OBJECTIVES:The survival rate of thalassemia patients has not been conclusively established, and the factors associated with survival remain unclear. This study aimed to determine the survival rate of thalassemia among patients in southern Iran and to identify the factors associated with mortality from thalassemia.METHODS:This retrospective cohort study was conducted based on a retrospective review of the medical records of 911 beta-thalassemia patients in 2014. Data analysis was conducted using the Kaplan-Meier method and Cox regression analysis.RESULTS:Overall, 212 patients (23.3%) died, and 26.8% had thalassemia intermedia. The 20-year, 40-year, and 60-year survival rates were 85%, 63%, and 54%, respectively. Both crude and adjusted analyses found that education, marital status, ferritin levels, and comorbidities were related to mortality.CONCLUSIONS:Sociodemographic and hematological factors were found to be significantly associated with the survival rate of thalassemia. Addressing these factors may help healthcare providers and physicians to provide the best possible care and to improve the survival rate.

Background and objective Ivermectin is a known anti‐parasitic agent that has been investigated as an antiviral agent against coronavirus disease 2019 (COVID‐19). This study aimed to evaluate the efficacy of ivermectin in mild COVID‐19 patients. Methods In this multi‐arm randomized clinical trial conducted between 9 April 2021 and 20 May 2021, a total of 393 patients with reverse transcription‐PCR‐confirmed COVID‐19 infection and mild symptoms were enrolled. Subjects were randomized in a 1:1:1 ratio to receive single‐dose ivermectin (12 mg), double‐dose ivermectin (24 mg) or placebo. The primary outcome was need for hospitalization. Results There was no significant difference in the proportion of subjects who required hospitalization between the placebo and single‐dose ivermectin groups (absolute difference in the proportions: −2.3 [95% CI = −8.5, 4.1]) and between the placebo and double‐dose ivermectin groups (absolute difference in the proportions: −3.9 [95% CI = −9.8, 2.2]). The odds of differences in mean change in severity score between single‐dose ivermectin and placebo groups (ORdifference = 1.005 [95% CI: 0.972, 1.040]; p = 0.762) and double‐dose ivermectin and placebo groups (ORdifference = 1.010 [95% CI: 0.974, 1.046]; p = 0.598) were not statistically significant. None of the six adverse events (including mild dermatitis, tachycardia and hypertension) were serious and required extra action. Conclusion Single‐dose and double‐dose ivermectin early treatment were not superior to the placebo in preventing progression to hospitalization and improving clinical course in mild COVID‐19.

Background. Using time series and spatiotemporal analyses, this study aimed to establish an Early Warning System (EWS) for COVID-19 in Fars province Iran. Methods. A EWS was conducted on (i) daily basis city-level time series data including 53 554 cases recorded during 18 February–30 September 2020, which were applied to forecast COVID-19 cases during 1 October–14 November 2020, and (ii) the spatiotemporal analysis, which was conducted on the forecasted cases to predict spatiotemporal outbreaks of COVID-19. Results. A total of 55 369 cases were forecasted during 1 October–14 November 2020, most of which (26.9%) occurred in Shiraz. In addition, 65.80% and 34.20% of the cases occurred in October and November, respectively. Four significant spatiotemporal outbreaks were predicted, with the Most Likely Cluster (MLC) occurring in ten cities during 2–22 October ( P < 0.001 for all). Moreover, subgroup analysis demonstrated that Zarrindasht was the canon of the epidemic on 6 October ( P = 0.04 ). As a part of EWS, the epidemic was triggered from Jahrom, involving the MLC districts in the center, west, and south parts of the province. Then, it showed a tendency to move towards Zarrindasht in the south and progress to Lar in the southernmost part. Afterwards, it simultaneously progressed to Fasa and Sepidan in the central and northwestern parts of the province, respectively. Conclusion. EWS, which was established based on the current protocol, alarmed policymakers and health managers on the progression of the epidemic and on where and when to implement medical facilities. These findings can be used to tailor province-level policies to servile the ongoing epidemic in the area; however, governmental level effort is needed to control the epidemic at a larger scale in the future.

Objective: we aimed to carry out an applied methodological tool, using Root-Cause Analysis (RCA), to determine the main causes of maternal mortality in Fars province, south of Iran, in 2014. Materials and methods: This is a case-series study and was conducted based on a careful examination of records and verbal autopsy with the family of the deceased person and their medical care team. Using RCA, quantitative dynamic modeling was done to display the overall impacts of different causes on maternal mortality. Finally, sensitivity analysis was done to determine the magnitude of contribution of each root-cause of maternal mortality. Results: Totally, all 10 maternal deaths with Maternal Mortality Rate (MMR) of 13.4 per 100.000 births, were recorded in the maternal surveillance system during 2014. The RCA results revealed that the root-causes of maternal mortality were ignorance and negligence (50%), delay in diagnosis (30%), delay in service provision in the first 24 hours after delivery (10%), and undesirable health care (10%). The results of sensitivity analysis in different scenarios revealed that medical negligence had the highest contribution to maternal mortality. Conclusion: Although maternal surveillance system stated some causes such as hemorrhage to be responsible for maternal deaths, the RCA showed that root-causes such as medical neglects had a fundamental role. Therefore, maternal mortality can be prevented by reforming the health care system and training all service providers, especially for high-risk mothers.

Objective: To investigate the trend of changes in Age-Specific Fertility Rate (ASFR), Total Fertility Rate (TFR), and Cohort Fertility Rate (CFR) in rural areas of Fars province, southern Iran during 1988-2012. Materials and methods: This cross-sectional study was conducted based on analyze fluctuations in fertility. Information about the number of births and mothers aged 15-49 years was collected. By calculating the ASFR, TFR, and CFR along with analyzing their patterns the trend of changes in fertility rate would be revealed. Finally, modeling and time series forecast of ASFR based on age groups was conducted using the SPSS software. Results: The TFR was estimated to be 4.21, 2.1, 1.76, 1.65, and 1.78 per thousand in 1992, 1997, 2002, 2007, and 2012, respectively. Moreover, CFR was 2.01, 1.54, 1.05, 0.54, and 0.13 for those born during 1972-1976, 1977-1981, 1982-1986, 1987-1990, and 1991-1995, respectively. Also the time trend of ASFR based on age groups showed a negative slope. Conclusion: The fertility followed a negative slope during 1992-2012, indicating their descending trend during these years. TFR = 2.1 was a standard population replacement rate in the societies. Therefore, continual decline of this rate during 1992-2012 could be a warning factor that requires planning for reform and precise evaluation.