Timely referral to health centers for the prevention of cardiovascular diseases: IraPEN national program.

Introduction: The IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease. Method: In this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes. Results: The total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance. Conclusion: The compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations.

The intestinal carrier status of Enterococcus spp. in children: clonal diversity and alterations in resistance phenotypes before and after admission to a pediatric intensive care unit.

BACKGROUND: This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods. METHODS: Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates. RESULTS: The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient. CONCLUSIONS: The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children.

HVAC filtration of particles and trace metals: Airborne measurements and the evaluation of quantitative filter forensics.

Filters installed in the heating, ventilation, and air-conditioning (HVAC) systems can serve as air-cleaning and sampling devices for indoor particles. The purpose of this article is to evaluate these dual roles. An occupied home with a central HVAC system equipped with a Minimum Efficiency Reporting Value (MERV, from ASHRAE Standard 52.2) 11 filter was monitored for six weeks. Weekly airborne gravimetric and real-time sampling was performed to measure the particle size distribution and the concentration of total suspended particles (TSP), PM10, PM2.5, PM1, and 12 trace metals. The weekly system runtimes were intentionally changed to provide a wide range of weekly filtration volumes. The quantitative filter forensics (QFF) concentrations of particulate matter (PM) and trace metals were calculated using the analysis of the dust collected on the HVAC filter, the filtration volume, and filter in-situ efficiency. The results indicated that filtration was not influential to remove PM and trace metals as the concentrations during the weeks with continuous HVAC operation were not consistently lower than those during the other weeks. This suggests the dominance of other particle and trace metal source and loss mechanisms weakens the influence of filtration in this home. The QFF evaluation results indicated that the concentration of TSP and over half of the tested trace metals (e.g., Pb, Cd, Ni, V, Sb, K, and Sr) could be estimated by QFF within a factor of two when compared to airborne sampling results. PM10, PM2.5, and PM1 concentrations were significantly underestimated by QFF potentially due to the limitations of size distribution analysis by a laser diffraction particle sizer (LDPS) for the detection of <1 µm particles. Overall, while QFF was promising for TSP and some trace metals, improvement in size distribution analysis could extend the application of QFF for airborne sampling.

Quantitative filter forensics: Size distribution and particulate matter concentrations in residential buildings.

We applied filter forensics, the analysis of dust from the heating, ventilation, and air-conditioning (HVAC) filters, to measure particle size distribution in 21 residences in Toronto, Canada over a year. Four filters with different nominal efficiencies (Minimum Efficiency Reporting Value (MERV) 8-14 from ASHRAE Standard 52.2) were deployed in each residence each for three months, while the effective filtration volumes (the product of flow rate, runtime, and in-situ filter efficiency) were characterized over each filter lifetime. Using extraction and laser diffraction, we found that approximately 90% of the volumetric distributions were >10 µm and the volume median diameter (VMD) ranged from 23.4 to 75.1 µm. Using quantitative filter forensics (QFF), total suspended particle (TSP) concentrations ranged from 2.9 to 823.7 µg/m3 (median = 89.8 µg/m3 ) with a moderate correlation with the content of TSP on the filters (in terms of g) and with the TSP effective filtration volume (m3 ) indicating the importance of both filter forensics and HVAC metadata parameters to QFF concentration estimates. There was no strong correlation between PM10 or PM2.5 concentrations and hourly airborne particle number concentrations measured by low-cost sensors suggesting an evaluation of QFF is warranted, particularly for the exploration of smaller particles.

How to improve Iranians' vision health: on the national policy of preventing Iranians' blindness.

AIM: To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education (MOHME). METHODS: This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders' opinions. RESULTS: Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians' vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health (SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. CONCLUSION: Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers (Behvarzes), optometrists and general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels.

Phthalates and organophosphates in settled dust and HVAC filter dust of U.S. low-income homes: Association with season, building characteristics, and childhood asthma.

Phthalates and organophosphates are ubiquitous indoor semi-volatile organic contaminants (SVOCs) that have been widely used as plasticizers and flame retardants in consumer products. Although many studies have assessed their levels in house dust, only a few used dust samples captured by filters of building heating, ventilation, and air conditioning (HVAC) systems. HVAC filters collect particles from large volumes of air over a long period of time (potentially known) and thus provide a spatially and temporally integrated concentration. This study measured concentrations of phthalates and organophosphates in HVAC filter dust and settled floor dust collected from low-income homes in Texas, United States, in both the summer and winter seasons. The most frequently detected compounds were benzyl butyl phthalate (BBzP), di-(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DnOP), tris (1-chloro-2-propyl) phosphate (TCIPP), triphenyl phosphate (TPHP), and tris (1,3-dichloroisopropyl) phosphate (TDCIPP). The median level of TCIPP in settled dust was 3- to 180-times higher than levels reported in other studies of residential homes. Significantly higher concentrations were observed in HVAC filter dust as compared to settled dust for most of the frequently detected compounds in both seasons, except for several phthalates in the winter. SVOC concentrations in settled dust in winter were generally higher than in summer, while different seasonality patterns were found for HVAC filter dust. Settled dust samples from homes with vinyl flooring contained significantly higher levels of BBzP and DEHP as compared to homes with other types of floor material. The concentration of DEHP and TDCIPP in settled dust also significantly associated with the presence of carpet in homes. Cleaning activities to remove dust from furniture actually increased the levels of certain compounds in HVAC filter dust, while frequent vacuuming of carpet helped to decrease the concentrations of some compounds in settled dust. Additionally, the size and age of a given house also correlated with the levels of some pollutants in dust. A statistically significant association between DEHP concentration in HVAC filter dust in summer and the severity of asthma in children was observed. These results suggest that HVAC filter dust represents a useful sampling medium to monitor indoor SVOC concentrations with high sensitivity; in contrast, when using settled dust, in addition to consideration of seasonal influences, it is critical to know the sampling location because the type and level of SVOCs may be related to local materials used there.

Validation of the influencing factors associated with traffic violations and crashes on freeways of developing countries: A case study of Iran.

Among the rural roads, freeways have the maximum allowable speed limit. This subject increases the tendency of drivers to use these kinds of roads, and despite its positive effects, it has caused numerous problems. One of them is the increase in the rate of traffic violations and crashes. The amount of crashes per kilometer in Iran's freeways is almost twice the other rural roads. Hence, finding a solution to this problem is of particular importance. This research intends to validate some of the influencing factors which cause traffic violations and crashes in freeways and determine their amount of influence through statistical models. For this purpose, the authors considered violations and crashes for 36 road segments as dependent variables and other factors as independent ones. Since dependent variables were count, discrete, and non-zero, the proposed models were Poisson and Zero-truncated Poisson. The processing of the models indicated that the amounts of Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) indices for the Zero-truncated Poisson model are less than those of the Poisson model and the result of the Pseudo-R2 test for this model is within the acceptable range. Moreover, the result of Chi-square test which shows the proximity of expected and observed amounts was better for Zero-truncated Poisson model. Thus, this model has a considerable advantage against Poisson model. Final models indicated that the average speed has a positive correlation with the number of violations and crashes and as it increases, they increase too. Besides, peripheral landscapes, number of interchanges, number of passing lanes, and exemption from paying toll have an opposite relationship with violations and crashes.

Intranasal Premedication Effect of Dexmedetomidine Versus Midazolam on the Behavior of 2-6-Year-Old Uncooperative Children in Dental Clinic.

OBJECTIVES: The aim of this study was to compare the intranasal premedication effect of newly introduced dexmedetomidine (DEX) versus midazolam on the behavior of uncooperative children in the dental clinic. MATERIALS AND METHODS: This crossover double-blind clinical trial was conducted on 20 uncooperative children aged 2-6 years who required at least two similar dental treatment visits. The subjects were randomly given 1 µg/kg of DEX and 0.5 mg/kg of midazolam via the intranasal route. For the sedation protocol in the two groups, 0.25 mg/kg of atropine in combination with 0.5 mg/kg of midazolam added to 1-2 mg/kg of ketamine were used 30 minutes after premedication and transferring the patient to the operating room. Dental treatments were carried out by a pediatric dentist blinded to the type of the administered premedication. The sedative efficacy (overall success rate) of the agents was assessed by two independent pediatric dentists based on the Houpt scale. Data analyses were carried out according to Wilcoxon signed-rank test and paired t-test. RESULTS: There were no significant differences in the premedication efficacy of intranasal DEX and midazolam according to the Houpt scale (P>0.05). CONCLUSIONS: Intranasal midazolam and DEX are satisfactory and effective premedication regimens for uncooperative children.

Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit.

BACKGROUND: Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient's outcome in Pediatric Intensive Care Units (PICU). OBJECTIVES: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. MATERIALS AND METHODS: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. RESULTS: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014). No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen) modifying agents (such as ranitidine or pantoprazole), presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087). Mortality rate was not statistically different between the VAP and control groups (p = 0.477). CONCLUSION: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.

A Stakeholder Perspective on Diabetes Mellitus and Diabetic Retinopathy Care in Iran; A Qualitative Study.

OBJECTIVE: To assess the national health system for management of diabetes mellitus (DM) in Iran, with particular focus on diabetic retinopathy (DR). MATERIALS AND METHODS: In this qualitative study, the national stakeholders related to DR and DM management system were invited to participate. Two researchers performed interview using a semi-structured questionnaire recommended by the World Health Organization titled "Tool for Assessment of Diabetic Retinopathy and DM Management Systems". The questionnaire contains seven different sections, each consisting of closed and open-ended questions, and a final Likert-type score, ranging from 1 indicating the worst to 4 indicating the best status. Inconsistencies were resolved through a collective decision of the research team, followed by a focus group discussion with stakeholders at the Ministry of Health. RESULTS: Fourteen stakeholders out of 15 total invitees were interviewed (response rate: 93.3%). There were national priorities, defined policies, and running programs (score = 3), but the care system should be strengthened in terms of implementation of clinical guidelines, with specific reference to the availability of regular screenings for DR (score = 2). The network of care providers, health information systems, and promotional programs were insufficient (score = 2). The health workforce and technology for DR and DM were acceptable (scores 4 and 3, respectively); however, there were concerns about the appropriate distribution and utilization of resources and out-of-pocket costs paid by patients. CONCLUSION: The existence of national policies, programs, a qualified workforce, and modern technology is promising. Nevertheless, other aspects of the health system need to be improved to ensure access to health and eye care for people with DM and achieve universal health coverage.

Effect of Perioperative Management on Outcome of Patients after Craniosynostosis Surgery.

BACKGROUND: Craniosynostosis results from premature closure of one or more cranial sutures, leading to deformed calvaria and craniofacial skeleton at birth. Postoperative complications and outcome in intensive care unit (ICU) is related to surgical method and perioperative management. This study determined the perioperative risk factors, which affect outcome of patients after craniosynostosis surgery. METHODS: In a retrospective study, 178 patients with craniosynostosis who underwent primary cranial reconstruction were included. Postoperative complications following neurosurgical procedures including fever in ICU, level of consciousness, re-intubation, and blood, urine, and other cultures were also performed and their association with the main outcomes (length of ICU stay) were analyzed. RESULTS: Factors independently associated with a longer pediatric ICU stay were fever (OR=1.59, 95% CI=1.25-4.32; p=0.001), perioperative bleeding (OR=2.25, 95% CI=1.65-3.65; p=0.01), age (having surgery after the first 5 years) (OR=1.59, 95% CI=1.33-3.54, p=0.016) and infection (OR=2.17, 95% CI=1.83-7.46; p=0.002). Mean blood loss during surgery was significantly higher in patients whose duration of ICU was longer than 4 days compare to less than 4 day (p=0.026). Amount of bleeding significantly was correlated to duration of surgery (r=0.70, p=0.001) and patient's age (r=0.23, p=0.44). CONCLUSION: perioperative management particularly blood loss could deteriorate patients outcome and length of stay in ICU and hospital. Infections in ICU could deteriorate outcomes.

Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial.

INTRODUCTION: Anesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient's physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction. PATIENTS AND METHODS: A total of 96 pediatric patients undergoing elective minor surgery (ASA 1-2) were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg) at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed. RESULTS: There was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001). The ICC scores showed that perfect score was significantly different in the PPIA and control groups (66.6% vs 6.3%; P<0.01). The STAI scores of the parents in the two groups did not differ in T0, T1, and T2. The mean parental satisfaction score was higher in the PPIA group than in the control group (7.6±7.0 vs 5.8±6.1; P<0.01). CONCLUSION: PPIA may reduce preoperative state anxiety of pediatric patients and improve quality of anesthesia induction based on ICC scores and higher parental satisfaction, but it does not impact on parental state anxiety.

Abdominal Mass Secondary to Human Toxocariasis.

Toxocariasis is an extensive helminthic infection that leads to visceral larva migrans in humans. A 2.5-year-old girl referred for abdominal mass. She had history of pharyngitis for two weeks. There were no other symptoms. Abdominal examination revealed an irregular solid mass in right lower quadrant (RLQ). Abdominal ultrasonography revealed an echohetrogenic large mass in RLQ, liver, and retroperitoneal area. Abdominal CT scan showed a huge mass. At laparotomy a large retroperitoneal mass that involved right liver lobe, bladder, ileocecal valve, small and large intestines was found. At histopathology diagnosis of toxocariasis was made.

Comparison of the Peak Inspiratory Pressure and Lung Dynamic Compliance between a Classic Laryngeal Mask Airway and an Endotracheal Tube in Children Under Mechanical Ventilation.

BACKGROUND: The present study was performed with the aim of comparing the peak inspiratory pressure and lung dynamic compliance between a classic laryngeal mask airway (LMA) and an endotracheal tube in children under mechanical ventilation. MATERIALS AND METHODS: In this study, 30 children aged 1 to 7 years with a physical condition of ASA I-II who were admitted for operations to repair inguinal hernias, hydroceles, or hypospadias were randomly enrolled. After induction of anesthesia, the appropriate laryngeal mask was used for each patient and they were placed under pressure-controlled mechanical ventilation. The peak inspiratory pressure was adjusted and recorded to obtain an appropriate tidal volume, then the laryngeal mask was removed and the appropriate size uncuffed endotracheal tube was inserted and the patient was placed again under controlled mechanical ventilation. The required settings were adjusted and peak inspiratory pressure and tidal volume were measured and recorded by the ventilator. Dynamic compliance was also calculated in both cases using the appropriate formula. RESULTS: The results showed that peak inspiratory pressure (PIP) with the use of LMA in children under mechanical ventilation was less than the PIP with the use of an endotracheal tube (p<0.05). Also, the pulmonary dynamic compliance with a laryngeal mask was greater than the use of an endotracheal tube (p<0.05). CONCLUSION: A laryngeal mask airway due to its low airway resistance and high dynamic compliance is an acceptable alternative to a tracheal tube during mechanical ventilation and it can be a good alternative to the endotracheal tube, especially during mechanical ventilation of children, in whom avoidance of barotrauma is desirable.

Skin and Neourethral Necrosis in Staged Hypospadias Repair.

Complications in hypospadias surgery are not uncommon however penile skin or flap necrosis is rarely reported. Ischemia of the flap or graft is a major complication in two stage repair of hypospadias. A 2-year old boy with proximal penile hypospadias, operated earlier for chordee correction and urethral plate formation with a preputial flap, presented for stage 2 repair. Ten days after surgery patient developed skin and neourethral necrosis. Early debridement was done followed by coverage with scrotal flaps.

Complete Urethral Duplication in Children: A Case Report.

INTRODUCTION: Urethral duplication (UD) is a rare congenital anomaly with multiple anatomical variants. CASE PRESENTATION: In this article we present a four year-old child with complete UD. The patient was admitted for hypospadias repair, in evaluation we found type IIA1 UD according to Effmann classification. Patient underwent hypospadias repair saving complete UD. CONCLUSIONS: After one year follow-up he has normal and continent urination.

Cataract surgical rate in Fars Province: Distribution and trend from 2006 to 2010.

PURPOSE: To determine changes in cataract surgical rate (CSR) in Fars Province from 2006 to 2010 and identify the contributions of public and private sectors. METHODS: This descriptive report is part of the Iranian Cataract Surgery Survey. To determine the provincial CSR, weights of major (>3000 annual surgeries) and minor (≤3000) centers were calculated based on the number of centers chosen for each year and multiplied by their numbers of surgeries. To determine public and private sectors' contributions, the numbers of surgeries in each sector were estimated based on the number of sampled centers. RESULTS: Overall, CSR improved by 25%; the number of CS decreased by 16% in the public sector and increased by 157% in the private sector. In 2006, the public sector contributed to 69% of the CSR, and by 2010, this rate had decreased to 43%. CONCLUSION: The decreasing contribution of the public sector calls for studies to identify causes and remove potential barriers.

Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis.

BACKGROUND: Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications. OBJECTIVES: This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate. PATIENTS AND METHODS: In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit's dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty. RESULTS: Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit's dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance. CONCLUSIONS: This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.

Complications of Cataract Surgery in Iran: Trend from 2006 to 2010.

PURPOSE: To determine intraoperative complications of cataract surgery over the period 2006 to 2010. METHODS: In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center's number of cataract surgeries, from which we retrieved intraoperative complications. RESULTS: The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53-6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84-5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93-5.66%) in 2006 to 2.81% (95% CI 1.3-4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25-0.87%) in 2006 and 0.46% (95% CI 0.3-0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58-0.61 days) and in complicated cases 1.14 days (95% CI 1.07-1.20 days; p < 0.001). CONCLUSION: Complications of cataract surgery in Iran had a decreasing trend during 2006-2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery.

Intraoperative Complications of Cataract Surgery in Tehran Province, Iran.

PURPOSE: To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. METHODS: Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. RESULTS: The prevalence of intraoperative complications of cataract surgery was 4.15% (95% confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11%, respectively. The prevalence of cataract surgery complications decreased from 6.95% in 2006 to 3.07% in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. CONCLUSIONS: This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age.