The Prevalence of Pulmonary Arterial Hypertension in Patients with Beta Thalassemia Major.

Pulmonary arterial hypertension (PAH) remains a concern in patients with Beta thalassemia major (TM). However, this study aims to investigate the prevalence of PAH in TM patients in Kerman City placed in the south of Iran. In this cross-sectional study on 271 IranianBeta-thalassemia patients (mean age 19.8 ± 7.9 in the range 10-60), Age, sex, weekly deferral taking, the number of blood transfusion in a month, and last echocardiography report data was gathered from every patient's file. SPSS for Windows (version 21) was used for analysis. According to the results, the prevalence of PAH was 10.3% (28 patients). PAH had significant associations with weekly deferral consumption (P = 0.028), ferritin serum level (P = 0.001), and ejection fraction (EF) (P = 0.001). PAH is positively associated with deferral consumption and is negatively associated with EF (respectively, P = 0.031, P = 0.001). It is very important to consider prevention and treatment for decreasing the mortality and morbidity of PAH patients in health planning and policy.

Sleep duration and Framingham´s cardiovascular risk score: results from the Hoveyzeh Cohort Study (HCS).

BACKGROUND: Cardiovascular diseases (CVDs) are the leading causes of global deaths. So, it is necessary to know the possible risk factors for each region. We aimed to assess the relationship between the risk of CVDs and sleep duration in the Iranian Arab population. METHODS: In this cross-sectional study, data from 8362 participants aged between 35 and 70 from the Hoveyzeh Cohort Study enrollment phase between 2016 and 2018 was analyzed. This study evaluated the association between ten-year CVD risk using the Framingham risk score and sleep duration. Self-reported sleep duration was categorized as short duration (equal to or less than 5 h), standard duration (6-8 h), or prolonged duration (equal to or greater than 9 h). Multivariable logistic regression to adjust for conventional CVD risks was used. RESULTS: Among the assessed participants, 4892 (58.50%) were female, and the mean age was 47.93 (9.01). The average sleep duration was 7.59 (1.56) hours. The low, intermediate-to-high, and high CVD risk individuals were 6461 (77.27%), 1185 (14.17%), and 716 (8.56%), respectively. There was a significant relationship between prolonged sleep duration and lower odds of intermediate-to-high CVD risk in males (OR 0.66, 95% CI: 0.49-0.87, P-value: 0.004). CONCLUSION: The results of our study showed that longer sleep duration has a protective association with the intermediate to high risk of cardiovascular diseases in males. However, long and short sleep durations have no significant relationship with females' risk of cardiovascular disease.

Health literacy and its related factors as predictors for the breastfeeding self-efficacy in a western province in Iran.

BACKGROUND: One of the effective factors on BF (Breastfeeding) continuation is Breastfeeding self-efficacy (BFSE). This study was conducted to determine the relationship between Health Literacy (HL) and BFSE in lactating mothers referring to primary health care centers. METHODS: This cross-sectional descriptive study was carried out on lactating mothers referring to primary health care centers in 2022. Multi-stage cluster sampling was done with 160 samples. The data were collected using demographic questionnaire, Persian shortened form of the BSES is a self-reported instrument for measuring a mother's Breastfeeding self-efficacy and Health Literacy for Iranian Adults (HELIA). Data were analyzed using ANOVA, independent t-test, correlation test and liner regression by SPSS version 16, with a significance level of 5%. RESULTS: There was a significant positive correlation between the HL score and its four domains( Reading, Behaviour and decision making, Accessing, and Understanding) except for the appraisal domain with BFSE score. The variables of use of formula, HL, duration of breastfeeding, and education were considered predictors of BFSE. CONCLUSION: In general, the results indicate a possible relationship between BFSE and mothers' HL. Therefore, improving mother's HL can have a positive effect on promoting infants' nutrition.

Information System Success of the Iranian Integrated Health Record System Based on the Clinical Information System Success Model.

Background: The Integrated Health Record System, locally known as the "SIB," is the most used information system for recording public health services provided to the Iranian population. The objective of this study was to evaluate the success rate of the SIB using the Clinical Information System Success Model (CISSM). Methods: This is a psychometric and evaluation study. The CISSM has a 26-item instrument that assesses 7 constructs in 3 following stages: (1) the socio-technical stage (facilitating conditions, social influence, information quality, and system performance(; (2) the integrated stage (system use dependency and user satisfaction); and (3) success outcome stage (net benefit). A Persian version of the CISSM instrument was validated and applied in this study. Based on this instrument, the reliability and the validity of the CISSM were assessed. The SIB success rate was evaluated using a validated CISSM. The study participants were 758 SIB users from different disciplines and different levels. Results: Assessment of content validity, construct validity, internal consistency, and test-retest reliability showed acceptable psychometric properties of the CISSM instrument. The results demonstrated that the SIB success rate was in the moderate range (59.6%). Facilitating conditions and information quality were strong predictors of use dependency and user satisfaction, while both of these 2 constructs significantly influenced net benefit. Conclusion: The SIB success was in the moderate range, and it needs to be enhanced. Therefore, Iranian healthcare policymakers should consider working on the most important factors influencing SIB success (facilitating conditions, information quality, use dependency, and user satisfaction) to improve SIB success.

Anti-proteinuria effect of active vitamin D in patients with type 2 diabetic nephropathy.

Introduction: Proteinuria is a common complication in patients with type 2 diabetic nephropathy (DN). The aim of this study was to evaluate the anti-proteinuria effect of active vitamin D in patients with type 2 DN. Methods: A double-blind randomized clinical trial study was conducted on 42 DN patients selected by convenience sampling method. After selecting patients based on inclusion criteria, they were randomly divided into control and intervention groups. Patients in the intervention group received 0.25 mg of active vitamin D per day for 12 weeks. The variables evaluated in the patients on the first day of the intervention included fasting blood sugar (FBS), calcium, phosphorus, creatinine, glomerular filtration rate (GFR), systolic and diastolic blood pressure, and proteinuria. These variables were also evaluated at the end of the first, second, and third month of intervention. Data were collected and analyzed in Statistical Package for Social Sciences software version 22. Results: Around 52.5% of the patients participating in this study were male and 47.5% were female. The mean age of the patients was 55.52 ± 6.58 years. The results of repeated measures analysis showed that active vitamin D significantly reduced proteinuria (P = 0.000) in patients in the intervention group. The changes in FBS (P = 0.235), calcium (P = 0.393), phosphorus (P = 0.694), creatinine (P = 0.232), GFR (P = 0.347), systolic blood pressure (P = 0.615), and diastolic blood pressure (P = 0.115) were not significant in patients in the intervention group. Conclusion: Prescription of active vitamin D can significantly reduce the incidence of proteinuria in patients with DN.

Efficacy of naproxen in the management of patients hospitalized with COVID-19 infection: A randomized, double-blind, placebo-controlled, clinical trial.

BACKGROUND AND AIMS: The current study was done to examine the efficacy of naproxen in the management of patients with COVID-19 infection. METHODS: This randomized, double-blind, placebo-controlled, clinical trial was done on hospitalized adult patients with confirmed COVID-19 infection. Patients were randomly assigned to receive either naproxen (two capsules per day each containing 500 mg naproxen sodium) or placebo (containing starch) for five days along with the routine treatment that was nationally recommended for COVID-19 infection. Clinical symptoms of COVID-19 infection, the time to clinical improvement, blood pressure, laboratory parameters, and death due to COVID-19 infection were considered as the outcome variables in the present study. RESULTS: Treatment with naproxen improved cough and shortness of breath in COVID-19 patients; such that, compared with placebo, naproxen intake was associated with 2.90 (95% CI: 1.10-7.66) and 2.82 (95% CI: 1.05-7.55) times more improvement in cough and shortness of breath, respectively. In addition, naproxen administration resulted in a significant increase in mean corpuscular volume (MCV) and had a preventive effect on the reduction of systolic blood pressure in COVID-19 patients. CONCLUSION: Treatment with naproxen can improve cough and shortness of breath in COVID-19-infected patients. Further studies are required to confirm our findings.

Effectiveness of massage therapy on fatigue and pain in patients with multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Fatigue and pain are prevalent symptoms of multiple sclerosis (MS) and frequent complaint in MS patients, which reduce their quality of life. This study aimed to assess the effect of massage therapy on pain and fatigue in MS Patients. METHOD: The original and Persian databases were searched included PubMed, web of science, embase, ovid, scopus, and the Cochrane Library, SID, and Iranedex from inception to November 2020. Studies that reported the effect of massage on fatigue and pain were included. Two investigators extracted all relevant data, independently. For deriving analysis, mean difference (MD) and standardized mean difference (SMD) were used. RESULT: Ten studies were eligible acoording criteria. The effect of massage on fatigue showed significant improvement (-1.62; 95% CL -2.40, -0.83; p < .00001), also results of the systematic review showed a significant reduction in pain severity. CONCLUSION: Massage as a complementary and non-pharmacological therapy might have been associated with alleviating fatigue and pain in M.S. patients. Based on the current study, massage intervention for MS patients could have possible clinical value for palliating pain and fatigue and improving quality of life; however, this matter needs further and more significant trial studies.

The impact of sofosbuvir/daclatasvir or ribavirin in patients with severe COVID-19.

OBJECTIVES: Sofosbuvir and daclatasvir are direct-acting antivirals highly effective against hepatitis C virus. There is some in silico and in vitro evidence that suggests these agents may also be effective against SARS-CoV-2. This trial evaluated the effectiveness of sofosbuvir in combination with daclatasvir in treating patients with COVID-19. METHODS: Patients with a positive nasopharyngeal swab for SARS-CoV-2 on RT-PCR or bilateral multi-lobar ground-glass opacity on their chest CT and signs of severe COVID-19 were included. Subjects were divided into two arms with one arm receiving ribavirin and the other receiving sofosbuvir/daclatasvir. All participants also received the recommended national standard treatment which, at that time, was lopinavir/ritonavir and single-dose hydroxychloroquine. The primary endpoint was time from starting the medication until discharge from hospital with secondary endpoints of duration of ICU stay and mortality. RESULTS: Sixty-two subjects met the inclusion criteria, with 35 enrolled in the sofosbuvir/daclatasvir arm and 27 in the ribavirin arm. The median duration of stay was 5 days for the sofosbuvir/daclatasvir group and 9 days for the ribavirin group. The mortality in the sofosbuvir/daclatasvir group was 2/35 (6%) and 9/27 (33%) for the ribavirin group. The relative risk of death for patients treated with sofosbuvir/daclatasvir was 0.17 (95% CI 0.04-0.73, P = 0.02) and the number needed to treat for benefit was 3.6 (95% CI 2.1-12.1, P < 0.01). CONCLUSIONS: Given these encouraging initial results, and the current lack of treatments proven to decrease mortality in COVID-19, further investigation in larger-scale trials seems warranted.

Inequality in the global incidence and prevalence of tuberculosis (TB) and TB/HIV according to the human development index.

Background: Tuberculosis (TB) is one of the ten leading causes of death, especially in developing countries. We aimed to assess the inequality in the incidence and prevalence of TB and TB/HIV based on the human development index (HDI) globally. Methods: In this ecological study, the data on the incidence and prevalence of TB, HIV, and TB/HIV co-infection in 168 countries were obtained from the World Health Organization (WHO). The HDI of these countries in 2000, 2005, 2010, and 2015 was also obtained from the United Nations Development Program (UNDP). The concentration index was used to assess the inequality of the incidence and prevalence of TB and TB/HIV based on the HDI globally. Results: The concentration index for the incidence of TB according to the HDI was -0.32 (95% CI: -0.46, -0.17), -0.36 (95% CI: -0.49, -0.23), -0.37 (95% CI: -0.52, -0.22), and -0.36 (-0.52, -0.21) in 2000, 2005, 2010, and 2015, respectively. The same pattern was observed for the incidence and prevalence of TB/HIV. The results showed that TB and TB/HIV mainly concentrated in countries with a lower HDI. Conclusion: According to the results of this study, the incidence of TB and TB/HIV and the prevalence of TB/HIV concentrated in the countries with a lower HDI. In addition, inequality in TB and HIV based on the HDI did not change from 2000 to 2015. Therefore, it seems that public health programs, especially in low-income countries, should be revised and the World Health Organization and the United Nations should provide more technical and financial help for these countries.

A Comparison between the Ability of Revised Trauma Score and Kampala Trauma Score in Predicting Mortality; a Meta-Analysis.

INTRODUCTION: Describing injury severity in trauma patients is vital. In some recent articles the Revised Trauma Score (RTS) and Kampala Trauma Score (KTS) have been suggested as easily performed and feasible triage tools which can be used in resource-limited settings. The present meta-analysis was performed to evaluate and compare the accuracy of the RTS and KTS in predicting mortality in low-and middle income countries (LMICs). METHODS: Two investigators searched the Web of Science, Embase, and Medline databases and the articles which their exact number of true-positive, true-negative, false-positive, and false-negative results could be extracted were selected. Sensitivity and subgroup analysis were performed using Stata software version 14 to determine the factor(s) affecting the accuracy of the RTS and KTS in predicting mortality and source(s) of heterogeneity. RESULTS: The heterogeneity was high (I2 > 80%) among 11 relevant studies (total n = 20,631). While the sensitivity of the KTS (0.88) was slightly higher than RTS (0.82), the specificity, diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio of the KTS (0.73, 20, 0.16, 3.30, respectively) were lower than those of the RTS (0.91, 45, 0.20, 8.90, respectively). The area under the summary-receiver operator characteristic curve for KTS and RTS was 0.88 and 0.93, respectively. CONCLUSION: However, regarding accuracy and performance, RTS was better than KTS for distinguishing between mortality and survival; both of them are beneficial trauma scoring tools which can be used in LMICs. Further studies are required to specify the appropriate choice of the RTS or KTS regarding the type of injury and different conditions of the patient.

Khuzestan dust phenomenon: a content analysis of most widely circulated newspapers.

Dust is an atmospheric phenomenon that causes adverse environmental effects. It is deemed to have harmful effects on health, economics, and climate. This study aimed to analyze the content published on the phenomenon of dust in the widely circulated newspapers in Iran. We investigated the content of all national and provincial newspapers that were published between July and August 2014. Data on the materials related to the dust phenomenon in the newspapers were categorized and coded. From a total of 510 newspaper issues, 143 articles were devoted to the dust phenomenon which 74.1% of them were published in provincial newspapers. Among the national newspapers, Hamshahri newspaper with 16 headlines and from the provincial newspapers; Karoon with 23 headlines published the highest number of articles on dust phenomenon. 45.5% of content on dust were printed on the first page of the newspapers. The most common approach to the type of content published in these newspapers was an interview. Moreover, we noticed that 28.7% of the content published in the newspapers was related to the health issue. The media plays an important role in the transmission of health information. Weaknesses in addressing the causes of dust occurrence and also in providing solutions for the dust control and prevention were noticeable in the content published in the newspaper. It seems necessary to take practical measures to disseminate relevant information to dust and also address the needs of the target audience community influenced by the dust phenomenon properly.