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Sara Ayazian Mavi,1 Mohammad Hossein Modarressi,2 Mehdi Mohebali,1,3 Saeedeh Shojaee,1 Hojjat Zeraati,4 Aref Teimouri,1,5 Hossein Keshavarz1,31Department of Medical Parasitology and Mycology, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Medical Genetics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; 3Center for Research of Endemic Parasites of Iran, Tehran University of Medical Sciences, Tehran, Iran; 4Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 5Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, IranBackground: Toxoplasmosis, a protozoan parasitic disease caused by Toxoplasma gondii, has been a serious human and veterinary medicine problem with global distribution. In the current study, we assessed immunogenicity and protective efficiency of a novel dual-promoter DNA vaccine, harboring SAG1 and GRA7 genes, from RH strain of Toxoplasma gondii (T. gondii) with or without CpG-ODN as adjuvant in a murine model.Methods: BALB/c mice were immunized intramuscularly with pVitro-SAG1-GRA7 alone and pVitro-SAG1-GRA7 with CpG-ODN three times at three-week intervals. Enzyme-linked immunosorbent assay (ELISA) was used to assess total IgG, IgG1 and IgG2a antibodies and gamma interferon (IFN-γ) and interleukin-10 (IL-10) cytokines in mice sera. Four weeks post final vaccination, MTT assay and lethal challenge-infection with 1×103 tachyzoites of T. gondii RH strain were carried out to assess stimulation index (SI) and mice survival time, respectively.Results: The IgG levels in mice immunized with multicomponent vaccines, including pVitro-SAG1–GRA7 alone and pVitro-SAG1–GRA7 with CpG-ODN, were significantly higher than those in control mice or single-gene DNA-vaccinated ones (P

Saeed Akhlaghi,1 Maryam Sahebari,2 Mahmoud Mahmoodi,1 Mehdi Yaseri,1 Mohammad Ali Mansournia,1 Houshang Rafatpanah,3 Hojjat Zeraati1 1Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; 2Rheumatic Diseases Research Center (RDRC), Mashhad University of Medical Sciences, Mashhad, Iran; 3Inflammation and Inflammatory Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Purpose: One of the most important long-term side effects of therapy for rheumatoid arthritis (RA) is the elevation of liver function tests, with earlier studies reporting an elevation of more than 1× the upper limit of normal (>1 × ULN). The current study expands the literature by comparing the trends of transaminase changes caused by conventional and biologic disease-modifying antirheumatic drugs (DMARDs).Patients and methods: The drug categories examined were methotrexate (MTX) and all other nonbiologic DMARDs. Where RA patients exhibited inadequate response to conventional DMARDs (cDMARDs), we added biologic DMARDs (bDMARDs) to the treatment. We compared the trend of changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the patients receiving MTX with the trend observed in the patients whose treatment encompassed both bDMARDs and MTX. The comparison was conducted using random intercept models, which are a type of linear mixed effects model.Results: This work involved 512 RA patients (MTX: 450, MTX + infliximab [INF]: 26, MTX + etanercept [ETA]: 36), whose ALT and/or AST levels were measured in 1,786 visits (MTX: 1,543, MTX + INF: 107, MTX + ETA: 136). ALT and/or AST elevations greater than 1 × ULN were observed in 344 (19.3%) visits (MTX: 295 [19.1%], MTX + INF/ETA: 49 [20.2%]). In this study, the trends of ALT and AST changes increased when receiving MTX, while the INF/ETA addition decreased these trends. The random intercept models indicated that changes in the mean ALT levels were significantly different over the time for MTX and MTX + INF/ETA groups (β [SE] =-0.190 [0.093], P= 0.040) but changes in the mean AST levels were nonsignificantly different over the time for such groups (β [SE] =-0.099 [0.064], P=0.120).Conclusion: Despite a higher incidence of elevated transaminases during the use of MTX + INF/ETA, the combination of INF/ETA with MTX reduced transaminase levels and returned ALT levels to normal concentrations. Keywords: longitudinal, ALT, AST, DMARDs, biologic DMARDs, MTX

Background: In spite of the increasing degree of automation in industry, manual material handling (MMH) is still performed in many occupational settings. The aim of the current study was to determine the maximum acceptable weight of lift using psychophysical and electromyography indices. Methods: This experimental study was conducted among 15 male students recruited from Tehran University of Medical Sciences. Each participant performed 18 different lifting tasks which involved three lifting frequencies, three lifting heights and two box sizes. Each set of experiments was conducted during the 20 min work period using free-style lifting technique and subjective as well as objective assessment methodologies. SPSS version 18 software was used for descriptive and analytical analyses by Friedman, Wilcoxon and Spearman correlation techniques. Results: The results demonstrated that muscle activity increased with increasing frequency, height of lift and box size (P

Group B streptococci (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. GBS normally colonizes the vagina in many women asymptomatically. During labor this organism may infect the newborn, leading to neonatal sepsis and meningitis. This study aimed to investigate the prevalence of group B streptococcus in pregnant women by a rapid and easy culture method. It seems that in cases in which GBS carriage is not suspected until the time of labor, using such a quick and specific culture method would be valuable. A total of 330 vaginal swabs were collected from women attending delivery room at Hedayat hospital, Tehran, Iran, from April through July 2008. Cotton swabs contaminated with vaginal fluid were placed into Amies transport medium and transported to the Avicenna laboratory daily. Vaginal specimens were cultured on selective GBS Agar Base medium (ISLAM) for isolation and detection of group B streptococcus. The plates were incubated at 35-37°C under anaerobic condition for 24 hours. Incubated S.agalactiae developed orange/red pigmented colonies in GBS agar plates. Among the 330 women, the results of the culture were positive for GBS in 68 women (20.6%). Statistical analyses showed no significant relationship between demographics, reproductive histories and obstetric characteristics of subjects with the test results. Solely the antibiotic therapy was associated with GBS colonization. The results are indicating that the relatively high maternal GBS colonization rate in pregnant women warrants a routine screening and prophylactic treatment of the infected women. Colonization with group B streptococcus can be identified directly by GBS agar medium and decrease the time to detection of GBS.

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Chlamydia trachomatis is a common and curable STI that may be symptomatic or asymptomatic. The few studies on C. trachomatis among Iranian women have had, for the most part, small sample sizes and are therefore unsuitable for epidemiological deductions. The aim of this study was to estimate the prevalence of urogenital C. trachomatis infections by PCR on urine samples of married women in their fertile years in order to determine the need for a C. trachomatis screening program for asymptomatic women in Iran."n"n Methods: This descriptive-analytical and cross-sectional study was performed on 991 married women. The research material consisted of questionnaires and urine samples, which were transported daily to Avesina Research Institute, Tehran, Iran, to extract their DNA and prepare them for PCR tests. The gathered data were analyzed by SPSS, version 13, and evaluated statistically by t-test, chi-square test, Fisher's exact test and logistic regression, considering p

Background: Laboratory bred sand flies are essential for the study of different biological phenomena including the transmis­sion dynamics of Leishmania. The aim of the study was to determine the suitable situation for colonization and main­tenance of Iranian strain of Phlebotomus papatasi at laboratory conditions from an endemic focus of cutaneous leishmani­asis due to Leishmania major.Methods: One hundred and thirty P. papatasi were collected by CDC miniature light traps and aspirator from indoors in Badrood, central Iran. The fly was maintained by the procedures of Modi & Tesh (1983) with minor modifications for 7 generations. Results: Minimum and maximum rate of productivity was calculated to be 8.5 and 56.1 in F7 and F3, respectively and signifi­cant difference was observed among productivity of some generations (P< 0.001). The sex ratio ranged between 70(F1) and 101.8(F6). The mean duration of egg to adult emergence varied between 47.21±4.46 and 52.6±7.85 days. The life cycle was completed in 34.4 to 60 days at 26±1 ºC. Conclusion: P. papatasi was colonized and maintained successfully for the first time as a laboratory strain. Using larval diet without liver powder is recommended. The blood of white hamster was preferred to golden hamster and guinea pig for the sand fly vector blood feeding at the insectary.

Introduction and objectives: Despite the advances in the control of food-borne diseases, still one of the dilemmas in the health of most societies and a matter of concern for health authorities is food poi­soning and food-borne diseases by unsafe foods.Materials and methods: In total 390 samples, including 195 samples of raw kebabs and hamburgers and 195 samples of the cooked ones were gathered from shops, sampling raw and cooked meat at the same time, and they were sent to the laboratory for testing, over a period of one year. The methods used for the tests were based on the Iranian National Standard procedures, numbers 356 and 2394.Results: All the cooked specimens had bacterial contamination in acceptable standard levels and there­fore were considered consumable. From the 165 raw kebab samples, 90 samples (54.5%) were con­sumable but 75 samples (45.5%) were not fit for consumption, where from 30 raw hamburger samples, 22 samples (73.3%) were consumable and 8 (26.7%) were inconsumable. In serological evaluations, Thompson serotype had the highest prevalence in kebab and hamburger samples.Conclusion: The results of present study show that there is no reason for concern in consuming cooked kebabs.

This research studies the quality of medical prescriptions for children under 5 years of age and their effective factors carried out by Behvarzes at Eslamshar town."nMaterials and Methods: The study took place in 19 health houses considering the medical family files of patient children seeking for medical care by 33 Behvarz for quality of medical prescription. Two questionnaire were used for the study. The first questionnaire contained information about children medical prescription and variables evaluated in relation to medical prescription dose, duration of consumption and the cure duration period, which carried out for both girl and boy group separately. The second questionnaire contained information about the condition of working Behvarzes demographic in health houses considered variable for Behvarzes are: Age, Sex , experience, education, place of residence marital status."nResults: The important points of the study are as follow: - In cases that according to Behvarzy training patient follow up is necessary, 56.9%of the needed cases did not full fill the appropriate and necessary follow up program. - One of the important constraints of the research is the high percent of unrecorded cases by Behvarzes including:"n1 - 1.2% unknown medical prescriptions."n2- 44.2% unknown dose of prescribed medicine"n3- 52.4% unknown care duration period"n4- 36.5% unknown period of time for taking the medicine. Conclusion: According to the information: 1- 64.9 dose of prescribed medicine"n2- 73.2 period of time for taking the medicine"n3- 84.1 care duration period There were appropriate.

Objective(s): To detcnninc the short-term reacrogenicity of diphtheria-tetanus-whole cell pertussis (DTwP) vaccine administered to preschool children in a number of health centers of Tehran in 2006. Methods: In this prospective cohort study, 337 children aged 4-6 years were injected with DTwP vaccine manufactured by Razi Institute of Iran. Reactogenicity was assessed by the parents for 7 days post vaccination using diary cards. Local (pain, redness and swelling) and systemic (fever, loss of appetite, gasterointestinal symptoms, vomiting and eczema) side effects were recorded daily. Results: Out of 337 children, 312 (92.6%) reported local reactions and 220 (65.3%) reported systemic reactions. No serious adverse events related to vaccination were reported. Among local reacuons, pain was the most frequent (86.9%), but 11 was mostly mild or moderate. Redness (52.8%) and swelling (41.2%) were the most frequently observed signs in the second day. The systemic reactions observed in children included fever (48.4%), loss of appetite (24%), gastrointestinal symptoms (5 6%), vomiting (8%) and eczema (2.7%). Only 3.6% of children had auxiliary fever above 39 chr('39')c. All signs were observed to have reduced or completely disappeared during a week. Conclusion: Compared with previous reports in Iran, reactogenicity of DTwP of Razi Institute seems to be reduced, but it was still more frequent than the internationally approved cellular vaccine counterparts. Reactogcnicity of the cellular triple vaccine may be related to the vaccine formulation or the bacterial cell fragments used in vaccine production.

Background and Objective: Anesthetic agents and type of surgery may lead to liver damage after surgery. Inhaled agents are associated with liver dysfunction after surgery. Propofol is expected to have a lower potential for postoperative liver damage. The present study was conducted to compare liver enzyme function after anesthesia with isoflurane and total intravenous anesthesia (TIVA). Methods: This clinical trial was conducted on 70 patients referred to Imam Ali Hospital in Bojnord. Patients were selected using convenience sampling and then divided into TIVA and Isoflurane groups using block randomization method. During surgery, anesthesia was maintained in the isoflurane group with isoflurane gas (1.2 MAC) and in the TIVA group with infusion of propofol (100 micrograms/kg/minute) and remifentanil (0.1 micrograms/kg/minute). The levels of ALT, AST, ALP, PTT, and INR factors of the patients were examined and compared using laboratory devices before the operation, immediately, 24 and 48 hours after the operation. Findings: There is no significant difference between the two groups in terms of demographic and interventional variables. ALT enzyme level in TIVA group increased from 17.6±10.7 to 21.2±14.2 and in isoflurane group from 16.7±9.4 to 28.4±16.1 (p<0.05). In other enzymes, this difference was not significant. Conclusion: The results of the study showed that the use of both TIVA and Isoflurane methods has an effect on the level of liver enzymes in patients undergoing laparoscopic cholecystectomy surgery. [ABSTRACT FROM AUTHOR]

Comprehensive data on drug-resistant patterns of Acinetobacter baumannii isolates in developing countries is limited. We conducted a multihospital study to assess the rate and trend of drug-resistant phenotypes in Ac. baumannii using standardized definitions and to determine the remaining therapeutic options against resistant phenotypes. The 401 nonduplicate isolates were collected from six hospitals which are geographically distributed across Tehran, Iran over a 3-year period. Following PCR of bla OXA-51-like gene, susceptibility testing was performed against nine antimicrobial agent categories. Three hundred and ninety (97%) isolates were resistant to least two carbapenems; carbapenem-resistant Ac. baumannii. The majority of isolates (366, 91·3%) were extensively drug resistant ( XDR) and the rest of the isolates were classified as multidrug resistant (26, 6·8%) and susceptible (9, 2·2%). The rate of XDR- AB slightly decreased from 93·8% in 2011 to 89·8% in 2013. A considerable decrease in resistance to doxycycline, minocycline and tigecycline was demonstrated. The XDR- AB isolates showed susceptibility to gentamicin (10·4%), tobramycin (23%), ampicilin-sulbactam (30·1%), minocycline (32·8%), tigecycline (10·7%), doxycycline (21·6%), colistin (100%) and polymixin B (100%). We demonstrated the rising trend of resistance to all antibiotic categories except tetracyclines and folate pathway inhibitors. We found that the treatment options against XDR- AB are extremely limited and each treatment alternative including even old, but safe, antibiotics might be considered. Significance and Impact of the Study The high frequency of drug-resistant phenotypes including carbapenem-resistant Acinetobacter baumannii, multidrug-resistant, and extensively resistant has been demonstrated in Ac. baumannii isolates tested here. As the antibiotic resistance pattern of isolates varies in different geographical regions, this study can provide comprehensive information about the antibiotic resistance profile of Ac. baumannii isolates in Tehran. In addition, the resistance profiles could be effectively considered by clinicians to manage antibiotic therapy. This work also emphasizes on the prudent use of antibiotics and the monitoring of antibiotic susceptibility trend and rate. [ABSTRACT FROM AUTHOR]

Aims The aim of this multi-hospital study was to assess the in vitro activity of doripenem and its comparators, imipenem and meropenem, using the new CLSI breakpoints against a large population of a frequently isolated nosocomial pathogen, Acinetobacter baumannii. Methods and Results During a 2-year period, four referral or tertiary hospitals submitted 400 isolates of Ac. baumannii for susceptibility testing using imipenem, meropenem and doripenem via disc diffusion and E-test methods. A subset of 390 isolates was resistant to all three tested carbapenems. Doripenem and meropenem ( MIC50, 32 μg ml−1) had comparable activity, albeit doripenem's activity was greater than imipenem ( MIC50, >32 μg ml−1). A significantly higher proportion of the isolates were inhibited by doripenem than by imipenem at MIC values of 12, 16, 24 and 32 μg ml−1 ( P < 0·05). The cumulative percentage of imipenem MICs was lower compared to its comparators. The comparison of resistance rate to imipenem and meropenem based on old and new breakpoints showed <1% difference. The overall agreement between the two susceptibility testing methods was ≥95%. Conclusion Doripenem has a slightly greater in vitro activity than imipenem in terms of zone breakpoints and MIC values, but its activity is comparable to meropenem. Significance and Impact of the Study Doripenem should be considered as a therapeutic option for monotherapy or combination therapy, particularly when the therapeutic options are limited. [ABSTRACT FROM AUTHOR]

Background and Objective: Stenotrphomonas maltophilia is an opportunistic nosocomial pathogen with high mortality in immunocompromised cases. The aim of this study was to isolate and identify Stenotrphomonas maltophilia in the hospitals' environment and wards. Material and Methods: In this cross-sectional study, a total of 1108 samples were collected from environment of two hospitals during 12 months. Identification of isolates was performed using biochemical, phenotypic (intrinsic resistance to carbapenems) and molecular methods (amplification of 23S rRNA gene). Results: Of the studied samples, 186 (16.78%) nonfermentative gram negative bacilli (NFGNB) were identified. Amongst NFGNB, 18 (1.62%) isolates were identified as S. maltophilia by using biochemical tests. Of 18 biochemically identified isolates, 15 (83.3%) were confirmed via PCR. Sinks (40%) and men surgery ward ( 33.3 %( were the most contaminated sites and wards of hospitals, respectively. Conclusion: S. maltophilia is repeatedly isolated from sink which shows that the moist hospital environments need to be considered as a source for dissemination of bacteria. [ABSTRACT FROM AUTHOR]

Background: One of the most important topics in clinical psychology is finding and measuring of independent tools that have the same results for the evaluation of a psychological characteristic. There are only few studies that have examined the agreement between these methods. This study aimed to compare the three screening instruments for mental disorder among students of Kashan University of Medical Sciences during 2011-2012. Materials and Methods: In this cross-sectional study, 983 students of Kashan University of Medical Sciences were selected using simple random sampling during 2011-2012. Students were asked to complete three mental health questionnaires including GHQ-28, BSI and MMPI. Data were analyzed using SPSS software. Results: Findings showed that the prevalence rates for mental disorder based on the GHQ-28, BSI and MMPI questionnaires were 39.1%, 44.8%, and 44%, respectively. Correlation coefficients for GHQ-28 with BSI, GHQ-28 with MMPI and BSI with MMPI were 0.588, 0.488, and 0.533, respectively. The corrected classification of GHQ28 with BSI was 73.3%, GHQ28 with MMPI 71.5% and BSI with MMPI 69.8%. Kappa coefficient showed high level of agreement between the three tests. Conclusion: According to the results of the study, there is a relatively high correlation between the three instruments in diagnosis of mental disorder among the students. [ABSTRACT FROM AUTHOR]

While long-term exposure to air pollutants is associated with an increase in heart diseases and mortality, little information is available about the short-term effects of air pollution. This case-crossover study assessed the relationship of particulate matter (PM10) and carbon monoxide (CO) levels with hospital admission for acute coronary syndrome in Tehran, Islamic Republic of Iran. We interviewed 250 patients with a first episode of acute coronary syndrome and obtained data from hospital records and Tehran Air Quality Control Company. The risk of acute coronary syndrome was significantly associated with elevated concentrations of CO the day before the event (OR 1.18; 95% CI: 1.03-1.34) but not significantly with PM10 (OR 1.00; 95% CI: 0.99-1.02). Stratification by age, sex, diabetes, hypertension and smoking status did not affect the results, but women were more susceptible than men to CO levels (OR for women/men 1.68; 95% CI: 1.25-2.26). [ABSTRACT FROM AUTHOR]

A case study was conducted to evaluate passengers' comfort on the Tehran-Andimeshk train in Iran. Hence, based on a=0.05, 91 passengers were selected. Whole-body vibration transmitted to the passengers was measured according to ISO 2631-1-1997. The crest factors in the the majority of wagons were below the 19 dB according to ISO 2631-1-1997 hence, the equal acceleration levels of the wagons were taken into consideration. The statistical relationships between 15 psychological and physiological disorders with age, gender, number of the trips and Aeq (equivalent acceleration level) were studied based on the questionnaires. The results revealed no statistical relationships between the health symptoms and age. Conversely, there was a significant statistical relationship between fatigue and gender. Also, sleeplessness and hearing disorders bother the passengers during the trips based on statistical analysis. Moreover, there were statistical relationships between studying with headache and nausea with eating. In addition, despite all 15 symptoms bothering the passengers during the trips, there was only a significant statistical relationship between Aeq (equivalent acceleration level) and anger. Hence, more factors must be taken into consideration to find the other reasons of passengers discomfort during the trips. [ABSTRACT FROM AUTHOR]

Background: The main goal of the present study was to develop a new sensitive and specific PCR based method for Identification of Cryptosporidium sp. using novel primers from 18S ribosomal RNA. Cryptosporidiosis in high-risk host groups particularly in neonates and immuno-compromised individuals may result in death. To the best of our knowledge this is the first study regarding develop a new PCR based method to diagnose the cryptosporidiosis in Iran. Methods: A total of 850 human fecal samples from patients clinically suspected to cryptosporidiosis and 100 healthy and diarrheic cattle stool specimens were collected. The simplified formol-ether concentration method was carried out for all samples. They were then examined microscopically by modified Ziehl-Neelsen staining method. Total DNA was extracted by QIA amp DNA stool mini kit. PCR and nested-PCR was carried out by using designed primers. Results: Twenty nine cases of cryptosporidiosis infection in human and 30 samples from cattle microscopically were positive. The described primary and nested PCR method could detect all Cryptosporidium positive samples from human and cattle. Regards to suspected negative samples in primary PCR examination, the Nested PCR could approve two more positive results. Furthermore, Nested PCR analysis was able to detect one more case which was negative in both microscopically examination and primary PCR. Specificity of the test was 100%. Sensitivity of Nested PCR in comparison to our gold standard; microscopy after Ridley concentration modified ziehl-Neelsen, was 100 %. Conclusion: Our developed PCR based method by using new primers devised from 18S ribosomal RNA revealed the ability for identification of the Cryptosporidium species such as C. parvum and C. huminis with high specificity and sensitivity. [ABSTRACT FROM AUTHOR]

This paper studied the casing vibration and noise radiation of a centrifugal fan at the blade passing frequency (BPF) induced by the internal unsteady flow. Three-dimensional numerical simulation of the complete unsteady flow in the whole impeller-volute configuration was carried out using computational fluid dynamics (CFD) techniques. Pressure fluctuations on the casing were obtained, and the BPF component was extracted after Fast Fourier Transform (FFT). In Part I of this two-part study, the BPF pressure fluctuation was modeled as aeroacoustic dipole source according to Lighthill's acoustic analogy theory, and sound propagation was simulated regarding the casing as a rigid body. In this part, the casing was modeled as an elastic structure in order to study the tonal vibroacoustics of the casing structure with the BPF pressure fluctuations as excitation. Time harmonic response of the casing was calculated using the finite element method (FEM) and vibroacoustic noise radiation was analyzed by the boundary element method (BEM). The primary objective is to make an attempt to quantitatively evaluate the flow-induced casing vibration and noise radiation in fluid machinery. Some results were obtained casting light on the characteristics of casing vibration and noise radiation. [ABSTRACT FROM AUTHOR]

Background and Aim: Many researchers have studied survival (time to death) of gastric cancer patients. Although gastric cancer diagnosed in early stages can be cured by surgery, chance of relapse still exists after operation. Hence, we should consider both events, that is, relapse of the disease and death, in order to be able to make a more precise estimation for survival of the patients. The purpose of this study was to use the competing risks method to estimate the cumulative incidence functions (CIF) of the relapse of disease and death and consequently to estimate the postoperative disease-free survival. Materials and Methods: A total of 330 patients admitted to Iran Cancer Institute and operated between March 1995 and March 1999 were enrolled in the study. They were followed up for at least 5 years to estimate their 5-year disease-free survival. Information on their demographic, clinical, and therapeutic characteristics, as well as on the type and time of occurrence of the first event (relapse of disease or death) after surgery was collected from their medical records. The direct parametric method was applied to estimate CIFs of relapse of the disease and death, while to adjust the effects of some covariates the parametric regression model was used. Data analysis was done using the R software and a p-value <0.05 was considered statistically significant. The findings were compared with the results obtained on the basis of data analysis in which the competing events were not considered. Results: The median follow-up time was 37.9 months. Of all the patients 13% experienced relapse and 60.9% death as the first event after surgery. The CIFs of relapse of disease and death 5 years after operation, with due consideration of covariates, were estimated at 11.0% and 68.6%, respectively. Age, stage of disease, and complementary treatment were statistically associated with the CIF of death, while only complementary treatment was related to the CIF of relapse. Older patients and those in more advanced stages of disease were more likely to die after operation. Moreover, while complementary treatment after operation decreased the CIF of relapse of disease, it increased the CIF of death. The disease-free survival of patients 5 years after surgery was 20.4% (considering the effects of some covariates). Conclusion: The competing risks method is recommended for analyzing survival data because of its capability in considering different events and, therefore, making it possible to make more precise estimations. By using this method, considering smaller variance estimates for model parameters and also narrow confidence intervals for the cumulative incidence functions of competing events, it is expected to obtain more precise results. Unfortunately, the results have revealed that the disease-free survival of gastric cancer patients is low in Iran. [ABSTRACT FROM AUTHOR]

Background: Due to its high prevalence, the survey on gastric cancer survival in Iran seems too important. In the case of relative long-term survival of the cases, using standard models is not conventional. So cure models are used to estimate the proportion of the cured patients that will never experience the event of interest and also to evaluate the survival function of susceptible individuals who may experience the event and effective factors. This study was carried out to determine the five-year survival rate of gastric cancer patients who have undergone surgical treatment. Materials and Methods: Three hundred and thirty gastric cancer operated patients with a maximum 10-year survival were enrolled in the study. The patients' life expectancy after surgery and cure fraction and their relationships with some variables were evaluated. Kaplan-Meier and Weibull Cure models were utilized for analyses. Results: The five-year survival rate and the median life expectancy were 24% and 19.9 months, respectively. Univariate analysis using the Weibull model showed that age, existence/site of metastasis and stage of disease influenced on the probability of curing (P<0.05). On assessing the simultaneous effect of different variables the age and stage of disease proved to be effective on curing (P<0.05), but none of the variables affected the life expectancy of patients (P>0.05). Conclusion: Using the cure models is beneficial in situations which the population under study suggests the presence of subpopulation. The cure/immune model methodology may separeltery identify the sets of covariates related to the cured proportion and also the failure time distribution of uncured one. [ABSTRACT FROM AUTHOR]

Background and Aim: Length of stay (LOS) in a hospital is one of the best hospital indicators that can be used for various purposes. In this survey, we studied the hospital LOS and its associated factors in Tehran University of Medical Sciences Women's Hospital (a teaching hospital) in Tehran using the Cox proportional hazards semi parametric model and compared the results with the results obtained using the multiple linear regression. Materials and Methods: This was a descriptive-analytical study in which we reviewed 3421 files of inpatients hospitalized in, and those discharged from, the oncology, surgery and obstetrics units in 2008. The required data were collected using a data collection sheet and inpatient interviews. A P<0.05 was considered statistically significant. Results: The median of patients' LOS in the hospital was 50.8 hours, that in the obstetrics, surgical and oncology units being 48.5, 54.4 and 94.2 hours, respectively. Of all the patients, 2632 (76.9%) had been discharged with a recovery status and the rest (23.1%) with a no-recovery status. Results of the Cox proportional hazards model showed that the following variables had increased LOS: a distance longer than 200 km between a patent's residence and the hospital, hospitalization in the surgery and oncology units, admission on a Thursday, admission by an internist, hospitalization for neoplastic, endocrine, nutritional, or genitourinary system diseases (P<0.005), as well as a high number of diagnostic laboratory tests, radiographies or sonographies (P<0.001). Patients admitted and hospitalized as an emergency case had a shorter LOS (P<0.001) than others. On the other hand, based on the multiple linear regression model results, some occupations (being a worker, a farmer, a stockbreeder, or a retired spouse) admission on a Thursday, (The first day of the weekend in Iran), suffering from a neoplastic disease, and a high number of diagnostic tests or radiographies or sonographies increased, and admission by a resident decreased, patients' LOS (P<0.05). Conclusion: Considering having censored data, the Cox proportional hazards model is a more suitable model than the multiple linear regression models for identifying factors influencing patients' LOS in a hospital. From among the LOS Cox model's associated factors as identified in this study, policy-makers and managers can only change admission days and the number of diagnostic tests. That is to say, they should try to prevent admission on a Thursday (unless emergency cases) and also perform the required primary diagnostic tests before admitting a patient into the hospital, which would lead to a more effective utilization of hospital beds and other resources [ABSTRACT FROM AUTHOR]

Background and Aim: The most common cancer in Iran is digestive system cancer, the highest incidence of which is reported from the Caspian Sea littoral. This study aimed to determine factors affecting the survival of patients with gastrointestinal cancer using the Cox and parametric models; the 2 models were compared. Materials and Methods: This survey was a prospective study conducted between 1990 and 1991. Data were collected through the Cancer Registry Center in Babol, which functions under supervision of the School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences. We tried to identify cases of gastrointestinal cancers. The individual characteristics of 484 patients, namely, age, sex, family history, marital status, smoking status, occupation, ethnicity, medication status, education, residence (urban, rural), and type of cancer were recorded. The patients were followed up for a period of 15 years, i.e., until 2006 year. To determine the effective factors on survival of patients, the Cox model and parametric models such as exponential, weibull, log-normal, log-logistic, and the AIC criteria and residuals were used to compare the effectiveness of the models. The SAS and STATA software were used for data analysis, with a significant level of 0.05. Results: Sixty-six percent of the patients (total n=484) were males and 34% females, with a mean age of 59 and 55 years, respectively. Their distribution according to type of cancer was as follows: esophageal cancer, 359 (74.2%); stomach cancer, 110 (22.7%); colorectal cancer, 15(3.1%). Estimated one-, three-, and five-year survival rates were 24%, 16% and 15%, respectively. Conclusion: The results of this study reveal that gender and family history can be strong risk factors for GI cancer. Log-normal and log-logistic models in multivariate and univariate analyses gave almost similar results. However, based on AIC criteria and residuals analysis, the log-logistic model gives the best fit as compared to other parametric models and can be used instead of the Cox model for determining factors affecting survival of patients with gastrointestinal tract cancer. [ABSTRACT FROM AUTHOR]

Objectives: To study the antigenic variations in influenza A/H3N2 viruses circulating in Iran for characterization and phylogenetic relationships to vaccine strains. Methods: RT-PCR, full sequencing of hemagglutinin (HA) and neuraminidase (NA) genes and analysis by sequence handling and phylogenetic programs were done. Results: The HA sequences of 2007 isolates fell within the clade represented by the HA of A/Brisbane/10/07 and characterized by the amino acid changes relative to the HA of A/Wisconsin/67/05, G50E and K140I. The only isolate in 2006 fell within A/Berlin/02/06 with V112I and K173E changes. The 2005 isolates characterized by Y159F, S189N and S227P changes within A/California/07/04. In all isolates we had E190D which is important because this was responsible for the loss of ability of A/H3N2 viruses to bind to chicken red blood cells. There were some substitutions in the antigenic sites of the HA. Similar to other studies, conserved residues for catalytic sites and also framework sites of NA supporting the catalytic residues were detected. We had some changes in the variable regions of the NA head domain. Conclusion: Comparison between Iranian viruses and vaccine strains showed high similarity between them and vaccine strains used in the northern hemisphere. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A field study has been carried out to investigate whole-body vibration exposure levels experienced by the train operators of an old train which circulates between Tehran and Andimeshk in the south of Iran. The objective of this study was to measure whole-body vibration transmitted to personnel on the train. Fatigue Decreased Proficiency Boundary (FDPB) and Exposure Limit (EL) were used to evaluate the vibration measured in three directions. The health effects related to whole-body vibration were statistically analyzed after completing a questionnaire. The results indicated that the total equivalent acceleration level induced in the personnel was higher than the permissible level of FDPB (108dB) and exposure limit (114dB) for 12 hours of exposure, recommended by ISO 2631. There were no statistically significant relationships amongst the health variables and age except lack of concentration, P=0.014, as well as job history. Conversely, there was significant statistical relationship between EL and Hearing disorders, Vomiting and Loss of appetite among personnel. Therefore, the statistical test results only revealed some physiological effects with regard to WBV. Hence, beside WBV other factors must be taken into consideration to judge about other physiological or subjective disorders caused by WBV. [ABSTRACT FROM AUTHOR]

Background and Aim: Today human beings working in organizations are faced with various types of stress factors which jeopardize healthiness of their body and mind. These stresses are not easy to identify and eliminate and, as a result, produce undesirable effects on the efficiency of trained manpower, particularly managers who play important roles in development and success of organizations. The objective of this study was to identify stress factors and the effect of stress on performance of managers in different sections of hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. Methods and Materials: This descriptive-analytic study conducted in 2008 included 220 managers from different sections of hospitals affiliated to Tehran University of Medical Sciences, Tehran, Iran. The data was collected using a standard questionnaire (Likert scale) with 70 questions in 4 parts. Results:About 68.2% of the managers were females, 72.8% were married, and 47.7% had a service record of 10-20 years. On the whole, 93.4% of the managers had had severe stresses in the previous 2 years. The work environment was the most stressful factor for 84.4% of the managers. Other stressful factors were the amount of work and expectations of the higher-ranking managers. The findings also indicated that stress had a negative impact on the managers' ability to make decisions effectively at work. There were statistically significant associations between stress factors and educational level (p=0.01) and between marital status and family stress factors (p = 0.05). In addition, an inverse relation was found between the effect of stress on performance and length of service record (-0.17, p=0.01 Conclusion: Based on the findings, it is suggested that the university authorities and hospitals' senior managers make attempts to minimize stressful conditions in the work environment. The following strategies can be adopted to achieve this end: sound management of human resources; social support of the personnel; better time management; delegating responsibilities to subordinates; and improving working conditions. [ABSTRACT FROM AUTHOR]

Background and Aim: The large volume of reports and statistics in the literature on the prevalence of musculoskeletal disorders (MSDs) in Iran and other countries indicates that it is essential to assess the ergonomic situation in different occupations. These disorders can be caused by long-term exposure to different agents or by trauma to the musculoskeletal system. A large part of the work force in Iran is engaged in general construction and dam construction workshops. The postures of these workers while working in the workshops are unsuitable postures. The objective of this study was to assess the ergonomic situation of workers in dam construction workshops. Methods and Materials: This was a cross-sectional study conducted in 2008. The sample included 110 randomly selected male-workers in a dam construction workshop in Takab City, Iran, engaged in 25 different jobs. Data were collected using the Nordic Musculoskeletal Questionnaire and the National Institute of Occupational Health-Center to Protect Worker Rights Checklist (NIOSH-CPWR), both developed by the National Institute of Occupational Health-Center to Protect Workers Rights. The software used to analyze data was SPSS. Results:The average service record of the workers was 36.6 ± 86.8 months. The data show that the most common (55.5%) MSDs were in the low back region. There were statistically significant positive associations between prevalence of MSDs and many independent variables, namely, age, weight, education level, service record, smoking, type of job, lengths of time of standing and sitting at work, total duration of work, work pressure, undesirable postures, and surface for walking. Conclusion: The results of this study generally confirm findings of previous investigators. It can be concluded that ergonomic assessment of jobs may give valuable information to be used by occupational health and safety authorities in planning preventive and educational programs. [ABSTRACT FROM AUTHOR]

Background and Aim: Like other cancers, gastric cancer is due to uncontrolled growth of tissues. Although there are different therapy methods to treat it, such as surgery, radiation therapy, chemotherapy, and multimodality therapy, relapse and death may occur. Reports show that in Iran gastric cancer is the first cause of death among deaths due to cancers. The purpose of this study was to determine the two-year survival rate after relapsing and its associated factors among gastric cancer patients who had undergone surgical treatment in Iran Cancer Institute, one of the most important cancer treatment centers in Iran. Methods and Materials: A total of 330 patients with gastric cancer who had been admitted to and operated on at the Iran Cancer Institute between January 1996 and April 2000 were enrolled in this study. The patients' life expectancy after relapse was determined. Survival was defined as the elapsed time between the two successive events, relapse and death, neither of which can be determined exactly; therefore the data are doubly censored failure time data. Thus, the relationships between life expectancy at relapse and such variables as age, gender, and factors related to the disease, such as the cancer site, pathologic type, stage, and sites of metastases were determined using the Cox proportional hazards model. Results: The two-year survival rate after relapsing and the median life expectancy after relapsing were 15% and 10.15 months, respectively. Univariate analysis showed that except disease stage, no other variable (age, gender, cancer site, pathologic type and sites of metastases) affected life expectancy after relapsing significantly. The Cox proportional hazards model for doubly censored failure time data showed that age, gender, and pathologic type had the highest influence, in a decreasing order, on the rate of survival after relapsing. Conclusion: Two-year survival rate after relapsing is very low in gastric cancer patients. One of the most important reasons seems to be delayed consultation and diagnosis. Most patients seek medical advice first with the disease in the late stages, when most have lymph node, liver or even distant metastasis which makes treatment even more complex, and when the risk of relapse and death would be increased. Thus, early diagnosis and therapy for a common stomach illness could help prevent a potential gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Candidiasis associated with indwelling medical devices is especially problematic since they can act as substrates for biofilm growth which are highly resistant to antifungal drugs. Farnesol is a quorum-sensing molecule that inhibits filamentation and biofilm formation in Candida albicans. Since in recent years Candida tropicalis have been reported as an important and common non-albicans Candida species with high drug resistance pattern, the inhibitory effect of farnesol on biofilm formation by Candida tropicalis was evaluated. Methods: Five Candida tropicalis strains were treated with different concentration of farnesol (0, 30 and 300 µM) after 0, 1 and 4 hrs of adherence and then they were maintained under biofilm formation condition in polystyrene, 96-well microtiter plates at 37°C for 48 hrs. Biofilm formation was measured by a semiquantitative colorimetric technique based on reduction assay of 2,3- bis -2H-tetrazolium- 5- carboxanilide (XTT). Results: The results indicated that the initial adherence time had no effect on biofilm formation and low concentration of farnesol (30 µM) could not inhibit biofilm formation. However the presence of non-adherent cells increased biofilm formation significantly and the high concentration of farnesol (300 µM) could inhibit biofilm formation. Conclusion: Results of this study showed that the high concentration of farnesol could inhibit biofilm formation and may be used as an adjuvant in prevention and in therapeutic strategies with antifungal drugs. [ABSTRACT FROM AUTHOR]

Backgrounds and Aim: One of the remuneration methods in the hospital system in Iran is per case, based on a classification system termed Global system (GS). The GS, supported by Iran's Ministry of Health and Medical Education (MOHME), was established in 1999 and is now used for cost reimbursement in the second- and third-levels of health care services. In this system, patients are classified into 60 categories, based on the most frequent surgical operations. However, it now appears, that there are many questions about this system. This study aims to compare the global operations reimbursement rates with actual costs in the Cancer Institute, Tehran, in 2003 and 2004. Materials and Methods: This survey was a retrospective, analytical-descriptive one aiming at comparing the global operations reimbursement rates with actual costs in 646 global operations carried out in the Cancer Institute in 2003 and 2004. The global-operations and actual-costs data were gathered from Hospital Information Systems (HIS) and High Council of Insurance annual regulations, respectively, and analyzed using SPSS 11.5 software and the Wilcoxon non-parametric test. Results: The differences between the cost reimbursement rates of global operations and their actual costs were lower in 2004 as compared to those in 2003. Also, the actual costs of operations were higher than the global operations reimbursement rates in both years and the difference was significant statistically in either year (P<0/001). Conclusion: Some of the MOHME and Cancer Institute's authorities and experts believe that the decrease in differences between the cost reimbursement rates of global operations and their actual costs in 2003 compred to 2004 is due to increased awareness of physicians and the accounting and discharge units' personnel of the global operations and related regulations, as well as increasing global operations reimbursement rates. Also, they believe that the differences between the global operations reimbursement rates and their actual costs in either year could be attributed to not considering the actual inflation rate, hospital types, patients' co-morbidities, etc. in calculating the global operations reimbursement rates. It is suggested to make more realistic calculations, taking into account such variables as the actual inflation rate, hospital types, patient co-morbidities, etc. [ABSTRACT FROM AUTHOR]

We evaluated the measles-rubella mass vaccination campaign in the Islamic Repub-lic of Iran in December 2003. Vaccination coverage, community awareness of the campaign and the quality of vaccination services were assessed in the population covered by Tehran University of Medical Sciences. At the end of the campaign 96.4% (95% CI: 94.6%-98.2%) of the population sample (n = 390) had been vaccinated. Awareness of the campaign was 80.59% of the sample (n = 190) at the start, rising to 96.8% during and 100.0% at the end of the campaign. None of the 24 vaccination teams sampled were over the threshold for unacceptable performance. The mass media and vaccination teams demonstrated good performance and have achieved their goals. [ABSTRACT FROM AUTHOR]

Abstract Background Gastrointestinal (GI) tract cancer is one of the common causes of the mortality due to cancer in most developing countries such as Iran. The digestive tract is the major organ involved in the cancer. The northern part of the country, surrounded the Caspian Sea coast, is well known and the region with highest regional incidence of the GI tract cancer. In this paper our aim is to study the most common risk factors affecting the survival of the patients suffering from GI tract cancer using parametric models with frailty. Methods This research was a prospective study. Information of 484 cases with GI cancer was collected from Babol Cancer Registration Center during 1990-1991. The risk factors we studied are age, sex, family history of cancer, marital status, smoking status, occupation, race, medication status, education, residence (urban, rural), type of cancer, migration status (indigenous, non-native). The studied cases were followed up until 2006 for 15 years. Hazard ratio was used to interpret the death risk. The effect of the factors in the study on the patients survival are studied under a family of parametric models including Weibull, Exponential, Log-normal, and the Log-logistic model. The models are fitted using with and without frailty. The Akaike information criterion (AIC) was considered to compare between competing models. Results Out of 484 patients in the study, 321 (66.3%) were males and 163 (33.7%) were females. The average age of the patient at the time of the diagnosis was 59 yr and 55 yr for the males and females respectively. Furthermore, 359 (74.2%) patients suffered from esophageal, 110 (22.7%) patients recognized with gastric, and 15 (3.1%) patients with colon cancer. Survival rates after 1, 3, and 5 years of the diagnosis were 24%, 16%, and 15%, respectively. We found that the family history of the cancer is a significant factor on the death risk under all statistical models in the study. The comparison of AIC using the Cox and parametric models showed that the overall fitting was improved under parametric models (with and without frailty). Among parametric models, we found better performance for the log-logistic model with gamma frailty than the others. Using this model, gender and the family history of the cancer were found as significant predictors. Conclusions Results suggested that the early preventative care for patients with family history of the cancer may decrease the risk of the death in the patients with GI cancer. The gender appeared to be an important factor as well so that men experiencing lower risk of death than the women in the study. Since the proportionality assumption of the Cox model was not held (p = 0.0014), the Cox regression model was not an appropriate choice for analysing our data.

Abstract Background The aim of this study is to evaluate the prognostic factors of overall survival (OS) after haematopoietic stem cell transplant (HSCT) in acute lymphoblastic leukaemia (ALL) patients using accelerated failure time (AFT), Cox proportional hazard (PH), and Cox time-varying coefficient models. Methods 206 patients were enrolled after HSCH in Shariati Hospital between 1993 and 2007. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, relapse and chronic graft-versus-host disease (cGVHD) (P < .001). Performance among AFT and Cox's models was assessed using explained variation and goodness of fit methods. Discrimination among the exponential, Weibull, generalized gamma (GG), log-logistic, and lognormal distributions was done using maximum likelihood and Akaike information criteria. Results The 5-year OS was 52% (95%CI: 47.3–56.7). Peak mortality hazard occurred at months 6–7 after HSCT followed by a decreasing trend. In univariate analysis, the data was better fitted by GG distribution than by other distributions. Univariate analysis using GG distribution showed a positive association between OS with acute graft-versus-host disease (aGVHD) (P = .021), no relapse (P < .001), cGVHD (P < .001), neutrophil recovery (P < .001) and platelet recovery (P < .001). Based on Cox PH models; however cGVHD and relapse were the predictive factors of OS (P < .001). Multivariate analysis indicated that, OS is related to relapse (P < .001) and platelet recovery (P = .037), where predictive power of Weibull AFT models was superior to Cox PH model and Cox with time-varying coefficient (R2 = 0.46 for AFT, R2 = .21 for Cox PH and R2 = .34 for Cox time-varying coefficient). Cox-Snell residual shows Weibull AFT fitted to data better than other distributions in multivariate analysis. Conclusion We concluded that AFT distributions can be a useful tool for recognizing prognostic factors of OS in acute lymphoblastic leukemia patients.

Abstract Background To date, few studies have assessed the association between the number of children and obesity in couples. We aimed to investigate this association in men and women aged 20–75 years. Methods Data from the National Health Survey were considered in this investigation. It included 2728 women and men (1364 couples) aged 20–75 years. Height and weight were actually measured rather than self-reported. A generalized estimating equation model was used to estimate the odds of obesity (body mass index (BMI ≥ 30)) as a function of the number of children adjusted for age, sex, education, economic index, workforce, smoking and place of residence. Results We infer that each additional child has at least 5% and at most 34% increase in the odds of obesity in men and at least 4% and at most 29% increase in the odds of obesity in women. Our test of interaction by sex showed that the association between the number of children and obesity was not different among men and women. Among women, factors that increased obesity included age, low education, having more children, being inactive workforce and being nonsmoker. Among men, these factors included high economic index, low education, having more children, and being nonsmoker. Conclusion Our results show an association between the number of children and obesity among men. We would recommend interventions to reduce the number of children to prevent obesity in men.

Abstract Background High incidence rates of gastrointestinal tract cancers have been reported in the Caspian region of Iran. This study aimed to: 1) describe the geographical spatial patterns of gastrointestinal tract cancer incidence based on cancer registry data and, 2) determine whether geographical clusters of statistical significance exist. Methods The Babol Cancer Registry, which covers the two major northern Iranian provinces of Mazandaran and Golestan (total population = 4,484,622) was used to identify new gastrointestinal tract cancer cases during 2001 to 2005. Age-specific cancer incidence rates were calculated for 7 gastrointestinal tract cancer sites in 26 wards of the Mazandaran and Golestan provinces. Spatial autocorrelation indices, hierarchical Bayesian Poisson models, and spatial scan statistics were used in measuring the geographic pattern and clusters. Results There were non-random spatial patterns in esophageal and stomach cancers that were similar for both sexes. Clusters of high incidence were identified in esophageal, stomach, colorectal and liver cancer for both sexes, as well as a possible cluster of pancreas cancer in males. Conclusion Gastrointestinal tract cancers exhibit significant spatial clustering of risk in northern Iran. Further work is needed to relate these geographical patterns to information on potential life-style and environmental factors.

Introduction: About 10% of couples are infertile. They are faced with several problems that affect their marital life. Infertility treatment is expensive and time consuming and occasionally isn't simply possible. Because, prediction of treatment success is important this paper has reviewed effective predictors based on previous studies. Materials and Methods: This study has been conduct as a systematic review in Avicenna Research Institute in 2014. Six data base searched base on WHO and international committee of monitoring ART definitions and MESH key words. Papers about prediction models in infertility were evaluated. Results: Fifty five papers were eligible for study. Papers covered years after 1986 and studies were designed retrospectively and prospectively. IVF prediction models have more shares in papers. Common predictors were age, duration of infertility, ovarian and tubal problems. Conclusion: Prediction model can be clinically applied if the model would be statistically evaluates and has a good validation for treatment success. To achieve better results the physician and the couples needs estimation for treatment success rate based on history, the examination and clinical tests. Models must be check for theoretical approach and appropriate validation. Appl>ing impact of prediction models are decreasing the cost and time saving, avoiding pain treatment for patients, assessment of treatment approach for physicians and decision making for health managers and massive governmental policy makers. Design and applying of prediction models in infertility treatment has been recently considered by researchers and is a new approach. Approach to the design and use of these models is inevitable. [ABSTRACT FROM AUTHOR]

Background: High incidence rates of gastrointestinal tract cancers have been reported in the Caspian region of Iran. This study aimed to: 1) describe the geographical spatial patterns of gastrointestinal tract cancer incidence based on cancer registry data and, 2) determine whether geographical clusters of statistical significance exist.Methods: The Babol Cancer Registry, which covers the two major northern Iranian provinces of Mazandaran and Golestan (total population = 4,484,622) was used to identify new gastrointestinal tract cancer cases during 2001 to 2005. Age-specific cancer incidence rates were calculated for 7 gastrointestinal tract cancer sites in 26 wards of the Mazandaran and Golestan provinces. Spatial autocorrelation indices, hierarchical Bayesian Poisson models, and spatial scan statistics were used in measuring the geographic pattern and clusters.Results: There were non-random spatial patterns in esophageal and stomach cancers that were similar for both sexes. Clusters of high incidence were identified in esophageal, stomach, colorectal and liver cancer for both sexes, as well as a possible cluster of pancreas cancer in males.Conclusion: Gastrointestinal tract cancers exhibit significant spatial clustering of risk in northern Iran. Further work is needed to relate these geographical patterns to information on potential life-style and environmental factors. [ABSTRACT FROM AUTHOR]

Introduction: Nowadays, HIV is mostly spreading in Asian countries. One of the important routes for HIV transmission in these countries is the vertical route which infects 35% to 45% of newborns. Mother's education, drug prophylaxis and Cesarean section, accompanied by banning breastfeeding will decrease this rate to 2%. Therefore, mothers' knowledge about Prevention of Mother to Child Transmission (PMTCT) has a great role in HIV/AIDS prevention. This study was designed to evaluate knowledge of pregnant women about HIV, its vertical transmission and prevention in Tehran, Iran.Materials and Methods: This cross-sectional study was conducted on 1577 pregnant women aged 15 - 46 years who were attending prenatal care clinics in Tehran, Iran. The research material was a questionnaire which was completed daily by trained midwives. The data were statistically analyzed by ANOVA, independent sample t-test, Pearson correlation and linear regression with a significance level of p = 0.05.Results: About 16.5% of the participants had good knowledge about HIV/AIDS and 54.1% about its transmission routes but awareness about its prevention was only 5.7%. Fifty-seven percent of the participant had not been tested for HIV earlier and 20.2% were not willing to undergo such tests. About 86.2% of the participants had no idea about the availability of drug prophylaxis in Iran for PMTCT.Conclusion: The fact that 28.2% of the participants were not willing to undergo HIV testing reflects negative attitude about HIV infection. Although the overall awareness about the infection and its transmission was good but knowledge about its prevention especially by PMTCT and its availability in Iran was low. Educational programs through mass media or prenatal care programs by focusing on HIV/AIDS prevention maybe useful. [ABSTRACT FROM AUTHOR]

Introduction: In non-obstructive azoospermia (NOA) men, evaluation of spermatogenesis is performed with histopathological techniques as a gold standard. Pathological assessment of testes could be imprecise due to randomized biopsy and presence of focal spermatogenesis. Therefore, a sensitive and specific biomarker of sperm production in NOA testis is critical for future of male infertility treatment. NOA men showed a variety of defects in spermatogenesis stages, therefore molecular analysis of the stage-specific of gene expression in the testis could be confirmatory of histopathological techniques in evaluation of spermatogenesis in NOA men. Materials and Methods: In this study, spermatogenesis status evaluated through expression of germ cell specific genes (DAZ, TSPY1, SPTRX3) and testicular biopsies were provided by infertile men undergoing diagnostic testicular biopsy in Avicenna infertility Clinic, Tehran. Histophatological evaluation was performed using H&E method. Semi-nested PCR was performed with designed specific primers. The molecular results were compared with the histopathological findings using Kappa test. Results: Molecular and histopathological results were categorized in three groups: sertoli cell only syndrome, maturation arrest and hypospermatogenesis. RT-PCR results showed a significance difference (Kappa coefficient=0.009, p=0.894) with the histopathological results. TSPY1, DAZ, SPTRX3 and SPTRX1 were expressed in 94%, 94%, 17.6% and 52.9% respectively in azoospermic men diagnosed as germ cell aplasia. This discrepancy is due to focal spermatogenesis in NOA testis. Conclusion: Detection of DAZ, TSPY1 and SPTRX1 transcripts in testicular tissue can be used to predict the presence of mature spermatids/sperm in the testis especially in men diagnosed as spermatogenesis arrest using histopathological technique and may provide the better chance of finding the mature sperm to use through ART. [ABSTRACT FROM AUTHOR]

Objective: This study reports the authors' experience with surgical interventions for nonsyndromic craniosynostosis. They assessed open surgery and minimally invasive endoscopic suturectomy in terms of periprocedural outcomes and related risk factors for postoperative complications and reoperation. This study aimed to provide insights toward surgical approach decisions and lay the groundwork for future prospective studies in this field., Methods: In this retrospective cohort study, the medical records of all patients with nonsyndromic craniosynostosis who underwent primary surgery at the authors' center from 2014 to 2024 were analyzed. The authors assessed open surgery and endoscopic suturectomy based on anesthesia time, length of hospitalization, hematological parameters, postoperative blood transfusion volume, and changes in head circumference percentile (HCP). A subgroup analysis was conducted for patients younger than 6 months across different types of craniosynostosis. Further investigation was conducted to identify potential risk factors for postoperative complications and reoperation., Results: A total of 633 pediatric patients treated for nonsyndromic craniosynostosis were included in this study (281 with endoscopic suturectomy, 352 with open surgery). These data indicated a growing trend for endoscopic procedures. The authors' center began performing endoscopic surgery in 2014, and by 2024, 75% of craniosynostosis patients underwent this procedure (p < 0.001). Patients in the endoscopic group experienced shorter anesthesia times (p < 0.001), reduced lengths of hospitalization (p < 0.001), and lower blood transfusion volumes (p < 0.001) compared with those in the open surgery group; however, blood transfusion volume differences were not significant in the subgroup analysis. The subgroup analysis revealed comparable HCP changes in sagittal (p = 0.4) and coronal (p = 0.85) craniosynostosis. In comparison, greater changes were noted after open surgery in cases of metopic (p = 0.03) and multisuture (p = 0.04) craniosynostosis. The rates of postoperative complications (endoscopic 6.4% and open 4.5%) and reoperation (endoscopic 4.6% and open 2.8%) were comparable between the two groups. In univariate analysis, higher weight (OR 1.07, p < 0.05) was identified as the only risk factor for postoperative complications, which can be attributed to delayed surgical intervention. Coronal (OR 8.38, p < 0.05) and multisuture (OR 23.66, p < 0.01) craniosynostoses were associated with higher reoperation rates, while adding barrel stave osteotomies was linked to a lower reoperation rate (OR 0.22, p < 0.05)., Conclusions: Endoscopic suturectomy is associated with acceptable periprocedural outcomes compared with open surgery, with comparable rates of complications and reoperation. These findings are supported by the subgroup analysis. However, further studies focusing on craniometric outcomes are needed, as surgical procedures have shown variable results across different types of craniosynostosis.

Background & Aim: Timely identification of the patients requiring intensive care unit admission (ICU) could be life-saving. We aimed to compare different machine learning algorithms to predict the requirements for ICU admission in COVID-19 patients., Methods: We screened all patients with COVID-19 at six academic hospitals in Tehran comprising our study population. A total of 44,112 COVID-19 patients (≥18 years old) were included, among which 7722 patients were hospitalized. We used a Random Forest algorithm to select significant variables. Then, prediction models were developed using the Support Vector Machine, Naıve Bayes, logistic regression, lightGBM, decision tree, and K-Nearest Neighbor algorithms. Sensitivity, specificity, accuracy, F1 score, and receiver operating characteristic-Area Under the Curve (AUC) were used to compare the prediction performance of different models., Results: Based on random Forest, the following predictors were selected: age, cardiac disease, cough, hypertension, diabetes, influenza & pneumonia, malignancy, and nervous system disease. Age was found to have the strongest association with ICU admission among COVID-19 patients. All six models achieved an AUC greater than 0.60. Naıve Bayes achieved the best predictive performance (AUC = 0.71)., Conclusion: Naïve Bayes and lightGBM demonstrated promising results in predicting ICU admission needs in COVID-19 patients. Machine learning models could help quickly identify high-risk patients upon entry and reduce mortality and morbidity among COVID-19 patients., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Health Science Reports published by Wiley Periodicals LLC.)

Background: Postoperative shoulder pain is one of the most common complications following laparoscopic surgery. Various interventions have been proposed to control this pain., Objectives: The main objective of this comparative study was to determine the effects of intraperitoneal bupivacaine and normal saline infusion, in combination with lung recruitment maneuver (LRM), on shoulder pain following laparoscopic surgery., Methods: The present randomized controlled trial was conducted on 105 candidates for laparoscopic cholecystectomy referred to Imam Ali Hospital in Bojnurd, Iran, from November 2021 to June 2022. The patients were assigned to three groups using block randomization: BR (receiving 50 cc of 0.25% diluted intraperitoneal bupivacaine + LRM), NR (receiving 50 cc of intraperitoneal normal saline + LRM), and N (receiving 50 cc of intraperitoneal normal saline). Postoperative shoulder pain and surgical incision site pain were assessed using the Visual Analogue Scale (VAS) at recovery intervals of 4, 12, 24, and 48 hours after surgery. Additionally, the prevalence of nausea and vomiting, the first time of need for sedation, and the incidence of sedation overdose in the first 24 hours after surgery were investigated. The data were analyzed using one-way analyzed by one-way analysis of variance (ANOVA) with SPSS software at a significance level of 0.05., Results: The findings showed no significant differences in demographic variables between the three groups. The range and mean score of shoulder pain based on VAS was 0 - 1 (0.3) in the BR group, 0 - 2 (1.4) in the NR group, and 1 - 3 (2.1) in the N group at 4 hours after surgery. The mean score of shoulder pain intensity in the BR group was lower compared to the NR and N groups during recovery time intervals at 4, 12, and 24 hours after surgery. This difference between groups was significant. There was also a statistically significant difference in the mean score of surgical incision site pain intensity and the first time of need for sedation between the three groups. The occurrence of side effects was not significant between the groups. Itching, bradycardia, and hypotension were not observed in any of the groups., Conclusions: The findings of this study showed that bupivacaine, along with LRM, is a safe method effective in relieving postoperative shoulder pain. It prolonged the first time of need for sedation and significantly reduced the incidence of shoulder pain., Competing Interests: The authors declared no conflict of interest., (Copyright © 2024, Shahinfar et al.)

Background: The second version of the Short-Form 6-Dimension (SF-6Dv2) classification system has recently been developed. The objective of this study was to develop a value set for SF-6Dv2 based on the societal preferences of a general population in the capital of Iran., Methods: A representative sample of the capital of Iran (n = 3061) was recruited using a stratified multistage quota sampling technique. Face-to-face interviews were conducted using binary choice sets from the international valuation protocol of the discrete choice experiment with duration. The conditional logit was used to estimate the final value set, and a latent class model was employed to assess heterogeneity of preferences., Results: Coefficients generated from the models were logically consistent and significant. The best model was the one that included an additional interaction term for cases where one or more dimensions reached their most severe levels. It provides a value set with logical consistent coefficients and the lowest percentage of worse than death health states. Predicted values for the SF-6Dv2 were within the range of - 0.796-1. Pain dimension had the largest impact on utility decrement, whereas vitality had the least impact. The presence of preference heterogeneity was evident, and the Bayesian Information Criterion indicated the optimal fit for a latent class model with two classes., Conclusion: This study provided the SF-6Dv2 value set for application in the context of Iran. This value set will facilitate the use of the SF-6Dv2 instrument in health economic evaluations and clinical settings., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Drug synergy prediction plays a vital role in cancer treatment. Because experimental approaches are labor-intensive and expensive, computational-based approaches get more attention. There are two types of computational methods for drug synergy prediction: feature-based and similarity-based. In feature-based methods, the main focus is to extract more discriminative features from drug pairs and cell lines to pass to the task predictor. In similarity-based methods, the similarities among all drugs and cell lines are utilized as features and fed into the task predictor. In this work, a novel approach, called CFSSynergy, that combines these two viewpoints is proposed. First, a discriminative representation is extracted for paired drugs and cell lines as input. We have utilized transformer-based architecture for drugs. For cell lines, we have created a similarity matrix between proteins using the Node2Vec algorithm. Then, the new cell line representation is computed by multiplying the protein-protein similarity matrix and the initial cell line representation. Next, we compute the similarity between unique drugs and unique cells using the learned representation for paired drugs and cell lines. Then, we compute a new representation for paired drugs and cell lines based on the similarity-based features and the learned features. Finally, these features are fed to XGBoost as a task predictor. Two well-known data sets were used to evaluate the performance of our proposed method: DrugCombDB and OncologyScreen. The CFSSynergy approach consistently outperformed existing methods in comparative evaluations. This substantiates the efficacy of our approach in capturing complex synergistic interactions between drugs and cell lines, setting it apart from conventional similarity-based or feature-based methods.