The Effect of Short-Term Treadmill Exercise on the Expression Level of TFAM in the Heart of Nicotine-Sensitized Rats

Introduction: TFAM (mitochondrial transcription factor A) is involved in mitochondrial biogenesis and induces anti-oxidant and anti-apoptotic effects. Nicotine can also alter the function of cardiovascular system and induce heart failure and other heart diseases. Interestingly, it has been reported that exercise can interfere with the effects of nicotine, and change the expression pattern of different genes. The goal of the present study was to investigate the effect of short-term treadmill exercise on the expression level of TFAM in the heart of nicotine-sensitized rats.Materials and Methods: Nicotine was administered intraperitoneally at the dose of 0.21 mg/kg. Treadmill exercise was performed during 14 days, according to the study’s protocol.Results: The results revealed that nicotine reduced the expression of TFAM. The treadmill (Fourteen-day training) increased the expression of TFAM in the heart of the control rats. Furthermore, 14-day training with treadmill restored the effect of nicotine on the expression of TFAM in nicotine-sensitized rats.Conclusion: Nicotine induced pro-apoptotic and anti-oxidative stress effects via down-regulating the expression of TFAM. Fourteen -day training with treadmill induced a protective effect against nicotine-induced cardiac apoptosis and oxidative stress, via restoring the effect of nicotine on TFAM. The results are indicative of the fact that short-term treadmill exercise may decrease the risk of heart failure and other cardiac diseases. 

Prevalence of Common Methods of Suicide among Iranian Men; a Systematic Review

Background: Suicide is one of the public health problems with a high rate worldwide. Sex is a risk factor for successful suicide, making it the seventh leading cause of death in men in the United States. Based on the increasing suicide rate in Iran, we aimed to investigate the common methods of suicide in Iranian men. Methods: This study is a systematic review with subgroup analysis based on the prevalence of methods of suicide in Iranian men during 2009-2019. Specific keywords based on medical subject headings (MeSH) were searched in Iranian and international databases including PubMed, Scopus, Google Scholar, SID, and MagIran by designing a search strategy. Selected studies were reviewed using the study evaluation tool. For data analysis, STATA software version 14 was used. Also, heterogeneity studies by Q and I2 statics were assessed. Results: In the first phase, 529 studies were extracted, and finally, data were extracted from 19 studies. Because of the heterogeneity of the studies, meta-analysis was not possible and the final results were extracted based on subgroup analysis. Drug abuse was the most common method of suicide and the use of firearms was the least prevalent among Iranian men. Conclusion: Currently, the most common method of suicide in Iranian men is drug abuse. Therefore, it is recommended to design preventive interventions based on gender and take into account commonly available methods

The Frequency of Alcohol Use in Iranian Urban Population: The Results of a National Network Scale Up Survey

Background: In Islamic countries alcohol consumption is considered as against religious values. Therefore, estimation of frequency of alcohol consumptions using direct methods is prone to different biases. In this study, we indirectly estimated the frequency of alcohol use in Iran, in network of a representative sample using network scale up (NSU) method. Methods: In a national survey, about 400 participants aged above 18 at each province, around 12 000 in total, were recruited. In a gender-match face to face interview, respondents were asked about the number of those who used alcohol (even one episode) in previous year in their active social network, classified by age and gender. The results were corrected for the level of visibility of alcohol consumption. Results: The relative frequency of alcohol use at least once in previous year, among general population aged above 15, was estimated at 2.31% (95% CI: 2.12%, 2.53%). The relative frequency among males was about 8 times higher than females (4.13% versus 0.56%). The relative frequency among those aged 18 to 30 was 3 times higher than those aged above 30 (3.97% versus 1.36%). The relative frequency among male aged 18 to 30 was about 7%. Conclusion: It seems that the NSU is a feasible method to monitor the relative frequency of alcohol use in Iran, and possibly in countries with similar culture. Alcohol use was lower than non-Muslim countries, however, its relative frequency, in particular in young males, was noticeable

National population size estimation of illicit drug users through the network scale-up method in 2013 in Iran

Background: For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. Methods: We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. Results: The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. Conclusion: It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Combination of Citalopram and Nortriptyline in the Treatment of Obsessive-Compulsive Disorder: A Double – Blind, Placebo-Controlled Trial

Objective: The fact that some antidepressants with strong effects on serotonin reuptake blockade fail to relieve obsessive-compulsive symptoms has caused growing interest in investigating noradrenergic function in obsessive-compulsive disorder (OCD) . In light of the above, we undertook a trial to investigate whether the combination of citalopram with nortriptyline is more effective in treating obsessive-compulsive symptoms than citalopram alone. Method: 40 patients who met the DSM-IV criteria for OCD were included in the study. Patients were allocated in a random fashion: 20 patients to citalopram 40mg /day plus nortriptyline 50mg /day, and 20 patients to citalopram 40mg /day plus placebo. Results: Both protocols significantly decreased the scores of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) over the trial period, but the combination of citalopram and nortriptyline showed a significant superiority over citalopram alone in the treatment of OCD. Conclusion: As this study indicates, nortriptyline improves the efficacy of citalopram. In addition, a rapid onset of action is one of the advantages of this combination. This study supports further investigation of the noradrenergic– serotonergic hypothesis in OCD

Combination of Citalopram and Nortriptyline in Treatment of Moderate to Severe Major Depression: A Double-blind, Placebo- controlled Trial

Objective: Depression is a major health problem, which is not only underrecognized and undertreated, but is also associated with significant morbidity and mortality. It has been suggested that combination therapy rapidly reduces depressive symptoms in patients with moderate to severe depression and is more effective than monotherapy; but this suggestion remains controversial. Serotonergic and noradrenergic enhancement may be synergistic and more effective than serotonergic enhancement alone in the management of depression. The objective of this double blind, placebo-controlled study was to investigate the efficacy and tolerability of the combination of citalopram and nortriptyline for the treatment of moderate to severe major depression. Method: 45 patients, who met the DSM-IV criteria for major depressive disorder based on the clinical interview, were included in the study. Patients had a baseline Hamilton Depression Rating Scale score of at least 20. In this trial, patients were randomly assigned to receive nortriptyline 50 mg/day plus citalopram 40 mg/day (group1) or placebo plus citalopram 40 mg/day (group2), for an 8 week, double-blind, placebo-controlled trial. Results: Both protocols significantly decreased the score of Hamilton Depression Rating Scale over the trial period, but the combination of nortriptyline and citalopram showed a significant superiority over citalopram alone in the treatment of moderate to severe major depressive disorder (t = 3.34, d.f. = 36, P = 0.001). The difference between the two groups in the frequency of side effects was not significant. Conclusion: The results of this study suggest that combination of nortriptyline and citalopram is more effective than citalopram alone in the treatment of depression. This advantage is probably the result of reuptake inhibition of both serotonin and norepinephrin

Barriers and gaps in tuberculosis care and treatment in Iran: A multi-center qualitative study

Introduction: Patients with Tuberculosis (TB) still have barriers in accessing high quality care and treatment services. In this qualitative study, we investigated barriers in accessing TB health services including confirmatory diagnosis, treatment adherence and recurrence of pulmonary TB using patients, physicians, and policy makers point of view. Materials and methods: In this qualitative research from November to March 2021, 3 policy makers from the Ministry of Health, 12 provincial TB experts and physicians from the TB control program and 33 patients diagnosed with TB from 4 provinces were enrolled for a semi-structured in-depth interview. All interviews were audio recorded and then transcribed. Framework analysis was done by MAXQDA 2018 software to identify key themes. Results: Several barriers reported for TB care and treatment: Poor knowledge of patents about TB symptoms, failure to screen for TB among at-risk patients by physicians, similar symptoms between TB and other lung diseases, low sensitivity of TB diagnostic tests, incomplete case finding and contact-tracing, stigma related to TB, and patients poor adherence due to long TB treatment. In addition, COVID-19 pandemic disrupted TB services and decreased detection, care and treatment services for TB patients. Conclusion: Our findings highlight the need for interventions to increase public and healthcare providers awareness about TB symptoms, using more sensitive diagnostic tests, and interventions to reduce stigma, and improve case finding and contact tracing effort. Improving patients’ adherence required better monitoring and shorter effective treatment regimes

Barriers and gaps in tuberculosis care and treatment in Iran: A multi-center qualitative study

IntroductionPatients with Tuberculosis (TB) still have barriers in accessing high quality care and treatment services. In this qualitative study, we investigated barriers in accessing TB health services including confirmatory diagnosis, treatment adherence and recurrence of pulmonary TB using patients, physicians, and policy makers point of view.Materials and methodsIn this qualitative research from November to March 2021, 3 policy makers from the Ministry of Health, 12 provincial TB experts and physicians from the TB control program and 33 patients diagnosed with TB from 4 provinces were enrolled for a semi-structured in-depth interview. All interviews were audio recorded and then transcribed. Framework analysis was done by MAXQDA 2018 software to identify key themes.ResultsSeveral barriers reported for TB care and treatment: Poor knowledge of patents about TB symptoms, failure to screen for TB among at-risk patients by physicians, similar symptoms between TB and other lung diseases, low sensitivity of TB diagnostic tests, incomplete case finding and contact-tracing, stigma related to TB, and patients poor adherence due to long TB treatment. In addition, COVID-19 pandemic disrupted TB services and decreased detection, care and treatment services for TB patients.ConclusionOur findings highlight the need for interventions to increase public and healthcare providers awareness about TB symptoms, using more sensitive diagnostic tests, and interventions to reduce stigma, and improve case finding and contact tracing effort. Improving patients' adherence required better monitoring and shorter effective treatment regimes

An Evaluation of The Diagnostic Value of Sputum Smears Microscopy and Pcr Relative to Sputum Culture in The Diagnosis of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis in Iran

Background: Tuberculosis is one of the oldest known diseases in humans, and early detection of tuberculosis is one of the main measures to decrease the spread of tuberculosis. In many parts of the world, including Iran, the diagnosis of tuberculosis is based on the detection of acid-fast bacillus in sputum smear microscopy and PCR. this study aimed to synthesize evidence on the diagnostic accuracy of sputum smear and PCR compared to sputum culture for the diagnosis of PT in Iranian patients. Methods: This systematic review and meta-analysis was conducted based on PRISMA guideline for systematic review and meta-analysis. Eligible studies were cross-sectional original diagnostic studies published in English and Persian in Iran which examined the sensitivity or specificity(study outcome) of sputum smear microscopy or PCR( as the test) relative to sputum culture (as the gold standard/comparator) among Iranian patients suspected of having tuberculosis( study population). Studies whose data were not complete or extractable were excluded. Results: A total of 3518 subjects were evaluated from 15 eligible studies. The pooled sensitivity of sputum smear and PCR was 75.12 (95% CI: 66.68-83.56) and 88.02 (95% CI: 82.87-93.27), respectively. The specificity for sputum smear and PCR was 93.94 (95% CI: 91.26-96.63) and 91.82 (95% CI: 87.29-96.35) respectively. The sensitivity of both sputum smears was higher in studies published after 2010, and had higher quality. The specificity of sputum smear was a bit lower in studies published after2010 but higher in studies with higher quality. The specificity of PCR was higher in studies published after 2010 but higher in studies with higher quality. Conclusion:The increased sensitivity of sputum smear and PCR during recent years suggests the improvement of preparation and laboratory methods in recent years. However, the imperfect sensitivity of these tests highlights the need for a more accurate diagnostic method for the detection of pulmonary tuberculosis in Iran