Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available.

This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019.

Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6–171.2) to 94.3 (73.4–121.1) per 100000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3–6.8) in Kuwait to 502.9 (375.2–655.3) per 100000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0–6.4) in Kuwait to 269.9 (195.8–368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations.

MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn’t achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.

Iran was one of the first countries to become an epicenter of the coronavirus disease 2019 (COVID-19) epidemic. However, there is a dearth of data on the outcomes of COVID-19 and predictors of death in intensive care units (ICUs) in Iran. We collected extensive data from patients admitted to the ICUs of the one of the tertiary referral hospitals in Tehran, Iran, to investigate the predictors of ICU mortality.

The study population included 290 COVID-19 patients who were consecutively admitted to the ICUs of the Sina hospital from May 5, 2021, to December 6, 2021, a period that included the peak of the epidemic of the delta (δ) variant. Demographic data, history of prior chronic diseases, laboratory data (including markers of inflammation), radiologic data, and medication data were collected.

Of the 290 patients admitted to the ICUs, 187 (64.5%) died and 103 (35.5%) survived. One hundred forty-one (141, 48.6%) were men, and the median age (10th percentile, 90th percentile) was 60 (41, 80). Using logistic regression models, older age, history of hypertension, high levels of inflammatory markers, low oxygen saturation, substantial lung involvement in computed tomography (CT) scans, and gravity of the disease as indicated by the WHO 8-point ordinal scale were primary predictors of mortality at ICU. The use of remdesivir and imatinib was associated with a statistically non-significant reduction in mortality. The use of tocilizumab had almost no effect on mortality.

The findings are consistent with and add to the currently existing international literature. The findings may be used to predict risk of mortality from COVID-19 and provide some guidance on potential treatments.

The Herat province of Afghanistan is located on the Asian Esophageal Cancer Belt (AECB), a wide area in Central and Eastern Asia where very high rates of esophageal cancer (EC) have been observed. Several risk factors have been reported in the AECB Region by previous studies. Considering lack of information in Afghanistan on this issue, a study was conducted to determine the major risk factors related to EC in order to guide protective measures.

A population-based case-control study was performed from July 2015 to August 2016 among 657 EC patients in the Herat Province and 180 histopathological confirmed cases and 189 controls were interviewed. A structured questionnaire was used and face-to-face interviews were conducted.

Low body mass index (BMI), low socio-economic status, family history of EC, consumption of dark tea, very hot beverage and qulurtoroosh were found to be statistically significant for EC and esophageal squamous cell carcinoma (ESCC) in univariate analyses. According to multivariate analyses, sex (OR=2.268; 95% CI=1.238–4.153), very hot beverages (OR=2.253; 95% CI=1.271– 3.996), qulurtoroosh (OR=5.679; 95% CI=1.787–18.815), dark tea (OR=2.757; 95% CI=1.531–4.967), high previous BMI (OR=0.215; 95% CI=0.117–0.431) and low socio-economic status (OR=1.783; 95% CI=1.007–3.177) were associated with ESCC. Being male was found to increase the risk of ESCC with OR=2.268 (95% CI=1.238–4.153).

Consuming very hot beverages dark tea and a local food, qulurtoroosh, were found as important risk factors for EC. Our findings warrant further studies and necessitate the implementation of protective measures for EC which is one of the leading cancers in the region.

After ruling out the most common causes of severe hemolytic anemia by routine diagnostic tests, certain patients remain without a diagnosis. The aim of this study was to elucidate the genetic cause of the disease in these patients using next generation sequencing (NGS).

Four unrelated Iranian families including six blood transfusion dependent cases and their parents were referred to us from a specialist center in Tehran. There was no previous history of anemia in the families and the parents had no abnormal hematological presentations. All probands presented severe congenital hemolytic anemia, neonatal jaundice and splenomegaly. Common causes of hemolytic anemia were ruled out prior to this investigation in these patients and they had no diagnosis. Whole exome sequencing (WES) was performed in the probands and the results were confirmed by Sanger sequencing and subsequent family studies.

We identified five variants in the PKLR gene, including a novel unpublished frameshift in these families. These variants were predicted as pathogenic according to the ACMG guidelines by Intervar and/or Varsome prediction tools. Subsequent family studies by Sanger sequencing supported the diagnosis of pyruvate kinase deficiency (PKD) in six affected individuals and the carrier status of disease in their parents.

These findings show that PKD is among the rare blood disorders that could remain undiagnosed or even ruled out in Iranian population without performing NGS. This could be due to pitfalls in clinical, hematological or biochemical approaches in diagnosing PKD. Furthermore, genotyping PKD patients in Iran could reveal novel mutations in the PKLR gene.

Iran, like many other countries, has committed to providing universal and equal access to health care and rehabilitation for people with disabilities by joining the Convention on the Rights of People with Disabilities. Thus, this study aimed to examine the availability of rehabilitation facilities on national and sub-national levels.

This cross-sectional study was conducted between May and December 2019. The data of rehabilitation facilities including infrastructure and rehabilitation workforce in health system settings were obtained using rehabilitation master list. The data were collected from the Vice-Chancellor for the Treatment Ministry of Health and Medical Education, the Rehabilitation of the State Welfare Organization, and Licensing and Planning the Medical Council in the 32 provinces of Iran and analyzed using Excel version 2016.

On the national level, the following situation was found: in inpatient settings: 1.1 beds per million population; in outpatient settings: physiotherapy 42.6, optometry 16.4, audiology 10.5,occupational therapy 8.2, speech therapy 8.1, orthotic & prosthetic 4.5, physical medicine & rehabilitation 3.8 centers; day-care centers 11.7 and rehabilitation centers 1.3 centers, community-based rehabilitation (CBR): 15.9 units, rehabilitation home care 2 centers, rehabilitation nursing home care 1.6 centers and medical rehabilitation home care 0.3; Long-term care centers: residential care 4.1 centers per million population. Regarding rehabilitation work force: physiotherapists 84, speech therapists 34.8, occupational therapists 32.5, optometrists 31.2, audiologists 27.9, prosthetists and orthotists 10.3 therapists and physical medicine & rehabilitation 5.1 specialists per million populations. On the sub-national level, there were no outpatient rehabilitation centers in 12 of the provinces and the distribution of day rehabilitation centers in the rich provinces was 10 times higher. The number of CBR units, rehabilitation home care and rehabilitation nursing home were 40, 22, and 23 times higher in rich provinces than in poor provinces, respectively and there were no medical rehabilitation home care centers in 21 provinces. Regarding long-term care, the residential care centers in the richest province were 8 times higher.

According to the WHO report and the rehabilitation expert panel, it was concluded that the number of rehabilitation facilities including rehabilitation centers and workforce was limited in Iran and that the available centers were also poorly distributed in the provinces of the country. This made it difficult for people to have fair access to rehabilitation services. It appears that health policymakers should pay special attention to further developing rehabilitation facilities.

Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality.

This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients.

Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.

Persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein (LSPV) is a rare systemic venous drainage anomaly. It can cause cyanosis and unexplained recurrent strokes. Undiagnosed, it can seriously disrupt the conduct of the cardiopulmonary bypass (CPB), causing sudden air lock and/or flooding of the operative field with venous blood. Its connection with the LSPV outside the pericardium makes its intraoperative diagnosis difficult. We report here the case of a 48-year-old man operated for mitral and aortic valve endocarditis, complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by the entrance of high volume of air bubbles into the superior vena cava cannula which resulted in sudden air lock of the venous outflow line. After multiple lowerings and cessations of pump flow, partial clamping of this cannula resulted in flooding of the LA with venous blood coming from the LSPV. The heart luxation did not allow us to find the LSVC in its usual intrapericardial location, between the LSPV and the left appendage. We had to widely open the left pleura to expose its completely extrapericardial path and its communication with the LSPV. The LSVC was temporally clamped during the remainder of the surgical procedure, then ligated at both ends. The patient underwent mitral valve repair, closure of the infundibular septal defect, aortic valve replacement and tricuspid annuloplasty. He was discharged 10 days later.