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Background: COVID-19 is known as a global health issue, which can cause high mor-bidity and mortality in patients. It is necessary to identify biomarkers, clinical and laboratory find-ings and effects on patients' mortality. Objective: This study aimed to evaluate the prognostic effect of clinical and laboratory findings on in-hospital mortality in patients with confirmed COVID-19. Methods: This retrospective cross-sectional study (February-August 2020) was conducted on adult patients with COVID-19 who were hospitalized in one of the main reference hospitals affiliated with Shiraz University of Medical Sciences, southern Iran. Patients with uncompleted or missed medical files were excluded from the study. Clinical and laboratory findings were extracted from the patients' medical files and then analyzed. The patients were categorized and later compared as survivor and nonsurvivors groups. Results: 345 patients were enrolled and 205 (59.4%) were male. The mean±SD of age was 53.67±16.97 years, and 32 (9.3%) out of the total did not survive. Hypertension (28.4%) and diabe-tes (25.5%) were the most prevalent comorbidities. All clinical symptoms were similar in both groups, except fever, which was observed significantly more in nonsurvivors (P=0.027). The dura-tion of hospitalization was 9.20±5.62 (range; 2-42) days, which was higher in nonsurvivors (P Conclusion: The current study showed that in-hospital mortality was 9.3%. It was found that CRP and INR were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19.

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

Background Influenza is one of the most important viral diseases with high mortality and morbidity that can have a great impact on public health and economy. Objective To investigate the clinical and epidemiological features of influenza virus A/H1N1, A/H3N2, and B infection in Fars province, southern Iran, in 2015-2019. Methods In this retrospective cross-sectional study, we assessed the archived data of Syndromic Surveillance System of Iran's Health Ministry, allowed access by Communicable Diseases' Unit of Health chancellor of Shiraz University of Medical Sciences, from December 22, 2015 to September 22, 2019. The participants included all patients whose data were recorded as influenza-like illness (ILI) and severe acute respiratory infections/illness (SARI). Influenza viral infection was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). Results Totally, 1269 patients suspected of influenza were sampled. The mean ± SD of age was 29.40 ± 26.91 years. Fever was the most common symptom (68.6%). The highest incidence was in winter (55.9%). Of 928/1269 laboratory's results which were recorded in the registry, 204 (16.08%) samples were positive and 724 (57.05%) were negative. Among 204 positive results, 191 (15.05%) were influenza type A, and 8 (0.63%) influenza type B. Among patients with definite influenza type A, 34 (2.68%) had H1N1/p subtype, 58 (4.57%) H3N2, and one (0.08%) had other subtypes; however, subtypes were not identified in 7.72% of patients. Six (3.0%) patients with confirmed influenza expired. Conclusion The incidence of influenza, especially type A, in Fars province, southern Iran is considerable and requires more attention for prevention in health policy programs.

Background: Helicobacter pylori infection is highly prevalent worldwide and affects more than half of the world's population. A variety of treatment regimens to eliminate H. pylori infection have been evaluated, but choosing the best treatment method that results in the most eradication at the lowest cost is one of the challenges facing physicians. Therefore, the present study aimed at analyzing the cost-effectiveness of using different methods to treat H. pylori in southern Iran. Methods: This study was a cost-effectiveness analysis conducted on 132 patients with H. pylori who referred to Shahid Motahari Clinic in Shiraz. The study was carried out in 2020 to evaluate two drug treatment strategies, including antibiotics (pantoprazole 40 mg, Bismuth subcitrate 108 mg, tetracycline 500 mg, and metronidazole 200 and 400 mg) and plants (Supermint Barij soft capsules 20 mg, Alium S garlic tablets 400 mg, and Green Teadin (green tea) tablets 500 mg). The patients were randomly divided into two groups, 64 of whom received an antibiotic regimen and 68 patients given a plant regimen. The success rate of clinical trials in each treatment method was determined as the clinical outcome. This study was conducted from a community perspective and therefore, direct and indirect costs were included. A data collection form was also used to collect the cost and effectiveness data. In addition, a one-way sensitivity analysis was performed to measure the robustness of the results. The data were analyzed using TreeAge Pro 2011 and Excel 2016 software. Results: The results showed that antibiotic treatment was cheaper and more effective than plant treatment and was the dominant strategy. The mean costs in the antibiotics and plant groups were $446.14 and $477.81, respectively, and the effectiveness was 0.625% and 0.382%. In addition, the one-way sensitivity analysis confirmed the robustness of the study results. Conclusion: The results showed that the use of antibiotics was a cost-effective and dominant strategy compared to plant treatment and could be suggested as a better alternative to a wide range of patients with Helicobacter pylori infection.

IntroductionDespite an increasing number of studies, there is as yet no efficient antiviral treatment developed for COVID-19. In this clinical trial, we examined the efficacy of a novel herbal antiviral preparation comprising Zataria multiflora Boiss, Glycyrrhiza glabra, Cinnamomum Vermont, Allium sativuml, and Syzygium aromaticum in critically ill patients with COVID-19.Methods A total number of 120 ICU-admitted patients requiring pulmonary support with a diagnosis of COVID-19 pneumonia were recruited to the trial. Participants were equally randomized to receive either the novel antiviral preparation sublingually, for up to two consecutive weeks or till discharge, or placebo. Clinical and laboratory parameters as well as survival rates were compared between the two groups at the study end.Results The cumulative incidence of death throughout the study period was 8.33% in the intervention group and 60% in the placebo group (risk ratio: 0.14; 95% confidence interval [CI], 0.05 to 0.32; P2 were improved in patients treated with the novel antiviral preparation compared with the placebo group.Conclusion The novel antiviral preparation tested in this trial significantly improved the survival rate and reduced mortality in critically ill patients with COVID-19. Thus, this preparation might be suggested as a potentially promising COVID-19 treatment. Funded by Shimi Teb Salamat Co., Shiraz, Iran, and registered on the Iranian registry of clinical trials (Trial registration: IRCT20200509047373N2. Registered 13 April 2021).

RationaleCoronavirus disease 2019 (COVID-19) leads to hospitalization and death, especially in elderly and those with comorbidities. There are evidences showing that sitagliptin and spironolactone can potentially improve the clinical outcomes of COVID-19 cases.ObjectiveIn this observational study on acutely symptomatic outpatient COVID-19 cases, we investigated the effects of spironolactone and sitagliptin on the outcomes of the disease.MethodsThis prospective cohort study was conducted at Shiraz University of Medical Sciences Clinics during the fifth wave of the COVID-19 pandemic between July 2021 and September 2021. We followed mild to moderate symptomatic COVID-19 patients, who were treated with either combination (spironolactone 100 mg daily and sitagliptin 100 mg daily) or standard (steroid, antiviral and/or supportive care) therapy up to 30 days. Our primary outcome was hospitalization rate. The secondary outcomes included ER visit, duration of disease, and complications, such as hypoglycemia, low blood pressure or altered mental status.ResultsOf the 206 patients referred to clinics, 103 received standard therapy and 103 treated with combination therapy. There were no significant differences in baseline characteristics, except for slightly higher clinical score in control group (6.92 ± 4.01 control, 4.87 ± 2.92 combination; P ). Treatment with combination therapy was associated with lower admission rate (5.8% combination, 22.3% control; P = 0.0011), ER visits (7.8% combination, 23.3% control; P = 0.0021) and average duration of symptoms (6.67 ± 2.30 days combination, 18.71 ± 6.49 days control; P =).ConclusionIn this prospective cohort study of acutely ill outpatients with COVID-19, the combination of sitagliptin and spironolactone reduced duration of COVID infection and hospital visits better than standard therapeutic approaches. The effects of combination of sitagliptin and spironolactone in COVID-19 patients should be further verified in a double blind, randomized, placebo-controlled trial.Iranian Registry of Clinical TrialsIRCT registration number: IRCT20201003048904N2, Registration date: December 10, 2020.

The development of novel antifungal agents and, in particular, the widespread use of these medications over the course of the past two decades, has had a significant impact on the treatment of fungal infectious diseases. This has resulted in a complete transformation of the treatment of fungal infectious diseases. However, the widespread development of antibiotic resistance has masked the significance of such breakthroughs. Antifungal infection treatment with nanoparticles has been shown to be effective. As a result of their unique characteristics, these substances, in contrast to antibiotics in their purest form, are able to exhibit an increased anti-proliferative capacity while requiring a lower concentration than traditional drugs do in order to achieve the same effect. Decreased drug effectiveness, minimal tissue penetration throughout tissue, restricted tissue penetration, decreased bioavailability, poor drug pharmacokinetics, and low water solubility are some of the major factors contributing to the employment of antifungal medicines in delivery systems. Because of this, one of the primary goals of incorporating antifungal medications into varying sorts of nanoparticles is to reduce the negative effects of the drugs’ inherent qualities. This article provides an overview of the many types of nanoparticles, such as metal, metal oxide, and non-metal oxide nanoparticles, carbon-based nanoparticles, nanostructured lipid carriers, polymeric nanoparticles, solid lipid nanoparticles, nanofibers, antifungal peptides, composites, and ZnO quantum dots, that can be used as antifungal drug delivery systems, as well as the benefits that these nanomaterials have over purified medications.

The use of anti-retroviral therapy has been effective in controlling the spread of HIV-1, and has prolonged life expectancy, but this success can be affected by the emergence of drug resistance. The main goal of this study was to investigate drug resistance in the reverse transcriptase (RT), and protease (PR) genes among HIV-1 infected individuals. We systematically selected 59 HIV-1 infected individuals from Shiraz Voluntary Counseling and Testing Center (29 treatment- naïve and 30 treated). In this study intravenous drug users older than 18 were included in this study. Using specific primers, nested RT-PCR was performed on RNA extracted from patient samples. The genes targeted for RT and PCR were successfully amplified and sequenced. The sequences of these two genes were compared with mutations related to drug resistance against nucleotide reverse transcriptase inhibitors (NRTI), non-nucleotide reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) using the latest database from the International AIDS society - USA, Stanford University, and the patterns were recorded. Among treatment-naïve, the detected NRTI and NNRTI resistance mutations were V179T, V75 M and E138A. V179T causes high level resistance to Efavirenze and Nevirapin. V75 M causes intermediate resistance to Stavudine. Regarding NRTI and NNRTI resistance mutations among treated patients, the most frequent mutation (7%) was M184 V, which causes high level resistance to zidovudin and emtricitabine. The interesting result from this study was the detection of NRTI and NNRTI resistance mutations before the initiation of treatment, which signifies the transmission of resistant strains of virus between individuals. This mutation highlights the importance of drug resistance HIV-1 genotyping before commencing treatment.

Background Head lice infestation (Pediculosis) is one of the most important health challenges particularly in primary school-aged children. It is often present among 6–11-year-old students in various tropical and temperate regions of the world. The aim of this study was to examine epidemiologic indices and comparative analysis of two pyrethroid-based and one non-chemical pediculicide products on head lice treatment of primary school girls in a rural setting of Fars province, south Iran, as part of a randomized controlled assessor blind trial. Methods Before treatment, infested students were screened using plastic detection combs to find live head lice. Three independent parallel groups, each with about 25 participants (#77) were eventually twice with a week apart treated with either 1% permethrin, 0.2% parasidose (d-phenothrin) or 4% dimeticone lotion preparations. In each case, a questionnaire form was completed on epidemiologic factors. Data were registered after a fortnight from primary scalp treatment and re-inspection on days 2, 6, 9 and 14. Data analyses were performed using Chi-square test with a P-value Results From 3728 inspected students, 87 (2.33%) girls were infested with head lice, Pediculus humanus capitis De Geer, 1778. Ten students dropped out pertaining to exclusion criteria. No significant correlation was found between head lice infestation level and hair length, hair style, itching, nationality, age, settlement site and baths; but there was a significant relationship between age and hair style (P = 0.027). The efficacy values on each of the above re-inspection days from each of the three treatments were 81, 74, 70 and 63% for permethrin; 83, 92, 100 and 100% for dimeticone; and 96, 88, 96 and 92% for d-phenothrin; respectively. A quartile difference in efficacy of permethrin relative to dimeticone on day 14 represented the scale of head lice resistance to permethrin treatment. There were significant statistical differences in case re-inspection days 9 (P = 0.008) and 14 (P = 0.003) post treatment. Only two dropout cases, one non-compliant and the other lost before the second-week treatment, from permethrin trial were observed following two applications a week apart. Conclusions Dimeticone lotion had the fullest efficacy (100%) among all treatments. This high cure rate was attributed to the low level of infestation and the extent of patients’ involvement. Parasidose swiftly ameliorated the infested cases by the second day since initial treatment. Female third grade students were the most infested cohort. Trial registration Current Controlled Trials- IRCT2016041627408N1, Dated: 21-08-2017.

Background: To date, not sufficient information is available regarding the effect of High Intensity Interval Training (HIIT) on diabetes-induced myocardial dysfunctions. Objectives: The present study aimed to evaluate the effect of 4-week HIIT on change in expression levels of ryanodine receptor calcium channel (RyR2) and ATPase calcium pump (SERCA2a) in diabetic rats. Materials and Methods: This study was conducted on 24 Wistar rats with average weight of 245 ± 10 g. The rats were randomly divided into a sedentary diabetic group and a trained diabetic group. Training was started two weeks after diabetes induction by Streptozotocin (STZ) injection. The training program consisted of 4 weeks running on a treadmill and was considered to be intense for the two groups’ diabetic rats. After all, the animals’ characteristics and myocardial gene expression were compared using independent t-test. Results: Measurement of gene expression by Real Time-PCR revealed that cardiac mRNA expression of RyR2 was enhanced in the HIIT group. The results also revealed a significant (P = 0.03) difference between the hearts of the sedentary controls and the trained group regarding RyR2 levels. However, no significant difference was observed between the two groups with respect to SERCA2a levels (P = 0.14). Conclusions: The study results showed that treatment with HIIT could prevent and/or minimize the loss in expression of RyR2 and SERCA2a.

Objective To predict the trend of cutaneous leishmaniasis and assess the relationship between the disease trend and weather variables in south of Fars province using Seasonal Autoregressive Integrated Moving Average (SARIMA) model. Methods The trend of cutaneous leishmaniasis was predicted using Mini tab software and SARIMA model. Besides, information about the disease and weather conditions was collected monthly based on time series design during January 2010 to March 2016. Moreover, various SARIMA models were assessed and the best one was selected. Then, the model's fitness was evaluated based on normality of the residuals' distribution, correspondence between the fitted and real amounts, and calculation of Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC). Results The study results indicated that SARIMA model (4,1,4)(0,1,0) (12) in general and SARIMA model (4,1,4)(0,1,1) (12) in below and above 15 years age groups could appropriately predict the disease trend in the study area. Moreover, temperature with a three-month delay (lag3) increased the disease trend, rainfall with a four-month delay (lag4) decreased the disease trend, and rainfall with a nine-month delay (lag9) increased the disease trend. Conclusions Based on the results, leishmaniasis follows a descending trend in the study area in case drought condition continues, SARIMA models can suitably measure the disease trend, and the disease follows a seasonal trend.

BACKGROUND Menstrual blood-derived stem cells (MenSCs) are a novel source of stem cells that can be easily isolated non-invasively from female volunteered donor without ethical consideration. These mesenchymal-like stem cells have high rate of proliferation and possess multi lineage differentiation potency. This study was undertaken to isolate the MenSCs and assess their potential in differentiation into epidermal lineage. METHODS About 5-10 ml of menstrual blood (MB) was collected using sterile Diva cups inserted into vagina during menstruation from volunteered healthy fertile women aged between 22-30 years. MB was transferred into Falcon tubes containing phosphate buffered saline (PBS) without Ca2+ or Mg2+ supplemented with 2.5 µg/ml fungizone, 100 µg/mL streptomycin, 100 U/mL penicillin and 0.5 mM EDTA. Mononuclear cells were separated using Ficoll-Hypaque density gradient centrifugation and washed out in PBS. The cell pellet was suspended in DMEM-F12 medium supplemented with 10% FBS and cultured in tissue culture plates. The isolated cells were co-cultured with keratinocytes derived from the foreskin of healthy newborn male aged 2-10 months who was a candidate for circumcision for differentiation into epidermal lineage. RESULTS The isolated MenSCs were adhered to the plate and exhibited spindle-shaped morphology. Flow cytometric analysis revealed the expression of mesenchymal markers of CD10, CD29, CD73, and CD105 and lack of hematopoietic stem cells markers. An early success in derivation of epidermal lineage from MenSCs was visible. CONCLUSION The MenSCs are a real source to design differentiation to epidermal cells that can be used non-invasively in various dermatological lesions and diseases.

Background: Unawareness of people about high risk behaviors lead in major problems in the present Iranian society. In this study, we tried to determine the prevalence of high risk behaviors among HIV positive patients. We also aimed to provide a pattern for these behaviors to help both policy makers and patients. Methods: This descriptive-analytic cross-sectional study used a census method to evaluate 1461 HIV patients that referred to the Disease Counseling Center at Shiraz University of Medical Sciences during 2003-2008. The study analyzed the information about high risk behaviors among these patients and extracted the risk factors, as well as their demographic and personal characteristics. In addition, the correlations between HIV and risk factors were determined by chi-square test and single-sample t-test at a significance level of 5%. Findings: This Study involved 1260 (86.3%) men and 201 (13.7%) women with a mean age of 41.5 ± 7.67 years. Among these patients, 78.9% had a history of imprisonment, 75.9% experienced drug injection, 45.1% had a history of sexual relationships, 32.5% tattooed outside the prison while and 24% tattooed inside the prison. Moreover, 30.2% and 4.6% had used a common razor inside and outside the prison, respectively. Hepatitis C and B and tuberculosis were found in 63.58%, 7.04% and 1.43% of the subjects, respectively. Finally, 6.57% had a history of sexually transmitted infections. Conclusion: Based on our findings, government and policy makers need to educate the youth on sexual relations, risks of drug injection and imprisonment, and also main health issues regarding high risk behaviors.

Evidence has shown that liver disease caused by hepatitis viruses can be more aggressive and severe in HIV infected subjects. Therefore, the present cross-sectional study aimed to evaluate the seroprevalence of HDV infection among HIV/HBV co-infected clients in Shiraz, southwest Iran. In this study, 178 patients co-infected with HBV and HIV individuals were enrolled. The diagnosis of HIV infection was documented based on serological assays. The demographic and complementary data were collected by a questionnaire. HBsAg and HDV Ab were detected by commercial quantitative enzyme linked immunosorbent assay kits according to the manufacturer’s instructions. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also measured. The mean age of the participants was 37.4±7.4 years (range 22-63). 175 (98.4 %) patients were male and 3 (1.6 %) were female. Among 178 patients co-infected with HIV/HBV, 35 cases (19.7%, 95% CI: 14%-25%) were anti-HDV‏ positive and 143 (80.3%) were negative for anti-HDV. HDV exposure in HIV/HBV co-infected patients was associated with blood transfusion (P=0.002, OR: 14.3) and prison history (P=0.01, OR: 2.31) but not with age, marital status, unsafe sex contact, and injection drug abuse. Our data showed a relatively high prevalence of HDV infection in HIV infected population in Shiraz, Iran. The high frequency of HDV Ab in patients with blood transfusion and prison history reveals that HDV transmission occurs more frequently in the parental route than sexual contacts; therefore, blood screening for HDV diagnosis in the high-risk group is recommended.

There is discrepancy about intervals of fluoride monitoring in groundwater resources by Iranian authorities. Spatial and temporal variability of fluoride in groundwater resources of Larestan and Gerash regions in Iran were analyzed from 2003 to 2010 using a geospatial information system and the Mann–Kendall trend test. The mean concentrations of fluoride for the 8-year period in the eight cities and 31 villages were 1.6 and 2.0 mg/l, respectively; the maximum values were 2.4 and 3.8 mg/l, respectively. Spatial, temporal, and spatiotemporal variability of fluoride in overall groundwater resources were relatively constant over the years. However, results of the Mann–Kendall trend test revealed a monotonic trend in the time series of one city and 11 villages for the 8-year period. Specifically, one city and three villages showed positive significant Kendall’s Tau values, suggesting an upward trend in fluoride concentrations over the 8-year period. In contrast, seven villages displayed negative significant Kendall’s Tau values, arguing for a downward trend in fluoride concentrations over the years. From 2003 to 2010, approximately 52 % of the Larestan and Gerash areas have had fluoride concentrations above the maximum permissible Iranian drinking water standard fluoride level (1.4 mg/l), and about 116,000 people were exposed to such excess amounts. Therefore, our study supports for a close monitoring of fluoride concentrations from health authorities in monthly intervals, especially in villages and cities that showed positive trend in fluoride concentrations. Moreover, we recommend simultaneous implementation of cost-effective protective measures or interventions until a standard fluoride level is achieved.

"Hepatitis B infection is the primary cause of liver diseases and liver cancer. The aim of this study is to determine the knowledge and behavioral intention about hepatitis B among college students. This cross sectional study was carried out on 1145 college students of Yazd universities both medical and non-medical, which recruited them with a random sampling method. The data gathering was done with standard self-administered questionnaire. Data were analyzed by SPSS-20 using t-test, Chi-square and ANOVA statistical tests at the 95% significant level. The Results showed there was a significant relation between knowledge and behavioral intention about hepatitis B among medical and non-medical college students. In addition, there were significant relation between gender, type of university and level of education with knowledge and behavior intention (P< 0.05). Our findings indicated the degree of knowledge and behavioral intention about hepatitis B was low among non-medical college studenst. We suggested the designing and implementing of education programs for increasing knowledge and behavioral intention about hepatitis B among non-medical college students."

International audience; The effectiveness of antimalarial drugs is declining at an ever accelerating rate, with consequent increase in malaria-related morbidity and mortality. The newest antiplasmodial drug from plants is needed to overcome this problem. The aim of this study was to assess antimalarial activity of the ethanolic extracts of 10 different medicinal plants from eight families against Plasmodium falciparum chloroquine-sensitive 3D7 strain. The selection of the hereby studied plants was based on the existing information on their local ethnobotanic history. Plants were dried, powdered, and macerated in a hydroalcoholic solution. Resulting extracts have been assessed for in vitro and in vivo antimalarial and brine shrimp toxicity activities. Of 10 plant species tested, four plants: Althea officinalis L. (Malvaceae), Myrtus communis Linn (Myrtaceae), Plantago major (Plantaginaceae), and Glycyrrhiza glabra L. (Papilionaceae) displayed promising antimalarial activity in vitro (50% inhibitory concentration values of 62.77, 42.18, 40.00, and 13.56 μg/mL, respectively) with no toxicity against brine shrimp larvae. The crude extracts of three active plants, G. glabra, M. communis, and A. officinalis, also significantly reduced parasitemia in vivo in female Swiss albino mice at a dose of 400 mg/kg compared to no treatment. Antiplasmodial activities of extracts of A. officinalis and M. communis are reported for the first time.

Background: Gastrointestinal tract cancer (GI.C) is one of the common cancers in world-wide. The incidence rate of it is different in various geographical regions. This study was performed to assess spatial clusters of the occurrence of GI.C in Fars Province. Methods: In this cross-sectional study, the new cases were 4569 cases from 2001 to 2009. The crude incidence rates were standardized based on world population for both sexes. The spatial analysis was conducted using the geographical information systems. We used the local Indicators of spatial association measure, in order to identify local spatial clusters. Results: From a total of the new cases, 62.8% cases were male. The most common GI.Cs were stomach and colorectal cancer in men and women respectively. The significant cluster patterns were discovered from 2002 to 2007. The common type of spatial clustering was a high-high cluster, that to indicate from North-west to South-east of Fars Province. Conclusions: Analysis of the geographical distribution of GI.C will provide opportunities for policymakers for applying preventive measures. Furthermore, it could be helpful for researchers for future epidemiological studies for investigation of etiological agents in regions with significant spatial clustering of high incidence of cancer.

Objective Despite premarital screening, prenatal diagnosis and the option for voluntary termination of pregnancy, some Iranian couples continue a pregnancy with a fetus affected with beta-thalassaemia major (β-TM). We examined the reasons for this decision, to evaluate the sociocultural challenges these couples face. Methods A retrospective evaluation of medical records of all fetuses aborted was conducted to identify those with β-TM, to determine the frequency of β-TM births and to establish the number of couples with β-thalassaemia who declined prenatal diagnosis or a termination of pregnancy in this period. We investigated the reasons for declining these options. Results The birth prevalence of β-TM decreased from 39.38 to 2.68 in 100,000 live births from 2005 to 2010. Terminations of pregnancy for affected fetuses increased from 67 in 2005 to 135 in 2010. We identified eight couples as β-thalassaemia carriers who declined prenatal diagnosis or a termination of pregnancy. All but one couple already had a child with β-TM. The reasons for declining prenatal diagnosis were strong religious beliefs, superstition and faith in a supernatural solution in six couples. Economic and cultural factors, and previous termination of pregnancy were also mentioned as reasons by the other two couples. Conclusion Although most of the couples had a β-TM child and related socioeconomic problems, their reasons for refusing prenatal diagnosis or termination remain a challenge for the healthcare system in Iran. Couple screening and educational programmes have effectively decreased the rates of refusal in at-risk couples in recent years.

Epidemics of food-borne pharyngitis due to group A Streptococcus are rarely reported. Here we present an outbreak of food-borne tonsillopharyngitis in female dormitories in the Islamic Republic of Iran. Throat swabs and cultures were performed on a number of patients, and of specimens from the nasopharynx and hands of staff who were involved in food processing. We planned a case-control study for assessing the source of epidemics. 11 out of 17 throat swabs of students were positive for Streptococcus group A and also 2 throat samples from asymptomatic cooks were positive. A DNA fingerprinting study showed that Streptococcus group A strains of 11 students and 1 cook had the same T agglutination pattern and M protein factor (M3/T13). It is suggested that group A streptococci as well as group C and G streptococci can cause epidemic food-borne pharyngitis. Regular health surveillance of food handlers and food preparation processes are important for prevention of such outbreaks.

Background Cancer registries help to decrease the burden of cancers by collecting accurate and complete data. We aimed to measure the completeness of coverage of information recorded between 2000 and 2009 in a cancer registry program in Fars province, southern Iran. Methods The cancer registry program run by Shiraz University of Medical Sciences was investigated in two periods: pathology-based data from 2000 to 2007 and population-based data from 2007 to 2009. Completeness of yearly coverage was measured as the number of reported cases of cancer in each year divided by estimated cases based on 107.3 new cases per 100 000 individuals. The percentage of complete data registration (patient’s name, age, gender, address, phone number and father’s name) and correct cancer encoding was calculated for each year and compared to the maximum acceptable error rate for each item. Results A total of 29 277 non-duplicate cancer records were studied. Completeness of coverage varied from 22.68% in 2000 to 118.7% in 2008. Deficiencies in patients’ demographic data were highest for name in 2002 (0.09%), age in 2006 (2.36%), gender in 2001 (0.06%) and father’s name in 2001 (52.5%). Incomplete address (99.7%) and missing phone number (100%) were most frequent in 2000, and deficiencies in encoding information were highest in 2008 (6.36%). Conclusions The cancer registry program in Fars province (southern Iran) was considered satisfactory in terms of completeness of coverage and information about age. However, it was deficient in recording patients’ phone number and address, and father’s name. The error level for cancer encoding was unacceptably high. Enhancing hardware and software resources, education and motivation in all public and private sectors involved in the cancer registry program, and greater attention to epidemiological research are needed to increase the quality of the cancer registry program, including its completeness.

Background: Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters. Methods: In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age-standardized incidence rates (ASR) per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system (GIS). Also, comparisons were made between ASRs in each county. Results: A total of 28,411 new cases were diagnosed with cancer during 2001-2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 ± 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran′s Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high-high cluster, that to indicate from north-west to south-east of Fars Province. Conclusions: Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures.

Background: The molecular studies indicate some of the genes in the promoter region itself, will undergo methylation. Methylation of CpG islands in the promoter region of that cause silence or reduced expression of genes involved in cell growth pathways, which are colorectal cancer causing agents. Detection of methylation status can be used as a marker for cancer diagnosis and prediction of disease. CDKN2A tumor suppressor gene encodes a protein, which inhibit CDK 4/6 and loss of retinoblastoma protein phosphorylation (pRb) is involved. The purpose of this study was to investigate the molecular hypermethylation in exon 1 of CDKN2A gene in patients with colorectal cancer and normal subjects. Methods: In this case-control study, the study population consisted of 20 patients with colorectal cancer and 10 healthy persons. Samples in paraffin blocks were prepared in pathology department of Mehr Hospital, Tehran, Iran, from December 2010 to June 2012. Then, specific primers were designed for the methylation and Non-methylation of CDKN2A gene. To determine the level of exon 1 methylation of CDKN2A gene, methylation-specific polymerase chain reaction (MSP) method was performed. Results: In this study, hypermethylation in exon 1 of CDKN2A gene were observed in 80% of tumor tissues (16 cases) and 20% of normal tissues (2 cases). The patients aged older than 50 years, had a higher CDKN2A gene methylation and frequency than patients younger than 50 years old (66% vs 34%) (P