Medical Journal of the Islamic Republic of Iran最新文献

This short communication reflects on this year's mental health day. The theme for this year is 'Mental health is a universal human right'. However, here the focus is on simple instances (politeness, and the culture of apology) to highlight how these could contribute to improved psychological well-being and mental health. It is hoped that by insisting on such deeds we could spread kindness in our community to make it a safer place for living and make life more enjoyable regardless of its all difficulties and limitations.

Background: More than 15% of the world's population live with some form of disability. Assessing socioeconomic inequalities in disability and monitoring its change over time can help policymakers to design and implement targeted interventions to reduce these inequalities. This study aimed to assess the change in socioeconomic inequality in disability in Iran from 2000 to 2010.

Methods: Data for this cross-sectional study were obtained from 2 waves of Iran's demographic and health surveys (2000 and 2010). The Wagstaff normalized concentration index was used to measure the socioeconomic inequality of disability. Contributing factors to the inequality in 2000 and 2010 were investigated by concentration index decomposition. The Blinder-Oaxaca decomposition method was used to determine contributing factors of change in disability inequality. All analyses were conducted in Stata14.

Results: The negative and statistically significant concentration indices (-0.132 in 2000 and -0.165 in 2010, P < 0.001) suggested more concentration of disability among poor people. The absolute value of inequality was increased by 0.034 between the 2 points of time (P = 0.025). Level of education (123.5%), household size (12.9%), age (-35.1%), and residency (in terms of Iran's provinces) (-19.3%) were the contributing factors to the measured disability inequality in 2000. In 2010, level of education (105.8%), household size (30.5%), and urban residency (-46.3%) explained the measured inequality. Change in disability inequality was explained by household size (99.4%), province of residence (54.8%), education (36.9%), socioeconomic status (20%), urban residency (-90.3%), and age (-47.7%).

Conclusion: Iran suffers from significant socioeconomic inequality in disability, and it significantly increased over time. Interventions such as increasing health literacy and providing suitable job opportunities for people with low education level, improving the socioeconomic status of extended households, and paying more attention to the balanced development in the provinces and urban and rural areas, and attending to prevention, treatment, and mitigation of disability adversities among poor young and elderly people could be recommended to tackle increased socioeconomic inequality in disability and its unfavorable consequences in Iran.

Background: Breast cancer is a non-communicable and common disease that accounts for a high percentage of deaths. Early diagnosis of this disease reduces the death rate. Screening methods such as digital mammography can help prevent or identify the disease earlier. Therefore, this study aims to analyze the cost-benefit of breast cancer using digital mammography.

Methods: This systematic review was conducted based on PRISMA 2020 checklist. PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar were searched without any time limitation on June 2022. The quality of the studies was evaluated with the CHEERS checklist. After data extraction, the results were synthesized by thematic content analysis.

Results: During the search, 3468 records were identified, of which 1061 were duplicates. 2407 titles and abstracts screened in terms of inclusion criteria. Finally, after studying 20 fulltexts, three of them were included in the study. The quality of these articles was scored between 10 and 16. These studies were from Spain, Denmark, and the United States from 2000 to 2019. Two studies showed that digital mammography is not as effective as other screening methods.

Conclusion: The results of this study showed that digital mammography is not very cost-benefit for the health care system. An increase in its repetition frequency imposes more costs on the health system and doesn't have more benefits for it.

Background: Noise induced hearing loss (NIHL) is an irreversible occupational disease among industrial workers. Recent studies have reported that changes in some metabolic factors such as the serum level of sugar and lipids might have a role in suffering from NIHL among workers exposed to noise. We designed this study to assess the association between lipid profile changes and NIHL occurrence among noise-exposed workers.

Methods: This case-control study has been conducted according to noise-exposed workers registry data in one of the Iranian automobile factories between 2007 and 2017. We classified study workers into the NIHL and control groups. We assessed the impact of lipid profile parameters across the study groups using the independent samples t-test, chi-square, and regression.

Results: The mean serum level of cholesterol was significantly higher in the NIHL group than in workers of the control group (215.27 ± 60.30 vs 204.49 ± 63.69 mg/dL; P = 0.041). Moreover, the serum level of HDL was significantly lower in workers in the NIHL group compared with the control group (35.21 ± 6.87 vs 37.43 ± 7.28 mg/dL; P < 0.001). Although other lipid profile parameters (LDL, TG, LDL/HDL ratio) were higher among workers of the NIHL group, their differences were not significant.

Conclusion: A cholesterol level lower than 200 mg/dL is known as a protective factor and an HDL level lower than 40 mg/dL is an NIHL risk factor. More attention should be paid to controlling serum levels of cholesterol and HDL.

Background: Hydatidosis, a chronic zoonotic disease, has a distribution worldwide and is caused by the larval stage of the Echinococcus helminth. The Dot-ELISA test can diagnose hydatidosis quickly and accurately. Additionally, unlike other hydatid disease tests now used, this quick and affordable enzyme immunoassay is very serum-conservative and antigen-conservative, needing just nanogram levels of parasite antigen.

Methods: In the present cross-sectional study, crude and B antigens of hydatid cyst fluid were obtained to diagnose human hydatidosis using CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immuno Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. Infected liver with a hydatid cyst was collected from Tehran's slaughterhouses to prepare cyst fluid in different stages. After extracting and purifying the Cyst fluid, it is centrifuged at 4ºc, then prepared to concentrate. The study also included sera from hydatidosis (n=60), samples of helminth parasites (n=55), fascioliasis (n=35), toxocariasis (n=20) and negative control (n=35) were tested by CIEP (Counter Immunoelectrophoresis), ELISA (Enzyme-linked Immune Sorbent assay), and Dot- ELISA (Dot Enzyme linked Immuno Sorbent Assay) methods. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) for Windows release 25.0 (SPSS Inc., Chicago, IL, USA).

Results: Crude antigen of hydatid cyst showed a specificity of 76.7%, a sensitivity of 93.3% using the ELISA method, and B antigen showed a specificity of 96.7% and sensitivity of 88.3% using the same method. The crude antigen of the hydatid cyst exhibited a specificity of 68.9% and a sensitivity of 86.7% using CIEP. The B antigen showed a specificity of 87.8% and sensitivity of 83.3% using the same method.The crude antigen of hydatid cyst having serum dilution at 1:800 exhibited a specificity of 83.3% and sensitivity of 100% using the Dot-ELISA method and B antigen having serum dilution at 1:800 serum showed a specificity of 100% and sensitivity of 98.3% using the same method. The results of this finding showed that B antigen has the maximum specificity to diagnose hydatid test using the Dot- ELISA method.

Conclusion: Hydatid cysts present with varied symptomatology. History of exposure to infected animals may not be present. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis. The Dot-ELISA system with native antigen B is a viable approach for the immunodiagnosis of human hydatidosis that is preferred to infection.

Background: Type II diabetes is considered a chronic disease that influences the affected person's quality of life and imposes a high economic burden on the patient and society. The enhancement of health literacy seems essential for self-management and disease control in patients with type II diabetes. Consequently, this study was performed to evaluate the cost-effectiveness of enhanced health literacy in type II diabetes patients.

Methods: This study was of quantitative and economic evaluation type. A population of 232 patients was selected among those referred to the Tafihan Shiraz clinic based on the quality of entry and exit. The health literacy educational intervention was carried out for three months. In order to collect information, researchers used the SF36 questionnaire and the checklist of costs. The Cost Effectiveness Ratio (CER) and Incremental Cost Effectiveness Ratio (ICER) were calculated. Moreover, the costs of each unit of increasing the quality of life before and after the intervention were calculated. A decision was made to determine the cost-effectiveness of the intervention.

Results: According to the results, 40% of the participants were females, and 34.5% were 30-40 years old. Examination of the quality of life in patients before the intervention indicated that the mean and standard deviation of the patients' quality of life before the intervention was 18.43±44.99, and the mean and standard deviation of the quality of life after the intervention was 49.57±16.21. Moreover, the patients' quality of life increased after the educational intervention. The total direct medical costs were $717,484 and $685,620 before and after the intervention, respectively. The total indirect medical costs were $604,122 and $493,011 before and after the intervention, respectively. Moreover, the total indirect costs were $122,535 and $122,119 before and after the intervention, respectively. The study was cost-effective with CER=0.9 and ICER= - 140,000 per increase in the quality of life.

Conclusion: Improving health literacy can have a range of benefits and improve the quality of life of patients with type II diabetes and reduce their treatment costs, and thereby, this may be seen as an effective step toward the recovery of patients with type II diabetes.

Background: Acute cerebrovascular accident is known to be one of the main causes of morbidity, mortality, long-term disability, and disability in society. To investigate the quality of life of patients who have suffered from acute cerebrovascular accident (hereinafter ACVA) in stratified groups by age, gender, diagnosis, type (primary or secondary), and severity of a stroke, as well as undergoing rehabilitation.

Methods: This research is a cross-sectional descriptive-analytical study. The main research method is a survey. Data collection was carried out in 2020 in Almaty of the Republic of Kazakhstan by inpatient doctors (City Clinical Hospital No. 5 of the Public Health Department of Almaty), engaged in the rehabilitation treatment of patients with acute cerebrovascular accident. The standardized questionnaire EQ-5D-5L was used to assess the quality of life due to health conditions. Data on the state of "mobility", "self-care", "daily activities", "pain", "anxiety", as well as data on self-assessment of health status (according to the EQ VAS scale) were analyzed using the Level Sum Scores (hereinafter LSS).

Results: The study involved 258 respondents who had a stroke. The survey was conducted 2 months after the respondents were discharged from the hospital. The average LSS index of patients who underwent ACVA was 10.2 (9.7±10.7). Significant differences in LSS levels ( P ≤ 0.001) were revealed by the severity of stroke and by the fact of rehabilitation. Differences in LSS levels by age, gender, diagnosis, and type of ACVA are insignificant (P > 0.05). The difference in health indicators of patients with primary and repeated strokes indicates the fact of deterioration in the quality of life with each subsequent stroke. The quality of life of patients with ACVA is associated with the fact of rehabilitation: low values of EQ VAS in the group of patients who did not undergo rehabilitation and high values of EQ VAS in those who underwent rehabilitation.

Conclusion: After a stroke, the majority of patients tend to have a negative quality of life, mostly due to violations of the component "daily activities". The identified significant disparities in LSS and EQ VAS indicators further show that the quality of life varies among stratified groups. The kind (primary or secondary) and severity of the stroke, as well as the existence of rehabilitation, are indicators that impact the quality of life of patients who have had ACVA.

Background: In human and animal studies, ankylosing spondylitis (AS) has been increasingly linked to changes in the microbial inhabitants in the human body (microbiome). These studies have primarily now concentrated on the microbial communities that live in the gastrointestinal tract. However, evidence suggests that various molecular techniques can be used to detect microbial DNA in blood circulation. This DNA might be an unknown reservoir of biomarkers with the potential to track alterations in the microbiomes of remote locations, such as the gut. To this end, we compared the presence and identity of microbial DNA in blood samples taken from ankylosing spondylitis patients to healthy control subjects by amplifying and sequencing the bacterial 16S rRNA variable region four.

Methods: The study's design is a case study based on the presence and identity of bacterial DNA in the blood of Ankylosing spondylitis (AS) patients (n = 10) and healthy control subjects (n = 10) was investigated by amplifying and sequencing the bacterial 16S rRNA gene. Blood concentrations of the cytokines TNF alpha, IL-17A, and IL-23 were determined by the Human Magnetic Luminex Screening, and data were analysed using an Unpaired T-test.

Results: Using PCR amplification, 8 of 10 AS patients (80%) and 8 of 10 healthy control samples (80%) had microbial 16S rRNA in their blood. At the phylum level, Proteobacteria (Control = 48.5%, AS = 52%), Firmicutes (Control = 27.8%, AS = 26.1%), Actinobacteria (Control = 15.4%, AS = 10.7%), and Bacteroidetes (Control = 6.5%, AS = 10%) dominated the blood microbiome. A two-tailed Mann-Whitney test found that Ankylosing Spondylitis was associated with significantly elevated Bacteroides (P < 0.05), Prevotella (P < 0.001), and Micrococcus (P < 0.01), and significantly reduced levels of Corynebacterium 1 (P < 0.001), Gemella (P < 0.01), and Alloprevotella (P < 0.05), compared to healthy controls. Additionally, it was shown that the presence of the Prevotella genus was highly positively correlated with higher levels of TNF-alpha (P < 0.05; r = 0.8) in AS patients' blood.

Conclusion: This article reveals that a blood microbiome exists in healthy individuals and identifies particular taxa modulated in disease. These blood-derived signatures indicate that this field needs more research and may be helpful as disease biomarkers.

Background: Pregnant women who have gestational diabetes mellitus (GDM) are more prone to adverse pregnancy outcomes. We estimated the prevalence of GDM in Iran.

Methods: Web of Science, Scopus, PubMed, Google Scholar, and Persian databases (SID, Magiran, Irandoc, and) were searched using the MeSH and non-MeSH terms in abstract, title, or keywords of articles until June 2021, with no limitation in time. Random effects models were applied to summarize the GDM prevalence in Iran. The obtained data were quantitatively analyzed to determine an effect size for each paper. The pooled effect size was introduced as prevalence and 95% confidence interval. Sensitivity analyses and subgroup analyses were done to determine heterogeneity. Publication bias was assessed by the classic fail-safe N and Egger test.

Results: A total of 53 papers were considered for meta-analysis, involving 56,521 Iranians. The total GDM prevalence in Iran was 7.6% (95% CI, 6.1%-9.4%).

Conclusion: This meta-analysis was the newest to estimate the GDM prevalence among Iranian women. Our results suggest a high prevalence of GDM in Iran, showing that Iran might have many GDM patients.