Economic burden of diabetic foot ulcer: a case of Iran.

BACKGROUND: Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran. METHODS: In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19). RESULTS: The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs). CONCLUSIONS: DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden.

Isolated tuberculosis of testis: A case report.

BACKGROUND: Extrapulmonary tuberculosis accounts for only 15% of new cases of tuberculosis. In extrapulmonary tuberculosis, usually affected areas include bone, pleura, lymph nodes, genitourinary system, joints, peritoneum and meninges. Tuberculosis epididymo-orchitis is an uncommon type of extrapulmonary tuberculosis. CASE PRESENTATION: We reported a case of tuberculosis epididymo-orchitis and involvement of the left testicle in a 37-year-old male patient. The left testicle had a heterogeneous parenchymal echo, and multiple hypo-echo and ill-defined areas were evident in the left testicle. In the color Doppler ultrasound, the left testicle with the epididymis on both sides was completely hyperemic. The findings were primarily in the favor of extrapulmonary tuberculosis. Therefore, after a 2-month first-stage treatment with four-drug therapy of anti-TB drugs such as rifampin 150 mg, isoniazid 75 mg, pyrazinamide 400 mg and ethambutol 275 mg, considering the weight of the patient (56 kg), 4 pills per day and the second phase with two-drug therapy, rifampin 150 mg and 75 mg of isoniazid, 4 pills per day for 4 months, extrapulmonary tuberculosis symptoms improved to a large extent. CONCLUSION: To prevent epididymectomy and the effects that the disease may have on fertility, it should be tried to quickly diagnose and treat the disease at the same early stage of the disease.

Evaluating the association between neonatal mortality and maternal high blood pressure, heart disease and gestational diabetes: A case control study.

BACKGROUND: Prevention of noncommunicable diseases (NCDs) during pregnancy is recommended due to severe complications for mothers and infants. Considering that NCDs have a significant impact on infant mortality, this study was conducted to investigate the relationship between mothers' underlying diseases and gestational diabetes and infant mortality in Iran. MATERIALS AND METHODS: Mothers who referred to the health centers in nine provinces of Iran were included. This case-control study used data collected from pregnant women. There were 1162 cases and 1624 controls. The required data were collected from mothers' health records and through interviews. RESULTS: The chances of neonatal mortality in women with a body mass index (BMI) of 30-35, 1.7 times (odds ratio [OR] = 1.7, confidence interval [CI]: 1.19-2.44, P = 0.003) was higher compared with women with a normal BMI. The chance of neonatal mortality among mothers with high blood pressure was three times higher compared with healthy mothers (OR = 3.04, 95% CI: 1.98-4.65, P < 0.001). The chance of neonatal mortality in women with kidney disease was also 1.64 times higher than mothers without kidney problems (OR = 1.64, 95% CI: 1.1-2.45, P = 0.015). In the study of gestational diabetes, the chance of neonatal mortality among the mothers who had at risk was 1.63 times higher than mothers without gestational diabetes (OR = 1.63, 95% CI: 0.84-3.16, P = 0.014). Furthermore, the chance of neonatal mortality among the mothers who had heart disease was 1.10 times higher than mothers without heart disease (OR = 2.10, 95% CI: 0.88-4.99, P = 0.014). CONCLUSION: This study showed that undiagnosed underlying diseases were related to neonatal mortality, which highlights the importance of caring for and counseling about the underlying diseases, screening, and controlling blood sugar levels before and during pregnancy to prevent infant mortality by all means possible.

Community health assessment: Knowledge, attitude and practice of women regarding water-pipe smoking in Bandar Abbas.

Based on the results of seventh round of community health assessment (CHA) in suburban areas of Bandar Abbas, "water-pipe smoking in women" was one of the major concerns of community members. Therefore, the present study designed to assess the knowledge, attitude and practice of women towards water-pipe smoking and related factors. High consumption of water-pipe among women was ranked as a prioritized health problem. To diagnose the problem, for creating action plan, the present cross - sectional study was conducted on 205 women aged over 18 randomly selected from Green-Tree region in suburb of Bandar Abbas city. All statistical analyses were performed using SPSS 24 software with 5% as the significant level. 205 women with a mean age of 36.9 (standard deviation:12.86) years, and a water-pipe prevalence of 15.1% were analyzed. The significant predictors of knowledge were educational level (ß = 0.182, p-value = 0.037), and being water-pipe smoker (ß = -0.251, p-value < 0.001); while for attitude they were educational level (ß = 0.221, p-value = 0.002), family size(ß = 0.152, p-value = 0.023), and subjective social status(ß = 0.149; p-value = 0.035); and for practice they was smoking waterpipe in parents (ß = -0.276, p-value < 0.001).The development action plans based on "CHA" could improve public health and enhance the performance of the community through improved education, policies and health interventions.