonia as the intervention group A, and 24 subjects with depression and anhedonia as the intervention group B. The safely emotional stimulation was done by Iranian music. To investigate the effect of music therapy on the brain, a task including 50 tracks of 12 s Iranian music (traditional and pop) was used. Finally, the data were analyzed using SPM Toolbox in MATLAB software. RESULTS: The results showed that brain patterns in depressed patients with and without anhedonia could be distinguished based on positive and negative musical stimuli (p < 0.05). Important fMRI biomarker such as effective connectivity strength related to the fronto-limbic network, including the supragenual ACC, subgenual ACC, AMYG, and FFG were evaluated in depressed patients with anhedonia. CONCLUSION: This was the first study to investigate the neural circuits involved in music-related emotional processing in patients with anhedonia symptoms. These findings could help advance neurological understandings of anhedonia and suggest new treatments.

A study of the evacuation and allocation of hospital beds during the Covid-19 epidemic: a case study in Iran.

BACKGROUND: Shortage of resources, such as hospital beds, needed for health care especially in times of crisis can be a serious challenge for many countries. Currently, there is no suitable model for optimal allocation of beds in different hospital wards. The Data Envelopment Analysis method (DEA) has been used in the present study to examine the evacuation and allocation of hospital beds during the covid-19 pandemic in order to contribute to effective planning for fighting the spread the covid-19 virus. METHODS: The present study was conducted in two stages in hospitals affiliated with Urmia University of Medical Sciences (UUMS) in 2021. First, the number of excess beds was determined by calculating the technical efficiency using the DEA method and Deap2.1 software. To reallocate excess beds to covid-19 patients, the types of hospital wards were considered. As a result of this analysis, the inefficient hospitals with excess beds in different wards, which could be used for covid-19 patients with more serious symptoms, were identified. RESULTS: The results of the study show that the average technical efficiency of the studied hospitals was 0.603. These hospitals did not operate efficiently in 2021 and their current output can be produced with less than 61% of the used input. Also, the potential of these hospitals, over a period of 1 year, for the evacuation of beds and reallocation of them to covid-19 patients was calculated to be 1781 beds, 450 of which belonged to general wards and 1331 belonged to specialized wards. CONCLUSIONS: The DEA method can be used in the allocation of resources in hospitals. Depending on the type of hospital wards and the health condition of patients, this method can help policy-makers identify hospitals with the best potential but less emergency services for the purpose of reallocation of resources, which can help reduce the severe effects of crises on health resources.

Numerical investigation of septal deviation effect on deposition of nano/microparticles in human nasal passage.

Three dimensional computational models of both sides of human nasal passages were developed to investigate the effect of septal deviation on the flow patterns and deposition of micro/nano-particles in the realistic human nasal airways before and after septoplasty. A series of coronal CT scan images from a live 25-year old nonsmoking male with septal deviation in his right nasal passage was used to construct the model. For low to moderate activities, the steady airflows through the nasal passages were simulated. Eulerian and Lagrangian approaches were used, respectively, for nano- and micro-particles. The results show that the flow field and particle deposition strongly depend on the passage geometry especially for micro particles. In particular, the deposition rate in the passage with septal deviation was much higher compared with those in the normal (left) passage and the postoperative passage. Despite the similarity of total micro-particle deposition in the postoperative and the normal cavities, the regional deposition patterns were quite different in these passages. The deposition of nano-particles, however, showed similar trends in the postoperative right nasal passage and the normal left passage. The simulation results showed that in addition to the major alteration of the airflow pattern after the septoplasty operation, there are significant changes in the deposition pattern of nano- and micro-particles. Despite the anatomical differences between the available experimental configuration and the present computer model, the simulation results for the deposition efficiency of particles of different sizes are in qualitative agreement with the available data.

The prevalence of labyrinthine fistula in chronic otitis media surgery in shiraz, southern iran.

BACKGROUND: The incidence of fistulas found during the surgery for chronic otitis media with cholesteatoma has been reported in a wide range in different geographical areas. This study aims to find the prevalence of labyrinthine fistula in the south of Iran. METHODS: A prospective cross sectional study of 787 (504 ears belong to 462 patients) consecutive tympanoplasty with or without mastoidectomy for chronic otitis media was performed. Data on preoperative clinical and preoperative and postoperative hearing status and intraoperative findings were analyzed. RESULTS: A labyrinthine fistula was found at surgery in 24 (4.7%) ears of the total 504 ears belonging to 462 patients undergoing surgery for chronic otitis media. Location of the fistula was the lateral semicircular canal in 23, posterior semicircular canal in 1 and promontory in 1 subject. There was a statistically significant difference in preoperative and postoperative AC threshold in 500-3000 Hz frequency and ABG 500-3000 Hz, but there was no statistically significant difference in the other variables. CONCLUSION: Regarding postoperative hearing outcome in the labyrinthine fistula surgery, it seems that there is no universal method of reporting of hearing results. Past hearing evaluation methods in the literature have been often poorly comparable, based on different methodology.

Assessment of the consensus about tonsillectomy and/or adenoidectomy among pediatricians and otolaryngologists.

BACKGROUND: Several recent publications have shown that the current indications for tonsillectomy and/or adenoidectomy (T&A) in children vary considerably between and even within countries. The objective of our study is to present statistically valid information to surgeons and pediatricians, primary care physicians, and family physicians as key referral channels to the operation, whether there is consensus between pediatricians and otolaryngologists regarding the appropriateness of T&A. METHODS: Six academic pediatricians and six otolaryngologists participated in the study. After otolaryngologists visited 200 patients, the cases were referred to a pediatrician who also visited the patients independently on the same day pre-operatively. They ranked the appropriateness of T&A on a numerical Likert scale from 0 (never indicated) to 9 (always indicated) in a questionnaire. RESULTS: Overall, 200 (102 boys and 98 girls) children with a mean age of 6.1+/-5.6 were enrolled in this study. Otolaryngologists and Pediatricians had agreed about the history of tonsillitis attacks in the previous 6 months and previous year. The patients provided them with the same history. The agreement between otolaryngologists and pediatrician's views about T&A was poor. CONCLUSIONS: This study can serve as an initial warning in developing a national community-based working group to prepare a transparent local guideline regarding T&A indications. More attention should focused the role of pediatricians, primary care physicians, and family physicians for more follow up and determining which patients will eventually need T&A.

Fine needle aspiration cytology of palatine tonsils: a study of 112 consecutive adult tonsillectomies.

OBJECTIVE: To study fine needle aspiration cytology (FNAC) findings of tonsillar lesions with histological controls and to assess its role in the diagnostic evaluation of tonsillectomy specimens. METHODS: This study consisted of 112 cases that required tonsillectomy, comprising 55 (49.1%) men and 57 (50.9%) women. The ages ranged between 20 and 62 years. The clinical diagnosis in 101 cases was chronic tonsillitis, whereas 11 were suspected of neoplasia. FNAC was performed before tonsillectomy under general or local anaesthesia or on fresh specimens using a 21-G needle. The smears were stained using Wright-Giemsa and Papanicolaou methods. Histological examination was carried out on surgical specimens of all cases and, when required, immunohistochemistry was performed on histological sections. The diagnostic outcomes between FNAC and surgical biopsy were compared. RESULTS: In this study, 106 cases were diagnosed as chronic tonsillitis/follicular hyperplasia, four cases as non-Hodgkin's lymphoma, one as Hodgkin's lymphoma and one as monophasic synovial sarcoma. All malignant cases were diagnosed by FNAC, but synovial sarcoma was incorrectly diagnosed as squamous cell carcinoma. Five cases clinically suspected of neoplasia were correctly diagnosed as chronic tonsillitis on cytology. CONCLUSION: Tonsillar aspiration is a safe procedure and is useful in the evaluation of tonsillectomy specimens. However, ancillary tests on cytological material are often needed when neoplasia is suspected and would help clinical management and allow histological examination of cases diagnosed cytologically as lymphoma.

Is Carhart notch an accurate predictor of otitis media with effusion?

BACKGROUND: In the era of pediatric otolaryngology, a number of different methods have been used for the diagnosis of otitis media with effusion (OME). Although there are divers articles within the filed of assessment of the accuracy of diagnostic methods of OME, surprisingly there are very few data published and a small number of researches explaining the accuracy of Carhart notch (CN) for diagnosis of OME cases and comparing the CN with abnormal tympanic membrane findings in binocular microtympanoscopy. METHODS: Audiometric parameters studied in 89 children (178 ears) suffering from chronic otitis media with effusion. Significant CN was defined as a minimum depression of 10 dB in comparison of the rest of thresholds, at any frequency from 500 to 4000 Hz. Intra-operative microscopic otoscopic findings and the type of middle ear fluid were documented in a specially formatted questionnaire. RESULTS: The incidence of CN was 44.94% (80 ears) and that of significant CN was 25.28% (45 ears). The correlation between abnormal tympanic membrane findings and significant CN was significant and the association between CN and middle ear effusion (MEE) was not statistically significant. CONCLUSIONS: Significant CN is a sensitive diagnostic tool for detection of MEE but not specific. The diagnosis of OME in children requires a combinational diagnostic methods including tympanometry and audiometric variables especially CN.

Histopathological screening of tonsillectomy and/or adenoidectomy specimens: a report from southern Iran.

BACKGROUND: The need for pathologic examination of all tonsillectomy and/or adenoidectomy (T&A) specimens is controversial. Microscopic pathologic examination of these specimens is costly, but neglecting this step may miss diagnoses of significant diseases, especially malignancies. This study was designed to determine the rate of unexpected malignancies among patients who underwent T&A. METHODS: All patients who underwent T&A at Shiraz University of Medical Sciences between February 2004 and February 2008 were included in a prospective study. Gross and microscopic pathologic examinations were done on all the specimens. The charts of the patients with significant pathological finding were reviewed. Information about pre-operative signs, symptoms, and risk factors were used to verify unexpected pathologic findings. RESULTS: A total of 5058 patients were included. The age distribution was 10 months to 92 years (mean 14.0 years). There were 2498 males (49.4) and 2560 females (50.6%). Significant pathological findings were detected in 54 patients (1%). One unexpected malignancy (0.019%) was found in an adult patient. No unexpected malignancies were found in pediatric patients. CONCLUSIONS: All T&A specimens in the adult population should be sent for microscopic pathological examination. Also specimens of nonroutine T&A in children (with positive findings in the medical history or on physical examination) should be sent for microscopic pathological examination. In children without positive findings in their history or on physical examination, gross pathological evaluation of routine T&A specimens by a pathologist is sufficient.

Chrysomya bezziana as a Causative Agent of Human Myiasis in Fars Province, Southern Iran.

Myiasis is the invasion of body tissues of humans or animals by the larvae of the Diptera or two-winged flies. The various forms of myiasis may be classified from clinical or entomological point. This study describes the existence of Chrysomya bezziana (Diptera: Calliphoridae) cases as a causative agent of myiasis in 18 and 87 year-old men in two different regions in Fars Province. To our knowledge, this is the first observation of mentioned species in this province.