Breast tuberculosis in Northeast Iran: Review of 22 cases

Background: Breast tuberculosis (breast TB) is an extremely rare disease, so case reviews are also rare.Methods: This study is a retrospective review of patients with breast TB who were treated between 2002 and 2012 at the Health Center of Gorgan City.Results: All 22 patients were females, their mean age was 32.4 years, and all were new cases. Patients presented with swelling of the breast (22%), lump (55%) and excretion from the involved breast (27%), and breast pain (55%). The highest rate of breast TB occurred in 2011 (27%). All patients received the DOTS regimen for a mean duration of 7.3 ± 0.7 months; in addition, segmental resection was performed on 11 patients (50%).Conclusions: The findings confirmed that breast TB in Iran should be considered as a differential diagnosis of breast masses. All patients in our study received the daily and 'Directly Observed Treatment Short-course' (DOTS) regimens. Anti-tubercular therapy for six months with or without minimal surgical intervention currently is the main treatment. © 2014 Khodabakhshi and Mehravar; licensee BioMed Central Ltd

Prevalence of asthma symptoms in Golestan schoolchildren aged 6–7 and 13–14 years in Northeast Iran

Asthma is the most common chronic disease among children, and its incidences are often imminent among elementary schoolchildren. This study aimed to examine the prevalence of asthma symptoms in Golestan schoolchildren aged 6–7 and 13–14 years in Northeast Iran. The prevalence rate was compared according to age group (aged 6–7 years vs. aged 13–14 years) and gender (male vs. female). In this cross-sectional study, 1706 Iranian schoolchildren aged 6–7 and 13–14 years in Golestan Province were enrolled. Participants completed questionnaires between February and July 2014. Asthma symptoms were assessed using the questionnaire of the International Study of Asthma and Allergies in Childhood protocol in Persian. The logistic regression model was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the asthma symptoms for each of the gender and age groups. The prevalence rates of “current asthma” symptoms and “asthma ever” in all the children were estimated as 9.5% and 7.5%, respectively. The prevalence of asthma (“asthma ever” and “wheezing in the past 12 months”) in junior high schoolchildren (aged 13–14 years) is higher than that in elementary schoolchildren (aged 6–7 years) (P < 0.05). The prevalence of the severity of wheezing in girls is lower than that in boys (OR = 1.7, 95%CI = 1.06–2.96, P = 0.02). Asthma is still a major public health problem. This study shows that the prevalence of the asthma symptoms in boys is lower than that in girls in both age groups, and the severity of asthma in girls is higher than that in boys aged 13–14 years. © 2016 Higher Education Press and Springer-Verlag Berlin Heidelber

Temperature-Vegetation-soil Moisture-Precipitation Drought Index (TVMPDI):21-year drought monitoring in Iran using satellite imagery within Google Earth Engine

Remote Sensing (RS) offers efficient tools for drought monitoring, especially in countries with a lack of reliable and consistent in-situ multi-temporal datasets. In this study, a novel RS-based Drought Index (RSDI) named Temperature-Vegetation-soil Moisture-Precipitation Drought Index (TVMPDI) was proposed. To the best of our knowledge, TVMPDI is the first RSDI using four different drought indicators in its formulation. TVMPDI was then validated and compared with six conventional RSDIs including VCI, TCI, VHI, TVDI, MPDI and TVMDI. To this end, precipitation and soil temperature in-situ data have been used. Different time scales of meteorological Standardized Precipitation Index (SPI) index have also been used for the validation of the RSDIs. TVMPDI was highly correlated with the monthly precipitation and soil temperature in-situ data at 0.76 and 0.81 values respectively. The correlation coefficients between the RSDIs and 3-month SPI ranged from 0.07 to 0.28, identifying the TVMPDI as the most suitable index for subsequent analyses. Since the proposed TVMPDI could considerably outperform the other selected RSDIs, all spatiotemporal drought monitoring analyses in Iran were conducted by TVMPDI over the past 21 years. In this study, different products of the Moderate Resolution Imaging Spectrometer (MODIS), Tropical Rainfall Measuring Mission (TRMM), and Global Precipitation Measurement (GPM) datasets containing 15,206 images were used on the Google Earth Engine (GEE) cloud computing platform. According to the results, Iran experienced the most severe drought in 2000 with a 0.715 TVMPDI value lasting for almost two years. Conversely, the TVMPDI showed a minimum value equal to 0.6781 in 2019 as the lowest annual drought level. The drought severity and trend in the 31 provinces of Iran have also been mapped. Consequently, various levels of decrease over the 21 years were found for different provinces, while Isfahan and Gilan were the only provinces showing an ascending drought trend (with a 0.004% and 0.002% trendline slope respectively). Khuzestan also faced a worrying drought prevalence that occurred in several years. In summary, this study provides updated information about drought trends in Iran using an advanced and efficient RSDI implemented in the cloud computing GEE platform. These results are beneficial for decision-makers and officials responsible for environmental sustainability, agriculture and the effects of climate change.</p

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Prevalence of asthma symptoms in Golestan schoolchildren aged 6�7 and 13�14 years in Northeast Iran

Asthma is the most common chronic disease among children, and its incidences are often imminent among elementary schoolchildren. This study aimed to examine the prevalence of asthma symptoms in Golestan schoolchildren aged 6�7 and 13�14 years in Northeast Iran. The prevalence rate was compared according to age group (aged 6�7 years vs. aged 13�14 years) and gender (male vs. female). In this cross-sectional study, 1706 Iranian schoolchildren aged 6�7 and 13�14 years in Golestan Province were enrolled. Participants completed questionnaires between February and July 2014. Asthma symptoms were assessed using the questionnaire of the International Study of Asthma and Allergies in Childhood protocol in Persian. The logistic regression model was used to estimate the odds ratios (ORs) and 95 confidence intervals (CIs) of the asthma symptoms for each of the gender and age groups. The prevalence rates of �current asthma� symptoms and �asthma ever� in all the children were estimated as 9.5 and 7.5, respectively. The prevalence of asthma (�asthma ever� and �wheezing in the past 12 months�) in junior high schoolchildren (aged 13�14 years) is higher than that in elementary schoolchildren (aged 6�7 years) (P < 0.05). The prevalence of the severity of wheezing in girls is lower than that in boys (OR = 1.7, 95CI = 1.06�2.96, P = 0.02). Asthma is still a major public health problem. This study shows that the prevalence of the asthma symptoms in boys is lower than that in girls in both age groups, and the severity of asthma in girls is higher than that in boys aged 13�14 years. � 2016, Higher Education Press and Springer-Verlag Berlin Heidelberg

Prevalence of infectious diseases in patients with end stage renal disease in Gorgan City in Iran

Background: The mortality rate of sepsis and pneumonia is higher in end-stage renal disease (ESRD) patients than in the general population. Bacterial infections are the most common cause of hospitalization in dialysis patients and the most common source of bacteremia is vascular access in these patients. The aim of this study was to determine the prevalence of infectious causes of hospitalization in patients with endstage renal failure in Gorgan. Methods: This cross-sectional study was performed on patients with ESRD who were admitted to the 5 Azar Medical Education Center of Gorgan City during 2014 to 2016. Patients' information was collected through their clinical records and analyzed statistically. Results: The prevalence of infectious diseases in ESRD patients during the 3 years was 12.7, out of 100 hospitalized patients with ESRD and infectious causes, the most common type of infectious disease was catheter infection (43) and sepsis (18), urinary tract infection (11) and pneumonia (8) were the next. The most common infectious causes leading to hospitalization in men with the ESRD were catheter infection, sepsis, and pneumonia, respectively, and in women, catheter infection, sepsis, and urinary tract infection. The highest incidence of catheter infection was in the age group of 66-70 years (30.2), 71-75 (25.6), and above 71 years (25.6), respectively. The highest incidence of sepsis occurred in the age group of 75-71 years (38.9) and also the highest incidence of urinary tract infections in the age group of less than 65 years. Age (P=0.003), sex (P=0.01), duration of disease (P=0.009), addiction (P=0.01), and diabetes (P=0.01) were the most common risk factors for infectious diseases in patients with ESRD. Conclusion: The results of this study showed that catheter infection is the most common cause of infection in patients with end-stage renal disease (ESRD). Therefore, avoiding multiple vascular manipulations, disinfection of the catheter, timely replacement, and training of dialysis staff are effective in reducing catheter infections. © 2020 Tehran University of Medical Sciences. All rights reserved

The role of social activity in the association between socioeconomic status and physical health in Tehran University of Medical Sciences employees` cohort study: a structural equation modeling

Socioeconomic status (SES) is often considered a major predictor of health outcomes. This study aimed to determine the role of social activity in the association between SES and physical health among Tehran University of Medical Sciences Employees� Cohort (TEC) study. In this cross-sectional design, we used the data of the enrolment phase of the Tehran University of Medical Sciences (TUMS) cohort study on 4461 employees. The latent variable of this study was the composite SES-index, which is a combination of assets, social activities, and education. A self-reporting questionnaire was used to measure the physical health conditions of the respondents. The relationship between variables was examined using the structural equation modeling (SEM) in STATA-14. The results showed that 2706 respondents (60.65) were female and the mean age of all participants was 42.29 years (SD = 8.71, range: 19 to 74). The SEM results showed that the composite SES-index had a significant effect on physical health (β = �0.21, SE = 0.017, p < 0.001, 95٪ CI = �0.25 to �0.18). Physical health also exhibited the greatest association with the social activity index (β = �0.18, SE = 0.014, p < 0.001, 95٪ CI = �0.21 to �0.15). In addition, the social activities, assets, and education explained 53%, 50%, and 43% of the estimated variance of the composite SES-index, respectively. This study demonstrated that the social activity index could be one of the best proxy indicators of objective SES when we intend to assess the association between SES and physical health. © 2022 Institute of Health Promotion and Education

The epidemiology of skeletal tuberculosis in northeast of Iran: A review of 229 cases

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1 of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3 were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8) were from the rural areas and most were diagnosed by the private healthcare system (63.8). The highest rate of skeletal TB was seen in 2013 (15.3). Spinal TB (81.2) scored the highest rate and pain (96.9) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed. © 2018, Shiraz University of Medical Sciences. All rights reserved

The epidemiology of skeletal tuberculosis in northeast of Iran: A review of 229 cases

Background: The incidence of tuberculosis (TB) has increased in recent years in both developed and developing countries. Skeletal tuberculosis occurs in approximately 1 of patients with tuberculosis. The present study aimed to evaluate the epidemiology of skeletal tuberculosis in Golestan province in northeastern Iran during 2005-2014. Methods: In the present retrospective study, the epidemiology of skeletal tuberculosis was studied in 229 skeletal tuberculosis patients who were diagnosed during 2005-2014. The prevalence rate of skeletal TB has been reported according to demographic and clinical features. Results: Over the 10-year period of this study, 229 known skeletal TB cases were identified in which 56.3 were male. The mean age of the patients was 44.0±17.7 (range 7-87). All of the patients were new cases. Most of the patients (56.8) were from the rural areas and most were diagnosed by the private healthcare system (63.8). The highest rate of skeletal TB was seen in 2013 (15.3). Spinal TB (81.2) scored the highest rate and pain (96.9) was the most prevalent symptom of skeletal TB. Conclusion: The findings suggest that skeletal tuberculosis in northeastern Iran should always be considered as a differential diagnosis for fever and pain on the spinal column. Due to the high level of tuberculosis in the Golestan province (Iran), further research on continued awareness of skeletal TB is stressed. © 2018, Shiraz University of Medical Sciences. All rights reserved

The effect of narrative writing on fathers� stress in neonatal intensive care settings

Objective: This study was conducted to examine the effect of narrative writing on fathers� stress in the Neonatal Intensive Care Units (NICUs) during infants� hospitalization. Methods: A quasi-experimental study was conducted among two groups of fathers with preterm infants in the NICUs of two teaching hospitals of Gorgan University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. Results: The mean total stress score was 74.05 ± 17.39 in the control and 80.11 ± 15.82 in the intervention group on the 3rd day, suggesting no significant difference. In other words, both groups had a similar stress level before the intervention (p-value =.13, t = 1.52). However, the mean total stress score was 85.45 ± 16.91 in the control group and 48.00 ± 10.49 in the intervention group on the 10th day, suggesting a significant reduction in the stress level in the intervention group following the intervention (p-value =.001, t = �11.01). Conclusion: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the fathers� stress in the NICUs. However, more research is needed to justify its implementation. © 2019 Informa UK Limited, trading as Taylor & Francis Group