Health system responsiveness for outpatient care in people with diabetes Mellitus in Tehran

Background: World Health Organization (WHO) defines three goals to assess the performance of a health system: the state of health, fairness in financial contribution and responsiveness. We assessed the responsiveness of health system for patients with diabetes in a defined population cohort in Tehran, Iran. Methods: Total responsiveness and eight domains (prompt attention, dignity, communication, autonomy, confidentiality, choice, basic amenities and discrimination) were assessed in 150 patients with diabetes as a representative sample from the Tehran Glucose and Lipid Study (TLGS) population cohort. We used the WHO questionnaire and methods for analysis of responsiveness. Results: With respect to outpatient services, 67 (n=100) were classified as Good for total responsiveness. The best and the worse performing results were related to information confidentiality (84 good responsiveness) and autonomy (51 good responsiveness), respectively. About 61 chose "communication" as the most important domain of responsiveness; it was on the 4th rank of performance. The proportions of poor responsiveness were higher in women, individuals with lower income, lower level of education, and longer history of diabetes. "Discrimination" was considered discrimination as the cause of inappropriate services by 15, and 29 had limited access to services because of financial unaffordability. Conclusion: Health system responsiveness is not appropriate for diabetic patients. Improvement of responsiveness needs comprehensive planning to improve attitudes of healthcare providers and system behavior. Activities should be prioritized through considering weaker domains of performance and more important domains from the patients' perspective

Prevalence of goiter among schoolchildren from Gorgan, Iran, a decade after national iodine supplementation: Association with age, gender, and thyroperoxidase antibodies

Background: One decade after universal salt iodization in Iran, goiter prevalence, urinary iodine concentration (UIC) and thyroperoxidase antibody (TPOAb) values were assessed among schoolchildren in Gorgan, Iran. Methods: From 2003-2004, 500 girls and 900 boys aged 7-11 yr were evaluated for goiter by palpation. UIC was measured in 183 randomly-selected goitrous children. Serum TSH, T 4, and TPOAb were measured in 53 goitrous and 30 non-goitrous children with adequate UIC. Results: Goiter was detected in 370 (26.4%) children. Goiter was present in 31 % of girls and 17% of boys age 9 (p<0.012); 37% of girls and 20% of boys age 10 (p<0.003); and 52% of girls and 19% of boys age 11 (p<0.0001). Median (range) UIC for all goitrous children sampled was 190 (20-600) μg/l; 220 (30-590) in boys and 170 (20-600) in girls (p=0.001). Eight point seven percent of goitrous children and 22% of goitrous girls aged 10-11 had UIC<100 μg/l, while 47% of the goitrous children had UIC≥200 μg/l. TPOAb was present in 52.8% of goitrous children and 10% of non-goitrous children (p=0.0001 ). TPOAb was present in 53.9% of 10-11 and 22.7% of 7-9 yr old goitrous and non-goitrous children (p=0.003) with adequate UIC. Median (range) TSH was 2.9 (0.3-10.9) mlU/l in TPO-positive and 1.8 (0.5-4.1) in TPO-negative children (p=0.001 ). Conclusions: Gorgan, Iran, is an iodine-sufficient area and almost half of schoolchildren have more than adequate UIC. TPOAb is associated with endemic goiter. Despite sufficient UIC overall, some school-aged girls remain at risk of iodine deficiency. ©2005, Editrice Kurtis

Associations of autozygosity with a broad range of human phenotypes

In many species, the offspring of related parents suffer reduced reproductive success, a phenomenon known as inbreeding depression. In humans, the importance of this effect has remained unclear, partly because reproduction between close relatives is both rare and frequently associated with confounding social factors. Here, using genomic inbreeding coefficients (F-ROH) for >1.4 million individuals, we show that F-ROH is significantly associated (p <0.0005) with apparently deleterious changes in 32 out of 100 traits analysed. These changes are associated with runs of homozygosity (ROH), but not with common variant homozygosity, suggesting that genetic variants associated with inbreeding depression are predominantly rare. The effect on fertility is striking: F-ROH equivalent to the offspring of first cousins is associated with a 55% decrease [95% CI 44-66%] in the odds of having children. Finally, the effects of F-ROH are confirmed within full-sibling pairs, where the variation in F-ROH is independent of all environmental confounding.Peer reviewe

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Value Of Fine Needle Aspiration In Diagnosing Abdominaland Retroperitoneal Masses Of Children

The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retroperitoneal masses within a 4 year period (1998-2001) preoperative fine needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases.This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity (positive or negative for malignancy) is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after f! ine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases

Detection and identification of Leishmania isolates from patients with Cutaneous Leishmaniasis (CL) in Isfahan (central region of Iran) by PCR method

Leishmaniasis is caused by parasitic protozoa of the genus Leishmania. Cutaneous leishmaniasis (CL) is a complex disease with wide spectrum of clinical manifestations. In order to identify leishmania species causing CL in Isfahan by a definite molecular technique (PCR method), this study was undertaken over 2010- 2011. 124 Patients with suspicious lesion of Leishmaniasis and positive direct smear from lesion were selected. Samples were cultured in NNN and RPMI 1640 media Negative and positive control and clinical samples was applied for PCR in the same condition. In the next step, standard PCR was carried out using classic protocol. From 124 patients, 111 (89.51%) cases were infected as L. major and 12 (9.67%) cases were infected by L. tropica, However only in one patient simultaneous infectious with both L. major and L. tropica was identified by PCR techniques which could not be possible in microscopy. L.major was the most prevalent species in the studied patients (p-value<0.001)

Molecular characterization of lpxACD and pmrA/B two-component regulatory system in the colistin resistance Acinetobacter baumannii clinical isolates

Colistin is drug of choice for treatment of carbapenem-resistant Acinetobacter baumannii infections. Unfortunately, global increase in clinical outbreaks of colistin and carbapenem resistant A. baumannii infections is on the rise and cause public health concern. In the present study, a total of 187 A. baumannii recovered from specimens of 240 patients admitted to intensive care units (ICUs) of two hospitals in Kerman, Iran during 2017�2018. Among the isolates, we found four extensive drug-resistant (XDR) with Minimum Inhibitory Concentration (MIC) �4 μg/mL against colistin. The colistin-resistant (Col-R) isolates harbored blaOXA�51 and blaOXA-23 carbapenemase genes, exhibited resistance to all antibiotic classes except tigecycline and ampicillin-sulbactam. They belonged to clonal complex 2, a new MLST type 1752 and displayed identical RAPD-PCR fingerprints. Phylogenetic tree analysis suggested that, the Col-R A. baumannii emerged by endogenous mutations rather than acquisition of preexisting clones. Expressions of pmrCAB by quantitative real-time PCR (qRT-PCR) revealed 8 and 7 folds increased in the transcription levels of pmrB/C genes in strain 1 grown in presence of 16 μg/mL colistin (p � 0.01). However, no change in the expression of the pmrA was observed. Furthermore, DNA sequencing of Col-R genes illustrated three nonsynonymous substitutions in the LpxA (N136 � K), LpxC (P293 � Q), and PmrB (V21 � F, S28 � R, I149 � F) in the strains 1 and 3, respectively showing MIC 32 μg/mL against colistin. Multiple amino acids alignments demonstrated several substitutions in N-terminal region of PmrB. In conclusion, the above results provide valuable insights into the mechanism of Col-R in A. baumannii and the expressions of relative genes. © 2020 Elsevier Inc

Stereochemical trajectories of a two-component regulatory system pmra/b in a colistin-resistant acinetobacter baumannii clinical isolate

Background: There is limited information on the 3D prediction and modeling of the colistin resistance-associated proteins PmrA/B TCS in Acinetobacter baumannii. We aimed to evaluate the stereochemical structure and domain characterization of PmrA/B in an A. baumannii isolate resistant to high-level colistin, using bioinformatics tools. Methods: The species of the isolate and its susceptibility to colistin were confirmed by PCR-sequencing and MIC assay, respectively. For 3D prediction of the PmrA/B, we used 16 template models with the highest quality (e-value <1 � 10�50). Results: Prediction of the PmrA structure revealed a monomeric non-redundant protein consisting of 28 α-helices and 22 β-sheets. The PmrA DNA-binding motif displayed three antiparallel α-helices, followed by three β-sheets, and was bond to the major groove of DNA by intermolecular van der Waals bonds through amino acids Lys, Asp, His, and Arg, respectively. Superimposition of the deduced PmrA 3D structure with the closely related PmrA protein model (GenBank no. WP071210493.1) revealed no distortion in conformation, due to Glu�Lys substitution at position 218. Similarly, the PmrB protein structure displayed 24 α-helices and 13 β-sheets. In our case, His251 acted as a phosphate receptor in the HisKA domain. The amino acid substitutions were mainly observed at the putative N-terminus region of the protein. Furthermore, two substitutions (Lys21�Ser and Ser28�Arg) in the transmembrane domain were detected. Conclusion: The DNA-binding motif of PmrA is highly conserved, though the N-terminal fragment of PmrB showed a high rate of base substitutions. This research provides valuable insights into the mechanism of Col-R in A. baumannii. © 2021, Pasteur Institute of Iran. All rights reserved

An assessment of urinary and breast milk iodine concentrations in lactating mothers from Gorgan, Iran, 2003

Dietary iodine is essential for the production of thyroid hormones. Breast-fed infants are reliant on maternal iodine intake. The aim of this study was to evaluate iodine sufficiency in lactating women in Iran. The sample consisted of 100 lactating mothers referred to the Taleghani Hospital of Gorgan, Iran. Goiter was graded according to World Health Organization (WHO) classification. Spot urine and breast-milk samples were collected for the measurement of iodine concentrations. Urine iodine concentrations (UIC) less than 100 and breast-milk iodine concentrations (MIC) less than 50 μg/L were considered consistent with iodine deficiency. Forty-three percent of women had grade 1 and 2 goiters, respectively. The median UIC was 259 μg/L. UIC was less than 100 in 16. Grade 1 and 2 goiters were each present in 8 of mothers with UIC less than 100 μg/L. The median MIC was 93.5 μg/L. MIC was less than 50 μg/L in 19. Grade 1 and 2 goiters were present in 11 and 8, respectively, of women with MIC <50 mg/L. MIC and UIC levels were significantly correlated (r = 0.44, p < 0.0001). Iodine deficiency and goiter were associated (p < 0.0001). UIC and MIC concentrations are sufficient in Gorgan, Iran. However, individual infants remain at risk for low iodine intake via breast milk. © Mary Ann Liebert, Inc