A clinical prediction model for predicting the surgical site infection after an open reduction and internal fixation procedure considering the NHSN/SIR risk model: a multicenter case–control study

IntroductionSurgical site infection (SSI) is one of the most common surgical-related complications worldwide, particularly in developing countries. SSI is responsible for mortality, long hospitalization period, and a high economic burden.MethodThis hospital-based case–control study was conducted in six educational hospitals in Tehran, Iran. A total of 244 patients at the age of 18–85 years who had undergone open reduction and internal fixation (ORIF) surgery were included in this study. Among the 244 patients, 122 patients who developed SSIs were selected to be compared with 122 non-infected patients used as controls. At the second stage, all patients (n = 350) who underwent ORIF surgery in a hospital were selected for an estimation of the standardized infection ratio (SIR). A logistic regression model was used for predicting the most important factors associated with the occurrence of SSIs. Finally, the performance of the ORIF prediction model was evaluated using discrimination and calibration indices. Data were analyzed using R.3.6.2 and STATA.14 software.ResultsKlebsiella (14.75%) was the most frequently detected bacterium in SSIs following ORIF surgery. The results revealed that the most important factors associated with SSI following an ORIF procedure were found to be elder age, elective surgery, prolonged operation time, American Society of Anesthesiologists score of ≥2, class 3 and 4 wound, and preoperative blood glucose levels of >200 mg/dl; while preoperative higher hemoglobin level (g/dl) was found to be a protective factor. The evidence for the interaction effect between age and gender, body mass index and gender, and age and elective surgery were also observed. After assessing the internal validity of the model, the overall performance of the models was found to be good with an area under the curve of 95%. The SIR of SSI for ORIF surgery in the selected hospital was 0.66 among the patients aged 18–85 years old.ConclusionNew risk prediction models can help in detecting high-risk patients and monitoring the infection rate in hospitals based on their infection prevention and control programs. Physicians using prediction models can identify high-risk patients with these factors prior to ORIF procedure

Assessing Substances Abuse-Induced Mortality Rates by Autopsy Method in Iran

Background: Substance abuse is among the main causes of preventable diseases and premature deaths worldwide. Despite legal efforts to prevent substance abuse, it has increased and imposed significant economic costs on societies. This analytical cross-sectional study aimed to explore the rate of substance abuse-induced mortality in the provinces of Iran, in 2017. We elaborated an evaluation structure to identify nationwide different substance abuse-related mortality rates. Methods: We employed the retrospective data extracted from autopsy, forensic medicine examination, and demographic characteristics from the recordings in the Iranian Legal Medicine Organization (ILMO). Stata and ArcGIS were applied for data analysis. Results: Nationwide, 3089 substance abuse-related deaths were recorded in the ILMO; the incidence rate was 38.17 per million subjects. The deaths mostly occurred in the 30-39 age group and males accounted for 90% of cases. The provinces of Kermanshah, Lorestan, Fars, Hamadan, and Semnan reported significantly higher rates, compared with the provinces of Mazandaran, West-Azerbaijan, and Golestan with the lowest mortality rates per million (74.72, 69.81, 63.42, 61.70, 58.53 vs. 10.82, 12.11, 14.30, respectively). Mortality rates due to the abuse of methadone (20.29), morphine (12.34), amphetamine (5.32), methamphetamine (7.05), codeine (4.21), tramadol (5.96), benzodiazepine (1.47), and diphenoxylate (0.05) were calculated per million populations of Iran.Conclusion: The obtained data suggested that preventive interventions should focus on the 20-40 age group. Methadone, morphine, and methamphetamine were associated with the highest mortality, compared to other substances; thus, they require effective treatment and preventive programs. Iranian Drug Control Headquarters, police department, and policymakers should act more efficiently regarding a preventive strategic plan in this respect

Research Paper: Quantification of Mortality Rate From Illicit Substance Abuse in Iran in 2016

Background: The present study aimed to evaluate the epidemiology of mortality due to substance abuse to provide useful information for local, national, and international administrators.Methods: This cross-sectional study was carried out in 12 months from March 2016 to February 2017. The study population was a random sample of people who died from substance abuse. Data were collected by checklists which were designed according to the study objectives. The obtained data were analyzed in Stata software.Results: Our findings show that the mortality rate for illicit opiate users was 40.90 per 1000000 population. Most deaths occurred among people aged 30 to 39 years (25%), single (46.75%) with low education levels. Kermanshah, Lorestan, and Alborz provinces had the highest mortality rate. History of overdose, suicide, hospitalization in psychiatric in hospital and incarceration was observed in some people who died from substance abuse. Conclusion: A large number of deaths from drug abuse occurred in unmarried, self-employed, young males 30 to 39 years old with low education levels. We suggest that training programs and harm reduction approaches be focused in these high risk groups

Associations between dietary risk factors and ischemic stroke: a comparison of regression methods using data from the Multi-Ethnic Study of Atherosclerosis

OBJECTIVES We analyzed dietary patterns using reduced rank regression (RRR), and assessed how well the scores extracted by RRR predicted stroke in comparison to the scores produced by partial least squares and principal component regression models. METHODS Dietary data at baseline were used to extract dietary patterns using the 3 methods, along with 4 response variables: body mass index, fibrinogen, interleukin-6, and low-density lipoprotein cholesterol. The analyses were based on 5,468 males and females aged 45-84 years who had no clinical cardiovascular disease, using data from the Multi-Ethnic Study of Atherosclerosis. RESULTS The primary factor derived by RRR was positively associated with stroke incidence in both models. The first model was adjusted for sex and race and the second model was adjusted for the variables in model 1 as well as smoking, physical activity, family and sibling history of stroke, the use of any lipid-lowering medication, the use of any anti-hypertensive medication, hypertension, and history of myocardial infarction (model 1: hazard ratio [HR], 7.49; 95% confidence interval [CI], 1.66 to 33.69; p for trend=0.01; model 2: HR, 6.83; 95% CI, 1.51 to 30.87 for quintile 5 compared with the reference category; p for trend=0.02). CONCLUSIONS Based primarily on RRR, we identified that a dietary pattern high in fats and oils, poultry, non-diet soda, processed meat, tomatoes, legumes, chicken, tuna and egg salad, and fried potatoes and low in dark-yellow and cruciferous vegetables may increase the incidence of ischemic stroke

Timely referral to health centers for the prevention of cardiovascular diseases: IraPEN national program

IntroductionThe IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease.MethodIn this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes.ResultsThe total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance.ConclusionThe compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations

An Estimation of Drug-Related Deaths in Iran, Using the Capture-Recapture Method (2014-2016)

Background: The Ministry of Health and Medical Education (MOHME) and the Legal Medicine Organization(LMO) are the 2 death registration systems in Iran for registering drug-related deaths. The aim of the presentstudy was to assess the number of undercount and the overlap between the deaths registered by the 2 sources.Methods: In this descriptive study, according to the 10th revision of the International Classification ofDiseases (ICD-10), the registered data on drug-related deaths in the years 2014-2016, as recorded by theMOHME and the LMO, were collected and the number of deaths was estimated using 2-source capturerecapture method and Excel and SPSS software.Findings: The total number of drug-related deaths, as registered by the 2 sources, was 8639 during the3 years. A major part of the drug-related deaths (75% of the data) had been registered by the LMO and only25% of deaths had been registered by the MOHME. There was also a small overlap (7.7% of deaths) betweenthe data from the 2 sources. The final estimation from the capture-recapture model and analysis of sensitivityshowed that, during the 3 years, the total number of drug-related deaths was 14517 [95% confidence interval(CI):14498-14558]. Based on the complete overlap assumption and 50% of unidentified individuals in the2 sources, the number of deaths was estimated at 11341 and 12418, respectively. The largest number ofdrug-related deaths had occurred within the age range of 25-39 years and in men. Kermanshah, Hamedan,and Zanjan Provinces (Iran) had the largest number of cumulative incidences of drug-related deaths. Basedon the data provided by the MOHME, the most common cause of death was Methadone poisoning.Conclusion: There was a small overlap between the MOHME and the LMO in the registration of drug-relateddeaths. Failure to enter accurate and correct information has led to miscalculations of these deaths in Ira

Burden of sexually transmitted infections in Iran from 1990 to 2010: Results from the global burden of disease study 2010

The present study describes the epidemiological status of sexually transmitted infections (STIs) in Iran based on the Global Burden of Disease study 2010 (the GBD 2010), and compares this with those of other neighboring countries. Methods: The burden of STIs from 1990 to 2010 in Iran was derived from a systematic study, namely the GBD 2010, which was conducted by the Institute for Health Metrics and Evaluation (IHME). Using a model-based estimation, Disability Adjusted Life Years (DALYs) were calculated on the basis of the prevalence of STIs. The GBD 2010 used disability weights, and a mortality rate that was obtained from the vital registration system of Iran. We review the results of the GBD 2010 estimations for STIs in Iran. Results: The trend of DALYs attributable to STIs (107. 3 and 26. 47 per 100, 000 people in 1990 and 2010, respectively) and deaths (1. 13 and 0. 12 per 100, 000 people in 1990 and 2010, respectively) decreased dramatically in Iran during the last two decades. The majority of individuals affected by STI DALYs were aged 1-4 and 20-24 years. Conclusion: Since the majority of DALYs attributed to STIs were observed among those aged 1-4 years and young people, the economic burden of STIs will remain high in Iran. Therefore, effective evidence-based planning is critical to allocate the essential budget for utilizing treatment and prevention approaches

The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran

Background: Needle and syringe programs (NSPs) are widely used to reduce harms associated with drug injecting. This study assessed the effect of facility-based (on-site services at drop-in centre) and outreach models of NSP on injection risk behaviours. Methods: Self-reported data from 455 people who injected drugs (PWID) during 2014 in Kermanshah, Iran, were examined to measure demographic characteristics and risk behaviors. Self-reported and program data were also assessed to identify their main source of injection equipment. Participants were divided into three sub-groups: facility-based NSP users, outreach NSP users and non-users (comparison group). Coarsened exact matching was used to make the three groups statistically equivalent based on age, place of residence, education and income, and groups were compared regarding the proportion of borrowing or lending of syringes/cookers, reusing syringes and recent HIV testing. Results: Overall, 76% of participants reported any NSP service use during the two months prior to interview. Only 23% (95%CI: 17–27) reported outreach NSP as their main source of syringes. Using facility-based NSP significantly decreased recent syringe borrowing (OR: 0.27, 95%CI: 0.10–0.70), recent syringe reuse (OR: 0.38, 95%CI: 0.23–0.68) and increased recent HIV testing (OR: 2.60, 95%CI: 1.48–4.56). Similar effects were observed among outreach NSP users; in addition, the outreach NSP model significantly reduced the chance of lending syringes (OR: 0.31, 95%CI: 0.15–0.60), compared to facility- based NSP (OR: 1.25, 95%CI: 0.74–2.17). Conclusion: These findings suggest that the outreach NSP model is as effective as facility-based NSP in reducing injection risk behaviours and increasing the rate of HIV testing. Outreach NSP was even more effective than facility-based in reducing the lending of syringes to others. Scaling up outreach NSP is an effective intervention to further reduce transmission of HIV via needle sharing