Mode of delivery and risk of asthma in children 5-14 years old in Tabriz, Iran

Introduction: It has been suggested that a cesarean section increases risk of developing asthma due to lack of exposure to maternal microflora during birth. To investigate the association between the mode of delivery and the risk of asthma in children aged 5-14 years in Tabriz, Iran. Methods: A case-control study was performed on 233 (case = 81, control = 152) children aged 5-14 years referred to outpatient clinics of Tabriz Children’s Hospital and Sheikhorrais Clinic in 2014. Clinical asthma diagnosis was done according to Global Initiative for Asthma Criteria. A questionnaire was administered to obtain a demographic, environmental, and clinical history. Age-sex frequency matching with cases was carried out during sampling for controlling of possible cofounding effects of age and sex for asthma. Results: Of 233 children, 53.6% of them were male (case group = 54.3% and control group = 53.3%). Over half (54.5%), the participants had been delivered by caesarian section. Cases were not significantly more likely to have been delivered by caesarian section as compared to controls [adjusted odds ratio (AOR) = 0.69; 95% confidence interval (CI) = 0.34-1.42]. However, more frequent episodes of common cold [b = 0.094; standard error (SE) (b) = 0.031, P \u3c 0.001], birth order (second born children compared to firstborns) (AOR = 2.54; 95% CI = 1.18-5.46), high maternal education levels: 12 years (AOR = 3.76; 95% CI = 1.10-12.9), collegiate (AOR = 6.12; 95% CI = 1.43-26.20), and intra-family marriage (AOR = 2.89; 95% CI = 1.21-6.89) were associated with childhood asthma. Conclusion: Delivery mode was not associated with risk of developing childhood asthma in our study. Intra-family marriage increased the odds of childhood asthma. Further study on the relationship between maternal education and the odds of asthma is proposed

Rapid and simultaneous genotypic detection of Rifampin-Isoniazid and Ethambutol resistant Mycobacterium tuberculosis by use of MAS-PCR

AbstractAims and objectivesThis study aims to identify common mutations leading to Isoniazid (INH), Rifampin (RMP) and Etambutol (EMB) resistance using Multiplex Allele-Specific Polymerase Chain Reaction (MAS-PCR).MethodIn a cross-sectional study during 2012–2013, 257 patients with smear-positive pulmonary tuberculosis residing in five frontier west and north-west provinces of Iran were evaluated in respect of common point mutations leading to resistance to tree first-line drugs.ResultsThe overall frequency of mutations was 37 out of which 8 mutations were related to katG 315, 26 mutations pertained to rpoB 516, 526 and 531 and 3 mutations related to emb B. The rpoB single, double and triple mutations were found in 45.3%, 42.3% and 15.4% of rpoB, respectively. Frequency of patients with mutation to katG and at least one rpoB codon was 7cases (2.7%) at the same time. In this study 60.0% of INH-resistant and 83.3% of RMP-resistant isolates were detected by MAS-PCR technique. Mutation odds were higher in females and in patients with a history of anti-TB drug use.ConclusionThe MAS-PCR is a relatively rapid, sustainable, efficient and accurate technique for detection of drug resistance in tuberculosis. This highlights also the role of mutation at inhA, ahp and oxy R genes in the creation of IHN resistance which may be the causative factor in the remainder of cases

When Is Non-Invasive Prenatal Testing Reliable in Pregnancies with a Vanishing Twin? - A Systematic Review of Case Reports

Background: Fetal demise can complicate aneuploidy screening in a multi fetal pregnancy. The cell-free DNA (CF-DNA) from a non-viable conception may be discordant with the viable fetuses. The Aim of study was to review the waiting period, follow-on single fetal demise in a twin gestation before performing NIPT (Non-Invasive Prenatal Testing).Methods: In this review article we searched through online databases of CINAHL, Cochrane, Database of Abstracts of Reviews of Effects (DARE), PubMed, Medical Library, and Google Scholar for English literature between 2011 to 2020, with the following keywords: “NIPT”, “non-invasive prenatal screening testing”, “cell-free DNA”, “vanishing twin” and “co-twin demise”. We included the studies regarding the duration between the twin vanishing or reduction and NIPT false results.Results: 201 studies across the eight scientific websites were detected; 178 of which were excluded for duplication or being irrelevant. And 29 studies were fully read. 4 case series, finally, met the criteria for systematic review. The findings suggested that the NIPT screening test can be falsely-positive several weeks after vanishing twins although the live fetus is normal. Therefore, the time duration in which the placenta can release CF-DNA of the vanished twin is unknown. In addition, several weeks after reduction, the fetal CF-DNA increases and then decreases, thus CF-DNA analyzing in multifetal pregnancies with reduction can be challenging as well.Conclusion: In pregnancies with vanishing twin or reduction, evaluating NIPT results is more complex than single fetal pregnancy. According to the reviewed studies, after a fetal demise, the cytotrophoblast continues to release to the CF-DNA in the maternal circulation for a variable time, which may cause a false-positive result if the demised twin is aneuploidy

Patterns of Self-Medication and Drug Storage: A Global Meta-Analysis: Self-medication and drug storage: a global meta-analysis

Self-medication, a universal public health issue, is an increasingly common concern. A meta-analysis of global self-medication patterns will be worthwhile for a comprehensive yet comparative consideration of the burden and related problems and planning for macro-health interventions and policies. This study aimed to determine the patterns of self-medication and drug storage behavior globally in various subgroups and its related factors. A systematic search detected relevant studies (1995 to 2018) in the English databases. The related observational study was concluded in this study. Studies that examined self-medication and drug storage at home in the general population were entered into the study. The pooled proportion and odds ratio of self-medication and drug storage at home were calculated by STATA -14. Of 25’225 titles found, 95 studies were included in the final analysis. The pooled prevalence of self-medication was calculated at 54.0% ±4.0% (60% for over-the-counter (OTC) drugs and 43.0% for prescription-only medicines (POM) drugs). The pooled prevalence of drug storage at home was estimated to be 53.0% (CI 95%: 36.0, 70.0). The proportion of self-medication and drug storage at home in continents was: Africa 64.0% and 39.0%, Asia 58.0% and 64.0%, Europe 39.0% (both), and America 32.0% and 8.0%, respectively. African countries had the highest consumers of POM drugs as well as antibiotics. Pharmacists provided the most information about drugs in African studies. The adjusted odds ratio of self-medication was higher in females with higher education status in European and African countries. The prevalence of self-medication for POM drugs was noteworthy, especially in Asian and African countries. Comprehensive education for pharmacists must be accomplished. Also, increasing drug information is critical for women who usually manage family health in households

Obstructive sleep apnea syndrome: complaints and housing characteristics in a population in the United States

CONTEXT AND OBJECTIVE Obstructive sleep apnea syndrome (OSAS) is one of the leading causes of morbidity and mortality in adults. Early detection of the disorder and discovery of risk factors through standardized questionnaires will lead to reduction of the OSAS burden. The main aim of this study was to estimate the prevalence of OSAS symptoms and examine their association with housing characteristics. DESIGN AND SETTING Cross-sectional study at a medical school. METHODS Demographic, housing and body measurement data on 5,545 individuals aged 16 years and over of various races were selected from the National Health and Nutrition Examination Survey. We analyzed the probability of OSAS based on habitual snoring combined with daytime sleepiness and/or witnessed apnea. Univariate and multiple linear regression were used. RESULTS 9.8% of the men and 6.9% of the women reported symptoms suggestive of OSAS (habitual snoring, daytime sleepiness and/or apnea). The following prevalences of symptoms were found among males and females respectively: frequent snoring 35.1%, 22.3%, excessive daytime sleepiness 6.4%, 3.4% and frequent apnea 14.9%, 20.6%. Using multiple linear regression, OSAS symptoms were correlated with gender, age, body mass index (BMI), marital status and education. Regarding housing characteristics, mildew or musty smell and pets in the environment were associated with a high probability of OSAS. CONCLUSION OSAS symptoms were more prevalent than in developing countries. The environment was an important risk factor, but environmental factors are easier to control and manage than other variables like BMI or socioeconomic status

Neo-epidemiological machine learning based method for COVID-19 related estimations.

The 2019 newfound Coronavirus (COVID-19) still remains as a threatening disease of which new cases are being reported daily from all over the world. The present study aimed at estimating the related rates of morbidity, growth, and mortality for COVID-19 over a three-month period starting from Feb, 19, 2020 to May 18, 2020 in Iran. In addition, it revealed the effect of the mean age, changes in weather temperature and country's executive policies including social distancing, restrictions on travel, closing public places, shops and educational centers. We have developed a combined neural network to estimate basic reproduction number, growth, and mortality rates of COVID-19. Required data was obtained from daily reports of World Health Organization (WHO), Iran Meteorological Organization (IRIMO) and the Statistics Center of Iran. The technique used in the study encompassed the use of Artificial Neural Network (ANN) combined with Swarm Optimization (PSO) and Bus Transportation Algorithms (BTA). The results of the present study showed that the related mortality rate of COVID-19 is in the range of [0.1], and the point 0.275 as the mortality rate provided the best results in terms of the total training and test squared errors of the network. Furthermore, the value of basic reproduction number for ANN-BTA and ANN-PSO was 1.045 and 1.065, respectively. In the present study, regarding the closest number to the regression line (0.275), the number of patients was equal to 2566200 cases (with and without clinical symptoms) and the growth rate based on arithmetic means was estimated to be 1.0411 and 1.06911, respectively. Reviewing the growth and mortality rates over the course of 90 days, after 45 days of first case detection, the highest increase in mortality rate was reported 158 cases. Also, the highest growth rate was related to the eighth and the eighteenth days after the first case report (2.33). In the present study, the weather variant in relationship to the basic reproduction number and mortality rate was estimated ineffective. In addition, the role of quarantine policies implemented by the Iranian government was estimated to be insignificant concerning the mortality rate. However, the age range was an ifluential factor in mortality rate. Finally, the method proposed in the present study cofirmed the role of the mean age of the country in the mortality rate related to COVID-19 patients at the time of research conduction. The results indicated that if sever quarantine restrictions are not applied and Iranian government does not impose effective interventions, about 60% to 70% of the population (it means around 49 to 58 million people) would be afflicted by COVID-19 during June to September 2021

Effect of Respiratory Rehabilitation before Open Cardiac Surgery on Respiratory Function: A Randomized Clinical Trial

Introduction: Prevention of pulmonary complications after coronary artery bypass graft is attended as a very important issue. The aim of this study was to evaluate the role of pulmonary rehabilitation before surgery for reducing the risk of pulmonary complications after surgery. Methods: In a randomized clinical trial, 60 patients undergoing heart surgery were randomly divided into two groups A and B. Chest physiotherapy was performed before and after surgery on group A patients however it was done on group B’s, only after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and arterial blood gas (ABG). Results: Thirty nine males (65%) and 21 females (35%) with mean age of 8.10 ± 9.56 were analyzed.The mean differences were statistically significant for predicted forced vital capacity (FVC) (CI95%:1.3 to 8.7) and Predicted Peak Flow indices (PEF) (CI 95%: 1.9 to 9.4) of spirometry indicator,PCO2 index (of ABG parameter) (CI 95%: 1.4 to 8.9) and mean oxygen saturation (mean Spo2) (CI 95%: 0.6 to 1.7) of ABG index in two groups. Conclusion: The performance of pulmonary rehabilitation program before surgery is recommended, as it may result in the reduction of complications of heart surgery

Beijing strains of Mycobacterium tuberculosis in smear-positive tuberculosis patients in North-West and West of Iran

Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among chronic infectious diseases. The goal of this cross-sectional study (2012–2014) was to examine the prevalence of Mycobacterium TB (MTB) Beijing strains in regions near the Iranian border and to identify any epidemiological links. Materials and Methods: To this end, MTB isolates were harvested, from 64 HIV-negative, pulmonary smear-positive TB patients from the Iranian border provinces of East Azerbaijan (North-West), Kurdistan (West), and Kermanshah (West) (2012–2014). Isolates were subjected to restriction fragment length polymorphism (RFLP) analysis, using the insertion sequence IS6110 as a probe (IS6110 RFLP), and drug susceptibility testing by the proportion method. We gathered demographic and clinical data using a questionnaire and reviewing patient records. Results were analyzed with Gel Compare II 6.6 and SPSS-18. Results: The mean age of the patients was 54.4 years and 46.9% were male. The prevalence of Beijing strains among the isolates was 9.4% (17.6% in the Western provinces and 0% in East Azerbaijan). There was a statistically significant relationship between the Beijing strains and drug resistance and also between these strains, and the recurrence of TB in patients that had previously received treatment (P = 0.02 and P = 0.04, respectively). Conclusions: Finally, the prevalence of Beijing strains in Western Iran was greater than expected. Our results therefore indicate that regional and cross-border tracing may be necessary to control spread of this organism