The Effects of Coenzyme Q10 on Contrast-Induced Acute Kidney Injury in Type 2 Diabetes: A Randomized Clinical Trial.

Contrast-induced acute kidney injury (CI-AKI) is a frequent challenge following the injection of contrast media and its subsequent oxidative stress. The aim of the present study was to evaluate the preventive effects of coenzyme Q10 (Q10), as a mitochondrial-targeted antioxidant in CI-AKI in diabetic patients, who account for a large proportion of angiographic cases. A total of 118 diabetic patients were randomly assigned to receive 120 mg of oral coenzyme Q10 (Q10 group) or placebo (Placebo group) for four days, starting 24 hours before contrast media injection. Blood urea nitrogen (BUN), serum and urinary creatinine, estimated glomerular filtration rate (eGFR), urinary malondialdehyde (UMDA), urinary total antioxidant capacity (UTAC), and urinary mitochondrial to nuclearDNA ratios (mtDNA/nDNA ratio) were evaluated before and after the treatment period. Urine sediments were also evaluated to report the urine microscopy score (UMS).The levels of BUN, serum and urine creatinine, and UMS were similar in the Q10 and placebo groups. EGFR was lower in the Q10 group before the treatment (p=0.013) but not after. The urinary mtDNA/nDNA ratio was 3.05±1.68 and 3.69±2.58 in placebo and Q10 groups, but UTAC was found to be lower in Q10 both before (p=0.006) and after the treatment (p<0.001). The incidence of CI-AKI was 14.40% and the mtDNA/nNDA ratio was similar between CI-AKI and non-CI-AKI patients. In conclusion, Q10 treatment shows no favorable effect on prevention of CI-AKI or a urinary mtDNA/nDNA ratio among diabetic patients.

Interaction between hepatitis B, hepatitis C and smoking in the development of hepatocellular carcinoma: a systematic review and meta-analysis.

BACKGROUND: This meta-analysis reports the relationship between hepatitis B virus (HBV), hepatitis C virus (HCV), smoking and their combined impact on the development of hepatocellular carcinoma (HCC). METHODS: We conducted a systematic search of PubMed, Web of Science and Scopus databases up to 15 July 2023. Observational studies investigating the association between HBV, HCV and smoking in the development of HCC were included. We assessed between-study heterogeneity using the I2 statistics. The effect sizes were estimated as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model. RESULTS: Out of 20 794 studies identified in the initial search, 32 observational studies involving 22 282 participants met the inclusion criteria. Our meta-analysis showed that the combined impact of HBV and smoking was associated with an OR of 19.81 (95% CI: 14.77, 26.58), HCV and smoking was associated with an OR of 24.86 (95% CI: 12.41, 49.79), and coinfection of HBV and HCV was associated with an OR of 32.58 (95% CI: 20.57, 51.60). CONCLUSIONS: Our findings indicate a significant interaction between HBV, HCV and smoking in the development of HCC and highlight the importance of addressing smoking cessation and viral hepatitis prevention and treatment as potential strategies for reducing HCC.

Evaluation of the sedative effect of sublingual lorazepam versus placebo in patients underwent endoscopy: a double-blind, randomized controlled clinical trial.

Background: Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects. Objective: This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE. Design: This is a mono-center, double-blind, and randomized controlled trial. Methods: A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology. Results: In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness. Conclusion: The results of this study showed that prescription of sublingual lorazepam 25-30 min before endoscopy provided mild sedation. Registration: IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568.

Evaluation and Comparison of Serum Vitamin D Levels between Injection Drug Users with and without Chronic Hepatitis C Infection in Hamadan-Iran.

Background and objective: Hepatitis C virus (HCV) infection causes disruption in the metabolism of biochemicals, such as vitamin D, and subsequently alters their serum level via the involvement of the liver. The current study aimed at determining the serum level of vitamin D in injection drug users with chronic HCV infection. Methods:The current case-control study was conducted on 46 injection drug users referred to Imam Khomeini Specialty Clinic in Hamadan City, Iran, between 2017 and 2019, when their HCV infection was diagnosed with HCV PCR test, and 46 healthy injection drug users as the control group in order to compare serum vitamin D levels and liver enzymes. Both the case and control groups were matched for age and gender. ELISA technique was used to measure serum vitamin D level. The collected data were analyzed with STATA software based on 95% significance level. Results:In the present study, 43 (93.5%) of all subjects were male and three (6.6%) females. The mean age of subjects in the case and control groups was 41.87 ± 11.97 and 40.66 ± 11.89 years, respectively. The mean serum vitamin D levels in the case and control groups were 21.20 ± 19.84 and 42.42 ± 29.08 ng/L, respectively (P = 0.001). The mean serum vitamin D levels in the injection drug users with mild, moderate, and severe HCV infection was 32.90, 30.34 and 29.74 ng/L, respectively (P = 0.454). The correlation between vitamin D level and AST and ALT enzymes was -0.053 and -0.103, respectively (P >0.05). Conclusion:Serum vitamin D level decreases in addicts with chronic HCV infection. With increasing the severity of HCV infection, the serum level of vitamin D decreases.

Impact of COVID-19 Disease Control Committee (CDCC) policies on prevention of the disease using Bayes network inference in west of Iran.

BACKGROUND: The start of the COVID-19 pandemic was an emergency situation that led each country to adopt specific regional strategies to control it. Given the spread of COVID-19 disease, it is crucial to evaluate which policy is more effective in reducing disease transmission. The purpose of this study was to determine the impact of policies made by COVID-19 Disease Control Committee (CDCC) to reduce the risk of the disease in Hamadan province. METHODS: In the observational study, the data were extracted from three sources in Hamadan, west of Iran; first, the session reports of CDCC; second, information on periodic evaluations conducted by the primary health care directory in Hamadan from April to August 2021 and third, expert panel opinion. Bayes network analysis was used to determine the effect of each policy on mortality rate by GeNIe software version 2.2. RESULTS: Among the policies adopted by CDCC in Hamadan, seven policies, i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene had the most impact to prevent the spread of COVID-19, respectively. In this study, the prevalence of the disease was 17.64% with the implementation of these policies. Now, if all these policies are observed 30% more, the prevalence will decrease to 14.18%. CONCLUSION: This study showed that if the seven policies (i.e., vaccination, limiting gatherings, social distancing, wearing a mask, job closure, travel restriction, and personal hygiene) are followed simultaneously in the community, the risk of contracting the disease will be greatly reduced. Therefore, in the pandemic of infectious diseases, such policies can help prevent the spread of the disease.

Outbreak detection algorithms based on generalized linear model: a review with new practical examples.

Public health surveillance serves a crucial function within health systems, enabling the monitoring, early detection, and warning of infectious diseases. Recently, outbreak detection algorithms have gained significant importance across various surveillance systems, particularly in light of the COVID-19 pandemic. These algorithms are approached from both theoretical and practical perspectives. The theoretical aspect entails the development and introduction of novel statistical methods that capture the interest of statisticians. In contrast, the practical aspect involves designing outbreak detection systems and employing diverse methodologies for monitoring syndromes, thus drawing the attention of epidemiologists and health managers. Over the past three decades, considerable efforts have been made in the field of surveillance, resulting in valuable publications that introduce new statistical methods and compare their performance. The generalized linear model (GLM) family has undergone various advancements in comparison to other statistical methods and models. This study aims to present and describe GLM-based methods, providing a coherent comparison between them. Initially, a historical overview of outbreak detection algorithms based on the GLM family is provided, highlighting commonly used methods. Furthermore, real data from Measles and COVID-19 are utilized to demonstrate examples of these methods. This study will be useful for researchers in both theoretical and practical aspects of outbreak detection methods, enabling them to familiarize themselves with the key techniques within the GLM family and facilitate comparisons, particularly for those with limited mathematical expertise.

The role of problem-solving skills in the prevention of suicidal behaviors: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis was conducted to assess the association between problem-solving skills and suicidal behaviors and elucidate the potential role of problem-solving skills in influencing the occurrence of suicidal behaviors. METHODS: PubMed, Web of Science, and Scopus were searched until August 16, 2023. Studies addressing the associations between problem-solving skills and suicidal behaviors were included. The I2 statistics were used to examine between-study heterogeneity. The Begg and Egger tests were used to determine the possibility of publication bias. Using a random-effects model, the overall effect size was presented as an odds ratio (OR) or standard mean difference (SMD) with 95% confidence intervals (CIs). RESULTS: Of 8040 identified studies, 29 (including 974,542 participants) were eligible. Based on observational studies, problem-solving skills were found to be inversely related to suicidal ideation (OR = 0.64; 95% CI: 0.50, 0.82); suicide attempts (OR = 0.75; 95% CI: 0.63, 0.89), and suicide death (OR = 0.02; 95% CI: 0.01, 0.03). The overall score of problem-solving skills was higher in those who did not attempt suicide than those who did (SMD = 0.84; 95% CI: 54, 1.13). Based on randomized clinical trials, problem-solving therapy was found to reduce the risk of suicide (OR = 0.51; 95% CI: 0.29, 0.87). Furthermore, the overall risk of suicide was lower among those who received problem-solving therapy than those who did not (SMD = -0.02; 95% CI: -0.29, 0.25). CONCLUSIONS: This meta-analysis revealed an inverse association between problem-solving skills and suicidal behaviors. However, further research is needed to better understand the complex relationship between problem-solving skills and suicidal behaviors.

Joint Modeling of Longitudinal Outcome and Competing Risks: Application to HIV/AIDS Data.

BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) are major public health challenges globally, and the number of TB infections and death caused by HIV are high because of HIV/ TB co-infection. On the other hand, CD4 count plays a significant role in TB/HIV co-infections. We used a joint model of longitudinal outcomes and competing risks to identify the potential risk factors and the effect of CD4 cells on TB infection and death caused by HIV in HIV-infected patients. STUDY DESIGN: This was a retrospective cohort study. METHODS: The current study was performed on 1436 HIV+patients referred to Behavioral Diseases Counseling Centers in Kermanshah Province during 1998-2019. In this study, joint modeling was used to identify the effect of potential risk factors and CD4 cells on TB and death caused by HIV. RESULTS: The results demonstrated that the decreasing CD4 cell count was significantly associated with an increased risk of death, while it had no significant relation with the risk of TB. In addition, patients with TB were at a higher risk of death. Based on the results, a significant relationship was found between CD4 count and sex, marital status, education level, antiretroviral therapy (ART), time, and the interaction between time and ART. Further, people infected with HIV through sexual relationships were at higher risk of TB, while those with a history of imprisonment who received ART or were infected with HIV through drug injection had a lower risk of TB. CONCLUSION: The findings revealed that the decreasing CD4 count had a significant association with an increased risk of death caused by HIV. However, it was not significantly related to the risk of TB. Finally, patients with TB were at higher risk of death caused by HIV.

Pharmaceutical Therapies for the Treatment of Obesity: A Network Meta-analysis.

PURPOSE: Despite the introduction of various pharmaceutical therapies for treating obesity, selecting the optimal treatment remains challenging for both patients and physicians. Therefore, in this network meta-analysis (NMA), we aim to simultaneously compare the available drugs for treating obesity to determine the most effective treatment options. METHODS: International databases, including PubMed, Web of Science, Scopus, Cochrane Library, and Embase, were searched for studies published from database inception to April 2023. The consistency assumption was evaluated using by the loop-specific and design × treatment interaction approaches. The effects of treatment in the NMA were summarized using mean differences based on a change score analysis. The random-effects model was used to report the results. Results were reported with 95% CIs. FINDINGS: Of 9519 retrieved references, 96 randomized controlled trials, including 68 with both men and women, 23 with women only, and 5 with men only, met the eligibility criteria for this study. There were 4 treatment networks in the trials of both men and women, 4 in the trials of women only, and 1 in the trials of men only. The best-ranked treatments in the network in the trials of both men and women were (1) semaglutide, 2.4 mg (P-score = 0.99); (2) hydroxycitric acid, 4667 mg 3 times daily, supervised walking, and 2000-kcal/d diet (P-score = 0.92); (3) phentermine hydrochloride and behavioral therapy (P-score = 0.92); and (4) liraglutide plus advice to diet and exercise (P-score = 1.00). In women, the best-ranked treatments were beloranib (P-score = 0.98) and sibutramine, metformin, and hypocaloric diet (P-score = 0.90). In men, there was no significant difference among treatments. IMPLICATIONS: According to the results of this NMA, semaglutide seems to be an effective treatment option for both men and women, whereas beloranib appears to be particularly effective for women with obesity and overweight, but its production has been stopped since 2016 and is not available.

Prevention of contrast induced-acute kidney injury using coenzyme Q10 in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

PURPOSE: We assessed the potential effect of CoQ10 administration for the prevention of contrast induced-acute kidney injury (CI-AKI) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). METHODS: One hundred fifty STEMI patients who were candidates for primary PCI, along with intravenous saline hydration, randomly received a placebo or CoQ10. CoQ10 was administrated orally, 400 mg before the procedure and 200 mg twice daily after the procedure for three consecutive days. Serum creatinine concentration and corresponding creatinine clearance (estimated by the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation) were measured at baseline and 24, 48, and 72 h after primary PCI. Furthermore, the serum level of superoxide dismutase (SOD), total antioxidant capacity (TAC), and malondialdehyde (MDA) was measured before and 72 h after primary PCI. RESULTS: The mean serum creatinine concentration before contrast administration was similar in the two groups (0.98 ± 0.08 versus 0.99 ± 0.09 mg/dL). While in both study groups, compared to baseline, the mean serum creatinine concentration increased at 48 and 72 h after contrast exposure, the CoQ10 group showed a lower serum creatinine concentration than the placebo group (P-value = 0.017 and 0.004, respectively). However, comparing the mean values of creatinine clearance between the groups at the study time points did not demonstrate a statistically significant difference. CI-AKI, defined as a > 25% or 0.5 mg/dL increase in baseline serum creatinine concentration, occurred in 8.00% of the cases in the CoQ10 group versus 20.00% in the placebo group (P-value = 0.034). Furthermore, at 72 h, the CoQ10-treated group exhibited higher serum levels of SOD and TAC and a lower MDA level than the placebo-treated group. CONCLUSIONS: Our research's findings proposed CoQ10 supplementation as an adjuvant to saline hydration as a preventive approach against CI-AKI. TRIAL REGISTRATION: The trial was registered at Iranian Registry of Clinical Trials ( https://www.irct.ir/trial/60435 , identifier code: IRCT20120215009014N414). Registration date: 2021-12-29.

Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study.

BACKGROUND: Osteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis. METHODS: This prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann-Whitney and the Rank Wilcoxson tests using Stata version 17 software. RESULTS: The mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37). CONCLUSION: This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.

The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models.

BACKGROUND: HIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients. METHODS: The total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed. RESULTS: Based on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62. CONCLUSION: This study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.

National trends and projection of chronic kidney disease incidence according to etiology from 1990 to 2030 in Iran: a Bayesian age-period-cohort modeling study.

OBJECTIVES: Chronic kidney disease (CKD) is a major public health problem worldwide. Predicting CKD incidence rates and case numbers at the national and global levels is vital for planning CKD prevention programs. METHODS: Data on CKD incidence rates and case numbers in Iran from 1990 to 2019 were extracted from the Global Burden of Disease online database. The average annual percentage change was computed to determine the temporal trends in CKD age-standardized incidence rates from 1990 to 2019. A Bayesian age-period-cohort model was used to predict the CKD incidence rate and case numbers through 2030. RESULTS: Nationally, CKD cases increased from 97,300 in 1990 to 315,500 in 2019. The age-specific CKD incidence rate increased from 168.52 per 100,000 to 382.98 per 100,000 during the same period. Between 2020 and 2030, the number of CKD cases is projected to rise to 423,300. The age-specific CKD incidence rate is projected to increase to 469.04 in 2030 (95% credible interval, 399.20 to 538.87). In all age groups and etiological categories, the CKD incidence rate is forecasted to increase by 2030. CONCLUSIONS: CKD case numbers and incidence rates are anticipated to increase in Iran through 2030. The high level of CKD incidence in people with diabetes mellitus, hypertension, and glomerulonephritis, as well as in older people, suggests a deficiency of attention to these populations in current prevention plans and highlights their importance in future programs for the national control of CKD.

Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial.

BACKGROUND: This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19. METHODS: In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO2:FiO2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P-values below 0.008 based on Bonferroni's multiple-testing correction method were considered statistically significant. RESULTS: According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO2:FiO2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study's small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 (p-value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups. CONCLUSION: Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.

Predictors of Premature Mortality Following Coronary Artery Bypass Grafting: An Iranian Single-Centre Study.

Modifiable risk factors play an important role in the premature mortality among patients undergoing coronary artery bypass grafting (CABG). The aim of this study was to examine the factors that influence the early death of patients who had CABG. We conducted a prospective cohort study and followed 2863 patients after their CABG, and collected data on their characteristics and blood tests. We used the Cox proportional hazards regression model in Stata, version 16, to identify the predictors of early mortality. Out of 2863 patients, 162 died during the follow-up period. The survival rate was 99.2% within the first three days after the surgery, 96.2% from the fourth day to the end of the first year, 94.9% at the end of the second year, and 93.6% at the end of the third year. After adjusting for confounding factors, we found that older age (hazard ratio [HR] 1.05, 95% CI 1.02, 1.08 for one year increase in age), obesity (HR 2.16, 95% CI 1.25, 3.72), ejection fraction < 50% (HR 1.61, 95% CI 1.06, 2.44), number of rehospitalizations (HR 2.63, 95% CI 1.35, 5.12 for two or more readmissions), history of stroke (HR 2.91, 95% CI 1.63, 5.21), living in rural areas (HR 1.58, 95% CI 1.06, 2.34), opium use (HR 2.08, 95% CI 1.40, 3.09), and impaired glomerular filtration rate increased the risk of early death after CABG, while taking a beta-blocker (HR 0.59, 95% CI 0.38, 0.91) reduced the risk. We conclude that modifiable risk factors such as excess body mass, high blood glucose, opium use, and kidney dysfunction should be monitored and managed in patients who had CABG to improve their survival outcomes.

Relationship of religion with suicidal ideation, suicide plan, suicide attempt, and suicide death: a meta-analysis.

BACKGROUND: Suicide is a significant public health problem and one of the leading causes of death worldwide. The effect of religion on suicidal behaviors (i.e., ideation, plan, attempt, and death) is an important issue worthy of consideration. METHODS: Major electronic databases, including MEDLINE, Web of Science, and Scopus, were searched for the articles published until 26 April 2021. Reference lists were also screened. Observational studies addressing the associations between religion and suicidal behaviors were also examined. Between-study heterogeneity was investigated using the χ2, τ2, and I2 statistics. The probability of publication bias was explored using the Begg and Egger tests, as well as trim-and-fill analysis. The effect size was expressed as odds ratio (OR) with 95% confidence intervals (CIs) using a random-effects model. RESULTS: Out of 11 389 identified studies, 63 articles were eligible, involving 8,053,697 participants. There was an inverse association between religion and suicidal ideation OR  =  0.83 (95% CI: 0.78, 0.88; P < 0.001), suicidal plan OR  =  0.93 (95% CI: 0.83, 1.04; P =  0.200), suicide attempt OR  =  0.84 (95% CI: 0.79, 0.89; P < 0.001), and completed suicide OR  =  0.31 (95% CI: 0.14, 0.72; P =  0.006). There was a no evidence of publication bias. CONCLUSIONS: The results of this meta-analysis support the notion that religion can play a protective role against suicidal behaviors. Nonetheless, the effect of religion on suicidal behaviors varies across countries with different religions and cultures. Although this association does not necessarily imply causation, an awareness of the relationship between religion and suicide risk can be of great help in suicide prevention policies and programs.

High-Risk Behaviors and Associated Factors among Iranian Adult Population: A National Survey.

Background: There is no official and representative information on certain health-risk behaviors in Iran. This national survey was performed to determine the prevalence of five high-risk behaviors among the adult population and underlying factors. Methods: This cross-sectional study was performed in 23 provinces of Iran in 2019 involving 10,957 participants. The following five risky behaviors were evaluated: (a) using illicit drugs in the past month, (b) drinking alcohol in the past month, (c) having extramarital sex in the past year, (d) having suicidal thoughts in the past month, (e) and attempting suicide in the past year. The logistic regression model was used for analyses and associations were reported using odds ratio (OR) with its 95% confidence interval (CI). Results: The prevalence of health-risk behaviors was as follows: illicit drug use 10.4%, drinking alcohol 16.8%, extramarital sex 9.9%, suicidal thoughts 8.8%, and suicide attempt 5.4%. Almost 27.6% of the participants were involved in at least one risky behavior. There was a strong association between illicit drugs use and male gender 2.51 (2.11-2.98) and using psychiatric medications 2.96 (2.46-3.55); between drinking alcohol and male gender 2.23 (1.93-2.58); between extramarital sex and divorced/widowed status 2.43 (1.72-3.44) and having an intimate friend of the opposite sex 3.75 (3.13-4.51); between suicidal thoughts and using psychiatric medications 2.23 (1.83-2.72); between suicide attempt and a history of running away from home 2.10 (1.64-2.68). Conclusion: More than one-fourth Iranian adult population is involved in at least one risky behavior. Engaging in any risky behavior may increase the possibility of engaging in other high-risk behaviors.

Prevalence of modifiable risk factors of tuberculosis and their population attributable fraction in Iran: A cross-sectional study.

BACKGROUND: The mycobacterium tuberculosis (Mtb) is necessary for the morbidity of tuberculosis (TB), but it is insufficient. Many risk factors increase the risk of disease among infected people. We aimed to estimate the prevalence of modifiable risk factors of TB and their related population attributable fraction (PAF) in the marginal population of Markazi province in Iran. DESIGN: In this cross-sectional study, the prevalence of the modifiable risk factors of TB was estimated. We designed and validated a questionnaire to determine the risk factors. The measures of association for the modifiable risk factors of TB were obtained via the review of published literature. We calculated the PAF for each modifiable risk factor. RESULTS: Out of the 1275 calculated sample size, 1146 people participated in this study, and the participation rate was 89.9%. The mean age was 39.26. Out of 1146 participants, 76% did not know anything regarding TB. The highest prevalence was related to the lack of physical activity (58.73%), lack of fish consumption (50.79%), lack of red meat consumption (21.20%), and secondhand smoke (19.02%). The highest PAF was related to secondhand smoke; this value based on the crude relative risk (RR) and crude odds ratio (OR) was 24.54% and 23.44%, respectively. Based on crude hazard ratio (HR) and crude OR, the PAF for smoking was 14.81% and 11.19%, respectively. PAF for lack of BCG vaccination based on the crude OR was 14.79%. CONCLUSION: Based on this study's results, poor nutrition, secondhand smoke, smoking, lack of BCG vaccination, and diabetes are the main prevalent modifiable risk factors for TB. The highest PAF for TB was related to secondhand smoke, smoking, lack of BCG vaccination, and diabetes.

Influence of Vitamin D Status on the Maintenance Dose of Warfarin in Patients Receiving Chronic Warfarin Therapy.

INTRODUCTION: Considering the anticoagulant actions of vitamin D, we hypothesize that vitamin D status might affect the required dose of warfarin for maintaining the therapeutic international normalized ratio (INR). METHODS: In a retrospective single-center cohort study, serum levels of 25-hydroxyvitamin D were assessed for 89 subjects receiving a stable dose of warfarin for 3 months or longer and had a stable INR between 2 and 3.5 for at least three consecutive visits. A warfarin sensitivity index (WSI), defined as the steady-state INR divided by the mean daily warfarin dose, was used for measuring the warfarin dose response. The relation between the serum level of 25-hydroxyvitamin D and WSI value and the difference in the mean WSI value between the subjects with different vitamin D status categories (sufficient, insufficient, and deficient) were assessed. RESULTS: Twenty-one subjects had vitamin D deficiency, 43 had vitamin D insufficiency, and only 25 had normal levels of 25-hydroxyvitamin D. Based on the multiple linear regression analysis, there was a significant but weakly positive correlation between WSI and 25-hydroxyvitamin D serum levels, as the value of WSI increases by almost 0.0027434 for every unit increase in 25-hydroxyvitamin D serum level (p value = 0.041). Using one-way ANOVA analysis, there was a trend in a significant difference between the groups with different vitamin D status categories regarding the mean WSI value (F = 2.95, p value = 0.057), as subjects with sufficient vitamin D state compared to those with vitamin D deficiency had a higher WSI value. CONCLUSIONS: Although the study's limitations limit our ability to draw definite conclusions, the present data suggest that in addition to other traditional factors, vitamin D status might also affect warfarin sensitivity and maintenance dose requirement. However, to more clearly explain this link, further studies with high involvement subjects are required.