Spatio-Temporal Variability of Malaria Infection in Chahbahar County, Iran: Association with the ENSO and Rainfall Variability

Malaria is one of the most widespread communicable diseases in the southeast of Iran particularly in Chahbahar County. Comprehensive understanding of the influence of climate on this disease is a key element for success in the environmental-based malaria elimination programs. After analyzing the spatio-temporal distribution of the disease, the relationships between the infection statistics and some important climate indices particularly the El Niño-Southern Oscillation (ENSO) and rainfall were investigated.The malaria statistics collected from various health centers were composited with the corresponding data of Southern Oscillation Index (SOI), ground-based meteorological records and satellite-based rainfall data. Non-parametric Mann-whitely test was applied to detect the significant difference between patient number between El Niño and La Niña and between the adopted wet and dry episodes. Patient number from highest to lowest was associated to summer, autumn, spring and winter, respectively. Plasmodium falciparum, Plasmodium vivax and other species were responsible for 22%, 75% and 3% of the sickness, respectively. While the outbreak of P. falciparum is in autumn; P. vivax is erupted in summer. When the epidemic statistics were collected from rural rather than urban areas, the effect of climate on the infection statistic was more obvious. Interpretation: For rural / urban areas, the infection statistics exhibited a significant decline / increase during El Niño episodes. In autumn, spring and winter, patient number has significantly increased / decreased during the dry / wet epochs, respectively. These relationships were, however, reversed during summertime of health indicators are rarely available for every population and period of interest, and available data.

SUMMARY: SOME FACTORS RELATED TO COMPLIANCE IN TREATMENT BASEDOW ON OUTPATIENTS

Objective: Analyzing factors related to the compliance with Basedow disease treatment on outpatients at Can Tho City General Hospital. Objects and methods: The perspective research on 60 outpatients who come for re-examination at Can Tho City General Hospital from July, 1st, 2020 – September, 30th, 2020. Results: There was a statistically significant correlation between the patient’s duration of Basedow disease, the number of drugs prescribed in the prescription, the number of medications per day, drug beliefs and the level of compliance of treatment (p<0.05). The remaining factors such as age, sex, educational qualifications, occupational status, and income were not found to be related to compliance of treatment (p>0.05). Conclusion: Factors of Basedow disease time of the patient, number of drugs prescribed in the prescription, number of medications per day, and belief in drugs to treat Basedow disease were related to compliance of treatment.

Diverse phenotypic expression associated with the same genetic variant in female heterozygote patients of Anderson–Fabry disease: a case series

Background Anderson–Fabry disease (AFD) is an X-linked lysosomal storage disorder resulting from a mutation of alpha-galactosidase A gene (GLA), causing deficiency in alpha-galactosidase activity. The enzyme deficit can lead to storage of globotriaosylceramide in various organs including heart. Studies suggest that vasospastic angina (VSA) is associated with AFD. Case summary This clinical case series aimed to present two female patients with AFD, including progressive cardiac involvement: a 50-year-old woman (patient number 1) and a 39-year-old woman (patient number 2) who are siblings with a male AFD patient harbouring p. Arg342Glu missense variant in alpha-galactosidase A gene (GLA), who suffered VSA and subsequent ventricular fibrillation. Enzymatic tests and genetic analysis confirmed AFD in both female patients and histological tests revealed globotriaosylceramide deposits in their hearts. In patient number 1, a 12-lead electrocardiography and transthoracic echocardiography revealed cardiac hypertrophy. Coronary angiography revealed no organic coronary artery stenosis and vasospasms was induced by spasm provocation test. In patient number 2, no signs of cardiac hypertrophy were found, and coronary arteries had no organic stenosis with negative spasm provocation test. Both patients received enalapril therapy and enzyme replacement therapy (ERT). Discussion Different phenotype of AFD was occurred even with the same genetic variant in female heterozygote patients. The duration of exposing accumulation of Gb3 might affect cardiac hypertrophy and vasospasms. Coronary angiography with acetylcholine provocation test should be considered in female AFD patient, especially in case with cardiac hypertrophy.

The Effect of Prostate Cancer Radiotherapy on Testosterone Level: A Systematic Review and Meta-analysis

Introduction: In the current study, a systematic search and meta-analysis were performed to evaluate the effect of prostate cancer radiotherapy on testosterone levels of patients. Methods: To illuminate the effect of radiotherapy on the testosterone level of prostate cancer patients, a systematic search was conducted in accordance with the PRISMA guideline in electronic databases of Scopus, Embase, PubMed, Web of Science, and clinical trials up to December 2018 using relevant keywords. Based on a certain set of inclusion and exclusion criteria, 12 eligible studies that had data on the testosterone level following prostate cancer radiotherapy were included in the meta-analysis. Results: According to the various techniques of prostate cancer radiotherapy, the dose values scattered to the testicular tissues ranged from 0.31 to 10 Gy. Combining the findings from 12 studies, it was found that prostate cancer radiotherapy leads to a significant reduction in the testosterone level (Weighted Mean Difference [WMD]: -51.38 ng/dL, 95% CI: -75.86, -26.90, I2=0.0%, P<0.05). Furthermore, subgroup analysis by the patient number showed a significant reduction in the testosterone level at patient number < 50 (WMD: -80.32 ng/dL, 95% CI: -125.10, -35.55, I2= 0.0%) and 50 < patient number < 100 (WMD: -46.99 ng/dL, 95% CI: - 87.15, -6.82, I2= 0.0%). Subgroup analysis based on treatment technique type revealed a significant reduction in testosterone level after conventional radiotherapy (WMD: -56.67, 95% CI: -100.45,-12.88, I2= 34.3%) and IMRT/SBRT technique (WMD: -57.42, 95% CI: -99.39, -15.46, I2= 0.0%) in comparison with the proton therapy (WMD: 0.00, 95% CI: -80.24, 80.24). Conclusion: The findings showed a significant decrease in the testosterone level of prostate cancer patients after radiotherapy compared with pre-treatment levels.

Spatio-Temporal Variability of Malaria Infection in Chahbahar County, Iran: Association with the ENSO and Rainfall Variability

Background: Malaria is one of the most widespread communicable diseases in the southeast of Iran particularly in Chahbahar County. Comprehensive understanding of the influence of climate on this disease is a key element for success in the environmental-based malaria elimination programs. After analyzing the spatio-temporal distribution of the disease, the relationships between the infection statistics and some important climate indices particularly the El Niño-Southern Oscillation (ENSO) and rainfall were investigated.Methods: The malaria statistics collected from various health centers were composited with the corresponding data of Southern Oscillation Index (SOI), ground-based meteorological records and satellite-based rainfall data. Non-parametric Mann-whitely test was applied to detect the significant difference between patient number between El Niño and La Niña and between the adopted wet and dry episodes.Findings: Patient number from highest to lowest was associated to summer, autumn, spring and winter, respectively. Plasmodium falciparum, Plasmodium vivax and other species were responsible for 22%, 75% and 3% of the sickness, respectively. While the outbreak of P. falciparum is in autumn; P. vivax is erupted in summer. When the epidemic statistics were collected from rural rather than urban areas, the effect of climate on the infection statistic was more obvious.Interpretation: For rural / urban areas, the infection statistics exhibited a significant decline / increase during El Niño episodes. In autumn, spring and winter, patient number has significantly increased / decreased during the dry / wet epochs, respectively. These relationships were, however, reversed during summertime of health indicators are rarely available for every population and period of interest, and available data.Funding: Shiraz University of Medical Sciences