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Multifactorial analysis of dietary patterns in healthy and coronary artery disease patients: brief report
Ali Maleki , Mahnaz Ashjaearvan , Ashraf Karimi ,
Volume 73, Issue 1 (4-2015)
Abstract
Background: The effects of consumption of nutrients on coronary artery disease (CAD) are widely observed. The aim of this study is to assess the exclusive Iranian dietary pattern on coronary artery diseases (CAD) and its risk factors. Methods: In this description-cross sectional study, 801 inhabitants of Borujerd City were included by random stratification method and a questionnaire regarding micro- and macronutrients for subjects over 35 years old from March 2011 to February 2012 was filed out. Of all the subjects consent to participate were prepared by volunteers. The complete description and a standard questionnaire to record demographic and socioeconomic status of people were taken. The prevalence of coronary artery disease and its risk factors determined Based on rose questionnaire and Monica questionnaire respectively. Results: In this study mean age of the subjects were 54.8±1.2 years, 388 male and 413 female. There was no meaningful relation between red meat consumption and coronary artery disease (P= 0.117). Nut consumption was higher in patients with CAD (P= 0.028). Use of fresh and cooked vegetables, dried fruit, animal oils cakes, french fries and some dairies are correlated with CAD (P< 0.05). However, artificially flavored soda in contrast to ordinary soda was not associated with coronary artery disease. Conclusion: Although there are some differences between dietary pattern in patient with coronary artery disease, nutritional attitudes are not significantly different in normal and CAD patients. However, according to the importance of diet in CAD, balancing these attitudes should be on the educational system high priority.
Assessment of background gamma radiation and determination of excess lifetime cancer risk in Sabzevar City, Iran in 2014
Akbar Eslami , Mohammad Hossien Saghi , Ayob Rastegar,
Volume 73, Issue 10 (1-2016)
Abstract

Background: Background gamma radiation levels vary in different locations and depended on many factors such as radiation properties of soil, building materials as well as construction types which human lives on it. People are always exposed to ionizing radiation, which could badly influence their health. The aim of this study was to evaluate the background gamma-ray dose rate and the estimated annual effective dose equivalent and determination of excess lifetime cancer risk in Sabzevar City, Iran.

Methods: The aim of this cross-sectional study was to determine the dose rate of background gamma radiation in outdoor an indoor areas, 26 stations were selected using the map of the Sabzevar City. The amount of gamma radiation was measured at 4 months (September to January) in 2014 year. The dosimeter used in this study was a survey meter, that is designed for monitoring radiation of x, gamma and beta rays.

Results: The obtained results show that there are significant differences between the indoor and outdoor exposures (P> 0.05). We did not observe significant differences between the time of sampling and sampling locations, (P<0.05). The minimum and maximum values of dose rate were found 66±20 nSvh-1 and 198±28 nSvh-1. The annual effective dose for Sabzevar residents was estimated to be 0.85 mSv and also the amount of excess lifetime cancer risk was estimated 3.39×10-3.

Conclusion: According to the results, the excess lifetime cancer risk and the annual effective dose for the Sabzavar City residents due to the background gamma radiation was higher than the global average (0.5 mSv). The epidemiological studies have been proposed to evaluate the risk of chronic diseases associated with natural radiation exposure among residents.


Risk factors of breast cancer in Dezful city of Iran: a case-control study
Behzad Jafarinia , Maryam Bahadorzai , Ali Delpisheh , Kourosh Sayehmiri , Mahdie Tavakoli ,
Volume 74, Issue 2 (5-2016)
Abstract

Background: Breast cancer is one of the most prevalent cancers among women and features increasing trends of incidence rates. Worldwide, yearly about 1.67 million of new cases and 522,000 of deaths from breast cancer are registered. The aim of this study was to determine the risk factors of breast cancer in women and to identify high risk groups.

Methods: In a case-control study, 170 women with breast cancer who were registered in cancer registration system from 2011 to 2015 at Dezful City, Iran, were compared with 170 healthy women with confirmation of mammography. After age matching of groups, the needed information about risk factors and demographic information including information, educational level, marital status, family history of breast cancer, age at menarche, parity, oral contraceptive use, age at first pregnancy, menopausal status, and age at menopause, breastfeeding, stress, abortion, alcohol use and smoking, hormone therapy and physical activity was collected by a questionnaire. The analysis of collected data was performed by using odds ratio and logistic regression model and SPSS software, version 16 (SPSS, Inc., Chicago, IL, USA). The statistical significance was set at a two-sided p-value of %5.

Results: The results of this study showed that, women with the family history [OR: 6.78 (95% CI: 2.15-21.41)] and women with the stress history [OR: 4.86 (95% CI: 2.46-9.59)] had higher risk of breast canser, while women with the history of having physical activity at least once a week [OR: 0.29 (95% CI: 0.13-0.65)] and women with the history breast feeding for 3 to 4 years [OR: 0.36 (95% CI: 0.16-0.81)] had lower risk of breast cancer.

Conclusion: It is recommended that the mentioned risk factors and protective factors be considered in first and second level (screening) of preventive programs.


A review on epidemiology of Clostridium difficile infection
Zahra Esfandiari , Mohammad Jalali , Leila Safaeian, J Scott Weese ,
Volume 74, Issue 5 (8-2016)
Abstract

Clostridium difficile (C. difficile) is an important factor in the development of the gastrointestinal diseases because of irrational antibiotic prescription and antimicrobial resistance. In the past, this bacterium was introduced as an agent of the infection in the hospitals called "hospital acquired Clostridium difficile infection". This infection is a main cause of morbidity and mortality internationally. But changing in the epidemiology of the infection was observed in recent years. People not taking antibiotics as well as any contact with the clinical system were hospitalized due to the infection named "Community-Associated Clostridium difficile infection". Furthermore, the hypervirulent strains of C. difficile were identified outside of the health care facilities in different sources such as environment, animals and food products. Today the role of C. difficile has not been confirmed as a zoonotic agent or foodborne pathogen. Taking into account, it should be taken attention to the sensitive individuals such as pregnant women, elderly and children for the consumption of the contaminated food products with C. difficile spores and probable cause of the infection in these individuals. For this purpose, presentation of the guidelines or the prevention strategies for the transmission of bacteria in the society as well as the healthcare facilities is important. In this review study, the history, the risk factors of disease and the reports of infection in the healthcare facilities and outside of this environment in Iran were discussed. Finally, we supposed that based on the isolation of C. difficile with different genetic profile in Iran in comparison with international ribotypes, the existence of native strains leading to the infection in the community and the healthcare facilities is possible. This hypothesis shows the significance of regional differences in the epidemiology and microbiology of disease. In addition, according to the present reports on the irrational prescription of the antibiotics in our country, it seems that C. difficile infection is increasing but any continuous monitoring is not being occurred for the supervision in Iran. Approving these hypotheses need to the careful and continuous assessment besides comprehensive examination of molecular epidemiology of disease in the organizations related to the health in Iran.


Risk factors of nonalcoholic fatty liver disease: a case-control study
Zeinab Moradi Kohnaki , Khairollah Asadollahi, Ghobad Abangah , Kourosh Sayehmiri ,
Volume 74, Issue 9 (12-2016)
Abstract

Background: Considering the high incidence and prevalence of nonalcoholic fatty liver disease (NAFLD) in the Iranian society and the limited number of studies to investigate its associated risk factors, the current study was designed to identify any relevant risk factor of this disease.

Methods: The present case-control study was performed among 150 nonalcoholic fatty liver disease patients and 150 normal liver participants who attended to gastroenterology clinics in Ilam city, Iran during 2014-2015. All demographic data, clinical trials and health behaviors associated with lifestyle such as nutritional status, smoking, physical activities were collected and compared between two groups.

Results: Among a total of 300 participants in the current study, the male female ratio was 46.54% and the mean±standard deviation of all participants was 42.13±12.15 years. The mean values of total cholesterol, triglycerides (TG), low density lipoprotein (LDL), alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were significantly higher in cases than controls group (P< 0.0001). A significant relationship was revealed between positive familial history, marriage, and low physical activities with NAFLD (P< 0.05). In the patient's group, consumption of red meat was significantly higher and dairy intake was significantly lower compared to the control group (P< 0.05). Using the multivariate logistic regression analysis, the adjusted odds ratio for variables of waist circumference, triglyceride, ALT and body mass index (BMI) were statistically significant [1.11, (1.04-1.18); 2.58, (1.01-6.67); 5.34, (1.84-15.52) and 7.28,) 1.89-27.99) respectively] (P< 0.05). Also, a significant association was observed among the variables of ALT, AST and BMI with the severity grade of NAFLD (P< 0.05).

Conclusion: The results of this study showed that waist circumference, BMI, serum level of ALT and TG concentrations can predict the occurrence of non-alcoholic fatty liver disease. BMI, ALT, and AST seem to be associated with the ultrasonography staging of liver in NAFLD. Therefore, these parameters could be used to predict the ultrasonography staging of liver in these patients.


Frequency of major and minor risk factors associated with jaundice in hospitalized newborns
Hassan Boskabadi, Maryam Zakerihamidi, Fatemeh Bagheri,
Volume 75, Issue 2 (5-2017)
Abstract

Background: Hyperbilirubinemia is the most common cause for readmission in the early neonatal period 5 to 36 percent of healthy term infants who are discharged from hospital are again hospitalized due to severe to moderate hyperbilirubinemia. Detection of major and minor risk factors associated with neonatal jaundice helps to identify high-risk infants and prevent neonatal jaundice. This study was performed aiming to evaluate the major and minor risk factors associated with jaundice in infants hospitalized.

Methods: This cross-sectional study was performed on 2207 term infants (<15 days) with hyperbilirubinemia (>15 mg/dl) in neonatal clinic or emergency unit or neonatal intensive unit, of Mashhad Ghaem Hospital, Iran, from April 2010 to May 2016. The jaundice of infants was confirmed by the pediatrician and laboratory tests. Then the researcher-made questionnaire containing maternal information and neonatal characteristics was completed. Values were expressed as mean±SD. Student t-test and Mann-Whitney test were used as appropriate. P-value less than 0.05 was considered significant.

Results: Sixty one percent of neonates had major risk factors and 80% of neonates had minor risk factor for jaundice. For neonatal jaundice, the most common major risk factors were significant weight loss (27.5%), jaundice visible in the first 24 hours (16.3%), history of treatment with phototherapy and exchange transfusion in sibling (14.8%), Gestational age of 35 to 36 week (9.9%), ABO incompatibility (9.2%), RH incompatibility (3.3%) and G6PD deficiency (3.33%), and the most common minor risk factors were age over 25 years (51.4%), male (49.7%), history of hyperbilirubinemia in sibling (22.3%), diabetic mother's infants (1.5%).

Conclusion: The major risk factors for neonatal hyperbilirubinemia were significant weight loss, jaundice visible in the first 24 hours, history of treatment with phototherapy and exchange transfusion in sibling, gestational age of 35 to 36 week, ABO incompatibility, RH incompatibility and G6PD deficiency.

TOX3 Gene polymorphisms and breast cancer; effects and implications of the variations: review article
Amir Tajbakhsh, Fahimeh Afzal Javan , Mostafa Fazeli, Mahdi Rivandi, Mohammad Mahdi Kushyar, Mohammadreza Nassiri, Alireza Pasdar,
Volume 75, Issue 5 (8-2017)
Abstract
Breast carcinoma is the most common cause of cancer mortality among women globally. Primary and secondary prevention through avoiding known risk factors, screening for early detection of tumors with different methods as well as timely treatment, can be effective in reduction of the burden of this devastating disease. This can in turn prevent death and also increase survival in patients with breast cancer. Both environmental and genetic factors are involved in the pathogenesis of breast cancer. Multiple genetic factors can influence the risk and development of breast cancer. Identification of genetic variants including single nucleotide polymorphisms (SNPs), which are associated with the risk of breast cancer development, are mostly done through genetic association studies. It is demonstrated that SNP allele frequencies vary amongst different populations. It has been shown that genetic risk factors like variations in TOX high mobility group box family member 3 (TOX3), which affect the liability for neoplasm, play an important role in the development of breast cancer. Although TOX3 is expressed mainly in the brain, its expression in other tissues especially breast has also been reported. TOX3 maps to chromosome 16q12 and encodes the nuclear high-mobility group (HMG)-box. It has calcium (Ca2+)-dependent transcriptional activities and is a co-factor of cAMP response element (CRE)-binding protein (CREB) and CREB-binding protein (CBP). TOX3, activated with Ca2+, is related with activation of the promoter of some other genes including BCL2 and C3 complement and also CITED1 gene expression. It also induces activation of the c-fos promoter and therefore its expression. Genome-wide association studies (GWAS) in different populations including European, Asian and African-American have demonstrated that a SNP near its 5ʹ end and the promoter of TOX3 gene appears to be significantly associated with breast cancer susceptibility. Furthermore, breast cancer–associated SNPs lead to enhanced FOXA1 bindings and in turn, a reduction in TOX3 gene expression. This review has highlighted the importance of TOX3 function, SNPs and its association with breast cancer risk and also its potential effects on breast cancer treatment; TOX3 plays dual and somehow conflicting roles in cancer initiation and progression which remains to be further investigated.

A review of the etiology and biomarkers of pancreatic cancer, with emphasis on the role of diabetes: review article
Akram Pourshams, Bahram Kazemi , Sima Kalantari ,
Volume 75, Issue 11 (2-2018)
Abstract
Cancer is the major cause of death in the world and the rate of mortality is higher in developed countries. Therefore, lifestyle could be effective in promoting the cancer. The pancreatic tumors, are 8th cause of mortality due to cancer, which have several types, among them ductal adenocarcinoma is the most common and includes 85% of cases. Since, it is almost impossible to diagnosis the tumor in early stages of the disease, it contributes to high rates of mortality, although if it diagnosis in early stage and the surgery performed for them only 10-20% of patients will be survived. Metastasis occurs when the tumor is smaller than 2 cm in size and because the pancreas is located in the depth of abdomen, typically, it happens after tumor is spread to other organs. A combination of medical imaging, blood tests, and examination of tissue samples are usually made for diagnosis and based on the cancer stage, surgery, radiotherapy and chemotherapy are chosen as treatment options. Some rare genetic variations can cause pancreatic cancer and about 5-10% of cases are linked to inherited genes. However, major risk factors are including age, obesity, tobacco smoking and diabetes. Smoking counts for about 25% of cases, and the diabetes is the main symptoms of pancreatic cancer, which observed in about 80% of cases. But, it is still unclear whether diabetes is a predisposing factor in pancreatic cancer, or the outcome of tumor progression. Recent studies have shown that, diabetes is unique in pancreatic cancer which is not related to common types. Currently, CA 19-9 is the only reliable tumor marker for pancreatic cancer that its frequency also increases in non-bad conditions, such as pancreatitis and obstructive jaundice, so is not sensitive and specific enough for diagnosis of this cancer. Due to researches continue to find more specific markers. In this review the etiology of pancreatic cancer, diabetes associated with this type of cancer and significant biomarkers for diagnosis will be considered.

Comparison of hepatitis C virus risk factors in genotypes 1a and 3a
Mansour Bahardoust, Shahram Agah , Arash Sarveazad , Amir Hossein Faghihi , Asrin Babahajian , Seyed Ali Hashemi Kiapay , Farnaz Farsi , Marjan Mokhtare,
Volume 76, Issue 3 (6-2018)
Abstract
Background: One of the most important causes of chronic liver disease is hepatitis C virus (HCV), which causes liver cirrhosis and hepatocellular carcinoma. To control the prevalence of the disease, knowledge and information in risk factor of HCV are required. The aim of this study was to compare the risk factors of infection between HCV patients with genotypes 1a and 3a.
Methods: This is an observational analytical study. HCV patients who referred to the clinic of hepatology, Rasoul-e-Akram University Hospital from July 2015 to July 2017, were assigned to the genotype 1a and 3a. Demographic (age, sex, family history), clinical (cirrhosis, hepatocellular carcinoma) and laboratory data, history of intravenous drug and alcohol usage, and history of imprisonment were gathered and compared between two groups. All the patients completed the informed consent form. Data analysis was performed by SPSS software, version 22 (IBM SPSS, Armonk, NY, USA). P value less than 0.05 was considered statistically significant.
Results: Overall, 97 HCV patients were included in this study. Mean age was 45±12 years and 78 (80%) of patients were male. Among them, 58 (60%) and 39 (40%) had genotype 1a and 3a. respectively. History of injection drug usage was recorded in 34/39 (87%) of patients with genotype 3a, and significantly higher in genotype 3a as compared to genotype 1a [OR adj: 3.1, CI (1.3-6.2)]. Also, in this study, genotype 3a was significantly recorded in younger patients [OR adj: 1.7, CI (1.2-4.1)]. However, cirrhosis and hepatocellular carcinoma was more common in patients with genotype 1a as compared to genotype 3a [OR adj: 2.05, CI (1.6-5.4) and OR adj: 2.8, CI (1.3-5.7)] respectively.
Conclusion: According to the results of this study, hepatitis C virus transmission risk factors differed in genotypes 3a and 1a. Genotype 3a is found among young patients with a history of intravenous drug usage and genotype 1a in patients with cirrhosis and hepatocellular carcinoma.

Balance in the elderly and its determinants
Mehdi Safarpour, Seyed Reza Hosseini , Hojjat Zeraati , Ali Bijani , Akbar Fotouhi ,
Volume 76, Issue 5 (8-2018)
Abstract
Background: With aging, muscles strength decrease. Balance disorder is one of the common aging problems which can cause falls and serious injuries. The purpose of this study was to present a model along with the determinants of balance status in the elderly.
Methods: This cross-sectional study is part of a cohort study, "investigation of the health status of elderly in Amirkola City", which was performed on 1616 old people aged≥ 60 years, (response rate 72 %). The baseline data of this study were collected in the Center for Social Determinants of Health (SDH) Research Centre of the Babol University of Medical Sciences during March 2011 to July 2012. We considered the age, sex, physical activity, quadriceps muscle strength, daily activity, serum level of vitamin D, BMI, number of comorbidities and orthostatic hypotension as independent variables. Using the results of Berg balance test, the balance status of participants (as dependent variable) was categorized into two groups: score between 41-56 as normal (low risk of fall) and score < 41 as balance disorder (medium or high risk of fall). Then, the association of independent variables with balance status were evaluated in the logistic regression model.
Results: The mean and standard deviation of participants' age was 69.37±7.6 years, 54.7% of them were men and 7.5% of them had balance disorder. The odds ratio of medium or high falls in women to men, the number of comorbidities, having strong quadriceps to weak muscles, seniors aged 80 years and over, to 60-69, seniors with high physical activity to low physical activity, daily activities were (OR=2.1, 95%CI: 1.0-4.1), (OR=1.7, 95%CI: 1.0-2.9), (OR=0.05, 95%CI: 0.0-0.4), (OR=5.0, 95%CI: 2.3-10.6), (OR=0.3, 95%CI: 0.1-0.6), (OR=14.4, 95%CI: 3.4-60.4), respectively and statistically significant. The odds ratio of fall for vitamin D, orthostatic blood pressure and BMI variables did not show any statistically significant differences. The results of the analysis showed that the balance in all age groups in men was better than women.
Conclusion: Weak quadriceps, aging, being a woman and having comorbidities are the most important risk factors of balance disorder in the elderly.

Designing an intelligent system for diagnosing type 2 diabetes using the data mining approach: brief report
Rohollah Kalhor , Asghar Mortezagholi , Fatemeh Naji, Saeed Shahsavari, Mohammad Zakaria Kiaei ,
Volume 76, Issue 12 (3-2019)
Abstract
Background: Diabetes mellitus has several complications. The Late diagnosis of diabetes in people leads to the spread of complications. Therefore, this study has been done to determine the possibility of predicting diabetes type 2 by using data mining techniques.
Methods: This is a descriptive-analytic study that was conducted as a cross-sectional study. The study population included people referring to health centers in Mohammadieh City in Qazvin Province, Iran, from April to June 2015 for screening for diabetes. The 5-step CRISP method was used to implement this study. Data were collected from March 2015 to June 2015. In this study, 1055 persons with complete information were included in the study. Of these, 159 were healthy and 896 were diabetic. A total of 11 characteristics and risk factors were examined, including the age, sex, systolic and diastolic blood pressure, family history of diabetes, BMI, height, weight, waistline, hip circumference and diagnosis. The results obtained by support vector machine (SVM), decision tree (DT) and the k-nearest neighbors algorithm (k-NN) were compared with each other. Data was analyzed using MATLAB® software, version 3.2 (Mathworks Inc., Natick, MA, USA).
Results: Data analysis showed that in all criteria, the best results were obtained by decision tree with accuracy (0.96) and precision (0.89). The k-NN methods were followed by accuracy (0.96) and precision (0.83) and support vector machine with accuracy (0.94) and precision (0.85). Also, in this study, decision tree model obtained the highest degree of class accuracy for both diabetes classes and healthy in the analysis of confusion matrix.
Conclusion: Based on the results, the decision tree represents the best results in the class of test samples which can be recommended as a model for predicting diabetes type 2 using risk factor data.

Incidence, risk factors and prevention of herpes zoster: review article
Soheila Nasiri Nasiri, Reza Mahmoud Robati , Mehdi Hedayati, Marjan Khazan ,
Volume 77, Issue 1 (4-2019)
Abstract
Herpes zoster (Shingles; Zona) is an acute infectious skin disease that is caused by the reactivation of varicella zoster virus (VZV). After the initial infection (chickenpox) or vaccination, the virus remains inactive or latent in the dorsal root ganglia (DRG); when decreasing cell mediated immunity (CMI) occurs, the virus is reactivated from a latent phase to a lytic phase and frequently replicated in the dorsal ganglion cells then move to the sensory nerves into the skin and causes herpes zoster, which is typically characterized by painful neuralgia and unilateral dermatomal vesicular rash that normally lasts 3 to 5 weeks. The most common complication of herpes zoster is chronic pain owing to postherpetic neuralgia (PHN), which is estimated to occur in approximately 20% of the people aged 50 and over. Although herpes zoster is rarely fatal, the pain related to the acute phase of herpes zoster and subsequent PHN can cause psychological distress, physical disability, impaired sleep and consequently negatively affect the quality of life that can be significantly reduced by all of these occurrences. Due to increasing trend in the incidence of herpes zoster and increasing older people population, it will be expected that herpes zoster and subsequent PHN cause a significant economic burden to the healthcare system, the government, and families along with reducing the quality of life. The average lifetime risk of herpes zoster is estimated to be approximately 30% in developing countries. Although the risk of herpes zoster significantly increases with increasing age and diminished immune system function, any factor impacting on VZV-specific humoral and cellular immune responses may affect the risk of herpes zoster. This paper is provided an overview of the incidence and potential risk factors of herpes zoster with emphasis on the role of micronutrients and their deficiencies in the impaired immune system function. Also, the common method for prevention by zoster vaccine and the role of micronutrients in the efficacy of vaccination are shown.

Spatial structure of breast cancer using Poisson generalized linear mixed model in Iran
Mansour Rezaei , Abdullah Jalilian , Behzad Mahaki , Maryam Veismoradi ,
Volume 77, Issue 3 (6-2019)
Abstract
Background: Breast cancer is one of the most common diseases in women and causes more deaths rather than other cancers. The increasing trend of breast cancer in Iran makes clear the need of extensive breast cancer research in this area. Some studies showed that in the variety countries and even in the different areas in one country has different risk of breast cancer incidence and this is a reason that there is a correlation between region of life and risk of breast cancer. The purpose of this study was to determine the spatial structure associated with the incidence of breast cancer based on statistical models and identification of areas with high incidence of breast cancer in Iran.
Methods: This ecological study was conducted in Kermanshah University of Medical Sciences, Iran, from February to July 2018. Data on breast cancer patients in all provinces of Iran (30 provinces) were investigated since 2004 to 2009. Risk factors in this study included fruit and vegetable consumption, physical activity, overweight or obesity, and human development index. In this study, we have used routine and spatial Poisson's generalized linear mixed models for data analysis.
Results: In both routine and spatial models, direct and significant correlation was found between the incidence of breast cancer and the human development index (P<0.05). In addition to human development index, overweight or obesity factors were also had direct and significant relationship to the incidence of breast cancer in the spatial Poisson's generalized linear mixed model (P<0.05). In the spatial Poisson's generalized linear mixed model with correlation structure of Besag Yorg Molie (BYM), two provinces of Gilan and East Azerbaijan had the highest risk of breast cancer incidence and province of Kohgiluyeh and Boyer Ahmad had the lowest risk of breast cancer incidence.
Conclusion: The results showed that the distribution of breast cancer incidence in Iran has a spatial structure. That is, the adjacent provinces have similar incidences of this disease.

The evaluation of clinical symptoms and underlying factors in infected patients with Covid-19
Mina Jaafarabadi, Maryam Bagheri, Mamak Shariat, Khadijeh Raeisie, Athareh Ranjbar, Faezeh Ghafoori, Fedyeh Haghollahi,
Volume 78, Issue 10 (1-2021)
Abstract
Background: The pandemic of Covid-19 is spreading around the world. Extensive research is needed to focus on identifying the underlying causes of the disease. This study aimed to investigate the clinical and etiological symptoms of the Covid-19.
Methods: This descriptive-analytical study, conducted on 510 infected patients in the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2019 to June 2020 for A period of Four months during the first wave of Covid-19 pandemic. The method of selecting patients was continuous and was divided into two groups of 179 inpatients and 331 outpatients based on lung scan and clinical symptoms. Demographic information, clinical signs, and risk factors were collected through a questionnaire and the data were statistically analyzed.
Results: Symptoms such as fever, chills and cough were reported in the majority of patients in both groups, to such an extent that they were present in 176 (52%) of outpatients and in 101 (59%) of inpatients. The mean hemoglobin measured in hospitalized patients was lower, P=0.001). Vitamin D3 supplementation was reported in 30% of outpatients and in 16.5% of hospitalized patients (P=0.001). This means that vitamin D3 consumption is higher in the outpatient group.
The results showed that Chronic diseases such as hypertension was 4.9 times more likely (OR=4.9, 95% CI2. 433-10.25, P=0.0001) and anemia with 22 times more likely (OR=22.905, 95% CI9. 355-56.083, P=0.000) to be effective in the severity of the disease. It seems Vitamin D3 intake has a supportive effect on reducing the severity of the disease and decreases the risk of the disease getting worse.
Conclusion: Fever, chills and cough were important symptoms in identifying infected patients with Covid-19. According to the results of the present study and the findings of other studies, the supportive effect of vitamin D3 in reducing the severity of infectious diseases should be considered. Clinical trials with appropriate sample size are recommended to investigate the functional role of this vitamin in Reducing the severity of viral diseases of the respiratory tract.
 

Factors predicting a positive pregnancy screening test at first trimester
Mahboobeh Shirazi, Elham Feizabad, Nesa Rajabpoor Nikoo , Fatemeh Rahimi Sharbaf, Maedeh Rahmanzadeh,
Volume 78, Issue 11 (2-2021)
Abstract
Background: For every pregnant woman, it is possible to have a child with chromosomal abnormalities. Although this possibility is not very high, by performing screening tests and considering the mother's background factors, we can largely realize the real extent of this possibility.
Many comorbidities (like high blood pressure, diabetes, and obesity) and high-risk exposures (like alcohol consumption) seem to have an important role in the development of chromosomal abnormalities. This study aimed to determine the predictive factors of a positive first-trimester screening test in the pregnant women.
Methods: This case-control study was done on pregnant women, who were referred to Yas Hospital for their first-trimester screening tests between April 2018 and February 2020. Of those who had positive screening test results, only ones with abnormal biochemical tests, were included in the study regardless of nuchal translucency (NT) examination results and were considered as cases, and the women with normal screening test results were considered as controls.
Results: Totally 960 pregnant women (760 controls and 200 cases) participated in the study. The mean age of the subjects was 31.07±0.17 years old with a minimum age of 17 and a maximum age of 45. The averge age of case group women was 33.57±0.40 years and this was 30.41±0.18 years in control group.
This study indicated that maternal age (P<0.001) and the number of pregnancies in the case group are significantly (P<0.001) higher than the control group. Also, having a history of miscarriage (P<0.001), having a history of infertility (P<0.001), and having hypothyroidism (P=0.030) are significantly more common in the case group. The frequency of intrauterine growth failure (P=0.003) and neonatal hospitalization (P<0.001) were also significantly higher in the case group.
Conclusion: Despite recent advances in the prenatal field, the accuracy of screening tests may still vary depending on maternal age and other existing characteristics. Hence, it seems considering the mother's background characteristics are important just the same as the screening test results.

Predictive factors of deep vein thrombosis in patients admitted to intensive care unit
Hossein Mahjobipoor, Mojtaba Rahimi-Varposhti , Hamidreza Shetabi , Soheila Heidari,
Volume 78, Issue 12 (3-2021)
Abstract
Background: Because deep vein thrombosis (DVT) is one of the most common problems in the intensive care unit, it may lead to complecating the patient's general condition. This study aimed to investigate the predictive factors of DVT in patients admitted to the intensive care unit (ICU) of Amin hospital in Isfahan.
Methods: In this retrospective study, all the records of patients admitted to the ICU ward of Amin Hospital located in Esfahan, from April 2015 to March 2018, were investigated and from all patients with DVT, 20 records were extracted and 40 cases of patients without DVT were also randomly selected. Information such as age, sex, Wells score, Apache score, nutritional status, clinical parameters, cause of hospitalization, length of stay, ICU induced disease and treatment were extracted from these records and compared between both groups with and without DVT.
Results: From 2000 patients admitted to the ICU ward, 20 cases were developed DVT. The age of patients in the DVT group was significantly higher (P=0.008). Factors such as increased Wells score, increased length of stay in the ICU, having ICU induced internal diseases and pneumonia increased the chance of DVT incidence as 18.75, 1.92 and 2.75 and 2.28 times, respectively and the increase of potassium level and use of heparin bandage for treatment reduced the chance of DVT by 2.31 and 2.55 times, respectively (P<0.05).
Conclusion: In the general intensive care unit, the incidence of deep vein thrombosis was higher in internal ward patients. Pneumonia was the most common disease associated with deep vein thrombosis and the risk of deep vein thrombosis was higher in the anemic patient. Patients with upper limited normal levels of potassium were less likely to develop deep vein thrombosis. It seems that potassium in the upper limit of normal reference can play a protective role against deep vein thrombosis. Further studies with larger sample sizes are suggested.

Studying the epidemiological and clinical features of neck masses in Kerman, Iran
Mohammad Ali Damghani , Fatemeh Fani Molky , Soheil Motamed ,
Volume 79, Issue 6 (9-2021)
Abstract
Background: Neck mass is one of the most common clinical findings in all age groups. Differential diagnosis of masses includes a range of pathologies from congenital to infectious or neoplasm. Understanding the risk factors of neck masses can help us to assess them properly. The purpose of this study is to obtain the epidemiological and clinical features of different neck masses in Kerman, Iran.
Methods: This research was a descriptive, retrospective and cross-sectional study. 120 Patients that have been biopsied from neck masses during March 2014 to March 2018  in the otorhinolaryngology department of Shafa hospital of Kerman (referral center of otorhinolaryngology disease of southeastern Iran), were the participants of the study. Data regarding age, sex, history of addiction, smoking and definite pathologic diagnosis were collected and analyzed with SPSS 20th version.
Results: Of 120 cases, 57.5 % were male and 42.5% were female. In the malignant masses group, the male to female ratio was 4.1 to 1. The average age of patients was 39.44 years old. From them, 20.83 percent had a history of smoking but 79.17 percent had never experienced smoking. In addition, 77.5% of the patients have not experienced opium consumption and 22.5% were addicted to opium regularly. There was a significant relationship between smoking and opium consumption and the incidence of malignant cervical masses (P<0.05). In the pathological study, inflammatory and infectious masses with 48.33 percent were in the head of pathology; malignant neoplasm with 25 percent, benign neoplasms with a prevalence of 12.5 percent and congenital masses with a prevalence of 9.7 percent were in the next ranks.
Conclusion: In this study, we investigated the epidemiological and clinical features of neck masses in Kerman. It is obvious that smoking is an important risk factor for neck mass malignancies. Also, the present study revealed that the incidence of malignant tumors increased with age.

Evaluation of common risk factors for cholangiocarcinoma in patients referred to Firoozgar Hospital, Tehran, Iran: a cross-sectional study
Amirhosein Faraji , Mehdi Nikkhah, Masoume Pouladi, Farhad Zamani, Seyed Vahid Mahmudi, Khatereh Yaghubzadeh Getabi ,
Volume 79, Issue 8 (11-2021)
Abstract
Background: Cholangiocarcinoma is a cancer of the bile duct epithelium that originates from the bile ducts inside or outside the liver. Although this tumor is not common, its mortality rate is high. This tumor accounts for about 3% of all gastrointestinal malignancies. Many patients are being detected when the disease has spread. Evaluating risk factors affecting the incidence of cholangiocarcinoma is very important to avoid exposure to them. Therefore, this study was performed to evaluate the risk factors for cholangiocarcinoma in a population in Iran.
Methods: This was a descriptive cross-sectional study. It was performed on 276 patients with cholangiocarcinoma who had been referred to Firoozgar Hospital affiliated with the Iran University of Medical Sciences in Tehran from March 2020 to February 2021. Demographic information, family and personal history, social history (tobacco or drug use) and blood group of patients were extracted from their files. SPSS version 16 was used for data analysis. A P-value below 0.05 was considered statistically significant.
Results: The mean±SD age of patients was 65.97±13.07 years, of whom 65.6% were male and 34.4% were females. The most common site of cholangiocarcinoma was the distal part of the bile ducts and the most common blood group was O+. The main manifestations were jaundice and pruritus. Among the risk factors, the most common ones were smoking, high blood pressure, history of gallstones, opium use, history of cancer of other systems in the family, history of cholecystectomy and diabetes mellitus. While, the lowest prevalence of risk factors was related to heroin use, IBD, Gallbladder polyps, pancreatitis and alcohol consumption. None of the patients in our study had a history of viral hepatitis or PSC.
Conclusion: This was a cross-sectional study and only in the group of cholangiocarcinoma patients, therefore, larger prospective studies are recommended to examine underlying mechanisms of malignant transformation in the biliary tree.

Determining the effect of sun exposure and physical activity on the incidence of primary progressive multiple sclerosis
Hasan Asadi Gandomani , Abdorreza Naser Moghadasi , Mohammad Ali Sahraian , Sharareh Eskandarieh,
Volume 79, Issue 12 (3-2022)
Abstract
Background: The onset of primary progressive multiple sclerosis (PPMS) can be triggered by sun exposure and physical activity. The present study aimed to determine the risk of sun exposure and physical activity in PPMS development.
Methods: The case-control study recruited PPMS cases and healthy controls from the general population from September 2019 to September 2020 in Tehran, Iran. The selection of sex-matched controls from the same source population of cases was performed. Sun exposure was assessed in terms of exposure time in two age groups of 13-19 years and over 20 years in winter and summer.
Results: This study examined 146 PPMS cases and 294 controls. The sun exposure in summer in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.68 (CI=0.57-0.82)). This relationship was also observed in the groups of men (OR=0.55 (CI=0.40-0.74)) and women (OR=0.70 (CI=0.53-0.91)). Exposure to sunlight in winter in the age group 13-19 was negatively associated with the incidence of the disease (OR=0.28 (CI=0.19-0.42)). In the group over 20 years, sun exposure was negatively associated with disease incidence in summer (OR=0.49 (CI=0.36-0.66)). Exposure to sunlight on average in winter in the age group over 20 years was negatively associated with the incidence of the disease (OR=0.14 (CI=0.07-0.28)) which in the male group OR=0.12 (0.04-0.32)) and women (OR=0.06 (CI=0.02-0.21)) were seen. Regarding physical activity, only physical activity above 4000 MET per week in the group of women was negatively associated with the incidence of the disease (OR=5.30 (CI=1.05-26.59), but in other groups, this negative relationship was not observed.
Conclusion: Exposure to sunlight in winter and summer had a negative relationship with the incidence of the disease. Physical activity was only negatively associated with the incidence of the disease in very high doses and women.
 

Ten-year prevalence survey of strongyloides stercoralis in patients referred to Rouhani hospital during 2011-2020 years: a brief report
Hossein Ghorbani, Mohammad Ranaee, Alireza Firouzjahi, Zahra Ahmadnia, Samaneh Rouhi, Farzane Jafarian, Rouzbeh Mohammadi Abandansari , Somayeh Ahmadi Gorji,
Volume 80, Issue 5 (8-2022)
Abstract
Background: Infection with Strongyloides stercoralis is common in tropical and subtropical regions. To prevent and treat these diseases, information on the distribution and frequency of these parasites in different geographical areas is needed. Due to the importance of diseases in the northern provinces of Iran, the present study was performed to determine the prevalence of Strongyloides stercoralis.
Methods: From April 2011 to March 2020, stool samples from patients who were referred to Rouhani hospital in Mazandaran province, Babol, were gathered. For stool samples, microscopic detection was performed immediately using the wet expansion method, followed by a formal-ether concentration process. Based on the sample size calculation, the minimum number of patients with Strongyloides stercoralis infection was considered to be 380 patients from the years 2011-2020. Mean and standard deviation indices were used to describe quantitative data and numbers and percentages were used to describe qualitative data.
Results: Out of the total number of 39,800 archived patient files that were reviewed, a total of 420 (1.05%) patients were confirmed for the presence of Strongyloides stercoralis in their feces. The age range of patients was 3 to 89 years. The population of male patients (249 patients) was higher than females (171 patients). In patients with positive Strongyloides stercoralis, disease symptoms were positive in 206 patients and negative in 214 patients. The most common underlying disease in patients was abdominal pain (220 patients). 271 patients received steroids.
Conclusion: Strongyloides stercoralis infection was detected in the northern region of Iran. The prevalence of this parasite was higher in men, the elderly, and people with underlying comorbidities. These results can be used to identify and compare areas where the prevalence of infection is higher. Therefore, revealing the effect of Strongyloides stercoralis infection on public health makes the need for in-depth clinical and diagnostic studies important. People with chronic diseases, whether symptomatic or asymptomatic, should be screened for parasitic diseases.

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