The relationship between compartment models and their stochastic counterparts:A comparative study with examples of the COVID-19 epidemic modeling

Deterministic compartment models(CMs)and stochastic models,including stochastic CMs and agent-based models,are widely utilized in epidemic modeling.However,the relationship between CMs and their corresponding stochastic models is not well understood.The present study aimed to address this gap by conducting a comparative study using the susceptible,exposed,infectious,and recovered(SEIR)model and its extended CMs from the coronavirus disease 2019 modeling literature.We demonstrated the equivalence of the numerical solution of CMs using the Euler scheme and their stochastic counterparts through theoretical analysis and simulations.Based on this equivalence,we proposed an efficient model calibration method that could replicate the exact solution of CMs in the corresponding stochastic models through parameter adjustment.The advancement in calibration techniques enhanced the accuracy of stochastic modeling in capturing the dynamics of epidemics.However,it should be noted that discrete-time stochastic models cannot perfectly reproduce the exact solution of continuous-time CMs.Additionally,we proposed a new stochastic compartment and agent mixed model as an alternative to agent-based models for large-scale population simulations with a limited number of agents.This model offered a balance between computational efficiency and accuracy.The results of this research contributed to the comparison and unification of deterministic CMs and stochastic models in epidemic modeling.Furthermore,the results had implications for the development of hybrid models that integrated the strengths of both frameworks.Overall,the present study has provided valuable epidemic modeling techniques and their practical applications for understanding and controlling the spread of infectious diseases.

Spatial analysis of animal bites in Iran(2015-2020):A cross-sectional study

Objective:To investigate the distribution pattern of animal bites in Mirjaveh,Iran from 2015 to 2020.Methods:The data on animal bites were collected from the Department of Infectious Diseases,the provincial health center.Monthly climatic data on precipitation and temperature during the study period were also collected.The correlation between incidence and temperature,precipitation rate,land type,and altitude was also analyzed.Results:The results showed that men were more affected by animal bites than women(76.4%,P<0.001),and the highest incidence rate occurred in the age group of 5-19 years.The incidence rate of animal bites was found to be correlated with temperature and altitude.An increase in temperature was associated with a rise in the incidence rate of animal bites.The number of animal bites increased until 2019,possibly due to an increase in the number of dogs in the area.Conclusions:Targeted interventions should be implemented to reduce the incidence of animal bites,particularly among children,housewives,and students.Improving access to appropriate treatments,increasing public awareness of the hazards of animal bites,and increasing the number of vaccinated dogs in the area are essential strategies to be considered.

Causal genetic regulation of DNA replication on immune microenvironment in colorectal tumorigenesis: Evidenced by an integrated approach of trans-omics and GWAS

The interplay between DNA replication stress and immune microenvironment alterations is known to play a crucial role in colorectal tumorigenesis,but a comprehensive understanding of their association with and relevant biomarkers involved in colorectal tumorigenesis is lacking.To address this gap,we conducted a study aiming to investigate this association and identify relevant biomarkers.We analyzed transcriptomic and proteomic profiles of 904 colorectal tumor tissues and 342 normal tissues to examine pathway enrichment,biological activity,and the immune microenvironment.Additionally,we evaluated genetic effects of single variants and genes on colorectal cancer susceptibility using data from genome-wide association studies(GWASs)involving both East Asian(7062 cases and 195745 controls)and European(24476 cases and 23073 controls)populations.We employed mediation analysis to infer the causal pathway,and applied multiplex immunofluorescence to visualize colocalized biomarkers in colorectal tumors and immune cells.Our findings revealed that both DNA replication activity and the flap structure-specific endonuclease 1(FEN1)gene were significantly enriched in colorectal tumor tissues,compared with normal tissues.Moreover,a genetic variant rs4246215 G>T in FEN1 was associated with a decreased risk of colorectal cancer(odds ratio=0.94,95%confidence interval:0.90–0.97,P_(meta)=4.70×10^(-9)).Importantly,we identified basophils and eosinophils that both exhibited a significantly decreased infiltration in colorectal tumors,and were regulated by rs4246215 through causal pathways involving both FEN1 and DNA replication.In conclusion,this trans-omics incorporating GWAS data provides insights into a plausible pathway connecting DNA replication and immunity,expanding biological knowledge of colorectal tumorigenesis and therapeutic targets.

Survival and risk analysis of patients with COVID-19 in Iran

Objective:To evaluate the risk factors of death caused by COVID-19 in Iran.Methods:This study was a retrospective cohort study from February 20,2020,to August 22,2022,in the hospitals in Isfahan,Iran.The data were collected through a researcher-made checklist.To determine the risk factors of the death,logistic regression and Cox regression models were used.For each variable,the odds ratio and 95%confidence interval were also reported.Results:1885 Patients were included.The age of deceased persons was significantly higher than that of the surviving persons.The risk of death for the age group above 60 years was about 14 times higher than that of people aged 19-35 years[95%CI:14.41(2.02-102.99),P<0.01].Hypertension[95%CI:1.92(1.47-2.5),P<0.01],diabetes[95%CI:1.62(1.23-2.13),P<0.001],and chronic obstructive pulmonary disease[95%CI:1.92(1.47-2.50),P<0.01]were also risk factors of mortality.Conclusions:This study reveals that the mortality rate due to COVID-19 is associated with old age,longer hospitalization in the ICU,increased length of stay,and comorbidities of high blood pressure,diabetes,and chronic pulmonary disease.

Lean body mass index is a marker of advanced tumor features in patients with hepatocellular carcinoma

BACKGROUND Obesity is an independent risk factor for the development of hepatocellular carcinoma(HCC)and may influence its outcomes.However,after diagnosis of HCC,like other malignancies,the obesity paradox may exist where higher body mass index(BMI)may in fact confer a survival benefit.This is frequently observed in patients with advanced HCC and cirrhosis,who often present late with advanced tumor features and cancer related weight loss.AIM To explore the relationship between BMI and survival in patients with cirrhosis and HCC.METHODS This is a retrospective cohort study of over 2500 patients diagnosed with HCC between 2009-2019 at two United States academic medical centers.Patient and tumor characteristics were extracted manually from medical records of each institutions'cancer registries.Patients were stratified according to BMI classes:<25 kg/m^(2)(lean),25-29.9 kg/m^(2)(overweight),and>30 kg/m^(2)(obese).Patient and tumor characteristics were compared according to BMI classification.We performed an overall survival analysis using Kaplan Meier by the three BMI classes and after adjusting for Milan criteria.A multivariable Cox regression model was then used to assess known risk factors for survival in patients with cirrhosis and HCC.RESULTS A total of 2548 patients with HCC were included in the analysis of which 11.2%(n=286)were classified as noncirrhotic.The three main BMI categories:Lean(n=754),overweight(n=861),and obese(n=933)represented 29.6%,33.8%,and 36.6%of the total population overall.Within each BMI class,the non-cirrhotic patients accounted for 15%(n=100),12%(n=94),and 11%(n=92),respectively.Underweight patients with a BMI<18.5 kg/m^(2)(n=52)were included in the lean cohort.Of the obese cohort,42%(n=396)had a BMI≥35 kg/m^(2).Out of 2262 patients with cirrhosis and HCC,654(29%)were lean,767(34%)were overweight,and 841(37%)were obese.The three BMI classes did not differ by age,MELD,or Child-Pugh class.Chronic hepatitis C was the dominant etiology in lean compared to the overweight and obese patients(71%,62%,49%,P<0.001).Lean patients had significantly larger tumors compared to the other two BMI classes(5.1 vs 4.2 vs 4.2 cm,P<0.001),were more likely outside Milan(56%vs 48%vs 47%,P<0.001),and less likely to undergo transplantation(9%vs 18%vs 18%,P<0.001).While both tumor size(P<0.0001)and elevated alpha fetoprotein(P<0.0001)were associated with worse survival by regression analysis,lean BMI was not(P=0.36).CONCLUSION Lean patients with cirrhosis and HCC present with larger tumors and are more often outside Milan criteria,reflecting cancer related cachexia from delayed diagnosis.Access to care for hepatitis C virus therapy and liver transplantation confer a survival benefit,but not overweight or obese BMI classifications.

Impact of Social Determinants of Health on Self-Perceived Resilience: An Exploratory Study of Two Cohorts of Adults with Congenital Heart Disease

Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.

Prediction of treatment response to antipsychotic drugs for precision medicine approach to schizophrenia:randomized trials and multiomics analysis

Background:Choosing the appropriate antipsychotic drug(APD)treatment for patients with schizophrenia(SCZ)can be challenging,as the treatment response to APD is highly variable and difficult to predict due to the lack of effective biomarkers.Previous studies have indicated the association between treatment response and genetic and epigenetic factors,but no effective biomarkers have been identified.Hence,further research is imperative to enhance precision medicine in SCZ treatment.Methods:Participants with SCZ were recruited from two randomized trials.The discovery cohort was recruited from the CAPOC trial(n=2307)involved 6 weeks of treatment and equally randomized the participants to the Olanzapine,Risperidone,Quetiapine,Aripiprazole,Ziprasidone,and Haloperidol/Perphenazine(subsequently equally assigned to one or the other)groups.The external validation cohort was recruited from the CAPEC trial(n=1379),which involved 8 weeks of treatment and equally randomized the participants to the Olanzapine,Risperidone,and Aripiprazole groups.Additionally,healthy controls(n=275)from the local community were utilized as a genetic/epigenetic reference.The genetic and epigenetic(DNA methylation)risks of SCZ were assessed using the polygenic risk score(PRS)and polymethylation score,respectively.The study also examined the genetic-epigenetic interactions with treatment response through differential methylation analysis,methylation quantitative trait loci,colocalization,and promoteranchored chromatin interaction.Machine learning was used to develop a prediction model for treatment response,which was evaluated for accuracy and clinical benefit using the area under curve(AUC)for classification,R^(2) for regression,and decision curve analysis.Results:Six risk genes for SCZ(LINC01795,DDHD2,SBNO1,KCNG2,SEMA7A,and RUFY1)involved in cortical morphology were identified as having a genetic-epigenetic interaction associated with treatment response.The developed and externally validated prediction model,which incorporated clinical information,PRS,genetic risk score(GRS),and proxy methylation level(proxyDNAm),demonstrated positive benefits for a wide range of patients receiving different APDs,regardless of sex[discovery cohort:AUC=0.874(95%CI 0.867-0.881),R^(2)=0.478;external validation cohort:AUC=0.851(95%CI 0.841-0.861),R^(2)=0.507].Conclusions:This study presents a promising precision medicine approach to evaluate treatment response,which has the potential to aid clinicians in making informed decisions about APD treatment for patients with SCZ.Trial registration Chinese Clinical Trial Registry(https://www.chictr.org.cn/),18 Aug 2009 retrospectively registered:CAPOC-ChiCTR-RNC-09000521(https://www.chictr.org.cn/showproj.aspx?proj=9014),CAPEC-ChiCTRRNC-09000522(https://www.chictr.org.cn/showproj.aspx?proj=9013).

Association of Human Whole-blood NAD+Levels with Nabothian Cyst

Objective Little is known about the association between whole-blood nicotinamide adenine dinucleotide(NAD^(+))levels and nabothian cysts.This study aimed to assess the association between NAD^(+)levels and nabothian cysts in healthy Chinese women.Methods Multivariate logistic regression analysis was performed to analyze the association between NAD^(+)levels and nabothian cysts.Results The mean age was 43.0±11.5 years,and the mean level of NAD^(+)was 31.3±5.3μmol/L.Nabothian cysts occurred in 184(27.7%)participants,with single and multiple cysts in 100(15.0%)and84(12.6%)participants,respectively.The total nabothian cyst prevalence gradually decreased from37.4%to 21.6%from Q1 to Q4 of NAD^(+)and the prevalence of single and multiple nabothian cysts also decreased across the NAD^(+)quartiles.As compared with the highest NAD^(+)quartile(≥34.4μmol/L),the adjusted odds ratios with 95%confidence interval of the NAD^(+)Q1 was 1.89(1.14–3.14)for total nabothian cysts.The risk of total and single nabothian cysts linearly decreased with increasing NAD^(+)levels,while the risk of multiple nabothian cysts decreased more rapidly at NAD^(+)levels of 28.0 to35.0μmol/L.Conclusion:Low NAD^(+)levels were associated with an increased risk of total and multiple nabothian cysts.

The Impact of Black Sea Sand Treatment Effectively Reducing Different Type of Pain

Purpose: Low back pain (LBP), Gonarthrosis, knee, and Carpal Tunnel Syndrome have been regarded as affecting more than three-quarters’ of individuals in their lifetime. The aim of this study was conducted to determine and compare the effects of topical patients with sand compared with control related to Gonarthrosis, LBP, knee, and Carpal Tunnel Syndrome pain. Methods: This is a prospective case and control designed study based on 101 pain case with Sand and 101 control subjects. The interventional groups in addition either topical sand or without sand 2 months after the intervention were assessed. We assessed tolerability of an established pain perception scale by the Numeric Rating Scale (NRS). Categorical variables were compared using the chi-square (χ2) test. The paired t-test was used to compare the two groups before and after the intervention. One-way analysis of variance (ANOVA) was employed for comparison of several group means. Results: The study was based on 202 patients, 41 males (20.3%) and 161 females (79.7%). There were statistically significant differences between subjects with and without Sand in term of Gonarthrosis, Rheumatoid Arthritis LBP, knee, and Carpal Tunnel Syndrome pain (p = 0.033). Majority of patients were over age 55 years old (55%) and females 78 (77.2%). The mean score of total pain experience before and after the intervention was 7.41 ± 1.1 for black sand, and 4.24 ± 2.38 for without sand as control group. The mean scores of these 5 groups were highly significant before and after the intervention (p There was statistically highly significant in regarding subjects with Sand as compared with those before Sand after treatment mean score specifically with gonarthrosis before pain 7.23 ± 1.86 vs after treatment 4.54 ± 2.18 p < 0.001;rheumatoid arthritis before 8.28 ± 1.48 vs after treatment 4.80 ± 3.71 p < 0.001;Low Back Pain before 8.42 ± 1.83 vs after treatment 4.37 ± 1.52 p < 0.001;knee pain before 8.93 ± 0.89 vs after treatment 4.24 ± 0.24 p < 0.001;Carpal Tunnel Syndrome before 7.664 ± 1.04 vs after treatment 4.26 ± 1.03 p Conclusion: The current study has revealed that the topical treatments with sand could have a significant effect on the perception of pain compared to those in the control group with respect of gonarthrosis, rheumatoid arthritis, LBP, knee, and Carpal Tunnel Syndrome pain .

Is routine pregnancy test necessary in women of reproductive age admitted to the emergency department?

BACKGROUND:This study aimed to determine the necessity of pregnancy test in women of reproductive age admitted to emergency department(ED) in routine practice.METHODS:We retrospectively reviewed the records of patients who presented to the ED between January 1,2006 and December 31,2010 and received a pregnancy test.RESULTS:The median age of 1 586 patients enrolled into the study was 27 years.Of these patients,19.55%had a positive result of pregnancy test.The most common complaint at admission was abdominal pain in 60.15%of the patients,and pregnancy test was prescribed.15.83%of the patients with abdominal pain had a positive result of pregnancy test.Of the patients,30.64%had nausea-vomiting at admission,and 11.52%had a positive result of pregnancy test.When other complaints were considered,the most commonly observed complaints were non-specific symptoms such as dizziness,malaise and respiratory problems.Of the patients,70.93%were not remembering the date of last menstruation,and 9.51%showed a positive result of pregnancy test.Urinary tract infection(UTI) was commonly diagnosed with an incidence of 17.65%,which was followed by nonspecific abdominal pain(NSAP)(16.77%) and gastrointestinal disorders such as gastritis and peptic ulcer(6.87%).Of the patients,88.40%were discharged from ED,and 11.60%were hospitalized.CONCLUSION:Pregnancy test should be given to women of reproductive age as a routine practice in ED in developing countries like Turkey.

Global Burden of Cardiovascular Disease Attributable to High Temperature in 204 Countries and Territories from 1990 to 2019

Objective This study aimed to estimate spatiotemporal variations of global heat-related cardiovascular disease(CVD)burden from 1990 to 2019.Methods Data on the burden of heat-related CVD were derived from the Global Burden of Disease Study 2019.Deaths and disability-adjusted life years(DALYs)were used to quantify heat-induced CVD burden.We calculated the age-standardized mortality rate(ASMR)and DALY rate(ASDR)per 100,000population to compare this burden across regions.Generalized linear models were applied to evaluate estimated annual percentage changes(EAPC)for temporal trends from 1990 to 2019.The correlation between the socio-demographic index(SDI)and age-standardized rate was measured using the Spearman rank test.Results Heat-induced CVD caused approximately 90 thousand deaths worldwide in 2019.Global ASMR and ASDR of heat-related CVD in 2019 were 1.17[95%confidence interval(CI):0.13-1.98]and 25.59(95%CI:2.07-44.17)per 100,000 population,respectively.The burden was significantly increased in middle and low-SDI regions and slightly decreased in high-SDI regions from 1990 to 2019.ASMR showed an upward trend,with the most considerable increase in low-latitude countries.We observed a negative correlation between SDI and EAPC in ASMR(rs=-0.57,P<0.01)and ASDR(rs=-0.59,P<0.01)among204 countries.Conclusion Heat-attributable CVD burden substantially increased in most developing countries and tropical regions.

Effect of changing mesopic and photopic light conditions on visual functions

AIM:To determine the effects of change in light conditions on refractive error and visual functions including visual acuity,stereopsis and contrast sensitivity.METHODS:This cross-sectional study was conducted in the optometry clinic of the Shahid Beheshti School of Rehabilitation on 48 students in 2021-2022.All of them had eye health and normal visual function and could have refractive errors or not.Light intensity of 4 lx was considered equivalent to photopic light condition and light intensity of 1 lx was considered to be equivalent to mesopic light condition.The amount of refractive error was checked by auto refractometer and its changes in mesopic light condition were subjectively measured.Also,visual acuity,stereopsis and contrast sensitivity(in five spatial frequencies of 1.5,3,6,12,and 18 cycles per degree),were measured first in photopic light condition and then in mesopic light condition,by Snellen control vision chart,stereo butterfly test and the M&S technology monitor test respectively.RESULTS:In the 48 student subjects with an average age of 22.69±3.56y,mean of refractive error as sphere equivalent,visual acuity and stereopsis were-1.25±1.74 diopters,0 logMAR,44.37±13.03 seconds of arc,respectively in photopic light condition while in mesopic light was equal to-1.56±1.75 diopters,0.12±0.09 logMAR and 50.62±33.35 seconds of arc,respectively.The mean of contrast sensitivity measured at spatial frequencies of 1.5,3,6,12,and 18 cycles per degree in photopic condition was equal to 2.38±0.04,2.37±0.07,2.04±0.21,1.27±0.32,0.82±0.27 logarithm of contrast sensitivity,respectively and in mesopic lighting condition was equal to 2.34±0.12,2.30±0.16,1.84±0.28,1.02±0.28,0.63±0.24 logarithm of contrast sensitivity,respectively.Statistical analysis showed a significant difference between the two lighting conditions in all evaluated variables[refractive error(P<0.001),visual acuity(P<0.001),stereopsis(P=0.008)and contrast sensitivity(P<0.001)].CONCLUSION:The refractive error of the student subjects in mesopic light condition change towards myopia,and its amount is clinically significant.Also,the examination and comparison of the factors of visual acuity,stereopsis and contrast sensitivity in these two lighting conditions show that the decrease in brightness level to the mesopic level causes a decrease in the aforementioned visual functions.

Time series modeling of animal bites

Objective:To explore the modeling of time series of animal bite occurrence in northwest Iran.Methods:In this study,we analyzed surveillance time series data for animal bite cases in the northwest Iran province of Iran from 2011 to 2017.We used decomposition methods to explore seasonality and long-term trends and applied the Autoregressive Integrated Moving Average(ARIMA)model to fit a univariate time series of animal bite incidence.The ARIMA modeling process involved selecting the time series,transforming the series,selecting the appropriate model,estimating parameters,and forecasting.Results:Our results using the Box Jenkins model showed a significant seasonal trend and an overall increase in animal bite incidents during the study period.The best-fitting model for the available data was a seasonal ARIMA model with drift in the form of ARIMA(2,0,0)(1,1,1).This model can be used to forecast the frequency of animal attacks in northwest Iran over the next two years,suggesting that the incidence of animal attacks in the region would continue to increase during this time frame(2018-2019).Conclusion:Our findings suggest that time series analysis is a useful method for investigating animal bite cases and predicting future occurrences.The existence of a seasonal trend in animal bites can also aid in planning healthcare services during different seasons of the year.Therefore,our study highlights the importance of implementing proactive measures to address the growing issue of animal bites in Iran.

Physical Activity,Sedentary Behavior,and the Risk of Cardiovascular Disease in Type 2 Diabetes Mellitus Patients:The MIDiab Study

The aim of this study was to explore the associations of moderate-to-vigorous-intensity physical activity(MVPA)time and sedentary(SED)time with a history of cardiovascular disease(CVD)and multifactorial(i.e.,blood pressure(BP),body mass index(BMI),low-density lipoprotein cholesterol(LDL-C),and glycated hemoglobin A1c(HbA1c))control status among type 2 diabetes mellitus(T2DM)patients in China.A cross-sectional analysis of 9152 people with type 2 diabetes from the Multifactorial Intervention on Type 2 Diabetes(MIDiab)study was performed.Patients were grouped according to their self-reported MVPA time(low,<150 min·week−1;moderate,150 to<450 min·week−1;high,≥450 min·week−1)and SED time(low,<4 h·d–1;moderate,4 to<8 h·d–1;high,≥8 h·d–1).Participants who self-reported a history of CVD were identified as having a CVD risk.Odds ratios(ORs)and 95%confidence intervals(CIs)of CVD risk and multifactorial control status associated with MVPA time and SED time were estimated using mixed-effect logistic regression models,adjusting for China’s geographical region characteristics.The participants had a mean±standard deviation(SD)age of(60.87±8.44)years,44.5%were women,and 25.1%had CVD.After adjustment for potential confounding factors,an inverse association between high MVPA time and CVD risk that was independent of SED time was found,whereas this association was not observed in the moderate-MVPA group.A higher MVPA time was more likely to have a positive effect on the control of BMI.Compared with the reference group(i.e.,those with MVPA time≥450 min·week−1 and SED time<4 h·d–1),CVD risk was higher in the low-MVPA group:The OR associated with an SED time<4 h·d–1 was 1.270(95%CI,1.040–1.553)and that associated with an SED time≥8 h·d–1 was 1.499(95%CI,1.149–1.955).We found that a high MVPA time(i.e.,≥450 min·week−1)was associated with lower odds of CVD risk regardless of SED time among patients with T2DM.

Excess mortality in Northeast Iran caused by COVID-19:Neglect of offset community transformations of health

Objective:To make evidence-based decisions based on broad mortality trends for Razavi Khorasan province,Iran.Methods:In order to determine the baseline number of deaths,we used univariate time series analyses for monthly data from the monthly vital statistics reports(From April 2015 to March 2022).For excess mortalities,these baselines were subtracted from reported deaths with a 95%prediction interval.To compare time and causes,a P-score was calculated.Results:From March 2020 to March 2022,there were 61949 registered deaths,and the estimated deaths with a 95%confidence interval(CI)were 43246.16(35718.28,50774.05).So,in 2020-2021 and 2021-2022,the death counts were 35.15%and 51.33%higher than projected.A total of 18666 cardiovascular diseases were reported and a total of 15704.46(12006.95,19401.96)was estimated.The P-score for this duration was 14.49%and 23.23%higher than expected.Infectious and parasitic diseases plus COVID-19 were 16633 and estimated to be 1044.87(456.77,1632.96).A total of 4420 diseases of the respiratory system were reported,and 4564.94 deaths were predicted(2277.43,6852.43).In the first year of the pandemic,the P-score dropped to-35.28%and in the second year,it jumped sharply to 22.38%.Conclusions:Excess mortality,along with cause-specific mortality,can be helpful for monitoring trends and developing public health policies at the local,national,and international levels.

Peripapillary and macular vascular densities in healthy,ocular hypertensive,and different stages of glaucomatous eyes

AIM:To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography(OCTA)in the early diagnosis of glaucoma.METHODS:Glaucoma patients and healthy controls(n=29 eyes)were investigated in this cross-sectional comparative study.Glaucoma patients were grouped as ocular hypertension(n=44 eyes),preperimetric glaucoma(PPG;n=32 eyes),early glaucoma(EG;n=35 eyes),moderate stage glaucoma(MG;n=36 eyes),and advanced glaucoma(AG;n=35 eyes).Peripapillary and macular vascular densities(VDs)of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness(RNFLT),ganglion cell analysis(GCA),and visual field(VF)tests were evaluated.Area under the receiver operation characteristic curves(AUC)of the peripapillary and macular VD parameters were obtained.RESULTS:VD values decreased with the progression of glaucoma.Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls(P<0.001).There was no significant difference in RNFLT between the PPG and EG groups,but most peripapillary and macular VDs were found to be lower in EG group than in PPG group(P<0.05).In most disease group,VDs were significantly correlated with OCT parameters(P<0.001)and VF index(P<0.05).There were no significant correlations between VF and RNFLT indices in the AG group,but significant correlations were found between VF and VD values(P<0.05).AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD(AUC:0.865,0.929,and 0.986,respectively in EG,MG,and AG groups).CONCLUSION:OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease.In cases where limitations or suspicions in structural and functional tests are present,OCTA can be used as a supportive diagnostic test,both in EG and AG.

Narrative minireview of the spatial epidemiology of substance use disorder in the United States:Who is at risk and where?

Drug overdose is the leading cause of death by injury in the United States.The incidence of substance use disorder(SUD)in the United States has increased steadily over the past two decades,becoming a major public health problem for the country.The drivers of the SUD epidemic in the United States have changed over time,characterized by an initial heroin outbreak between 1970 and 1999,followed by a painkiller outbreak,and finally by an ongoing synthetic opioid outbreak.The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic.Moreover,the geospatial distribution of the SUD epidemic is not homogeneous.The United States has specific locations where vulnerable communities at high risk of SUD are concentrated,reaffirming the multifactorial socioeconomic nature of this epidemic.A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies.This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods,revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks.By analyzing the epidemic of SUD-related deaths,we also describe the epidemic behavior in areas with high incidence of cases.Finally,we describe public health interventions that can be effective for demographic groups,and we discuss future challenges in the study and control of the SUD epidemic in the country.

Prevalence and risk factors of infertility in a Mongolian population

Objective:To investigate and analyze the prevalence and risk factors of infertility in a Mongolian population.Methods:We conducted a population-based cross-sectional study between September 2016 and November 2021.Our study population of 1919 participants consisted of residents of Ulaanbaatar city and four regions of Mongolia.A pretested standardized and structured questionnaire was used to gather data from the participants.Our questionnaire comprised categories influencing infertility,such as socioeconomic status,lifestyle factors,health,reproductive history,present status,and sexual function.In addition,trained staff conducted face-to-face interviews with the participants.Results:Our study showed an infertility incidence of 8.2%,with primary infertility at 2.76%and secondary infertility at 5.47%.Compared with the urban area of Ulaanbaatar,the prevalence of infertility was significantly higher amongst the rural population(P<0.001).Risk factors of infertility included advanced age(35-39 years,OR 1.8,95%CI 1.99-6.55;>40 years,OR 2.1,95%CI 2.62-8.55),living rural region(aOR 2.4,95%CI 1.62-3.69),alcohol consumption(aOR 1.6,95%CI 1.11-2.44),chronic diseases(aOR 1.6,95%CI 1.20-2.38),reproductive disease(aOR 2.6,95%CI 1.86-3.88),gynecological operative history(aOR 2.1,95%CI 1.38-3.21),ovarian cyst(aOR 4.2,95%CI 2.70-6.40),gonorrhea(aOR 2.4,95%CI 1.01-6.16),non-malignant uterine cancer(aOR 2.9,95%CI 1.40-6.70),and endometriosis(aOR 4.7,95%CI 1.41-15.62).Conclusions:In Mongolia,the average infertility rate is 8.2%,similar to the average worldwide and is significantly higher in rural communities.Our study shows the most significant risk factors for infertility are age,alcohol consumption,and rural living.In addition,an unfavorable gynecological history and some diseases also pose a risk to fertility.

Association of point in range withβ-cell function and insulin sensitivity of type 2 diabetes mellitus in cold areas

Background and Objective:Self-monitoring of blood glucose(SMBG)is crucial for achieving a glycemic target and upholding blood glucose stability,both of which are the primary purpose of anti-diabetic treatments.However,the association between time in range(TIR),as assessed by SMBG,andβ-cell insulin secretion as well as insulin sensitivity remains unexplored.Therefore,this study aims to investigate the connections between TIR,derived from SMBG,and indices representingβ-cell functionality and insulin sensitivity.The primary objective of this study was to elucidate the relationship between short-term glycemic control(measured as points in range[PIR])and bothβ-cell function and insulin sensitivity.Methods:This cross-sectional study enrolled 472 hospitalized patients with type 2 diabetes mellitus(T2DM).To assessβ-cell secretion capacity,we employed the insulin secretion-sensitivity index-2(ISSI-2)and(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,while insulin sensitivity was evaluated using the Matsuda index and HOMA-IR.Since SMBG offers glucose data at specific point-in-time,we substituted TIR with PIR.According to clinical guidelines,values falling within the range of 3.9-10 mmol were considered"in range,"and the corresponding percentage was calculated as PIR.Results:We observed significant associations between higher PIR quartiles and increased ISSI-2,(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,Matsuda index(increased)and HOMA-IR(decreased)(all P<0.001).PIR exhibited positive correlations with log ISSI-2(r=0.361,P<0.001),log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index(r=0.482,P<0.001),and log Matsuda index(r=0.178,P<0.001)and negative correlations with log HOMA-IR(r=-0.288,P<0.001).Furthermore,PIR emerged as an independent risk factor for log ISSI-2,log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,log Matsuda index,and log HOMA-IR.Conclusion:PIR can serve as a valuable tool for assessingβ-cell function and insulin sensitivity.