Comparing body composition measures in children with end stage liver disease using noninvasive bioimpedance analysis.

BACKGROUND: Chronic liver disease (CLD) in children, often leads to cirrhosis and end-stage liver disease (ESLD). CLD poses significant challenges in management and prognosis. Assessing body composition, including sarcopenia, is increasingly recognized as important in understanding outcomes in this population. METHODS: We conducted a prospective observational study, involving children aged 2 to 18 years with ESLD awaiting liver transplantation. Socio-demographic, clinical, and laboratory data were collected, and body composition was assessed using Bioelectrical Impedance Analysis (BIA). Sarcopenia was defined using age-specific cut-off points for appendicular skeletal muscle mass (aSMM) and fat-free mass (FFM). RESULTS: The study included 57 children (42.1% girls, 57.9% boys; median age: 10.9 years) with liver cirrhosis. Of them 11 (19.3%) died during the study. The mean duration of living with end-stage liver disease prior to participation was 5.43 years [IQR: 3.32, 8.39]. The most common etiology was biliary atresia (24.6%), followed by cryptogenic (22.8%). Deceased children exhibited significantly higher sarcopenia prevalence, lower basal metabolic rate and growth scores compared to survivors (P < 0.05), (771.0 vs. 934.0, P = 0.166) (65.0 vs. 80.5, P = 0.005). Total body and limb-specified lean mass were lower in deceased children, although not statistically significant. Similarly, total mineral (90% normal) and bone mineral content were lower in deceased children, with a significant difference observed only in water-to-FFM percentage (72.5 vs. 73.1, P = 0.009). CONCLUSION: This study highlights the high prevalence of sarcopenia among children with ESLD and its association with adverse outcomes, including mortality. Bioimpedance analysis emerges as a promising, non-invasive method for assessing body composition in pediatric ESLD, warranting further investigation and integration into clinical practice.

Projection of the prevalence of tracheal, bronchus, and lung cancer incidence using cigarette smoking prevalence in Iran from 1990 to 2018: a comparison of latent period-based models with standard forecasting models.

BACKGROUND: Smoking is the major risk factor for tracheal, bronchus, and lung (TBL) cancers. We investigated the feasibility of projecting TBL cancer incidence using smoking incidence rates by incorporating a range of latent periods from the main risk factor exposure to TBL cancer diagnosis. METHODS: In this ecological study, we extracted data on TBL cancer incidence rates in Iran from 1990 to 2018 from the Global Burden of Disease (GBD) database. We also collected data on Iranian cigarette smoking patterns over the past 40 years through a literature review. The weighted average smoking incidence was calculated using a fixed-effects model with Comprehensive Meta-Analysis (CMA) software. Using these data, the five-year TBL cancer incidence in Iran was projected through time series modeling with IT Service Management (ITSM) 2000 software. A second model was developed based on cigarette smoking incidence using linear regression with SPSS (version 22), incorporating different latent periods. The results of these two models were compared to determine the best latent periods. RESULTS: An increasing trend in TBL cancer incidence was observed from 2019 to 2023 (first model: 10.30 [95% CI: 9.62, 10.99] to 11.42 [95% CI: 10.85, 11.99] per 100,000 people). In the second model, the most accurate prediction was obtained with latent periods of 17 to 20 years, with the best prediction using a 17-year latent period (10.13 to 11.40 per 100,000 people) and the smallest mean difference of 0.08 (0.84%) per 100,000 people using the standard forecasting model (the ARIMA model). CONCLUSION: Projecting an increase in TBL cancer incidence rates in the future, an optimal latent period of 17 to 20 years between exposure to cigarette smoke and TBL cancer incidence has implications for macrolevel preventive health policymaking to help reduce the burden of TBL cancer in upcoming years.

Trend Analysis of Suicide and Homicide Mortality and Years of Life Lost (YLL) in Children Aged 10-19 Years in the South of Iran, 2004-2019.

BACKGROUND: This study aimed to investigate mortality and years of life lost (YLL) due to suicide and homicide in children aged 10-19 years in southern Iran from 2004 to 2019. Study Design: A cross-sectional study. METHODS: The data on all deaths due to suicide and homicide in Fars province were obtained from the population-based electronic death registration system (EDRS). Crude mortality rate and YLL were calculated. The joinpoint regression method was used to examine the trend. RESULTS: During the study period, 563 cases of suicide and 218 cases of homicide in children aged 10-19 have occurred. The total number of YLL due to suicide was 9766 in men and 6261 in women. According to the joinpoint regression analysis, the trend of YLL due to suicide was increasing in males. In other words, the annual percent change (APC) was 4.8% (95% CI 0.4 to 9.5, P=0.036). Additionally, there was a constant trend in females, and APC was 2.7% (95% CI -2.0 to 7.7, P=0.241). The number of YLL due to homicide was 4890 in males and 1294 in females. The trend of YLL due to homicide was stable in males and females. In other words, APC was -1.6% (95% CI -5.6 to -2.6, P=0.422) in males and -2.7% (95% CI -10.0 to 5.2, P=0.467) in females. CONCLUSION: Based on the findings of this study, the trend of mortality rate and YLL due to suicide in men has been increasing and it has been stable in women. Moreover, the trend of mortality due to homicide was stable for both males and females. Therefore, it is necessary to take preventive actions.

The two-year epidemiological investigation of the COVID-19 pandemic in the nomadic population of Fars province, Southern Iran: An ecological study (February 20, 2020, to February 19, 2022).

Background: The COVID-19 pandemic has highlighted the vulnerability of traveling populations, yet little is known about the health status of nomadic communities. This ecological study aimed to investigate the health status of the nomadic population in Fars Province, Iran, during the first two years of the COVID-19 pandemic. Methods: Nomadic Information Registration System (NIRS) data were used to compare COVID-19 diagnostic tests, confirmed cases, referrals, hospital admissions, deaths, and vaccination coverage between the nomadic and general populations. Non-parametric chi-square test was used for data analysis. Results: In Fars Province, COVID-19 diagnostic tests were performed on 2.73 % of the nomadic population and 40 % of the general population. The test positivity rate was 23.91 % for the nomadic population and 29.3 % for the general population. The case fatality ratio (CFR) for COVID-19 was 9.24 % for the nomadic population and 1.29 % for the general population. Additionally, only 41.83 % and 24.35 % of the nomadic population had received the first and second doses of a COVID-19 vaccine, respectively, which were lower than the general population's rates of 65.65 % and 59.71 %. Conclusion: The nomadic population in Fars Province received suboptimal COVID-19 care compared to the general population.

The Trend of Years of Life Lost due to Gastrointestinal Cancers in Fars (Iran) 2004-2019.

Background: Gastrointestinal cancers can cause major health problems globally since their burden is increasing in many countries. We aimed to investigate the trend of years of life lost due to gastrointestinal cancers in Fars Province, southern Iran during the 2004-2019. Methods: In this cross-sectional survey study, we obtained the information regarding all deaths due to gastrointestinal cancers in Fars Province from the electronic population-based death registration system (EDRS). Years of Life Lost (YLL) was calculated using the YLL template of 2015 by the WHO. To examine the trend for different years, join point regression based on the log-linear model was used. Joinpoint regression analysis describes changing trends over successive periods of time and the increasing or decreasing rate within each period. Results: During the years of 2004-2019, 9742 deaths due to gastrointestinal cancers occurred in Fars Province. 6013 (61.72%) cases were male and 3729 (38.28%) cases were female (Male / Female Sex Ratio: 1.61). Overall, 4152 cases (42.63%) were due to gastric cancer and 2112 cases (21.68%) were due to liver cancer. Total years of life lost due to premature death from gastrointestinal cancers during the 16-year study period was 73565 yr (2.33 per 1000 persons) in men, 52766 yr (1.71 per 1000 persons) in women, and 126331 yr (2.02 per 1000 persons) in both sexes. Conclusion: Among all cancers, the highest mortality rates in both sexes belong to gastric cancer. This study showed the trend of YLL rate of malignant neoplasms of liver and intrahepatic bile ducts, esophagus, oral cavity, and colon cancer were increasing in both sexes, however, the trend of YLL rate for malignant neoplasms of the small intestine was decreasing in both sexes. Variation of GI cancers patterns and trends around the Fars Province indicated that a more comprehensive control plan is needed to control these variations.

Trend Analysis of Lung Cancer Mortality and Years of Life Lost (YLL) in South of Iran, 2004-2019.

Background: We aimed to determine the mortality rate and Years of Life Lost (YLL) due to lung cancer in Fars, Iran, during the period from 2004 to 2019. Methods: All deaths due to lung cancer in Fars Province, Iran from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated and trends examined. Results: During 2004-2019, 3346 deaths occurred due to lung cancer in Fars Province, which was 10.8% (3346/30936) of the total cancer deaths in this period. Crude mortality rate of lung cancer had increased 70% and 53% in male and female respectively from 2004 to 2019. The total YLL of lung cancer during the 16-year study period was 28,094 (0.9 per 1000) in men, 14,174 (0.5 per 1000) in women, and 42,268 (0.8 per 1000) in both sexes (sex ratio male/female=2). According to the join point regression, the 16- year trend of YLL rate due to premature mortality was increasing: APC was 2.5% (95% CI 0.9 to 4.2, P=0.005) for males, 1.4% (95% CI 0.3 to 2.6, P=0.017) for females. Conclusion: The mortality rate and YLL due to lung cancer in Fars Province is increasing, although the standardized mortality has a constant trend. Tobacco control is the most effective and least expensive way to reduce the number of lung cancer patients worldwide. National and local media can also play an important role in informing people about the risk factors.

Excess Deaths During the COVID-19 Pandemic in Southern Iran: Estimating the Absolute Count and Relative Risk Using Ecological Data.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic led to increased mortality rates. To assess this impact, this ecological study aimed to estimate the excess death counts in southern Iran. METHODS: The study obtained weekly death counts by linking the National Death Registry and Medical Care Monitoring Center repositories. The P-score was initially estimated using a simple method that involved calculating the difference between the observed and expected death counts. The interrupted time series analysis was then used to calculate the mean relative risk (RR) of death during the first year of the pandemic. RESULTS: Our study found that there were 5571 excess deaths from all causes (P-score=33.29%) during the first year of the COVID-19 pandemic, with 48.03% of these deaths directly related to COVID-19. The pandemic was found to increase the risk of death from all causes (RR, 1.26; 95% confidence interval [CI], 1.19 to 1.33), as well as in specific age groups such as those aged 35-49 (RR, 1.21; 95% CI, 1.12 to 1.32), 50-64 (RR, 1.38; 95% CI, 1.28 to 1.49), and ≥65 (RR, 1.29; 95% CI, 1.12 to 1.32) years old. Furthermore, there was an increased risk of death from cardiovascular diseases (RR, 1.17; 95% CI, 1.11 to 1.22). CONCLUSIONS: There was a 26% increase in the death count in southern Iran during the COVID-19 pandemic. More than half of these excess deaths were not directly related to COVID-19, but rather other causes, with cardiovascular diseases being a major contributor.

Factors associated with late initiation of antiretroviral therapy in Iran's HIV/AIDS surveillance data.

Early initiation of Antiretroviral Treatment (ART) in HIV patients is essential for effectively suppressing the viral load and prognosis. This study utilized National HIV/AIDS Surveillance Data in Iran to identify factors associated factors with the duration to initiate ART. This hybrid cross-sectional historical cohort study was conducted on Iran's National HIV/AIDS Surveillance Data from 2001 to 2019. Sociodemographic characteristics, route of transmission, HIV diagnosis date, and ART initiation date were collected. Multivariable linear and quantile regression models were employed to analyze the duration to initiate ART by considering predictor variables. This study included 17,062 patients (mean age 34.14 ± 10.77 years, 69.49% males). Multivariate quantile regression coefficients varied across different distributions of the dependent variable (i.e., duration to initiate ART) for several independent variables. Generally, male gender, injecting drug use (IDU), and having an HIV-positive spouse were significantly associated with an increased duration to initiate ART (p < 0.05). However, a significant decrease was observed in older patients, those with a university level education, men who had sex with men (MSM), and patients diagnosed after 2016 (p < 0.05). Despite improvements in the duration to initiate ART after implementing the WHO's 2016 program in Iran, various sociodemographic groups were still vulnerable to delayed ART initiation in the region. Therefore, programs including early testing, early ART initiation, active care, educational and cultural interventions, and appropriate incentives are required for these groups.

Mortality Rate and Years of Life Lost Due to Road Traffic Accidents in Fars Province, 2004-2019.

Background: Traffic accidents are one of the most critical health problems and the ninth leading cause of death globally. We aimed to determine the Mortality rate and the number of Years of Life Lost (YLL) due to road traffic accidents. Methods: In this retrospective cohort study, mortality rate and YLL due to road traffic accidents were examined in Fars province, central Iran during the years 2004-2019. Mortality statistics were collected through death registration of ministry of health and medical education for Fars Province. Age Standardized mortality Rate (ASR) was calculated and join point regression analysis carried out to examine the trend of YLL rate. Data were analyzed using Excel spreadsheet version 2016 and Join point Regression Program 4.9.0.0. Results: During the 16-year study period, 25,858 deaths due to road traffic accidents occurred in the province. 79.2% (20483 cases) were in men, and 33.7% (8703 cases) were aged 15-29 years. Total YLL during the 16-year study period were 458,975 (14.6 per 1000 people) in men, 117,999 (3.8 per 1000 people) in women. According to the join point regression, the 16- year trend of YLL rate due to premature mortality was decreasing: AAPC was -4.9% (95% CI: -8.8 to -0.9; P=0.018) for male, and -3.5% (95% CI: -6.3 to-0.5; P=0.011) for female. Conclusion: Considering that the number of deaths, mortality rate and YLL has decreased in Fars province during the 16 years under study. Therefore, because the mortality rate due to road traffic accidents in Iran is higher than the global average, the need for training programs for drivers, compliance with standards and retrofitting of vehicles, road safety, driving supervision and the use of seat belts are essential.

Comparison of Time to Report the Side Effects after AstraZeneca and Sinopharm Vaccinations in Users of the COVID-19 Symptom Study App: A Survey in South Iran.

Background: Concerns about the side effects of SARS-CoV-2 vaccines have been raised nationwide. We aimed to compare the time to report the side effects of the Oxford-AstraZeneca and Sinopharm COVID-19 vaccines. Methods: Information on side effects of AstraZeneca and Sinopharm COVID-19 vaccines was obtained from the COVID-19 Symptom Study App affiliated with Shiraz University of Medical Science during 2021. A COX regression model with an adjusted Hazard Ratio and 95% Confidence Interval; HR (95% C.I) was reported at the significance level of < 0.05. Results: 4478 and 5555 participants received the AstraZeneca and Sinopharm vaccines, respectively; more age, history of SARS-CoV-2 infection, first vaccine dose, hypertension, and hypertension with cardiovascular disease were seen in the AstraZeneca group (P < 0.05 for all). However, the AstraZeneca group had lower immune deficiency and time to report the side effects (P < 0.05 for both). There was significantly less time to pain HR(95% C.I.); 0.50 (0.47-0.52), vertigo 0.65 (0.61-0.69), weakness 0.41 (0.38-0.44), headache 0.43 (0.39-0.74), anorexia 0.31 (0.28-0.34), nausea 0.56 (0.51-0.62), severer allergy 0.71 (0.63-0.81), general inflammation 0.27 (0.23-0.31), fever > 38oC 0.12 (0.1-0.15), eye inflammation 0.45 (0.39-0.52), diarrhea 0.85 (0.73-0.99), blurred vision 0.73 (0.61-0.86), injection site redness 0.32 (0.26-0.39), fatigue/paleness 0.53 (0.50-0.57), joint pain 0.55 (0.41-0.73), auxiliary gland inflation 0.59 (0.43-0.80), convulsions 0.30 (0.17-0.52), and severe side effects 0.3 (0.27-0.33) in the AstraZeneca group; However, skin rash 0.77 (0.57-1.05) and hospitalization 0.72 (0.21-2.55) were the same. Conclusion: Sinopharm COVID-19 vaccine recipients reported longer times to report vaccine-related side effects than AstraZeneca; due to the lack of adverse effects like hospitalization, vaccination should continue to control the pandemic; more real-population studies are needed on the long-term effects of vaccination against COVID-19.

Forced inspiratory suction and swallow tool (FISST): an automation of Valsalva maneuver variants for therapeutic interventions.

INTRODUCTION: The Valsalva maneuver and its modifications have been utilized across several conditions in medicine; however, there have been difficulties in its application. Thus, at the University of Texas Health Science Center in San Antonio, we designed and patented an affordable and accessible device that mimics Valsalva called "Forced Inspiratory Suction and Swallow Tool (FISST). AREAS COVERED: In this review, we discuss the premise for the design of FISST, based on applications of the law of conservation energy, the continuity equation, and Bernoulli's principle. We then detail the mechanism by which FISST stimulates hiccup cessation by increasing negative inspiratory pressure when drinking through the apparatus, causing diaphragmatic contraction and disruption of the hiccup reflex. We then detail the efficacy and future applications of FISST in addressing other pathologies. EXPERT OPINION: FISST has been used to address hiccups by utilizing its reverse-Valsalva effect to increase parasympathetic stimulation by increasing vagal tone. In a prospective study that we conducted on a cohort of 249 hiccup subjects worldwide, this tool achieved 92% effectiveness. Additionally, several cases, including a published case report, have found FISST successful in terminating supraventricular tachycardias (SVT). FISST may be further utilized in diagnosing or addressing various upper airway pathologies and should be explored further.

The Burden of Premature Mortality in Southern Iran during 2004-2019 Using Standard Expected Years of Life Lost: A Population-Based Study.

Background: Traditionally, mortality rates are used to estimate public health problems and determine the relative significance of different causes of mortality, but they cannot necessarily determine the burden of premature death. We aimed to investigate the 16-year trend of burden of premature mortality in Southern Iran. Methods: In this cross-sectional study, all deaths due to various causes of death in Fars Province from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, Years of Life Lost (YLL) and YLL rate data were calculated and to examine the trend, joinpoint regression was used. Results: During the study period, 281,903 deaths occurred, of which, 59.85% (n=168,735) occurred in men. Also, 42.18% of these deaths (n=118,610) occurred due to cardiovascular diseases (CVDs). The total number of YLLs due to premature death was 4,154,828 years. Of these, 2,591,564 years (62.37%) were in men. The highest number of YLL was due to CVDs, external causes of death and cancer. Trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -2.1% (95% CI -2.6 to -1.6, P<0.001) for males, -0.9% (95% CI -1.4 to -0.4, P=0.002) (P=0.002) for females. Conclusion: Although the trend of premature death has been decreasing during the years of study, but the seven major causes of premature death in 2004 to 2019 were non-communicable diseases, especially ischemic heart diseases, stroke, external cause of morbidity, and cancer. Furthermore, our findings indicate a change in the role of non-communicable diseases in premature mortality in recent years.

Trend analysis of asthma mortality and years of life lost from 2004 to 2019 in Southern Iran.

Objective: Asthma is a globally important non-communicable disease with major public health consequences. The aim of this study was to determine the mortality rate and years of life lost (YLL) due to asthma in southern Iran. Methods: All deaths due to asthma in Fars province from the electronic population-based death registration system (EDRS) were obtained. Crude mortality rate, age-standardized mortality rate, YLL and YLL rate data were calculated. The JoinPoint Regression method was used to examine the trend. Results: During the 16-year study period (2004-2019), 1167 deaths due to asthma occurred in Fars province among which 54.7% (638 cases) were men and 29.6% (346 cases) were in the age group of 70-79 years. Crude mortality rate of asthma had decreased by 121% and 84% in males and females, respectively from 2004 to 2019. The total years of life lost due to asthma during the 16-year study period were 7697 (0.24 per 1000 people) in men, 6882 (0.22 per 1000 people) in women. According to the join point regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing: the annual percent change (APC) was -5.6% (95% CI -8.2 to -2.9, P = 0.001) for males, -4.4% (95% CI -7.3 to -1.4, P = 0.008) for females. Conclusion: The trend of mortality and years of life lost due to asthma has decreased significantly during the years of study, although in some age groups, especially the age group of 45-59 years which has the highest number of years of life lost, this trend has been constant and unchanged. It is necessary to conduct other studies to investigate the possible reasons for this unchanged trend in vulnerable age groups.

Unintentional injuries in children in the south of Iran, 2004-2019: a trend analysis of mortality rates.

INTRODUCTION: Injury is one of the main causes of death and disability in the world. This study was designed to determine the trend of mortality rate and years of life lost (YLLs) due to unintentional injuries in children in southern Iran. METHOD: In this cross-sectional study, we extracted all death reports due to unintentional injuries based on age, gender and the year of death based on International Classification of Diseases (ICD-10)from the Electronic Death Registration System. The YLL analysis due to premature death related to unintentional injuries was executed by the 2015 YLL template from the WHO using the Excel V.2016 software. To examine the trend of crude mortality rate and YLL rates for different years, joinpoint regression was used based on the log-linear model. RESULTS: During the 16-year study period (2004-2019), 6590 deaths due to unintentional injuries in children aged 0-19 years have occurred. The total YLLs due to unintentional injuries were 138 482 in males and 53 168 in females. The three main causes of YLLs in our study were transportation injuries (67.37%), drowning (7.19%) and burns (6.70%). According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing; the annual per cent change was -5.2% (95% CI -6.5% to -3.9%, p<0.001) for males and -4.3% (95% CI -5.7% to -3.0%, p<0.001) for females. CONCLUSION: Based on the findings of this study, the trend of mortality and YLL rate has been decreasing. Road traffic injuries were the most frequent injuries and the most common cause of death. Mortality rates fell by half. To improve child survival, injuries must now be recognised as a major child health problem, and to prevent deaths from injuries in children, early and preventive measures should be taken into account.

Epidemiological features and consequences of COVID-19 in patients with and without gastrointestinal symptoms in southwestern Iran. A retrospective observational study.

Background and Aims: Some studies have shown that in addition to respiratory symptoms, gastrointestinal (GI) manifestations reported in patients with coronavirus disease 2019 (COVID-19). The aim of this study was to compare the epidemiological features and consequences of COVID-19 in patients with and without GI symptoms. Methods: This retrospective observational study concluded on 15,323 COVID-19 patients with GI symptoms and 95,724 patients without symptoms. All symptoms and comorbidities of the patients collected. To investigate the differences between qualitative variables in the two groups, χ 2 test was used. Logistic regression analysis also used to identify determinants of mortality in patients with COVID-19. Results: During the course of the study, 111,047 cases of COVID-19 occurred. Of these, 13.8% of patients had GI symptoms, and 9.9% of deaths due to COVID-19 occurred in these patients. The most common reported GI symptoms among COVID-19 patients were nausea, vomiting, and diarrhea. In addition, comorbidities, such as diabetes, cardiovascular disease, and thyroid disease were significantly higher in patients with GI symptoms. The result of multiple logistic regression showed that the chance of mortality is higher in a patient with COVID-19 who have dyspnea, fever, cough, hypertension, cardiovascular disease, diabetes, immunodeficiency, chronic kidney disease, thyroid disease, chronic pulmonary disease, and male gender. The chance of death was lower in people with GI symptoms. Conclusion: According to the findings of this study, nausea, vomiting, and diarrhea were the most common GI symptoms. Also, the chance of death is higher in people with co-morbidities such as cardiovascular diseases, diabetes, and high blood pressure. Therefore, it is necessary to follow these people closely.

Trend Analysis of Homicide Mortality and Years of Life Lost in the South of Iran, 2004-2019.

BACKGROUND: This study was conducted to determine the mortality rate and years of life lost (YLL) due to homicide in Fars province. STUDY DESIGN: This was a cross-sectional study. METHODS: All data related to deaths due to homicide in Fars province were obtained from the Populationbased Electronic Death Registration System. Crude and age-standardized mortality rate, YLL, and YLL rate data were calculated and joinpoint regression was used to examine the trend. RESULTS: During 2004-2019, 2148 deaths due to homicide occurred in Fars province, and (1782 cases (83.0%) were men. The crude mortality rate in men decreased by 44.0% from 2004 to 2019, but a stable trend was observed in women. The total YLL due to homicide during these 16 years was 43230 (1.37 per 1000 people) in men and 8931 (0.29 per 1000 people) in women. According to the joinpoint regression analysis, the 16-year trend of the YLL rate due to premature mortality in men was decreasing, and the annual percent change (APC) was -4.00% (95% confidence interval [CI]: -6.60 to -1.20, P=0.008). However, women demonstrated stable trends in this respect, and APC was -0.50% (95% CI: -3.10 to 2.20, P=0.704). CONCLUSION: The crude and standardized mortality rates and the number of YLL due to homicide in the study period had a significant decreasing trend in men but a stable trend in women. To control this issue, officials and policymakers should identify the areas of homicide and control its risk factors such as economic and social issues, drug addiction, and the state of violence.

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study.

OBJECTIVES: Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran. METHODS: This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide. RESULTS: The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder. CONCLUSIONS: The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging.

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis.

Objective: Delayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran. Methods: This hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group. Results: The DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients. Conclusion: A simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD.

Correlation Between Diabetes and COVID-19 Indices: A Global Level Ecological Study.

Introduction: Coronavirus is threatening the global public health as a new and widespread crisis. The researchers must keep in mind that one of the most vulnerable groups to COVID-19 are the people with underlying diseases, especially diabetes. Objective: This ecological study aimed to investigate the correlation between diabetes and the epidemiological indices of COVID-19. Methods: This ecological study included 144 countries. Their available data consists of the cumulative incidence rate of cases, cumulative incidence rate of death, recovery rate, case fatality rate, and performed tests of COVID-19, and diabetes. To collect the variables, a data set was provided which included the information of 144 countries based on diabetes and COVID-19 indices. Spearman coefficients were used for assess correlation between diabetes and COVID-19 indices. Also, Scatter plots of diabetes for the studied countries were drawn based on cumulative incidence rate of cases, cumulative incidence rate of death, tests, recovery rate, and case fatality rate of COVID-19. Results: The results of this ecological study showed in total countries, there was a weak positive correlation between diabetes and cumulative incidence rate of cases and also cumulative incidence rate of death. Correlation between diabetes with test of COVID-19 was very weak. Scatter plots showed a weak liner correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death and test of COVID-19. Conclusions: In this study, there was a weak positive correlation between diabetes and cumulative incidence rate of cases, cumulative incidence rate of death, and performed test of COVID-19. This disease is an enormous challenge for health policymakers; therefore, it is necessary to develop strategies and practical guidelines specific to each region to take the necessary care, especially for diabetic patients.