Effects of Intravenous Lipid Emulsion Administration in Acute Tramadol Poisoning: A Randomized Controlled Trial.

BACKGROUND: As the prevalence of tramadol toxicity is increasing, managing these patients with the aim of treatment and complete recovery has become a major challenge for health care professionals. OBJECTIVE: This study evaluated the short-term effects of IV lipid emulsion (ILE) administration in cases of tramadol poisoning. METHODS: In this double-blind, randomized controlled trial, 120 patients with pure tramadol poisoning and a Glasgow Coma (GCS) score ≤ 12 referred to a poisoning center in Tehran, Iran were selected and randomly assigned 1:1 to receive ILE 20% (intervention) or 0.9% saline (control) after admission and primary stabilization. The patient's vital signs, GCS score, hospitalization duration, and rate of seizure occurrence were recorded and compared between the two groups. RESULTS: Mean (SD) age of participants was 25.3 (5.4) years and 84 (70%) were male. Mean (SD) ingested dose of tramadol was 3118 (244) mg, which was not different between the groups. Compared with controls, the ILE group had a higher level of consciousness after treatment (median [interquartile range] GCS score 12 [10-13] vs. 10 [8-12]; p = 0.03). In addition, length of hospitalization (median [interquartile range] (2 [1-3] days vs. 4 [4-6] days; p < 0.01) and rate of seizure occurrence were lower in the intervention group (16/60 vs. 30/60; p < 0.01). CONCLUSIONS: In the setting of tramadol poisoning with a decreased level of consciousness and based on our study's findings, administration of ILE is suggested to help manage patients in hospital emergency departments. However, larger trials might be needed to confirm these findings before entering the guidelines.

xsGastrointestinal symptoms are associated with a lower risk of hospitalization and mortality and Outcomes in COVID-19.

BACKGROUND: We aimed to find the association between gastrointestinal (GI) and respiratory symptoms with mortality and hospitalization among COVID-19 patients. METHODS: We analyzed the registered data of COVID-19 patients from February 20, 2020, to March 10, 2021. Depending on the patients' disease symptoms, four categories were defined: patients with only GI symptoms, patients with only respiratory symptoms, patients with both symptoms, and patients with other symptoms. Logistic regression analysis was used to assess the association of groups with outcomes. RESULTS: A total of 42,964 patients from 23 hospitals were included, of which 26.5% patients had at least one or more GI symptoms. Of total patients, 51.58% patients were hospitalized among which 22.8% had at least one or more GI symptoms. GI symptoms significantly decreased the odds of mortality (OR 0.72, 95% CI 0.56-0.92), but respiratory symptoms increased the odds for mortality (1.36: 1.24-1.50), compared with patients with other symptoms. Moreover, the odds ratio of patients who had both respiratory and GI symptoms increased (1.52: 1.31-1.78) compared with patients with other symptoms. The same results were observed for hospitalization as the outcome. CONCLUSIONS: Our study showed that the presence of GI symptoms in COVID-19 at the time of admission was associated with a lower odds of hospitalization and mortality; however, this association had higher odds for respiratory symptoms.

Comparing the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID-19 patients.

The purpose of this study was to compare the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID-19 patients based on clinical and laboratory parameters. We prospectively evaluated the clinical and laboratory outcomes of 62 moderate to severe COVID-19 patients during a 10-day treatment plan. Patients were randomly assigned to either KH (receiving Lopinavir/Ritonavir [Kaletra] plus Hydroxychloroquine) or ADH (receiving Atazanavir/Ritonavir, Dolutegravir, and Hydroxychloroquine) groups. During this period, clinical and laboratory parameters and outcomes such as intensive care unit (ICU) admission or mortality rate were recorded. Compared to the KH group, after the treatment period, patients in the ADH group had higher activated partial thromboplastin time (aPTT) (12, [95% confidence interval [CI]: 6.97, 17.06), p = <0.01), international normalized ratio (INR) (0.17, [95% CI: 0.07, 0.27), p = <0.01) and lower C-reactive protein (CRP) (-14.29, (95% CI: -26.87, -1.71), p = 0.03) and potassium (-0.53, (95% CI: -1.03, -0.03), p = 0.04) values. Moreover, a higher number of patients in the KH group needed invasive ventilation (6 (20%) vs. 1 (3.1%), p = 0.05) and antibiotic administration (27 (90%) vs. 21(65.6), p = 0.02) during hospitalization while patients in the ADH group needed more corticosteroid administration (9 (28.1%) vs. 2 (6.7%), p = 0.03). There was no difference in mortality rate, ICU admission rate, and hospitalization period between the study groups. Our results suggest that the Atazanavir/Dolutegravir treatment regimen may result in a less severe disease course compared to the Lopinavir/Ritonavir treatment regimen and can be considered as an alternative treatment option beside standard care. However, to confirm our results, larger-scale studies are recommended.

Spatio-temporal analysis of Pertussis using geographic information system among Iranian population during 2012-2018.

Background: In spite of existing vaccination programs in many countries, outbreaks of pertussis are still reported. In Iran, the suspected and confirmed cases of pertussis are reported annually. Due to the lack of similar studies, the purpose of the current study was to determine the Spatio-temporal distribution of Pertussis using Geographic Information System (GIS) to identify high-risk areas in Iran during 2012-2018. Methods: In the current cross-sectional study, registered data in the department of vaccine-preventable diseases in the Iranian ministry of health were used. To assess the temporal trend, the Cochran-Armitage test was used. To show the spatial distribution and to identify hotspot areas, Choropleth map and Getis-Ord Gi statistics were used. All analyses performed by Arc.map10.5, Stata 15 and Excel 2010. Results: The incidence of suspect pertussis cases had an increasing trend but did not have a linear trend (p=0.06). Most of the cases happened in under 1 year infants (62.66%). The incidence of reported cases in northern areas was higher than in the Southern areas. The Zanjan had the most reported cases during the understudied period with a median of 7.63 reported cases per 100,000. The clustering of infection and hotspots were identified in northern areas of Iran including Qazvin, Qom, Markazi, and Hamadan. Conclusion: Our results showed that the cumulative incidence of reported cases is increasing. The northern provinces had the highest incidence of Pertussis. Therefore, the causes of this spatio-temporal pattern of pertussis should be determined. Also, supervision on vaccination programs in high-risk areas is recommended.

The effect of a 12-week combinational exercise program on CD4 count and mental health among HIV infected women: A randomized control trial.

BACKGROUND/OBJECTIVE: There are conflicting results regarding the effects of exercise on immune function of HIV positive patients. Exercise can also be beneficial to psychological functioning of the patients. The purpose of this study was to determine the impact of a 12-week aerobic and resistance exercise training program on mental health and CD4 counts among female HIV+ patients. METHODS: This clinical trial was conducted between September and December 2013. Forty participants (women age range 20-40) were carefully selected from 240 HIV-positive women referred to Voluntary Counseling and Treatment Center (VCT) and randomly assigned to either exercise (80 min of aerobic and strength training while receiving the VCT's routine services) group (n = 20) or control (received the VCT's routine services only) group (n = 20). To assess their mental health status, all participants completed GHQ28 questionnaire. Blood samples were collected to measure CD4 and T-cell counts at baseline and at the end of the 12-week intervention. RESULTS: From a sample of 40 women with HIV infection, the data of 30 participants [experimental group (14) and control group (16)] were analyzed (participation rate 75%). The results indicated that after the intervention program, a significant difference in CD4 cell counts was found between the two groups (P = 0.01). With regard to mental health, after performing intervention, significant improvement in all subscales including anxiety disorder, social function, depression and mental health's total score was observed in the exercise compared to the control groups (P < 0.001). CONCLUSION: Exercise training can be included in health care services in order to improve the mental health status of women with HIV infection. No effect on CD4 count was detected.

Subgroup dairy products consumption on the risk of stroke and CHD: A systematic review and meta-analysis.

Background: There is no global consensus about the relationship between dairy consumption and cardiovascular diseases (CVD). This study aimed at integrating the results of several studies to predict the dairy effects on CVD, e.g. stroke and CHD. Methods: In the present study, some major databases such as Scopus, Science Direct, and PubMed were searched up to September 2014. All prospective cohort studies dealing with dairy products consumption and CVD were surveyed regardless of their publication date or language. This reference population includes all individuals without any delimitation with regard to age, gender, or race. The quality of the study was evaluated using STROBE Checklist. Study selection and data extraction were done by 2 independent researchers separately. The indices in this study were RR and HR. The random model was used to combine the results. Results: Out of 6234 articles, 11 were included in the meta-analysis. No relationship was found between stroke and consumption of milk, cream, and butter, and the results are as follow: RR = 0.91 (95%CI: 0.81-1.01) for milk, RR = 0.97 (95%CI: 0.88-1.06) for cream, and RR = 0.95 (95%CI: 0.85-1.07) for butter. However, cheese was found to decrease stroke risk: RR = 0.93 (95%CI: 0.88-0.99). The relationship of CHD with consumption of milk, cheese, cream, and butter are as follows, respectively: RR = 1.05 (95% CI: 0.96- 1.15), RR = 0.90 (95%CI: 0.81-1.01), RR = 0.96 (95% CI: 0.87-1.06), and RR = 0.99 (95%CI: 0.89-1.11). In other words, no relationship existed between dairy products and CHD. Conclusion: No relationship was found between consumption of various dairy products and CHD or stroke, except for cheese that decreased stroke risk by 7%. Considering the small number of studies, the result of the present study is not generalizable and more studies need to be conducted.

Determinants of maternal mortality in Eastern Mediterranean region: A panel data analysis.

BACKGROUND: As one of the main criteria of health outcomes, maternal mortality indicates the socioeconomic development level of countries. The present study aimed at identifying and analyzing the effective factors on maternal mortality in Eastern Mediterranean Region (EMR) of the World Health Organization (WHO). METHODS: Analytical model was developed based on the literature review. Panel data of 2004-2011 periods for 22 EMR countries was used. Required data were collected from WHO online database. Based on results of diagnostic tests for panel data model, parameters of model were estimated by fixed effects method. RESULTS: Descriptive statistics demonstrated the large disparities in social, economic, and health indicators among EMRO countries. Findings obtained from evaluating the model showed a negative, significant relationship between GDP per capita (ß=-0.869, p<0.01), health expenditure) ß=-0.525, p<0.01 (female literacy rate) ß=-1.045, <0.01 (skilled birth attendance) ß=-0.899, p<0.05) and maternal mortality rate. CONCLUSION: Improved income and economic development, increased resources allocated to the health sector, improved delivery services particularly the increased use of trained staff in the delivery, improve quality of primary care centers, mitigating the risks of marginalization and its dangers, and especially improving the level of women's education and knowledge are the key factors in policy making related to maternal health promotion.

Health-related quality of life and its related factors in HIV(+) patients referred to Shiraz Behavioral Counseling Center, Iran in 2012.

BACKGROUND: HIV/AIDS is known to affect an individual not only physically but also mentally, socially, and financially. It is a syndrome that builds a vacuum in a person affecting his/her life as a whole. Nowadays, using anti-viral medication delays the onset of the disease cycle and increases the patients' life time. From the psychological point of view, however, such patients are faced with a great number of social and cultural limitations which affect various dimensions of their health as well as quality of life. Therefore, the present study aimed to investigate the quality of life and its related factors in HIV patients in Shiraz Behavioral Counseling Center. METHODS: The present analytical cross-sectional study was conducted on 129 HIV patients in Shiraz Behavioral Counseling Center who were selected through convenience sampling. The data were gathered using demographic as well as SF-36 questionnaires and analyzed through T-test, ANOVA, X(2), and Schiff's post hoc test. RESULTS: In this study, the patients' mean score of quality of life was 48.8+14. In addition, the mean scores of males' and females' life quality were 47.7+16.2 and 59.5+20.4, respectively and the difference was statistically significant (p<0.05). The mean difference of the patients' quality of life was also found to be significant based on employment status, marital status, and history of drug abuse (p<0.05), while it was not significant regardin gage, level of education, length of disease, and the distance between the house and the service providing center. CONCLUSION: In comparison to the physical dimension, the HIV-positive individuals' quality of life mean score was lower in the mental dimension. In addition, the mean difference revealed to be significant based on marital as well as employment status. These findings show such patients' needs for psychological support, more psychological interventions, and creation of appropriate job opportunities.

Epidemiologic characteristics of HIV-positive patients referring to behavioral diseases consultation center in Shiraz, Iran.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) was firstly reported from California and soon became a pandemic in the world. This disease poses serious threats to humans' health. In this study, we intended to examine the characteristics of HIV-positive patients who referred to the Behavioral Diseases Consultation Center (BDCC) in Shiraz, Iran. METHODS: This was a cross-sectional descriptive study. HIV-positive patients, referring toBDCC of Shiraz University of Medical Scienceswere the population under the study. The data, collected through a checklist, were encoded and entered in to the SPSS 19. Then descriptive statistics such as mean, median, standard deviation and range were used to describe the variables. Also, the relationships between the variables were tested using X2 test. RESULTS: The mean and median age of the HIV-positive patients were 39 + 8.7 and 38years, respectively.Nearly327 (65.4%) of the studied population were male and 173 (34.6%) were female. With respect to marital status, 225 (45%) participants were married, 133 (27%) were single, 91 (18.2%) were divorced and 49 (9.8%) were widowed. Also, 265(53%) of the participants were infected through injection drug use, 198 (39.6%) through sexual route, 7 (1.4%) through blood and blood products, 6 (1.2%) through tattoos and 21 (4.2%) by other routes. Most of the participants had a HIV-positive history in their family, and 145 (29%) mentioned that their wives were HIV-positive. Moreover, 320 (62.7%) of the participants had a positive history of drug use, 176 (35.2%) did not have a history of drug abuse, and the status of 10 (2%) participants was not recognized. CONCLUSION: Although the results of this study highlighted that injection addiction remains the major transmission route inIran, the role of sexual transmission should be acknowledged in the future.

Spatio-temporal analysis of deaths from carbon monoxide poisoning in Iran between 2011 and 2018: An ecological study.

Background and Aims: Mortality caused by carbon monoxide every year threatens the lives of Iranian people, whose spatial and temporal distribution is not known for formulating prevention policies and interventions. This study was conducted to determine the trend of mortality rate changes due to carbon monoxide CO poisoning by Spatio-temporal analysis in Iran from 2011 to 2018. Methods: An ecological study was conducted based on data from the reports at the National Center for Statistics of Iran for 8 years from 21 March 2011 to 21 March 2018. The number of deaths due to CO poisoning and the annual mortality rates of CO poisoning per 100,000 populations were calculated. To determine the geographical and temporal distribution of death caused by carbon monoxide, spatiotemporal statistical analysis was used. Results: A total of 6078 deaths were reported due to CO poisoning 4497 deaths were male (74%) and 1596 were female (26%) from 2011 to 2018. Both sexes' mortality rate due to CO poisoning was 1.26 from 2011 to 0.91 in 2018. According to the results, the overall male-to-female ratio was 2.8. The mortality rate due to CO Poisoning had a decreasing trend. However, this trend did not have a linear trend (p = 0.37). The highest mortality due to CO poisoning was seen in the northern and western provinces of Iran. Conclusion: Our results showed that the mortality rate due to CO poisoning had a decreasing trend during the understudied period. Also, most of the deaths due to CO poisoning occurred in the northern and western provinces of Iran. So, designing prevention programs as well as increasing people's awareness in these regions is recommended.

Forty-seven year trend of measles in Iran: An interrupted time series analysis.

Background and Aim: Measles is an acute viral infectious disease usually characterized by erythematous maculopapular rash and sometimes pneumonia, diarrhea, and Central Nervous System disturbance. The current study aimed to describe the trend of measles in Iran before and after the 1978 revolution and COVID-19 pandemic. Methods: In the current quasi-experimental study, we used annual data on confirmed cases of measles in Iran, from 1974 to 2021. Data were extracted from the World Health Organization website. An interrupted time series model was used to assess the effect of different events on the incidence of measles. Results: The trend of new cases increase every year until 1980 according to the preintervention slope of 2040 (95% confidence interval [CI] = -1965-2045; p < 0.31). After Iran's revolution, the occurrence of new cases significantly decreased (-845 [95% CI = -1262 to -432; p = 0.001]). After the COVID-19 pandemic, the trend of new cases significantly increased (41 [95% CI = 12-70; p = 0.006]). Conclusion: It seems that social or health-related events are among the effective factors on the incidence of measles. But with maintaining vaccination coverage in the community and vaccination of immigrants, this fluctuation in the disease trend can be decreased.

Performance of discrete wavelet transform-based method in the detection of influenza outbreaks in Iran: An ecological study.

Background and Aim: Timely detection of outbreaks is one of the main purposes of the health surveillance system. The presence of appropriate methods in the detection of outbreaks can have an important role in the timely detection of outbreaks. Because of the importance of this issue, this study aimed to assess the performance of discrete wavelet transform (DWT) based methods in detecting influenza outbreaks in Iran from January 2010 to January 2020. Methods: All registered influenza-positive virus cases in Iran from January 2010 to January 2010 were obtained from the FluNet web base tool, the World Health Organization website. The combination method that includes DWT and Shewhart control chart was used in this study. All analyses were performed using MATLAB software version 2018a Stata software version 15. Results: The Mean ± SD and median of reported influenza cases from January 2010 to January 2020 was 36 ± 108 and four cases per week. The combination of the DWT and Shewhart control chart with K = 0.25 had the most sensitivity. The most specificity in the detection of nonoutbreak days was seen in the combination of DWT and Shewhart control chart with K = 1.5, K = 1.75, and K = 2, respectively. The combination of DWT and Shewhart control chart with K = 0.5 had the best performance in the detection of outbreaks (sensitivity = 0.64, specificity: 0.90, Youden index: 0.54, and area under the curve [AUC]: 0.77). Conclusion: The DWT-based method in detecting influenza outbreaks has acceptable performance, but it is recommended that this method's performance be assessed in detecting outbreaks of other infectious diseases.

Occupational needle stick injuries and related factors among healthcare workers in military hospitals in Tehran.

AIM: Healthcare workers (HCWs) are always at risk of experiencing occupational needle stick injuries (NSIs). The primary aim of this study was to assess the prevalence of NSIs among Iranian HCWs in military hospitals in Tehran. DESIGN: This cross-sectional study was conducted in four military hospitals in the summer of 2019 in Tehran. METHOD: By Census, 802 HCWs were included. Data were collected through a questionnaire consisting of vaccination history, safety equipment, use of safety box, history of NSIs and demographic variables. The logistics regression was used to estimate the odds ratios (OR) and 95% confidence interval (CI). The statistical significance level was set at 5%. The data were analysed using the SPSS software version 23. RESULTS: A total of 203 (25.3%, CI: 22.3-28.4) of the participants reported a history of NSIs at least once during the past year. Single HCWs had a higher risk of NSIs compared to married HCWs (OR: 1.59, 95% CI (1.09, 2.30)). Also, the night shift working (OR: 1.91, 95% CI (1.18, 3.12)), higher educational degree (OR: 2.25, 95% CI (1.21, 4.20)), working overtime (OR: 1.50, 95% CI: (1.07, 2.12)), older age (OR: 1.02, 95% CI (1.01, 1.04)) and needle recapping (OR: 2.90, 95% CI: (1.98, 4.22)) were identified as significant associated factors. The study draws attention to a relatively high prevalence of NSIs as well as high-risk activities among military HCWs. The primary source of NSIs is needle recapping. Measures such as setting up training courses for the military HCWs are needed to be planned.

Is single point HbA1c a reliable predictor for death in severe COVID-19?

Introduction: The severity of COVID-19 infection is affected by several risk factors such as Diabetes Mellitus (DM). The current study aimed to determine the effect of single-point HbA1c on the severity and mortality of hospitalized COVID-19 patients. Methods: This cross-sectional study was conducted among hospitalized moderate and severe COVID-19 patients in Baharloo Hospital in Iran between December 23rd and February 23rd, 2021. The patients have been diagnosed by Polymerase Chain Reaction (PCR) and Chest Computed Tomography (CT) imaging as COVID-19. Demographic data, clinical presentation, laboratory results, and treatments along with the HbA1c data were included. Results: 165 COVID-19 cases were included in this study; 126 (76.4%) of which were severe cases. 89 (53.9%) patients were male, with a mean age of 59.89 ± 16.59 years. Severe COVID-19 patients were more prone to a longer hospital stay, and a higher level of inflammatory mediators, compared to the moderate COVID-19 patients (p < 0.05). No significant association was found between single point HbA1c, FBS, and severity and mortality of COVID-19 cases (p > 0.05). Conclusions: Single point HbA1c was not a reliable mediator for the prediction of severity or death in hospitalized COVID-19 patients.

Prevalence of Amiodarone Induced Hypothyroidism and Hyperthyroidism in Patients with Heart Diseases: A Systematic Review and Meta-Analysis.

BACKGROUND: Due to the importance of amiodarone-induced hyperthyroidism in patients with heart failure, the purpose of the present systematic review and metaanalysis was to determine the prevalence of thyroid dysfunction (hypothyroidism and hyperthyroidism) in patients with heart disease who received amiodarone. METHODS: Electronic databases including Scopus, PubMed, Web of Science, and Science Direct were searched by two investigators. To assess the heterogeneity between the included studies, the chi-square χ2 test (α=0.05) and I2 index were used. Additionally, a random-effects model with 95% CI was used to estimate the pooled prevalence of thyroid dysfunction due to the heterogeneity of the studies. To identify the cause of heterogeneity, a meta-regression analysis was employed. All analyses were performed using Stata ver13 (Stata Corporation, College Station, TX, USA). RESULTS: The pooled prevalence of hypothyroidism was 23.43% (95% CI: 11.54-35.33) and hyperthyroidism was 11.61% (95% CI: 7.20-16.02). There was no significant association between the prevalence of hypothyroidism and the year of the study (p=0.152), sample size (p=0.805), and mean age of subjects in the sample groups (p=0.623). However, there was a significant association between the prevalence of hyperthyroidism and the year of the study (p=0.037), but no statistically significant association between either the prevalence of hyperthyroidism and sample size (p=0.425), or the prevalence of hyperthyroidism and the mean age of subjects in the sample groups (p=0.447). CONCLUSION: The prevalence of thyroid dysfunction in patients with cardiac arrhythmias receiving amiodarone was considerable. Extreme care should be exercised to improve the monitoring of any thyroid abnormalities that may arise in patients receiving amiodarone.

The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019.

Importance: Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. Objective: To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. Evidence Review: The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. Findings: In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia. Conclusions and Relevance: In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

Effect of epidemic management and control plan on COVID-19 mortality in Iran: an interrupted time series analysis.

Background: Globally, several measures have been taken to decrease COVID-19 mortality. However, the effectiveness of preventive measures on the mortality related to COVID-19 has not been fully assessed. Thus, the present study aimed the present study aimed to assess the success of COVID-19 epidemic management and control plan on the mortality associated with COVID-19 in Iran from February 19, 2020, to February 5, 2021. Methods: In the current quasi experimental study an interrupted time series analysis of daily collected data on confirmed deaths of COVID-19 occurred in Iran and in the world, were performed using Newey ordinary least squares regression-based methods. Results: In Iran, the trend of new deaths increased significantly every day until 24 November 2020 according to pre-intervention slope of [(OR 1.14, 95% CI 0.96-1.32,); P < 0.001]. The occurrence of new deaths had a decreasing trend after November 24, 2020, with a coefficient of [(OR -5.12, 95% CI -6.04 - -4.20), P < 0.001)]. But in the global level daily new deaths was increasing before [(OR 18.66, 95% CI 14.41-2292; P < 0.001)] and after the 24 November 2020 [(OR 57.14, 95% CI 20.80-93.49); P: 0.002]. Conclusions: Iranian COVID-19 epidemic management and control plan effectively reduced the mortality associated to COVID-19. Therefore, it is essential to continue these measures to prevent the increase in the number of deaths.

Global COVID-19 vaccine acceptance rate: a systematic review and meta-analysis.

Aim: Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates. Subject and methods: International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to pool estimate vaccine acceptance rates. Results: The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1-70.1; P < 0.001, I2 = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5-74.5; P < 0.001, I2 = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8-64.1; P < 0.001, I2 = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1-57.0)), and the highest coverage rate was (85% (71-99.1)) in South America. Conclusion: COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate.

COVID-19: Clinical features, case fatality, and the effect of symptoms on mortality in hospitalized cases in Iran.

Objective: Identifying the epidemiological characteristics of COVID-19 could help to control the pandemic. The aim of this study was to characterize the epidemiological features of hospitalized COVID-19 patients in Iran. Methods: Data were collected on patients admitted to a military referral hospital in Tehran, Iran, from February 8, 2020 to July 28, 2021. Sex, age, clinical symptoms, outcome, type of comorbidities, level of blood Spo2, time of admission, and time of discharge were investigated. Sex ratio, case fatality rate (CFR), and daily trends of hospital admissions and deaths were also determined. Descriptive statistics and multiple logistic regression with 95% confidence intervals were used for data analysis. The statistical significance level was set at 0.05. STATA16.0 and Excel 2010 were used for data analysis. Results: The median hospital length of stay (LOS) was 6 days. The following symptoms were most common: cough (63.5%), fever (50%), respiratory distress (46.1%), and muscular pain (40.8%). Hypertension (29.5%), diabetes (24.7%), and cardiovascular diseases (21.8%) were the most prevalent comorbidities. The CFR was calculated at 8.30%. Respiratory symptoms increased the odds of death by 45% (OR 1.45, 95% CI 1.03-2.06). Gastrointestinal symptoms were associated with a reduction in the mortality of COVID-19 cases, but this association was not statistically significant (OR 0.94, 95% CI 0.73-1.21). Conclusions: The results of this study emphasize higher mortality rates among older age groups, male patients, and patients with underlying diseases.

Platelet-rich plasma in the treatment of scars, to suggest or not to suggest? A systematic review and meta-analysis.

Despite the rising trend for applying platelet-rich plasma (PRP) in the management of various types of scars, there is no convincing evidence supporting its use. This motivated us to review the randomized clinical trials that examine the effectiveness and safety of PRP, alone or in combination with other methods, for the management of atrophic or hypertrophic/keloidal scars. The Web of Science, Scopus, Google Scholar, and Cochrane Library databases were systematically searched until September 1st , 2020. Thirteen clinical trials were enrolled in the meta-analysis, and 10 more were reviewed for their results. The random effect meta-analysis method was used to assess the effect size of each outcome for each treatment type, and I2 was used to calculate the statistical heterogeneity between the studies. Patients treated with PRP experienced an overall response rate of 23%, comparable to the results seen with laser or micro-needling (22% and 23%, respectively) When used alone, moderate improvement was the most frequently observed degree of response with PRP (36%) whereas, when added to laser or micro-needling, most patients experienced marked (33%, 43%, respectively) or excellent (32% and 23%, respectively) results. Concerning the hypertrophic/keloid scars, the only study meeting the required criteria reported a better improvement and fewer adverse effects when PRP was added to the intralesional corticosteroids. Platelet-rich plasma appears to be a safe and effective treatment for various types of atrophic scars. In addition, when added to ablative lasers or micro-needling, it seems to considerably add to the efficacy of treatment and reduce the side effects.