The impact of anti-tumor necrosis factor alpha drugs on lipid profile of patients with rheumatoid arthritis or seronegative spondyloarthropathy

Background: Inflammatory arthritis is associated with abnormal levels of lipoprotein. The cause is considered to be inflammation. Recently, the use of biologic drugs in the treatment of inflammatory arthritis, especially rheumatoid arthritis (RA) and seronegative spondyloarthropathy, has increased. There are different results of the effect of these drugs on fat profile. Evaluate the impact of anti-tumor necrosis factor (TNF) alpha drugs on lipid profile of patients with RA or seronegative spondyloarthritis. Methods: In this cross-sectional descriptive study, 50 patients with rheumatoid arthritis or seronegative spondyloarthritis, who were candidates for TNF alpha treatment, were included in the study. After obtaining written consent, a checklist was completed for all patients including demographic information such as age, sex, height, weight, place of residence, level of education, type of disease, and lipid profile test results including total cholesterol, triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) were recorded. Then the patients were treated and evaluated for fat profile after 3, 6, 9 months after receiving the relevant treatment regimen. The test results were recorded in checklists. After completing the study, the data were entered into the statistical package for the social sciences (SPSS) 24 software and analyzed. Results: The mean age of patients was 46.38±14.33 years. 54% of patients were female. 54% of patients had rheumatoid arthritis. 62% of patients were treated with Sinora. The results of this study showed that serum triglyceride levels increased during the study period and this increase was statistically significant but the trend of changes in serum cholesterol, HDL and LDL levels was not statistically significant. However, serum LDL levels measured in the ninth month increased significantly compared to the initial measurement. Conclusions: Results showed that there was a significant relationship between lipid profile changes and anti-TNF alpha consumption. Although decreased inflammation appears but other mechanisms may be involved in dyslipidemia

Decomposition of socioeconomic inequality in cardiovascular disease prevalence in the adult population: A cohort-based cross-sectional study in northwest Iran

Objectives: The incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran. Methods: This cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality. Results: The overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, -0.077: 95% confidence interval, -0.103 to -0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model. Conclusions: The most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran

Seroprevalence of SARS-CoV-2 antibodies and its risk factors in the north-west of Iran: A population-based cross-sectional study

Background: The aim of this study is to determine the prevalence of SARS-CoV-2 seropositivity and to examine the risk factors for seropositivity among the people of Ardabil, in the northwestern part of Iran. Methods: A community-based survey was carried out involving 1013 participants (690 from urban and 323 from rural areas), who were selected based on the cluster sampling method. Iran’s FDA-approved Pishtaz Teb SARS-CoV-2 ELISA kits were used to assess the presence of SARS-CoV-2-specific immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies in serum samples. Weighted seroprevalence, the number of infections, infection to case ratio (ICR), and infection fatality ratio (IFR) were estimated after adjusting for survey design and serial test performance. The factors associated with IgG/IgM positive were determined using logistic regression. Results: Between May 20 and June 7, out of 1013 survived people, 123 (12.11%) were IgG positive, 49 (4.8%) were IgM positive and 122 (12.04%) were having both IgG and IgM antibodies. The highest frequency of positive test for IgG and IgM antibodies was found in people with diabetes, followed by people with obesity and heart disease, respectively. Multivariate logistic regression showed old age (2.04, 95% CI: 1.02 to 11.74), male sex (1.52, 95% CI: 1.15 to 2.13), urbanization (1.40, 95% CI: 1.02 to 3.22), higher family number (9.44, 95% CI: 1.69 to 52.13), obesity (2.14, 95% CI: 1.11 to 5.86), NCDs (1.22, 95% CI: 1.01 to 2.16), having symptoms (3.02, 95% CI: 1.64 to 8.61), traveling (2.70, 95% CI: 1.76 to 10.8), history of contact with infected patients (2.38, 95% CI: 1.08 to 7.03), as factors associated with IgG/IgM positive test. Conclusion: Around the mid of May 2020, SARS-CoV-2 seroprevalence was low among Ardabil's adult population. Several factors have been found to be associated with SARS-CoV-2 seroprevalence, which should be considered by policymakers to set policies against the SARS-CoV-2 pandemic

Economic evaluation of dialysis and comprehensive conservative care for chronic kidney disease using the ICECAP-O and EQ-5D-5L; a comparison of evaluation instruments

AbstractBackgroundChronic Kidney Disease (CKD) patients often require long-term care, and while Hemodialysis (HD) is the standard treatment, Comprehensive Conservative Care (CCC) is gaining popularity as an alternative. Economic evaluations comparing their cost-effectiveness are crucial. This study aims to perform a cost-utility analysis comparing HD and CCC using the EQ-5D-5L and ICECAP-O instruments to assessing healthcare interventions in CKD patients.MethodsThis short-term economic evaluation involved 183 participants (105 HD, 76 CCC) and collected data on demographics, comorbidities, laboratory results, treatment costs, and HRQoL measured by ICECAP-O and EQ-5D-5L. Incremental Cost-Effectiveness Ratios (ICERs) and Net Monetary Benefit (NMB) were calculated separately for each instrument, and Probabilistic Sensitivity Analysis (PSA) assessed uncertainty.ResultsCCC demonstrated significantly lower costs (mean difference $8,544.52) compared to HD. Both EQ-5D-5L and ICECAP-O indicated higher Quality-Adjusted Life Years (QALYs) for both groups, but the difference was not statistically significant (p > 0.05). CCC dominated HD in terms of HRQoL measures, with ICERs of -$141,742.67 (EQ-5D-5L) and -$4,272.26 (ICECAP-O). NMB was positive for CCC and negative for HD, highlighting its economic feasibility.ConclusionCCC proves a preferable and more cost-effective treatment option than HD for CKD patients aged 65 and above, regardless of the quality-of-life measure used for QALY calculations. Both EQ-5D-5L and ICECAP-O showed similar results in cost-utility analysis

Smartphone photography as a teledentistry method to evaluate anterior composite restorations

Objective. Today, teledentistry have gain more attention than past due to the advances in technology. The aim of this study was to compare the use of smartphone photography as a method in teledentistry with the face-to-face examination in the evaluation of anterior composite restorations. Materials and Methods. In this study, photographs of 24 composite restorations in patients attended to the clinic of Ardabil Dental School were obtained using a smartphone without any additional equipment and sent by email to 10 remote observers. As a gold standard method, these restorations were evaluated by an experienced expert in restorative dentistry a face-to-face examination. In both methods FDI criteria were used to evaluate the restorations and classified them as acceptable or not. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the photographic method relative to face-to-face method were calculated. Furthermore the Mann–Whitney U test was used to statistically compare the two methods in detail. Results. The sensitivity, specificity, positive predictive value, and negative predictive value of the smartphone photography method was 69.35%, 48.72%, 87.34%, and 23.75%, respectively. A diagnostic accuracy of 65.97% was obtained. Statistically, in overall the photographic method rated the restorations as better than they were in reality (face-to-face examination) ( p = 0.002 ). Conclusions. The diagnostic accuracy of the method of evaluating anterior composite restorations by smartphone photography was moderate and the use of this method in teledentistry, although was promising, needs to be improved

Assessment of electrocardiogram interpretation competency among healthcare professionals and students of Ardabil University of Medical Sciences: A multidisciplinary study

Background: Electrocardiogram (ECG) interpretation is a core clinical skill that helps to rapid diagnosis of potentially life-threatening diseases. Misinterpretation of the electrocardiogram can lead to inappropriate clinical decisions with adverse outcomes. The main aim of this survey was to assess the competency of electrocardiogram interpretation and related factors among healthcare professionals and students of Ardabil University of Medical Sciences. Methods: This descriptive cross-sectional study included 323 staff and students of Ardabil University of Medical Sciences in northwestern Iran. Data were collected randomly from November to January 1400 using the Badell-Coll ECG Interpretation Competency Questionnaire and analyzed using SPSS V.14. Statistical analysis included descriptive statistics, independent t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. Results: The results showed that the mean and standard deviation of electrocardiogram interpretation competency of health professional staff and students was 5.13 ± 2.25 (maximum score = 10). The large number of participants wasn’t able to identify normal sinus rhythm (n = 251, 77.3%), acute myocardial infarction (n = 206, 63.8%) and pathological Q waves (n = 201, 62.2%). The results of multiple linear regression showed that the variables of education level, self-assessment of electrocardiogram interpretation competence, work experience, and type of hospital were able to predict the competence of ECG interpretation in participants. Conclusions: Our findings showed that the participants’ level of electrocardiogram interpretation competency was low. Hence, regular, standard training and education are recommended. Also, managers and educators of the health system should consider the role of positive self-assessment and exposure to ECG interpretation in improving the competence of staff and students to interpret ECG

Evaluation of knowledge and health behavior of University of Medical Sciences students about the prevention of COVID-19

Background: Coronaviruses are a large family of viruses that have symptoms ranging from the common cold to severe respiratory syndromes. Objective: The purpose of this study is to provide appropriate strategies to raise knowledge and health behavior of students of the University of Medical Sciences to prevent COVID-19. Methods: This study was conducted as a cross-sectional and descriptive study, and the online questionnaire was used by random sampling. Our sample size was 360 subjects and the statistical population was the students of the University of Medical Sciences. We used the nonparametric test (Kruskal Wallis, Mann-Whitney U) and (Chi-Square t-test) for statistical analysis. Results: The test results were statistically significant for students' health behavior (p<0.01, df -99). The knowledge of women was higher than men (F=5.32, p<0.02). Conclusion: The results show that the Ministry of Health has acted well in promoting students' knowledge and health-promoting behaviors. Therefore, it is recommended that such research be conducted in the public statistical population

Socioeconomic and environmental factors associated with waterpipe tobacco smoking among Iranian adults: A PERSIAN cohort-based cross-sectional study

BACKGROUND: Waterpipe tobacco smoking (WTS) is associated with several deleterious health outcomes. We sought to estimate the prevalence of WTS and explore socioeconomic inequalities associated with this culturally-rooted tobacco smoking practice among Iranian adults. METHODS: A cross-sectional analysis was conducted among 20,460 adults (ages 18 and older) enrolled in the PERSIAN cohort study during 2020. Data were collected on socioeconomic status (SES), lifestyle, alcohol consumption, cigarette smoking, and several risk factors related to non-communicable diseases. The concentration curve and relative concentration index (RCI) were administered to assess and quantify the SES-based inequality in WTS. RESULTS: Overall age-adjusted prevalence of past-month WTS was 5.1% (95%CI:4.6-5.8), with about 1% for women and 10.6 for men. Age-adjusted prevalence of WTS was higher among younger adults, men, cigarette smokers, obese adults, and those with higher SES. The RCI estimation showed that WTS is more popular among adults with high income and education. WTS was higher among younger adults, cigarette smokers, obese adults, and those with higher SES. CONCLUSION: There is a clear socioeconomic inequality in WTS, with a higher prevalence among adults with higher income and education. The findings suggest the need for targeted interventions to address this inequality and reduce the prevalence of WTS among high-income communities

Economic burden of cardiovascular diseases before and after Iran’s health transformation plan: Evidence from a referral hospital of Iran

Background: Different countries have set different policies to control and decrease the costs of cardiovascular diseases (CVDs). Iran was aiming to reduce the economic burden of different disease by a recent reform from named as health transformation plan (HTP). This study aimed to examine the economic burden of CVDs before and after of HTP. Methods: This cross-sectional study was conducted on 600 patients with CVDs, who were randomly selected from a specialized cardiovascular hospital in the north-west of Iran. Direct and indirect costs of CVDs were calculated using the cost of illness and human capital approaches. Data were collected using a researcher-made checklist obtained from several sources including structured interviews, the Statistical Center of Iran, Iran’s Ministry of Cooperatives, Labor, and Social Welfare, the central bank of Iran, and the data of global burden of disease obtained from the Institute for Health Metrics and Evaluation to estimate direct and mortality costs. All costs were calculated in Iranian Rials (IRR). Results: Total costs of CVDs were about 5571 and 6700 billion IRR before and after the HTP, respectively. More than 62% of the total costs of CVDs accounted for premature death before (64.89%) and after (62.01%) the HTP. The total hospitalization costs of CVDs was significantly increased after the HTP (p = 0.038). In both times, surgical services and visiting had the highest and lowest share of hospitalization costs, respectively. The OOP expenditure decreased significantly and reached from 54.2 to 36.7%. All hospitalization costs, except patients’ OOP expenditure, were significantly increased after the HTP about 1.3 times. Direct non-medical costs reached from 2.4 to 3.3 billion before and after the HTP, respectively. Conclusion: Economic burden of CVDs increased in the north-west of Iran after the HTP due to the increase of all direct and indirect costs, except the OOP expenditure. Non-allocation of defined resources, which coincided with the international and national political and economic challenges in Iran, led to unsustainable resources of the HTP. So, no results of this study can be attributed solely to the HTP. Therefore, more detailed studies should be carried out on the reasons for the significant increase in CVDs costs in the region

Gastric troubles in Iran: The role of social and economic factors in Helicobacter pylori infection

Background: Helicobacter pylori infection is a major risk factor for gastric cancer in Iran, but the impact of socioeconomic factors on its prevalence is poorly understood. This study aimed to assess the socioeconomic inequalities and risk factors associated with H. pylori infection in Iran. Methods: This cross-sectional study was conducted based on the PERSIAN cohort study. A total of 20460 individuals aged 35 to 70 years in Ardabil, Iran were included in the study. H. pylori infection was determined based on stool tests and clinical records. Multilevel logistic regression models with random intercepts at household and community levels were used to identify risk factors associated with H. pylori prevalence. The concentration index (CIn) and concentration curve (CC) were employed to assess socioeconomic-related inequality. Results: In this study, 70.4% (CI 69.6–71.0) of the participants were infected with H. pylori, with a higher prevalence in women (71.2%) than men (69.6%). Age (OR: 1.37, CI: 1.17-1.61), sex (OR: 1.20, CI: 1.12-1.28), level of education (OR: 1.33, CI: 1.17-1.49), cardiac disease (OR: 1.32, CI:1.18-1.46), and BMI groups (OR: 2.49, CI: 1.11-5.58) were significantly associated with H. pylori infection based on the multivariable logistic regression. The results of the CIn and CC indicated that H. pylori were more prevalent among economically disadvantaged groups (CIn: -0.1065; [-0.1374 to -0.0755]). Conclusion: The prevalence of H. pylori in Iran is higher than in other developing countries, and significant socioeconomic inequality exists between the poor and the rich. To reduce the rate of gastric cancer, socio-economic and demographic factors, especially the poor and people with low levels of education, should be considered