Combination of spironolactone and sitagliptin improves clinical outcomes of outpatients with COVID-19: a prospective cohort study

BACKGROUND

There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases. In this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease.

METHODS

This is a prospective, naturally randomized cohort study. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. The primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status.

RESULTS

Of the 206 patients referred to clinics randomly, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92 combination; P < 0.0001). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011), ER visits (7.8% combination, 23.3% control; P = 0.0021) and average duration of symptoms (6.67 ± 2.30 days combination, 18.71 ± 6.49 days control; P ≤ 0.0001).

CONCLUSIONS

The combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches in outpatients with COVID-19. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double-blind, randomized, placebo-controlled trial.

A Novel Multiplex LAMP Assay for the Rapid and Accurate Diagnosis of Visceral Leishmaniasis Caused by Leishmania infantum from Iran

Visceral leishmaniosis (VL) is one of the neglected tropical diseases despite being responsible for serious clinical symptoms, some of which lead to fatal outcomes. Thus, there is a need to apply accurate, rapid, and specific diagnostic measurements in order to control the disease and reduce the mortality rate. We aimed to develop and validate a multiplex LAMP assay for the diagnosis of VL caused by Leishmania infantum (L. infantum). Moreover, a thorough assessment was conducted to determine the effectiveness of multiplex LAMP in identifying various Leishmania species, such as Leishmania tropica (L. tropica) and Leishmania major (L. major) in comparison to Leishmania infantum (L. infantum). The diagnostic performance of the multiplex LAMP method for VL was compared to each LAMP assay, real-time polymerase chain reaction (RT-qPCR), and nested PCR technique. Two separated primers were set and used in a multiplex LAMP assay which was designed based on the ITS2 (internal transcribed spacer II) and were selected on the basis of conserved and high copy number region. Multiplex LAMP primers were designed using an online tool available at https://www.primerexplorer.jp/e. The alignment was performed using MEGA5, and the primers were further adjusted utilizing GENE Runner software. All molecular methods were tested on the serial dilution of cloned plasmid containing ITS region from standard strains of L. infantum, L. tropica, and L. major. Moreover, multiplex LAMP assay was evaluated and compared based on both standard strains and 55 clinical samples from humans as well as dogs. Various approaches were applied to interpret the multiplex LAMP reaction which deciphered a higher sensitivity when compared to the RT-qPCR for L. infantum (one copy number of plasmid, equal to 0.85 femtograms (fg) of plasmid concentration, and 0.004 parasite DNA per μL) detection while these three standard strains of Leishmania were confirmed to contain 40 DNA copies using RT-qPCR. Additionally, the multiplex LAMP detection limit was approximately equivalent to RT-qPCR for L. major and L. tropica, which included 0.342 picograms (pg) and 342 femtograms (fg) of plasmid concentration, 4 × 103 and 4 × 102 copy number of plasmid, and 17.1 and 1.71 parasite DNA per μL for L. major and L. tropica, respectively. Nested PCR exhibited a lower detection limit for L. infantum of 4 × 106 plasmid copy number compared to multiplex LAMP and RT-qPCR. Multiplex LAMP has the potential for accurate and rapid detection of infectious disease, successful treatment, and finding and monitoring asymptomatic cases, especially in low-income countries.

Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

The prognostic effect of clinical and laboratory findings on in-hospital mortality in patients with confirmed COVID-19 disease

Background:

COVID-19 is known as a global health issue, which can cause high morbidity and mortality in patients. It is necessary to identify biomarkers, clinical and laboratory findings and effects on patients' mortality.

Objective:

This study aimed to evaluate the prognostic effect of clinical and laboratory findings on in-hospital mortality in patients with confirmed COVID-19.

Methods:

This retrospective cross-sectional study (February-August 2020) was conducted on adult patients with COVID-19, who were hospitalized in one of the main reference hospitals affiliated to Shiraz University of Medical Sciences, southern Iran. Patients with uncompleted or missed medical files were excluded from the study. Clinical and laboratory findings were extracted from the patients' medical files and then analyzed. The patients were categorized as survivor and nonsurvivors groups, and they were compared.

Results:

Totally, 345 patients were enrolled that 205 (59.4%) were male. The mean±SD of age was 53.67±16.97 years, and 32 (9.3%) were died. Hypertension (28.4%) and diabetes (25.5%) were the most prevalent comorbidities. All clinical symptoms were similar in both groups, except fever, which was observed significantly more in nonsurvivors (P=0.027). The duration of hospitalization was 9.20±5.62 (range; 2-42) days, which was higher in nonsurvivors (P<0.001). The results of Multivariate Logistic Regression Model showed that CRP (OR=1.032, P=0.01) and INR (OR=48.88, P=0.049) were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19.

Conclusion:

The current study showed that in-hospital mortality was obtained as 9.3%. It was found that CRP and INR were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19.

Prophylactic Antibiotic Practices in Common Otologic Surgeries in Iran

INTRODUCTION

Rational surgical antibiotic prophylaxis is suggested for some selected surgical processes. However, inappropriate utilization of antimicrobial prophylaxis reduces benefits and increases costs and risks, such as antibiotic resistance. This study aimed to evaluate the current practice of antibiotics prescribed by surgeons in common otologic surgeries.

MATERIALS AND METHODS

This cross-sectional study was conducted among otolaryngologists with at least 5 years of experience in common otologic surgeries (tympanoplasty, tympanomastoidectomy, stapes, or middle ear exploration (MEE) surgeries). A total of 257 otolaryngologists filled a checklist about their selected regimen and timing of antibiotic(s) administration.

RESULTS

The rates of antibiotic prophylaxis prescription in dry and wet ears in tympanoplasty were 7.4% and 87.1% (preoperative), 40.9% and 47% (intraoperative), 88.3% and 98% (postoperative); in tympanomastoidectomy with no cholesteatoma were 7.1% and 97.8% (preoperative), 39.6% and 50.9% (intraoperative), 93.7% and 99.6% (postoperative); in tympanomastoidectomy with cholesteatoma were 14% and 98.3% (preoperative), 45.4% and 51.9% (intraoperative), 98.3% and 99.6% (postoperative), respectively, and in stapes or MEE surgeries were 6.4% (preoperative), 41.7% (intraoperative) and 73.1% (postoperative), respectively. There were no significant differences in the rates of prescribing intraoperative prophylaxis between wet and dry ears, except in tympanomastoidectomy without cholesteatoma. Overall, the most prescribed antibiotics were cephazolin, cephlexin, and ciprofloxacin drop.

CONCLUSION

The results of this study revealed the inappropriate administration and timing of antibiotic prophylaxis regarding current literature evidence. Despite the lack of evidence on the potential role of antibiotic prophylaxis in clean-contaminated and contaminated ears, a significant number of surgeons prescribed prophylactic antibiotics in tympanoplasty and tympanomastoidectomy without cholesteatoma.

Epidemiology of Influenza in Fars Province, Southern Iran; a Population-Based Study (2015-2019)

BACKGROUND

Influenza is one of the most important viral diseases with high mortality and morbidity that can have a great impact on public health and economy.

OBJECTIVE

To investigate the clinical and epidemiological features of influenza virus A/H1N1, A/H3N2, and B infection in Fars province, southern Iran, in 2015-2019.

METHODS

In this retrospective cross-sectional study, we assessed the archived data of Syndromic Surveillance System of Iran's Health Ministry, allowed access by Communicable Diseases' Unit of Health chancellor of Shiraz University of Medical Sciences, from December 22, 2015 to September 22, 2019. The participants included all patients whose data were recorded as influenza-like illness (ILI) and severe acute respiratory infections/illness (SARI). Influenza viral infection was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR).

RESULTS

Totally, 1269 patients suspected of influenza were sampled. The mean ± SD of age was 29.40 ± 26.91 years. Fever was the most common symptom (68.6%). The highest incidence was in winter (55.9%). Of 928/1269 laboratory's results which were recorded in the registry, 204 (16.08%) samples were positive and 724 (57.05%) were negative. Among 204 positive results, 191 (15.05%) were influenza type A, and 8 (0.63%) influenza type B. Among patients with definite influenza type A, 34 (2.68%) had H1N1/p subtype, 58 (4.57%) H3N2, and one (0.08%) had other subtypes; however, subtypes were not identified in 7.72% of patients. Six (3.0%) patients with confirmed influenza expired.

CONCLUSION

The incidence of influenza, especially type A, in Fars province, southern Iran is considerable and requires more attention for prevention in health policy programs.

Potential Effects of Climatic Parameters on Human Brucellosis in Fars Province, Iran, during 2009-2015

BACKGROUND

Human brucellosis is widespread in Fars province. The present study aimed to investigate the effect of climate on its incidence and determine the areas prone to the infection.

METHODS

Monthly meteorological data and the incidence rate of human brucellosis during 2009-2015 were collected and their correlation was studied using Pearson's correlation coefficient. Additionally, the multiple regression method and multi-layer perceptron neural network model were used to predict the incidence of human brucellosis. In order to analyze the data SPSS software (version 16.0), MATLAB software (version 8.1), and GIS software (version 10.4) were used.

RESULTS

Pearson's regression analysis, on a monthly basis, showed a significant indirect correlation between the incidence of human brucellosis (with a time lag of up to 5 months) and climatic parameters (minimum temperature: -0.72 and evaporation: -0.73) in Abadeh (Fars, Iran). Moreover, there was a significant direct correlation (P<0.001) between the incidence of human brucellosis and the maximum relative humidity (+0.67) and rainfall (+0.48). The incidence of human brucellosis in Abadeh was predicted by using artificial neural network models (4 layers, 4 neurons in each layer), the Levenberg-Marquardt training algorithm, and Sigmoid transfer function. It was determined that a correlation rate of 0.89 in the training level and 0.8 in the test level (with the lowest error rate) were the best values in multi-layer perceptron modeling.

CONCLUSION

Climatic parameters are important factors in determining the incidence rate of human brucellosis in Fars province. Climate conditions provide a favorable environment for the spread of human brucellosis in this area.

Comparative efficacy of three pediculicides to treat head lice infestation in primary school girls: a randomised controlled assessor blind trial in rural Iran

Background

Head lice infestation (Pediculosis) is one of the most important health challenges particularly in primary school-aged children. It is often present among 6–11-year-old students in various tropical and temperate regions of the world. The aim of this study was to examine epidemiologic indices and comparative analysis of two pyrethroid-based and one non-chemical pediculicide products on head lice treatment of primary school girls in a rural setting of Fars province, south Iran, as part of a randomized controlled assessor blind trial.

Methods

Before treatment, infested students were screened using plastic detection combs to find live head lice. Three independent parallel groups, each with about 25 participants (#77) were eventually twice with a week apart treated with either 1% permethrin, 0.2% parasidose (d-phenothrin) or 4% dimeticone lotion preparations. In each case, a questionnaire form was completed on epidemiologic factors. Data were registered after a fortnight from primary scalp treatment and re-inspection on days 2, 6, 9 and 14. Data analyses were performed using Chi-square test with a P-value < 0.05 being taken as statistically significant.

Results

From 3728 inspected students, 87 (2.33%) girls were infested with head lice, Pediculus humanus capitis De Geer, 1778. Ten students dropped out pertaining to exclusion criteria. No significant correlation was found between head lice infestation level and hair length, hair style, itching, nationality, age, settlement site and baths; but there was a significant relationship between age and hair style (P = 0.027). The efficacy values on each of the above re-inspection days from each of the three treatments were 81, 74, 70 and 63% for permethrin; 83, 92, 100 and 100% for dimeticone; and 96, 88, 96 and 92% for d-phenothrin; respectively. A quartile difference in efficacy of permethrin relative to dimeticone on day 14 represented the scale of head lice resistance to permethrin treatment. There were significant statistical differences in case re-inspection days 9 (P = 0.008) and 14 (P = 0.003) post treatment. Only two dropout cases, one non-compliant and the other lost before the second-week treatment, from permethrin trial were observed following two applications a week apart.

Conclusions

Dimeticone lotion had the fullest efficacy (100%) among all treatments. This high cure rate was attributed to the low level of infestation and the extent of patients’ involvement. Parasidose swiftly ameliorated the infested cases by the second day since initial treatment. Female third grade students were the most infested cohort.

Trial registration

Current Controlled Trials- IRCT2016041627408N1, Dated: 21-08-2017.

The Fauna and Active Season of Mosquitoes in West of Fars Province, Southwest of Iran

Culicidae are highly important for public health as they can be vectors of diseases and are responsible for a wide spectrum of infections. Five collection sites were selected randomly with regards to existing facilities in Firouzabad County. For collecting larvae and total catch for adult mosquitoes, sampling was carried out by dipping technique for collecting larvae and total catch for adult mosquitoes. A total of 689 adults and 1313 larvae of Culicidae were collected, of which 3 genera and 6 species of Culicidae were recognized, namely, Anopheles superpictus, Anopheles d&amp;rsquo;thali, Culex sinaiticus, Culex theileri, Culex mimeticus, and Culiseta longiareolata. Cx. theileri was the most frequent Culicidae collected at Firouzabad, with a total of 613 and 247 larval and adult specimens, respectively. The highest number of mosquitoes was collected in June (31.1%) and the lowest in May (3.4%). The mean temperatures in June and May were 31.3˚C and 28.2˚C, respectively. We found some vectors that are of medical and veterinary importance; our results could be applied in vector control programs that aim at eradication or control of mosquitoes in this area.

Comparison of antiretroviral drug resistance among treatment-naive and treated HIV-infected individuals in Shiraz, Iran

The use of anti-retroviral therapy has been effective in controlling the spread of HIV-1, and has prolonged life expectancy, but this success can be affected by the emergence of drug resistance. The main goal of this study was to investigate drug resistance in the reverse transcriptase (RT), and protease (PR) genes among HIV-1 infected individuals. We systematically selected 59 HIV-1 infected individuals from Shiraz Voluntary Counseling and Testing Center (29 treatment- naïve and 30 treated). In this study intravenous drug users older than 18 were included in this study. Using specific primers, nested RT-PCR was performed on RNA extracted from patient samples. The genes targeted for RT and PCR were successfully amplified and sequenced. The sequences of these two genes were compared with mutations related to drug resistance against nucleotide reverse transcriptase inhibitors (NRTI), non-nucleotide reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) using the latest database from the International AIDS society - USA, Stanford University, and the patterns were recorded. Among treatment-naïve, the detected NRTI and NNRTI resistance mutations were V179T, V75 M and E138A. V179T causes high level resistance to Efavirenze and Nevirapin. V75 M causes intermediate resistance to Stavudine. Regarding NRTI and NNRTI resistance mutations among treated patients, the most frequent mutation (7%) was M184 V, which causes high level resistance to zidovudin and emtricitabine. The interesting result from this study was the detection of NRTI and NNRTI resistance mutations before the initiation of treatment, which signifies the transmission of resistant strains of virus between individuals. This mutation highlights the importance of drug resistance HIV-1 genotyping before commencing treatment.

The Potential of Menstrual Blood-Derived Stem Cells in Differentiation to Epidermal Lineage: A Preliminary Report

BACKGROUND

Menstrual blood-derived stem cells (MenSCs) are a novel source of stem cells that can be easily isolated non-invasively from female volunteered donor without ethical consideration. These mesenchymal-like stem cells have high rate of proliferation and possess multi lineage differentiation potency. This study was undertaken to isolate the MenSCs and assess their potential in differentiation into epidermal lineage.

METHODS

About 5-10 ml of menstrual blood (MB) was collected using sterile Diva cups inserted into vagina during menstruation from volunteered healthy fertile women aged between 22-30 years. MB was transferred into Falcon tubes containing phosphate buffered saline (PBS) without Ca2(+) or Mg2(+) supplemented with 2.5 µg/ml fungizone, 100 µg/mL streptomycin, 100 U/mL penicillin and 0.5 mM EDTA. Mononuclear cells were separated using Ficoll-Hypaque density gradient centrifugation and washed out in PBS. The cell pellet was suspended in DMEM-F12 medium supplemented with 10% FBS and cultured in tissue culture plates. The isolated cells were co-cultured with keratinocytes derived from the foreskin of healthy newborn male aged 2-10 months who was a candidate for circumcision for differentiation into epidermal lineage.

RESULTS

The isolated MenSCs were adhered to the plate and exhibited spindle-shaped morphology. Flow cytometric analysis revealed the expression of mesenchymal markers of CD10, CD29, CD73, and CD105 and lack of hematopoietic stem cells markers. An early success in derivation of epidermal lineage from MenSCs was visible.

CONCLUSION

The MenSCs are a real source to design differentiation to epidermal cells that can be used non-invasively in various dermatological lesions and diseases.

The Prevalence and Risk Factors of Hepatitis Delta Virus in HIV/HBV Co-Infected Patients in Shiraz, Iran, 2012

Evidence has shown that liver disease caused by hepatitis viruses can be more aggressive and severe in HIV infected subjects. Therefore, the present cross-sectional study aimed to evaluate the seroprevalence of HDV infection among HIV/HBV co-infected clients in Shiraz, southwest Iran. In this study, 178 patients co-infected with HBV and HIV individuals were enrolled. The diagnosis of HIV infection was documented based on serological assays. The demographic and complementary data were collected by a questionnaire. HBsAg and HDV Ab were detected by commercial quantitative enzyme linked immunosorbent assay kits according to the manufacturer's instructions. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also measured. The mean age of the participants was 37.4±7.4 years (range 22-63). 175 (98.4 %) patients were male and 3 (1.6 %) were female. Among 178 patients co-infected with HIV/HBV, 35 cases (19.7%, 95% CI: 14%-25%) were anti-HDV‏ positive and 143 (80.3%) were negative for anti-HDV. HDV exposure in HIV/HBV co-infected patients was associated with blood transfusion (P=0.002, OR: 14.3) and prison history (P=0.01, OR: 2.31) but not with age, marital status, unsafe sex contact, and injection drug abuse. Our data showed a relatively high prevalence of HDV infection in HIV infected population in Shiraz, Iran. The high frequency of HDV Ab in patients with blood transfusion and prison history reveals that HDV transmission occurs more frequently in the parental route than sexual contacts; therefore, blood screening for HDV diagnosis in the high-risk group is recommended.

The geographical clusters of gastrointestinal tract cancer in fars province, southern iran

BACKGROUND

Gastrointestinal tract cancer (GI.C) is one of the common cancers in world-wide. The incidence rate of it is different in various geographical regions. This study was performed to assess spatial clusters of the occurrence of GI.C in Fars Province.

METHODS

In this cross-sectional study, the new cases were 4569 cases from 2001 to 2009. The crude incidence rates were standardized based on world population for both sexes. The spatial analysis was conducted using the geographical information systems. We used the local Indicators of spatial association measure, in order to identify local spatial clusters.

RESULTS

From a total of the new cases, 62.8% cases were male. The most common GI.Cs were stomach and colorectal cancer in men and women respectively. The significant cluster patterns were discovered from 2002 to 2007. The common type of spatial clustering was a high-high cluster, that to indicate from North-west to South-east of Fars Province.

CONCLUSIONS

Analysis of the geographical distribution of GI.C will provide opportunities for policymakers for applying preventive measures. Furthermore, it could be helpful for researchers for future epidemiological studies for investigation of etiological agents in regions with significant spatial clustering of high incidence of cancer.

The Spatial Distribution of Cancer Incidence in Fars Province: A GIS-Based Analysis of Cancer Registry Data

BACKGROUND

Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters.

METHODS

In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age-standardized incidence rates (ASR) per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system (GIS). Also, comparisons were made between ASRs in each county.

RESULTS

A total of 28,411 new cases were diagnosed with cancer during 2001-2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 ± 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran's Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high-high cluster, that to indicate from north-west to south-east of Fars Province.

CONCLUSIONS

Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures.

Antiplasmodial activity of ethanolic extracts of some selected medicinal plants from the northwest of Iran

The effectiveness of antimalarial drugs is declining at an ever accelerating rate, with consequent increase in malaria-related morbidity and mortality. The newest antiplasmodial drug from plants is needed to overcome this problem. The aim of this study was to assess antimalarial activity of the ethanolic extracts of 10 different medicinal plants from eight families against Plasmodium falciparum chloroquine-sensitive 3D7 strain. The selection of the hereby studied plants was based on the existing information on their local ethnobotanic history. Plants were dried, powdered, and macerated in a hydroalcoholic solution. Resulting extracts have been assessed for in vitro and in vivo antimalarial and brine shrimp toxicity activities. Of 10 plant species tested, four plants: Althea officinalis L. (Malvaceae), Myrtus communis Linn (Myrtaceae), Plantago major (Plantaginaceae), and Glycyrrhiza glabra L. (Papilionaceae) displayed promising antimalarial activity in vitro (50% inhibitory concentration values of 62.77, 42.18, 40.00, and 13.56 μg/mL, respectively) with no toxicity against brine shrimp larvae. The crude extracts of three active plants, G. glabra, M. communis, and A. officinalis, also significantly reduced parasitemia in vivo in female Swiss albino mice at a dose of 400 mg/kg compared to no treatment. Antiplasmodial activities of extracts of A. officinalis and M. communis are reported for the first time.

Data coverage of a cancer registry in southern Iran before and after implementation of a population-based reporting system: a 10-year trend study

Background

Cancer registries help to decrease the burden of cancers by collecting accurate and complete data. We aimed to measure the completeness of coverage of information recorded between 2000 and 2009 in a cancer registry program in Fars province, southern Iran.

Methods

The cancer registry program run by Shiraz University of Medical Sciences was investigated in two periods: pathology-based data from 2000 to 2007 and population-based data from 2007 to 2009. Completeness of yearly coverage was measured as the number of reported cases of cancer in each year divided by estimated cases based on 107.3 new cases per 100 000 individuals. The percentage of complete data registration (patient’s name, age, gender, address, phone number and father’s name) and correct cancer encoding was calculated for each year and compared to the maximum acceptable error rate for each item.

Results

A total of 29 277 non-duplicate cancer records were studied. Completeness of coverage varied from 22.68% in 2000 to 118.7% in 2008. Deficiencies in patients’ demographic data were highest for name in 2002 (0.09%), age in 2006 (2.36%), gender in 2001 (0.06%) and father’s name in 2001 (52.5%). Incomplete address (99.7%) and missing phone number (100%) were most frequent in 2000, and deficiencies in encoding information were highest in 2008 (6.36%).

Conclusions

The cancer registry program in Fars province (southern Iran) was considered satisfactory in terms of completeness of coverage and information about age. However, it was deficient in recording patients’ phone number and address, and father’s name. The error level for cancer encoding was unacceptably high. Enhancing hardware and software resources, education and motivation in all public and private sectors involved in the cancer registry program, and greater attention to epidemiological research are needed to increase the quality of the cancer registry program, including its completeness.

Sociocultural challenges of beta-thalassaemia major birth in carriers of beta-thalassaemia in Iran

Objective

Despite premarital screening, prenatal diagnosis and the option for voluntary termination of pregnancy, some Iranian couples continue a pregnancy with a fetus affected with beta-thalassaemia major (β-TM). We examined the reasons for this decision, to evaluate the sociocultural challenges these couples face.

Methods

A retrospective evaluation of medical records of all fetuses aborted was conducted to identify those with β-TM, to determine the frequency of β-TM births and to establish the number of couples with β-thalassaemia who declined prenatal diagnosis or a termination of pregnancy in this period. We investigated the reasons for declining these options.

Results

The birth prevalence of β-TM decreased from 39.38 to 2.68 in 100,000 live births from 2005 to 2010. Terminations of pregnancy for affected fetuses increased from 67 in 2005 to 135 in 2010. We identified eight couples as β-thalassaemia carriers who declined prenatal diagnosis or a termination of pregnancy. All but one couple already had a child with β-TM. The reasons for declining prenatal diagnosis were strong religious beliefs, superstition and faith in a supernatural solution in six couples. Economic and cultural factors, and previous termination of pregnancy were also mentioned as reasons by the other two couples.

Conclusion

Although most of the couples had a β-TM child and related socioeconomic problems, their reasons for refusing prenatal diagnosis or termination remain a challenge for the healthcare system in Iran. Couple screening and educational programmes have effectively decreased the rates of refusal in at-risk couples in recent years.

Prevention of Disease Complications through Diagnostic Models: How to Tackle the Problem of Missing Data?

BACKGROUND

Diagnostic models are frequently used to assess the role of risk factors on disease complications, and therefore to avoid them. Missing data is an issue that challenges the model making. The aim of this study was to develop a diagnostic model to predict death in HIV/AIDS patients when missing data exist.

METHODS

HIV patients (n=1460) referred to Voluntary Consoling and Testing Center (VCT) of Shiraz southern Iran during 2004-2009 were recruited. Univariate association between variables and death was assessed. Only variables which had univariate P< 0.25 were selected to be offered to the Multifactorial models. First, patients with missing data on candidate variables were deleted (C-C model). Then, applying Multivariable Imputation via Chained Equations (MICE), missing data were imputed. Logistic regression was fitted to C-C and imputed data sets (MICE model). Models were compared in terms of number of variables retained in the final model, width of confidence intervals, and discrimination ability.

RESULT

About 22% of data were lost in C-C model. Number of variables retained in the C-C and MICE models was 2 and 6 respectively. Confidence Intervals (C.I.) corresponding to C-C model was wider than that of MICE. The MICE model showed greater discrimination ability than C-C model (70% versus 64%).

CONCLUSION

The C-C analysis resulted to loss of power and wide CI's. Once missing data were imputed, more variables reached significance level and C.I.'s were narrower. Therefore, we do recommend the application of the imputation method for handling missing data.

An outbreak of food-borne group A Streptococcus (GAS) tonsillopharyngitis among residents of a dormitory

Epidemics of food-borne pharyngitis due to group A Streptococcus are rarely reported. Here we present an outbreak of food-borne tonsillopharyngitis in female dormitories in the Islamic Republic of Iran. Throat swabs and cultures were performed on a number of patients, and of specimens from the nasopharynx and hands of staff who were involved in food processing. We planned a case-control study for assessing the source of epidemics. 11 out of 17 throat swabs of students were positive for Streptococcus group A and also 2 throat samples from asymptomatic cooks were positive. A DNA fingerprinting study showed that Streptococcus group A strains of 11 students and 1 cook had the same T agglutination pattern and M protein factor (M3/T13). It is suggested that group A streptococci as well as group C and G streptococci can cause epidemic food-borne pharyngitis. Regular health surveillance of food handlers and food preparation processes are important for prevention of such outbreaks.