Cost-of-illness analysis of type 2 diabetes mellitus in Iran

Introduction

Diabetes is a worldwide high prevalence chronic progressive disease that poses a significant challenge to healthcare systems. The aim of this study is to provide a detailed economic burden of diagnosed type 2 diabetes mellitus (T2DM) and its complications in Iran in 2009 year.

Methods

This is a prevalence-based cost-of-illness study focusing on quantifying direct health care costs by bottom-up approach. Data on inpatient hospital services, outpatient clinic visits, physician services, drugs, laboratory test, education and non-medical cost were collected from two national registries. The human capital approach was used to calculate indirect costs separately in male and female and also among different age groups.

Results

The total national cost of diagnosed T2DM in 2009 is estimated at 3.78 billion USA dollars (USD) including 2.04±0.28 billion direct (medical and non-medical) costs and indirect costs of 1.73 million. Average direct and indirect cost per capita was 842.6±102 and 864.8 USD respectively. Complications (48.9%) and drugs (23.8%) were main components of direct cost. The largest components of medical expenditures attributed to diabetes''s complications are cardiovascular disease (42.3% of total Complications cost), nephropathy (23%) and ophthalmic complications (14%). Indirect costs include temporarily disability (335.7 million), permanent disability (452.4 million) and reduced productivity due to premature mortality (950.3 million).

Conclusions

T2DM is a costly disease in the Iran healthcare system and consume more than 8.69% of total health expenditure. In addition to these quantified costs, T2DM imposes high intangible costs on society in terms of reduced quality of life. Identification of effective new strategies for the control of diabetes and its complications is a public health priority.     

Sporotrichosis in Iran

This report describes a 23 year-old male florist gardener diagnosed with subcutaneous sporotrichosis caused by the dimorphic pathogenic soil fungus Sporothrix schenckii. The patient had several small skin lesions over the left upper arm with ascendant chains of enlarged lymph nodes.Sporothrix schenckii was detected from clinical samples by direct microscopy and culture and its ability to switch from mould to yeast form at 37 degrees C. The patient was successfully treated with long-term potassium iodide and advised to wear gloves and long sleeves when handling any kind of plant material.     

Triassic in Iran

Summary Except of the Nakhlak and Aghdarband regions, Lower and Middle Triassic strata in Iran consist almost exclusively of carbonate rocks built on vast platforms along the shelves of the Paleo- and Neotethys. The depositional environments varied from shallow shelf sea to lagoonal and near-shore tidal flats, becoming even evaporitic towards the coastal regions of the Persian Gulf. During the early Late Triassic the formerly dominating platform carbonates were strongly reduced, being restricted for the rest of the Early Mesozoic to Southwest Iran which remained on the northern passive margin of Gondwana (later Arabian Plate). On the Iran Plate otherwise, as a result of the closure of the Paleotethys and the continent-continent collision with the southern active margin of Eurasia (Turan Plate), there was a change to thick siliciclastic and molassic sediments with only minor carbonate content durig the Upper Triassic and Lower Jurassic. Geographically restricted and completely different sequences of thick volcanoclastic and basinal Triassic sediments are known from Nakhlak in Central and from Aghdarband in Northeast Iran, both interpreted as remanents of the northern Paleotethys margin (Turan Plate).     

Transferrin subtypes in Iran

The frequency of transferrin Tf C subtypes has been determined by double one-dimensional electrophoresis of plasma samples from Moslems (n = 91), Zoroastrians (n = 97), Jews (n = 88) and Armenians (n = 88) of Iran. The Zoroastrians show the lowest frequency of TfC1 (0.4999) and highest frequencies of TfC2 and TfC3 (.02215, and 0.2783, respectively). The Jews have the highest TfC1- and the lowest TfC2- and TfC3 frequencies (0.8011, 0.1478, and 0.0512, respectively). It could be shown that the differences between Zoroastrians and Jews are highly significant (p less than 0.001). Arbitrary subtyping of transferrin Tf B and TfD phenotypes could be done on samples from three regional groups of Iran: North: n = 282, Central: n = 548, and South: n = 587 into Tf B (Iran 1, 2, 3 and 4) and Tf D (Iran 1, 2 and 3) was performed according to mobilities relative to the transferrin C protein during polyacrylamide gel electrophoresis and by relative pI deviations from the Fe2-transferrin C1 protein after isoelectric focussing. The allele frequencies found in the total sample (n = 1417) are: TfB1 = 0.0003, TfB2 = 0.0010, TfB3 = 0.0042, TfB4 = 0.0007; TfD1 = 0.0017, TfD2 = 0.0014, and TfD3 = 0.0010.     

Serumprotein polymorphisms in Iran

Summary The results of a population genetic investigation on Iranians are given and compared to the results obtained on other populations from Southwestern and Southern Asia. Our total material from Iran comprises n=1020 nonrelated male and female individuals of different age. The following serum groups have been typed: Hp, Gc, Gm, and Inv. In general there exist no remarkable age or sex differences in the distribution of phenotypes and alleles (the only exception: sex differences in the distribution of the Gm (7)-phenotype). The regional distribution of phenotypes and alleles yield no marked differences, too, apart from the Invphenotypes, however. For the total material of Iran the following alleles frequencies could be calculated: Hp¹=0.3045, Hp²=0.6595, Gc²=0.3405; Gm¹=0.1780, Gm^1,2=0.0537, Gm^1,5=0.0632, Gm⁵=0.7051. The Gm (7)-phenotype turned out to be 36.6%; the Inv (1)-phenotype amounts to 25.6%. Comparing with other populations, especially Pakistani and Indian samples, some heterogeneity in the distribution of phenotypes and alleles within Southwestern and Southern Asia was to be demonstrated. Some distributional trends of alleles frequencies shall be mentioned here: the increase of Hp², Gc¹, and Gm¹ alleles from West towards East, and in the opposite direction the decrease of Hp¹, Gc², and Gm⁵ alleles. Selective acting forces are supposed to be most important factors for this. D77     

Gum tragacanth in Iran

Several species of the genus Astragalus, growing wild in Iran, Iraq, Turkey, Afghanistan and adjacent Russia are the commercial sources of this exudate, obtained by tapping the branches or roots. Its hydrophilic and colloidal properties are of value in the manufacture of ice cream, liquors, lotions, sizings and other industrial products.     

Kefir production in Iran

Kefir grains were prepared in a goat-hide bag using pasteurized milk inoculated with sheep intestinal flora, followed by culture of the surface layer in milk. From the grain, 11 strains of lactic acid bacteria, non-lactic acid bacteria and yeasts were isolated and identified. Six samples of kefir were prepared by fermenting pasteurized milk for different lengths of time. Sensory evaluation identified the sample prepared by 24 h fermentation as the best product.     

HHEX gene polymorphisms and type 2 diabetes mellitus: A case-control report from Iran

Genome-wide association studies indicated that hematopoietically-expressed homeobox (HHEX) gene is a remarkable candidate for type 2 diabetes (T2D) mellitus susceptibility in spite of the fact that the results are ambiguous in some cases. So, this study aimed to evaluate the possible correlation between HHEX gene polymorphisms and T2D development in a sample of the Iranian population. The rs1111875G/A, rs7923837A/G, and rs5015480C/T HHEX gene polymorphisms were genotyped in 250 cases and 250 matched (age and sex) healthy controls using tetra-amplification-refractory mutation system-polymerase chain reaction method. The finding revealed the all measured inheritance models of rs1111875G/A and of rs5015480C/T variants dramatically increase the risk of T2D while another polymorphism (rs7923837A/G) was not associated with risk/protective role in T2D. The results indicated that rs1111875G/A and rs5015480C/T may contribute to the enhancement of T2D risk in a sample of the southeast Iranian population.     

Foundations of morality in Iran

Most moral psychology research has been conducted in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. As such, moral judgment, as a psychological phenomenon, might be known to researchers only by its WEIRD manifestations. Here, we start with evaluating Moral Foundations Theory (MFT) using the Moral Foundations Questionnaire, and follow up by building a bottom-up model of moral values, in Iran, a non-WEIRD, Muslim-majority, understudied cultural setting. In six studies (N = 1945) we examine the structural validity of the Persian translation of the Moral Foundations Questionnaire, compare moral foundations between Iran and the US, conduct qualitative interviews regarding moral values, expand the nomological network of “Qeirat” as a culture-specific set of moral values, and investigate the pragmatic validity of “Qeirat” in Iranian culture. Our findings suggest an additional moral foundation in Iran, above and beyond the five foundations identified by MFT. Specifically, qualitative studies highlighted the role of “Qeirat” values in Iranian culture, which are comprised of guarding and protectiveness of female kin, romantic partners, broader family, and country. Significant cultural differences in moral values are argued in this work to follow from the psychological systems that, when brought to interact with particular socio-ecological environments, produce different moral structures. This evolutionarily-informed, cross-cultural, mixed-methods research sheds light on moral concerns and their cultural, demographic, and individual-difference correlates in Iran.     

Coding and traceability in Iran

Transplantation has a long history in Iran. Cornea was the first tissue transplantation in 1935. The Central Eye Bank of Iran was established in 1991 and the Iranian Tissue Bank (ITB) in 1994. Now, there are also some private cell and tissue banks in the country, that produce different tissue grafts such as homograft heart valves, musculoskeletal tissues, soft tissues, cartilages, pericardium, amniotic membrane and some cell based products. There is not a separate legislation for tissue transplantation but the legal framework for tissue donation is based on the “Deceased or Brain dead patient organ transplantation” act (passed on April 6, 2000). For tissue banking there is no regulatory oversight by the national health authority. To increase the level of safety and considering the importance of effective traceability, each tissue bank has its own policy and terminology for coding and documentation without any correlation to others. In some cases tissue banks have implemented ISO based standards (i.e., ISO 9001) as a basic quality management system.     

New taxa ofRubiaceae-Rubieae from Iran

Asperula sect.Oppositifoliae is validated. 2 new species ofAsperula and 7 new species and 1 variety ofGalium from Iran are described, discussed in respect to their affinities and illustrated. 2 subspecies are raised to species rank.     

The birthrate drop in Iran

The recent steep decline in Iran's birthrate poses methodological and interpretive challenges insofar as statistical information on demographic factors cannot satisfactorily establish causalities or delineate processes of change. Our research suggests that this decline rests on the interplay of socio-cultural “idea” variables that augment factors of the developmental paradigm commonly used in population studies. Especially modernist ideas labeled “progress” in Iran have influenced reproductive behavior. Aiming to demonstrate the usefulness of idea-oriented qualitative research for understanding demographic dynamics represented quantitatively in the literature, we contribute to an explanation of a particular case as well as to demographic research methods.