Insight into blood pressure targets for universal coverage of hypertension services in Iran: the 2017 ACC/AHA versus JNC 8 hypertension guidelines

BACKGROUND: We compared the prevalence, awareness, treatment, and control of hypertension in Iran based on two hypertension guidelines; the 2017 ACC/AHA -with an aggressive blood pressure target of 130/80 mmHg- and the commonly used JNC8 guideline cut-off of 140/90 mmHg. We shed light on the implications of the 2017 ACC/AHA for population subgroups and high-risk individuals who were eligible for non-pharmacologic and pharmacologic therapies. METHODS: Data was obtained from the Iran national STEPS 2016 study. Participants included 27,738 adults aged ≥25 years as a representative sample of Iranians. Regression models of survey design were used to examine the determinants of prevalence, awareness, treatment, and control of hypertension. RESULTS: The prevalence of hypertension based on JNC8 was 29.9% (95% CI: 29.2-30.6), which soared to 53.7% (52.9-54.4) based on the 2017 ACC/AHA. The percentage of awareness, treatment, and control were 59.2% (58.0-60.3), 80.2% (78.9-81.4), and 39.1% (37.4-40.7) based on JNC8, which dropped to 37.1% (36.2-38.0), 71.3% (69.9-72.7), and 19.6% (18.3-21.0), respectively, by applying the 2017 ACC/AHA. Based on the new guideline, adults aged 25-34 years had the largest increase in prevalence (from 7.3 to 30.7%). They also had the lowest awareness and treatment rate, contrary to the highest control rate (36.5%) between age groups. Compared with JNC8, based on the 2017 ACC/AHA, 24, 15, 17, and 11% more individuals with dyslipidaemia, high triglycerides, diabetes, and cardiovascular disease events, respectively, fell into the hypertensive category. Yet, based on the 2017 ACC/AHA, 68.2% of individuals falling into the hypertensive category were eligible for receiving pharmacologic therapy (versus 95.7% in JNC8). LDL cholesterol< 130 mg/dL, sufficient physical activity (Metabolic Equivalents≥600/week), and Body Mass Index were found to change blood pressure by - 3.56(- 4.38, - 2.74), - 2.04(- 2.58, - 1.50), and 0.48(0.42, 0.53) mmHg, respectively. CONCLUSIONS: Switching from JNC8 to 2017 ACC/AHA sharply increased the prevalence and drastically decreased the awareness, treatment, and control in Iran. Based on the 2017 ACC/AHA, more young adults and those with chronic comorbidities fell into the hypertensive category; these individuals might benefit from earlier interventions such as lifestyle modifications. The low control rate among individuals receiving treatment warrants a critical review of hypertension services

Quality evaluation of national cancer registry system in Iran: Study protocol

Background: Cancer registry can be a very important component of health information system in developing countries. Routine collection of data and ongoing monitoring of their quality can have a crucial role in priority setting and evidence-based policy making for controlling cancers and trends follow-up in low and middle-income countries. Evaluation of cancer registered data consists of four important components including: comparability, completeness, validity, and timeliness. Similar frameworks are utilized in different countries all over the world.Methods and Materials: We will use the national annual cancer registry reports in Iran alone or perhaps along with other Iranian published reports about childhood cancer incidence to determine the stability and trend of incidence rates over time and compare above mentioned reports with childhood cancer incidence data reported by other countries through a systematic review as well as in some cases meta-analysis in order to assess data quality. Data will also be collected from other sources such as death certificates to estimate mortality rates and other different methods will also be additionally applied, by use of which death certificates would be utilized to assess the quality of data, too. Conclusion: As the first step for proper measuring incidence rate of all types of cancers all over the country, we will assess and evaluate reported national cancer registry data in Iran in order to estimate the national burden of cancers in 1990-2013

Impact of pre-existing dengue immunity on human antibody and memory B cell responses to Zika

Little is known about enduring memory B cell (MBC) responses to Zika virus (ZIKV) and their relationship with circulating antibodies. Here we comprehensively assess MBC frequency and specificity alongside serum binding and neutralizing antibody responses to ZIKV ~2 weeks and ~8 months postinfection in 31 pediatric subjects with 0, 1 or >1 prior infections with the related dengue virus (DENV). ZIKV infection elicits a robust type-specific MBC response, and the majority of late convalescent anti-ZIKV serum neutralizing activity is attributable to ZIKV-specific antibodies. The number of prior DENV infections does not influence type-specific or cross-reactive MBC responses, although ZIKV has the highest cross-reactivity with DENV3. DENV cross-reactive MBCs expanded by ZIKV infection decline in number and proportion by late convalescence. Finally, ZIKV induces greater cross-reactivity in the MBC pool than in serum antibodies. Our data suggest immunity to DENV only modestly shapes breadth and magnitude of enduring ZIKV antibody responses

Is salt intake reduction a universal intervention for both normotensive and hypertensive people: a case from Iran STEPS survey 2016

Purpose: There is a direct association between salt intake and blood pressure (BP), one of the main risk factors for CVDs. However, yet there has been a debate that how strong is this association in people with and without hypertension. This study was conducted to evaluate the magnitude of the association between salt intake and BP in hypertensive and normotensive population among a nationally representative population. Methods: The study was conducted on a nationally representative sample of 18,635 Iranian adults aged 25 years and older who participated in the STEPS survey 2016 and provided urine sample. Salt intake was estimated through spot urine sample and Tanaka equation. Multiple linear regression model in survey data analysis was used to assess the independent effect of salt intake on BP. Results: After adjusting for covariates, there was a significant association between salt intake and SBP in hypertensive (p ' 0.001) and normotensive people (p ' 0.001). In hypertensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.37 mmHg and 0.07 mmHg, respectively. Whereas in normotensive people, with 1 g of increase in salt intake, the SBP and DBP increased 0.26 mmHg and 0.05 mmHg, respectively. Moreover, there was a significant trend toward an increase of SBP across salt intake quartiles in both hypertensive (p ' 0.001) and normotensive people (p = 0.002), though the slope was steeper in hypertensive than in normotensive people. Conclusions: The present study demonstrated that salt intake significantly increased SBP in both hypertensive and normotensive people, though the magnitude of this increase was greater in hypertensive people as compared with normotensive people

Neuropathic pain in a rehabilitation setting after spinal cord injury: an interpretative phenomenological analysis of inpatients’ experiences

Study design Qualitative, semi-structured interviews. Objectives Neuropathic pain (NP) can be psychologically and physically debilitating, and is present in approximately half of the spinal cord injured (SCI) population. However, under half of those with NP are adherent to pain medication. Understanding the impact of NP during rehabilitation is required to reduce long-term impact and to promote adherence to medication and psychoeducation recommendations. Setting United Kingdom. Methods Five males and three females with SCI and chronic NP, resident in rehabilitation wards at a specialist SCI center in the United Kingdom, took part. Semi-structured interviews were conducted with participants less than 15 months post-SCI (mean = 8.4 months). Verbatim transcripts were subject to interpretative phenomenological analysis (IPA). Results Three super-ordinate themes were identified, mediating pain and adherence: (1) the dichotomy of safety perceptions; (2) adherence despite adversity; and (3) fighting the future. Analyses suggest that experience of the rehabilitation setting and responsiveness of care shapes early distress. Attitudes to medication and psychosocial adjustment are relevant to developing expectations about pain management. Conclusions Enhancing self-efficacy, feelings of safety in hospital, and encouraging the adoption of adaptive coping strategies may enhance psychosocial and pain-related outcomes, and improve adherence to medication. Encouraging adaptive responses to, and interpretation of, pain, through the use of interventions such as coping effectiveness training, targeted cognitive behavioral pain management, and acceptance-based interventions such as mindfulness, is recommended in order to reduce long-term reliance on medication

Study of the Effects of Hydro-methanol Extracts of Lavandula vera DC. and Cuscuta epithymum Murr. on the Seizure Induced by Pentylentetranzol in Mice

Abstract: Introduction: Epilepsy is the second most common nervous disorder after brain strok. In spite of present anticonvulsant drugs, researchers need to search for drugs with better efficacy and less side effects. Medicinal plants with various natural components so that different properties are suitable field for investigation. In this study, anticonvulsant effect of Lavandula vera DC. and Cuscuta epithymum Murr. were investigated. Methods: After collection and identification, percolation extract of the plants were prepared by methanol 80% and different doses of extracts were injected intraperitoneally in to mice. Pentylen tetrazole (PTZ) with dose of 90 mg/kg was used for induction of seizure. Changes in the onset time of seizure, duration of seizure, percent of mortality and the percent of seizure protection were determined in different groups. Results: Different doses of extracts of Lavandula vera and Cuscuta epithymum delayed the onset of seizure (P<0.01), but the duration of seizure did not change significantly. Pretreatment of animals with different doses of extracts decreased the mortality rate significantly (P<0.01), the percent of seizure protection was also greater than control group significantly (P<0.05) The most effective dose of Cuscuta epithymum and Lavandula vera were 100 mg/kg and 50 mg/kg respectively. Conclusion: It seems that Cuscuta epithymum and Lavandula vera have effective anticonvulsant component, however more investigations are needed in this field. Keywords: Lavandula vera, Cuscuta epithymum, Seizure, Pentylen tetrazol

Intravenous Paracetamol vs Intranasal Desmopressin for Renal Colic in the Emergency Department: A Randomized Clinical Trial

OBJECTIVE: To evaluate the analgesic efficacy of intranasal desmopressin alone vs intravenous paracetamol in patients referred to the emergency department with renal colic. DESIGN: Randomized clinical trial. SETTING: This study was conducted in the emergency unit of a university hospital. SUBJECTS: Patients referred to the emergency room with renal colic. PRIMARY OUTCOME: Effect of intranasal desmopressin in pain relief in comparison with intravenous paracetamol. METHODS: In this trial, 240 patients diagnosed with renal colic were randomly divided into two groups to compare the analgesic effect of intravenous paracetamol (15â��mg/kg) and intranasal desmopressin spray (40â��μg). Pain scores were measured by a numeric rating scale at baseline and after 15, 30, and 60â��minutes. Adverse effects and need for rescue analgesic (0.05â��mg/kg max 3â��mg morphine sulphate) were also recorded at the end of the study. RESULTS: Three hundred patients were eligible for the study; however, 240 were included in the final analysis. The patients in the two groups were similar in their baseline characteristics and baseline pain scores. The mean pain score after 15â��minutes was more reduced and was clinically significant (>3) in the desmopressin group (Pâ��6). CONCLUSIONS: Our study showed that intranasal desmopressin is as effective as intravenous paracetamol for renal colic pain management; however, significant clinical reduction in pain score occurred faster with intranasal desmopressin. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

Hepatitis B virus infection in Iranian hemodialysis patients: A systematic review and meta-analysis

Introduction. Hepatitis B virus (HBV) infection in hemodialysis patients and its associated adverse health consequences are a worldwide health priority. This systematic review aimed to provide evidence on HBV infection in Iranian hemodialysis patients. Materials and Methods. Through a comprehensive systematic review of literature, which led to meta-analysis of findings, we estimated the pooled prevalence of HBV infection in Iranian hemodialysis patients. The main international electronic data sources were MEDLINE, Institute of Scientific Information, and Scopus. We also search several Persian-language databases. All cross-sectional and analytical studies conducted in Iran concerning HBV infection were included irrespective of date and language. Results. Of 602 publications retrieved from literature search, 66 met the inclusion criteria, and 36 were eligible for including in the study. The prevalence rate varied from zero to 9.75 across different provinces. The national prevalence of HBV was reported between 2.1 and 18.2. Significant heterogeneity was found between reported prevalence rates (I2 = 83.5, P &lt; .001), as a result of which, we used random effect analysis. Results of meta-analysis showed that the estimated pooled prevalence was 4 (95 confidence interval, 3.3 to 4.7). Conclusions. To our knowledge, this was the first comprehensive systematic review of HBV infection in the hemodialysis patients of Iran. Results could be useful for informed health policy making and planning further studies in this field. © 2018, Iranian Society of Nephrology. All rights reserved

Mortality attributable to nutritional deficiencies among iranian children under the age of five at national and sub-national level: 1995-2015

Background: Under-five mortality is considered an indicator of population well-being and health equality in societies. Under-five mortality caused by nutritional deficiencies is a public health concern in developing countries. In this study, we aimed to report the trend and mortality rate of nutritional deficiencies from 1995 to 2015 in children aged under five years. Methods: In this study, we used the death registration system (DRS) data to estimate age- and sex-specific nutritional deficiency mortality rates at national and sub-national levels in Iran from 1995 to 2015. The Iranian DRS used the 10th revision of International Classification of Diseases (ICD-10) but we report our results based on Global Burden of Diseases (GBD) study codes. We used the average annual percent change (AAPC) to quantify trend in under-five mortality rate attributable to nutritional deficiencies from 1995 to 2015. Results: At national level, mortality rates in both sexes were 8.53 (95 uncertainty interval UI: 7.69-9.47), 1.04 (0.86-1.36), and 0.37 (95% UI: 0.28-0.57) per 100,000 in 1995, 2005, and 2015, respectively. AAPC was estimated between 1995 and 2015. At sub-national level, the highest and lowest mortality rates across provinces ranged from 17.7 per 100 000 in 1995 to 1.1 per 100 000 in 2015. In the latest years, protein-energy malnutrition (PEM) was the most frequent cause of mortality among other nutritional deficiencies. Conclusion: The results show a substantial reduction in terms of mortality caused by nutritional deficiencies at national, as well as provincial, level among children under-five years of age. © 2020 The Author(s)