Households catastrophic health expenditure among older people with noncommunicable diseases: A cross-sectional study from Iran.

Background and Aims: Noncommunicable diseases are one of the main difficulties faced by older adults in many countries. The study aimed to investigate the households' catastrophic health expenditure (CHE) among older people with noncommunicable diseases. Methods: This cross-sectional study was conducted between October and December 2022 in Semnan, Iran, with the participation of 400 older individuals suffering from diabetes and hypertension. The Content Validity Ratio (which is calculated based on necessity criterion) and Content Validity Index (which calculated based on relevance, transparency, and simplicity criteria) values of 0.94 and 0.89, respectively, confirmed the content validity of the researcher-made questionnaire. The occurrence of CHE was estimated using the World Health Organization's rule of "allocating at least 40% of non-food household costs to healthcare." Due to the qualitative nature of the data, the χ 2 test was utilized to assess the statistical association between demographic and background variables and occurrence of CHE. Results: Older people with diabetes and hypertension had an annual direct medical costs of $821 averagely, which includes 9.7% for diagnosis, 23.9% for doctor visits, and 66.4% for treatment. Direct medical costs account for around 0.26 of nonfood costs, with 12.5% of seniors facing high medical charges. Age, marital status, type of basic health insurance, diabetes, the time elapsed since initial diabetes diagnosis, the severity of diabetes complications, and the development of diabetes-related visual impairments, are associated with CHE (p < 0.05). Conclusion: While the prevalence of CHE among elderly individuals with diabetes and hypertension is reasonably manageable, targeted promotional efforts are still necessary to protect those at high risk.

Design, implementation, and evaluation of an innovative intelligence information management system for premature infants.

Introduction: Low birth weight is the most important condition of neonatal community health and the main cause of neonates' mortality. Identifying the indexes associated with this condition, and factors to prevent, and managing related data can help reduce the birth of premature infants to reduce the mortality rate due to this condition. The goal of present study was to design, implement and evaluate an innovative intelligence information management system for premature infants. Material and method: The present study was a multidisciplinary research that was done in 2019 to 2021 in four integrated phases in Iran. The first phase aimed to compare the current status of registration systems of premature infants through a systematic review and semi-structured interviews by using the Delphi model Then the minimum data set was determined and was designed a proposed model based on it. In the second phase, the structure and how the user interacts with the system were determined, and, using Microsoft Visio software, Unified Modeling Language diagrams were drawn to define the logical relationship of data. In the third phase, the system was developed, and finally in the last phase, in three methods, users' views on the usability of the system were evaluated. Results: The findings of this study included 233 essential data elements that were placed in two main groups of essential data, and the system was approved by end users for 87.73% consent and 67.19% satisfaction for SUMI (Software Usability Measurement Inventory) and 7.97 of 9 in QUIS questionnaire. Conclusion: This research's results can be beneficial and functional such as a complete sample for design and development of other systems concerned to health systems.

Expression of cathelicidin, ERK, MyD88, and TLR-9 in the blood of women in the pre-pregnancy, pregnancy, and their infant cord blood.

During pregnancy, the immune responses are modulated to protect mothers and infants from different pathogens. Cathelicidin as an antimicrobial peptide has a defending role against many pathogens. In this study, to better understand the role of cathelicidin peptide and three of its related proteins in immune pathways (ERK, MyD88, and TLR-9) in the immune system during pregnancy, we examined their expression in the blood of non-pregnant and pregnant mothers and their infant's cord blood. Blood samples were taken, and their peripheral blood mononuclear cells (PBMCs) were obtained. The expression level of cathelicidin was determined by quantitative PCR. Also, the expression of cathelicidin, ERK, MyD88, and TLR-9 was assessed by Western blotting. Higher level of cathelicidin mRNA was detected in the cord blood samples compared to other samples. The Western blotting results showed higher levels of cathelicidin, ERK, MyD88, and TLR-9 in the cord blood samples than in the blood of both pregnant and non-pregnant samples. Also, the level of all molecules was higher in pregnant than non-pregnant women. These high levels of the mentioned molecules are necessary to protect the mother and fetus against various pathogens, although understanding their mechanism of action needs more studies.

Knowledge, Attitudes, and Practices toward COVID-19 among Persian Birth Cohort Participants.

BACKGROUND: Knowledge, attitudes, and practices (KAP) toward COVID-19 play an important role in controlling the outbreak. The present study aimed to investigate the KAP of a group of women toward COVID-19 during the second wave of the outbreak in Iran. METHOD AND MATERIAL: A cross-sectional survey of 2862 women was conducted in May and June 2020 in two centers of Persian birth cohort. The survey instrument was a self-reported questionnaire Multivariable linear regression analysis to identify factors associated with knowledge and practice. toward COVID-19 and multinomial logistic regression analyses to identify factors associated with attitudes. Unstandardized regression coefficients (ß) and odds ratios and their 95% confidence intervals were used to quantify the associations between variables and KAP. RESULT: Good knowledge and optimistic attitudes toward the successful control of COVID-19 was seen among participants. Overall, about 57.3% (1640), 41.1% (1176), and 1.6% (46) of respondents were categorized as low (score <50%), moderate (score: 50%-80%), and high (score > 80%) proper practice, respectively. Eighty-five individuals with COVID-19 experience (3.0%) had lower knowledge score (79.91 ± 17.93 vs. 83.81 ± 13.88, P < 0.001) and lower proper practice score (40.22 ± 16.57 vs. 47.96 ± 16.15, respectively, P < 0.001) compared to those who were not infected. A higher level of knowledge was associated with appropriate practice in both groups of positive attitudes (χ2 = 32.23, P < 0.001) and negative attitudes (χ2 = 31.49, P < 0.001). CONCLUSION: This survey recorded good knowledge and relatively good attitudes among women. Special health policies plan should be taken for target populations among women during the COVID-19 pandemic.

Comparison of Gastrointestinal Complications of Paracetamol and Ibuprofen in the Management of Infants with Patent Ductus Arteriosus: A Randomized Clinical Trial Study.

BACKGROUND: Patent ductus arteriosus (PDA) is one of the more common congenital heart defects in preterm neonates. The closure of PDA can be done with ibuprofen; however, this drug is associated with many contraindications and potential side-effects. In the past years, paracetamol has been proposed for the treatment of PDA. This study was designed to evaluate the efficacy and gastrointestinal complications of paracetamol and ibuprofen for the pharmacological closure of PDA in preterm infants. METHODS: In a clinical trial study, 40 preterm infants with echocardiographically confirmed PDA were randomly assigned to receive either paracetamol (n = 23; 15 mg/kg every 6 h for 2 days) or ibuprofen (n = 17; initial dose of 10 mg/kg, followed by 5 mg/kg every 12 h for 2 days). The neonates matched for gestational age and weight. We used t-test for parametric, Chi-square for categorial, and Wilcoxson for nonparametric variables. Significant level was considered less than 0.05. RESULTS: Platelet count, BUN and creatinine levels, and closure of PDA had not significant difference between two groups (P > 0.05). Incidence and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen (P < 0.05). CONCLUSIONS: There were no differences in the rate of PDA closure between the two drugs, but with respect to complications, rate and severity of GI bleeding, feeding intolerance, and NEC were significantly more in infants who received paracetamol than ibuprofen. Therefore, paracetamol could not be used as a proper alternative agent for ibuprofen in the treatment of PDA in preterm infants.

Prevalence of COVID-19 Virus Infection in Semnan province.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) causing a human pandemic disease named COVID-19 has become a major global health concern. Iran as one of the most affected countries needs unprecedented effort for monitoring and evaluation of COVID-19. OBJECTIVE: To determine the seroprevalance of COVID-19 in Semnan province North-East of Iran. METHODS: Six hundred people were randomly selected using the "SIB data-base". From 1 to 30 June, 2020, 153 participants of Semnan population were enrolled. Blood, nasopharyngeal and oropharyngeal samples were obtained. Prevalence of IgM and IgG antibodies were ascertained using ELISA and Real-Time PCR was conducted to evaluate viral load. Estimates of prevalence were standardized by age and sex, based on the 2015 national census of Semnan province. RESULTS: Seroprevalence showed no difference between females and males and no significant association between age and seropositivity. Among total participants, the age and sex adjusted prevalence of SARS-CoV2 infection was 19.3% (95% CI, 14.0-26.7 per 100 persons). Approximately 10% of participants had detectable antibodies but showed a negative-PCR result. However, approximately 80% of participants did not show an evidence of infection. CONCLUSION: The majority of the population in Semnan province has no detectable antibodies to SARS-CoV-2. Therefore, Semnan is considered a SARS-CoV-2 susceptible area. These results emphasize the need for maintaining public health measures to tackle the new epidemic wave.

Thermal inactivation of COVID-19 specimens improves RNA quality and quantity.

The rapid spread of coronavirus disease 2019 (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2, poses a huge demand for immediate diagnosis. Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) of nasopharyngeal (NP) and oropharyngeal (OP) swabs have been used to confirm the clinical diagnosis. To avoid the risk of viral-exposure of laboratory workers, thermal inactivation is currently recommended but has unknown effects on the accuracy of the rRT-PCR results. Thirty-six NP/OP specimens were collected from COVID-19 patients and subjected to thermal inactivation (60°C for 30 min) or the RNA extraction processes to activate the form. Here, our data showed that the concentration of extracted-RNA increases upon thermal inactivation compared to the active form (p = .028).  Significantly higher levels of RNA copy number were obtained in inactivated compared to the active samples for both N and ORF1ab genes (p = .009, p = .032, respectively). Thermal inactivation elevated concentration and copy number of extracted-RNA, possibly through viral-capsid degradation and/or nucleoprotein denaturation.

Coenzyme Q10 Influences on the Levels of TNF-α and IL-10 and the Ratio of Bax/Bcl2 in a Menopausal Rat Model Following Lumbar Spinal Cord Injury.

The roles of the immune response and apoptosis as potential mediators of secondary damage in spinal cord injury (SCI) are being investigated. Research is also being done to determine the effects of female gonadal steroids, which decrease during menopause, and antioxidants, such as coenzyme Q10 (CoQ10) on SCI. We hypothesized that in the absence of female gonadal steroids, which provide protection following an SCI, CoQ10 could modulate the expression of cytokines, such as tumor necrosis factor (TNF)-α and interleukin (IL)-10, besides aquaporin-4 (AQP4) water channels in the CNS, which participate in neuroinflammation, as well as the Bax and Bcl2 proteins that are involved in apoptosis at the site of injury. The spinal cord was compressed at the level of the T10 vertebrae and rats were treated by 10 mg/kg/day CoQ10 for 3 weeks after surgery. The TNF-α and IL-10 expressions were studied using an ELISA. Western blot was used to investigate the Bax/Bcl-2 ratio, AQP4. The level of TNF-α significantly decreased following the administration of CoQ10 compared with the level of IL-10. When the treatment group was compared with the OVX-SCI group, the ratio of Bax/Bcl2 significantly decreased in the groups (P < 0.01). Based on our findings, CoQ10 could be used to compensate for the absence of the neuroprotection effects provided by female gonadal steroids via reducing the inappropriate effects of the two main pathways of secondary damage in SCI apoptosis.

A Comparison of the Effect of Nasal bi-level Positive Airway Pressure and Sigh-positive Airway Pressure on the Treatment of the Preterm Newborns Weighing Less than 1500 g Affiliated with Respiratory Distress Syndrome.

BACKGROUND: Nowadays, administering noninvasive positive airway pressure (PAP) is considered as the building block for the management of respiratory distress syndrome (RDS). Since nasal continuous PAP (n-CPAP) established its roots as an interventional approach to treat RDS, there have always been concerns related to the increased work of breathing in newborns treated with this intervention. Therefore, respiratory support systems such as nasal bi-level PAP (N-BiPAP) and sigh-PAP (SiPAP) have been developed during the last decade. In this study, two respiratory support systems which, unlike n-CPAP, are categorized as cycled noninvasive ventilation, are studied. METHODS: This study was a randomized clinical trial done on 74 newborns weighing 1500 g or less affiliated with RDS hospitalized in NICU at Al-Zahra Hospital from October 2012 to March 2014. Patients were randomly assigned to two respiratory support groups of N-BiPAP and SiPAP. Each group contained 37 newborns who were compared, according to their demographic characteristics, duration of noninvasive ventilation, the need to administer surfactant, apnea incidence, the need for mechanical ventilation, pneumothorax, intraventricular hemorrhage (IVH), patent ductus arteriosus (PDA), the duration of oxygen supplement administration, and chronic lung disease (CLD). RESULTS: The average duration of noninvasive respiratory support, and the average duration of the need for oxygen supplement had no significant difference between the groups. Moreover, apnea incidence, the need for mechanical ventilation, pneumothorax, IVH, PDA, CLD, the need for the second dose of surfactant, and the death rate showed no significant difference in two groups. CONCLUSIONS: In this study, SiPAP showed no significant clinical preference over N-BiPAP in the treatment of the newborns with RDS weighing <1500 g.

Cancer occurrence in Semnan Province, Iran: results of a population-based cancer registry.

INTRODUCTION: suitable information of different cancers in special geographic areas can help define medical programs for treatment and screening of high-risk groups. AIMS AND METHODS: The provincial health authority reported a high mortality rate from upper GI cancer in the center of Iran. A comprehensive search was undertaken to survey and register all cases of cancer during a 5-year (1998-2002) period among the indigenous population of Semnan Province. Diagnosis of cancer was based on histopathology, clinical or radiological findings, and death certificates. RESULTS: A total of 1732 patients with cancers (mean age 59.41% +/-19.08% years) were found during the study. Of these, 936(54.86%) were in males. Crude rates were 124.8/100,000 and 112.1/100,000 for males and females, respectively. Age-standardized ratios (ASRs) for all cancers in males and females were 156/100,000 and 136/100,000 person-year, respectively. Gastric cancer was the most common tumor with an incidence rate of 19.7 per 100,000 people (ASR=27.5). In upper gastrointestinal cancers, gastric cancer was the most common (47.17%), followed by colon malignancies (8.1%, 9.5 per 100,000 populations), esophagus (6.8%, 7.9 per 100,000 populations), liver (2.4%, and 2.8 per 100,000 populations). In women, breast, uterine and ovary, stomach and skin were the most common cancers. In the child population the most common tumors were of the brain, acute lymphocytic leukemia, and bone. CONCLUSION: Gastric cancer alone constitutes one-sixth of all cancers in Semnan, with the highest ASR incidence rate reported from Iran up to now.