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BACKGROUND: Air pollution is associated with increased risk of cardiovascular disease (CVD). This study aims to evaluate the correlation between air pollutants and hospitalization due to myocardial infarction (MI) as part of "correlation of air pollution with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study". METHODS: This case-crossover study analyzed the data of 319 patients who were admitted with diagnosis of ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) in three main hospitals of Isfahan, Iran. The data of airborne pollutants including particulate matter < 10 μm (PM10), particulate matter < 2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) as well as climatic indices (temperature, wind speed, and humidity) at 24 hours, 48 hours, and one week before admission were extracted from CAPACITY study. The conditional logistic regression method was used to evaluate the correlation between air pollutants and MI hospitalization. RESULTS: 319 patients with mean age of 63.15 ± 28.14 years, including 238 men (74.6%), and 207 patients (64.8%) with STEMI. The risk of hospitalization significantly increased in STEMI patients with 10-unit increment in PM2.5 at 48 hours before admission [odds ratio (OR) = 3.70, 95% confidence interval (CI): 1.69-7.69]. Although, majority of air pollutants had positive association with hospitalization in patients with NSTEMI, they were not statistically significant. CONCLUSION: This study showed significant association between elevated PM2.5 at 48 hours with hospitalization of patients with STEMI. This finding can warn policy makers to design and provide better care services for patients at risk of acute MI during the times of increased air pollution. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer (GC) is the first and the third prevalent cancer among males and females in Iran, respectively. The aim of this study was mainly to identify high-risk areas of GC by assessing the spatial and temporal pattern of incidence, and second, to explore some risk factors of GC in ecological setting. Methods: In this cross-sectional ecological study we used Bayesian hierarchical space-time model to measure the relative risk and temporal trends of GC in Iran from 2005 to 2010 based on available data. Data analysis was done by the use of integrated nested Laplace approximation Bayesian approach in R software. Results: Overall trend of GC was significantly decreasing during the study period. Ardabil, Khorasan Razavi, West Azarbaijan, Zanjan, and Mazandaran provinces had the highest risk of incidence. Overweight and smoking were directly and significantly associated with GC risk. Conclusions: During the study period, GC has decreased in Iran. Nevertheless, GC risk was generally high in Northern and Northwestern provinces of Iran. Different health policies according to GC risk and trend are required for each province. Improvements in screening and education programs and conducting further epidemiological studies could help to reduce the incidence of GC in high risk provinces. [ABSTRACT FROM AUTHOR]

Summary: Background: Vitiligo is a pigmentary disorder of skin affecting at least 1% of the world population of all races in both sexes. Its importance is mainly due to subsequent social and psychological problems rather than clinical complications. Various treatment choices are available for vitiligo; however, laser‐based courses have shown to give more acceptable results. Objective: The aim of this trial was to evaluate the efficacy of Er:YAG laser as a supplementary medicine to topical 5FU and clobetasol in vitiligo patients. Methods: Two comparable vitiligo patches from 38 eligible patients were randomized to receive topical 5FU and clobetasol in control group and additional Er:YAG laser in intervention group. Major outcomes of interest were the size of patch and pigmentation score at randomization and 2 and 4 months after therapy. Results: Final sample included 18 (47%) male patients and age of 35.66±8.04. The performance Er:YAG group was superior in all sites. Reduction in the size of patches was greater in Er:YAG group (p‐value=.004). Also, this group showed a higher pigmentation scores in the trial period than control group (p‐value<.001). Conclusions: Greater reduction in the size and increase in pigmentation score was seen in Er:YAG group especially for short periods after therapy and repeating laser sessions may help improving final outcomes. Er:AYG could help in reducing complications of long‐term topical treatments, achieving faster response, and improving patient adherence. [ABSTRACT FROM AUTHOR]

Background: Trend analysis is an important tool to monitor epidemiological changes of disease over time to guide resource allocation. This study aimed to study incidence trends and change-points of smear positive, smear negative, extra-pulmonary and relapse of tuberculosis (TB) in Iran from 2001 to 2015. Study design: Repeated cross-sectional study Methods:Nonlinear segmented regression w as used to describe TB incidence trends; annual percent change (APC), average annual percent changes (AAPC) and change points for each disease separately. Results: Of 154930 TB cases, 49.8% w ere smear positive, 19.7% smear negative, 27.32% extrapulmonary and 3.18% relapse. For all TB types, the peak of incidence w as in 2001. Tw o change point w ere estimated for all TB types (P<0.05). The APC of all TB types w ere -6.51 (95% CI: -7.4, -5.4) for first and 2.4 (95% CI: 0. 7, 4.1) for second segment. Although the trends w ere significantly decreasing from 2001 to 2015 for smear positive (AAPC=2.06%), smear negative (AAPC=3.57%), extra pulmonary (AAPC=3.2%) and relapse (AAPC=3.3%), the AAPCs of trends w ere not significant from 2006 to 2015. Except for Extra pulmonary TB (APC=4-.9%, 95%CI:-10, 1.2), the APCs of the last segments w ere significant. Conclusions:Even though the TB incidence rates w ere decreasing, the amount of reductions seem inadequate, to reach the goals of TB control in Iran. Especially, the increase in the extra-pulmonary TB rates is a point of concern that highlights more attention is required for these cases. It is essential to improve economic supports tow ard TB control, illegal immigrants, data registry systems and physician's sensitivity in TB detection. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a metabolic disorder and its subsequent complications such as retinopathy, nephropathy, ulcers, disability, and amputation increase the burden of the disease. Patient knowledge-improving programs are employed to prevent disease progression and to improve the quality of life of the patients. In this way, we need to characterize the groups of patients in urgent need for more and rich-in-content programs. In the present study, we used piecewise regression to evaluate the trends of diabetic nephropathy prevalence in patients registered in the Sedigheh-Tahereh Research Center and to identify patients who were in need of more attention. Materials and Methods: Piecewise regression, used in this study, is a statistical method to identify change points, if any, in the trends of mortality rates, prevalence of a disease, or any other trends. Available information for 1,935 patients were retrieved from the database. Joinpoint program 3.5.3 and Statistical Package for the Social Sciences (SPSS) 20 was used to fit piecewise regression and obtain descriptive statistics, respectively. Results: We assessed the trend of diabetic nephropathy in different groups of diabetic patients with respect to sex, blood pressure status, education, family history of diabetes, and age. The results showed an increasing trend in females, patients without family history of diabetes, and eover th recent years. The prevalence of diabetic nephropathy in patients with academic education was high. Conclusion: The groups with high prevalence or increasing trends need more preventive intervention and detailed assessment of the present trends. Exploring high-risk groups is beneficial for better policy-making in the future. However, discovering the reasons for the increased trend of the disease is really helpful in controlling diabetes complications. [ABSTRACT FROM AUTHOR]

Introduction: Toxoplasma gondii is an obligate intracellular parasite affecting a broad range of warm-blooded animals, including humans. Infection acquired during pregnancy can be transmitted to the fetus and leading to serious problems such as spontaneous abortion, stillbirth, or severe mental and/or physical handicaps in the child. The purpose of this study was to investigate the seroprevalence of Toxoplasma infection and related risk factors in pregnant woman., Methodology: The study enrolled 1200 serum samples of pregnant women from February-November 2017. Then the samples were tested for the presence of anti-T. gondii antibodies (Ab) using enzyme-linked immunosorbent assay., Results: Out of the 1200 samples, 381 (31.7%) and 41 (3.4%) subjects were positive for IgG and IgM Ab, respectively. Among the evaluated risk factors, the seroprevalence of Toxoplasma infection was not related to the occupation in a significant way. However significant relationship was observed with factors such as; contact with soil, cats, consumption of raw washed vegetables, and washed hands before meals., Conclusions: According to the results, more than two-thirds of pregnant women are susceptible to Toxoplasma infection, hence training health care programs should be provided to prevent infection., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2024 Gholamreza Barzgar, Ehsan Ahmadpour, Mohammad Hasan Kohansal, Sirous Mehrani Moghaddam, Tohid Jafari Koshki, Aleksandra Barac, Veeranoot Nissapatorn, Alok K Paul, Jelena Micić.)

Background: The rate of seat belt use in rural societies is less than in urban societies. The present study aimed to determine the effect of demographic and traffic-related variables on seat belt use among rural non-drivers based on the theory of planned behavior (TPB)., Methods: This study was conducted among 450 non-drivers in the rural areas of Hashtroud district in Iran. For collection of data, a questionnaire containing questions about demographic characteristics and general information on traffic-related behaviors of non-drivers, and questions on seat belt use based on constructs of the TPB was used., Results: The lowest seat belt use rate was for non-drivers that sit in the rear seat of a car on rural roads (22.4 % never, 14.4 % always). Also, the rate of seat belt use among parents of participants on rural roads was lower than on city roads. Adherence to traffic rules and having training about seat belt use had significant effects on the construct of TPB, including attitude, subjective norms, perceived behavioral control, behavioral intention, and behavior of seat belt use. With increasing age, subjective norms about seat belt use have improved. The attitude toward seat belt use among females was better than males., Conclusions: The result indicated that most of rural non-drivers did not adhere to traffic rules. Adherence to the traffic rules and having training on seat belt use had a significant impact on seat belt use behavior. Training seat belt use especially by parents could be effective in improving seat belt use.

Background: Breast cancer (BC) was the fifth cause of mortality worldwide in 2015 and second cause of mortality in Iran in 2012. This study aimed to explore factors associated with survival of patients with BC using parametric survival models., Materials and Methods: Data of 1154 patients that diagnosed with BC recorded in the East Azerbaijan population-based cancer registry database between March 2007 and March 2016. The parametric survival model with an accelerated failure time (AFT) approach was used to assess the association between sex, age, grade, and morphology with time to death., Results: A total of 217 (18.8%) individuals experienced death due to BC by the end of the study. Among the fitted parametric survival models including exponential, Weibull, log logistic, and log-normal models, the log-normal model was the best model with the Akaike information criterion = 1441.47 and Bayesian information criterion = 1486.93 where patients with higher ages (time ratio [TR] =0.693; 95% confidence interval [CI] = [0.531, 0.904]) and higher grades (TR = 0.350; 95% CI = [0.201, 0.608]) had significantly lower survival while the lobular carcinoma type of morphology (TR = 1.975; 95% CI = [1.049, 3.720]) had significantly higher survival., Conclusion: Log-normal model showed to be an optimal tool to model the survival of patients with BC in the current study. Age, grade, and morphology showed significant association with time to death in patients with BC using AFT model. This finding could be recommended for planning and health policymaking in patients with BC. However, the impact of the models used for analysis on the significance and magnitude of estimated effects should be acknowledged., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Research in Medical Sciences.)

Background: Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran., Methods: Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study., Results: The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar., Conclusion: The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

Objective: Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris., Methods: In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2 nd , and 3 rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit., Findings: The IPL group showed greater reduction in AGSS ( P < 0.001) and TLC ( P = 0.005) than the control group. However, the difference in ASI was not significant ( P = 0.12). Patients in IPL groups were more satisfied than control group ( P < 0.001)., Conclusion: Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind., Competing Interests: There are no conflicts of interest.

Background: In many countries gastric cancer has the highest incidence among the gastrointestinal cancers and is the second most common cancer in Iran. The aim of this study was to identify and map high risk gastric cancer regions at the county-level in Iran. Methods: In this study we analyzed gastric cancer data for Iran in the years 2003-2010. Areato- area Poisson kriging and Besag, York and Mollie (BYM) spatial models were applied to smoothing the standardized incidence ratios of gastric cancer for the 373 counties surveyed in this study. The two methods were compared in term of accuracy and precision in identifying high risk regions. Result: The highest smoothed standardized incidence rate (SIR) according to area-to-area Poisson kriging was in Meshkinshahr county in Ardabil province in north-western Iran (2.4,SD=0.05), while the highest smoothed standardized incidence rate (SIR) according to the BYM model was in Ardabil, the capital of that province (2.9,SD=0.09). Conclusion: Both methods of mapping, ATA Poisson kriging and BYM, showed the gastric cancer incidence rate to be highest in north and north-west Iran. However, area-to-area Poisson kriging was more precise than the BYM model and required less smoothing. According to the results obtained, preventive measures and treatment programs should be focused on particular counties of Iran., (Creative Commons Attribution License)

Background: Atopic dermatitis is a chronic skin disease with increasing prevalence worldwide and a considerable burden especially among children. To circumvent the problems related to oral azathioprine (AZT) we aimed to evaluate its topical variant and assess its efficacy in patients aged 2-18., Materials and Methods: In a single-blind trial, we randomized the patients into two groups, one treated with topical emollient containing AZT and betamethasone (BM), and the other treated solely with topical emollient of BM. The treatments were administered twice a day for 8 weeks in both groups. The efficacy, recurrence, and the presence of side effects were evaluated using SPSS 20., Results: The amount of reduction in severity scoring for atopic dermatitis (SCORAD) score was significantly greater in the group treated with the topical AZT (P = 0.024). Incidentally, there were no difference between two treatments in difference in proportions of recurrence and adverse effects as well as SCORAD reduction in subgroups of sex and age (all P > 0.05)., Conclusions: Our results showed the superiority of topical AZT over BM with a low recurrence and adverse effects. No expectation of severe side effects, like those of oral AZT, is the major advantage of topical AZT. The sample size was an issue in uncovering the value of AZT in the subgroups. Conducting prolonged studies of quality-of-life and comparing the topical AZT potency relative to the common alternatives are recommended areas of future work.

Background: Prostate cancer is the most commonly diagnosed form of cancer and the sixth leading cause of cancer-related deaths among men in the entire world. Reported standardized incidence rates are 12.6, 61.7, 11.9 and 27.9 in Iran, developed countries, developing countries and the entire world, respectively. The present study investigated the relative risk of PC in Iran at the province level and also explored the impact of some factors by the use of Bayesian models., Materials and Methods: Our study population was all men with PC in Iran from 2005 to 2008. Considered risk factors were smoking, fruit and vegetable intake, physical activity, obesity and human development index. We used empirical and full Bayesian models to study the relative risk in Iran at province level to estimate the risk of PC more accurately., Results: In Iran from 2005 to 2008 the total number of known PC cases was 10,361 with most cases found in Fars and Tehran and the least in Ilam. In all models just human development index was found to be significantly related to PC risk Conclusions: In the unadjusted model, Fars, Semnam, Isfahan and Tehran provinces have the highest and Sistan-and-Baluchestan has the least risk of PC. In general, central provinces have high risk. After adjusting for covariates, Fars and Zanjan provinces have the highest relative risk and Kerman, Northern Khorasan, Kohgiluyeh Boyer Ahmad, Ghazvin and Kermanshah have the lowest relative risk. According to the results, the incidence of PC in provinces with higher human development index is higher.

Background: The aim of this study was to apply a new method for selecting a few genes, out of thousands, as plausible markers of a disease., Methods: Hierarchical clustering technique was used along with Support Vector Machine (SVM) and Naïve Bayes (NB) classifiers to select marker-genes of three types of breast cancer. In this method, at each step, one subject is left out and the algorithm iteratively selects some clusters of genes from the remainder of subjects and selects a representative gene from each cluster. Then, classifiers are constructed based on these genes and the accuracy of each classifier to predict the class of leftout subject is recorded. The classifier with higher precision is considered superior., Results: Combining classification techniques with clustering method resulted in fewer genes with high degree of statistical precision. Although all classifiers selected a few genes from pre-determined highly ranked genes, the precision did not decrease. SVM precision was 100% with 22 genes instead of 50 genes while the NB resulted in higher precision of 97.95% in this case. When 20 highly ranked genes selected to be fed to the algorithm, same precision was obtained using 6 and 5 genes with SVM and NB classifiers respectively., Conclusion: Using hybrid method could be effective in choosing fewer number of plausible marker genes so that the classification precision of these markers is increased. In addition, this method enables detecting new plausible markers that their association to disease under study is not biologically proved.