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Introduction Autism spectrum disorders (ASD) encompass a range of neurodevelopmental disorders that affect the patient's communication and behavior. There are some reports about the increasing prevalence of ASD in recent decades, mostly due to the improvement in diagnosis and screening status. Few studies suggested a lower prevalence of ASD in North Africa and Middle East compared to more developed regions. The aim of this study is to provide a comprehensive outlook of ASD in the region. Methods We used Global Burden of Disease (GBD) data from 1990 to 2019 in North Africa and Middle East, which is one of the seven super regions of the GBD categorization. In this study, we reported the epidemiologic indices, including prevalence, incidence, and years lived with disability (YLDs) for ASD in the 21 countries of the super region. We also compared these indices between the countries based on their sociodemographic index (SDI) which was calculated according to income per capita, mean education, and fertility rate. Results Age‐standardized prevalence rate (ASPR) of ASD in the region is 304.4 (95% uncertainty interval 251.2–366.1) per 100,000 in 2019 with less than one percentage change since 1990. Age‐standardized YLDs and incidence rates were 46.4 (30.4–67.5) and 7.7 (6.3–9.3) per 100,000 in 2019. The ASPR was 2.9 times greater in males compared to females in 2019. The highest age‐standardized prevalence, incidence, and YLD rates among the countries were seen in Iran in 2019 (370.3, 9.3, and 56.4 per 100,000, respectively). High SDI countries had higher age‐standardized YLDs rates compared to the other countries of the region. Conclusion In conclusion, the trends of age‐standardized epidemiologic indices remained approximately steady through the years 1990–2019 in the region. Though, there was a wide discrepancy between the countries of the region. The difference of YLDs among the countries of this region is related to the SDI of the countries. Monetary and public awareness status are the SDI factors that may affect the quality of life of ASD patients in the region. This study provides valuable information for governments and health systems to implement policies for maintaining the improving trend, achieving more timely diagnosis, and bettering the supportive actions in this region. In this paper, we provided a prospect for health officials of the countries to implement their health care policies and programs and we also mentioned the possible ways to enhance the quality of life for these patients.

Cancer is most commonly associated with aging. It is necessary to gain a better understanding of cancer's trend and distribution among elderlies and provide comprehensive cancer care for this population. The aim of the current study was to show the trends in cancer incidence focusing on the population aged 60+ from 1990 to 2016 in Iran. We used the dataset of the Iran Cancer Registry to estimate cancer incidences by sex, age, province, and year. In order to account for incomplete data we used a two‐stage spatiotemporal model along with random intercept mixed effect models. We calculated annual age‐standardized incidence rates (ASIRs) for age groups 60+ and 5‐interval age groups. There was an increasing trend of 25.3% to 936.9% (95% uncertainty interval: 769.6–1141.8) in ASIR in the elderly in 2016. ASIR of all cancers were 889.7 (731.3–1083.6) in women and 988.1 (811.1–1205) in men in 2016, per 100 000 respectively, which had an increasing trend comparing 1990. Skin, breast, and stomach cancers in women and prostate, skin, and stomach cancers in men were the most common types in 2016. All the most incident cancer subtypes underwent an increasing trend in both sexes, except for the bladder, esophageal, and skin cancers which almost had a similar level in 1990 and 2016. Most provinces had an increasing trend in ASIR in all cancers combined from 1990 to 2016 except Zanjan with a decreasing trend. Regarding the persistent increasing trend of most elderly cancers' incidence, this is crucial for policymakers to establish preventive plans, determine proper resource allocation, and develop specific treatments for elderly cancer patients.

Background Lung cancer is one of the leading cancers, with a high burden worldwide. As a developing country, Iran is facing with population growth, widespread tobacco use, demographic and epidemiologic changes, and environmental exposures, which lead to cancers becoming a severe concern of public health in Iran. We aimed to examine the burden of lung cancer and its risk factors in Iran. Methods We utilized the Global Burden of Disease 2019 data and analyzed the total burden of the lung cancer and seven related risk factors by sex, age at national and sub‐national levels from 1990 to 2019. Results The lung cancer age‐standardized death rate increased from 11.8 (95% Uncertainty Interval: 9.7–14.4) to 12.9 (11.9–13.9) per 100,000 between 1990 and 2019. This increase was among women from 5 (4.2–7.1) to 8 (7.2–8.8) per 100,000; in contrast, there was a decline among men from 18.5 (14.8–22.6) to 17.8 (16.2–19.4) per 100,000. The burden of lung cancer is concentrated in the advanced age groups. Smoking with 53.5% of total attributable deaths (51.0%–55.9%) was the leading risk factor. At the provincial level, there was a wide range between the lowest and highest, from 8.3 (7.0–10.0) to 19.1 (16.4–22.0) per 100,000 population in the incidence rate and from 8.7 (7.3–10.3) to 20.6 (17.7–24.0) per 100,000 population in mortality rate, respectively in Tehran and West Azerbaijan provinces in 2019. Conclusion The increasing trend of lung cancer burden among the entire Iranian population, the inter‐provincial disparities, and the significant rise in burden of this cancer in women necessitate the urgent implementation and development of policies to prevent and manage lung cancer burden and strategies to reduce exposure to risk factors. Age‐standardized incidence, DALYs, and death rate in females were lower than males but had a remarkable increase. The study showed that the highest incidence and DALYs rate of LC were in the age group >70. Smoking was the first leading risk factor among the overall population, men, and all provinces of Iran.

Organophosphorus pesticides are widely used in agriculture in Iran; we evaluated exposure to these pesticides among Iranian adults. Pesticide-specific urinary metabolites were used as biomarkers for exposure to various pesticides, including organophosphorus insecticides. The aim of the study was to estimate reference values (RV95) and their relationships with the measured factors. We used the 95th percentile as the basis for deriving these reference values. The analysis included descriptive statistics and multiple linear regression, conducted using Python software. We measured metabolites for Chlorpyrifos (TCP: 2-isopropyl-4-methyl-6-hydroxypyrimidine), Diazinon (IMPY: 2-isopropyl-4-methyl-6-hydroxypyrimidine), and Malathion (Malathion dicarboxylic acid) in 490 healthy Iranian adults. Additionally, we recorded age, gender, wealth index, and body composition parameters including body fat, muscle mass, visceral fat, and BMI. Fasting urine sampling, along with body composition and demographic measurements, were conducted. Urine samples were subsequently analyzed. The Chlorpyrifos, Diazinon, and Malathion Reference Value (RV95) levels ranged from ND-24.9 µg/L (RV95: 2.8 µg/L, 2.9 µg/gcrt), ND-64.36 µg/L (RV95: 8.6 µg/L, 9.3 µg/gcrt), and ND-47.69 µg/L (RV95: 9.8 µg/L, 8.2 µg/gcrt), respectively. Diazinon (IMPY) and Malathion (Malathion dicarboxylic acid) showed no significant relationship between their urinary levels and demographic features. However, visceral fat percentage had a significant inverse correlation with urinary levels of Chlorpyrifos (TCP) (P = 0.038). Other factors such as age, sex, visceral fat, BMI, and wealth index showed no significant relationship with urinary levels (P > 0.05). Non-zero levels were found in 98.8% of adults’ urine samples for this metabolite. The reference value of this pesticide metabolite in urine could be helpful for policymakers in assessing the level of exposure among Iranians.

Background The aim of this study was to examine the quality of care by age and gender in oesophageal cancer using Global Burden of Disease (GBD) database. Methods Patients aged 20 and over with oesophageal cancer were included in this longitudinal study using GBD 1990-2019 data. We used the Socio-Demographic Index (SDI) to classify the regions. We used Principal Component Analysis (PCA) method to calculate the Quality of Care Index (QCI). The QCI was rescaled into a 0-100 single index, demonstrating that the higher the score, the better the QC. Results The age-standardized QCI for oesophageal cancer dramatically increased from 23.5 in 1990 to 41.1 in 2019 for both sexes, globally. The high SDI regions showed higher QCI than the rest of the regions (45.1 in 1990 and 65.7 in 2019) whereas the low SDI regions had the lowest QCI, which showed a 4.5% decrease through the years (from 13.3 in 1990 to 12.7 in 2019). Globally, in 2019, the QCI showed the highest scores for patients aged 80-84, reported 48.2, and the lowest score for patients aged 25-29 reported 31.5, for both sexes. Globally, in 2019, age-standardized Gender Disparity Ratio (GDR) was 1.2, showing higher QCI in females than males. Conclusion There were fundamental differences in the QCI both globally and regionally between different age groups as well as between males and females. To achieve the goal of providing high-quality services equally to people in need in all over the world, health systems need to invest in effective diagnostic services, treatments, facilities, and equipment and to plan for screening and surveillance of high-risk individuals.

Tobacco smoking is a significant global public health challenge, responsible for 8 million deaths annually. This study aimed to analyze the age of smoking initiation and its sociodemographic determinants among Iranian adults, based on data from the 2021 STEPwise approach to surveillance (STEPS) survey, to inform targeted public health interventions. The analysis of 27,874 adults revealed that the average initiation ages for cigarette and hookah smoking were 22.2 years and 24.9 years, respectively. Men typically began smoking earlier than women, with average ages of 21.9 years for males and 27.7 years for females. No significant differences were observed in smoking initiation ages between rural and urban areas. Education level and marital status were also influential, with the youngest initiators having 7–12 years of education and being single. This study highlights the significant roles of gender, education, and urban-rural differences in smoking initiation in Iran. The findings underscore the need for targeted public health strategies conforming to the WHO’s MPOWER initiatives and the Framework Convention on Tobacco Control (FCTC). Increased investment in public health, focusing on education and preventive measures, is crucial to reduce early smoking initiation and its associated health risks, ultimately supporting broader health policy goals.

Background Despite the simplicity of male circumcision, complications occur frequently. Post-circumcision meatal stenosis is a concerning complication that might require several interventions. Aim This study aims to evaluate the incidence of meatal stenosis in long-term follow-up, following three common circumcision methods: frenular artery preservation, frenular ligation, and the Plastibell device. Methods This study is the continuation of the previous randomized clinical trial, the preliminary abstract of which has been accepted in the annual meeting of the American Urological Association in 2011. However, in this paper, we only included the patients with results of long-term follow-up. Patients were followed for a median of 11 years (range, 7–17). Follow-ups were recorded by evaluation of meatus and signs and symptoms of meatal stenosis. Results Two hundred six boys (80 neonates and 126 non-neonates) at the time of procedure were included in this study. The circumcision was conducted on 23.3% (48/206) of boys with the Plastibell device (PD) and 39.3% (81/206) of cases with frenular artery preservation (FAP) and 37.4% (77/206) of cases with frenular artery ligation (FAL). Meatal stenosis presented in 13 children during follow-up. Considering the three methods of circumcision, a significant difference in the incidence of meatal stenosis among the types of circumcisions was observed (6.3% in PD and 1.2% in FAP, 11.7% in FAL, P  = 0.026). Conclusion The present study revealed that the technique preserving the frenular artery is associated with a significantly lower incidence of meatal stenosis. Hence, the FAP is the recommended technique for circumcision as compared to two other methods.

Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.

Purpose Chronic Kidney Disease (CKD) has become the 8 th leading cause of death in Iran in 2017, 5 steps up from 1990. This is important as hypertension, diabetes, and chronic glomerulonephritis along with exposure to toxins or heavy metals are the main risk factors for the disease. Despite its heavy burden, there are limited studies on the incidence and prevalence of the disease in the Iranian adult population. The present article studies the burden of CKD at the national level in 2019, and its trend over the past three decades. Methods In 2019, the Global Burden of Disease (GBD) study provided an annual estimation of the burden of 369 diseases and injuries in 204 countries from 1990 until 2019. The data estimating CKD and related mortality in Iran were collected from the disease registry, survey, and scientific literature. All-ages and age-standardised indices of incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) were extracted for both sexes. Results Since 1990, the age-standardized incidence (34.7% (95% uncertainty interval 30.8 – 38.8)) and prevalence (19.6% (17.7 – 21.8)) of CKD have risen, while a 21.5% (-28.8 – -15.4) and 18.0% (-35.4 – -10.8) decrease were noted in age-standardized DALYs and deaths rates, respectively. The lowest prevalence was reported in the eastern and western provinces. Conclusion Current study provides comprehensive knowledge about the CKD burden, suggesting the Iranian healthcare system has been more effective in averting deaths rather than managing morbidities. Multi-sectoral action plans are needed to strengthen preventive and early detection programs in high-risk areas.

Purpose Describing the trends of metabolic risk factors (MRFs) in the elderly population. Methods We used modeled data from previous comprehensive systematic reviews for MRFs among adults aged ≥ 60 years. Two stages of age-specific Spatio-temporal modeling and Gaussian process regression were used to estimate the mean of MRFs. We used crosswalk modeling to estimate the prevalence of elevated and raised Total cholesterol (TC), overweight/obesity and obesity, hypertension, and diabetes. Estimates were analyzed based on combinations of sex, age, year, and province from 1990 to 2016. Results Comparing prevalence estimates from 2016 with those of 1990, in the elderly population, the age-standardized prevalence of overweight/obesity, obesity, diabetes, and hypertension increased, conversely, the prevalence of hypercholesteremia decreased. The prevalence of hypertension increased about 141.5% and 129.9% in men and women respectively. The age-standardized prevalence of diabetes increased about 109.5% in females, and 116.0% in males. Prevalence of elevated TC at the national level decreased to 67.4% (64.1–70.4) in women and to 51.1% (47.5–54.8) in men. These findings were almost shown across provinces. In general, the northern and western provinces had the highest prevalence of overweight/obesity in women in 2016. Conclusion The rising prevalence of most MRFs, as well as the greater prevalence and mean of all MRFs in women, necessitate effective public health policies to reduce the burden of non-communicable diseases and run preventive programs.