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Background Colorectal cancer (CRC) has been regarded as one of the most frequently diagnosed malignancies among the leading causes of cancer-related morbidity and mortality globally. Diagnosis of CRC at the early-stages of tumour might improve the survival rate of patients. The current study sought to determine the performance of fecal Fusobacterium nucleatum (F. nucleatum) and Streptococcus bovis (S. bovis) for timely predicting CRC. Methods Through a case–control study, the fecal sample information of 83 individuals (38 females, 45 males) referring to a hospital in Tehran, Iran was used. All patients underwent a complete colonoscopy, regarded as a gold standard test. Bacterial species including S. bovis and F. nucleatum were measured by absolute quantitative real-time PCR. The Bayesian univariate and bivariate latent class models (LCMs) were applied to estimate the ability of the candidate bacterial markers in order to early detection of patients with CRC. Results Bayesian univariate LCMs demonstrated that the sensitivities of S. bovis and F. nucleatum were estimated to be 86% [95% credible interval (CrI) 0.82–0.91] and 82% (95% CrI 0.75–0.88); while specificities were 84% (95% CrI 0.78–0.89) and 80% (95% CrI 0.73–0.87), respectively. Moreover, the area under the receiver operating characteristic curves (AUCs) were 0.88 (95% CrI 0.83–0.94) and 0.80 (95% CrI 0.73–0.85) respectively for S. bovis and F. nucleatum. Based on the Bayesian bivariate LCMs, the sensitivities of S. bovis and F. nucleatum were calculated as 93% (95% CrI 0.84–0.98) and 90% (95% CrI 0.85–0.97), the specificities were 88% (95% CrI 0.78–0.93) and 87% (95% CrI 0.79–0.94); and the AUCs were 0.91 (95% CrI 0.83–0.99) and 0.88(95% CrI 0.81–0.96), respectively. Conclusions Our data has identified that according to the Bayesian bivariate LCM, S. bovis and F. nucleatum had a more significant predictive accuracy compared with the univariate model. In summary, these intestinal bacteria have been highlighted as novel tools for early-stage CRC diagnosis.

BACKGROUND: Interferons are essential part of the innate immune system and have antiviral and immunomodulatory functions. We studied the effects of Interferon s-1a on outcomes of severe cases of COVID-19. MATERIAL AND METHODS: This retrospective study was conducted on hospitalized COVID-19 patients in Loghman-Hakim hospital from 20 February 2020 to 20 April 2020, Tehran, Iran. Patients were selected from two groups, the first group received Interferon s-1a in addition to standard treatment regimen, and the second group received standard care. The clinical progression of two groups during their hospital admission has been compared. RESULTS: We studied a total number of 395 hospitalized COVID-19 patients. Out of this number, 111 patients (33.5%) died (31.3% of the Interferon s-1a group and 34.1% of the control group). Mortality rate indicated no statistically significant difference between groups (p-value = 0.348), however for patients who were hospitalized for more than a week, the rate of mortality was lower in the Interferon s-1a group (p-value = 0.014). The median hospital stay was statistically longer for patients treated by Interferon s-1a (p-value

Background Males are more likely to die from COVID-19 than females. In addition, the mortality rate among positive and suspected COVID-19 patients were reported in many studies. The aim of this study is to evaluate the sex differential effect in the COVID-19 mortality by different age groups and polymerase chain reaction (PCR) test results. Research design In a multicenter cross-sectional study from 55 hospitals in Tehran, Iran, patients were categorized as positive, negative and suspected cases. Age group, sex and hospital wards were also assessed in the analysis. Results A total of 25481 cases (14791 males) were included in the study with a mortality rate of 12.0%. The mortality rates in positive, negative and suspected cases were 20.55%, 9.97% and 7.31%, respectively. Although the mortality in negative test group was considerable, sex was not associated with the death rate in this group. Using a Cox regression model, sex had a significant effect on the hazard of death due to COVID-19 in adult and senior male patients having positive and suspected PCR test results. However, sex was not found as significant factor for mortality in patients with a negative PCR test in different age groups. Conclusions Regardless of other risk factors, we found that the effect of sex on COVID-19 mortality varied significantly in different age groups. Therefore, appropriate strategies should be designed to protect adult and senior males from this deadly infectious disease. Furthermore, owing to the considerable death rate of COVID-19 patients with negative test results, new policies should be launched to increase the accuracy of diagnosis tests.

There is still an urgent need to develop effective treatments to help minimize the cases of severe COVID-19. A number of tools have now been developed and applied to address these issues, such as the use of non-contrast chest computed tomography (CT) for evaluation and grading of the associated lung damage. Here we used a deep learning approach for predicting the outcome of 1078 patients admitted into the Baqiyatallah Hospital in Tehran, Iran, suffering from COVID-19 infections in the first wave of the pandemic. These were classified into two groups of non-severe and severe cases according to features on their CT scans with accuracies of approximately 0.90. We suggest that incorporation of molecular and/or clinical features, such as multiplex immunoassay or laboratory findings, will increase accuracy and sensitivity of the model for COVID-19 -related predictions.

Background The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD). Methods To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches. Results In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high‐income Asia‐Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively. Conclusions Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

Background: Retraction of articles occurs as a result of scientific misconducts or honest errors. Objectives: This study aimed to identify the frequency of retracted Iranian publications, compared to those of other countries and adjust them with influential parameters. Methods: All publications that were indexed on the Scopus database from 2008 to 2017 and then retracted, due to scientific misconduct were extracted through the Retraction Watch database and selected as the research community. To calculate the growth of retraction for each proposed country (or region), first, the rate of an absolute number of retracted papers for the years 2013-2017 was divided by the similar number for years 2008-2012, then this rate was adjusted to the retracted rate which is similarly computed for the total retracted statistics of the world. Results: Overall, 545 Iranian retracted publications from 2008 to 2017 were identified, of which 240 and 305 retracted articles were related to the first five years and the second five years of the study, respectively. The results showed that less than 1% (0.82) of all scientific articles published by Iranian researchers were retracted. However, the rate of retracted scientific articles in Iran compared to this rate in the world was significantly higher. Conclusion: Although retracted Iranian publications make up a small percentage of all Iranian publications, the number of retracted publications is increasing. It is important to recognize the reasons for scientific misconducts and to provide researchers with proper education.

Introduction: This study aimed to determine the viral agent (s) and their genome burden associated with an aseptic meningitis outbreak that occurred in Yasuj, Iran. Materials and Methods: During April to August 2015, 104 CSF samples from 104 patients under 14 years old admitted to the hospital of Yasuj, Iran, with aseptic meningitis associated clinical signs were collected. 200 μl CSF specimens was prepared for DNA and RNA viral genome extraction each and then subjected to diagnostic Taq-man real time PCR assays for the present of Enteroviruses, HSV, VZV, mumps, measles and rubella in the samples. Results: The majority of them had experienced clinical meningitis sign. Primary laboratory differentiated tests were in favor of viral meningitis. Among a total of 104 patients diagnosed with clinically aseptic meningitis, enterovirus as the most significant viral agent was detected in 53 subjects. However, mumps, HSV and VZV, as the endemic causes of viral meningitis, were detected in 6, 6 and 2 of the affected patients. It was revealed that two HSV and one VZV affected patients were co-infected with enteroviruses. All affected children with relatively variable viral load recovered without any sequels. Conclusion: The present study revealed enterovirus as the main predominant cause of pediatric aseptic meningitis that broke out in Yasuj-Iran. Also, the co-circulation of mumps, HSV and VZV, as the endemic cause during the same aseptic meningitis outbreak, was demonstrated in some cases.

Background. The outbreak of coronavirus disease 2019 (COVID-19) dates back to December 2019 in China. Iran has been among the most prone countries to the virus. The aim of this study was to report demographics, clinical data, and their association with death and CFR. Methods. This observational cohort study was performed from 20th March 2020 to 18th March 2021 in three tertiary educational hospitals in Tehran, Iran. All patients were admitted based on the WHO, CDC, and Iran’s National Guidelines. Their information was recorded in their medical files. Multivariable analysis was performed to assess demographics, clinical profile, outcomes of disease, and finding the predictors of death due to COVID-19. Results. Of all 5318 participants, the median age was 60.0 years, and 57.2% of patients were male. The most significant comorbidities were hypertension and diabetes mellitus. Cough, dyspnea, and fever were the most dominant symptoms. Results showed that ICU admission, elderly age, decreased consciousness, low BMI, HTN, IHD, CVA, dialysis, intubation, Alzheimer disease, blood injection, injection of platelets or FFP, and high number of comorbidities were associated with a higher risk of death related to COVID-19. The trend of CFR was increasing (WPC: 1.86) during weeks 25 to 51. Conclusions. Accurate detection of predictors of poor outcomes helps healthcare providers in stratifying patients, based on their risk factors and healthcare requirements to improve their survival chance.

Objective The actual impact of the pandemic on COVID-19 specific mortality is still unclear due to the variability in access to diagnostic tools. This study aimed to estimate the excess all-cause mortality in Iran until September 2021 based on the national death statistics. Results The autoregressive integrated moving average was used to predict seasonal all-cause death in Iran (R-squared = 0.45). We observed a 38.8% (95% confidence interval (CI) 29.7%–40.1%) rise in the all-cause mortality from 22 June 2020 to 21 June 2021. The excess all-cause mortality per 100,000 population were 178.86 (95% CI 137.2–220.5, M:F ratio = 1.3) with 49.1% of these excess deaths due to COVID-19. Comparison of spring 2019 and spring 2021 revealed that the highest percent increase in mortality was among men aged 65–69 years old (77%) and women aged 60–64 years old (86.8%). Moreover, the excess mortality among 31 provinces of Iran ranged from 109.7 (Hormozgan) to 273.2 (East-Azerbaijan) per 100,000 population. In conclusion, there was a significant rise in all-cause mortality during the pandemic. Since COVID-19 fatality explains about half of this rise, the increase in other causes of death and underestimation in reported data should be concerned by further studies.

Background and aims Non-contrast chest computed tomography (CT) scanning is one of the important tools for evaluating of lung lesions. The aim of this study was to use a deep learning approach for predicting the outcome of patients with COVID-19 into two groups of critical and non-critical according to their CT features. Methods This was carried out as a retrospective study from March to April 2020 in Baqiyatallah Hospital, Tehran, Iran. From total of 1078 patients with COVID-19 pneumonia who underwent chest CT, 169 were critical cases and 909 were non-critical. Deep learning neural networks were used to classify samples into critical or non-critical ones according to the chest CT results. Results The best accuracy of prediction was seen by the presence of diffuse opacities and lesion distribution (both=0.91, 95% CI: 0.83-0.99). The largest sensitivity was achieved using lesion distribution (0.74, 95% CI: 0.55-0.93), and the largest specificity was for presence of diffuse opacities (0.95, 95% CI: 0.9-1). The total model showed an accuracy of 0.89 (95% CI: 0.79-0.99), and the corresponding sensitivity and specificity were 0.71 (95% CI: 0.51-0.91) and 0.93 (95% CI: 0.87-0.96), respectively. Conclusions The results showed that CT scan can accurately classify and predict critical and non-critical COVID-19 cases.

Background and Objectives: Colorectal Cancer (CRC) is the fourth cancer-related cause of death worldwide. CRC is a multi-stage cancer, which is curable during the early stages of the disease. Therefore, determining the time of cut-point existence could improve treatment planning and help directly allocate resources. This study aims to determine the cut point in the age of CRC diagnosis. Methods: This study, covering the course 1985 to 2012, consisted of 345 colorectal cancer patients registered in Taleghani Hospital, Tehran, Iran and followed up to 2013. The cut-point in the age of CRC diagnosis was obtained using a mixture cure model. The data were analyzed using SPSS and R, V. 20 and 2.15.0, respectively. Results: The results showed that the cut point in the age of CRC diagnosis was 50 years. Based on our estimation, 65% of the patients diagnosed with CRC at or younger than 50 were cured, while 31% of them diagnosed older than 50 were cured, and the younger group had a better survival over the older group. Conclusion: Since access to a cut-point and analysis of created prognostic groups are important in screening and treatment planning, our results suggested that it is better to estimate the cut-point in the age of curable cancers in early stages via survival cure models, and the cure rate would increase by CRC timely screening.

Purpose Otomycosis is a mycotic infection of the external auditory canal and can be caused by a wide range of fungal species. In this study, we aimed to identify fungal isolates from patients suspected of otomycosis. Methodology External ear canal samples were taken from patients referred to the outpatient department of Shahid-Mofatteh Clinic in the city of Yasuj, Iran, and examined by direct microscopy and culture. DNA of the isolated fungi was tested by internal transcribed spacer PCR restriction fragment length polymorphism analysis for identification of yeasts and β-tubulin sequencing for identification of Aspergillus species. Results Among 275 patients suspected of otomycosis, 144 cases (83 female and 61 male) were confirmed with otomycosis. For 89% (n=128) of positive cultures, microscopy was also positive, while there were no cases with a microscopy-positive and culture-negative result. The predominant predisposing factor was self-cleaning of the external ear using unhygienic tools, and the main risk occupation was 'housewife'. The most common isolated fungi were typically Aspergillus (n=120), including 73 isolates of Aspergillus section Nigri, 43 of section Flavi, 3 of section Terrei and 1 of section Fumigati. After sequencing, 44 out of 73 strains primarily identified as Aspergillus niger turned out to be Aspergillus tubingensis. Thirty-five isolates were identified as Candida, including Candida parapsilosis (n=22), Candida albicans (n=12) and Candida tropicalis (n=1). Conclusion Aspergillus tubingensis was the most common species involved in otomycosis. This work corroborates the difficulty of precise identification of species within the black Aspergilli by morphological characteristics.

BACKGROUND Currently, teledermatology assumes a progressively greater role in the modern healthcare system, especially in consultation, diagnosis, or examining lesions and skin cancers. One of the major challenges facing teledermatology systems is determining the optimal image compression method to efficiently reduce the space needed for electronic storage and data transmission. OBJECTIVE To the objective and subjective assessment of HEIC compression method on dermatological color images and benchmarking the performance of High-Efficiency Image Coding (HEIC) with different algorithms to a feasibility study of the method for teledermatology. METHODS Twenty-five clinical and five skin histopathology images were taken in department of dermatology, Imam Reza Hospital, Mashhad, Iran. For each image, a set of 24 compressed images with different compression rates, which is composed of eight JPEG, eight JPEG2000, and eight HEIC images, has been prepared. Compressed and original images were shown simultaneously to three dermatologists and one dermatopathologist with different experiences. Each dermatologist scored quality and suitability of compressed images for diagnostic, as well as educational/scientific purposes. An objective evaluation was performed by calculating the mean "distance" of pixel colors and peak signal-to-noise ratio (PSNR). RESULTS All compression rates for HEIC were objectively better than JPEG and JPEG2000, particularly at PSNR. Moreover, mean "color distance" per pixel for compressed images using HEIC was lower than others. The subjective image quality assessment also confirms the results of objective evaluation. In both educational and clinical diagnostic applications, HEIC compressed images have the highest score. CONCLUSION In consideration of objective and subjective evaluation, the HEIC algorithm represents an optimal performance in dermatology images compression compared with JPEG and JPEG2000.

The outbreak of COVID-19 has laid unprecedented psychological stress on healthcare workers (HCWs). We aimed to assess the immediate psychological impact of COVID-19 epidemic on the HCWs at Baqiyatallah Hospital in Tehran, Iran.We conducted a cross-sectional survey of HCWs using questionnaires in February and March 2020 in Baqiyatallah Hospital, Tehran. We evaluated depression, stress, and anxiety levels using the DASS-21 questionnaire. Participants were selected by using census sampling. All statistical analyses were performed using R version 3.5.1.The study population included 217 HCWs (111 male, 116 female) and the mean age of the study group was 39.6 years old. Approximately two-thirds of the HCWs stayed in the hospital for 2-3 weeks. The mean scores of depression and stress were at a "severe" level, while anxiety scores were at an "extremely severe" level. The prevalence of severe scores was 38.71%, 2.30%, and 48.97% for depression, anxiety, and stress, and the prevalence of extremely severe scores was 46.54%, 97.24%, and 4.98% depression, anxiety, and stress, respectively. In stress subscale, moderate stress was 47.46%. Female HCWs reported higher levels of depression compared with males.In this study, HCWs reported experiencing severe and extremely severe psychological burdens. Timely interventions to promote mental health in HCWs exposed to patients with COVID-19 need to be immediately implemented, with female nurses requiring particular attention. This process could be facilitated via tests for molecular biomarkers in accessible body fluids, such as saliva, plasma, and serum.

We aimed to describe the epidemiological and clinical characteristics of Iranian patients with COVID-19.In this single-center and retrospective study, patients with confirmed COVID-19 infections were enrolled. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with outcomes.Of 179 patients with confirmed COVID-19 infection, 12 remained hospitalized at the end of the study and 167 were included in the final analysis. Of these, 153 (91.6%) were discharged and 14 (8.38%) died in hospital. Approximately half (50.9%) of patients suffered from a comorbidity, with diabetes or coronary heart disease being the most common in 20 patients. The most common symptoms on admission were fever, dyspnea, and cough. The mean durations from first symptoms to hospital admission was 8.64 ± 4.14 days, whereas the mean hospitalization time to discharge or death was 5.19 ± 2.42 and 4.35 ± 2.70 days, respectively. There was a significantly higher age in non-survivor patients compared with survivor patients. Multivariate regression showed increasing odds ratio (OR) of in-hospital death associated with respiratory rates20 breaths/min (OR: 5.14, 95% CI: 1.19-22.15, p = 0.028) and blood urea nitrogen (BUN)19 mg/dL (OR: 4.54, 95% CI: 1.30-15.85, p = 0.017) on admission. In addition, higher respiratory rate was associated with continuous fever (OR: 4.08, 95% CI: 1.18-14.08, p = 0.026) and other clinical symptoms (OR: 3.52, 95% CI: 1.05-11.87, p = 0.04).The potential risk factors including high respiratory rate and BUN levels could help to identify COVID-19 patients with poor prognosis at an early stage in the Iranian population.

Aim The COVID-19 was declared a pandemic in early 2020 and is associated with high public anxiety all over the world. The healthcare community is at the highest risk of infection and thereby prone to most distress. The aim of this study was to explore and evaluate the degree of depression, anxiety, and stress levels among medical college students during the COVID-19 epidemic in Iran. Methods A cross-sectional study was conducted in February and March 2020, 3 weeks after the first reported COVID-19 infection was identified in Iran. All medical college students who entered clinical courses were eligible for the study. Depression, stress, and anxiety were evaluated in these students using the DASS-21 questionnaire. Participants were selected by using availability sampling. All statistical analyses were performed using R version 3.5.1. Results The total number of participants was 207, with 143 males and 64 females. More than half of the participants (57.97%) were married. The mean duration of working experience among students with COVID-19 infection and experience in a medical ward was 3.00 ± 1.27 days and 17.40 ± 7.26 months, respectively. The majority of students had 2 or 3 days working experience with COVID-19 infection. The mean anxiety score of participants was 28.56 ± 4.68, the depression score was 29.36 ± 4.42, and the stress score was 28.99 ± 4.53. Our findings indicated that the mean scores of depression were at an "extremely severe" level, while stress and anxiety were at "severe" levels. The prevalence of "severe" symptoms of depression, stress, and anxiety was 69.57%, 60.87%, and 99.04%, respectively. Conclusions There is a high prevalence of anxiety and depression among medical students who were exposed to COVID-19-infected patients. Our results highlight the need to establish psychological support programs, training, and self-care for medical college students in relation to mental health. We recommend incorporation of molecular biomarker tests into an algorithm to aid in assessments and consideration of the appropriate therapeutic responses.

Patients with confirmed COVID-19 infection can develop several psychological consequences. Epidemiological data on mental health and psychological disorder inpatients infected with COVID-19 pneumonia are not available in Iranian patients. The purpose of this study was to evaluate the anxiety, stress, and depression of patients with COVID-19.This cross-sectional survey was conducted in 2020. All confirmed patients with COVID-19 were included in the study by census sampling. Assessment of depression, stress, and anxiety was performed using the DASS-21 questionnaire. All statistical analyses were performed using R version 3.5.1.The questionnaires were completed by 221 patients with COVID-19 infection (204 males, 17 females). The mean age was 45.90 ± 7.73 years. Our results indicated that the mean scores of depression and anxiety were at "extremely severe" levels, while stress levels were "severe." The prevalence of "extremely severe" symptoms of depression and anxiety was 54.29% and 97.29%, respectively. The prevalence of severe stress was 46.61%.In this study, patients infected with COVID-19 reported severe and extremely severe experience psychological distress. Further studies should focus on the combined use of psychological and molecular biomarker testing to increase accuracy. Overall, the findings demonstrate the necessity of special intervention programs for the confirmed patients with emerging infectious disease COVID-19 to promote mental health needs.

Identification of the causal risk factors of COVID-19 would allow better risk stratification and designing effective therapies. Epidemiological data have shown a higher incidence and mortality of COVID-19 in males compared to females. Here, we have used logistic regression analysis modeling to determine the association between gender and COVID-19 mortality in the Iranian population. The records of 2293 patients with COVID-19 infection were analyzed. The odds of death due to COVID-19 were 1.7 times higher in males compared to females after adjustment for age and background diseases. The gender difference was mainly observed at higher ages, suggesting an adjusted 2.32-fold higher risk of mortality in males aged59.5 years old compared to females within the same age group. This finding suggests the male gender is a potential predisposing factor for mortality due to COVID-19 infection. The potential role of male hormones, particularly testosterone, as therapeutic targets deserves further investigation.

Aim The ongoing COVID-19 outbreak has not only had an impact on physical health but also on psychological health. The aim of this study was to measure the prevalence and severity of psychological distress in the community due to the COVID-19 pandemic. Methods This cross-sectional survey was conducted in February and March 2020 in Tehran, Iran. We analyzed demographic characteristics and assessed depression, anxiety, and stress levels in 241 people using convenience sampling and the DASS-21 questionnaire. All statistical analyses were performed using R. Results The study population included 241 community-dwelling participants, of whom 145 were women and 96 were males. The mean age was 49.16 ± 8.01 years. Approximately two-thirds of participants (n = 158) reported no history of comorbid illness. The mean scores of depression and stress were at a "severe" level, while anxiety levels were at an "extremely severe" level. The prevalence of severe and extremely severe depression readings was 51.45 and 38.17%, respectively. In the anxiety subscale, the prevalence of severe and extremely severe depression was 95.90 and 4.1%, and in the stress subscale the prevalence was 48.97 and 4.98%, respectively. Conclusion In this study, people reported experiencing severe and extremely severe psychological distress. Therefore, there is an urgent need to implement mental health intervention policies to cope with this ongoing challenge. We suggest that the incorporation of molecular biomarker tests into the algorithm could aid in assessment of patients and guide the most appropriate therapeutic response.

Aim: To estimate the epidemiological parameters related to the Covid-19 outbreak in Iran. Background: Estimating the epidemiological parameters of new public health threat (COVID-19) is essential to support and inform public health decision-making in different communities including Iran. Methods: We established a mathematical model to estimate the epidemiological parameters from 19 Feb to 15 March based on daily COVID-19 confirmed cases in Iran. Then, we estimated the effect of early traffic restriction on our estimation. Results: We estimated the R0 at 2.11 (95% CI, 1.87-2.50) and the infected number at 92,260 (95% CI: 59,263 -152,212) by 15 March. Our estimate for the ascertainment rate was about 1.2% (95% CI: 1.1-1.4). The latent period estimation was 4.24 (95% CI: 2.84-6.65). We observed a decline in our estimate after considering the traffic restriction. Conclusion: Our results suggest that health authorities in Iran must take impactful strategies to control the COVID-19 outbreak to reach R0

Background. Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices. Objectives. The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve. Design. A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement. Methods. At first, the primary checklist was prepared to assess the nurses’ ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package. Results. According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills. Conclusions. Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971.

Colorectal cancer (CRC) is known as one of the malignant form of cells growing in the inner lining of colon and rectum which could seriously affect the cure rate of patients. We aimed to evaluate the effect of prognostic factors on cure fraction of CRC patients.A total of 1043 CRC patients were included to the study from December 2001 to January 2007 at the Research Center of Gastroenterology and Liver Disease in Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients' information was extracted from their medical records, then they were followed to identify their death status via phone-call. Weibull non-mixture cure model was used to evaluate the effect of the risk factors on cure fraction of CRC patients.The five-years survival rate was 0.66 (males: 0.64 and female: 0.69). The median survival time for non-cured CRC patients were 3.45 years (males: 3.46; females = 3.45 years). In the single Weibull model, BMI≥30 (OR = 4.61, p-value = 0.033), poorly differentiated tumor grade (OR = 0.36, p-value = 0.036), tumor size≥25 mm (OR = 0.22, p-value = 0.046), and N1-stage (OR = 0.42, p-value = 0.005) had significant effect on females' cure fraction. Also, cure fraction of male CRC patients significantly affected by BMI (levels:25.0-29.9-OR = 12.13-p-value0.001; ≥30-OR = 7.00-p-value = 0.017), T1-stage (OR = 0.52, p-value = 0.021), M1-stage (OR = 0.45, p-value = 0.007), IV-staging (OR = 0.36, p-value = 0.041) and IBD (OR = 0.26, p-value = 0.017). In multiple Weibull model, females were associated with tumor size≥25 mm (OR = 0.20, p-value = 0.044) and N1-stage (OR = 0.45, p-value = 0.013) and males were affected by M1-stage (OR = 0.41, p-value = 0.011) and IBD (OR = 0.20, p-value = 0.022).The cure fraction of males and females CRC patients was 64% and 69%, respectively.The prognostic factors for cure fraction of patients with CRC may be different among males and females. Further multicenter studies are required to assess the effect of common prognostic factors between males and females.

Introducción y objetivos El papel fundamental de la tomografía computarizada (TC) de tórax para el diagnóstico y el pronóstico de la enfermedad por coronavirus-2019 (COVID-19) sigue siendo un campo abierto por explorar. Este estudio se realizó para evaluar las características de la TC en los casos confirmados con COVID-19. Materiales y métodos De forma retrospectiva, se revisaron los datos de la TC torácica inicial de 363 casos confirmados con COVID-19. Todos los sujetos se estratificaron en tres grupos en función de los resultados clínicos de los pacientes; grupo no crítico (n=194), grupo crítico (n=65), y grupo de muerte (n=104). Los detalles de los hallazgos de la TC se obtuvieron de las historias clínicas de los pacientes y posteriormente se evaluaron para cada grupo. Además, se utilizó la regresión logística multinomial para analizar los factores de riesgo según los hallazgos de la TC en tres grupos de pacientes con COVID-19. Resultados En comparación con el grupo no crítico, las opacidades mixtas en vidrio esmerilado (GGO, por sus siglas en inglés) y la lesión de consolidación, la lesión de derrame pleural, la presencia de opacidad difusa en los casos, más de 2 lóbulos afectados y las puntuaciones de opacidad fueron significativamente mayores en los grupos crítico y de muerte (P

Background Gastric cancer (GC) has been considered as the 5th most common type of cancer and the third leading cause of cancer-associated death worldwide. The aim of this historical cohort study was to evaluate the survival predictors for all patients with GC using the Cox proportional hazards, extended Cox, and gamma-frailty models. Methods This historical cohort study was performed according to documents of 1695 individuals having GC referred to three medical centers in Iran from 2001 to 2018. First, most significant prognostic risk factors on survival were selected, Cox proportional hazards, extended Cox, gamma-frailty models were applied to evaluate the effects of the risk factors, and then these models were compared with the Akaike information criterion. Results The age of patients, body mass index (BMI), tumor size, type of treatment and grade of the tumor increased the hazard rate (HR) of GC patients in both the Cox and frailty models (P P Conclusions Some prognostic factors, including age, tumor size, the grade of the tumor, type of treatment and BMI, were regarded as indispensable predictors in patients of GC. Frailty model revealed that there are unknown or latent factors, genetic and environmental factors, resulting in the biased estimates of the regression coefficients.

Aim: To estimate the number of confirmed cases and the rate of death and also to investigate the cause of death in Italy, Iran and South Korea in the next month. Background: Growing number of confirmed and deaths cases from the coronavirus worldwide, particularly in Italy, Iran and South Korea, has resulted concerns about the future of these countries and their deterioration. Also the European region is likely to face more casualties due to the delay in the virus reaching most of its regions and, of course, as the trend continues. Methods: We conducted a simulation in both current and ideal situation for the next month to predict the death rate and examine the reason for the difference in Italy, Iran and South Korea individually. If we assume the cultural and political factors and age pyramids distribution are similar across regions, the differences are mainly due either to the heavier health-care burden owing to the larger population or to the medical facilities diversities. Results: Our results for Italy showed higher death number, but the rate would be more for Iran. South Korea is also expected to have a smaller increase in the number of confirmed cases and deaths compared to Iran and Italy by the next month. Conclusion: Given the prevailing conditions around the world and the increasing number of casualties, it is essential that all countries, especially those with fewer days of involvement, shall do their best to avoid major losses and damages.

Introduction: Psychiatric disorders, especially anxiety, are considered extraintestinal manifestations of celiac disease (CD). Objective: This study aims to evaluate the level of anxiety in treated patients with CD in Iran. Methods: A total of 283 CD patients (190 female, 93 male) were enrolled in a study during 2016–2018 from 9 centers in Iran. The Zung Self-Rating Anxiety Scale questionnaire was completed. The anxiety index was calculated. Also, demographic data and the duration of treatment with a gluten-free diet (GFD) were recorded. Data were analyzed by SPSS version 20. Results: Anxiety symptoms were reported in 67.8% of patients. Female patients had a higher anxiety index than male patients. Duration of treatment with a GFD did not influence the anxiety index (17.3% were on a GFD for 2 years; p = 0.86). Conclusions: These results suggest that anxiety symptoms are common among patients, especially females, with CD in Iran and GFD duration has no effect on their improvement.

Background Coronavirus disease 2019 (COVID-19) pandemic has caused serious psychological problems, including panic attack, anxiety, stress, and depression. The main objective of this study was to measure the prevalence and compare the severity of this psychological distress among four groups of an Iranian population. Method In a cross-sectional survey, the mental health status of four groups of an Iranian society including community population, patients with COVID-19, medical staff, and medical students were investigated by the self-report questionnaire of Depression, Anxiety, and Stress Scale (DASS). DASS-21 questionnaire and the demographic data sheet were filled out by the participants. All statistical analyses were done using R version 3.6.1 software. P-values less than 0.05 were considered as statistically significant. ANOVA test was used to compare the severity of stress, anxiety, and depression between the four study groups. Results Of the 886 participants in this survey, 554 (62.5%) were men and 332 (37.5%) were women, and the mean ± standard division of age was 40.91 ± 10.7 years. Among these participants, 241 (27.2%) were selected from community population, 221 (24.9%) were patients with COVID-19, 217 (24.5%) were medical staff, and 207 (23.4%) were medical students. The mean score of stress, anxiety, and depression in medical students and patients with COVID-19 was significantly higher than in medical staff and community population (P P = 0.006), and unmarried participants had a significantly higher depression score compared with the married group (27.5 ± 4.8 vs. 26.7 ± 4.6, P = 0.023). In addition, the score of depression was higher in female medical staff (27.08 ± 4.6 vs. 25.33 ± 4.3, P = 0.011) and community population (26.6 ± 4.3 vs. 25.3 ± 4.3, P = 0.02) than in male. Conclusion COVID-19 patients and medical students in contact with these patients were at a high risk for mental illness due to lower experience compared with professional medical staff and community population. Continuous surveillance and monitoring of psychological distress for outbreaks should become a routine part of preparedness efforts worldwide.

Occupational exposure to benzene has been associated with leukemia, anemia, leukopenia, and thrombocytopenia. Genetic susceptibility to benzene toxicity in humans may be related to variations in benzene metabolizing genes. The main objective of this study was to ascertain whether polymorphism of GSTP1, GSTM1, GSTT1 and CYP2E1 genes might influence susceptibility to the adverse effects of benzene among employees of a petrochemical plant. In this cross-sectional study, 124 employees of a petrochemical plant who had been occupationally exposed to benzene and had one or more abnormal hematological parameter (cases) and 184 subjects with a similar exposure scenario, free from any abnormal hematological parameters (referent) were studied. Atmospheric concentrations of benzene were measured and GSTM1 and GSTT1 genotypes were evaluated using the multiplex polymerase chain reaction (PCR) technique. Additionally, GSTP1 and CYP2E1 genotypes were determined by PCR- restriction fragment length polymorphism (PCR–RFLP). The frequency of null GSTT1 genotype in cases was significantly higher than that of referent group (32.3 vs. 18.5%, OR 2.1, 95% CI 1.23–3.56, p = 0.004). The mean value of platelets in subjects with null GSTT1 genotype was significantly lower than that of individuals with positive GSTT1 genotype (p = 0.015). Conversely, the mean value of leukocytes was significantly higher in subjects with null GSTM1 genotype as compared to those with positive GSTM1 genotype (p = 0.026). Logistic regression analysis showed that, subjects with null GSTT1 genotype had a significantly higher risk for hematological disorders, as compared to those with positive GSTT1 genotype (OR 2.1, 95% CI 1.23–3.56). Moreover, subjects with both null GSTT1 and GSTM1 genotypes had a significantly higher risk for hematological disorders as compared to subjects with positive GSTT1 and GSTM1 genotypes (OR 2.35, 95% CI 1.14–4.8). The results of this study showed that, individuals carrying null GSTT1 or both null STT1 and GSTM1 genotypes had a higher risk and were more susceptible to benzene-induced hematological disorders.

Aim: The aim of this study was to identify the esophageal cancer (EC) high risk regions to evaluate changes of relative risks (RRs) for both genders by time in Iranian provinces. Background: EC is one of the public health problems in Iran. In spite of this fact, there is not comprehensive study estimating RRs across the Iranian provinces. Methods: In this cross-sectional study the data for EC cases were extracted from Ministry of Health and Medical Education (MOHME) including 30 provinces from 2004 to 2010. For estimating the model parameters, we used Bayesian approach by regarding spatial correlations of adjacent provinces. Results: The Northern half of Iran has high risk and other half has low risk. During the time, the range of RRs has decreased for both gender and also the dispersion of EC is decreasing for women but nearly is fixed for men. Conclusion: While RR has declined during the study, focusing on the Northern half of Iran as high risk regions is a considerable fact for policymakers.