Search

Background: Unmeasured confounding is the primary obstacle to causal inference in observational research. We aimed to illuminate the association between exposure to influenza vaccination (IV) within six months before contracting the coronavirus disease (COVID-19) and COVID-19 hospitalization in relation to unmeasured confounding using the E-value method. Materials and Methods: Information about 367 patients, 103 of whom (28.07 %) had received IV, and confounders included sex, age, occupation, cigarette smoking, opium, and comorbidities were collected. We estimated the interest association using the inverse probability weighted (IPW) method. There was no information on some potential unmeasured confounders, such as socioeconomic status. Therefore, we computed E-value as a sensitivity analysis, which is the minimum strength of unmeasured confounding to explain away an exposure-outcome association beyond the measured confounders completely. Results: IPW denoted 1.12 (95% CI: 0.71 to 1.29) times greater risk of COVID-19 hospitalization in patients exposed to IV than in unexposed individuals. Sensitivity analysis demonstrated that an E-value (95% CI) of 1.49 (1.90 to 2.15) is required to shift the RR and the corresponding confidence Interval (CI) lower and upper limits toward the null. Moreover, if they had been omitted, the most computed E-values for measured confounders were relatively larger than for unmeasured confounders. Conclusion: According to the context of the measured confounders, if they had been omitted, an E-value of 1.16 to 1.76, a weaker confounding could fully explain away the reported association, suggesting that no relationship exists between IV and COVID-19 hospitalization. [ABSTRACT FROM AUTHOR]

In this study, we aimed to estimate the causal effect of normalized protein catabolic rate (nPCR) on mortality among end-stage renal disease (ESRD) patients in the presence of time-varying confounding affected by prior exposure using g-estimation. Information about 553 ESRD patients was retrospectively collected over an 8-year period (2011–2019) from hemodialysis facilities in Kerman, Iran. nPCR was dichotomized as <1.2 g/kg/day versus ≥1.2 g/kg/day. Then a standard time-varying accelerated failure time (AFT) Weibull model was built, and results were compared with those generated by g-estimation. After appropriate adjustment for time-varying confounders, weighted g-estimation yielded 78% shorter survival time (95% confidence interval (95% CI): −81, −73) among patients with a continuous nPCR <1.2 g/kg/day than among those who had nPCR ≥1.2 g/kg/day during follow-up, though it was 18% (95% CI: −57, 54) in the Weibull model. Moreover, hazard ratio estimates of 4.56 (95% CI: 3.69, 5.37) and 1.20 (95% CI: 0.66, 2.17) were obtained via weighted g-estimation and the Weibull model, respectively. G-estimation indicated that inadequate dietary protein intake characterized by nPCR increases all-cause mortality among ESRD patients, but the Weibull model provided an effect estimate that was substantially biased toward the null. [ABSTRACT FROM AUTHOR]

Objective: Oral clefting including cleft lip with or without cleft palate (CL/P), are considered as common congenital anomalies, particularly in Asia population. The aim of this study was to evaluate the incidence rate of CL/P according to ethnicity in Northern Iran. Materials and Methods: This cross-sectional, analytic study was carried out on 92 420 live newborns in Golestan province, the Northern Iran, from 2008-2011. The newborns were evaluated for the CL/P and recorded according to ICD10. Gender, ethnicity and parental consanguinity were filled out for each subject. The subjects grouped according to ethnicity into native Fars, Turkmen, and Sistani groups. Results: The rate of oral clefts was determined 0.72 per 1000 live newborns. The incidence rate of CL/P was 0.69 per 1000 in males and 0.75 per 1000 in females. The incidence of CL/P among native Fars, Turkmen and Sistani was 0.96, 0.61, and 0.57 per 1000 live births, respectively. Conclusion: The incidence rate of oral clefting was lower than in our previous study (1.05 per 1000), and it was higher in the native Fars population. [ABSTRACT FROM AUTHOR]

Introduction: The main tasks of postoperative care are post- operative pain and complications control which play an important role in accelerating the recovery of patient's general condition. Aim: This study was performed in order to compare the effects of diclofenac suppository, intravenous acetaminophen and their combination on the severity of postoperative pain in patients undergoing spinal anaesthesia for cesarean section in Sayyad Shirazi teaching Hospital, Gorgon, Iran. Materials and Methods: This was a double-blind clinical trial on 90 patients undergoing cesarean section. The patients were randomly divided into three groups, group A: 100 mg diclofenac suppository, group B: 1000 mg intravenous acetaminophen, group C: 100 mg diclofenac suppository and 500 mg intravenous acetaminophen. The same spinal anaesthesia circumstances were applied for all the participants. At the end of surgery, pain severity was assessed according to VAS scale at different times. Data were then analysed by SPSS 18 statistical software. results: The mean age of participants was (28.27±6.07). There was significant difference between the mean pain scores of the three groups before the intervention (p=0.018), which was considered as co-variate. This difference was more notable between the combination of acetaminophen -- diclofenac group and diclofenac alone. After the intervention, significant difference was observed in mean pain severity between acetaminophen group and the combination group and also between diclofenac and the combination group. During the study, the least mean pain severity was found in the combination group and the highest was observed in the diclofenac group. conclusion: Results of this study indicates a significant effect of concomitant use of intravenous acetaminophen and diclofenac suppository on pain severity reduction and reducing the need for repeated doses of narcotics and prolonging the postoperative analgesia. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study is assessment of insulin resistance (IR) in obese women by TyG-Index and compared with the HOMA-IR index. Materials and Methods: This cross-sectional study was performed on 61 obese women aged 18-45 years. Weights, height, waist circumference (WC) were measured and body mass index (BMI) was calculated and recorded. A sample of fasting serum was collected to determine the glucose, triglyceride, insulin, total cholesterol, HDL-C and LDL-C concentration. HOMA-IR and TyG-Index were calculated as markers of insulin resistance. Results: The mean age of the precipitants was 32.5 ±0.79 years old and the mean weight was 86.0±1.7 Kg. The number of people with IR who determined by HOMA and TyG index were 21(34%) and 36(61%), respectively. There was a significant relationship between HOMA-IR and TyG Index, r= 0.044 (P<0.001). Conclusion: TyG index represents a useful and accessible tool for assessment of IR instead HOMA_IR in Iranian population, but more researches with greater sample size and via gold standard lab test need to evaluate the specificity and sensitivity of this new method. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran.Methods: We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates.Results: Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model.Conclusions: Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs. [ABSTRACT FROM AUTHOR]

Background and purpose: Lack of awareness of people about the future environmental risks posed by wastes is the most important problem of this sector. Awareness, and then cultural education in this area, can be a breakthrough to this significant environmental problem. This study aimed to assess the degree of awareness of the people of the cities of Gorgan, Gonbad, and Aliabad Katool (Iran) in relation to municipal solid waste management. Materials and methods: In this descriptive-periodic study in 2012, a questionnaire with a Cronbach's alpha of 0.78 was used. 550 questionnaires were completed: 200 in different areas of the city of Gorgan, 240 in different areas of the city of Gonbad, and 110 in different areas of the city of Aliabad Katool. Data were analyzed by SPSS software. Results: The awareness of the citizens in the studied cities in the area of waste-related diseases and the waste effect on the environment was satisfactory. The rate of citizens' awareness in the field of recycling and ways of reduction of household waste and the methods of waste disposal was above the average. The awareness in the area of existence of urban recycling organization and its duties was rated weak to average and in the area of compost, it was weak. The performance of citizens in the area of relation of people with urban materials recycling organization and regional municipality regarding solid waste materials was rated very weak to weak and in the area of source waste separation, the performance was rated average. Conclusion: Considering the results obtained, the information of people regarding compost production and existence of urban recycling organization and its duties was low and, it is necessary to provide certain educational programs for increasing public awareness. [ABSTRACT FROM AUTHOR]

Limited evidence is available to acknowledge the association between opium use and liver cancer. In a case-control study, we recruited 117 cases of primary liver cancer (PLC) and 234 age and sex-matched neighborhood controls from 2016 to 2018. We calculated odds ratios (OR) for opium use and 95% confidence intervals (95% CI), using conditional logistic regressions. Compared with non-users the adjusted OR (AOR, 95% CI) for opium use was 6.5 (95% CI, 2.87-13.44). Compared with people who had no history of use, a strong dose-response effect of opium use was observed by amount of use (AOR, 10.70; 95% CI, 3.92-28.70). Cumulative use of opium also indicated that using over 30 gr-year could increase the PLC risk dramatically (AOR, 11.0; 95% CI, 3.83-31.58). Those who used opium for more than 21 years were highly at risk of PLC (AOR, 11.66; 95% CI, 4.43-30.67). The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking)., Prevention Relevance: The results of this study indicate that opium use dramatically increased the risk of liver cancer. Because opioids are increasing for medical and non-medical use globally; accordingly, severe health consequences such as liver cancer have to be investigated widely., (©2022 American Association for Cancer Research.)

Background: Congenital anomalies are important medical and public health conditions. The pattern and prevalence of birth defects may vary over time or with geographical location. We investigated the live birth prevalence and occurrence pattern of birth defects in Golestan Province, northern Iran., Methods: This cross-sectional descriptive study was carried out on 144920 live newborns in 13 hospitals in Golestan Province, northern Iran, from 21 Jan 2008 to 19 Mar 2013. The newborns were examined for the presence of birth defects and mothers were interviewed for variables such as maternal age and ethnicity. In addition, data for each newborn was filed in a questionnaire and the coding of birth defects was translated to the International Classification of Diseases 10th revision-clinical modification (ICD-10-CM)., Results: Overall, 1690 infants were diagnosed as having birth defects among 144920 live newborns. The prevalence rate of birth defects was 11.66 per 1000 live births, the prevalence of birth defects per 1000 was11.62 in males and 11.42 in females. The prevalence of congenital anomalies among native Fars, Turkmen and Sistani were 13.03, 11.16 and 13.07, respectively, per 1000 live births. Anomalies of the cardiovascular system were the most common defects; the prevalence rate of cardiovascular system was 8.34 per 1000 live birth., Conclusion: The prevalence rate of birth defects in this area was lower than in the other regions in Iran (20.3 per 1000 live births) but higher than in some parts of Asia (7.33 per 1000 live births)., Competing Interests: Conflicts of interest The authors declare that there is no conflict of interest.