Intra-operative Risk Factors Affecting Mortality after Heart Transplantation: A Referral Center Experience in Iran.

Background: Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality. Methods: This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted. Results: In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults. Conclusion: There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.

Exchange Transfusion Trends and Risk Factors for Extreme Neonatal Hyperbilirubinemia over 10 Years in Shiraz, Iran.

Background: Exchange transfusion (ET) is an effective treatment for acute bilirubin encephalopathy and extreme neonatal hyperbilirubinemia (ENH). It can reduce mortality and morbidity. This study aimed to investigate the trends and risk factors of ENH requiring ET in hospitalized neonates in Iran. Methods: A retrospective analysis of medical records of neonates who underwent ET due to ENH was conducted from 2011 to 2021, in Shiraz, Iran. Clinical records were used to gather demographic and laboratory data. The quantitative data were expressed as mean±SD, and qualitative data was presented as frequency and percentage. P<0.05 was considered statistically significant. Results: During the study, 377 ETs were performed for 329 patients. The annual rate of ET decreased by 71.2% during the study period. The most common risk factor of ENH was glucose-6-phosphate dehydrogenase (G6PD) deficiency (35%), followed by prematurity (13.06%), ABO hemolytic disease (7.6%), sepsis (6.4%), Rh hemolytic disease (6.08%), and minor blood group incompatibility (3.34%). In 28.52% of the cases, the cause of ENH was not identified. 17 (5.1%) neonates had acute bilirubin encephalopathy, of whom 6 (35.29%) had G6PD deficiency, 6 (35.29%) had ABO incompatibility, and 2 (11.76%) had Rh incompatibility. Conclusion: Although the rate of ET occurrence has decreased, it seems necessary to consider different risk factors and appropriate guidelines for early identification and management of neonates at risk of ENH should be developed. The findings of the study highlighted the important risk factors of ENH in southern Iran, allowing for the development of appropriate prevention strategies.

The role of bacterial genital infections in spontaneous preterm delivery: a case-control study.

Background: Spontaneous preterm delivery is defined as the beginning of the birth process before the 37th week of pregnancy. The presence of microorganisms in the fetal membranes is accompanied by an increase in the production of prostaglandin, one of the important factors associated with the prevalence of preterm birth. The invasion of microorganisms leads to the production of protease, coagulase, and elastase, which directly stimulate the onset of childbirth. We investigated the role of genital infections in women with preterm birth. Methods: The present case-control study was conducted in the west of Iran on 100 women with spontaneous preterm delivery (following 24 weeks of gestation and before 36 weeks and 6 days) as the case group and 100 women with normal delivery as controls. A questionnaire was applied to collect the data. Polymerase chain reaction and pathological examination of the placenta were performed. Results: The average age in women with normal delivery (30.92 ± 5.10) in women with spontaneous preterm delivery (30.27 ± 4.93). The prevalence of Chlamydia trachomatis, Neisseria gonorrhea, Listeria monocytogenes, and Mycoplasma genitalium infections was zero in both groups. The highest prevalence of Gardnerella vaginalis was 19 (19%) in the case group and Ureaplasma parvum 15 (15%) in the control group. Also, Placental inflammation was zero in controls and 7(7%) in the patient group. There was a significant relationship between Gardnerella vaginalis bacteria and spontaneous preterm delivery. Conclusion: The results of our study showed that except for Gardnerella vaginalis bacteria, there is no significant relationship between the above bacterial infections and spontaneous preterm birth. Moreover, despite the significant reduction in the prevalence of many sexually transmitted infections in this research, it is still suggested to increase the awareness of people, including pregnant women, about the ways it can be transmitted by gynecologists and health and treatment centers.

The association of rs17713054 with Neanderthal origin at 3p21.31 locus with the severity of COVID-19 in Iranian patients.

Since the COVID-19 pandemic, the diversity of clinical manifestations in patients has been a tremendous challenge. It seems that genetic variations, as one of the players, contribute to the variety of symptoms. Genome-wide association studies have demonstrated the influence of certain genomic regions on the disease prognosis. Particularly, a haplotype at 3p21.31 locus, inherited from Neanderthals, showed an association with COVID-19 severity. Despite several studies regarding this haplotype, some key variants are not sufficiently addressed. In the present study, we investigated the association of rs17713054 at 3p21.31 with COVID-19 severity. We analyzed the genotype of 251 Iranian COVID-19 patients (151 patients with asymptomatic to mild form as control and 100 patients with severe to critical symptoms without any comorbidities as case group) using the ARMS-PCR method. Results demonstrated that the A allele confers an almost twofold increased risk for COVID-19 severity (P value = 0.008). The AA genotype also raises the risk by more than 11 times following the recessive model (P value = 0.013). In conclusion, the A allele in rs17713054 was a risk allele in Iranian patients and was independently associated with COVID-19 severity. More studies are beneficial to confirm these findings in other populations and to develop strategies for risk assessment, prevention, and personalized medicine.

Predicting dyslipidemia incidence: unleashing machine learning algorithms on Lifestyle Promotion Project data.

BACKGROUND: Dyslipidemia, characterized by variations in plasma lipid profiles, poses a global health threat linked to millions of deaths annually. OBJECTIVES: This study focuses on predicting dyslipidemia incidence using machine learning methods, addressing the crucial need for early identification and intervention. METHODS: The dataset, derived from the Lifestyle Promotion Project (LPP) in East Azerbaijan Province, Iran, undergoes a comprehensive preprocessing, merging, and null handling process. Target selection involves five distinct dyslipidemia-related variables. Normalization techniques and three feature selection algorithms are applied to enhance predictive modeling. RESULT: The study results underscore the potential of different machine learning algorithms, specifically multi-layer perceptron neural network (MLP), in reaching higher performance metrics such as accuracy, F1 score, sensitivity and specificity, among other machine learning methods. Among other algorithms, Random Forest also showed remarkable accuracies and outperformed K-Nearest Neighbors (KNN) in metrics like precision, recall, and F1 score. The study's emphasis on feature selection detected meaningful patterns among five target variables related to dyslipidemia, indicating fundamental shared unities among dyslipidemia-related factors. Features such as waist circumference, serum vitamin D, blood pressure, sex, age, diabetes, and physical activity related to dyslipidemia. CONCLUSION: These results cooperatively highlight the complex nature of dyslipidemia and its connections with numerous factors, strengthening the importance of applying machine learning methods to understand and predict its incidence precisely.

Significant increased isolation of Escherichia coli in Iranian women with endometriosis: a case control - study.

BACKGROUND: The role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens. MATERIAL AND METHOD: In this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared. RESULTS: Results of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001). CONCLUSION: Based on The high occurrence of E. coli in women with endometriosis, along with its potential involvement in the progression and/or recurrence of this condition, the researchers propose that treating women with endometriosis and recurrent IVF failure, as well as those with endometriosis recurrence after surgical treatment, with suitable antibiotics and repeated culture until the culture becomes negative, could be beneficial.

Prevalence, socio-economic, and associated risk factors of oral cavity parasites in children with intellectual disability from Lorestan province, Iran.

Introduction: Children with intellectual disability (ID) often face challenges in maintaining proper oral hygiene due to their motor, sensory, and intellectual impairments, which can lead to compromised oral health; therefore, there is a need to enhance the oral health status of these populations and establish an effective system for administering preventive interventions. Here, we aimed to evaluate the prevalence of Entamoeba gingivalis and Trichomonas tenax among children with ID in Lorestan province, in Western Iran through parasitological and molecular methods. Methods: The current descriptive investigation involved 215 in children with ID and 215 healthy children (non-ID) who were referred to health facilities in Lorestan province, Iran between October 2022 and March 2024. The prevalence of protozoa in the oral cavity was found through the utilization of both microscopic analysis and conventional polymerase chain reaction (PCR) techniques. Results: The total prevalence of the E. gingivalis and T. tenax in children with ID was found to be 87 (40.5%) and 92 (42.8%) through microscopic and PCR methods, respectively. Among the positive samples, 57 (61.9%) and 35 (38.1%) children tested positive for E. gingivalis and T. tenax, respectively. In contrast, among the 215 non-ID children in the control group, 39 (18.1%) and 42 (19.5%) tested positive by microscopic and PCR methods, respectively. Among positive samples in non-ID children, 23 (54.7%) and 19 (45.3%) children were positive for E. gingivalis and T. tenax, respectively. Multiple logistic regression analysis indicated that residing in urban areas, parental education, monthly family income, and tooth brushing p<0.001) were identified as independent risk factors for oral cavity parasites. Conclusion: This study identified a notable prevalence of oral cavity parasites in children with ID in Lorestan province, Western Iran. It is imperative to recognize the primary risk factors associated with these parasites, particularly inadequate teeth brushing, in order to enhance public and oral health strategies for children with ID. Therefore, pediatric dental professionals should remain vigilant regarding these risk factors to effectively recognize and address oral health issues in this population, thereby mitigating the occurrence of oral diseases and infections.

Histopathological, morphological, and molecular characterization of fish-borne zoonotic parasite Eustrongylides Excisus infecting Northern pike (Esox lucius) in Iran.

Eustrongylides excisus is a fish-borne zoonotic parasite known to infect various fish species, including Northern pike (Esox Lucius). This nematode, belonging to the family Dioctophymatidae, has a complex life cycle involving multiple hosts. This study aimed to investigate the occurrence of Eustrongylides nematodes in Northern pike (E. Lucius) collected from Mijran Dam (Ramsar, Iran). Between June and October 2023, an investigation was conducted on Northern pike from Mijran Dam in Ramsar, Iran, following reports of reddish parasites in their muscle tissues. Sixty fish were examined at the University of Tehran, revealing live parasites in the muscles, which were then analyzed microscopically and preserved for a multidisciplinary study. The skeletal muscle tissues of 85% (51/60) of fish specimens were infected by grossly visible larvae which were microscopically identified as Eustrongylides spp. In histopathological examination, the lesion was composed of encapsulated parasitic granulomatous myositis. Microscopically, the cystic parasitic granulomas compressed the adjacent muscle fibers, leading to their atrophy and Zenker's necrosis. Moreover, epithelioid macrophages, giant cells and mononuclear inflammatory cells were present around the larvae and between the muscle fibers. Finally, a molecular analysis by examining the ITS gene region, revealed that they belong to the species E. excisus. Eustrongylidiasis in northern Iran necessitates further research into the biology, epidemiology, and control of Eustrongylides nematodes, focusing on various hosts. This study is the first to comprehensively characterize E. excisus in Northern pike in Ramsar, Iran, raising concerns about possible zoonotic transmission.

Factors Associated With Recurrence of Underlying Diseases Among Liver Transplant Recipients: A Single-Center Study.

OBJECTIVES: The recurrence of underlying diseases remains a major cause of graft failure after liver transplant. This study aimed to identify factors associated with the recurrence of underlying diseases and investigate the incidence of these factors and recurrence at the main liver transplant center in Iran. MATERIALS AND METHODS: We included adult liver transplant recipients followed at Shiraz Transplant Center between 2011 and 2018 with a confirmed diagnosis of recurrence of underlying disease in our study. We reviewed medical records and extracted data on demographic characteristics, clinical and paraclinical features, medication use, and current status. We used a systematic random sampling method to select a control group of 95 transplant recipients who did not have recurrence. Of 3022 total transplant recipients, 76 recipients experienced a recurrence of their underlying disease. RESULTS: Model for End-Stage Liver Disease score, underlying disease, recipient blood group, donor sex, donor blood group, and rejection frequency were significantly different between study groups with and without recurrence of underlying diseases. Liver transplant recipients with recurrence had lower mean Model for End-Stage Liver Disease score. Recipients with recurrence also had higher rate of drug consumption (eg, prednisolone, tacrolimus, mycophenolate mofetil, sirolimus). Regression analysis showed that donor sex and rejection frequency had an effect on disease recurrence. Death occurred more frequently in liver transplant recipients with recurrence than in the control group (39.5% vs 26.3%), butthe difference was not significant. CONCLUSIONS: Donor sex and acute rejection frequency are independent factors predictive of the recurrence of underlying disease. Modifying risk factors can help minimize the recurrence of underlying diseases after liver transplant.

Exposure to second-hand smoke and risk of lung cancer among Iranian population: A multicenter case-control study.

OBJECTIVE: Despite the implementation of the WHO Framework Convention on Tobacco Control (FCTC) program in Iran, the regulation of second-hand smoke (SHS) exposure-an often-overlooked hazard-, still requires improvement. We employed a multi-center case-control study to investigate the association between exposure to secondhand smoke (SHS) from various tobacco products (cigarettes, water-pipes, pipes, and chopogh), opium use, and the risk of lung cancer. METHOD: We included 627 lung cancer cases and 3477 controls. Exposure to SHS tobacco and SHS opium was collected through a questionnaire. We used mixed-model logistic regressions to estimate odds ratios (ORs) and 95% confidence intervals (CI). RESULT: Among the overall population exposed to second-hand tobacco smoke (SHTS), the odds ratio (OR) compared to those never exposed was 1.35 (95% CI: 1.08-1.71). Never smokers who were ever exposed to second-hand tobacco smoke (SHTS) had 1.69-fold risk of lung cancer compared to those who were never exposed (95% CI: 1.13-2.52). Exposure to SHTS between 2-3 per day (OR = 2.27, 95% CI: 1.13-4.53) and more than three hours per day (OR = 2.29, 95% CI: 1.20-4.37) can increase the risk of lung cancer compared with the no exposure group (P-trend <0.01). We did not observe any association between exposure to second-hand opium smoke (SHOS) and the risk of lung cancer, either in the overall population or among never-smokers. CONCLUSION: Our study estimates the impact of second-hand tobacco smoke (SHTS) on lung cancer risk in both the overall population and never-smokers. Additional studies are required to evaluate the association between exposure to second-hand smoke from opium and other type of tobacco, including water-pipe and the risk of lung cancer.

The ten-year evaluation of clinical characteristics in congenital lung anomaly in pediatrics; a retrospective study in North of Iran.

INTRODUCTION: Congenital lung anomalies (CLA) are a group of anomalies, including congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestrations (BPS), congenital lobar emphysema (CLE), and bronchogenic cysts (BC). The prevalence of these rare anomalies has risen in recent years, according to various population-based studies due to advances in fetal ultrasound technology. METHOD: This retrospective study examines the diagnosis of CLA, and was conducted on 72 patients between March 2014 and March 2024 at Taleghani Pediatric Hospital in Gorgan, Iran. RESULT: The average age was 18.8 ± 30.3 months, with the majority being boys (62.5%). Most participants had CCAM (41.7%), followed by CLE (18.1%), BPS (16.7%), pulmonary hypoplasia (9.7%), BC (8.3%), and hybrid lesion (5.6%). The majority of patients were Fars (62.5%), and the average hospitalization days was 9.4 ± 4.5 days. Cardiac anomalies were observed in 19.4% of the patients. 62 patients (86.1%) exhibited respiratory symptoms, and prenatal screening during pregnancy led to the diagnosis in 51 patients (70.8%). Most patients had left lung anomalies (43; 59.7%), and the majority (90.3%) survived. There is a statistically significant relation between needed for surgical treatment and patients' type of pulmonary lesions (p-value: 0.02). In addition, there was a significant relation between the Fars ethnicity and the presence of cardiac anomalies (p-value: 0.04). CONCLUSION: Some CLAs remain undiagnosed or untreated due to the rare nature of congenital lung anomalies. Nevertheless, improvements in ultrasound and other imaging methods will make diagnosing and managing these anomalies during the prenatal period more prevalent, resulting in enhanced understanding.

Risk factors for postpartum readmission: a prediction model in Iranian pregnant women.

BACKGROUND: Postpartum readmissions (PPRs) are an important indicator of maternal postpartum complications and the quality of medical services and are important for reducing medical costs. The present study aimed to investigate the risk factors affecting readmission after delivery in Imam Ali Hospital in Amol, Iran. METHODS: This retrospective cohort study was conducted on the mothers who were readmitted after delivery within 30 days, at Imam Ali Hospital (2019-2023). The demographic and obstetrics characteristics were identified through the registry system. Univariate and multivariate logistic regressions with odds ratios (ORs) and 95% CIs were carried out. To identify the most important variables by machine learning methods, a random forest model was used. The data were analyzed using SPSS 22 software and R (4.1.3) at a significant level of 0.05. RESULTS: Among 13,983 deliveries 164 (1.2%) had readmission after delivery. The most prevalent cause of readmission after delivery was infection (59.7%). The chance of readmission for women who underwent elective cesarean section and women who experienced labor pain onset by induction of labor was twice and 1.5 times greater than that among women who experienced spontaneous labor pain, respectively. Women with pregnancy complications had more than 2 times the chance of readmission. Cesarean section increased the chance of readmission by 2.69 times compared to normal vaginal delivery. CONCLUSION: The method of labor pain onset, mode of delivery, and complications during pregnancy were the most important factors related to readmission after childbirth.

Clinico-histopathological and molecular detection of small ruminants' papillomaviruses in Iran.

BACKGROUND: Papilloma DNA viruses are one of the viruses that cause skin lesions in ruminants. OBJECTIVES: The clinical, histopathological and molecular characteristics of cutaneous papilloma in ruminants in Iran are to be investigated in this study. METHODS: Samples were collected from 19 small ruminants (5 sheep and 14 goats) with various papillomatosis lesions. The samples taken were studied with histopathological and molecular techniques. RESULTS: In clinical terms, the lesions appeared in different sizes, ranging from 0.5 to 11 cm, and the cauliflower exophytic masses appeared in other parts of the animal's body. In the limbs, most papilloma lesions have been seen (42.1%). In histopathological examination, perinuclear vacuolation epidermal granule layer with various degrees of hypergranulosis, hyperkeratosis, acanthosis, orthokeratosis and parakeratosis were seen. Moreover, all the suspected samples were positive for papillomavirus using the polymerase chain reaction technique. CONCLUSIONS: Although the prevalence of papillomaviruses in Iranian sheep and goats is low, it seems necessary to distinguish them from other viral skin diseases, such as cutaneous contagious ecthyma, using molecular techniques and histopathology.

The association of dietary indices for hyperinsulinemia and insulin resistance with the risk of metabolic syndrome: a population-based cross-sectional study.

We aimed to investigate the association between an empirical dietary index for hyperinsulinemia (EDIH), empirical dietary index for insulin resistance (EDIR), and MetS and its components in an adult Iranian population. In this cross-sectional study, a total of 6482 participants aged 35-65 years were recruited as part of the MASHAD cohort study. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ). The International Diabetes Federation (IDF) criteria were used to define MetS. Multivariable logistic regression models were applied to determine the association between EDIH, EDIR, and MetS and its components. The mean age and BMI of participants were 48.44±8.20 years, and 27.98±4.73 kg/m2, respectively. Around 59% of the population was female. Of the total population, 35.4% had MetS. According to the full-adjusted model, there was no significant association between higher quartiles of EDIH and EDIR and odds of MetS (Q4 EDIH; OR (95%CI):0.93 (0.74-1.18), Q4 EDIR; OR (95%CI):1.14 (0.92-1.40). Regarding MetS components, EDIR was associated with increased odds of hypertension and diabetes (Q4 EDIR; OR (95%CI):1.22 (1.04-1.44) and 1.22 (1.01-1.47), respectively). EDIH was also associated with decreased odds of hypertriglyceridemia (Q4 EDIH; OR (95%CI): 0.72 (0.60-0.87)). This study showed no significant association between hyperinsulinemia and insulin resistance potential of diet and odds of MetS among Iranian adults. However, EDIR was significantly associated with increased odds of hypertension and diabetes as MetS components.

Pregnancy outcomes in women with Celiac disease in Northeast Iran: a regional retrospective cohort study.

PURPOSE: To investigate the odds and associations of pregnancy outcomes with exposure to biopsy-confirmed celiac disease (CD) in Northeast Iran. METHODS: In this regional retrospective cohort study, pregnancy records of all women with celiac disease who visited Celiac Disease Clinic of Imam-Reza Hospital from 2017 to 2023 (exposed group) and a sample of women without CD (unexposed group) were extracted using the Electronic Health Record of Mashhad University of Medical Sciences called "Sina". The unexposed group was randomly selected of the database and matched to exposed group on age, location of residence, socioeconomic factors. Our exclusion criteria included age ≥ 45, presence of concomitant disorders, history of non-obstetric uterine surgery, induction of pregnancy through assisted reproductive technology, and any concurrently ongoing pregnancy at the time of study. Pregnancy outcomes evaluated in this study included normal delivery, miscarriage, preterm labor, preeclampsia, and stillbirth. Adjusted odds ratios were calculated using logistic regression adjusted for confounders. RESULTS: Ninety pregnancy records of women with CD and 270 pregnancies of women without CD were included in this study. Low neonatal birthweight (i.e. under 2500 g) had no significant association with CD (aOR = 0.99, 95% CI = 0.92-1.06), as well as postpartum hemorrhage (aOR = 1.12, 95%CI = 0.91-1.38), fetal anomaly (aOR = 0.89, 95%CI = 0.69-1.15), miscarriage (aOR = 1.00, 95%CI = 0.91-1.10), ectopic pregnancy (aOR = 0.94, 95%CI = 0.73-1.20), preterm labor (aOR = 1.00, 95%CI = 0.92-1.10), gestational diabetes mellitus (aOR = 1.07, 95%CI = 0.98-1.16), gestational hypertension (aOR = 0.99, 95%CI = 0.89-1.11), and gestation hypothyroidism (aOR = 0.95, 95%CI = 0.82-1.11). However, we found significantly lower odds of preeclampsia in pregnancies affected by CD (aOR = 0.83, 95%CI = 0.69-0.99). CONCLUSION: Celiac disease was not associated with increased odds of low neonatal birthweight, postpartum hemorrhage, fetal anomaly, miscarriage, ectopic pregnancy, preterm labor, gestational diabetes mellitus, gestational hypertension and gestational hypothyroidism. Preeclampsia had significantly lower odds in pregnancies affected with CD.

The association between potential predictors and death of patients during the COVID-19 pandemic in Shiraz: a hierarchical multiple regression analysis.

INTRODUCTION: Identifying clinical factors that increase the risk of mortality in COVID-19 patients is crucial. This enables targeted screening, optimizing treatment, and prevention of severe complications, ultimately reducing death rates. This study aimed to develop prediction models for the death of patients (i.e., survival or death) during the COVID-19 pandemic in Shiraz, exploring the main influencing factors. METHOD: We conducted a retrospective cohort study using hospital-based records of 1030 individuals diagnosed with COVID-19, who were hospitalized for treatment between March 21, 2021, and March 21, 2022, in Shiraz, Iran. Variables related to the final outcome were selected based on criteria and univariate logistic regression. Hierarchical multiple logistic regression and classification and regression tree (CART) models were utilized to explore the relationships between potential influencing factors and the final outcome. Additionally, methods were employed to identify the high-risk population for increased mortality rates during COVID-19. Finally, accuracy was evaluated the performance of the models, with the area under the receiver operator characteristic curve(AUC), sensitivity, and specificity metrics. RESULTS: In this study, 558 (54.2%) individuals infected with COVID-19 died. The final model showed that the type of medicine antiviral (OR: 11.10, p = 0.038) than reference (antiviral and corticosteroid), and discharge oxygen saturation(O2) (OR: 1.10, p < 0.001) had a positive association with the chance of survival, but other variables were not considered as predictive variables. Predictive models for the final outcome(death) achieved accuracies ranging from 81 to 87% for hierarchical multiple logistic regression and from 87 to 94% for the CART model. Therefore, the CART model performed better than the hirerical multiple logistic regression model. CONCLUSION: These findings firstly elucidate the incidence and associated factors of the outcome (death) among patients in Shiraz, Iran. Furthermore, we demonstrated that antiviral medication alone (without corticosteroids) and high O2 increase the survival chances of COVID patients.

The High-Dietary Insulin Load Score Is Associated With Elevated Level of Fasting Blood Sugar in Iranian Adult Men: Results From Fasa PERSIAN Cohort Study.

Aim: The potential of different foods to induce postprandial hyperinsulinemia may be involved in the development of metabolic syndrome (MetS). We aimed to evaluate the association between dietary insulin indices and MetS in a large population of adults in Iran. Methods: A total of 6356 adults aged 35-70 years were included in the present cross-sectional study. A validated block-format 125-item semiquantitative food frequency questionnaire (FFQ) was used to obtain usual food intakes, and MetS was defined according to the International Diabetes Federation (IDF) and American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) criteria. Results: MetS was prevalent in 13.8% of participants. Mean age of the study participants was 46.58 ± 8.82 years, and mean body mass index (BMI) was 25.02 ± 4.60 kg/m2. Mean dietary insulin index (DII) and dietary insulin load (DIL) were 63.15 ± 7.57 and 168.253 ± 52.09, respectively. In the crude model, men in the highest DIL quartile were more likely to have hyperglycemia than those in the lowest quartile (OR: 1.75, 95% CI: 1.12-2.73, p trend = 0.04). This association remained significant and was even stronger after adjusting for potential confounders in model I (OR: 3.64, 95% CI: 1.57-8.47, p trend = 0.005) and further adjustment for BMI in model II (OR: 3.61, 95% CI: 1.55-8.44, p trend = 0.006). Conclusions: In healthy men, adherence to a high-DIL diet may be associated with a greater likelihood of having hyperglycemia. No statistically significant association was observed between insulin indices and the odds of having MetS.

Alcohol consumption among Iranian population based on the findings of STEPS survey 2021.

Alcohol production and consumption have been prohibited in Iran for over four decades, leading to a typical underestimation of its consumption. This study aimed to assess the prevalence of alcohol consumption, its associated factors, and estimate per capita alcohol consumption among Iran's adult population. In this population-based survey, 27,874 adults from across Iran were selected using systematic proportional-to-size cluster sampling. Alcohol consumption was evaluated through a modified Persian version of the STEPS questionnaires from previous studies, applied over different timespans. Per capita consumption was calculated using the quantity-frequency method, expressed in liters of pure alcohol. Adjusted odds ratios were reported for associates of alcohol consumption concerning metabolic risk factors, sociodemographic elements, and lifestyle variables. The prevalence of lifetime alcohol consumption was 6.9% (95% CI 6.5-7.2) in the adult population, with a notable sex difference (males: 13.7% [95% CI 13-14.4]; females: 1.4% [95% CI 1.1-1.6]). The 12 month prevalence was 3.8% (95% CI 3.6-4.1). For individuals aged 18 and older, the per capita alcohol consumption in Iran was 0.12 L. Factors such as being a lifetime smoker, younger, wealthier, and having 7-12 years of education were significantly linked to higher alcohol consumption. Significant associations were also observed between alcohol consumption and having a history of heart attacks (OR = 2.04, 95% CI 1.44-2.89), and physical injuries (OR = 1.88, 95% CI 1.34-2.64). The estimated lifetime and 12-month prevalence of alcohol use in our study were higher among some of the subpopulations. The findings also revealed a complex relationship between alcohol consumption, behavioral risk factors, and metabolic profiles. Consequently, immediate preventive measures tailored to each factor's association with alcohol use are recommended.

Crimean-Congo Hemorrhagic Fever Virus Kinetics in Serum, Saliva, and Urine, Iran, 2018.

Little is known about using noninvasive samples for diagnosing Crimean-Congo hemorrhagic fever (CCHF). We investigated detection of CCHF virus in serum, saliva, and urine samples. Our results indicate that serum is the best sample type for CCHF diagnosis; saliva can be used for noninvasive sampling.

Loneliness and its correlation with self-care and activities of daily living among older adults: a partial least squares model.

BACKGROUND: The growing elderly population worldwide is accompanied by an increased disrupting daily activities and self-care. Neglecting the multifaceted needs of the elderly can lead to detrimental effects such as loneliness or social isolation, threatening healthy aging. Self-care is a key strategy to enhance daily functioning and mitigate feelings of loneliness among the elderly. This study was conducted with the aim of investigating the feelings of loneliness and its relationship with self-care and Activities of Daily Living (ADL) among the older adults of Tabriz city. METHODS: In this observational cross-sectional study, we engaged 315 older adults using a simple random sampling. Participants were selected randomly from Iran's Integrated Health System (IIHS) framework. Three questionnaires including de Jong Gierveld Loneliness Scale, Persian version of self-care scale, and ADL-Katz were used for data collection. The Partial Least Squares and Spearman's correlation were used to investigate the relationships between demographic characteristics, loneliness, self-care, and ADL. RESULTS: The sample comprised 315 respondents 51.1% were female, 49.5% had a middle school literacy and 86% were married. A significant negative relationship was observed between loneliness and self-care (P < 0.001 and r =-0.311). Demographic characteristics, including age and marital status, were found to negatively moderate the relationship between self-care (path coefficient - 0.07, P = 0.044) and positively moderate the relationship with loneliness (path coefficient 0.29, p < 0.001). ADL was positively associated with self-care (path coefficient 0.41, p = 0.046) and also a direct and significant relationship was observed between ADL and daily self-care (P < 0.001 and r = 0.335). CONCLUSION: This study underscores the complex interplay between loneliness, self-care, and ADL. It highlights the need for interventions that address emotional health and daily living skills as part of comprehensive self-care strategies. Further research is needed to explore these relationships in more detail and to develop targeted interventions for different demographic groups.