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

Factors related to pedestrians mortality following road traffic accidents in Tehran and Alborz Provinces, Iran

Background and aims: This study aimed to investigate the deaths and injuries following pedestrian traffic accidents and factors associated with death of pedestrian in Tehran and Alborz provinces. Methods: In this cross-sectional study all traffic accidents related to pedestrians in Tehran and Alborz provinces reported from March 21, 2013 to March 21, 2014 by the traffic police were studied. The Database related to death of Legal Medicine Organization was used in order to determine the exact number of deaths. The standard population of World Health Organization was used in order to calculate the age-standardized incidence rate. We used Chi-square test, T-test and logistic regression to extract statistically significant associations. P-value under 0.05 was considered significant. Result: The age-standardized mortality and injury rate were respectively, 6.1 and 65.1 per 100,000 populations. The pedestrian’s road traffic (PRT) mortality and injury rates in men were 3 and 1.5 times more than women respectively. Statistically significant relationships were observed between the pedestrian’s age, the direct cause in the accident, classification of road, month of occurrence, days of week, type of vehicle, accident location and pedestrian action with the death of pedestrians. Conclusion: Given that the highest incidence rate of death was observed in the age group over 65 years old, it is necessary to pay special attention to the physiologic characteristics of this age group by predicting safety plans and also to provide more secure conditions for this high risk group in accident-prone road sections

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

Analysis of Mortality Rate of Illicit Substance Abuse and its Trend in Five Years in Iran, 2014-2018

Background: Addiction and drug misuse is an illness that affects every community in every country. Based on the previous research in many parts of the world, illicit drug use is considered as a well-known risk factor for morbidity, disability, and premature mortality. Although this issue is a hot topic for public health, little studies have looked the epidemiology of substance abuse death and its trends among Iranian society. This study aims to calculate the rate of substance misuse mortality and investigate its trend in Iran. Methods:This research was a cross-sectional study. For doing this study, the demographic and epidemiological data of people who died from substance misuse from 2014-2018 were extracted from Legal Medicine Organization (LMO). Finally, descriptive statistics were used to analyze the data. Findings: 15304 deaths due to drug misuse were recorded in 2014-2018. The substance abuse mortality rate has increased during the study period in men and women. There were significant differences in death rates between men and women. Crude mortality rate was significantly higher among men compared to women. The majority of deaths has occurred in young men aged 30-39 years with high school education and self-employed. Conclusion: The results revealed that death from substance misuse has increased during the study period. This increasing trend was observed in women and men. Further preventive measures, however, should be devised to reduce drug-related deaths. The majority of deaths occurred in young men aged 30-39 years with high school education and self-employed. In our opinion and based on the study results, programs, policies, and preventive measures should be taken to prevent these people from accessing and using the drug

Characterizing Mortality from Substance Abuse in Iran: An Epidemiological Study during March 2014 to February 2015

Background: Drug abuse is a severe and chronic disorder that leaves morbidity, disability and premature mortality in the society. The study of death due to substance abuse provides useful information for local, national and international administrators. Thus, by identifying the factors that have an impact on overdose-related mortality we can provide suitable intervention for vulnerable groups. The aim of this study was an investigation of mortality rate caused by consumption of narcotic and psychoactive substances in Iran.Methods: In this cross-sectional study, demographic and epidemiological data about all people whose cause of death was substance abuse in March 2014 to February 2015 were collected from Legal Medicine Organization (LMO). Finally, the information that was extracted from two checklists was analyzed by descriptive statistics.Findings: In this study, 2986 cases died from substances abuse were evaluated. Most deaths have befallen in unmarried young men with mean age of 36.9 ± 12.3, in the private locations. The mortality rate of drug abuse in the whole country was 38.4 per 1000000 population. The proportion of mortality was higher in Iranian nationality and in people who had a diploma and less education. History of overdose, suicide, hospitalization in a psychiatric hospital, staying in prison and substance abuse in the family were investigated in the study population.Conclusion: The present study revealed that mortality rate from substance abuse is more among unmarried young men aged 30-39 years with low education level and also in the self-employed group. We suggest that policies should be taken to prevent these people from accessing and using the drug

Epidemiological and Clinical Aspects of COVID-19; a Narrative Review

There are significant misconceptions and many obstacles in the way of illuminating the epidemiological and clinical aspects of COVID-19 as a new emerging epidemic. In addition, usefulness of some evidence published in the context of the recent epidemic for decision making in clinic as well as public health is questionable. However, misinterpreting or ignoring strong evidence in clinical practice and public health probably results in less effective and somehow more harmful decisions for individuals as well as subgroups in general populations of countries in the initial stages of this epidemic. Accordingly, our narrative review appraised epidemiological and clinical aspects of the disease including genetic diversity of coronavirus genus, mode of transmission, incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance, clinical case management and also successful measures for preventing its spread in some communities. Keywords:COVID-19; severe acute respiratory syndrome coronavirus 2; epidemiology; public health; communicable diseases; emergin

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

Risk of second primary cancer among breast cancer patients: A systematic review and meta-analysis

ObjectivesThe aim of this study was to estimate the extra risk of second primary cancer among breast cancer patients.Methods and materialsThis is a systematic review. A comprehensive search of literature was performed in PubMed, Web of Science, Cochrane library, and Scopus. The search included all published studies up to October 2022. This systematic review included studies published in the English language that reported the risk of second primary non-breast cancer [i.e., standardized incidence ratio (SIR)] among breast cancer patients older than 15 years. After evaluating the methodological quality of the selected studies, SIRs were pooled with consideration of heterogeneity among studies. The estimates were pooled by age and time since the diagnosis of primary breast cancer for both sexes (male and female). Age was categorized based on before 50 years and after 50 years, and time was categorized as duration of less than and more than 10 years, respectively.ResultsFrom 2,484 articles, 30 articles were eligible for inclusion in the systematic review and meta-analysis. The studies varied in terms of population, number of cases, study design, setting, and year of implementation of the research. The estimated SIR for men and women was 1.28 (95% CI: 1.18, 1.38) and 1.27 (95% CI: 1.15, 1.39), respectively. Women diagnosed with breast cancer before menopause [SIR: 1.52 (95% CI: 1.34, 1.71) vs. 1.21 (95% CI: 1.08, 1.34)] as well as women after 10 years since their breast cancer diagnosis [1.33 (95% CI: 1.22, 1.431) vs. 1.24 (95% CI: 1.10, 1.37)] were at a higher risk of developing second primary cancer. Among men, while there were no differences in risk based on age, with the increase of time, the risk of second primary cancer was reduced [SIR: 1.22 (95% CI: 1.12, 1.33) vs. 1.00 (95% CI: 0.79, 1.22)].ConclusionThere is an extra risk of second primary cancer among breast cancer patients. The extra risk should be considered for further screening and preventive measures among this population.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336062, identifier (CRD42022336062)