The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users : A Modeling Study

Article Accepted Date: Oct 7, 2013 Acknowledgments: We would like to thank all MMT centers' staff in Shiraz for their cooperation in this study. Funding Support: This study was funded and supported by the Tehran University of Medical Sciences.Peer reviewedPublisher PD

Sensitivity and specificity of chest computed tomography scan based on RT-PCR in COVID-19 diagnosis

Purpose: COVID-19 is a novel, severely contagious and progressive infection occurring worldwide. The diagnosis of the disease is based on real-time polymerase chain reaction (RT-PCR) and computed tomography (CT) scan, even though they are still controversial methods. Material and methods: We studied 54 patients with suspected COVID-19 and the two mentioned methods were compared with each other. Results: Sensitivity and specificity of the abnormal chest CT scan, ground-glass opacity (GGO), consolidation opacity, and both of GGO and consolidation were also surveyed based on RT-PCR. The results showed that RT-PCR assay was negative in 23 (42.6%) patients and positive in 31 (57.4%) cases. Also, the patients with an abnormal chest CT scan comprised 37 (68.5%). The sensitivity and specificity of abnormal CT scan were 78.6% and 42.3%, respectively, based on the RT-PCR method. Conclusions: Other techniques alongside CT scan and RT-PCR are advocated for accuracy of the COVID-19 diagnosis

Risk factors for COVID-19 severity and mortality among inpatients in Southern Iran

Introduction: COVID-19 is a highly contagious respiratory disease and many factors can affect its severity and mortality. This study aimed to investigate the risk factors associated with the severity and mortality of COVID-19. Methods: In this study, 311 cases with COVID-19 approved by the CORONA database in the Center for Disease Control and Prevention (CDC) of Shiraz University of Medical Sciences were selected using a random systematic sampling method. The study data were collected through interviews and phone calls. Results: The mean age of the participants was 45.82±17.92 years, and the male to female ratio was 1.57:1. In addition, the Case Fatality Rate (CFR) was 4.50%, and the disease was severe in 47.5% of the cases. The most common clinical symptoms were cough (39.22%), fever (31.83%), and dyspnea (24.76%). The severity of COVID-19 was significantly associated with age and history of Cardiovascular Disease (CVD). Besides, the mortality of COVID-19 was significantly related to age, gender, hypertension, CVD, and Chronic Kidney Disease (CKD). The mean interval between the onset of the first symptom and referral to health center was 3.02±2.82 days. Additionally, the mean interval between the referral to health centers and testing was 0.88±2.20 days. Conclusion: Older patients and those who had CVD needed more careful healthcare and early intervention to prevent the exacerbation of COVID-19. Furthermore, the interval between the onset of the first symptom and testing was relatively long. Overall, early diagnosis, isolation, and treatment of patients were found to be essential to control COVID-19

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

ObjectiveDelayed 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.MethodsThis 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.ResultsThe 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.ConclusionA 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

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

High Titers of Hemagglutination Inhibition Antibodies against 2009 H1N1 Influenza Virus in Southern Iran

ABSTRACT Background: Pandemic flu had at least two waves in Iran. Knowing how many of the general population were already exposed to this infection has a major impact on national preventive measures. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths. Objective: In this study we aim to measure, as a pilot study, the seroprevalence of positive antibody titer (humoral immunity) against 2009 H1N1 virus in Iranian population in Shiraz, Southern Iran. Methods: Through cluster random sampling of families residing in Shiraz, 2553 subjects were selected and after a medical interview blood samples were taken and checked for polyclonal antibody against 2009 H1N1 antigen using hemagglutination inhibition assay. An antibody titer of more than 1:40 dilution was considered positive. Data were analyzed considering the demographic characteristics of the population and were compared among different age groups. Results: 1504 (58.91%) samples were tested positive for the presence of polyclonal antibody against 2009 H1N1 virus. The prevalence of positive titers were significantly higher in 60 to 64 years old group and significantly lower in 20 to 24 years old group (p<0.05). Data did not differ based on other demographic characteristics or the history of flu like illnesses in the past 6 months. Conclusion: High seroprevalence of antibody against 2009 H1N1 in the sera of our subjects describes either a high level of preexisting immunity against H1N1 in Iranian population or a high rate of asymptomatic infection in our area compared to other countries

Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.</p

Factors affecting public dissatisfaction with urban family physician plan: A general population based study in Fars Province

Background: Understanding the level of public satisfaction with a family physician plan as well as the relevant factors in this respect, can be employed as valuable tools in identifying quality of services. Objective: To determine the factors affecting public dissatisfaction with an urban family physician plan in Iran. Methods: This cross-sectional study was conducted from January 2014 through June 2015 on Fars Province residents in Iran, selected based on cluster sampling method. The data collection instrument was comprised of a two-part checklist including demographic information and items related to dissatisfaction with the family physician plan, specialists, para-clinic services, pharmacy, physicians on shift work, emergency services, and family physician assistants. Data were described by SPSS 20. Results: In this study, 1,020 individuals (524 males, 496 females) were investigated. Based on the results, the most frequent factor affecting dissatisfaction with physicians was their single work shifts and unavailability (53%). In terms of dissatisfaction with family physicians’ specialist colleagues and para-clinic services, the most common factors were related to difficulty in obtaining a referral form (41.5%) and making appointments (21.6%), respectively. Given the level of dissatisfaction with pharmacies, the significant factor was reported to be excessive delay in medication delivery (31.6%); and in terms of physicians on shift work and emergency services, the most important factor was lower work hours for family physicians (9.2%). Conclusion: It seems that, the most common causes of dissatisfaction with the urban family physician plan are due to the short duration of services, obtaining a referral form and making appointments, and providing prescribed medications

Perception of medical students and residents about virtual interviews for residency applications in the United States.

IntroductionResidency applications via virtual-interview could potentially mitigate the extensive cost and time required for customary in-person interviews. We outline the perception of medical students and residents on the use of virtual-interview for residency applications in lieu of in-person interviews.MethodsWe obtained 1824 responses from medical students and residents through an online questionnaire between March2019-Feb2020 in Texas-United States. The survey had 11 statements (five in favor of in-person interviews and 6 in favor of virtual interviews) that respondents could rank on a 5-point Likert scale. All statements' scores were summed based on the response given by each participant to create a total score between 11 and 55. The perception of the two groups was analyzed using an independent sample T-test and ANOVA.ResultsWe received a total of 1711 responses from medical students and 113 from medical residents. Respondents were more female (82.2% of medical students and 47.8% of residents), with a mean age of 22.87±3.42 years old for medical students and 28.72±4.35 years old for residents. Both groups preferred in-person interviews; however, the residents were significantly more in favor (P = 0.03). Both groups agree that virtual-interviews should be as an option, though this was considerably higher in the medical students (P = 0.001). In the multivariate analysis, "travel distance" and "type of medical school" had a significant impact on choosing the virtual-interviews in both groups (pConclusionsIn-person interviews are favored by both medical students and residents compared to virtual-interview services in normal circumstances. However, both groups agree that programs should offer the option of having virtual-interviews as an available choice. Distance to an interview location and the type of medical school were the factors that had a significant impact on perception of using virtual-interviews. Knowing about the applicants' attitude toward residency interviews and the national circumstances are essential when preparing the interview guides. Our findings are limited by the small sample size and the low response rate. Further extensive studies are warranted to better understand the perception of residency applicants toward virtual-interviews to improve the interview process in the United States

Estimating the prevalence and incidence of treated type 2 diabetes using prescription data as a proxy: A stepwise approach on Iranian data

Aims: Type 2 diabetes is a serious health challenge, and large-scale studies on its prevalence in Iran are lacking. In pharmacoepidemiology, case-finding can be done by reviewing the prescription databases for specific drug(s) prescribed for a disease. We aimed to determine the prevalence and incidence of type 2 diabetes in Fars province, Iran, using prescription data and a stepwise approach to ascertain the results. Methods: A dataset of 3,113 insured individuals aged ≥35 years were selected. Their Prescription Data Centre records were reviewed for all drugs frequently used in controlling type 2 diabetes available in the Iranian pharmacopeia. Then we used a stepwise method for case-finding. In step one, each individual with a positive drug history for type 2 diabetes was labeled as an individual with diabetes. The next two steps were implemented for ascertainment of step one estimations. Results: Prevalence of type 2 diabetes based on prescription, internist opinion, and phone call verification in 2015 and 2016 was 9.3% and 10.3%, 8.5% and 9.8%, and 7.2% and 8.7%, respectively. An incidence of 1.9% was determined for 2016. Conclusions: We obtained a realistic estimation of prevalence and incidence of treated type 2 diabetes, using prescription data which are large-scale, low cost, and real-time