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  • 1
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    Neonate, Infant, and Child Mortality in North Africa and Middle East by Cause: An Analysis for the Global Burden of Disease Study 2019
    Maad Rayan Publishing Company ; 2022
    In:  Archives of Iranian Medicine Vol. 25, No. 12 ( 2022-12-01), p. 767-778
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 25, No. 12 ( 2022-12-01), p. 767-778
    Abstract: Background: During the past three decades, neonate, infant, and child mortality declined in North Africa and Middle East. However, there is substantial heterogeneity in mortality rates across countries. Methods: This study is part of the Global Burden of Diseases study (GBD) 2019. We report the number as well as mortality rates for neonates, infants, and children by cause across 21 countries in the region since 1990. Results: Between 1990 and 2019, the neonate mortality rate in the region declined from 31.9 (29.8, 34.0) to 12.2 (11.1, 13.3) per 1000 live births. Respective figures for under 5 mortality rates (U5MRs) were 79.1 (75.7, 82.7) in 1990 and 24.4 (22.3, 26.7) per 1000 live births in 2019. The majority of deaths among children under 5 years were due to under 1 year deaths: 75.9% in 1990 and 81.8% in 2019. Mortality rates in males were higher than females. The mortality rate among neonates ranged from 2.4 (2.1, 2.6) per 1000 live births in Bahrain to 25.0 (21.6, 28.4) in Afghanistan in 2019. Similarly, in 2019, the U5MR ranged from 5.0 (4.2–6.0) per 1000 live births in United Arab Emirates to 55.3 (47.9–63.5) in Afghanistan. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of neonate, infant, and child mortality in almost all countries in the region. Conclusion: In 2019, most countries in this region have achieved the SDG targets for neonate and child mortality. However, there is still substantial heterogeneity across countries.
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2022.122
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2022
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  • 2
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    Burden of Liver Diseases: A Review from Iran
    Maad Rayan Publishing Company ; 2019
    In:  Middle East Journal of Digestive Diseases Vol. 11, No. 4 ( 2019-11-05), p. 189-191
    Details
    In: Middle East Journal of Digestive Diseases, Maad Rayan Publishing Company, Vol. 11, No. 4 ( 2019-11-05), p. 189-191
    Abstract: There has been an increase in the burden of liver diseases in Iran, with an increasing trend from communicable to non-communicable diseases. Almost 5400 deaths were due to chronic liver diseases in 2017. We aim to provide a concise update on the epidemiological trends of liver diseases in Iran. Estimations of deaths, disability-adjusted life years, prevalence of chronic liver diseases and cirrhosis in Iran with its common etiologies have been reported. We investigated the major causes of chronic liver diseases in Iran, we have reported our hepatology research centers, and also we have depicted the future of liver diseases in Iran. In 2017, there was a rising trend in chronic liver diseases in Iran. The most common etiologies for chronic liver disease were chronic hepatitis B, chronic hepatitis C, and non-alcoholic steatohepatitis with highest mortalities due to liver cancer and hepatitis C. The prevalence of HBV infection has decreased from 2.9% to 1.3% with effective vaccination, but new cases are still seen due to perinatal transmission. Treatment of HCV has dramatically changed with new drugs which are being produced by local pharmaceuticals at a low cost. The main obstacle in its elimination is finding patients and linkage to care. More than a third of our population have non-alcoholic fatty liver disease in which central obesity had a stronger association than weight itself. Iran has a high burden of liver diseases. The Ministry of Health has effectively controlled hepatitis B and is working towards the World Health WHO’s goals for hepatitis C by 2030. This being said, non-alcoholic fatty liver disease is becoming a major threat to our nation’s health and quality of life.
    Type of Medium: Online Resource
    ISSN: 2008-5249
    URL: Article
    DOI: 10.15171/mejdd.2019.147
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2019
    detail.hit.zdb_id: 2623796-9
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  • 3
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    Upper Normal Limits of Serum Alanine Aminotransferase in Healthy Population: A Systematic Review
    Maad Rayan Publishing Company ; 2020
    In:  Middle East Journal of Digestive Diseases Vol. 12, No. 3 ( 2020-07-19), p. 194-205
    Details
    In: Middle East Journal of Digestive Diseases, Maad Rayan Publishing Company, Vol. 12, No. 3 ( 2020-07-19), p. 194-205
    Abstract: BACKGROUND Measuring serum alanine aminotransferase (ALT) enzyme is a routine clinical test commonly used to evaluate abnormalities in the body in general, and in the liver function in particular. Higher ALT levels are associated with some metabolic disorders. The upper limit normal (ULN) is considered as a reliable threshold for the definition of high ALT. OBJECTIVES: To assess the existing evidence on the ULN for ALT in the general population. DATA SOURCE: PubMed (Medline), EMBASE, Scopus, and Web of Science (ISI) were searched using a specified search strategy. ELIGIBILITY CRITERIA: We collected documents published from 1980 to 2018 in the English language, focusing on human samples at the population level and extracted the data after qualitative evaluation. METHODS We conducted this study in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. We used specific search terms and their combinations to find documents from relevant databases. We used a snowballing approach to find documents not captured in the main phase of the search. Two authors separately conducted the search, screened the articles, and selected documents that were qualified for data extraction based on the defined inclusion criteria. Finally, data extraction was conducted by two authors using PRISMA checklist. Reported ULNs for ALT and 95% confidence intervals (CIs) were documented in previously developed datasheets. RESULTS Out of 15242 studies, 47 articles were included for data extraction and analysis. Data were sparse and lacked the consistency to precisely estimate ULN for serum ALT. The ULN of ALT was significantly diverse across various geographical locations and sexes. The lowest value of ULN for ALT was 19 IU/L in Chinese children (age range: 7 to 〈 10 years), and the highest value of ULN for ALT was 55 IU/L in children from Ghana aged 〈 5 years. LIMITATIONS: The main limitation of the current systematic review was the scarcity of the reported measures for ULN of ALT. CONCLUSION Based on the results of the current systematic review, it is suggested that the normal range of ALT be redefined, but this redefinition should be done according to the localized data. In order to redefine the ULN for ALT, regional differences, methods used in ALT measurements, and ULN determination should be considered.
    Type of Medium: Online Resource
    ISSN: 2008-5249
    URL: Article
    DOI: 10.34172/mejdd.2020.182
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2020
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  • 4
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    Levels and Trends of Maternal Mortality and Morbidity by Cause in North Africa and Middle East, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019
    Maad Rayan Publishing Company ; 2022
    In:  Archives of Iranian Medicine Vol. 25, No. 10 ( 2022-10-01), p. 666-675
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 25, No. 10 ( 2022-10-01), p. 666-675
    Abstract: Background: 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. Methods: 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. Results: 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. Conclusion: 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.
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2022.105
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2022
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  • 5
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    Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran
    Maad Rayan Publishing Company ; 2020
    In:  International Journal of Health Policy and Management ( 2020-07-15)
    Details
    In: International Journal of Health Policy and Management, Maad Rayan Publishing Company, ( 2020-07-15)
    Abstract: Background : Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region. Methods : We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models’ discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level. Results : After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766- 0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%). Conclusion : Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.
    Type of Medium: Online Resource
    ISSN: 2322-5939
    URL: Article
    DOI: 10.34172/ijhpm.2020.103
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2020
    detail.hit.zdb_id: 2724317-5
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  • 6
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    Levels and Trends of BMI, Obesity, and Overweight at National and Sub-national Levels in Iran from 1990 to 2016; A Comprehensive Pooled Analysis of Half a Million Individuals
    Maad Rayan Publishing Company ; 2021
    In:  Archives of Iranian Medicine Vol. 24, No. 5 ( 2021-05-01), p. 344-353
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 24, No. 5 ( 2021-05-01), p. 344-353
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2021.51
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2021
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  • 7
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    Burden of Transport-Related Injuries in the Eastern Mediterranean Region: A Systematic Analysis for the Global Burden of Disease Study 2017
    Maad Rayan Publishing Company ; 2021
    In:  Archives of Iranian Medicine Vol. 24, No. 7 ( 2021-07-01), p. 512-525
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 24, No. 7 ( 2021-07-01), p. 512-525
    Abstract: Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age. Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs). Results: In 2017, there were 5.5 million (UI 4.9–6.2) transport-related incident cases in the EMR – a substantial increase from 1990 (2.8 million; UI 2.5–3.1). The age-standardized incidence rate for the EMR in 2017 was 787 (UI 705.5–876.2) per 100000, which has not changed significantly since 1990 (-0.9%; UI -4.7 to 3). These rates differed remarkably between countries, such that Oman (1303.9; UI 1167.3–1441.5) and Palestine (486.5; UI 434.5-545.9) had the highest and lowest age-standardized incidence rates per 100000, respectively. In 2017, there were 185.3 thousand (UI 170.8–200.6) transport-related fatalities in the EMR – a substantial increase since 1990 (140.4 thousand; UI 118.7–156.9). The age-standardized death rate for the EMR in 2017 was 29.5 (UI 27.1–31.9) per 100000, which was 30.5% lower than that found in 1990 (42.5; UI 36.8–47.3). In 2017, Somalia (54; UI 30–77.4) and Lebanon (7.1; UI 4.8–8.6) had the highest and lowest age-standardized death rates per 100,000, respectively. The age-standardised DALY rate for the EMR in 2017 was 1,528.8 (UI 1412.5–1651.3) per 100000, which was 34.4% lower than that found in 1990 (2,331.3; UI 1,993.1–2,589.9). In 2017, the highest DALY rate was found in Pakistan (3454121; UI 2297890- 4342908) and the lowest was found in Bahrain (8616; UI 7670-9751). Conclusion: The present study shows that while road traffic has become relatively safer (measured by deaths and DALYs per 100000 population), the number of transport-related fatalities in the EMR is growing and needs to be addressed urgently.
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2021.74
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2021
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  • 8
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    Neonate, Infant, and Child Mortality by Cause in Provinces of Iran: An Analysis for the Global Burden of Disease Study 2019
    Maad Rayan Publishing Company ; 2022
    In:  Archives of Iranian Medicine Vol. 25, No. 8 ( 2022-08-01), p. 484-495
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 25, No. 8 ( 2022-08-01), p. 484-495
    Abstract: Background: Since 1990, neonatal, infant, and child mortality has substantially decreased in Iran. However, estimates for mortality by cause at subnational scale are not available. Methods: This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report the number and rates of neonate, infant, and child deaths by cause across provinces of Iran from 1990 to 2019. Results: Between 1990 and 2019, the neonatal mortality rate per 1000 live births decreased from 31.8 (95% UI: 28.1–35.5) to 6.8 (6.1–7.4). The child mortality rates decreased from 71.2 (63.6–79.1) to 11.1 (10.2–12.0) per 1000 live births. Mortality rates among neonates per 1000 live births ranged from 3.1 (2.6–3.7) to 10.0 (9.2–10.8) across provinces in 2019. Child mortality rate per 1000 live births ranged from 5.5 (4.6–6.5) to 17.9 (16.4–19.4) across provinces in 2019. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of mortality in almost all provinces of Iran. The majority of neonatal disorders were due to neonatal preterm birth and neonatal asphyxia, trauma, and infections. The trends of mortality across provinces from 1990 to 2019 were converging and decreased along with increase in sociodemographic index (SDI). Conclusions: All provinces achieved the Sustainable Development Goal 3.2 of neonatal mortality less than 12 and child mortality less than 25 per 1000 live births. However, disparities still exist across provinces, specifically in low-SDI provinces.
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2022.80
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2022
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  • 9
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    Effectiveness of Polypill for Prevention of Cardiovascular Disease (PolyPars): Protocol of a Randomized Controlled Trial
    Maad Rayan Publishing Company ; 2020
    In:  Archives of Iranian Medicine Vol. 23, No. 8 ( 2020-08-01), p. 548-556
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 23, No. 8 ( 2020-08-01), p. 548-556
    Abstract: Background : Cardiovascular diseases (CVDs) are the leading cause of death in Iran. A fixed-dose combination therapy (polypill) was proposed as a cost-effective strategy for CVD prevention, especially in lower-resource settings. We conducted the PolyPars trial to assess the effectiveness and safety of polypill for prevention of CVD. Methods : The PolyPars trial is a pragmatic cluster randomized controlled trial nested within the Pars Cohort Study. Participants were randomized to an intervention arm and a control arm. Participants in the control arm received minimal non-pharmacological care, while those in the intervention arm received polypill in addition to minimal care. The polypill comprises hydrochlorothiazide 12.5 mg, aspirin 81 mg, atorvastatin 20 mg, and either enalapril 5 mg or valsartan 40 mg. The primary outcome of the study is defined as the first occurrence of acute coronary syndrome (non-fatal myocardial infarction and unstable angina), fatal myocardial infarction, sudden cardiac death, new-onset heart failure, coronary artery revascularization procedures, transient ischemic attack, cerebrovascular accidents (fatal or non-fatal), and hospitalization due to any of the mentioned conditions. The secondary outcomes of the study include adverse events, compliance, non-cardiovascular mortality, changes in blood pressure, fasting blood sugar, and lipids after five years of follow-up. Results : From December 2014 to December 2015, 4415 participants (91 clusters) were recruited. Of those, 2200 were in the polypill arm and 2215 in the minimal care arm. The study is ongoing. This trial was registered with ClinicalTrials.gov number NCT03459560. Conclusion : Polypill may be effective for primary prevention of CVDs in developing countries.
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2020.58
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2020
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  • 10
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    Levels and Trends of Hypertension at National and Subnational Scale in Iran from 1990 to 2016: A Systematic Review and Pooled Analysis
    Maad Rayan Publishing Company ; 2021
    In:  Archives of Iranian Medicine Vol. 24, No. 4 ( 2021-04-01), p. 306-316
    Details
    In: Archives of Iranian Medicine, Maad Rayan Publishing Company, Vol. 24, No. 4 ( 2021-04-01), p. 306-316
    Type of Medium: Online Resource
    ISSN: 1029-2977 , 1735-3947
    URL: Article
    DOI: 10.34172/aim.2021.43
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2021
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