Strict association between development of psychological conditions and hypertension incidence: A cross-sectional study.

Background/Aims: Previous studies indicated a significant association between mental disorders and cardiovascular diseases, including heart failure (HF) and coronary artery disease (CAD) with comorbidity hypertension (HTN), and vice versa, leading to a challenge in the final decision. To resolve this issue, we aimed to exclude comorbidities and further assessed to better find any association between mental disorders and cardiovascular diseases (CVD). Methods: The cross-sectional study involved 300 participants: 100 with HTN (without HF or CAD), 100 with HF (without HTN or CAD), 100 with CAD (without HTN or HF), and 100 healthy individuals as a control group. To evaluate depression, anxiety, and stress levels, the Depression, Anxiety, and Stress Scale - 21 (DASS-21) was applied. For further analysis, the SPSS ver.20 was used. Results: The analysis showed that the score of depression, anxiety, and stress was higher in the HTN patients compared to the control (p < 0.001), CAD (p < 0.001), and HF (p < 0.001) groups, respectively. However, no significant differences were observed between the other study groups. Notably, patients with HF and CAD without concurrent HTN had similar psychological distress levels to healthy participants. Conclusion: The present study emphasized the higher prevalence of psychological distress in HTN patients and suggests a requirement for further research regarding the etiology involved in this association.

The economic burden of road traffic injuries until one-year after hospitalization: A survey study.

OBJECTIVE: Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization. METHODS: The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model. RESULTS: The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location. CONCLUSIONS: Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.

Remifentanil with or without Propofol as Anesthesia Agents for Trans- Vaginal Ultrasonography Oocyte Retrieval (TUGOR) on Pregnancy and Anesthesia Outcomes: A Randomized Controlled Trial.

BACKGROUND: Transvaginal Ultrasound-Guided Oocyte Retrieval (TUGOR) is a painful procedure, which often requires the application of anesthesia agents. There is a controversy in the literature about the effects of administrated anesthetics for TUGOR on patients & pregnancy outcomes. OBJECTIVE: The current study aimed to compare the effects of remifentanil with or without propofol, administrated for TUGOR, on pregnancy and anesthesia outcomes. METHOD: In a double-blind randomized controlled trial, 180 candidates of TUGOR, aged 18-40 years old, were included in the study. All study women received midazolam 0.03 mg/kg and remifentanil 1 ug/kg as anesthesia induction; Later on, they were randomly assigned in two equalsize groups in terms of anesthesia maintenance, as the intervention group received remifentanil infusion 0.25 µg/kg/min and the control group received remifentanil infusion 1ug/kg/min with propofol 50-150 ug/kg/min. Hemodynamic symptoms, operation outcomes, including the side effects, and pregnancy outcomes, were compared between the study groups. The study is registered with the Iranian Clinical Trials Registry, number IRCT201611177013N15. RESULTS: Although the hemodynamic symptoms showed significantly better ranges in the remifentanil group, however, the study groups were not significantly different in durations of operation, anesthesia, and recovery. However, the anesthesia side effects during and after the operation were not significantly different between the groups; they were more common in control one. The reproductive outcomes (numbers of collected oocytes, fertilized oocytes and transferred embryos, pregnancy rates) showed better but non-significant ranges in the remifentanil group. CONCLUSION: Using remifentanil alone in comparison to remifentanil & propofol in the TUGOR procedure can be achieved better pregnancy outcomes without imposing the side effects of propofol; therefore, it is not recommended to use propofol as an anesthesia agent for a TUGOR procedure.

Prenatal Administration of Betamethasone and Neonatal Respiratory Distress Syndrome in Multifetal Pregnancies: A Randomized Controlled Trial.

BACKGROUND: Neonatal Respiratory Distress Syndrome (NRDS) is one of the most frequent causes of neonatal mortality especially in premature infants. Although it has been well established that maternal antenatal corticosteroid therapy has a positive effect on NRDS reduction, yet the effectiveness of this treatment in multifetal pregnancies is dubious. OBJECTIVE: We aimed to investigate the effect of betamethasone therapy on the incidence of NRDS in multifetal pregnancies through a randomized controlled trial. METHODS: 140 women with a multifetal pregnancy at less than 28 weeks' gestational age were randomly allocated into intervention and control groups. Women at the intervention group received intramuscularly betamethasone (12 mg/kg/BW twice). Neonatal outcomes were evaluated between two groups of intervention and control, and two subgroups of preterm and term births. This study is registered with the Iranian Clinical Trials Registry, number IRCT20180227038879N1. RESULTS: The incidence of NRDS was significantly lower in infants of betamethasone group than the ones in the control group (4.9% vs 18.1%, P=0.034) while it did not show a significant reduction in preterm infants compared to mature ones. Also, the intervention group presented a significant lower neonatal ventilation than the control group (47.2% vs 63.2%, P=0.041). Other neonatal outcomes, including age at birth, birth weight, Apgar score, NICU admission, and the number of mortalities were not significantly different between study groups. CONCLUSION: Betamethasone therapy during 28-32 weeks of gestation in multifetal pregnancies was associated with better neonatal outcomes through significant reductions in NRDS incidence and requiring ventilator treatment. However, betamethasone administration did not reduce the chance of NRDS in premature infants.

Road safety data collection systems in Iran: A comparison based on relevant organizations.

PURPOSE: Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source. METHODS: This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system. RESULTS: Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance. CONCLUSION: All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.