Changes in the Epidemiology of Cutaneous Leishmaniasis in Northeastern Iran.

The province of Khorasan-Razavi in the North East of Iran is an endemic area for anthroponotic cutaneous leishmaniasis (ACL caused mainly by Leishmania tropica) and zoonotic cutaneous leishmaniasis (ZCL caused mainly by Leishmania major). Based on clinical signs, some cities were considered as ACL foci while others were considered to be endemic for ZCL. This paper reviews studies performed on patients diagnosed with cutaneous leishmaniasis (CL) via the use of direct slide examination, ELISA, electrophoresis isoenzyme, RAPD PCR and PCR in Mashhad; the study also includes cases of CL in other cities of the Khorasan-Razavi province where only PCR used as a diagnostic tool. The data show that both Leishmania tropica and Leishmania major caused CL in most of the cities investigated. Our review shows that Leishmania major was found in areas where ACL is prevalent and Leishmania tropica was observed in areas with high incidence of ZCL. This distribution represents a major change in the epidemiological pattern of Leishmania in the Khorasan-Razavi province

The evaluation of a virtual education system based on the DeLone and McLean model: A path analysis [version 2; referees: 3 approved]

Background: The Internet has dramatically influenced the introduction of virtual education. Virtual education is a term that involves online education and e-learning. This study was conducted to evaluate a virtual education system based on the DeLone and McLean model. Methods: This descriptive analytical study was conducted using the census method on all the students of the Nursing and Midwifery Department of Alborz University of Medical Sciences who had taken at least one online course in 2016-2017. Data were collected using a researcher-made questionnaire based on the DeLone and McLean model in six domains and then analyzed in SPSS-16 and LISREL-8.8 using the path analysis. Results: The goodness of fit indices (GFI) of the model represent the desirability and good fit of the model, and the rational nature of the adjusted relationships between the variables based on a conceptual model (GFI = 0.98; RMSEA = 0.014).The results showed that system quality has the greatest impact on the net benefits of the system through both direct and indirect paths (β=0.52), service quality through the indirect path (β=0.03) and user satisfaction through the direct path (β=0.73). Conclusions: According to the results, system quality has the greatest overall impact on the net benefits of the system, both directly and indirectly by affecting user satisfaction and the intention to use. System quality should therefore be further emphasized, to use these systems more efficiently

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The Effect of Whole Wheat and White Breads on Serum Lipid Profile, Malondialdehyde, and C-Reactive Protein in Over-Weight and Obese Patients with Coronary Stent

Background: Observational studies showed that intake of whole-grain is associated with a reduced risk of coronary heart disease, hypertension, hyperlipidemia. However, only a few dietary intervention trials have investigated the effect of whole-grain consumption on health outcomes. So we aimed to examine the effect of whole wheat vs. white bread on serum lipid profiles, malondialdehyde (MDA); and C-reactive protein (CRP) in overweight and obese patients with coronary stent. Methods: In a randomized, single-blind, parallel trial, 90 participants who had stent and body mass index (BMI)≥25 were divided into two groups. Intervention group consumed 150 g of whole-wheat bread daily accompanied with a low-calorie diet and the control group consumed 150 g of white-wheat bread as well as a low-calorie diet. The intervention was continued for 12 weeks. Outcomes such as BMI, lipid profile, MDA, high-sensitivity (hs)-CRP, blood pressure, waist and hip circumferences were evaluated at baseline and end of the study. Results: Whole- bread diet in comparison with white diet could significantly reduce weight ,BMI, cholesterol, Low Density Lipoprotein (LDL), systolic blood pressure and MDA. No significant differences were noted between the two diets for triglyceride, High Density Lipoprotein (HDL) and hs-CRP levels. Conclusion: The present results suggest that whole bread can significantly reduce oxidative and inflammatory marker level and several cardiovascular risk factors among overweight or obese patients with coronary stent

Passive Sampling of Aromatic Hydrocarbons Toluene, Xylene and Ethylbenzene Using Activated Carbon Fabric in Ambient Air of Tehran

Background & Objectives: Air pollution is one of the most important environmental problems in large cities. Aromatic hydrocarbons as volatile organic compounds (VOCs) have been listed in Hazardous Air Pollutants (HAPs) by Environmental Protection Agencies (EPA). The aim of this study is Passive sampling and determination of aromatic hydrocarbons (AHs) toluene, xylene and ethylbenzene using activated carbon fabric in ambient air of Tehran Methods: Activated carbon fabric (ACF) was used as adsorbent for adsorption of aromatic hydrocarbons. The chemical specifications of activated carbon fabric such as specific surface area and pores volume were determined by nitrogen adsorption isotherm (BET method), the microscopic images by scanning electron microscopy (SEM) and surface functional groups by X-ray Photoelectron Spectroscopy (XPS). Air sampling was achieved by passive samplers equipped with activated carbon fabric in cylindrical holders at 8 different stations of Tehran. Gas chromatography mass spectrometry (GC-MS) was used for determination of Toluene, Ethylbenzene, and Xylene after extraction in CH2Cl2. Results: The results showed activated carbon fabric is an efficient adsorbent for passive sampling of aromatic hydrocarbons and at different stations the concentrations of Toluene, Ethylbenzene, and Xylenes were determined. The results indicated that Javadiyeh station (Region 17) and Imam Khomeini station (Region 10) were polluted than other stations, whereas at Chitgar station (Region 22), Sattari station (Region 5) and Tehran pars station (Region 8) had lower concentrations of AHs. The good correlation between carbon monoxide and aromatic hydrocarbons concentrations in each sampling station showed they have similar source of emission (cars). The concentration of these pollutants is influenced by topography, wind direction and speed and the number of car passing through different stations. Conclusion: As the concentrations of aromatic hydrocarbons in ambient air are low using AFC in passive sampler is an efficient method for sampling and adsorption of AHs and then their determination. For this purpose it is necessary to exist special functional groups and especially oxygen containing fuctional groups on the surface of carbon fabric

Three Planar Symmetry of Hip, Knee and Ankle Joints’ Moments during Running: Three planar Symmetry of Hip, Knee and Ankle Joints’ moments during Running

Introduction: Symmetry and asymmetry of the limbs’ movement pattern during running are introduced as one of the main critical challenges of human locomotion. The aim of this study was to investigate three planar symmetry of hip, knee and ankle joints’ moments during running at a fixed speed. Methods and Materials: the present study was conducted as a quasi-experimental study. Elite runner (age: 34.75±6.63 years) participated in this study. Running at constant speed was conducted by each subject at 2/5 m.s-1 on treadmill while kinematic (Raptor-4 motion analysis) and kinetic data (Force plate, Bertec) were captured at 150 Hz and 300 Hz, respectively. The internal joint moments in each plane were represented in the joint-coordinate system and were calculated using a standard inverse-dynamics approach and were normalized by the subject’s body mass as well as running cycle over 101 time points. Independent t tests were conducted to examine the symmetry of hip, knee and ankle moments between dominant and non-dominant joints during stance phase of running (P<0.05). Results: results of the present study showed no significant difference between two limb’s peak moments of lower joints in every three plane. Highest values of the dominant limb’s peak moments in sagittal, frontal and transvers plane were derived in (knee, ankle, hip), (hip, knee, ankle) and (knee, ankle, hip) respectively. Conclusion: Symmetry exists in lower joints three planar moments during running at the constant speed. According to the results dominant and non- dominant lower joints play propulsive and absorbent roles cooperatively

A Comparison of Kinematic Symmetry of Lower Limbs during Running at Different Speeds

Introduction: Symmetry and asymmetry of lower limbs are introduced as main critical challenges of human movement. The aim of this study was to compare the kinematic symmetry of lower limbs during running at different speeds. Material and Methods: The study was conducted as a quasi-experimental design. Twenty-eight professional runners (aged: 34.75±6.63 years) voluntarily participated in this study. Running at three progressive speeds (2.5, 3.5 and 4.5 m/s) was conducted by each subject on a treadmill while kinematic data were captured at 150 Hz. Peak angle of hip, knee and ankle joints during flexion were derived in the stance phase of running. Independent T-test were performed to examine the symmetry of peak flexion angles of hip, knee and ankle joints during running at different speeds using SPSS ver. 22 (P<0.05). Results: Findings showed no significant difference between two limbs in peak flexion angles of lower joints at every speed. Conclusions: Symmetry exists in peak flexion angles of lower joints in stance phase during running at the different progressive speeds. Coaches and biomechanists would achieve benefits of kinematic symmetry of lower joints in order to prevent injuries and optimize athletes’ running performance

Heterozygosity analysis of polycystic kidney disease 1 gene microsatellite markers for linkage analysis of autosomal dominant polycystic kidney disease type 1 in the iranian population

Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic cause of end-stage renal disease. Although imaging techniques are a means of accurate diagnosis when the cysts appear in the third or fourth decades of the patient's life, they are of little value for early diagnosis. Genetic tests are required for preimplantation genetic diagnosis, decision-making for kidney donation to an affected relative. Although mutation of the polycystic kidney disease (PKD1) gene is solely responsible for the most cases of ADPKD, direct genetic testing is limited by the large size of this gene and the presence of many mutations without hot spots. Therefore, indirect diagnosis with linkage analysis using informative microsatellite markers has been suggested. Materials and Methods: In this study, we assessed the informativeness of the PKD1 gene markers D16S475, D16S291, and D16S3252 in Iranian population. Using specific primers, fluorescent polymerase chain reaction (PCR) was performed on genomic DNA extracted from fifty unrelated individuals. PCR products were analyzed by the ALFexpress DNA sequencer system, and the number and frequency of alleles were determined to calculate the heterozygosity (HET) and polymorphism information content (PIC) values. Results: We found that the HET and PIC values for the D16S475 marker are 0.92 and 0.91, respectively. These two values are 0.82 and 0.80 for D16S291 and 0.50 and 0.47 for D16S3252, respectively. Conclusion: Based on this data, D16S475 and D16S291 are highly and D16S3252 is moderately informative for indirect genetic diagnosis of PKD1 mutations in this population

A study to assess the knowledge and practice of medical professionals on radiation protection in interventional radiology

Objective: Ionizing radiation has been extensively used in medical procedures throughout the world. Such interventional radiological procedures could result in occupational exposure that needs urgent control. Therefore, MPs (medical professionals) should receive education and appropriate training on occupational radiation protection. In this context, the present study is aimed to investigate the MPs’ knowledge and practice regarding radiation protection principles during interventional radiological procedures. Material and Methods: A descriptive questionnaire-based study was carried out among 215 MPs involved in interventional fluoroscopy procedures. The practice of 31 MPs was studied using a checklist based on ALARA principles and ICRP guidelines. Results: A total of 43.3% and 45.1% answered correctly for knowledge and practice. However, the difference between radiation protection knowledge and practice between the physicians and nurses was statistically significant. The knowledge and practice survey of MPs demonstrated that nurses rarely adhered to radiation-protection measures. Conclusion: The present study reflects the lack of knowledge and practice concerning radiation protection concepts among the nurses. This deficiency needs to be resolved by periodic practical radiation protection courses in the curriculum of medicine