COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, ...cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.
Abstract
Background
Considering the importance of intention to receive COVID-19 vaccine among healthcare workers and its role in maintaining their health and inhibiting the epidemic spread of ...Covid-19, the present study was done to identify the changes in intention to receive COVID-19 vaccine rate in two different time points and it’s determinants based on the dimensions of the health belief model among healthcare workers in Iran.
Methods
Two cross-sectional surveys performed to investigate COVID-19 vaccination intent and associated factors based on the health belief model. The first conducted on 1244 participants from August 18 to 23, 2020, and the second on 1514 participants from February 5 to April 29, 2021, both using a questionnaire of intent to accept COVID-19 vaccination. The questionnaire distribution platform in both surveys was similarly, WhatsApp and Telegram social and working virtual groups of HCWs. Data were analyzed with SPSS-16 software for descriptive and analytical statistics.
Results
In the first survey, 58.4% (95% CI: 0.55-0.61%) of healthcare workers intended to receive the COVID-19 vaccine, the rate dropped to 45.7% (95% CI: 0.43-0.48%) in the second survey (
P
< 0.001). The regression analysis indicated six factors that were significantly associated with higher intention to receive COVID-19 vaccine: being a female (OR = 1.84, 95% CI (1.11-3.03)), history of Covid-19 infection (OR = 1.54, 95% CI (1.09-2.18), perceptions of Covid-19 disease (OR = 1.13, 95% CI (1.01-1.28)), perceived benefits of COVID-19 vaccine (OR = 1.34, 95% CI (1.22-1.47)), prosocial norms for COVID-19 vaccination (OR = 1.25, 95% CI (1.21-1.29)), and COVID-19 vaccine safety/cost concerns (OR = 1.25, 95% CI (1.17-1.33)).
Conclusions
Present study showed an undesirable rate of intention to receive COVID-19 vaccine among healthcare workers, especially decreasing over the time, emphasize the need of interventions to promote healthcare workers’ intention to receive the vaccine and reduce the spread of COVID-19 disease.
Background
The prevalence of dyslipidemia in patients with type 2 diabetes (T2D) has been reported to be relatively high. The current study aimed to investigate the trend of serum lipid levels and ...the prevalence of dyslipidemia in patients with T2D.
Methods
Data were extracted from a cohort of patients with T2D who had regular follow-ups every year for three years. TG, TC, LDL-C, HDL-C, and non-HDL-C were analyzed. The atherogenic index of plasma (AIP) was calculated using log (TG/HDL-C).
Results
A total of 747 patients with T2D were included in this study, consisting of 469 (62.8%) women and 278 (37.2%) men. There was a significant downward trend in mean TG, TC, LDL-C, non-HDL-C, and AIP levels. The trend of mean HDL-C levels showed no significant change. The prevalence of high TG, high TC, high LDL-C, and high non-HDL-C significantly decreased from the first to the last visit. There was no significant change in the trend of prevalence of low HDL-C. The prevalence of high AIP significantly decreased in women and showed no significant changes in men.
Conclusions
A decreasing trend was observed in the mean levels and prevalence of TG, TC, LDL-C, non-HDL-C, and AIP. HDL-C did not change significantly. The success rate in achieving a complete normal lipid profile during follow-up years was not promising and continues to be challenging.
The burden of non-communicable diseases is rising globally. This trend seems to be faster in developing countries of the Middle East. In this study, we presented the latest prevalence rates of a ...number of important non-communicable diseases and their risk factors in the Iranian population.
The results of this study are extracted from the third national Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007), conducted in 2007. A total of 5,287 Iranian citizens, aged 15-64 years, were included in this survey. Interviewer-administered questionnaires were applied to collect the data of participants including the demographics, diet, physical activity, smoking, history of hypertension, and history of diabetes. Anthropometric characteristics were measured and serum biochemistry profiles were determined on venous blood samples. Diabetes (fasting plasma glucose >or= 126 mg/dl), hypertension (systolic blood pressure >or= 140 mmHg, diastolic blood pressure >or= 90 mmHg, or use of anti-hypertensive drugs), dyslipidemia (hypertriglyceridemia: triglycerides >or= 150 mg/dl, hypercholesterolemia: total cholesterol >or= 200 mg/dl), obesity (body mass index >or= 30 kg/m2), and central obesity (waist circumference >or= 80 cm in females and >or= 94 cm in males) were identified and the national prevalence rates were estimated.
The prevalence of diabetes, hypertension, obesity, and central obesity was 8.7% (95%CI = 7.4-10.2%), 26.6% (95%CI = 24.4-28.9%), 22.3% (95%CI = 20.2-24.5%), and 53.6% (95%CI = 50.4-56.8%), respectively. The prevalence of hypertriglyceridemia and hypercholesterolemia was 36.4% (95%CI = 34.1-38.9%) and 42.9% (95%CI = 40.4-45.4%), respectively. All of the mentioned prevalence rates were higher among females (except hypertriglyceridemia) and urban residents.
We documented a strikingly high prevalence of a number of chronic non-communicable diseases and their risk factors among Iranian adults. Urgent preventive interventions should be implemented to combat the growing public health problems in Iran.
Background: There is debate on the necessity of booster doses of COVID-19 vaccination, especially in countries with limited resources. Methods: This cross-sectional study was conducted in a referral ...laboratory in Tehran, Iran. The level of COVID-19 antibodies was measured and compared between individuals regarding the number of COVID-19 vaccine shots. Results: In this study, 176 individuals with a mean age of 36.3 (±11.7) years participated. A total of 112 individuals received two doses of the COVID-19 vaccine, and 64 individuals received three doses. Level of all antibodies was higher in those who received three doses than in those who received two doses of the COVID-19 vaccine. Considering the SARS-CoV-2 Spike IgG, the difference was not statistically significant but for the SARS-CoV-2 RBD IgG and SARS-CoV-2 NAB the difference was statistically significant. Regarding to the background variables, receiving influenza vaccine in the past year, history of autoimmune diseases and past medical history of chicken pox showed a significant association with the number of vaccine doses received. Their effects on the outcome variables assessed with multivariate logistic regression analysis. Conclusion: The results of our study show that a booster dose of the COVID-19 vaccine enhances the antibody response.
Abstract
Background
The etiology of LARS has not been elaborated on clearly. Studies have reported neoadjuvant therapy, low-lying rectal cancers, adjuvant therapy and anastomotic leakage as risk ...factors for the development of LARS. Anastomotic level has also been proposed as a possible risk factor; However, there have been conflicting results. This study aims to evaluate the role of the level of anastomosis as a potential risk factor for the development of LARS.
Method
A systematic literature search was conducted on Pubmed, Scopus, Embase, and Web of Science databases using Mesh terms and non-Mesh terms from 2012 to 2023. Original English studies conducted on rectal cancer patients reporting of anastomotic level and LARS status were included in this study. Eligible studies were assessed regarding quality control with Joanna-Briggs Institute (JBI) questionnaires.
Results
A total of 396 articles were found using the research queries, and after applying selection criteria 4 articles were selected. A sample population of 808 patients were included in this study with a mean age of 61.51 years with male patients consisting 59.28% of the cases. The Mean assessment time was 15.6 months which revealed a mean prevalence of 48.89% for LAR syndrome. Regression analysis revealed significantly increased risk of LAR syndrome development due to low anastomosis level in all 4 studies with odds ratios of 5.336 (95% CI:3.197–8.907), 3.76 (95% CI: 1.34–10.61), 1.145 (95% CI: 1.141–2.149) and 2.11 (95% CI: 1.05–4.27) for low anastomoses and 4.34 (95% CI: 1.05–18.04) for ultralow anastomoses.
Conclusions
LARS is a long-term complication following surgery, leading to reduced quality of life. Low anastomosis level has been reported as a possible risk factor. All of the studies in this systematic review were associated with an increased risk of LARS development among patients with low anastomosis.
Activation of proinflammatory and anti-inflammatory cytokines network seems to have a role in febrile seizures (FS). The present meta-analysis was aimed to pool the inconsistent data provided with ...case-control studies on the relationship of proinflammatory and anti-inflammatory cytokines and FS/epilepsy risk. The genotype interleukin (IL)-1α-889 1/1 (recessive model) was significantly correlated with increased risk of epilepsy (p=0.008) and FS/epilepsy (p=0.004). Patients with IL-1β-511 T/T homozygote were more susceptible to develop FS (p=0.036) but not epilepsy. Furthermore, the T/T genotype was totally associated with increased risk of FS/epilepsy (p=0.043). Although the recessive model was also confirmed for the Asian subgroup (FS and FS/epilepsy), we found a protective effect of C/C genotype toward developing FS in the Caucasian race (p=0.020). The second meta-analysis on cytokine levels showed a statistically higher serum level of IL-6 in patients with epilepsy compared to control subjects without epilepsy. The present meta-analysis showed that two alleles of proinflammatory cytokines (IL-1α-889 and IL-1β-511) in addition to the serum concentration of IL-6 were significantly associated with FS and epilepsy or both in various subgroup analyses.
Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and ...duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.
Abstract Aims Central obesity, a prominent feature of metabolic syndrome (MetS), is commonly assessed by gender- and ethnicity-specific waist circumference (WC) cut-off values. Since 2006, the ...recommended WC cut-offs by the International Diabetes Federation (IDF) for Europeans are used in Iran because of limited data availability. The purpose of this study was to determine optimal cut-off points for the diagnosis of MetS in Iran. Methods A total of 2752 adults (1046 men) were studied. Subjects with two or more of the following risk factors from the IDF criteria were considered to have multiple risk factors: hyperglycemia (FBG ≥ 100 mg/dL or diagnosed diabetes), high blood pressure (SBP ≥ 130 mmHg, DBP ≥ 85 mmHg, or using antihypertensive drugs), low HDL (<50 mg/dL for females and <40 mg/dL for males), and high TG (>150 mg/dL). Results The WC cut-off yielding maximum sensitivity plus specificity for predicting the presence of multiple risk factors was 91.5 cm in men and 85.5 cm in women. Sensitivity and specificity were 77% (86%) and 58% (50%) in men (women), respectively. MetS prevalence was estimated to be approximately 27% in Tehran. Conclusions WC cut-offs recommended by the IDF are not appropriate for use in Iran.
Abstract Background Karydakis flap (K-flap) and excision with healing by secondary intention (EHSI) are currently accepted methods for surgical management of sacrococcygeal pilonidal disease. This ...clinical trial study aimed to compare early and late outcomes of these two surgical techniques. Materials and methods In this controlled, prospective, randomized clinical trial, patients diagnosed with sacrococcygeal pilonidal disease were randomly allocated to two groups. Patients in the first group underwent Karydakis procedure, whereas EHSI was the surgical management in the second group. The two techniques were compared based on their overall time of wound healing, return to work, rate of complications, and recurrence. Results A total of 321 patients including 161 in the K-flap group and 160 in the EHSI group were included in the study. The median follow-up duration was 49 mo. The mean time of wound healing (16.44 versus 80.01 d, P < 0.001), return to work (14.44 versus 24.19, P < 0.001), rate of wound complications (18.7% versus 31.2%, P = 0.006), and recurrence (1.2% versus 7.5%, P = 0.005) were all significantly lower in the K-flap group. The mean operation time was significantly shorter in the EHSI group (15.87 versus 55.17 min, P < 0.001). The K-flap group showed significantly higher pain on their first postoperative day and significantly less pain after 1 wk ( P < 0.001). Conclusions Although both techniques are safe, the K-flap is associated with significantly lower rates of complications and recurrence and significantly shorter time of wound healing and return to work.
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