A pilot study using financial transactions' spatial information to define high-risk neighborhoods and distribution pattern of COVID-19.

BACKGROUND: Development of surveillance systems based on big data sources with spatial information is necessitated more than ever during this pandemic. Here, we present our pilot results of a new technique for the incorporation of spatial information of transactions and a vital registry of COVID-19 to evaluate the disease spread. METHODS: We merged two databases of laboratory-confirmed national COVID-19 registry of Iran and financial transactions of point-of-sale devices from February to March 2020 as our training data sources. Spatial information was used for the visualization of maps and movements of sick individuals. We used the point-of-sale devices-related guild to check for the dynamics of financial transactions and effectiveness of quarantines. FINDINGS: In the study period, 174,428 confirmed cases were in the COVID-19 registry with accompanying transactions information. In total, 13,924,982 financial transactions were performed by them, with a mean of 1.2 per day for each person. All guilds had a decreasing pattern of "risky" transactions except for grocery stores and pharmacies. The latter showed a decreasing pattern by impose of lockdowns. Different cities were the hotspot of disease transmission as many "high-risk" transactions were performed in them, among which Tehran (mainly its central neighborhoods) and southern cities of Lake Urmia predominated. Lockdowns indicated that the disease gradually became less transmissible. INTERPRETATION: Financial transactions can be readily used for epidemics surveillance. Semi real-time results of such iterations can be informative for policy makers, guild owners, and general population to prepare safer commuting and merchandise spaces.

COVID-19 in patients with diabetes: factors associated with worse outcomes.

Purpose: Diabetes is one of the major comorbidities associated with COVID-19. We aimed to determine the clinical and epidemiological factors associated with the mortality of COVID-19 in diabetic patients in Iran, and also the impact of prescribed antiviral and antibiotics on patients' status. Methods: In this study, we used the national registry of hospitalized patients with Severe Acute Respiratory Syndrome (SARS) Symptoms with diabetes from February 18, 2020, to December 22, 2020. Demographic, clinical features, treatments, concurrent comorbidities, and their associations with mortality and severity outcomes were assessed using logistic regression. Results: 78,554 diabetic in-patients with SARS symptoms were included from 31 provinces of whom 37,338 were PCR positive for COVID-19. Older age and male gender are associated with COVID-19 mortality in diabetic patients. CVD is the most frequent comorbidity (42%). CVD, kidney disease, liver disease, and COPD are associated comorbidities which increased the risk of mortality. The mortality rate is higher in diabetic patients comparing to patients with no comorbidities, particularly in younger age groups. The frequency of antiviral, and antibiotics in COVID-19 positive patients was 34%, and 31%, respectively. Antibiotic treatment has no association with mortality in COVID-19 patients. Conclusions: Diabetic patients indicate higher mortality comparing to patients without any underlying comorbidities. Restrict strategies on increasing effective health care utilization must be considered in diabetic patients, especially in those with parallel underlying comorbidities. Regarding the antibiotic resistance issue and the noticeable use of antibiotics in diabetic patients, it is recommended to prioritize an antibiotic guideline prescription in COVID-19 patients for better stewardship by countries.

Developing a Prognostic Model to Predict Mortality in Patients with Acute Bacterial Meningitis.

Bacterial meningitis is one of the harmful and deadly infectious diseases, and any delay in its treatment will lead to death. In this paper, a prognostic model was developed to predict the risk of death amongst probable cases of bacterial meningitis. Our prognostic model was developed using a decision tree algorithm on the national meningitis registry of the Iranian Center for Disease and Prevention (ICDCP) containing 3,923 records of meningitis suspected cases in 2018-2019. The most important features have been selected for the model construction. This model can predict the mortality risk for the meningitis probable cases with 78% accuracy, 84% sensitivity, and 73% specificity. The identified variables in prognosis the death included age and CSF protein level. CSF protein level (mg/dl) <= 65 versus > 65 provided the first branch of our decision tree. The highest mortality risk (85.8%) was seen in the patients >65 CSF protein level with 30 years < of age. For the patients <=30 year of age with CSF protein level >137 (mg/dl), the mortality risk was 60%. The prognostic factors identified in the present study draw the attention of clinicians to provide early specific measures, such as the admission of patients with a higher risk of death to intensive care units (ICU). It could also provide a helpful risk score tool in decision-making in the early phases of admission in pandemics, decrease mortality rate and improve public health operations efficiently in infectious diseases.

Estimation of Burden of Cystic Echinococcosis in Iran Using Disability Adjusted Life Years (DALYs) in 2018.

BACKGROUND: Human hydatidosis as a public concern has increased in a number of countries that have reduced control programs for the disease due to lack of resources or policies. We aimed to estimate Disability-Adjusted Life Years (DALYs) for human hydatidosis in Iran in 2018. METHODS: Data were collected from the Center of Communicable Diseases Control, Ministry of Health &Medical Education, Tehran, Iran in 2018. To calculate DALYs, years of life lost due to premature death (YLL) with years of life with disability (YLD) were calculated according to the formula as DALY = YLL + YLD. The standard life expectancy lost method (SEYLL) was used to calculate the years lost due to premature death. RESULTS: DALYs for human hydatidosis was calculated as 1210.12 years (YLD equals to 177.12 and YLL equals to 1033) in Iran for the year 2018. It was estimated to be 700.2 years for men and 509.8 years for women. DALYs in men were significantly different from women (P= 0.001) so DALYs were more in men than women were. YLD was calculated at 78.228 years in men and 98.892 years in women and in both men and women at 177.12 years. YLD was significantly different in women compared to men (P=0.001), so YLD in women was more than in men. CONCLUSION: We reached considerable indices for hydatidosis in our study. Therefore, disease prevention and control programs in Iran seem necessary by the policy makers.

Epidemiological Characteristics and Trend in the Incidence of Human Brucellosis in Iran from 2009 to 2017.

BACKGROUND: The development of preventive measures and promotion of healthcare delivery systems for disease management is dependent on detecting the incidence rates of the diseases and important risk factors. The current study aimed to determine some epidemiological indices and trends of the human brucellosis incidence in Iran between 2009 and 2017. STUDY DESIGN: A descriptive cross-sectional study. METHODS: In the current study, online data were gathered from all cases of brucellosis who were potentially or definitely diagnosed and registered in medical centers, hospitals, laboratories, and private clinics in all districts of Iran. Epidemiologic questionnaires were used to collect data on demographic and background characteristics, risk factors, high-risk behaviors, and lab test results, respectively, based on the national brucellosis control plan. RESULTS: A total of 138,448 cases of brucellosis have been studied in Iran from 2009 to 2017. The highest (25.89) and the lowest (12.07) incidence rates were observed in 2014 and 2009, respectively. In this nine-year study, the highest incidences were reported in the Hamedan, Lorestan, Kordestan, and Kermanshah provinces. The cumulative percentages of the disease were estimated for different variables at the following rates: by gender: 57.9% for males; by age groups: 36.2% and 16.7% for the 25-44 and16-24 years age groups, respectively; by occupation: 33.2% for housewives; and by residential area: 75.7% for rural residents. CONCLUSIONS: Based on the obtained results, although the incidence of human brucellosis in Iran has declined since 2015, the number of cases has remained high.

Malaria Four-year Epidemiological Trends in Sistan and Baluchistan Province, Iran.

INTRODUCTION: Malaria is one of the foremost public health concerns in Iran, where more than 90% of malaria cases are reported in the southern and south-eastern areas of the country. The aim of this study was to assess the epidemiological trends of malaria over a four-year period in in the Sistan and Baluchistan province in south east of Iran. METHODS: This descriptive epidemiological study examined malaria trends in Sistan and Baluchistan province from 2011 to 2014. The study used data collected in accordance with the Iranian Ministry of Health's malaria control and elimination protocol. This protocol has digitized the data reporting system for malaria, and all information were sent online to the Center of Disease Control in the Ministry of Health. In this manner, information on malaria cases in Sistan and Baluchistan were made available for the researchers to analyze. Descriptive and comparative analyses were conducted using the SPSS version 13. RESULTS: Annual incidence rates reported in 2011, 2012, 2013, and 2014 showed the prevalence of 89.9, 43.9, 38.3 and 36.6 (per 100,000 persons), respectively. Across all 4 years, the highest numbers of cases were found in persons 16-25 years old and among males. Most of the infected individuals were villagers and workers. In total, 64.8% of patients were Iranian and 29.5% were Pakistani. The highest number of cases was diagnosed in the cities of Sarbaz and Chabahar, with 1,742 and 1,707 cases, respectively. The results showed that over the last 4 years, 50.8% of cases have entered into Iran from foreign countries. The majority of cases involved parasites in the trophozoite stage of the life cycle. In terms of surveillance, passive care was reported in the majority of cases, and vivax malaria had the highest prevalence in comparison with other types. CONCLUSION: The findings are showing that the care, control and treatment system applied to Sistan and Baluchistan province has had a positive effect on decreasing the prevalence rate of Malaria disease. Meanwhile, it is recommended to policy makers to provide more health controls for border entries, stop irregular immigration and apply more precise case searches in order to have a complete and on time treatment in a way that the chain of transmission of the disease would be cut. Health education and knowledge-ability promotion programs are better to be set in order to develop self-protection and environment improvement among people.