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Background Bladder cancer disproportionally affects the communities. While it is the ninth most common cancer in the world, in some parts of Iran including Kerman province it is the most common cancer among men. This study aimed to determine potential risk factors of bladder cancer in Kerman province, Iran. Methods During February to July 2020, in this matched hospital-based case-control study, 100 patients with bladder cancer and 200 healthy individuals (matched in age and sex) were recruited. Socio-demographics status, occupational exposures, common diet, history of drug use and family history of cancer, were collected using a structured questionnaire. Bivariable and multivariable logistic regression were applied and crude and adjusted odds ratios (AOR) along with their 95% confidence intervals (95%CI) were calculated. Data were analyzed using Stata version 14 software. Results Opium consumption, cigarette smoking and low level of income were associated with increased chance of bladder cancer. Compared to never use, use of opium up to 18000 Gram -year was associated with increased chance of bladder cancer (AOR: 6; 95% CI =2.3, 15.5). The chance was higher among those who used opium more than 18,000 Gram - year (AOR: 11.3; 95% CI =2.3, 15.5). In comparison with never smokers, the chance of bladder cancer increased among those who smoked up to 20 pack-year cigarette) (AOR: 3.4; 95%CI= 1.3, 8.9) and those who smoke ≥ 20 pack-year (AOR: 15.8; 95% CI= 5.9, 42.4). Conclusions The observed strong dose-response association between opium consumption, cigarette smoking and bladder cancer highlights the need for extension of harm reduction programs especially in regions with high burden of disease.

This cross-sectional study aimed to assess the prevalence of high-risk sexual behaviors and the associated factors of inconsistent condom use among non-medical university students in Iran. We recruited an equal number of male and female students from five non-medical universities (n = 742) through a convenience sampling approach. Using a standard self-administered questionnaire, we asked students about their sexual behaviors and condom use practices. We defined inconsistent condom use as not using condom at least once during all sexual contacts in the previous year. Correlates of inconsistent condom use were evaluated using multivariable logistic regression analyses. Premarital sex was reported by 28.8% of single students and was significantly more prevalent among male students (41.6% vs. 11.4%). Male students experienced their first sexual contacts at significantly younger ages compared to female students (mean age of 18.2 vs. 20.1 years). Most of sexually active single students reported inconsistent condom use in all of their past-year sexual contacts (80.4%) and no condom use in their last sex (67.5%); these high-risk behaviors were reported more by female than male students. Condom unavailability during sexual contacts was the main reason of not using condom (38.8%). In the multivariable analysis, male students who started their first sexual contact ≤ 18 years of age were 2.4 times more likely to not use condom consistently in their sexual contacts compared to other students. Given the high prevalence of high-risk sexual contacts among Iranian students, especially males, establishing a comprehensive age- and gender-specific educational program on sexual health issues is warranted.

This study aimed to determine the prevalence and the correlation between early sexual intercourse and its consequences among men who inject drugs (MWID) in Iran. In this cross-sectional survey, 2399 subjects who inject drugs were recruited using facility-based sampling from ten cities in 2014. A structured questionnaire was used to collect data regarding the participants’ sexual and drug-related practices. Early sexual intercourse was defined as having sex before the age of 18 years old. Among the study samples, 2333 subjects were men and 2027 of them reported a lifetime history of their sexual intercourse. Totally, 1978 (97.6%) MWID reported their age at the time of their first sexual intercourse. The prevalence of early sexual intercourse was estimated as 32.9%. Using the multivariable logistic regression, it was shown that early sexual contact is significantly associated with age

Background: Chronic obstructive pulmonary disease (COPD) is a major health issue worldwide. Introduction: This study aimed to evaluate the effect of aerobic exercises at steep surfaces on Apo A1 and Apo B serum levels and their ratio in COPD patients. Methods: This interventional study was undertaken on 16 COPD patients. The sample was selected by using the random sampling method. Patients were randomly divided into 2 groups of 8 members: uphill and downhill. Spirometry was conducted prior to the exercises and pulmonary volumes were measured. Aerobic exercises (stationary bicycle and treadmill) were started 3 times a week for 8 weeks. The duration of exercises in each session was determined based on the patients’ ability (30-40 min). In the first and second group, exercises were performed on sloped surfaces that were downwards and upwards at a 10-degree angle, respectively. Blood samples were taken from the patients before and after the 8 weeks. Apo A1 and Apo B serum levels and Apo A1 to Apo B ratio were measured. Data were analyzed by SPSS software. P Results: ApoA1/Apo B ratio in the uphill group before and after the intervention was 1.43±0.21 and 1.53±0.24 mg/dL, respectively, with P-value=0.36. In the downhill group, this value was 1.27±0.17 and 1.30±0.18, respectively, with a P-value=0.032. Conclusion: In light of the results of the present study, incorporating downhill exercises in COPD patients' rehabilitation program can help improve pulmonary function and prevent atherosclerotic events.

Background: Cigarette smoking is a shared risk factor for a variety of health conditions. Aims: To estimate the prevalence of cigarette smoking among Iranian adolescents and young adults. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, Scopus and domestic databases from January 2001 to December 2018. Cross-sectional studies that reported the prevalence of cigarette smoking among high school students, university students or general population aged 14–30 years were eligible. Data on prevalence of smoking, age and gender of subjects, sample size, date, and location of studies were extracted by 2 independent reviewers. Results: We included 99 studies in the analysis. For high school students, the pooled life-time prevalence of cigarette smoking was 13% in girls and 23% in boys. For university students, the life-time prevalence was 11% in women and 33% in men. The pooled prevalence of current and regular smoking among high school boys was 9% and 5%, respectively, compared with 3% and 1% in girls. The pooled prevalence of current and regular smoking among male university students was 22% and 11%, respectively, compared with 5% and 1% among female students. The prevalence of current smoking among the general population aged 15–24 years was 3.3–13.9%. The prevalence of regular smoking among this population was 1.0–10.2%. Conclusion: Cigarette smoking is notable among Iranian young adults especially boys and university students. Our findings call for reinforcement of tobacco prevention and control policies across Iranian schools and universities.

Background Understanding the reasons for loss to follow-up (LTFU) in cohort studies, especially among marginalized groups such as people who inject drugs (PWID), is needed to strengthen the rigor of efficacy trials for prevention and treatment interventions. We assessed the proportion and reasons for loss to follow-up in a recent cohort of PWID enrolled in the southeast of Iran. Methods Using respondent-driven sampling, we recruited 98 PWID age 18 years or older who reported injecting drugs in the past 6 months, and were negative for HIV and HCV at initial screening. Participants were followed at 6 week intervals, alternating a short six-week visit and long 12-week or quarterly visit to measure incidence of HIV and HCV. Methods to enhance retention included incentives for completing each visit, tracking people who missed the scheduled visits through their peer referral networks, engaged outreach teams to explore hotspots and residences, and photos. LTFU was defined as participants who missed their quarterly visits for two or more weeks. Results Mean (SD) age of participants was 39.7 years (SD 9.6). Of 98 enrolled, 50 participants (51.0%) were LTFU by missed their scheduled quarterly visits for 2 weeks or more. For those whose reasons for LTFU could be defined (46.0%, 23 of 50), main reasons were: forgetting the date of visit (43.5%, 10 of 23), being incarcerated (39.1%, 9 of 23), and moving out of the city (17.4%, 4 of 23). Conclusion This study highlighted the difficulty in retaining PWID in longitudinal studies. Despite having several retention strategies in place, over half of PWID were LTFU. The LTFU might be reduced by setting up more effective reminder systems, working closely with security systems, and online means to reach those who move outside the study area.

Background Opioid agonist therapy (OAT) uptake has been associated with multiple positive health outcomes among people who inject drugs (PWID). This study evaluated the pattern of OAT uptake among PWID in two consecutive national bio-behavioral surveillance surveys (2010 and 2014) in Iran. Methods Data were obtained from two national bio-behavioral surveillance surveys (N2010 = 1783 and N2014 = 2166) implemented using convenience sampling at the harm reduction facilities and street venues in 10 geographically diverse urban centers across Iran. Multivariable logistic regression models were built to determine the correlates of OAT uptake for the 2014 survey, and adjusted odds ratios (AORs) along with 95% confidence intervals (CI) were reported. Results The prevalence of OAT uptake decreased from 49.2% in 2010 to 45.8% in 2014 (P value = 0.033). OAT uptake varied across the studied cities ranging from 0.0 to 69.3% in the 2010 survey and 3.2 to 75.5% in the 2014 survey. Ever being married (AOR = 1.40; 95% CI 1.12, 1.75), having a history of incarceration (AOR = 1.56; 95% CI 1.16, 2.09), and human immunodeficiency virus (HIV) sero-positivity (AOR = 1.63; 95% CI 1.08, 2.50) were associated with OAT uptake. Conversely, PWID who reported using only non-opioid drugs (AOR = 0.43; 95% CI 0.26, 0.71) and those who reported concurrent use of opioid and non-opioid drugs (AOR = 0.66; 95% CI 0.51, 0.86) were less likely to uptake OAT. Conclusions Although OAT uptake among PWID in Iran is above the 40% threshold defined by the World Health Organization, there remain significant disparities across urban settings in Iran. Importantly, the OAT services appear to be serving high-risk PWID including those living with HIV and those with a history of incarceration. Evaluating service integration including mental health, HIV and hepatitis C virus care, and other harm reduction services may support the optimization of health outcomes associated with OAT across Iran.

Introduction Polyomaviruses including BK virus (BKV) and JC virus (JCV) are widespread in human and have been associated with colorectal cancer (CRC) in some studies. The aim of present systematic review and meta-analysis article is to calculate the pooled prevalence of BKV and JCV in patients with CRC and assessing their association with this malignancy. Materials and methods Domestic databases and Sciences Direct, PubMed, ProQuest, Web of Sciences and Scopus were searched for relevant articles up to 2nd June 2019Two independent reviewers extracted the related data from eligible articles. The pooled prevalence and pooled odds ratio (POR) and their 95% confidence interval (95% CI) were calculated using "metaprop" and "metan" commands in Stata 14. Where I2 statistics were >50%, the random effect model was used. Results From 1461 relevant studies, 24 articles were eligible and included in the qualitative while 19 articles included in quantitative analysis. The pooled prevalence based on diagnostic methods varies from 29% using immunohistochemistry to 52% using nested-PCR method. The likelihood of being infected with JCV was significantly higher in CRC patients compared to healthy (POR: 4.41, 95% CI: 2.13 - 9.13) controls, normal adjacent mucosa (POR: 2.79, 95% CI: 1.3-5.9) and colorectal adenoma (POR: 3.1, 95% CI: 1.5-6.5) but was not significant when non-CRC patients used as control group. Conclusion The prevalence of JCV in colorectal patients was substantially variable by different methods and targets. The significant association between JCV and CRC that was observed in the present study is not indicative of causation and should be studied more in large-scale prospective designs.

Objective To assess the efficacy of prostaglandin F 2 alpha (PGF2α) in hysteroscopic myomectomy of submucous myomas. Design A single-blind, randomized clinical trial study. Setting A teaching hospital, affiliate of Iran University of Medical Sciences, Tehran, Iran. Patients Forty-four patients with symptomatic submucous myomas were randomly assigned to the intervention group (n=21; 1 excluded owing to myoma not identified on pathology) and the control group (n=22). Interventions In the intervention group, PGF2α was injected into the cervix twice: before the beginning of surgery and after resection of the intrauterine portion of the submucous myoma. The procedure was continued until complete removal of the remnant intramural node contracted into the uterine cavity from induction following PGF2α administration. The same procedure was performed in the control group without PGF2α injection. Measurements and Main Results There was no difference in demographics, size, or type of myomas between groups at baseline. Although complete removal of submucous myomas in the intervention group (PGF2α) was higher (20/23 myomas or 87%) than the control group (15/23 myomas or 65.2%), the difference was not significant (P=0.1). The number of 1-step complete removal of large submucous myomas (>5 cm) in the PGF2α group was significantly higher compared to the control group (8/10 myomas [80%] vs. 2/8 myomas [25%], p= 0.03). Mean duration of operative time was significantly longer in the intervention group than the control group (p=0.01). The intervention group experienced more days of postoperative bleeding than the control group (p=0.001). There were no differences between groups regarding hospital length of stay or hemoglobin levels (p=0.07). Conclusions In the current study, injection of PGF2α was beneficial for 1-step complete resection of large (> 5 cm) submucous myomas via hysteroscopic myomectomy.

Patients with ostomy are faced with several physical, psychological, and social challenges and need to be prepared to overcome these challenges. Studies have shown that training plays an important role in helping patients to adapt with ostomy, live with it, and improve their psychological well-being and quality of life (QOL). Therefore, the present study aimed to determine the effect of structured ostomy care training on QOL and anxiety of the patients with permanent ostomy. In this randomised clinical trial study, 60 eligible participants were recruited from the only ostomy clinic in Kerman, Iran. They were selected using a purposive sampling method and randomly assigned to either a control group that received routine ostomy care or an intervention group that attended oral and practical training and a question and answer session by a trained ostomy nurse and received an ostomy information booklet besides their routine care. Outcome variables were anxiety and QOL in general and its physical, mental, social, and spiritual dimensions in detail. By using the anxiety subscale of Hospital Anxiety and Depression Scale (HADS) and City of Hope-quality of life [COH-QOL], data were collected before and 2 months after intervention in both groups. Data were analysed by SPSS version 19 using χ², analysis of variance (ANOVA), independent t, and paired t test and multiple regression analysis. The results showed that the intervention group had significantly lower mean scores in anxiety (P = .001) and a higher mean score in overall QOL (P = .009) compared with the control group. The most significant increase was observed for psychological, social, and physical aspects, and the least was in the spiritual aspect, all of which improved after intervention. After controlling the effects of confounding variables such as age, ostomy period, and number of children, the structured training programme still had a positive effect on QOL. Structured ostomy care training, including face-to-face education and personal practice of using ostomy equipment, along with written material provided by the ostomy nurse specialist, may lead to an increase in the overall QOL and a decrease in the perceived anxiety level in patients. This type of training is not routinely delivered to ostomy patients in our health care setting, so it is feasible to prepare surgical wards and to educate nurses to work with their patients before and after ostomy creation. Furthermore, to ease patients' religious concerns, we recommend counselling, and the support of religious leaders in the Muslim community may play a key role to adaptation regarding religious matters after ostomy surgeries and alleviate patients' concerns.

This clinical study was designed to find out the correlation between oxidative stress and sialic acid (SA) content of plasma and RBCs in patients with type 2 diabetes. We evaluated SA concentration and oxidative stress biomarkers in healthy subjects and diabetic patients with and without complications in a cross-sectional survey. Significant changes in oxidative stress biomarkers and RBC-SA were revealed in the diabetic patients compared to those in the healthy group. Plasma SA significantly increased with an increase in lipid peroxidation of RBCs (LPO-RBC) (P

Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulnessbased stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery. Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups. Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories. Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancyrelated anxiety is recommended to increase the birth rate.

Objectives Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran. Study design In this cross-sectional study, we recruited 202 homeless youth (age: 15–29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017. Methods Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis. Results The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1–192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3–15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1–4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1–8.8). Conclusion Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.

We used two national surveys (2010: N = 1597; 2013: N = 1057) of people who inject drugs (PWID) in past-month to assess the prevalence and population size of PWID with either safe or unsafe injection and sex behaviors, overall and by HIV status. In 2013, only 27.0% (vs. 32.3% in 2010) had safe injection and sex, 24.6% (vs. 23.3% in 2010) had unsafe injection and sex, 26.4% (vs. 26.5% in 2010) had only unsafe injection, and 22.0% (vs. 18.0% in 2010) had unsafe sex only. Among HIV-positive PWID in 2013, only 22.1% (~ 2200 persons) had safe injection and sex, 14.2% (~ 1400 persons) had unsafe injection and sex, 53.1% (~ 5200 persons) had unsafe injection, and 10.6% had unsafe sex (~ 1100 persons). Among HIV-negative PWID in 2013, only 27.5% (~ 22,200 persons) had safe injection and sex, 25.9% (~ 20,900 PWID) had unsafe injection and sex, 23.2% (~ 18,700 persons) had unsafe injection, and 23.3% (~ 18,800 persons) had unsafe sex. HIV-positive and -negative PWID in Iran continue to be at risk of HIV acquisition or transmission which calls for targeted preventions services.

Background Among various methods and types of drug abuse, injection receives a great deal of importance because of its related dangerous behavior and health consequences. It seemed that some of the network's indicators affect dangerous behavior of injection. Objective To determine the relationship between a network's indicators and basic factors with high-risk behavior of injection among injecting drug users (IDU) via the multiple memberships multilevel model. Methods In this cross-sectional study, the data related to 147 IDUs in Kerman province, who were interviewed from October 2013 through March 2014, were used, and these addicts were chosen for interview from specific resorts used for common injection. In this study, for analyzing data, multiple membership multilevel model and MLwiN 2.02 software were used. Results In this study, the mean age of people, who were mostly men, was 37.2±9.02. Based on the result, it becomes obvious that variables of in-degree with OR=1.49 (p=0.006) and the whole number of people related to the person with OR=1.18 (p=0.003) influences the high-risk behavior of injection. Also, none of the demographic variables influenced the high-risk behavior of injection. Conclusion Totally based on the results of this study, one can find a suitable method in the social network of IDUs in order to create essential strategies, reducing the risk throughout the country. In addition, in minimum time with fewer expenses, aggravation of dangerous behavior especially high-risk behavior of injection can be prevented.

Background HIV prevalence among prisoners is over eight times higher than that of the general in Iran. Considering that sexually transmitted infections (STIs) increase the susceptibility to HIV infection, this study estimates the prevalence and correlates of STI-related symptoms among prisoners in Iran. Methods In this cross-sectional study, 27 prisons across 16 provinces were selected using a stratified random sampling approach. Men aged ≥18 years who spent at least 1 week in the prison and self-reported having had sex during last year were eligible for this analysis. Participants were asked about their current STI symptoms including penile discharge (PD) and genital ulcers (GU). Demographic variables, HIV/STI-related knowledge, STI care seeking practices, HIV self-perceived risk, as well as history of substance use, incarceration, and sexual behaviours were collected using a face-to-face pilot-tested risk assessment questionnaire. HIV tests were completed using ELISA of dried blood spots. Correlates of having STI symptoms were identified using descriptive statistics and logistic regression models. Results Out of 2610 male prisoner recruited (Mean age ±SD: 35.7±0.19), 7% reported symptoms for PD, UC, or both; 45% of whom had not sought STI care inside prisons. Having STI-related symptoms were positively associated with a history of injection drug use (adjusted odds ratio [AOR]: 2.1, 95% CI, 1.4–3.1), condom accessibility inside prison (AOR: 1.7, 95% CI , 1.1–2.8), self-perceived risk of HIV (AOR: 1.5, 95% CI , 1.1–2.2), HIV-seropositivity (AOR: 3.3, 95% CI , 1.3–10.6), while negatively associated with having sufficient STI-related knowledge (AOR: 0.6, 95% CI, 0.4–0.8). Conclusion STI symptoms are notable among prisoners in Iran with a higher prevalence among specific groups (i.e., those who inject drugs and live with HIV). Our findings call for revisiting current HIV/STI prevention policies across Iranian prisons to help improve prisoners’ HIV/STI knowledge and encourage their HIV/STI preventive practices. Disclosure No significant relationships.

Background Prisoners are disproportionately at increased risk of HIV infection. Despite the importance of assessing HIV testing rates among key populations at risk of HIV, our understanding of HIV testing practices of Iranian prisoners is limited. This study utilizes data from two repeated behavioral survey studies to shed light on the prevalence and correlates of HIV testing among Iranian prisoners. Methods Data were obtained from two consecutive surveys in 2009 (N = 5913) and 2013 (N =5430) using a multistage random sampling approach including both large and small prison settings. Having a recent HIV test result was defined as having an HIV test result over the last 12 months. Biological and survey data were collected through dried blood spot testing and standardized risk assessment questionnaire, respectively. Descriptive statistics including frequencies, percentages, and 95% confidence intervals (CI) were reported. Bivariable and multivariable logistic regression models were built to compare the odds of having a recent HIV test result among different subgroups of prisoners. Results Most participants had never tested for HIV (68.7% in 2009 and 62.2% in 2013). Only 9.9% (in 2009) and 11.6% (in 2013) of the participants had a recent HIV test result. Older age (AOR=1.50), lifetime history of drug use (AOR=1.87) and sexual intercourse (AOR=1.42), and self-perceived risk of HIV (AOR=0.74) were significantly associated with recent HIV testing in 2009. Female sex (AOR=4.03), multiple incarcerations (AOR=1.40), alcohol consumption (AOR=1.23), and STI (AOR=1.79) and HIV knowledge (AOR=1.62) were significant correlates in 2013. Conclusion HIV testing is extremely low among prisoners in Iran. There is an urgent need to revisit current HIV testing policies across Iranian prisons and identify the barriers to HIV testing within the prison settings. Scaling up rapid tests as well as routine opt-out HIV testing services could help encourage prisoners to further use the available harm reduction facilities inside prisons. Disclosure No significant relationships.

Background: Painful memories from previous childbirth can linger and impose negative effects on the mind of a woman throughout her life. They may also create a permanent fear of delivery and turn into a barrier to future pregnancies. Objectives: The aim of this study was to investigate the impact of mindfulness-based stress reduction (MBSR) on the fear of delivery in single-child mothers with a history of vaginal delivery in the city of Kerman, Iran. Methods: This is an experimental, interventional study with pretest-posttest design and a control group. The statistical population encompassed all single-child women in the city of Kerman who had had childbirth at least six years earlier and had not become pregnant due to childbirth fear. The sample consisted of 41 participants, 20 of whom received the MBSR group training in eight sessions (each lasting for 90 minutes). Fear of childbirth was evaluated before and after the intervention using Harman's Childbirth Attitudes Questionnaire (CAQ). Data were analyzed by SPSS 22 using a paired t test, covariance, independent t test, and chi-square test. Results: The mean scores of childbirth fear in the intervention and control groups were 37.58 ± 5.9 and 33.19 ± 6.55, respectively, before implementing the program and 36.25 ± 5.40 and 33.00 ± 6.47 after that. The level of fear after the intervention was significantly higher in the experimental group than in the control group (P < 0.001). Besides, the greatest effects of the instructions were observed on the fear of painful injections, loneliness, and worry over the hospital environment. Conclusions: Group training of MBSR is helpful in reducing childbirth fear, and thus it can be deployed as a procedure for encouraging childbearing in women who are not willing to re-experience pregnancy due to the fear of delivery.

Purpose. To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). Methods. We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. Results. The rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. Conclusions. AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.

Background For a better understanding of the current situation of drug use in Iran, we utilized the network scale-up approach to estimate the prevalence of illicit drug use in the entire country. Methods We implemented a self-administered, street-based questionnaire to 7535 passersby from the general public over 18 years of age by street based random walk quota sampling (based on gender, age and socio-economic status) from 31 provinces in Iran. The sample size in each province was approximately 400, ranging from 200 to 1000. In each province 75% of sample was recruited from the capital and the remaining 25% was recruited from one of the large cities of that province through stratified sampling. The questionnaire comprised questions on demographic information as well as questions to measure the total network size of participants as well as the network size in each of seven drug use groups including Opium, Shire (combination of Opium residue and pure opium), Crystal Methamphetamine, heroin/crack (which in Iranian context is a cocaine-free drug that mostly contains heroin, codeine, morphine and caffeine with or without other drugs), Hashish, Methamphetamine/LSD/ecstasy, and injecting drugs. The estimated size for each group was adjusted for transmission and barrier ratios. Results The most common type of illicit drug used was opium with the prevalence of 1500 per 100,000 population followed by shire (660), crystal methamphetamine (590), hashish (470), heroin/crack (350), methamphetamine, LSD and ecstasy (300) and injecting drugs (280). All types of substances were more common among men than women. The use of opium, shire and injecting drugs was more common in individuals over 30 whereas the use of stimulants and hashish was largest among individuals between 18 and 30 years of age. Conclusion It seems that younger individuals and women are more desired to use new synthetic drugs such as crystal methamphetamine. Extending the preventive programs especially in youth as like as scaling up harm reduction services would be the main priorities in prevention and control of substance use in Iran. Because of poor service coverage and high stigma in women, more targeted programs in this affected population are needed.

Background Homeless youth are at increased risk of substance use and its consequences worldwide. Substance use among youth who are homeless has not been as well studied, particularly in developing country settings. We therefore aimed to assess the prevalence and correlates of substance use among homeless youth in Kerman, a city in southeast Iran. Methods In a cross-sectional survey by convenience sampling, we recruited 202 homeless youth from September to December 2017. Data were collected in face-to-face interviews using a standardized questionnaire. Youth were eligible if they were 15–29 years old and homeless or unstably housed for at least one month during last year. Factors associated with substance use were characterized by multivariable logistic regression analysis. Results In our survey, 50.0% (95% CI 43.0–56.9) of homeless youth reported substance use in the last month. The most common substances used were heroin (34.0%), alcohol (31.2% – illegal in Iran), and methamphetamine (24.0%). Substance use was associated with male sex (adjusted odds ratio [AOR] 6.57, 95% CI 2.72, 15.85), age 25–29 vs. 15–24 years (AOR 4.02, 95% CI 1.57, 10.29), current tobacco use (AOR 6.49, 95% CI 2.63, 16.00), and absolute homelessness vs. relative homelessness (AOR 7.75, 95% CI 2.90, 20.68). Conclusions Findings highlight the need for prevention programs to reduce substance use-related harm among homeless youth, particularly among tobacco users and those completely homeless. Innovative strategies are needed reach the absolutely homeless and simultaneously address the substance use and competing social welfare needs of this vulnerable population.

We examined the association of dyadic-level factors with syringe sharing among people who inject drugs (PWID) in Kerman, Iran. In a cross-sectional study, we collected data on 329 drug-injecting dyads by individual face-to-face interviews. An injecting dyad was defined as 2 PWID who knew each other and injected drugs together during the last 6months. If they reported at least 1 occasion of syringe sharing, the dyad was considered high-risk. Dyadic-level factors associated with syringe sharing were assessed using cross-classified multilevel logistic regression. The rate of syringe sharing was significantly higher for dyads who were more intimate (adjusted odds ratio [AOR] 4.5, CI 95%, 2.3-8.6), who had instrumental support (AOR 2.1, 95% CI 1.1-4.5), and who pooled money for drugs (AOR 4.1, 95% CI 2.0-8.3). The rate was lower in same-sex dyads (AOR 0.4, 95% CI 0.2-0.9) and in dyads who shared health information (AOR 0.5, 95% CI 0.2-0.9). Findings highlight close-peer influences on syringe-sharing behavior.

Background Schizophrenia is a chronic, disabling and severe mental disorder, characterised by disturbance in perception, thought, language, affect and motor behaviour. Chlorpromazine and clotiapine are among antipsychotic drugs used for the treatment of people with schizophrenia. Objectives To determine the clinical effects, safety and cost-effectiveness of chlorpromazine compared with clotiapine for adults with schizophrenia. Search methods We searched Cochrane Schizophrenia's Trials Register (last update search 16/01/2016), which is based on regular searches of CINAHL, BIOSIS, AMED, Embase, PubMed, MEDLINE, PsycINFO and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the Register. Selection criteria All randomised clinical trials focusing on chlorpromazine versus clotiapine for schizophrenia. We included trials meeting our selection criteria and reporting useable data. Data collection and analysis We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses. We assessed risk of bias for included studies and created a 'Summary of findings' table using GRADE. Main results We have included four studies, published between 1974 and 2003, randomising 276 people with schizophrenia to receive either chlorpromazine or clotiapine. The studies were poor at concealing allocation of treatment and blinding of outcome assessment. Our main outcomes of interest were clinically important change in global and mental state, specific change in negative symptoms, incidence of movement disorder (dyskinesia), leaving the study early for any reason, and costs. All reported data were short-term (under six months' follow-up). The trials did not report data for the important outcomes of clinically important change in global or mental state, or cost of care. Improvement in mental state was reported using the Positive and Negative Syndrome Scale (PANSS). When chlorpromazine was compared with clotiapine the average improvement scores for mental state using the PANSS total was higher in the clotiapine group (1 RCT, N = 31, MD 11.50 95% CI 9.42 to 13.58, very low-quality evidence). The average change scores on the PANSS negative sub-scale were similar between treatment groups (1 RCT, N = 21, MD -0.97 95% CI -2.76 to 0.82, very low-quality evidence). There was no clear difference in incidence of dyskinesia (1 RCT, N = 68, RR 3.00 95% CI 0.13 to 71.15, very low-quality evidence). Similar numbers of participants left the study early from each treatment group (3 RCTs, N = 158, RR 0.68 95% CI 0.24 to 1.88, very low-quality evidence). Authors' conclusions Clinically important changes in global and mental state were not reported. Only one trial reported the average change in overall mental state; results favour clotiapine but these limited data are very difficult to trust due to methodological limitations of the study. The comparative effectiveness of chlorpromazine compared to clotiapine on change in global state remains unanswered. Results in this review suggest chlorpromazine and clotiapine cause similar adverse effects, although again, the quality of evidence for this is poor, making firm conclusions difficult.

AIM Insulin-like growth factor-1 (IGF-1) has been identified as a valuable indicator for impaired glucose tolerance, and its relationship with the presence of coronary atherosclerosis has been also suggested. A few studies have assessed the relationship between IGF-1 level and severity of atherosclerosis. In the present study, the relationship between IGF-1 and coronary artery disease (CAD) was examined with particular attention to the association between this parameter and Gensini score as a good angiographic marker for determining extension and severity of CAD. METHODS One hundred and seven patients with suspected CAD consecutively referred for selective coronary angiography at the Shafa Hospital in Kerman between April and September 2010 were prospectively enrolled. Total IGF-1 was measured using radioimmunoassay methods (Diagnostics Systems Laboratory, Iran). Selective coronary angiography was performed for all study patients and the Gensini score is computed by assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its importance based on location. RESULTS According to the Spearman correlation analysis, total IGF-I was directly correlated with Gensini score (Spearman's rho = 0.362, P = 0.041). Total IGF-I was slightly related to the number of involved coronary vessels (P = 0.058). Relation between age-adjusted and sex-adjusted mean total IGF-I levels with Gensini score remained significant (P = 0.046); however, the association between IGF-1 and the number of diseased vessels lost statistical significance after this adjustment. CONCLUSION IGF-1 appears as a positive indicator for severity of CAD assessed by the Gensini score, and thus its concentration may be an important indicator for assessing the extent of coronary artery involvement.

Background Globally, one in three women who inject drugs is involved in sex work which increases their vulnerability to sexually transmitted infections including HIV. This study was conducted to improve our understanding of injection drug use practices among Iranian female sex workers (FSWs) and shed light on the high-risk profile of FSWs who inject drugs (FSW-IDUs). Methods This survey was conducted in 2010, by recruiting 872 FSWs through facility-based sampling from 21 sites in 13 cities in Iran. Data were collected through face-to-face interviews and lifetime injection drug use was assessed through the responses to the question "Have you ever injected any illicit drugs?". Independent variables included a range of socio-demographic and risk characteristics. Logistic regression models were applied to investigate the correlates of lifetime history of injection drug use. Results Median (Q1, Q3) age of the participants was 30 (25, 37) and a total of 127 (14.6%, 95% confidence interval (CI): 12.3–17.1) had ever injected drugs. In the multivariable logistic regression model, older age (adjusted odds ratio (AOR)=AOR 25–34 vs. =3.37, 95% CI: 1.64, 7.70; AOR ≥35 vs. =2.80, 95% CI: 1.11, 7.10), longer duration (>5 years) of involvement in sex work (AOR=1.06, 95% CI: 1.02, 1.10), and history of drinking alcohol (AOR=4.42, 95% CI: 2.67, 7.32) were positively associated with lifetime history of drug injection and younger age at sex work debut (AOR=0.52, 95% CI: 0.28, 0.96) was negatively associated with lifetime history of illicit drug injection among FSWs. Conclusion The prevalence of injection drug use among FSWs in Iran is concerning. Given the potential of this sub-population in bridging HIV into the general population, gender-sensitive and peer-led harm reduction programs should be further scaled up to meet the special needs of this vulnerable population.

Background: One of the main concerns of policymakers is to measure the impact of harm reduction programs and different interventions on the risk of HIV transmission among Injecting Drug Users (IDUs). Looking simultaneously at multiple factors and conditions that affect the risk of HIV transmission may provide policymakers a better insight into the mixed nature of HIV transmission. Objectives: The present study aimed to design a simple, brief, and multi-dimensional scale for measuring HIV transmission risk among IDUs. Patients and Methods: From October 2013 to March 2014, we conducted face-to-face interviews with 147 IDUs. Eligible participants were individuals 18 years or older who had injected drugs at least once during the last year and had not participated in similar studies within the 2 months before the interview. To design a scale for measuring HIV transmission risk, we specified 11 items, which address different dimensions of HIV risk taking behaviors/situations based on experts’ opinion. We applied exploratory factor analysis (EFA) with principal component extraction to develop scales. Eigen values greater than 1 were used as a criterion for factor extraction. Results: We extracted 7 items based on first factor, which were accounted for 21% of the variations. The final scale contained 7 items: 4 items were related to injecting practice and 3 items related to sexual behaviors. The Cronbach’s α coefficient was 0.66, acceptable for such a brief scale. Conclusions: Applying a simple and brief scale that incorporates the different dimensions of HIV transmission risk may provide policymakers and harm reductionists with a better understanding of HIV transmission in this key group and may be advantageous for evaluating intervention programs.

PURPOSE: Anal sphincter defects and fecal incontinence are complicated surgical problems. We investigated the ability of human umbilical cord matrix (hUCM) and rabbit bone marrow (rBM) stem cells to improve anal sphincter incontinence due to induced sphincter defects without surgical repair. METHODS: We harvested hUCM cells from human Wharton's jelly and rBM stem cells from rabbit femurs and tibias. To induce sphincter defects, we made an incision in the external anal sphincter. Rabbits were randomly allocated to 5 groups to receive either no intervention (n = 3) or injections of 10 4 hUCM cells in medium (10 μL RPMI-1640), rBM cells in medium, medium only, or normal saline (n = 7 per group), 2 weeks after sphincterotomy. Transplanted cells were tracked in the injured sphincters by prelabeling with bromodeoxyuridine. Electromyography was performed before and 2 weeks after the external anal sphincterotomy, and 2 weeks after cell transplantation. We also evaluated the proliferation and differentiation of injected cells with histopathologic techniques. RESULTS: Electromyography showed significant improvement in sphincter function 2 weeks after local injection of rBM stem cells compared with pretreatment values and controls. Moderate, nonsignificant improvement was observed with hUCM cell injection. Cells with incorporated bromodeoxyuridine were detected at the site of injury after transplantation of hUCM and rBM. Histopathologic evaluation showed normal or muscle-dominant sphincter structure in all animals receiving rBM and fibrous-dominant sphincter structure in most animals receiving hUCM. CONCLUSIONS: Stem cell injection at the site of injury can enhance contractile function of the anal sphincter without surgical repair. Transplantation of stem cells, particularly bone marrow mesenchymal cells, may provide an effective tool for treating anal sphincter injuries in humans.

Evidence on STI knowledge among Iranian nonmedical university students is limited. Information is needed to inform research and policies to improve the sexual health of university students in Iran.A convenience sample of 742 male and female undergraduate and graduate students was recruited from five nonmedical public and private universities in Iran in 2014. Respondents' awareness of and knowledge about STIs were assessed using a validated questionnaire. Chi-square tests, student t tests and one-way analysis of variance were used to compare the percentage of respondents giving correct responses across subgroups of students.Half of the respondents had ever heard of STIs, but most could not correctly identify STIs in a list of diseases. A total of 49%, 42% and 9% of the respondents had low, moderate and high STI knowledge scores, respectively. Respondents reported online sources (62%) and friends (32%) as their main sources of information about STIs, and those who were older, ever-married or more educated were more knowledgeable than other respondents.Given that the Internet was students' main source of information, increasing the accessibility and visibility of credible Internet sites about sexual health is warranted. Also, key individuals in students' networks (e.g., parents, teachers, peers) should be equipped with required training and knowledge on STI-related topics and be actively involved in sexual health education efforts.La evidencia sobre los conocimientos acerca de las ITS entre los estudiantes universitarios iraníes que no estudian medicina es limitada. Se necesita información para dar sustento a las investigaciones y políticas dirigidas a mejorar la salud sexual de los estudiantes universitarios en Irán. MÉTODOS: En 2014 se reclutó en Irán una muestra por conveniencia de 742 hombres y mujeres cursando estudios de licenciatura y posgrado de cinco universidades públicas y privadas donde no se estudia medicina. Se evaluaron la concientización y los conocimientos sobre las ITS de las personas entrevistadas mediante la aplicación de un cuestionario validado. Para comparar el porcentaje de personas entrevistadas que respondió correctamente a lo largo de subgrupos de estudiantes, se usaron pruebas Chi cuadrado, pruebas t de Student y análisis de varianza de una vía.La mitad de los entrevistados había escuchado acerca de las ITS alguna vez, pero la mayoría no pudo identificar correctamente las ITS en una lista de enfermedades. Un total de 49%, 42% y 9% de los entrevistados obtuvieron calificaciones bajas, moderadas y altas en su conocimiento de las ITS, respectivamente. Las personas entrevistadas reportaron que sus principales fuentes para obtener información sobre las ITS son las fuentes provenientes de Internet (62%) y las amistades (32%), y las personas de mayor edad, que alguna vez estuvieron casadas o que tenían niveles más altos de educación estuvieron mejor informadas que las otras personas entrevistadas.Dado que Internet fue la principal fuente de información de los estudiantes, se justifica el aumento de la accesibilidad y la visibilidad de sitios de Internet confiables sobre salud sexual. Además, deberían equiparse a las personas clave que conforman las redes de los estudiantes (p. ej., padres, maestros, pares) con la capacitación y conocimientos requeridos sobre temas relacionados con las ITS e involucrarlos activamente en los esfuerzos de educación en salud sexual.La connaissance des IST parmi les étudiants universitaires des facultés non médicales d'Iran n'est guère documentée. Il convient de le faire pour éclairer la recherche et les politiques d'amélioration de la santé sexuelle des étudiants universitaires du pays. MÉTHODES: Un échantillon de commodité de 742 étudiants et étudiantes de premier et deuxième cycles a été recruté dans cinq facultés non médicales d'universités iraniennes publiques et privées en 2014. La sensibilisation et la connaissance des répondants au sujet des IST ont été évaluées sur la base d'un questionnaire validé. Le pourcentage de participants répondant correctement dans les sous-groupes d'étudiants a été comparé par tests chi carré, tests t de Student et analyse de variance simple. RÉSULTATS: La moitié des répondants avaient entendu parler des IST mais la plupart ne pouvaient pas les identifier correctement dans une liste de maladies. Un total de 49%, 42% et 9% des répondants a atteint, respectivement, une cote de connaissance des IST faible, moyenne et élevée. Les répondants ont déclaré les sources en ligne (62%) et leurs amis (32%) comme principales sources de leur information sur les IST. Ceux plus âgés, qui avaient déjà été mariés ou davantage instruits se sont avérés plus informés que les autres sur la question.Internet étant la principale source d'information des étudiants, il conviendrait d'accroître l'accessibilité et la visibilité de sites crédibles sur la santé sexuelle. Il serait par ailleurs utile de doter les personnes clés, au sein des réseaux des étudiants (parents, enseignants et pairs, par exemple), de la formation et des connaissances requises au sujet des IST et de les engager activement dans des efforts d'éducation à la santé sexuelle.

OBJECTIVE Much attention has recently been focused on the underlying role of circulating inflammatory biomarkers such as high-sensitivity C-reactive protein for predicting cardiovascular disease progression. We therefore set out to assess the relationship between the value of high-sensitivity C-reactive protein and (i) coronary artery disease severity, and (ii) left ventricular end diastolic pressure. DESIGN A cross-sectional study. SETTING The Shafa hospital in Kerman, Iran. PATIENTS A total of 107 consecutive patients referred for coronary angiography from January 2008 to January 2009 were prospectively studied. INTERVENTION AND MAIN OUTCOME MEASURES All patients underwent coronary angiography. They all had undergone left ventricular end diastolic pressure measurement, involving a 6-Fr pigtail catheter and a properly zeroed fluid-filled pressure transducer. For each patient, the level of high-sensitivity C-reactive protein was also determined using enzyme-linked immunosorbent assay kits. RESULTS The high-sensitivity C-reactive protein levels could strongly predict increased left ventricular end diastolic pressure (standardised beta=1.010; P=0.008), with other patient variables being confounders, but there was no significant association between these levels and Gensini scores. Multiple linear regression analysis showed that among the study parameters, systolic hypertension (standardised beta=1.611; P=0.047) and a family history of coronary artery disease (standardised beta=1.911; P=0.005) were the main predictors of high Gensini scores in study patients. CONCLUSION High-sensitivity C-reactive protein level is a clinical parameter that could predict left ventricular end diastolic pressure and left ventricular dysfunction, but was not associated with the severity of coronary artery disease.

Background: Opium abuse as a relatively common behavior among Iranian population may have an association with the other coronary artery disease (CAD) risk factors. Here, we reported the prevalence of opium abuse and its co-exposures with oral health and other CAD risk factors. Methods: We recruited 5900 inhabitant aged 15-75 years using a randomized cluster household survey. All were interviewed for level of physical activity (PA), depression, anxiety and opium use and assessed for hypertension, diabetes, hyperlipidemia, and oral health status. Regarding to opium abuse, participants were grouped into: "Non-," "occasional," and "dependent" users. Using logistic regression model for every CAD risk factor, we assessed whether the co-exposure of opium and CAD risk factor is significant. Results: Overall, 10.6% reported ever opium use including 5.6% dependent and 5% occasional users. The prevalence of opium abuse was increased from 2.1% in 15-25 years to 24.5% in 55-64 years group. Opium abuse, in occasional and dependent forms, was associated with depression (adjusted odds ratio [AOR] 1.81 and 2.49) and low PS (AOR 1.43 and 1.71 respectively). Dependents were less obese than nonusers (P < 0.01). Opium abuse had no significant association with hypertension, diabetes, oral health status and lipid profile. Conclusions: Opium abuse was associated with depression and low PA. No ameliorative effect was observed on hypertension, diabetes, and plasma lipid profile. Therefore, positive association of opium with depression and LPA and the incorrectness of belief on its ameliorative effect on three other important risk factors of CAD should be clearly highlighted in public health messages to the community.