The epidemiology of cholera in the Islamic Republic of Iran, 1965�2014 �pidémiologie du choléra en République Islamique d�Iran (1965-2014)

Background: Cholera is endemic in the Islamic Republic of Iran. According to surveillance system records and historical documents, cholera epidemics have led to thousands of deaths throughout the country in past centuries. Aims: The aim of this study was an overview of cholera disease during the last 5 decades (1965�2014) and the epidemiological features of the most recent large-scale outbreaks. Methods: In this descriptive study, cholera incidence data provided by the National Surveillance Database were extracted and significant fluctuating trends for 1965�2014 were tested using the Cochran�Armitage test. To identify the factors most associated with cholera incidence in the outbreaks, adjusted odds ratios were computed by ordinal logistic regression. Results: Analysis of data has shown a tremendous decrease in incidence trends, from 19.7/100 000 to 0.01/100 000 over the 9 cholera epidemics that occurred at 5�6 year intervals during 1965�2014. Younger age groups (15�44 years) and inhabitants in urban areas have been more vulnerable to cholera in recent epidemics. The virulence of the pathogen and the case fatality rates have not changed during the last 3 epidemics. Conclusion: The burden of cholera in terms of case load has dramatically reduced during 1965�2014. Furthermore, the epidemiological feature of cholera with regard to transmission route, domicile, age, immigration, mortality and antimicrobial resistance has changed considerably in recent epidemics. While the number of epidemic regions has diminished, some areas are still susceptible to cholera outbreaks. © World Health Organization (WHO) 2020

Multifocal peliosis hepatis: MR and diffusion-weighted MR-imaging findings of an atypical case

Peliosis is a rare benign disorder that is characterized by the presence of diffuse blood-filled cystic spaces and can occur in the liver, spleen, bone-marrow, and lungs. We present a 10-year-old boy with Fanconi anemia who presented with peliosis hepatis due to androgen treatment. Magnetic resonance (MR) imaging revealed multiple non-enhancing masses. Some of the lesions revealed fluid-fluid levels and extrahepatic extension on MR images. Diffusion-weighted (DW) imaging showed restricted diffusion. Fluid-fluid levels and extrahepatic extensions are unusual findings for hepatic peliotic lesions. In addition, DW imaging findings of peliosis hepatis have not been reported previously

Incidence, mortality, and burden of hepatitis B and C and geographical distribution in Iran during 2008-2015

Background: This study aimed at estimating the incidence, mortality, and burden of Hepatitis B (HBV) and Hepatitis C (HCV) viruses and their trends from 2008 to 2015. Methods: The Disability Adjusted Life Year (DALYs) index was applied to calculate the burden of the diseases by age, sex, time, and locations. The incidence and demographic data were obtained from HBV and HCV surveillance system, and the data on natural history was extracted from the cohort studies; moreover, the data on the standard life expectancy was obtained from the Iranian life table 2016. The two values of 0.03 and 21.5 yr were set as the discount rate and mean standard duration of the disease for both types of hepatitis. Results: The burden of HBV decreased from 13735 to 78277.6 yr, but there was an increase in the burden of HCV from 5174 to 14395 yr over the studied period. The burden of both types of hepatitis was higher among males than females. The incidence of HBV increased from 46611 to 22996 cases, and the incidence of HCV increased from 1210 to 3939 cases. The HBV decreased from 1925 to 1394 cases; however, the number of deaths caused by HCV increased from 197 to 583 cases over the studied period. The share of YLLs raised from 5 to 10 for HBV whereas it changed from 23 to 62 for HCV over the studied years. Tehran, Khorasan Razavi, and Golestan had the highest and Chaharmahal and Bakhtiari, Kurdistan, and Kermanshah had the lowest adjusted burden of HBV per 1000 population. Conclusion: Although the incidence, mortality, and burden of HBV declined over the eight studied years, these values increased dramatically for HCV. © 2019, Iranian Journal of Public Health. All rights reserved

Incidence, mortality, and burden of crimean congo hemorrhagic fever and its geographical distribution in Iran during 2009-2015

Background: This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Crimean Congo Hemorrhagic Fever (CCHF) using Disability Adjusted Life Years (DALYs) in Iran 2009-2015. Methods: CCHF-related DALYs was calculated using a method developed by WHO for the investigation of Global Burden of Diseases (GBD). DALYs was calculated through adding years of life lost due to premature death (YLLs) to years lived with disability (YLDs). To calculate YLD, the average duration of the disease and its disability weight were set at 25 d and 0.613, respectively. The data on the incidence and mortality were collected from the CCHF surveillance system from the governmental section. Results: The highest and the lowest incidence rates of CCHF were observed in 2009 (122 cases) and 2010 (254 cases), respectively. Moreover, the lowest and highest mortality rates were reported in 2009 (20 cases) and 2012 (52 cases), respectively. The mean rate of fatality from CCHF observed between 2009 and 2015 was about 21.1. In addition, the lowest and highest DALYs were observed in 2009 (483 cases) and 2010 (1156 cases), respectively. CCHF incidence, DALYs, and mortality rate over the studied period were higher among males than females. CCHF-related DALYs did not have an equal distribution in all provinces of Iran; some provinces were suffering from a higher burden of the disease. Conclusion: It is recommended to improve the CCHF surveillance system, identify high-risk areas, practice early diagnosis and intervention, develop vaccines, control, and fight tick, and screen livestock to control and prevent the spread of this disease. © 2019, Iranian Journal of Public Health. All rights reserved

Incidence, mortality, and burden of acute watery diarrhea and its geographical distribution in Iran during 2009-2016

Background: Diarrhea is a major cause of public health burden, especially in children under 5 yr of age. This study aimed at estimating the incidence, mortality, burden, and geographical distribution of Acute Watery Diarrhea (AWD) in Iran from 2009 to 2016. Methods: This study was conducted in 2018. The data on the incidence and mortality from 2009 to 2016 was obtained from AWD surveillance system of the Centre for Communicable Diseases Control (CCDC), Ministry of Health and Medical Education (MOHME) of Iran. Disability Adjusted Life Years (DALYs) was used to estimate the burden of AWD. The DALYs-related AWD was calculated using a method developed by WHO. The average duration of the disease and its disability weight, respectively, were set at 5 d (0.0137 years) and 0.093 for all age groups. Results: The incidence of AWD had an ascending trend over the studied period. Forty cases of deaths from AWD were reported. The lowest and highest burdens of AWD, respectively, were 436.1 DALYs in 2010 and 975.9 DALYs in 2015. The incidence and burden of AWD did not have an equal distribution across the country, between the provinces. Conclusion: The incidence of AWD had an ascending trend over the studied period that can be attributed to the improvements in the disease surveillance system. Moreover, the incidence, mortality, and burden of AWD did not have an equal distribution in Iran. Hence, it is recommended to strengthen AWD surveillance system. In addition, it is suggested to adopt proper interventions for controlling the disease in areas with a high burden of AWD. © 2019, Iranian Journal of Public Health. All rights reserved

Erythropoietic protoporphyria without skin symptoms-you do not always see what they feel

Erythropoietic protoporphyria (EPP) is an inherited disorder of the porphyrin metabolism that often remains undiagnosed in children. We report on a 4-year-old girl who had been suffering for 1 year from recurrent painful crises affecting her hands, feet, and nose following sun exposure. Objective skin lesions were absent until the age of 6. Porphyrin analysis revealed elevated free erythrocyte protoporphyrin (FEP) levels confirming the diagnosis of EPP. This illustrates that skin lesions might be completely absent in children affected with EPP, a fact that has only been reported once previously. Because EPP can manifest with few and unspecific cutaneous symptoms or no skin lesions at all, like in this patient, the diagnosis of EPP might be delayed or missed. EPP should be excluded in all photosensitive children, especially when discomfort is disproportionate to the extent of the cutaneous lesions. The clinic, pathophysiology, diagnosis, complications, and therapy of EPP are discussed

Mitochondrial energetic defects in muscle and brain of a Hmbs-/- mouse model of acute intermittent porphyria

Acute intermittent porphyria (AIP), an autosomal dominant metabolic disease (MIM #176000), is due to a deficiency of hydroxymethylbilane synthase (HMBS), which catalyzes the third step of the heme biosynthetic pathway. The clinical expression of the disease is mainly neurological, involving the autonomous, central and peripheral nervous systems. We explored mitochondrial oxidative phosphorylation (OXPHOS) in the brain and skeletal muscle of the Hmbs(-/-) mouse model first in the basal state (BS), and then after induction of the disease with phenobarbital and treatment with heme arginate (HA). The modification of the respiratory parameters, determined in mice in the BS, reflected a spontaneous metabolic energetic adaptation to HMBS deficiency. Phenobarbital induced a sharp alteration of the oxidative metabolism with a significant decrease of ATP production in skeletal muscle that was restored by treatment with HA. This OXPHOS defect was due to deficiencies in complexes I and II in the skeletal muscle whereas all four respiratory chain complexes were affected in the brain. To date, the pathogenesis of AIP has been mainly attributed to the neurotoxicity of aminolevulinic acid and heme deficiency. Our results show that mitochondrial energetic failure also plays an important role in the expression of the disease

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015

Objectives: To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran. Methods: Cross-sectional study of 6200 Iranian prisoners in 2015. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants was determined by HBsAg and HCV antibodies blood tests using enzyme-linked immunosorbent assay (ELISA). Data were analysed in STATA-12. Result: Prevalence of HCV exposure was 9.48 (95 CI: 8.73�10.27), and prevalence of HBV was 2.48 (95 CI: 2.07�2.89) in the general prison population. In multivariate analysis, the most important risk factor for HBV was a history of drug use in lifetime (adjusted odds ratio, AOR: 1.8, 95 CI: 1.17�3.02). The main risk factors for HCV exposure were a history of drug use in lifetime (AOR: 4.08, CI: 2.56�6.27), age over 30 (AOR: 2.68, CI: 2.01�3.56), and having tattoos (AOR = 1.67, CI: 1.35�2.07). Conclusion: Although vaccination is used to control HBV among prisoners, prevalence of HCV exposure is alarming in the prison population of Iran, especially among people who inject drugs. Eliminating viral hepatitis in Iran by 2030 requires a national commitment and rapid measures for targeting this high-risk group. Given the increased efficiency of HCV treatment in recent years, prisons provide an opportunity to access patients for treatment. © 2018 John Wiley & Sons Lt

Prevalence and risk factors for HBV and HCV in prisoners in Iran: a national bio-behavioural surveillance survey in 2015

Objectives: To provide more accurate estimates of the prevalence of Hepatitis B (HBV) and Hepatitis C (HCV) and their contributing factors among prisoners in Iran. Methods: Cross-sectional study of 6200 Iranian prisoners in 2015. Data were collected through questionnaires and interviews. HBV infection and HCV exposure status of the participants was determined by HBsAg and HCV antibodies blood tests using enzyme-linked immunosorbent assay (ELISA). Data were analysed in STATA-12. Result: Prevalence of HCV exposure was 9.48 (95 CI: 8.73�10.27), and prevalence of HBV was 2.48 (95 CI: 2.07�2.89) in the general prison population. In multivariate analysis, the most important risk factor for HBV was a history of drug use in lifetime (adjusted odds ratio, AOR: 1.8, 95 CI: 1.17�3.02). The main risk factors for HCV exposure were a history of drug use in lifetime (AOR: 4.08, CI: 2.56�6.27), age over 30 (AOR: 2.68, CI: 2.01�3.56), and having tattoos (AOR = 1.67, CI: 1.35�2.07). Conclusion: Although vaccination is used to control HBV among prisoners, prevalence of HCV exposure is alarming in the prison population of Iran, especially among people who inject drugs. Eliminating viral hepatitis in Iran by 2030 requires a national commitment and rapid measures for targeting this high-risk group. Given the increased efficiency of HCV treatment in recent years, prisons provide an opportunity to access patients for treatment. © 2018 John Wiley & Sons Lt

Association of HbA1c Values with Mortality and Cardiovascular Events in Diabetic Dialysis Patients. The INVOR Study and Review of the Literature

BACKGROUND: Improved glycemic control reduces complications in patients with diabetes mellitus (DM). However, it is discussed controversially whether patients with diabetes mellitus and end-stage renal disease benefit from strict glycemic control. METHODS: We followed 78 patients with DM initiating dialysis treatment of the region of Vorarlberg in a prospective cohort study applying a time-dependent Cox regression analysis using all measured laboratory values for up to more than seven years. This resulted in 880 HbA(1c) measurements (with one measurement every 3.16 patient months on average) during the entire observation period. Non-linear P-splines were used to allow flexible modeling of the association with mortality and cardiovascular disease (CVD) events. RESULTS: We observed a decreased mortality risk with increasing HbA(1c) values (HR = 0.72 per 1% increase, p = 0.024). Adjustment for age and sex and additional adjustment for other CVD risk factors only slightly attenuated the association (HR = 0.71, p = 0.044). A non-linear P-spline showed that the association did not follow a fully linear pattern with a highly significant non-linear component (p = 0.001) with an increased risk of all-cause mortality for HbA(1c) values up to 6-7%. Causes of death were associated with HbA(1c) values. The risk for CVD events, however, increased with increasing HbA(1c) values (HR = 1.24 per 1% increase, p = 0.048) but vanished after extended adjustments. CONCLUSIONS: This study considered the entire information collected on HbA(1c) over a period of more than seven years. Besides the methodological advantages our data indicate a significant inverse association between HbA(1c) levels and all-cause mortality. However, for CVD events no significant association could be found