Journal of Iranian Medical Council
Volume:4 Issue: 1, Winter 2021

Although the number of new HIV infections continues to decline in Iran, the number of HIV-infected patients aged ≥50 years continues to rise due to the introduction of new treatment and longer survival. The higher prevalence of medical comorbidities and treatment failure in this population is a critical challenge in HIV treatment. In the present study, prevalence of comorbidities, rate of response to treatment, and results of HIV drug resistance tests were explored in older patients.

A cross-sectional study was conducted at a tertiary referral HIV center in Tehran, Iran. The data for all the HIV-positive patients older than 50 years old were collected by reviewing their medical records within the last 15 years. Data included demographic and behavioral characteristics, immunologic and virologic response, rate of treatment failure, and HIV resistance.

The records for 100 patients with a mean age of 62.5 (range 50-79) years were reviewed and analyzed. Medical comorbidities were observed in 20% of the patients, with HCV co-infection, diabetes mellitus, and neuropsychiatric impairments being the most common. Complete immunologic and virologic responses were respectively observed in 88 and 97% of patients. The treatment regimen was modified in 66 patients, with drug side effects being the reason in 63 patients (95.4%). HIV drug resistance tests showed a low rate of resistance (<10%) to all drugs used in this population.

Our findings highlight the high prevalence of comorbidities in older HIV-positive individuals in Iran. A thorough endocrine and neuropsychiatric assessment at each visit is recommended for these patients. Access to an appropriate psychosocial support system will ensure earlier detection of HIV infection and comorbidities in the older population, and will undoubtedly improve the treatment outcome and quality of life among them.

Determination of contributing factors for jaundice would result in better programming for prevention. This study was performed to determine the prevalence rate of Urinary Tract Infection (UTI) among neonates with jaundice admitted in Arash Hospital from October 2013 to October 2014. In this descriptive cross-sectional study, term neonates with non-hemolytic jaundice admitted in Arash Hospital from October 2013 to October 2014 were evaluated for UTI by urine culture and the data were recorded by checklist using medical documents. A total of 436 term infants were enrolled in the study. Mean age at the time of admission was 6.03±3.355 days with age range of 3-18 days including 291(0.66%) males and 145(0.33%) females. Urine culture was positive in 32 neonates (7.3%).The most common germs were Klebsiella in 37.5%, Escherichia coli (E. coli) in 21.9%, Staphylococcus in 9.4%, Pseudomonas in 3.1%, Enterococcus in 15.6%, Enterobacter in 9.4%, and Group B Streptococcus (GBS) in 3.1%. Urine culture should be a part of routine clinical evaluation for all icteric neonates at the age of 5-6 days or more who have no risk factors to exclude the possibility of coincidental UTI.

Migraine is a recurrent disorder which can cause socio-economic and public health burdens. Many factors, especially dietary factors are suggested to induce migraine headaches. The aim of this study was to examine the association between plant-based dietary patterns and headache severity and duration among migraine patients. A sample of two hundred and sixty-six women with migraine (18-50 years) took part in the present cross-sectional study. Dietary intake data was collected using a validated and reliable food-frequency questionnaire. Three dietary indices were evaluated including an overall plant-based diet (PDI), healthful Plant-based diet (hPDI), and unhealthful plant-based diet (uPDI). Anthropometric measurements, headache duration, Migraine Disability Assessment (MIDAS), and Visual Analog Scale (VAS) were assessed for all cases. Multinomial logistic regression and linear regression models were used to show the association between headaches and plant-based dietary patterns. An inverse association between higher adherence to hPDI and severity of headaches was found based on VAS (OR=0.40; 95% CI: 0.21, 0.74; p=0.003), and severe disability based on MIDAS (OR=0.50; 95% CI: 0.26, 0.95; p=0.03). Conversely, uPDI scores were positively associated with severe headaches (OR=3.00; 95% CI: 1.72, 5.23; p <0.001), and disability (OR=2.50; 95% CI: 1.39, 4.51; p=0.001). Moreover, headaches duration showed an inverse significant association with hPDI scores (β=-0.21, 95% CI=-4.69, -1.08, p=0.002). Plant-based diet, particularly healthful plant foods, was inversely associated with lower severity, disability and duration of headaches. In addition, unhealthy plant foods were associated with higher risk of migraine headaches.

A novel human coronavirus (COVID-19) was reported in China at the beginning of 2020 and then emerged as a pandemic. Due to this pandemic, surgical practices changed worldwide. First, postponing elective surgeries to the end of pandemic was suggested. Therefore, conducting safe surgeries became a critical concern. This is a multicenter prospective study. The data of 85 patients undergoing laparoscopic surgery in this pandemic era were recorded to evaluate their postoperative outcomes. Among all patients with mean age of 43.7±15.6 and mean surgical duration of 94.6 minutes, none of them showed any complication or any COVID-19 related symptoms after surgery or in follow up time. The mean hospital stay was 3.5 days. There was no increased risk of postoperative complications and COVID-19 infection for patients undergoing various types of laparoscopic surgery in this study and laparoscopy was safe for the patients.

Patients under mechanical ventilation are at risk of ventilator-associated complications. One of these complications is lung injury due to high tidal volume. Nurses’ competence in mechanical ventilation is critical for preventing ventilator-associated complications. This study assessed the effects of feedback and education on nurses’ clinical competence in mechanical ventilation and accurate tidal volume setting. This single arm pretest-post-test interventional study was conducted in 2019 at Shariati hospital affiliated to Tehran University of Medical Sciences.Participants were 75 conveniently selected nurses. Initially, nurses’ clinical competence in mechanical ventilation and ventilator parameters of 250 patients were assessed. A mechanical ventilation -based feedback and education intervention was implemented for nurses. Finally, mechanical ventilation clinical competence of nurses and ventilator parameters of 250 new patients were assessed. Moreover, patients’ height was estimated based on their ulna length and then, their predicted body weight was calculated using their estimated height. Accurate tidal volume was determined per predicted body weight. The mean score of nurses’ clinical competence increased from 8.27±3.09 at pretest to 10.07±3.34 at post-test (p <0.001). The mean values of both total tidal volume and tidal volume per kilogram of predicted body weight were significantly reduced respectively from 529.84±69.11 and 9.11±1.73 (ml) at pretest to 476.30±31.01 and 7.79±1.14 (ml) at post-test (p <0.001). The feedback and education intervention is effective in promoting nurses’ clinical competence in mechanical ventilation and reducing tidal volume. Thereby, it can reduce lung injuries associated with high tidal volume and ensure patient safety.

The study aimed to assess how people change their social and health-related behavior in the context of COVID-19 epidemic in Iran. To this end, the theory of planned behavior was applied for predicting compliance with government-advised preventive measures. An attempt was made to examine how groups of people in terms of age, gender, educational level, income level, marital status, and health condition were observing the government-advised preventive measures. Totally, 5021 people above the age of 15 years responded to an online questionnaire that included items related to demographic features, compliance with COVID-19 preventive behavioral guidelines (home quarantine, avoiding social gathering, keeping physical distance of 1.5-2 meters, frequent hand sanitization, and avoiding shopping and outside recreation), TPB constructs (behavioral attitudes, subjective norms, perceived behavioral control, intentions to do the preventive behavior), and risk perception. The study was descriptive and conducted in year 2020. T-test, ANOVA, and correlations indicated that younger individuals, men, singles, people with lower educational levels, lower income level and no health condition reported lower compliance. Regression showed that intentions, perceived behavioral control, and subjective norm were associated with higher compliance. Furthermore, in regression, young age, male gender, and lower level of education were associated with lower compliance with C-19 PB. Young males with lower level of education infrequently comply with government-advised preventive measures. Also, intention, perceived behavioral control, and subjective norm are related to compliance with government-advised preventive measures.

Orofacial cleft is one of the most common congenital malformations of craniofacial region. Otitis media with effusion causing conductive hearing loss is a considerable challenge for many children with cleft lip and palate. The aim of this study was to evaluate the prevalence of hearing disorders and associated malformations in these patients. The research population consisted of patients with cleft palate, between years 2012 and 2014, who were referred to Children’s Medical Center and Vali-e-Asr hospital in Tehran, Iran. Otoscopic examination, tympanometry, pure tone audiometry and echocardiography were performed for each patient. Among patients with cleft palate, 73% suffered from hearing disorders. There was no relationship between prevalence of hearing loss and sex, presence of other congenital anomalies and degree of cleft, but middle ear diseases were significantly higher in children younger than 2 years. Among patients with cleft lip or palate, 10% suffered from cleft lip, 63% suffered from cleft palate and 27% suffered from cleft lip and palate. There was at least one congenital anomaly in 53% of patients. This study demonstrates high prevalence of otitis media with effusion and conductive hearing loss in patients with cleft. However, audiologic problems are alleviated when patients become older.

The aging of the world’s population represents one of the key challenges over the next decades. Both life expectancy and the proportion of older adults are increasing; therefore, promoting and maintaining the quality of life at an older age is essential, especially in developing countries. It is estimated that one in five of the elderly population will be more than 80 years old in 2050 (1). In Iran, according to the medium-fertility variant in more recent analyses, the rate of people with the age over 60 and 65 is represented to be around 31% and 22%, respectively, in 2050 (2).