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Introduction People living with HIV (PLHIV) are at an increased risk of type 2 diabetes mellitus (T2DM) due to aging, lifestyle, and antiretroviral therapy-related factors. This systematic review and meta-analysis estimated the pooled incidence, prevalence, and risk factors for T2DM among PLHIV globally, focusing on older populations. Methods This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We conducted a comprehensive literature search in PubMed, Embase, Web of Science, and Scopus for English-language articles published by December 25, 2024. The I² index and Cochrane’s Q statistic were also used to assess study heterogeneity. A random effects model was used to compute the pooled measure of association with 95% confidence intervals. Moreover, the Egger test was used to assess publication bias. Result After screening, 112 studies were selected for analysis. These included 491,367 PLHIV, of whom 39,021 had diabetes. Among them, 5,363 PLHIV were over 50 years old with diabetes. One hundred and twelve of these studies have assessed the prevalence of diabetes among people with HIV, while ten studies have reported both the incidence and prevalence of diabetes in this group. This analysis demonstrated an association between HIV and increased odds of T2DM (OR: 1.61, 95% CI: 1.09–2.38). Additionally, there was a significant association between T2DM and being over 50 years (OR: 3.35, 95% CI: 2.52–4.44), having a family history of DM (OR: 2.30, 95% CI: 1.58–3.73), a body mass index (BMI) greater than 25 (OR:2.43, 95% CI: 1.58–3.73), and having hypertension (OR: 1.10, 95% CI: 1.39–3.19) among PLHIV. Furthermore, the prevalence of T2DM among PLHIV was found to be 9% (95% CI: 8%–10%), and it was 11% (95% CI: 9%-13%)among PLHIV aged 50 and older. Additionally, a higher prevalence of T2DM was observed in PLHIV who use NRTIs14% (95% CI: 2%-28%), those who have been on antiretroviral therapy for more than 10 years 15% (95% CI: 6%-26%), and those diagnosed with advanced HIV disease 8% (95% CI: 4%-14%). Conclusion This analysis highlights a significant association between HIV and increased T2DM risk, with age, family history of DM, high BMI, and hypertension as key factors. Comprehensive diabetes screening and preventative interventions, including lifestyle modifications such as personalized nutritional guidance, promotion of regular physical exercise, and consistent glucose monitoring, are crucial for improving outcomes in PLHIV. Clinical trial Not applicable.

Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery. A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences. Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02-12.55%, χ =12986.44, P<0.001). Operative time and higher wound class were both significant consistent risk factors for SSI incidence. Patients' educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were all candidates for consistent risk factors, with insufficient evidence. The findings of the present study indicated that SSI in abdominal surgery was a multifactorial phenomenon with a considerable risk and had different risk factors with various relative importance. Determining the relative importance of the risk factors for the prevention and control of SSI is strongly recommended.This manuscript has been released as a preprint at the research square: (https://doi.org/10.21203/rs.3.rs-3219597/v1).

The Iranian government does not fund pre-exposure prophylaxis (PrEP), and it is not used in Iran due to uncertainties in its cost-effectiveness. In this study, we examined the cost-effectiveness of PrEP among female sex workers (FSWs) in Iran. The cost-effectiveness analysis compared only PrEP, a combination of PrEP with harm reduction (HR) with only HR scenario among FSWs over a 10-year time horizon. The perspective of the healthcare provider was used in the analysis. The primary outcome was disability-adjusted life year (DALY) averted. Analyses included health and cost outcomes, as well as the incremental cost-effectiveness ratio (ICER), which was reported as the cost per DALY averted. Only PrEP was not cost-effective at a willingness to pay threshold of 4669.6 USD per DALY averted in Iran. In contrast, PrEP and HR strategies were cost-effective at the same willingness to pay threshold. The ICER was 868.47 USD per DALY averted for PrEP and HR compared to HR alone. Compared to HR, combining PrEP with HR is a cost-effective intervention among Iranian FSWs for reducing the clinical and economic burden associated with HIV over a 10-year time horizon. Iran should add PrEP to current HR programs for FSWs.

Despite the effectiveness of pre-exposure prophylaxis (PrEP) in reducing HIV incidence, this intervention is inaccessible in Iran. We examined the interest in using PrEP and associated factors among people who inject drugs (PWID) in 2023 using data from 2,174 PWID. The main outcome was interest in using PrEP, which was divided into three categories: interest in using PrEP under any circumstances, interest in using PrEP if provided for free, and no interest in using PrEP. We found that 37.9% of PWID were interested in using PrEP under any circumstances, 48.3% were interested in using PrEP if provided for free, and 13.8% were not interested in using PrEP. Additionally, only 7.7% of participants reported prior awareness of PrEP. Having high school or more education (adjusted relative risk ratios [ARRR]: 1.92; 95% confidence interval [CI]: 1.42, 2.61), having access to opioid agonist treatment (OAT) in the last six months (ARRR: 1.59; 1.13, 2.25), and having sufficient HIV knowledge (ARRR: 2.87; 2.03, 4.06) were positively associated with interest in using PrEP under any circumstances. Similarly, having high school or more education (ARRR: 1.50; 1.10, 2.04), having access to OAT in the last six months (ARRR: 2.63; 1.88, 3.67), and having sufficient HIV knowledge (ARRR: 4.53; 3.23, 6.37) were associated with interest in using PrEP if provided for free. Health insurance was negatively associated with interest in using PrEP under any circumstances (ARRR: 0.64; 0.47, 0.87) and with interest in using PrEP if provided for free (ARRR: 0.33; 0.23, 0.45). The findings show a strong potential for PrEP acceptance, indicating that addressing financial and logistical barriers to free PrEP access could greatly reduce HIV incidence among PWID in Iran.

Background Pre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran. Methods We conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants’ experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs. Results We interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator’s theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier’s theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers). Conclusions We identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.

Background There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive recommendations for the management of these patients. This systematic review and meta-analysis aimed to review the evidence with regard to the impact of maternal psoriasis on maternal and neonatal outcomes. Methods Following the PRISMA guideline, a systematic search of English articles using PubMed, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted. The search was performed from inception to 22 nd of May 2022. Result A significant association was observed between psoriasis and maternal outcomes, including cesarean delivery [OR = 1.25 (95% CI: 1.13–1.30, p -value = 0.001)], (pre)eclampsia [OR = 1.29 (95% CI: 1.15–1.44, p -value = 0.0001)], gestational diabetes [Odds Ratio (OR) = 1.23 (95% Confidence Intervals (CI): 1.15–1.30, p -value = 0.001)], gestational hypertension [OR = 1.31 (95% CI: 1.18–1.45, p -value = 0.001)] and preterm birth [OR = 1.22 (95% CI: 1.10–1.35, p -value = 0.001)]. Also, there was a significant association between psoriasis and neonatal outcomes, including small for gestational age [OR = 1.07 (95% CI: 1.02–1.11, p -value = 0.053)], low birth weight [OR = 1.19 (95% CI: 1.02–1.38, p -value = 0.001)] and stillbirth [OR = 1.27 (95% CI: 1.04–1.55, p -value = 0.023)]. Conclusion Maternal psoriasis could negatively impact maternal and neonatal outcomes. Our results strengthen the importance of close monitoring of the mothers’ psoriasis status before and during pregnancy.

Background Understanding the hepatitis C virus (HCV) cascade of care (CoC) and factors associated with engagement is crucial for designing interventions for achieving HCV elimination. However, data on engagement in the HCV CoC among people who inject drugs (PWID) in the Middle East and North Africa remains limited. We examined the HCV CoC and factors associated with testing among Iranian PWID. Methods We recruited PWID in 14 cities using respondent-driven sampling. PWID completed structured interviews capturing measures on socio-demographics, behaviors, and HCV CoC. We examined the self-reported numbers and proportions of individuals who ever tested for HCV, tested positive for HCV antibody, were diagnosed with HCV, initiated HCV treatment, and achieved sustained virologic response (SVR). Multivariable logistic regression models were built to assess factors associated with HCV antibody testing. Results Of 2308 PWID, 23.1% had ever received an HCV antibody test, 13.9% received the HCV antibody test in the last year, 3.4% had tested positive for HCV antibodies, and 2.5% had received an HCV diagnosis. Of those diagnosed, 54.4% reported initiating treatment, and 31.6% had achieved SVR. HCV antibody testing was significantly associated with having knowledge about HCV transmission through sharing needle/syringe (adjusted odds ratio [aOR] 8.09; 95% confidence intervals [CI] 5.25, 12.48), living with HIV (aOR 4.15; 1.58, 10.92), no previous history of homelessness (aOR 1.89; 1.31, 2.72), history of arrest/incarceration (aOR 1.83; 1.26, 2.64), history of being diagnosed with any mental health problems (aOR 2.88; 1.79, 4.61), history of non-fatal overdose (aOR 1.51; 1.08, 2.10), receiving needle exchange programs in the last 12 months (aOR 6.20; 3.86, 9.93), opioid agonist treatment in the last six months (aOR 2.10; 1.39, 3.18), and having ever received HBV vaccine (aOR 2.31; 1.59, 3.35). Conclusions We found a considerably low engagement in HCV CoC among PWID in Iran. Enhancing access to testing services for PWID, especially those with limited awareness of HCV transmission and those encountering structural challenges, is essential as the initial step in the HCV CoC. This improvement is vital for strengthening HCV elimination efforts in Iran.

Background and Objective Cardiovascular diseases (CVDs) are the top cause of death and disability globally. Estimating the years of life lost (YLL) can inform policy and intervention programs. The present study was designed and implemented to estimate the number of deaths and YLL, estimate their trend, and examine demographic characteristics due to cardiovascular diseases. Material and Methods This retrospective population‐based study analyzed mortality trends and YLL associated with 4314 deaths caused by CVDs. Data recorded in the Kazerun Forensic Medicine Organization were used to calculate the YLL due to cardiovascular diseases. For the descriptive analysis, we utilized the χ2 test, considering a p value of less than 0.05 as statistically significant. Results Men died from CVDs at an average age of 63.4 (±16 years), while women died at an average age of 61.5 (±17 years). CVDs caused over half (52.3%) of mortality in both sexes. Mortality from heart disease was significantly higher among individuals with lower education levels and self‐employed individuals throughout all years. The total number of YLLs due to CVDs was 43,107, which equals 14 years lost per 1000 individuals. While more men died from CVDs throughout most of the study, the difference between the number of male and female mortality narrowed in 2018 and from 2021 to 2023. According to the generalized additive model (GAM), years of life lost from heart disease mortality were increasing until almost 2019, but after 2019, this trend has been decreasing. Conclusion The calculation of total YLL reveals a significant social burden of premature mortality from CVDs in the southwest of Fars province. This issue should be prioritized as a public health concern, necessitating preventive measures such as education, evaluation, and reduction of modifiable risk factors, increased physical activity, and blood pressure management to decrease mortality rates.

Background and Aims HIV pre‐exposure prophylaxis (PrEP) has a crucial role in HIV prevention globally. Our study aimed to explore the approaches to address and overcome barriers to PrEP implementation among key populations in Iran. Methods In this multi‐stage qualitative study, first, we employed in‐depth interviews to identify possible barriers to PrEP implementation in Iran. Second, we conducted three focus group discussions with HIV experts to categorize barriers to PrEP implementation among key populations using the Causal layered analysis. Last, we collected HIV expert's opinions on possible solutions to overcome the barriers. Results We found four layers of barriers (including potential solutions) in PrEP implementation: litany, systemic causes, and discourse/myth. In the litany layer, increasing HIV knowledge among key populations and healthcare providers was identified as a solution. In the systemic layer, cooperation and coordination among all societal organizations and providers were reported as a solution. In the discourse/myth layer, gaining the trust of the key populations, providing PrEP in private sectors, using telemedicine, and religious beliefs were identified as solutions. Conclusion Our deep multi‐step qualitative analysis showed that barriers to implementing PrEP in Iran are several, complex, and cross‐cutting. Addressing them requires interventions among key populations at risk for HIV, such as PrEP users, health providers, and the community in general, to build a supportive environment for PrEP as one of the HIV prevention strategies in Iran.

Nosocomial infections remain one of the most severe public health issues, infecting millions of patients worldwide each year.  The global prevalence of nosocomial infections varies between 3.0% and 20.7%, with an incidence rate ranging from 5% to 10%. In this short article, we have tried to present a different perspective on the future of nosocomial infections from the author's viewpoint. According to our assessment, due to megatrends such as global exposure, population aging, and augmenting drug resistance, nosocomial infections are expected to become more severe in the future. On the other hand, advancements in health technologies such as e-health, Artificial Intelligence, the Internet of Things, and less invasive interventions form a new generation of hospitals capable of preventing and controlling nosocomial infections. Presenting novel approaches to nosocomial infection management will transform medicine. Therefore, it seems that in the following years, nosocomial infections will follow a different trend.