Iranian Population Policy and Aging: New Health Concerns

Iran’s population policy underwent a bizarre fluctuation in recent decades. During the Iran–Iraq war (1979–1987), the total fertility rate was about 6.53%. Following this period and owing to economic problems, the government reversed the population policy in 1988. A new population plan was officially proposed to reduce the rate of population growth. In the 2011 census, the birth rate was reported to have declined to 1.29%. Moreover, according to data from the World Health Organization (WHO), the life expectancy in Iran increased dramatically from 54.67 years in 1980 to 75.5 years in 2015. Both these factors increased the rate of population aging (or the double-aging process). The migration of young adults to other countries has also accelerated this phenomenon. The 2011 census observed a significant demographic change in the elderly population of Iran (the percentage of the elderly population increased from 7.27% to 8.20% from 2006 to 2011, and to 8.65% in 2016). The aging population is predicted to rise to 10.5% in 2025 and to 21.7% in 2050. Recently, considering the predictions relating to population aging, the government policy has changed. It is now pushing for an increase in the rate of population growth

Recurrent Human Tragedy During Hajj

Hajj, a unique yearly mass gathering pilgrimage of more than 2 million Muslims from around the world, presents enormous challenges to the Saudian Arabia government. The potential for deadly epidemic outbreaks of bacterial and viral diseases leading to upper respiratory infection and meningitis and human stampedes call for prompt attention from both pilgrims and the ministry of health. Trauma during Hajj is a real surgical dilemma that deserves special attention. Stampede during Hajj presents the most dreaded trauma risk. In 2006, the Hajj stampede led to pilgrims crossing over fallen down pilgrims and ended up with 289 injured and 380 deaths. Fatalities are caused by head injury and asphyxiation, that cannot be attended to in huge crowds. Every year, because of overcrowding and population density, numerous pilgrims, are traumatized or killed during the Hajj rituals

Is exercise a medicine or a vaccine adjuvant? A Look at Obesity and Covid-19

Dear Editor-in-ChiefIn recent years, exercise has been called an ‘amazing’ medicine and a ‘miracle’ cure. Scientific research shows that regular exercise is effective in preventing and treating many common diseases, including type 2 diabetes, dementia, depression, heart disease, some cancers, and other common diseases (Fang et al., 2022). In fact, exercise in a specific dose and formula is prescribed for each patient who is diagnosed with the disease. The prescription should be very clear in terms of modality, intensity, frequency, and duration.In this regard, the American College of Sports Medicine (ACSM) has launched the "Exercise is Medicine" project to recognize the myriad health benefits of exercise. These include reducing the incidence of a number of different cancers, lowering the risk of excessive weight gain (along with related health problems as well as diabetes), and improving cardiovascular health (as well as reducing the risk of high blood pressure in addition to heart stroke) (Ghardashi-Afousi et al., 2018).The acute effect of exercise has been shown to lead to a transient decrease in triglyceride levels, an increase in HDL cholesterol levels, a decrease in blood pressure, a decrease in insulin resistance, and an improvement in glucose control. Regular exercise increases blood flow and oxygen to the brain which improves memory and mental function. It also increases the production of a number of hormones that stimulate the growth of brain cells (Ueno-Pardi et al., 2022).In addition, some literature describes exercise even better than medicine. For example, a review of more than 300 randomized controlled trials found that exercise was as effective as drugs at risk for heart disease and diabetes, and more effective than post-stroke rehabilitation drugs (Naci & Ioannidis, 2013).It has previously been suggested that vaccinating children with exercise can control the obesity epidemic in them. Recently, in the coronavirus outbreak, exercise has been referred to as a vaccine or vaccine adjuvant (Naci & Ioannidis, 2013). A recent study in the British Journal of Sports Medicine (BJSM) suggests that routine activities may protect people with COVID-19 from serious illness.Evidence suggests that exercise and obesity are involved in the pathogenesis of COVID-19 disease and vaccine efficacy. Regular exercise has been shown to exert immune regulatory effects, control viral gateway, modulate inflammation, stimulate NO production pathways, and control oxidative stress. Adaptation to ordinary exercise seems to affect immune function, particularly innate and adaptive immunity, and ameliorate humoral immunity with enhanced vaccination responses. Exercise may at least partially reduce the detrimental effect of SARS-CoV-2 binding to the ECA2 receptor. Exercise training can activate anti-inflammatory signaling pathways (Shirvani & Rostamkhani, 2020). Today, COVID-19 vaccination has shown that individuals who exercise continuously and regularly may develop higher antibody titers to the SARS-CoV-2 strain contained in the vaccine compared to individuals who do not exercise (Hallam et al., 2022).On the other hand, understanding how obesity and adiposity affect immunity and more specifically the production and function of antibodies is of great importance (Malavazos et al., 2020). Numerous studies have shown the effect of obesity on antibody properties. For example, adaptive immune responses to influenza virus are impaired during obesity, innate and adaptive immune responses to influenza are delayed in obese patients, and obesity was suggested to decline influenza antibody titers following influenza vaccination and reduce vaccine efficacy with poor vaccine immunization. In the same manner, lower COVID-19 mRNA vaccine-induced antibody titers have been related to central obesity and severe acute respiratory syndrome (Ghanemi et al., 2021).     In general, recent research on the Covid-19 epidemic has shown that exercise is not only a wonderful medicine in the prevention and treatment of many diseases, but also regular exercise can act as an adjunct vaccine. Therefore, prescribing exercise will always help promote community health and is completely in line with the P4 medicine approach (predictive, preventative, personalized, and participatory)

A Comparison between the Ability of Revised Trauma Score and Kampala Trauma Score in Predicting Mortality; a Meta-Analysis

Introduction: Describing injury severity in trauma patients is vital. In some recent articles the Revised Trauma Score (RTS) and Kampala Trauma Score (KTS) have been suggested as easily performed and feasible triage tools which can be used in resource-limited settings. The present meta-analysis was performed to evaluate and compare the accuracy of the RTS and KTS in predicting mortality in low-and middle income countries (LMICs). Methods: Two investigators searched the Web of Science, Embase, and Medline databases and the articles which their exact number of true-positive, true-negative, false-positive, and false-negative results could be extracted were selected. Sensitivity and subgroup analysis were performed using Stata software version 14 to determine the factor(s) affecting the accuracy of the RTS and KTS in predicting mortality and source(s) of heterogeneity. Results: The heterogeneity was high (I2 > 80%) among 11 relevant studies (total n = 20,631). While the sensitivity of the KTS (0.88) was slightly higher than RTS (0.82), the specificity, diagnostic odds ratio, negative likelihood ratio, and positive likelihood ratio of the KTS (0.73, 20, 0.16, 3.30, respectively) were lower than those of the RTS (0.91, 45, 0.20, 8.90, respectively). The area under the summary-receiver operator characteristic curve for KTS and RTS was 0.88 and 0.93, respectively. Conclusion: However, regarding accuracy and performance, RTS was better than KTS for distinguishing between mortality and survival; both of them are beneficial trauma scoring tools which can be used in LMICs. Further studies are required to specify the appropriate choice of the RTS or KTS regarding the type of injury and different conditions of the patient

Up-to-date Treatments of Primary Hyperhidrosis with Focus on Sympathectomy and Sympathicotomy; a Narrative Review

Background: Primary hyperhidrosis (PH) refers to excessive sweating, beyond normal physiological levels, in specific sites of the body for unknown reasons. It is usually bilateral and is most prominent in the palms, axillae, feet, and face. PH prevalence is estimated to be 0%-6.1% in different populations. It usually begins in childhood and is more frequent in women. In 57% of cases, there is a positive family history. It is an autosomal dominant disorder with variable penetration in chromosomes 5, 14, or both. Objective: The aim of this study was to illustrate current treatments of PH while focusing on surgical therapies through a narrative review. Methods: A complete search of online articles from 2007 to 2014 in PubMed, Scopus, and the Cochrane Library was performed. A free search and a search in the MeSH database for the study’s keywords were also done. More than 600 relevant articles were found, of which 51 were chosen for this study. This article is based on those articles. Results: Surgery is the best and more permanent therapy for PH. The most common consequences of surgery are compensatory sweating and gustatory sweating. There is controversy concerning whether lowering the level and limiting the number of ganglia on which surgery is performed reduces compensatory sweating. Conclusion: It seems that ramicotomy (selective division of the sympathetic postganglionic fibers) reduces compensatory sweating, but this theory should be confirmed with more studies

Is a Single dose of Prophylactic Antibiotics Sufficient in Patients with Acute Non-Complicated Appendicitis?

Background: Acute appendicitis is one of the most common acute surgery events. Its main treatment is surgery. However medical management before and after the surgery has an important impact on the treatment. Objective: The aim of study was evaluating the outcomes of single dose and quadruple doses of prophylactic antibiotic therapy in patients with acute non-complicated appendicitis. Methods: This randomized double blind clinical trial was carried out on 294 patients in single dose (136 patients) and the quadruple doses (158 patients) groups. In single dose group, a dose of 1g Cefazolin + 500mg Metronidazole was prescribed intravenously about half an hour before surgery. The quadruple doses group received three more doses after surgery.  Two groups were followed for fever, erythema, seroma, wound infection, intra-abdominal abscess formation and readmissions within one month after discharge. Results: The mean age of patients was 31±5.14 years. 203(69%) of patients were men while 91(31%) were women. There were no significant statistical differences between groups in age, sex and body mass index (BMI) variables. No significant statistical differences were observed during surgery and hospitalization period between two groups. In the single dose group, wound infection was 8(5.9%), while it was 6(3.8%) in the quadruple doses group; hence, there were no significant statistical differences in this regard. There was no abdominal abscess in groups. There were significant statistical differences regarding erythema, seroma and antibiotics consumption costs between groups. Conclusion: A single dose of prophylactic antibiotics is sufficient in patients with acute suppurative non-complicated appendicitis

Coronavirus disease 2019: a revolution in biological triage in the emergency setting

Triage is a familiar concept for all who work at the forefront of the treatment of patients and the emergency medical staff know their duty in different situations including crisis and epidemics. Accordingly, the coronavirus outbreak has also a major effect on the emergency department (ED) as it changes the routine ED function. Our main question was what are the main triage challenges in the recent pandemic and how we could overcome these challenges? Therefore, a search of the main Web databases was performed for articles published till May 1st, 2020 using various related keywords. In various steps, the title, summary, methodology, results, and discussion of the selected studies were assessed to find out the recent triage strategies in the COVID-19 outbreak. Hence, all the available and related English review articles, case series, and experimental studies were evaluated. Among 200 studies initially reviewed, 59 met the study criteria for the final assessment. COVID-19 puts a significant load on public health services and potential damage to social and psychiatric situations by marked morbidity and mortality. In line with the various presentations and according to the changing of the COVID-19 epidemic to a worldwide pandemic problem, the management and treatment protocols changed several times. Accordingly, the local and even global hospital protocols were changed as well. The first simple concept of coronavirus triage in an emergency department is the separation of COVID-19 infected patients from the others. This approach has been practiced around the world. Changing the ED layout from a usual triage or fast track set to an isolated room is necessary for such a pandemic situation. It is very important to consider staff communication and the application of PPE. All the efforts should be taken to protect patients as well as the medical staff from unnecessary exposure and infection; this serves to keep the health facilities working well in the outbreak and diffusion of SARS-CoV-2

Comparison of outcomes in four different surgical methods for sacral pilonidal sinus with long-term follows-up

Background: Sacrococcygeal pilonidal disease (PD) is prevalent in the young adults. The cause of PD is unclear, and there are different surgical procedures for the treatment. The Pilonidal sinus disease is an unpleasant, chronic relapsing condition that is difficult to cure. There is a wide variety of surgical treatments with sub-optimal results for it. The ideal treatment for the pilonidal sinus disease has yet to be defined. There are many surgical approaches described in the literature. In this study, the long-term outcomes of four current surgical methods for PD were evaluated and compared. We aimed to assess recurrence, satisfaction, complications rate and wound healing time in the four current surgical methods for PD. Methods: This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires. Results: In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups. Conclusion: The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate

Assessment of needlestick injuries and hepatitis B and C infection among surgeons

Background Specialist surgeons are at high risk of exposure to hepatitis viruses through occupational exposure to blood or body fluids. Protective measures against occupational exposure to the hepatitis B virus (HBV) and hepatitis C virus (HCV) must be taken in order to prevent infection in surgeons. We aimed to determine the needlestick injuries, and markers HBV and HCV in Iranian surgeons. Methods This study was cross-sectional research, performed in Baqyatallah, Shohada, Rasoul Akram, Sina, Taleghani, and Emam Hossein hospitals (all university hospitals) of Tehran, Iran. Overall 318 eligible surgeons were included. Anonymous questionnaires were used containing data about demographic characteristics, self-reported blood and needlestick contacts, occasional exposures, risk behaviors and vaccination. Also, the blood samples were taken and tested for hepatitis B surface antigen (HBsAg), antibody against Hepatitis B surface antigen (antiHBs) and HCV antibody (HCVAb). Fisher exact test and Kruskal Wallis test were used to analyze the data. Results The mean age of the surgeons was 47.76 ± 8.95 years and 177 of them (55.66%) were male. The average number of needle–sticks was 28.28 ± 16.58 during the surgeons’ working life. Among them, 5 cases (1.59%) were positive for HBsAg and 2 cases (0.66%) were positive for HCVAb. Conclusion In spite of the high needlestick rate in Iranian surgeons, prevalence of hepatitis B and C is not very high among them. A high degree of vigilance and a careful surgical technique is the only means available to prevent the transmission of the viruses