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Objectives: Landmines remain a potential public health concern in the western and southern border regions of Iran. The aim of this study was to assess the health-related consequences of landmine explosions in Kurdistan Province during the past 4 decades. Methods: This retrospective cross-sectional study was conducted in Kurdistan Province of Iran in 2016-2017. The data gathering process was questionnaire based. Survivors, or a member of the deceased's family, were interviewed, and 410 questionnaires were completed. Data analysis was performed by using descriptive or analytical tests in SPSS software V.22. Results: Antipersonnel landmines caused death immediately after the explosion 32.1% of the time, and 67.9% survived with various disabilities, such as blindness, deafness, and limb amputation. Sixty-three percent of the injuries were related to limb amputation, which was the most prevalent injury among survivors. The adjusted regression test revealed a significant relationship between severity of injury and variables such as living in the villages, education, and occupation (P-value < 0.05). Conclusions: Recognizing the mined areas and intensifying clearance measures are crucial for Kurdistan Province. Providing landmine awareness programs is likely to yield useful results in reducing casualties. Also, landmine survivors should have access to physical and social rehabilitation programs. [ABSTRACT FROM AUTHOR]

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most signifuicant pathogens in Iran; it is one of the WHO-declared microbial resistance emergencies; and also one of the most important challenges facing the prevalence of resistance. The aim of this study was to detect MRSA using Broth Micro Dilution method and meta-analysis in Iran from 2007 to 2016. Methods: Persian databases (including Magiran, Irandoc, and SID) and International databases (including pubmed, science direct, and scopus) were searched during this period (2007-2016), such that the high heterogeneity (50% < I2) in this study was analyzed using the DerSimonian Laird method. Data were categorized into subgroups based on year of study and province. Due to the high validity of the diagnosis of organisms and quantitative results, antimicrobial susceptibility test (AST) was used to detect MRSA. Data analysis was performed using statsdirect software. Results: Based on the available data in medical databases, 678 articles were selected. In total, 29 remaining studies entered the meta-analysis phase. In this study, the overall prevalence of MRSA using MIC is 53% (95% CI: 0.42.31, 63.90); in 2016 it was 77.56% (95% CI: 76.07, 78.99) and in 2007 was 57.49% (95% CI: 53.17, 61.72). The heterogeneity was estimated to be 98.5% (95% CI: 98.4, 98.6). Conclusion: Based on the results, there is an increasing prevalence of MRSA in Iran. These may be due to the failure or lack of infection control activities and antimicrobial selection pressure. [ABSTRACT FROM AUTHOR]

Background: Few studies have focused on syndromic data to determine levels of alarm thresholds to detection of meningitis outbreaks. The purpose of this study was to determine threshold levels of meningitis outbreak in Hamadan Province, west of Iran. Methods: Data on both confirmed and suspected cases of meningitis (fever and neurological symptom) from 21 March 2010 to 20 March 2012 were used in Hamadan Province, Iran. Alarm threshold levels of meningitis outbreak were determined using four different methods including absolute values or standard method, relative increase, statistical cutoff points and upper control limit of exponentially weighted moving average (EWMA) algorithm. Results: Among 723 reported cases, 41 were diagnosed to have meningitis. Standard level of alarm thresholds for meningitis outbreak was determined as incidence of 5/100000 persons. Increasing 1.5 to two times in reported cases of suspected meningitis per week was known as the threshold levels according to relative increase method. An occurrence four cases of suspected meningitis per week that equals to 90th percentile was chosen as alarm thresholds by statistical cut off point method. The corresponding value according to EWMA algorithm was 2.57 i.e. three cases. Conclusions: Policy makers and staff of syndromic surveillance systems are highly recommended to apply the above different methods to determine the levels of alarm threshold. [ABSTRACT FROM AUTHOR]

Objective: The surveillance of acute flaccid paralysis (AFP) is a key strategy for monitoring the progress of poliomyelitis eradication and is a sensitive measure for detecting potential cases of poliomyelitis and poliovirus infection. This study was conducted to describe the characteristics of patients reported with AFP, and to evaluate the performance of the surveillance system in Kurdistan province, western Iran, using indicators recommended by the World Health Organization (WHO). Methods: This observational study was conducted from January 2000 to December 2010 at the Kurdistan Center for Disease Control and the Department of Pediatrics. All children who fulfilled the WHO definition for AFP were included in our study. The stool samples of all the children were sent for poliovirus isolation. All the patients were evaluated for 60 days after the onset of symptoms to identify the signs of residual weakness. Findings: One-hundred thirty nine children aged <15 years were reported to the Center for Diseases Control with AFP. In 138 (99%) stool samples no poliovirus was isolated. None of the patients was diagnosed as having acute poliomyelitis or polio-compatible paralysis. Guillain-Barré syndrome was the most frequent final diagnosis (79 cases) followed by Transverse Myelitis (7 cases) and Encephalitis (6 cases). By detecting 1.3 to 3.6 (mean 3.2) AFP cases per 100 000 population in Kurdistan during the study period, we achieved the WHO target for AFP surveillance. All performance indicators but one consistently met the WHO requirements and therefore demonstrated the effectiveness of the AFP surveillance program in Kurdistan. Conclusion: The effective surveillance system in Kurdistan and its evaluation may serve as a model for the surveillance of other infectious diseases. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the relationship between congenital hypothyroidism and several variables using two different adjustment methods. Methods: This matched case-control study was conducted in Hamadan Province, the west of Iran, in 2012 enrolling neonates born between 2005 and 2011 and covered by screening program for congenital hypothyroidism. The neonates with TSH titer more than 10 mU/l or T4 titer less than 6.4 μg/dl were considered as cases. Each case was individually matched for birth place and year with four neonates with normal TSH and T4 titers as controls. The data were analyzed using two different approaches including propensity score and multiple conditional logistic regression model. Results: Of 1313 enrolled neonates, 277 (159 girls) were cases and 1036 (531 girls) were controls. The most important prognostic factors which had significant effect on congenital hypothyroidism included twin, birth season, maturity, jaundice at birth, birth weight, age at pregnancy, maternal anemia and goiter, gestational age, delivery type, father’s education and smoking status, and consanguinity. The associations reported by logistic regression were stronger that of than propensity score analysis in most items, although the differences were not statistically significant. Conclusions: We addressed the effect of numerous potential risk factors on congenital hypothyroiditis and the impact of these factors on the disease occurrence. However, future prospective studies are needed to test these findings and hypothesis and to investigate the true effect of these potential risk factors on congenital hypothyroiditis. [ABSTRACT FROM AUTHOR]

Background: We conducted this study to estimate the prevalence of biomarkers, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) among patients with breast cancer and to explore their effects on disease mortality. Methods: We conducted this registry-based retrospective cohort study in Tehran, in 2014, using the data on 1622 patients with breast cancer, diagnosed pathologically and registered with the Comprehensive Cancer Control Center from 1998 to 2013. The outcome of interest was the survival probability of patients with breast cancer based on receptor status along with other prognostic factors such as age, histopathology, stage/grade of tumor, metastatic status, and surgical procedures using the life table, Kaplan-Meier curves, and multivariate Cox proportional hazard model. We generated different subtypes based on expression of ER, PR, and HER2, positive (+) and/or negative (-). Results: ER+/PR+/HER2- subtype (51.5%) was the most common form of breast cancer cells. Compared to the ER+/PR+/HER-subtype, the hazard ratio (95% confidence interval) of cancer mortality was 2.14 (1.13, 4.03) for ER-/PR-/HER2- subtype, 1.92 (1.03, 3.59) for ER-/PR-/HER2+ subtype and 5.19 (1.51, 17.86) for ER-/PR+/HER2+ subtype. Conclusion: In this study, breast cancer cases with ER-/HER2+ tumors had shorter survival than those with ER+/PR+/HER2-tumors. Triple negative tumors were the only other subtype with a statistically significant poorer prognosis. The results of this study in a middle-income country further indicate the importance of receptor status, in particular HER2 status, in the prognosis of breast cancer. [ABSTRACT FROM AUTHOR]

Introduction: The investigations on suicide conducted within low- and middle-income countries are limited. This study evaluated the trend of suicide and its associated risk factors in the west of Iran. Methods: This six-year population-based survey was conducted in Kermanshah Province, in 2012. The data on suicide was extracted from the suicide database of the Provincial Health Center, which was collected for six successive years. Multivariate logistic regression analysis was performed and odds ratio (OR) as well as its 95% confidence intervals (CI) was reported. Results: During the study period, 13,810 attempted suicides occurred of which 1,564 (11.33%) were completed. The incidence rate of suicide has increased in recent years. Based on logistic regression analysis, OR estimate of completed suicide increased 1.46 (95% CI: 1.36, 1.56) fold for every 10-year increase in age. Moreover, OR estimate of completed suicide was 2.53 (95% CI: 1.94, 3.31) in men compared to women. Compared to married people, the OR estimate of completed suicide was 1.41 (95% CI: 1.15, 1.72) in single people, 1.92 (95% CI: 1.15, 3.23) in widowed people, and 1.97 (1.32, 2.95) in divorced people. The lower the educational level, the higher the risk of completed suicide. Compared to school/college students, the risk of completed suicide was higher among housewives, employed people or employees, and retirees. A majority of the suicides (90.05%) occurred at home. Taking medications was the most common way (69.13%) of a suicide attempt. Conclusion: We indicated that associated factors with completed suicide vary in Iran compared to other developed and developing countries and that factors associated with attempted suicide are different from that of completed suicide. [ABSTRACT FROM AUTHOR]

Background: Stomach cancer is the fourth most common cancer and the second leading cause of death from cancer in the world. In Iran, this type of cancer has high rates of incidence and mortality. This study aimed to assess the survival rate of patients with stomach cancer and its determinants in Kurdistan, a province with one of the highest incidence rates of stomach cancer in the country., Materials and Methods: We studied a total of 202 patients with stomach cancer who were admitted to Tohid Hospital in Sanandaj from 2009 to 2013. Using KaplanMeier nonparametric methods the survival rate of patients was calculated in terms of different levels of age at diagnosis, gender, education, residential area, occupation, underweight, and clinical variables including tumor histology, site of tumor, disease stage, and type of treatment. In addition, we compared the survival rates using the logrank test. Finally, Cox proportional hazards regression was applied using Stata 12 and R 3.1.0 software. The significance level was set at 0.05., Results: The mean age at diagnosis was 64.7 ± 12.0 years. The survival rate of patients with stomach cancer was 43.9% and 7% at the first and the fifth year after diagnosis, respectively. The results of logrank test showed significant relationships between survival and age at diagnosis, education, disease stage, type of treatment, and degree of being underweight (P<0.05). Moreover, according to the results of Cox proportional hazards regression model, the variables of education, disease stage, and type of treatment were associated with patient survival (P<0.05)., Conclusions: The survival rate of patients with stomach cancer is low and the prognosis is very poor. Given the poor prognosis of the patients, it is critical to find ways for early diagnosis and facilitating timely access to effective treatment methods.

Background: Based on some estimation more than two million peoples in Iran are affected by Type 2 diabetes. The present study was designed to evaluate the status of diabetes control among Type 2 diabetes patients in Kurdistan, west of Iran and its associated factors., Methods: In our cross sectional study conducted in 2010, 411 Type 2 diabetes patients were randomly recruited from Sanandaj, Capital of Kurdistan. Chi square test was used in univariate analysis to address the association between HgAlc and FBS status and other variables. The significant results from Univariate analysis were entered in multivariate analysis and multinomial logistic regression model., Results: In 38% of patients, FBS was in normal range (70-130) and in 47% HgA1c was <7% which is normal range for HgA1c. In univariate analysis, FBS level was associated with educational levels (P=0.001), referral style (P=0.001), referral time (P=0.009), and insulin injection (P=0.016). In addition, HgA1c had a relationship with sex (P=0.023), age (P=0.035), education (P=0.001), referral style (P=0.001), and insulin injection (P=0.008). After using multinomial logistic regression for significant results of univariate analysis, it was found that FBS was significantly associated with referral style. In addition HgA1c was significantly associated with referral style and Insulin injection., Conclusions: Although some of patients were under the coverage of specialized cares, but their diabetes were not properly controlled.