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Abstract Background Anemia presents a considerable public health challenge, standing as a leading contributor to elevated rates of mortality and morbidity. Therefore, this study aimed to investigate the prevalence of anemia and related factors among Tabari cohort population. Methods This study involved a cross-sectional investigation carried out during the enrollment phase of the Tabari cohort. The Tabari cohort is a subset of the larger nationwide cohort study known as the “Prospective Epidemiological Research Studies in IrAN” (PERSIAN) cohort. The collected data included general information, anthropometric measurements, medical history and blood samples. Anemia was defined as a hemoglobin level less than 13 mg/dL for men and less than 12 mg/dL for women. Data were analyzed using SPSS V.16. Results Out of the 10,073 participants included in the analysis, 1,352 individuals (13.4%) were diagnosed with anemia. In the multiple regression analysis, the odds of anemia were significantly 2.31 times in females compared to males, 3.69 times in urban residents compared to rural residents, 1.41 times in social economic categories of IV and 1.35 in social economic categories of V compared to social economic categories of I, 1.70 times in drug abuse compared to non-drug abuse, 0.71 times in body mass index (BMI) categories of 25–29.9 kg/m² and 0.70 in BMI ≥ 30 kg/m² compared to BMI 150 compared to below 150, 0.76 times for total cholesterol(TC) > 200 compared to below 200, 0.83 times for high waist-to-hip ratio (WHR) compared to low WHR, 1.33 times in low High-density Lipoprotein (HDL) compared to high HDL, 1.18 times in diabetics (DM) compared to non-DM, and 1.37 times in individuals with coronary heart diseases (CHD) compared to healthy individuals. Conclusion Anemia was a prevalent condition among Tabari cohort population. Several conditions including female gender, urban residence, Social economic level of IV and V, drug abuse, low HDL, high WHR, DM, and CHD conditions were significantly associated with increased odds of anemia. Furthermore, BMI categories of 25–29.9 kg/m² and ≥ 30 kg/m², high TC and high TG were significantly associated with decreased odds of anemia among this population.

Abstract Studies have shown that the co-occurrence of diabetes mellitus (DM) and thyroid dysfunction (TD) exacerbates diabetes complications and imposes a financial burden on the healthcare system. Therefore, this study aimed to investigate the prevalence of TD-DM comorbidity and its associated risk factors. This cross-sectional study was conducted on enrollment phase data of the TABARI cohort population which consisted of 10,255 adults aged between 35 to 70 years old residing in Sari, Mazandaran, Iran from 2015 to 2017. A total of 9939 out of 10,255 individuals (96.92%) entered the study. The prevalence of TD among T2DM patients was 13.2%. The prevalence of T2DM among patients with TD was 9.2%. Furthermore, the prevalence of TD-DM comorbidity in the overall population was 2.2%. Logistic regression analysis revealed that the odds of TD-DM comorbidity was significantly higher in women (OR 2.85; 95% CI 1.58–5.11), in the age group of 60–70 years (OR 9.62; 95% CI 3.69–25.10), in smokers (OR 2.32; 95% CI 1.19–4.52), in individuals with high waist circumference (WC) (OR 2.22; 95% CI 1.32–3.75), in individuals with low high-density lipoprotein (HDL) (OR 1.60; 95% CI 1.20–2.14), in individuals with high total cholesterol (TC) (OR 1.71; 95% CI 1.21–2.41), in individuals with high triglycerides (TG) (OR 1.79; 95% CI 1.27–2.51), and significantly lower in individuals with higher physical activity (PA) (OR 0.67; 95% CI 0.49–0.93). The present study demonstrated a prevalence of 2.2% in patients with both TD and T2DM. Additionally, female gender, older age, smoking, high WC, low HDL, high TC, high TG, and low PA were predictors of TD-DM comorbidity.

Background and purpose: Anemia in cancer patients and following chemotherapy in affected patients is one of the factors affecting the health status and even the survival of patients, which should be evaluated. Considering the significant prevalence of cancer in Mazandaran province, this study was conducted to determine the incidence of anemia caused by chemotherapy and determine some factors related to it in patients with solid tumors in Imam Sari Hospital. Materials and methods: The current research is a cross-sectional study. The samples were selected from patients with solid tumors who were referred to the chemotherapy centers of Imam Sari Hospital in 2021 and 2022. The convenience sampling method was used. The inclusion criteria were patients over 18 years of age with solid tumors and the exclusion criteria were history of receiving blood in the last three months, radiotherapy, and anemia requiring treatment at the beginning of the study. CBC results of patients before and after chemotherapy cycles were recorded, and anemia was determined based on hemoglobin values. According to hemoglobin, the patients were classified into 4 categories: normal, mild anemia, moderate anemia, and severe anemia. Also, a decrease in hemoglobin (2 units or more) in the intervals between chemotherapy cycles was considered chemotherapy-induced anemia. In addition, information such as age, gender, type of cancer, and the type of chemotherapy regimen received were also recorded. Results: The total number of people who entered the study was 146, and the number of males was 91 (62.3%). The mean±standard deviation of the age of the participants was 56.8±12.7 years. Breast tumors in 56 people (38.4%), stomach in 48 people (32.9%), colorectal in 18 people (12.3%), and lung in 7 people (4.8%) were more than others. 51 people (34.9%) had Platinum-based chemotherapy, at first 39 people (26.7%) had normal hemoglobin, 80 people (54.8%) had mild anemia and 27 people (18.5%) had moderate anemia. 51.8% of patients with breast tumors, 22.2% of genitourinary tumors, and 8.8% of patients with gastrointestinal tumors had normal hemoglobin at the beginning of the study. The frequency of moderate anemia increased from 18.5% before chemotherapy to 36.1% after the third cycle of chemotherapy and 1.4 to 2.7% of patients developed severe anemia after different cycles of chemotherapy. 23 people (15.8 percent) of the examined patients had 2 or more units of hemoglobin drop after the first stage of chemotherapy, which happened in 10 people after the second stage (8.8 percent) and after the third cycle in 1 person (1.8 percent), it was observed. There was no significant relationship between 2 units or more hemoglobin drop with gender, age, tumor type, and type of chemotherapy regimen after the first cycle of chemotherapy (P

Background and purpose: Being Overweight is a global health problem and is related to important underlying diseases such as cardiovascular disease, malignancy, diabetes, fatty liver, etc. Over the past three decades, obesity has increased globally, especially in low-and middle-income countries. Numerous studies have shown that obesity increases the risk of developing chronic and threatening diseases including diabetes, cardiovascular diseases, blood pressure, and reduces life expectancy. On the other hand, chronic inflammation around fat cells plays an important role in obesity-related diseases. Also, changes in blood parameters are associated with increased body mass and chronic inflammation in obesity, and peripheral blood cells, such as the number of platelets, neutrophils, lymphocytes, and monocytes, are related to the progression of various types of diseases and inflammatory conditions. Therefore, the purpose of this study is to find the relationship between blood count biomarkers and anthropometric indicators in the adult group according to the Tabari cohort data. Materials and methods In the present study, cross-sectional data from a population-based cohort study called "Tabari Cohort Study" collected from 2014 to 2016 were used. This study is part of a nationwide study called "Epidemiological Prospective Study Group in Iran (Persian Cohort)". In the first phase of the Tabari cohort study, 10,255 participants aged between 35-70 years from urban and rural areas of Sari city were registered. Exclusion criteria in this study were inflammatory diseases, autoimmunity, malignancy, cardiovascular diseases, transplantation, and receiving any type of immunosuppressive drug, and finally 9939 people including 4043 men and 5896 women were included in the study. Age, height, weight, anthropometric measurements (BMI, waist circumference), CBC parameters including leukocytes, platelets, neutrophils, lymphocytes, and monocytes), and platelet distribution width (PDW) were recorded from the participants. By using the histogram drawing method to check whether the variables follow the normal distribution to decide between parametric or non-parametric analysis, T-test and ANOVA statistical tests, and SPSS 21 software, the results were extracted. The significance level in this study was considered to be 0.05 or less. Results: Waist-to-hip ratio was associated with higher WBC (P

Background and purpose: Breast cancer is one of the most common cancers among women. Abnormal expression of microRNAs is associated with cancer. Therefore, this study aimed to evaluate the expression of miRNA-210 in the serum of breast cancer patients. Materials and methods: The studied population included 49 breast cancer patients and 55 healthy individuals, and the samples were evaluated using Real Time PCR. Results: The data analysis of this study revealed that the expression level of miR-210 in the blood of breast cancer patients is significantly higher compared to the blood of healthy people. Also, there is a negative correlation between the age of breast cancer patients and the expression of miR-210 (r=-0.309, P=0.031) and a significant positive correlation between the increase in the expression of mir-210 and the expression of the Ki-67 marker (r=0.412, P = 0.004).

Background and purpose: Metabolic syndrome (MetS) refers to a combination of metabolic disorders which is considered a set of risk factors for chronic diseases such as cardiovascular disease and type 2 diabetes. Oral contraceptive pills (OCPs) are one of the most popular and effective methods of preventing pregnancy. The aim of this study is to investigate the relationship between the use of OCPs and MetS in the Tabari cohort population. Materials and methods: The current cross-sectional study utilized data collected in the enrolment phase of the Tabari cohort study (TCS). In total data of 5979 women aged 35 to 70 years were analyzed. The obtained data were analyzed using Chi-square tests and logistic regression analysis to assess the relationship between the use of OCPs and its duration with the risk of MetS and its components. Results: The prevalence of MetS among women participated in TCS was 49% (2930 individuals). The frequency of OCPs consumption was 42.9% (2563 individuals). The average duration of OCP use in women with and without MetS was 69.15±67.06 71.46±68.38 months respectively (P=0.388). After adjusting of confounding variables, no statistically significant association was observed between the use of OCPs and MetS and its parameters (except blood pressure). Similarly, the duration of taking these pills was also not significantly associated with MetS and these parameters. Conclusion: The use of oral contraceptives is not associated with MetS and other parameters, but its use, especially in the long term, can be accompanied by high blood pressure.

Background and purpose: During the onset of the COVID-19 pandemic, some studies showed that control of blood pressure reduces the burden of the SARS-CoV-2 virus. The present study was conducted to investigate the effect of antihypertensive drugs on the outcome of COVID-19. Materials and methods: In this cross-sectional retrospective study, we used the medical records of 129 patients with high blood pressure and COVID-19 hospitalized in hospitals affiliated with Mazandaran University of Medical Sciences. The outcome of the disease such as length of stay in hospital, transfer to intensive care units, the need for ventilator, death, etc. were recorded. Data analysis was done in Stata 17. Fisher's exact test, Chi-square, Mann-Whitney, and simple logistic regression were used. Results: The average age of patients was 64.4±11.3 years and 44.2% had at least one underlying disease. There was no significant relationship between the type of antihypertensive drugs, underlying diseases, gender, age and the outcome of COVID-19 such as ICU admission, use of mechanical ventilation, and death (P>0.05). A significant relationship was observed between hospital length of stay and the dosage of antihypertensive drugs (P

Background and purpose: Breast cancer is one of the most common cancers and the first cause of cancer-related deaths in women. Evidence suggests that allergies may be associated with cancer progression. Immunoglobulin E as part of the allergic immune response plays a role in the occurrence of type 1 hypersensitivity responses and allergic diseases such as asthma, allergies, allergic rhinitis, and probably cancers. Materials and methods: We carried out a cross-sectional study in breast cancer patients as a case group and people without cancer as a control group. Total IgE level in the groups was measured by ELISA method using the monoset kit by Calbiotech (USA). Data, including total IgE level and eosinophil percentage of the patients along with participans’ age were recorded in excel. Data analysis was done in SPSS V19 using T-test, Mann-Whitney and partial correlation. Results: In this study, 160 patients were examined. The mean ages of patients in the case group and control group were 48.18±10.49 years and 41.68±7.95 years, respectively. There was a significant difference between the two groups in mean age (P

Background: Metabolic syndrome is a critical health concern associated with an elevated risk of chronic health problems including cardiovascular disease and diabetes. There are shreds of evidence that novel inflammatory ratios including neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios serve as prognostic biomarkers for metabolic syndrome (MetS). This hypothesis was investigated in a cohort of the Iranian population. Methods: selection of MetS + subjects was based on the National Cholesterol Education Program Adult Treatment Panel III criteria 3 (NCEP ATP 3). The control group consisted of participants negative for any of the five MetS criteria. Demographic and laboratory data were extracted from the Tabari cohort study. Results: A total of 1930 subjects including 965 Mets positive and 965 MetS criteria negative participants were evaluated. Diabetes (84.8%), hypertension (48.9%), hypertriglyceridemia (81.7%), low HDL cholesterol (70.3%), and high waist circumference (78.9%) were observed in patients. There were no differences between NLR (1.66±0.71 vs. 1.69±0.72 P=0.42), LMR (11.23±3.13 vs. 11.30±11.99, P= 0.86) and PLR (113.85±68.67 vs 114.11±35.85, P=0.91) between case and control groups, respectively. Logistic regression analysis revealed no association between ratios and MetS risk even after adjusting for potential confounders including age, gender, living place, and BMI. Conclusion: In a relatively large population from Northern Iran, no association was observed between CBC-derived inflammatory ratios and the presence of MetS.

The coronavirus disease 2019 (COVID-19) pandemic is spreading rapidly, and its psychosocial impact remains a big challenge. In this respect, quarantine has been recommended, as a significant practice, to prevent the given condition. Therefore, the present study was to determine the prevalence rates of depression, anxiety, and stress and to reflect on the impact of COVID-19, as a traumatic stressor event, on individuals. This web-based survey was fulfilled via an online questionnaire, completed by respondents selected through the cluster sampling technique, from March 24 to April 10, 2020, living in Mazandaran Province, Northern Iran. Accordingly, the data regarding demographic characteristics, physical health status, quarantine compliance, contact with COVID-19, and additional information were collected. The psychosocial impact of the pandemic was then assessed by the Impact of Event Scale-Revised (IES-R), and the respondents' mental health status was evaluated using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Data analysis was further performed by linear regression. The study findings, from 1075 respondents, revealed that 22.5% of the cases had moderate-to-severe depression, 38.5% of the individuals were suffering from moderate-to-severe anxiety, and 47.2% of the participants were experiencing moderate-to-severe stress. In 14.5% of the respondents, the psychosocial impact of COVID-19 also varied from the possibility of post-traumatic stress disorder (PTSD) to immunosuppression (p < 0.01). With the high prevalence rates of depression, anxiety, and stress, mental health professionals are suggested to develop psychosocial interventions and support plans for the general population to reduce the impact of the COVID-19 pandemic on public mental health status., Author(s): Maryam Hasannezhad Reskati [sup.1] , Misagh Shafizad [sup.2] , Mohsen Aarabi [sup.3] , Akbar Hedayatizadeh-Omran [sup.4] , Sahar Khosravi [sup.5] , Forouzan Elyasi [sup.6] [sup.7] [sup.8] Author Affiliations: (1) [...]

Background: Since a comprehensive study of eating disorders in children with type 1 diabetes in the Iranian population is necessary, this study aimed to investigate the prevalence of eating behaviors and metabolic control status of children and adolescents with diabetes mellitus. Objectives: The present cross-sectional study aim to explore the prevalence of eating behaviors and their influence on metabolic control of children with type 1 diabetes mellitus. Methods: In this cross-sectional study, all children and adolescents 6 to 12 years old with diabetes were included. First, the prevalence of eating-related behaviors in participants was assessed and recorded. Then the recorded data were statistically analyzed. Results: The Mean±SD age of the study participants was 8.92±1.925 years. One hundred children with food approach scores above 12.29 had food-approach behaviors, and 78 children with food avoidance scores above 11.85 were classified as having food avoidance behaviors. The relationships between food-approach behaviors and hemoglobin A1C (HbA1c) and insulin dose, body mass index (BMI), and lipid profile were significant (P0.05). Conclusions: High BMI, high insulin dose, increased lipid levels, and high HbA1c are associated with an increased eating tendency in children. Therefore, these children should be evaluated for disordered eating behaviors.

Background and Objective: Considering the prevalence of gastrointestinal cancers in the region and the importance of helpful criteria in the diagnosis of the disease, the present study was conducted to compare the blood parameters neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and lymphocyte to monocyte ratio (LMR) in gastric cancer patients in Mazandaran province and its comparison with non-affected people. Methods: This cross-sectional study was conducted in 2019 and 2020 on 62 cancer patients referred to Imam Hospital in Sari in the case group and 124 non-patients from the community in the control group. Convenience sampling was used in the case group and random sampling was used in the control group from among the Tabari Cohort Population. The two groups were matched in terms of age and gender. The required data including age, gender, LMR, NLR and PLR for all subjects as well as pathological indices and chemotherapy status were recorded for the case group. Findings: The gender ratio in both groups was 69.4% males and 30.6% females. The mean age of the examined subjects in the group of cancer patients and the control group was 62.3±12.53 and 51.7±9.02 years, respectively (p=0.105). The mean NLR (2.14 vs. 1.62, p=0.000) and PLR (9.48 vs. 6.27, p=0.000) in the group with gastric cancer were significantly higher than the healthy control group, and the mean LMR (3.42±2.12 vs. 10.9±2.99, p=0.000) was significantly lower than the healthy control group. Conclusion: The results of high NLR and PLR and low LMR showed that these indices can be used in gastric cancer screening studies.

Abstract Background and Aim The coronavirus disease 2019 (COVID‐19) pandemic has to date overwhelmed the survivors and the general population. The present study aimed to compare the mental health status and the COVID‐19 event impact between the survivors and the general population in Mazandaran Province, Northern Iran. Design A web‐based cross‐sectional survey was used. Methods This study was performed using convenience sampling. Results In total, 1,766 participants were included in this study. The findings revealed that the posttraumatic stress disorder (PTSD) severity in both outpatient and hospitalized groups was significantly higher than that in the general population. Besides, the levels of anxiety and depression in the group receiving inpatient care and treatment had significantly elevated than those in the general population. Conclusion Given the high prevalence rate of mental disorders, healthcare professionals are recommended to plan for various interventions and support services to boost community mental health status.

Background and purpose: The northern regions of Iran have a high incidence of esophageal cancer. This study was conducted with the aim of epidemiological investigation of esophageal cancer patients in the population covered by Mazandaran University of Medical Sciences. Materials and methods: In this cross-sectional descriptive study, the records of 170 patients over 18 years of age who were referred to Tuba Oncology Clinic (affiliated with Mazandaran University of Medical Sciences) between 2014 and 2016 were reviewed. All relevant information, including age, sex, occupation, marital status, level of education, clinical and pathological findings of patients were collected and analyzed in SPSS V22 using Chi-square and Fisher’s exact test. Results: The mean age of patients with esophageal cancer was 68.2±12 years. The disease was more frequent in patients aged 70-79 years old. There were 53.5% male patients and 94.1% of patients had dysphagia. The frequency of squamous cell carcinoma (SCC) was found to increase by aging. The most and least metastatic segments were middle and upper parts of the esophagus, respectively. Conclusion: Esophageal cancer is common in old age and age is probably the most important factor in developing the disease.

Background and purpose: Recently, several studies have shown type 2 diabetes to be associated with gastric cancer and metformin appears to inhibit the growth of cancer cells by inducing apoptosis. This study was conducted to investigate the relationship between metformin and gastric cancer. Materials and methods: This case-control study included patients with gastric cancer (case group, n= 121) and a family member of patients with cancer (control group, n= 119). Diabetes history, duration and management of glucose level were recorded in a checklist and data were analyzed in SPSS applying T-test and Chi-square test. Also, logistic regression was used to calculate the odds ratio. Results: There were significant differences between the case group and control group in terms of age, gender, place of residence, level of education, BMI, and smoking (P0.05). Conclusion: According to current study, it appears that, in north of Iran, there is no association between gastric cancer and diabetes, control drugs (including metformin), and other factors such as duration of diabetes or a family history of diabetes.

Background and Objective: Considering the anti-cancer effects of statins on colon cancer previously reported in epidemiological studies and uncertainty about the mechanisms of action, this study was performed to investigate the effect of statins in combination with chemotherapy on colon cancer cell lines. Methods: The present study, which is a laboratory study, was performed on HT-29 cell line as colon cancer cell line and normal HFF cell line. After cell culture, atorvastatin at doses of 15 and 30 μM, rosuvastatin at doses of 30 and 60 μM, simvastatin at doses of 10 and 20 μM and 5-fluorouracil (5-FU) at 20 μg/ml were used for interventions in this study. Interventions were performed alone and in combination. Finally, MTT test was performed to evaluate cell viability. Findings: Mean cell viability in simvastatin (20 μM) and simvastatin (20 μM)+5-FU (20 μg/ml) on colorectal cancer cell lines was 58.46±7.58 and 55.73±15.33 (p=0.999), respectively, in rosuvastatin (30 μM) and rosuvastatin (30 μM)+5-FU (20 μg/ml) was 91.63±10.3 and 56.2±10.27 (p=0.026), respectively, and in atorvastatin (30 μM) and atorvastatin (30 μM)+5-FU (20 μg/ml) was 82.3±26.9 and 52.16±9.49 (p=0.24), respectively. Conclusion: The evaluation of cell proliferation showed that the addition of rosuvastatin to standard chemotherapy, unlike atorvastatin and simvastatin, had an increasing effect on cytotoxicity.

Background and purpose: There are controversies on the association between electrolytes and Coronavirus disease 2019 (COVID-19) and its severity. Studies on these issues may help in resolving ambiguities. The purpose of this study was to assess the association between electrolyte indices and being infected with COVID-19 and developing severe symptoms using a meta-analysis. Materials and methods: A thorough search was done in national and international electronic databases using Medical Subject Headings (MeSH) terms. Quality assessment was conducted by Newcastle-Ottawa scale (NOS) checklist. We estimated the standardized mean difference between electrolyte indices and the incident of COVID-19 infection and its severity. Results: After screening the papers, 12 met the inclusion criteria. According to the meta-analysis results, the standardized mean differences for serum level of sodium and potassium between the dead and survived COVID-19 patients was estimated to be 0.22 (95% CI: -0.03, 0.46) and 0.14 (95% CI: -0.22, 0.50), respectively. The standardized mean differences for serum levels of sodium, calcium, and potassium between patients with severe and non-severe COVID-19 were estimated to be -0.28 (95% CI: -0.72, 0.17), -1.07(95% CI: -1.58, -0.55), and -0.10 (95% CI: -0.47, 0.27), respectively. Conclusion: In this meta-analysis, the standardized mean difference for calcium was significantly lower in severe COVID-19 patients compared to that in patients with mild and moderate forms of the disease.

Abstract The Sputnik V is a COVID- 19 vaccine developed by the Gamalia institute of epidemiology and microbiology and released on August 11, 2020. We provided independent evidence on side effects and immunogenicity following the administration of the Sputnik V COVID-19 in Iran. In this observational study, the healthcare workers who were vaccinated with the Sputnik V COVID-19 vaccine within February and April 2021 were evaluated. Among a total of 13,435 vaccinated healthcare workers, we received 3236 self-declaration reports of Sputnik V associated adverse events with the mean age 39.32 ± 10.19 years old which 38.8% were men and 61.2% were women. Totally 68.8% of females versus 66.2% of males reported side effects after receiving the first dose and 31.2% of females versus 33.8% of males reported side effects after the second dose of vaccine. The most common side effect was a pain in the injection site (56.9%), fatigue (50.9%), body pain (43.9%), headache (35.7%), fever (32.9%), joint pain (30.3%), chilling (29.8%) and drowsiness (20.3%). Side effects of the vaccine were significantly more frequent in females and younger individuals. Among a total of 238 participants, more than 90% after the first and second dose of vaccine had a detectable level of SARS-CoV-2 RBD antibody and SARS-CoV-2 neutralizing antibody. Although the overall rate of adverse effects was higher than the interim results from randomized controlled trials, our findings support the manufacturer’s reports about the high humoral immunogenicity of vaccine against COVID-19.

Introduction: Cancers are the second cause of death worldwide. Prevalence and incidence of cancers is getting increased by aging and population growth. This study aims to predict the incidence of breast, colorectal and bladder cancers in north of Iran until 2020 using time series models. Methods: The number of breast, colorectal and bladder cancer cases from April 2014 to March 2016 was extracted. The time variable was each month of the study years and using the number of daily registered cancers in each month, the time series of the monthly incident cases was designed. Then, three methods of time series analysis including Box Jenkins, Bayesian and Bootstrap were applied for predicting the incidence of the above cancers until March 2020. Results: The number of bladder cancer cases in March 2014 was 6 cases. This study showed that the number of breast cancer cases in March 2020 will be increased to 15, 15 and 26 cases based on ARIMA, Bootstrap and Bayesian methods respectively. In addition, the incident cases of breast cancer, will be increased from 32 in 2014 to 65 (ARIMA method), 47 (Bootstrap method) and 364 (Bayesian method). The corresponding figure for colorectal cancer was 30, 30 and 95 respectively. Conclusion: The increasing trend of breast, bladder and colorectal cancers will be continued which is considerable based on the Bayesian method results. Considering the limited reliable data used in a short time, it seems that the forecasting results of this model is acceptable.

Background and purpose: Given the role of cancer stem cells in cancer, the aim of this study was to determine the expression of LGR5 marker in gastric cancer and its association with cagA genotype of Helicobacter pylori infection. Materials and methods: A case-control study was performed in gastric biopsy specimens from antrum and body during endoscopic examination of patients attending Sari Touba Clinic, 2017-2018. After reviewing the patient records, the samples from those aged 50 and higher were studied. Case group included gastric cancer specimens with H. pylori infection (n=30) and control group included non-cancerous samples with H. pylori infection (n=30). LGR5 expression and presence of cagA were evaluated by IHC and PCR methods, respectively. Results: The mean ages of gastric cancer and control group were 69.5±10.1 and 62.3±7.8, respectively (P= 0.003). Twenty three patients (76.7%) in cancer group and 24 patients (80%) in control group were positive for cagA genotype. Overexpression of LGR5 was observed in 15 patients (51.7%) with gastric cancer and 11 patients (39.3%) in control group (P= 0.429). LGR5 was also overexpressed in 18 cases (40.9%) with cagA positive genotype and 8 cases (61.5%) with negative cagA genotype (P=0.22). Conclusion: High expression of LGR5 was observed in half of patients with gastric cancer but it was not significantly associated with cagA H.pylori genotype.

Background and purpose: The association between ABO blood types and Coronavirus disease 2019 (COVID-19) have been investigated in several studies but there are inconsistencies in results. The purpose of this study was to investigate the association between ABO blood types and COVID-19 infection based on serologic results. Materials and methods: A cross-sectional seroepidemiologic study was carried out in 1504 people living in Mazandaran province, north of Iran. Blood samples were drawn to determine blood groups. Also, IgG and IgM antibodies were measured by ELISA. Data analysis was done using Chi-square, Fisher’s exact test, univariate and multivariate logistic regression analyses in SPSS V25. Results: The frequency of IgG positive among blood groups A, B, AB, and O was 12.7%, 11.8%, 9.4%, and 9.6%, respectively. After adjusting for suspicious confounding factors, the odds ratio of COVID-19 infection was 1.19 (95% CI:0.85-1.67) in blood group A, 1.33 (95% CI:0.94-1.87) in blood group B, 0.82 (95% CI:0.44-1.55) in blood group AB, and 0.70 (CI 95%:0.50-0.98) in blood group O based on serologic results (IgG+/IgM+). Conclusion: The odds ratio for COVID-19 was significantly lower (30%) in blood group O compared to other blood groups, so blood group O can be considered as a protective factor against COVID-19.

Background and purpose: Colorectal resection is used for various diseases and leakage in an anastomosis is one of its complications. Some studies confirmed the predictive effects of C-reactive protein (CRP) and procalcitonin markers leakage in anastomosis. This study aimed to investigate the prognostic value of CRP and procalcitonin in predicting anastomotic leakage in elective colorectal surgery in Mazandaran province, Iran. Materials and methods: This longitudinal study was performed in patients (n=72) undergoing intestinal anastomosis in Sari Imam Khomeini Hospital, Oct 2016-March 2017. White blood cells (WBC), temperature (T), CRP, and procalcitonin levels were measured at days 3 and 5 after the surgery. Data were analyzed using SPSS V21. Results: Anastomotic leakage occurred in two patients (2.8%). Procalcitonin levels (P= 0.000), CRP levels at days 3 (P= 0.000) and 5 (P= 0.000), WBC at day 5 (P = 0.041), and body temperature at days 3 (P= 0.014) and 5 (P= 0.004) after the surgery were associated with the incidence of anastomotic leakage. Conclusion: Procalcitonin and CRP levels, WBC count, and body temperature were found to be correlated with anastomotic leakage, so they should be monitored at days 3 and 5 after the surgery to predict the incidence of complications.

Background and purpose: Vitamin D deficiency is highly prevalent in Iran. Death toll due to the Coronavirus Disease 2019 (COVID-19) is high in this country. The purpose of the present investigation was to provide more information on the relationship between serum levels of vitamin D in confirmed cases of COVID-19 in north of Iran. Materials and methods: This cross-sectional descriptive study was performed in COVID-19 patients (n=80) attending Sari Imam Khomeini Hospital, Iran 2020, who were confirmed for COVID-19 infection with CT-Scan or RT-PCR. Seventy healthy individuals were also examined as the control group. SPSS V19 was applied for data analysis. Results: In this study, 80 patients with COVID-19 (mean age: 57.22 ± 17.44 years old) and 70 healthy individuals (mean age: 48.69 ± 12.99 years) were studied. There were 38 and 35 males in these two groups, respectively. Serum Vitamin D levels were significantly lower in patients with COVID-19 than those in the control group (18.72 ± 12.53 vs. 30.86 ± 15.19 ng/ml, P< 0.001). Conclusion: This study showed that serum levels of Vitamin D were lower in patients with COVID-19 than healthy individuals and frequency of Vitamin D deficiency was higher in these patients. Hence, further studies are needed to clarify the role of serum Vitamin D concentrations in patients with COVID-19 infection.

Abstract Background The COVID‐19 outbreak has exerted a great deal of psychological pressure on Iranian health workers and the general population. The aim of this study was to determine the effect of pandemic on anxiety and depression in Iranian population. Methods An online cross‐sectional study was conducted for the general public and healthcare workers in Iran using a questionnaire comprised of demographic questions and Hospital Anxiety and Depression Scale. Chi‐square test and univariate and multivariate logistic regression models were conducted. Results Of the 2045 participants, 1136 (65.6%) were considered to have moderate and severe anxiety symptoms, and 865 (42.3%) had moderate and severe depression symptoms. The prevalence of anxiety was higher in the females than in the males (OR = 1.4, 95% CI: 1.123‐1.643, P = .002); the prevalence of anxiety was significantly higher in those aged 30‐39 years than in other age‐groups (OR = 1.6, 95% CI: 1.123‐2.320, P = .001); furthermore, the prevalence of anxiety and depression was significantly higher in doctors and nurses compared with other occupations ((OR = 1.9, 95% CI: 1.367‐2.491, P

This study was aimed at preparing and characterising kojic acid nanostructured lipid carriers (KA-NLCs) for delivery to skin. KA-NLCs were prepared using high-speed homogenization followed by ultra-probe sonication method. KA-NLCs were optimized by glyceryl mono-stearate (GMS) and cholesterol (Chol) as solid lipid excipients, oleic acid (OA) as liquid lipid excipient, span 60 (SP 60) and Tween 20 (Tw 20) as co-emulsifiers. For optimized formulation (KA-NLC3), values of particle size, encapsulation efficiency, drug loading, polydispersity index (PDI) and zeta potential (ZP) were found to be 172.9 ± 7.1 nm, 76.4 ± 0.1%, 17.6 ± 1.3%, 0.3 ± 0.1 and −39.1 ± 2.7 mV, respectively. KA-NLC3 was stable at 4 °C and 25 for 3 months. TEM image confirmed these results. ATR-FTIR, DSC and PXRD results indicated suitable entrapment of KA in NLCs without any chemical interaction. The release profile of KA-NLC3 followed a sustained pattern. KA-NLC3 has potent tyrosinase inhibitory activity in comparison with pure KA. Nanoparticles showed a higher antioxidant activity than pure KA. The results of the ex vivo and in vitro percutaneous absorption showed that KA-NLC3 improved percutaneous delivery of KA. Concentrations below 250 μg/mL were determined as suitable concentrations for KA-NLC3. It seems to be biocompatible formulation for the cosmetics aims.

Background: The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis given the role of complete blood counts in the COVID-19 prognosis. Methods: COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population who were matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study. Results: The number of participants in the case and control groups was 527. Of these, 464 (44%) were females. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (p = 0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P = 0.000). NLR had a significant relationship with severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P = 0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06) respectively. Conclusion: NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those died and recovered from COVID-19.

Background and purpose: Research is one of the significant foundations of community development, which requires understanding the capabilities, weaknesses and strengths of programs. This study aimed at investigating the motivations and barri ers to research in clinical faculty members. Materials and methods: This descriptive-analytical study was conducted in clinical faculty members (surgeon and non-surgeon) in Mazandaran University of Medical Sciences using census sampling. Data were collected via Research Barriers Questionnaire (Sotodeh Asl et al.) and Research Motivation Scale (Salehi). Data analysis was done applying Mann-Whitney test and Kruskal-Wallis test. Results: One hundred thirty-nine individuals aged 40-50 years participated in this study and the participation rate was high (81%). The motivation for research activities was higher in females (59.92 ± 6.38) than males (57.24 ±5.47) (P< 0.05). Major obstacles to preparation and compiling a research project, in both surgeon and non-surgeon groups, were lack of clear research needs (3.68 ± 0.67) and priorities (3.11 ± 0.89) in the university. In project implementation, lack of appropriate space (3.50 ±1.04) was reported as the main problem by both groups. In administrative and management context, little attention to creativity (3.80 ± 0.86) and financial and budget problems (3.27 ± 1.21) were the main barriers according to both surgeon and non-surgeon faculty members, respectively (P> 0.05). Conclusion: Despite sufficient motivation, organizational and individual barriers affect research activities. These obstacles could be removed by clarifying research priorities, creating a suitable physical space, and solving financial problems.

Background: To examine the serum levels of vitamin D in newly diagnosed gastric cancer (GC) patients compared with normal subjects and any possible association with prognostic variables. Methods: One-hundred subjects (50 GC and 50 controls) were enrolled and serum vitamin D levels were assessed using ELISA. Based on two definitions, vitamin D was classified as a sufficient level (≥30 ng/dL) and optimal level (25-80 ng/dL). The χ2 and unpaired t-test was used for data analysis with a significance level of 0.05. Results: The mean serum levels of vitamin D in patients and controls were 26.86 (±14.6) and 31.72 (±13.4), respectively (P=0.09). The prevalence of vitamin D insufficiency and deficiency was higher in GC cases than controls (P=0.045 if sufficient level ≥30 and P=0.065 if sufficient level ≥25). According to histological grade analysis, grade 3 patients (poorly differentiated) were found with significantly lower vitamin D concentrations in serum than grade 1 and 2 subjects (22.25 vs 33.29 ng/dL, P=0.021). No significant differences were observed between the two groups in pathological tumor-node-metastasis (pTNM) stages, distant metastasis, and location of the tumor. Conclusion: Higher prevalence of vitamin D insufficiency and deficiency in GC patients may reflect its role in malignancy; however, further studies are needed to confirm this relationship and any possible benefits to the patients.a

BACKGROUND AND OBJECTIVE: Identification of cancer risk factors in the community and prevention planning in high-risk groups can be helpful in cancer prevention program. Hence, the aim of this study was to investigate the relationship between reproductive factors and breast cancer in the Tabari population-based cohort study in a case-control design. METHODS: This case-control study was performed on the enrolment phase of the Tabari population-based cohort. Patients with breast cancer were considered as case group (51) and non-cancerous individuals (204) as a control group. The two groups were matched based on age category and oral contraceptive pill (OCP) intake. The studied variables included breast cancer history, demographic and reproductive factors. FINDINGS: Mean age of first pregnancy (22.76±4.99 vs. 20.8±4.16, p=0.005), mean age at first birth (23.57±4.94 vs. 21.66±4.07, p=0.006) and age of marriage (22.24±5.75 vs. 19.54±4.92, p=0.001) in the case group were significantly higher than the control group and the number of pregnancies (3.76±2.22 vs. 4.67±2.76, p=0.032) and number of children (3.27±1.97 vs. 4.16±2.44, p=0.019) in the case group was significantly less than the control group. According to multivariate analysis, the odds of incidence of breast cancer in people with first pregnancy over 22 years was 2.76 times more than (p= 0.027) those with first pregnancy age below 22 years. CONCLUSION: “Age at first full-term pregnancy” is one of the major risk factors for breast cancer in the area.

Background and purpose: The relationship between obesity and the risk of breast cancer has been highlighted in some studies. This research aimed at studying the association between anthropometric indices and breast cancer based on enrolment phase (cross-sectional phase) data in Tabari cohort study. Materials and methods: In this cohort, 51 cases of breast cancer were recorded which were considered as the case group. Also, 153 individuals (without any type of cancer) from Tabari cohort population were randomly selected as control group. Data analysis was performed applying independent t-test, chi-square, and multivariate logistic regression. Results: The frequency of waist circumference ≥88 cm in case group was slightly lower than that of the control group (74.5% vs. 75.2%, P= 0.926). In case group, the frequency of waist to hip ratio (less than 0.85) was lower than that of the control group (70.6% vs. 80.4%, P= 0.144). The risk of breast cancer was found to be higher in rural population (OR: 8.28, P

Background and purpose: There is lack of concordance between researchers' interests and clinical problems. This study aimed at explaining researchable clinical problems from the perspective of healthcare providers to provide a better understanding of the issues that could be solved by the health system. Materials and methods: This qualitative study was carried out in 27 healthcare providers in selected hospitals affiliated to Golestan University of Medical Sciences, 2017. The participants were selected by purposive sampling. Focused Group Discussion (FGD) was used to collect the data. The participants explained their experiences through three FGDs which began with a broad open-ended question and further probing questions were used. Interviews were recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. Results: The participants aged 25-53 years old with 2-26 years of clinical experience, among whom 59% were males. The analysis of data led to the development of four main themes. The researchable clinical problems included clinical problems associated with health system structure, the status of healthcare providers, the status of service delivery in the health system and needs assessment, and problems associated with clinical processes. Conclusion: Current study suggests that after determining the priority of researchable problems regional issues should be addressed in designing and performing clinical researches.

Background: Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and platelet-lymphocyte ratio (PLR) have a prognostic value in several types of diseases such as cancers and they vary in different races. So, we aimed to evaluate the normal range of these markers among healthy people to determine the normal value in Iranian population. Methods: In the present study, cross-sectional data of population-based cohort study named “Tabari cohort study” was utilized. In the first phase of Tabari cohort, 10255 participants aged 35-70 years from urban and rural areas of Sari, Mazandaran, Iran entered into the study. The study included a questionnaire survey and blood collection. Blood samples were collected after 12 hours fasting from all participants during the study. Hematological indices were measured for all samples using Celltac Alpha MEK-6510 K (Tokyo, Japan). Results: After sample exclusion, 2212 healthy subjects of Tabari's normal cohort population were investigated. The mean age of the samples was 47.9±9.29 years. The mean of NLR, LMR, PLR were 1.70±0.70, 11.15±3.14 and 117.05±47.73, respectively. Conclusion: Our investigation provides preliminary reference values for NLR, LMR, and PMR among Iranian population that can be used for disease progress in various clinical procedures.

Objectives: Investigating the survival of patients with cancer is vitally necessary for controlling the disease and for assessing treatment methods. This study aimed to compare various statistical models of survival and to determine the survival rate and its related factors among patients suffering from lung cancer. Methods: In this retrospective cohort, the cumulative survival rate, median survival time, and factors associated with the survival of lung cancer patients were estimated using Cox, Weibull, exponential, and Gompertz regression models. Kaplan-Meier tables and the log-rank test were also used to analyze the survival of patients in different subgroups. Results: Of 102 patients with lung cancer, 74.5% were male. During the follow-up period, 80.4% died. The incidence rate of death among patients was estimated as 3.9 (95% confidence [CI], 3.1 to 4.8) per 100 person-months. The 5-year survival rate for all patients, males, females, patients with non-small cell lung carcinoma (NSCLC), and patients with small cell lung carcinoma (SCLC) was 17%, 13%, 29%, 21%, and 0%, respectively. The median survival time for all patients, males, females, those with NSCLC, and those with SCLC was 12.7 months, 12.0 months, 16.0 months, 16.0 months, and 6.0 months, respectively. Multivariate analyses indicated that the hazard ratios (95% CIs) for male sex, age, and SCLC were 0.56 (0.33 to 0.93), 1.03 (1.01 to 1.05), and 2.91 (1.71 to 4.95), respectively. Conclusions: Our results showed that the exponential model was the most precise. This model identified age, sex, and type of cancer as factors that predicted survival in patients with lung cancer.

Background and purpose: Breast cancer is the most common cancer in women. Most recently C3435T polymorphism of MDR1 gene is considered as one of the major causes of drug resistance in treatment of this disease. This study was conducted to investigate the relationship between C3435T MDR1 gene polymorphism and treatment response in breast cancer patients. Materials and methods: In this longitudinal study, blood samples were collected from all cases and gene polymorphism was performed by PCR-RFLP method. Then, all patients underwent chemotherapy and patient response to treatment was evaluated. They were divided into two categories according to clinical response to treatment and lack of treatment response. Results: This research included 152 women (mean age: 49.84±10.95 years) with breast cancer. The genotype found more frequently was CT (49.2%). Among the patients, 74.3% responded to treatments and in 25.7% there was no response to treatment. We found no significant differences between different genotypes in response to treatment (P=0.485). Conclusion: There was no direct relationship between the response of breast cancer to treatment and C3435T polymorphism of MDR1 gene.

Background and purpose: Coronary artery disease (CAD) is a complex disease that is caused by both environmental and genetic factors. Methylenetetrahydrofolate (MTHFR) enzyme is associated with metabolism of homocysteine and its impaired function is considered as a risk factor for developing CAD. Some variants are involved in decreased activity of MTHFR and its deficiency. The polymorphism of C677T (rs1801133) seems to be a significant variant that is related with CAD. The purpose of this study was to determine the relationship between MTHFR C677T gene polymorphism and susceptibility of CAD. Materials and methods: This case-control study was performed in 71 patients with coronary artery disease and 71 healthy subjects (control group). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to genotype MTHFR polymorphism. Results: The mean ages of subjects in case and control groups were 58.2±8.9 and 46±13.9 years, respectively (P= 0.0000). The case group included 37 (52.1%) males and 34 (47.9%) females. In control group, there were 38 (53.5%) males and 33 (46.5%) females. The frequency of CC, CT, and TT genotypes in C677T polymorphisms was 59.2%, 35.2%, and 5.6%, in CAD patients and 62%, 32.4%, and 5.4%, in controls, respectively, indicating no significant differences between the cases and controls (p= 0.937). The frequency of T allele was 40.8% in cases and 38% in controls which also showed no significant difference between the two groups (P= 0.864). Conclusion: Current study found no relationship between MTHFR C677T gene polymorphism and CAD. However, further studies in larger population are recommended to achieve better understand this relationship.

Background and purpose: The impact of cancer on various aspects of life is definitely proven in many studies. In this research, we aimed to study the psychological, social, and economic status of patients with different types of cancer in Mazandaran province, Iran. Materials and methods: This cross-sectional study was conducted in patients with cancer who were admitted to Sari Imam Khomeini Hospital, 2017. Data was collected using a researcher-made form that was designed to determine the frequency of the most important and the most common psychological, social, and economic components. The form was completed by researchers, at the Cancer Research Center, for 375 patients with cancer who were selected by convenience sampling. Results: Psychologically, most of the patients accepted their disease at the time of diagnosis (46.9%). Most of the participants mentioned the death of loved ones as the most important bitter incident before the disease (41.6%). Children status was one of the main concerns among the patients (57.3%). From the social point of view, the majority of patients reported optimum emotional relationship with their spouse (75.4%). The results also showed that most of the patients were financially dependent on their spouse (62.7%). Conclusion: This study suggests that simultaneous attention to psychological, social, and economic aspects of cancer patients can lead to significant outcomes.