The Long-Term Effectiveness of Methadone Maintenance Treatment in Prevention of Hepatitis C Virus Among Illicit Drug Users : A Modeling Study

Article Accepted Date: Oct 7, 2013 Acknowledgments: We would like to thank all MMT centers' staff in Shiraz for their cooperation in this study. Funding Support: This study was funded and supported by the Tehran University of Medical Sciences.Peer reviewedPublisher PD

Cost-effectiveness of Methadone Maintenance Treatment in prevention of HIV among drug users in Shiraz, south of Iran

Background: The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS. Objectives: This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users. Materials and Methods: In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER). Results: Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $547423 and that of HIV/AIDS care in the no intervention scenario was estimated$ 14171816. ICER was $106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from$ 39149 to $ 290004 per HIV case averted. Conclusions: With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable. © 2013, Iranian Red Crescent Medical Journal

Trends in 5-, 10-, 20-, and 30-year survival rates of beta-thalassemia patients in Southern Iran, 1995-2016: A retrospective cohort study

Background: There is currently lack of knowledge about survival trend analysis of thalassemia patients. Therefore, the aim of the present study was to assess 5-, 10-, 20-, and 30-year survival of thalassemia patients over a 20- year time period. Methods: In this retrospective cohort study, we analysed the data of 982 beta-thalassemia patients in Iran. Birth cohort and traditional cohort analyses were used to obtain the 5-, 10-, 20-, and 30-year survival rates in various time intervals between 1995 and 2016. Results: Five and 10-year survival rates remained unchanged since 1995-2016. Overall, 20- and 30-year survival rates were lower in younger birth cohorts than older ones. A declining trend was found in 20-year survival rate from 1995 to 2000 for all and also for thalassemia major patients, but was stable from 2001 to 2016. In addition, there was a declining trend in 30-year survival rate from 1995 to 2008 for all and also for thalassemia major patients, but was an increased trend from 2009 to 2016. Conclusion: Over the past two decades and in recent birth cohorts, the 20- and 30-year survival rates has declined. In other words, declining survival trends in the birth cohorts may be associated with some different causes of mortality such as exposure to the toxic effects of iron over time and the occurrence of disease-related mortality

Sensitivity and specificity of chest computed tomography scan based on RT-PCR in COVID-19 diagnosis

Purpose: COVID-19 is a novel, severely contagious and progressive infection occurring worldwide. The diagnosis of the disease is based on real-time polymerase chain reaction (RT-PCR) and computed tomography (CT) scan, even though they are still controversial methods. Material and methods: We studied 54 patients with suspected COVID-19 and the two mentioned methods were compared with each other. Results: Sensitivity and specificity of the abnormal chest CT scan, ground-glass opacity (GGO), consolidation opacity, and both of GGO and consolidation were also surveyed based on RT-PCR. The results showed that RT-PCR assay was negative in 23 (42.6%) patients and positive in 31 (57.4%) cases. Also, the patients with an abnormal chest CT scan comprised 37 (68.5%). The sensitivity and specificity of abnormal CT scan were 78.6% and 42.3%, respectively, based on the RT-PCR method. Conclusions: Other techniques alongside CT scan and RT-PCR are advocated for accuracy of the COVID-19 diagnosis

Risk factors for COVID-19 severity and mortality among inpatients in Southern Iran

Introduction: COVID-19 is a highly contagious respiratory disease and many factors can affect its severity and mortality. This study aimed to investigate the risk factors associated with the severity and mortality of COVID-19. Methods: In this study, 311 cases with COVID-19 approved by the CORONA database in the Center for Disease Control and Prevention (CDC) of Shiraz University of Medical Sciences were selected using a random systematic sampling method. The study data were collected through interviews and phone calls. Results: The mean age of the participants was 45.82±17.92 years, and the male to female ratio was 1.57:1. In addition, the Case Fatality Rate (CFR) was 4.50%, and the disease was severe in 47.5% of the cases. The most common clinical symptoms were cough (39.22%), fever (31.83%), and dyspnea (24.76%). The severity of COVID-19 was significantly associated with age and history of Cardiovascular Disease (CVD). Besides, the mortality of COVID-19 was significantly related to age, gender, hypertension, CVD, and Chronic Kidney Disease (CKD). The mean interval between the onset of the first symptom and referral to health center was 3.02±2.82 days. Additionally, the mean interval between the referral to health centers and testing was 0.88±2.20 days. Conclusion: Older patients and those who had CVD needed more careful healthcare and early intervention to prevent the exacerbation of COVID-19. Furthermore, the interval between the onset of the first symptom and testing was relatively long. Overall, early diagnosis, isolation, and treatment of patients were found to be essential to control COVID-19

A 30-year trend of the incidence and death of tracheal, bronchial, and lung cancers in Iran and forecasting until 2026 based on time series analysis

Objective: Lung cancer is the second most common cancer in the world, with an estimated 2.2 million new cases and 1.8 million deaths and is the fifth most common cancer in men and the sixth most common cancer in women in Iran. This study was conducted to investigate a 30-year trend of the incidence and death of tracheal, bronchial, and lung cancer in Iran and its forecasting until 2026. Materials and Methods: The Iranian population's age-standardized (ASR) incidence and death rates of tracheal, bronchial, and lung (TBL) cancers were extracted from the Global Burden of Disease (GBD) Online Database from 1990 to 2019. Statistical analysis was performed using the time series method with Interactive Time Series Modeling (ITSM) software and Autoregressive Integrated Moving Average (ARIMA) model. Results: The age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) of lung cancer in Iranians (both gender) had an increasing trend from 2004 to 2019 among men and from 1990 to 2019 in women with a continued predicted increasing trend for 7 years. ASIR will increase to 13.53, 17.36, and 9.26 per 100,000 people in the total population, men and women, respectively. ASDR will increase to 14.13, 18.18, and 9.22 per 100,000 people in the total population, men and women, respectively. Conclusions: In according to the predicted increasing trend of TBL cancers in Iran in the future, the reasons for the continuation of this increasing trend should be fully investigated, and then by using the experiences of successful countries in reducing lung cancer, effective measures should be considered to reduce the morbidity, mortality, and burden of these cancers in Iran

Epidemiology of Suicide by Hanging in Fars Province, Iran (2011-2019): A Population-based Cross-sectional Study

Objectives Hanging is a common method of attempted suicide. This study investigated the epidemiological profile of attempted and completed suicides by hanging in southern Iran. Methods This cross-sectional study was performed on 1167 suicide attempts by hanging between 2011 and 2019. All data related to suicide attempts by hanging were collected from the Fars Suicide Surveillance System. The trends in suicide cases and the mean age of attempted and completed suicides were plotted. The chi-square test was used to identify suicide-related factors. Crude rates of incidence, mortality, and standardized fatality during the study period were calculated. Finally, logistic regression was used to identify the predictors of death in individuals who attempted suicide. Results The mean age of those who attempted suicide was 33.21±16.82 years; the majority were male (80.5%). The rate of attempted and completed suicide by hanging were 3.50 and 2.79 per 100 000 people, respectively. The case-fatality rate was calculated as 79.34%. The results of our study indicated an increasing trend in suicide attempts by hanging. The likelihood of death was 2.28 times higher in individuals with a previous history of suicide attempts and 1.85 times higher in those with a psychological disorder. Conclusions The findings of this study suggest an increasing trend in attempted and completed suicide by hanging, especially among individuals with a history of suicide attempts and psychological disorders. It is necessary to take action to reduce the rate of suicide attempts and identify the underlying causes of suicide attempts by hanging

Duration of delayed diagnosis in HIV/AIDS patients in Iran: a CD4 depletion model analysis

ObjectiveDelayed diagnosis of HIV can lead to an inappropriate response to antiretroviral therapy (ART), rapid progression of the disease, and death. It can also carry harmful effects on public health due to the increment of transmission. This study aimed to estimate the duration of delayed diagnosis (DDD) in HIV patients in Iran.MethodsThis hybrid cross-sectional cohort study was conducted on the national HIV surveillance system database (HSSD). Linear mixed effect models with random intercept, random slope, and both were used to estimate the parameters required for the CD4 depletion model to determine the best-fitted model for DDD, stratified by the route of transmission, gender, and age group.ResultsThe DDD was estimated in 11,373 patients including 4,762 (41.87%) injection drug users (IDUs), 512 (4.5%) men who had sexual contact with men (MSM), 3,762 (33.08%) patients with heterosexual contacts, and 2,337 (20.55%) patients who were infected through other routes of HIV transmission. The total mean DDD was 8.41 ± 5.97 years. The mean DDD was 7.24 ± 0.08 and 9.43 ± 6.83 years in male and female IDUs, respectively. In the heterosexual contact group, DDD was obtained as 8.60 ± 6.43 years in male patients and 9.49 ± 7.17 years in female patients. It was also estimated as 9.37 ± 7.30 years in the MSM group. Furthermore, patients infected through other transmission routes were found with a DDD of 7.90 ± 6.74 years for male patients and a DDD of 7.87 ± 5.87 years for female patients.ConclusionA simple CD4 depletion model analysis is represented, which incorporates a pre-estimation step to determine the best-fitted linear mixed model for calculating the parameters required for the CD4 depletion model. Considering such a noticeably high HIV diagnostic delay, especially in older adults, MSM, and heterosexual contact groups, regular periodic screening is required to reduce the DDD

Effectiveness of methadone maintenance treatment in prevention of hepatitis C virus transmission among injecting drug users

Background: Injecting drug users (IDUs) are a major and most important risk factor for rising hepatitis C virus (HCV) prevalence in Iran. Objectives: The objective of this study was to determine the effectiveness of methadone maintenance treatment (MMT) in prevention of HCV infection transmission among IDUs. Patients and Methods: A mathematical modeling has been used to estimate number of HCV infections averted. The input parameters used in the model were collected by self-reported method from 259 IDUs before registering and one year after MMT. Nonparametric statistical tests have been used to compare risky injecting and sexual behaviors among IDUs before and after participating in MMT program. Deterministic sensitivity analyses were done to show the effects of parameters' uncertainty on outcome. Results: Of the 259 participants, 98.4 (255) were men, the mean age ± SD was 33.1 ± 7.58 years and HCV prevalence was 50. The studied IDUs reported lower rate of risky injecting and sexual behavior after participation in MMT program. The cumulative incidence of HCV per 100 IDUs due to sharing injection and unsafe sexual contact with MMT program were 13.84 (95 CI: 6.17 -21.51), 0.0003 (0.0001 - 0.0005) and without it 36.48 (25.84 - 47.11) and 0.0004 (0.0002-0.0006) respectively. Conclusions: The MMT program is an effective intervention to prevent HCV infection transmission, although it is essential to compare its effectiveness with other interventions before implementing it in nationwide. © 2013, Kowsar Corp.; Licensee Kowsar Ltd

High Titers of Hemagglutination Inhibition Antibodies against 2009 H1N1 Influenza Virus in Southern Iran

ABSTRACT Background: Pandemic flu had at least two waves in Iran. Knowing how many of the general population were already exposed to this infection has a major impact on national preventive measures. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths. Objective: In this study we aim to measure, as a pilot study, the seroprevalence of positive antibody titer (humoral immunity) against 2009 H1N1 virus in Iranian population in Shiraz, Southern Iran. Methods: Through cluster random sampling of families residing in Shiraz, 2553 subjects were selected and after a medical interview blood samples were taken and checked for polyclonal antibody against 2009 H1N1 antigen using hemagglutination inhibition assay. An antibody titer of more than 1:40 dilution was considered positive. Data were analyzed considering the demographic characteristics of the population and were compared among different age groups. Results: 1504 (58.91%) samples were tested positive for the presence of polyclonal antibody against 2009 H1N1 virus. The prevalence of positive titers were significantly higher in 60 to 64 years old group and significantly lower in 20 to 24 years old group (p<0.05). Data did not differ based on other demographic characteristics or the history of flu like illnesses in the past 6 months. Conclusion: High seroprevalence of antibody against 2009 H1N1 in the sera of our subjects describes either a high level of preexisting immunity against H1N1 in Iranian population or a high rate of asymptomatic infection in our area compared to other countries