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Abstract Breast cancer is the most common cancer in women. Previous studies have investigated estimating and predicting the proportional hazard rates and survival in breast cancer. This study deals with predicting accelerated hazards (AH) rate based on age categories in breast cancer patients using deep learning methods. The AH has a time-dependent structure whose rate changes according to time and variable effects. We have collected data related to 1225 female patients with breast cancer at the Mandarin University of Medical Sciences. The patients' demographic and clinical characteristics including family history, age, history of tobacco use, hysterectomy, first menstruation age, gravida, number of breastfeeding, disease grade, marital status, and survival status have been recorded. Initially, we dealt with predicting three age groups of patients: ≤ 40, 41–60, and ≥ 61 years. Then, the prediction of accelerated risk value based on age categories for each breast cancer patient through deep learning and the importance of variables using LightGBM is discussed. Improving clinical management and treatment of breast cancer requires advanced methods such as time-dependent AH calculation. When the behavioral effect is assumed as a time scale change between hazard functions, the AH model is more appropriate for randomized clinical trials. The study results demonstrate the proper performance of the proposed model for predicting AH by age categories based on breast cancer patients' demographic and clinical characteristics.

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.

Abstract Background Estrogen receptors express in nearly 70% of breast cancers (ER-positive). Estrogen receptor alpha plays a fundamental role as a significant factor in breast cancer progression for the early selection of therapeutic approaches. Accordingly, there has been a surge of attention to non-invasive techniques, including circulating Cell-free DNA (ccfDNA) or Cell-Free DNA (cfDNA), to detect and track ESR1 genotype. Therefore, this study aimed to examine the diagnosis accuracy of ESR1 mutation detection by cell-free DNA in breast cancer patientsthrough a systematic review and comprehensive meta-analysis. Methods PubMed, Embase, and Web of Science databases were searched up to 6 April 2022. Diagnostic studies on ESR1 measurement by cfDNA, which was confirmed using the tumour tissue biopsy, have been included in the study. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were considered to analyse the data. Results Out of 649 papers, 13 papers with 15 cohorts, including 389 participants, entered the meta-analyses. The comprehensive meta-analysis indicated a high sensitivity (75.52, 95% CI 60.19–90.85), specificity (88.20, 95% CI 80.99–95.40), and high accuracy of 88.96 (95% CI 83.23–94.69) for plasma ESR1. We also found a moderate PPV of 56.94 (95% CI 41.70–72.18) but a high NPV of 88.53 (95% CI 82.61–94.44). We also found an NLR of 0.443 (95% CI 0.09–0.79) and PLR of 1.60 (95% CI 1.20–1.99). Conclusion This systematic review and comprehensive meta-analysis reveal that plasma cfDNA testing exhibits high sensitivity and specificity in detecting ESR1 mutations in breast cancer patients. This suggests that the test could be a valuable diagnostic tool. It may serve as a dependable and non-invasive technique for identifying ESR1 mutations in breast cancer patients. However, more extensive research is needed to confirm its prognostic value.

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: According to previous reports, between 2%-5% of multiple sclerosis (MS) cases occur before the age of 16 years. Objectives: This study aims to investigate the clinical and epidemiological features of MS in Iranian children to provide diagnostic criteria for policymakers and physicians. Methods: This study objectives are achieved in two phases. The first phase was conducted and the second phase is underway. The first phase was performed in one year to design and finalize a pediatric MS registry software. For this reason, all variables and registration methods were determined. The second phase which has been started since 2016 consists of a routine data registry in the national phase. The project information, including all cases, epidemiological, clinical, and diagnostic factors is being reported based on different geographical areas of Iran. Results: We registered 932 cases with MS since 2017, of whom 74.4% were girls. There was no significant difference in mean age between girls and boys with MS (mean difference=0.73 years, P=0.133). Most of the children who were diagnosed were between the ages of 15 to 18 years (52.4%). Conclusions: The registry for MS in children in Iran can improve the knowledge of health policymakers on the incidence of MS in children throughout the country, the first and most common symptoms of MS in children, raising physicians’ awareness about early diagnosis and treatment that consequently reduce the economic, psychological, and psychological burden of the disease.

Background and purpose: COVID-19 is one of the biggest pathogens that mainly targets the human respiratory system. Among the preventive methods against contracting COVID-19, vaccination has had an important effect in preventing COVID-19 and is an essential component in prevention. Various vaccines were provided to prevent COVID-19, one of these vaccines was Sinopharm, which was used for cancer patients in Iran, so this study aimed to determine the antibody response following the injection of Sinopharm vaccine in cancer patients in Iran in 2021. Materials and methods: This cross-sectional study was conducted in 2021 on 74 patients with various types of cancers in Amol and Sari cities who received two doses of the Sinopharm vaccine. Subjects participated in the study after obtaining informed consent. Cancer patients who were referred to vaccination centers were asked to refer to the reference laboratory 4 to 6 weeks after the second dose if they wished to determine the antibody level. A 5 cc blood sample was taken 4-6 weeks after receiving the second dose of the vaccine, and then the serum was separated from the samples and stored at -20. The level of SARS-CoV-2 Neutralizing antibody, Anti-RBD, and Anti-Spike IgG were provided by Kit Eliza, Pishtaz Tab Company. The sensitivity and specificity of the kits used for neutralizing antibodies are 100% and 99% respectively, for Anti-RBD 98.4% and 97.7%, and Anti-Spike IgG 98.16% and 99.01% respectively. Finally, according to the instructions of the kit, neutralizing antibody values greater than 2.5 Mg/ml and optical absorption greater than 1.1 for RDB antibody and anti-spike antibody values greater than 8 RU/ml were considered positive. Results: The average age of the subjects was 57.1±11.7 years. In terms of gender distribution, 45 people (60.8%) were women. The neutralizing antibody status was positive in 41 people (55.4%). There was no significant relationship between the presence of neutralizing antibodies and gender (P=0.811) and age (P=0.443). Antibody against RDB antigen was positive in 31 people (41.9%). There was no significant relation between the presence of antibodies against RDB antigen with gender (P=0.091) and age (P=0.336). Antibody against Spike virus antigen was positive in 20 people (27%). A significant relationship was observed between the presence of antibodies against the Spike antigen and gender (P=0.008) and the proportion of women who produced antibodies against the Spike virus antigen was more than men, but there was no significant relationship between the presence of antibodies against the Spike gene and age (P=0.336). Conclusion: The results of the present study showed that the vaccination of COVID-19 by Sinopharm in immunocompromised patients such as cancer patients can induce an antibody response, although the percentage is not high. Also, no significant relationship was observed between antibody production and age.

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: Gastro-esophageal reflux disease (GERD) is a very common complaint. It is a major health concern and there is paucity of information about the epidemiology of the disease and its risk factors in Iran, especially Mazandaran province (North of Iran). This study aimed at investigating the prevalence of regurgitation and the factors associated with this condition in Tabari cohort study. Methods: This was a cross-sectional study that analyzed data from Tabari cohort study. Information including the presence and frequency of heartburn and regurgitation, demographic characteristics, socioeconomic status, occupational history, history of chronic illnesses, history of alcohol and cigarette consumption were recorded. Results: The prevalence of GERD symptoms were 27.6% (20.4% in men, and 32.4% in women, p=0.0001). The frequency of typical symptoms was significantly higher in women than that in men. The risk of developing GERD symptoms were 1.7 times higher in women (p=0.0001). The highest prevalence of GERD symptoms was found in urban areas (41.8%, p=0.0001), in people with low educational levels (48%, p=0.0001), and in participants with history of depression symptoms (36.2%, p=0.0001). The prevalence of GERD symptoms was significantly high in individuals with higher BMI (29.5%, p=0.006), greater waist to hip ratio (29.1%, p=0.0001, p=0.0001), and high waist circumference (31.7%, p=0.0001). Conclusion: This study showed gender, region of residence, educational level, and depression symptoms as the main risk factors for developing GERD symptoms.

Background: The MUC1 gene encodes glycoproteins attached to cell membrane that play a protective role in gastric cancer and protect epithelial surfaces against external factors such as Helicobacter pylori. H. pylori infection can induce a cascade of innate and acquired immune responses in gastric mucosa. Relationship between rs4072037G>A polymorphism of MUC1 gene and increased susceptibility to H. pylori infection aimed to investigate in patients with gastric cancer in Mazandaran, northern Iran. Methods: A case-control study was conducted on 99 patients with gastric cancer (H. pylori positive and negative) and 98 controls (H. pylori positive and negative) without gastric cancer (confirmed by pathological biopsy samples obtained during endoscopy). H. pylori infection was diagnosed by histological examination using Giemsa staining. Genomic DNA extracted from peripheral blood was analyzed by PCR-RFLP technique. Results: Analysis of all genetic models showed no significant relationship between rs4072037G>A polymorphism and risk of gastric cancer (GC). The relationship between H. pylori infection and rs4072037G>A polymorphism showed an increased susceptibility to gastric cancer in both positive and negative H. pylori groups (including case and control groups). The genetic model of GA/GG and H. pylori- positive versus GA/GG and H. pylori-negative showed a significantly increased susceptibility to gastric cancer (OR=0.251, CI: 0.128-0.493, P=0.000). Conclusion: These findings indicate that rs4072037G>A polymorphism may interact with H. pylori infection to increase the risk of GC.

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 objectivesThis study aimed to investigate the possible prognostic significance of interferon alpha–beta receptor subunit 2 (IFNAR2) and tyrosine kinase 2 (TYK2) expressions.MethodsWe conducted a retrospective study including COVID-19 adult patients. All blood samples were collected before any interventions. The expressions of IFNAR2 and TYK2 were assessed using real-time PCR in venous blood samples of 54 cases and 56 controls. The transcript quantities of IFNAR2 and TYK2 genes were assessed using a Delta-Ct method.ResultsOur findings show no significant differences in gene expression levels for IFNAR2 and TYK2 between patients who required oxygen (O2) therapy and those who did not (p-value = 0.732 and p-value = 0.629, respectively). Likewise, there were no significant differences in IFNAR2 and TYK2 expressions between patients hospitalized for less than 7 days and those hospitalized for 7 days or more (p-value = 0.455 and p-value = 0.626, respectively). We also observed a weak correlation between IFNAR2 expression and CRP (p-value = 0.045, r = 0.192). There was a negative correlation between the expression levels of IFNAR2 and TYK2 transcripts in COVID-19 patients (p-value = 0.044; partial correlation coefficient = -0.283). Additionally, IFNAR2 and TYK2 were significantly downregulated in the COVID-19 group compared to healthy subjects (p-value = 0.002 and p-value = 0.028, respectively). However, neither IFNAR2 nor TYK2 expression was significantly different between the case subgroups based on COVID-19 severity. The IFNAR2 ΔΔCt (B = -0.184, 95% CI: -0.524–0.157, p-value = 0.275) and the TYK2 ΔΔCt (B = 0.114, 95% CI: -0.268–0.496, p-value = 0.543) were not found to be significant predictors of hospitalization duration. The area under the curve (AUC) for IFNAR2 expression is 0.655 (p-value = 0.005, 95% CI: 0.554–0.757), suggesting its poor discriminative value.ConclusionWe were unable to comment definitively on the prognostic power of IFNAR2 and TYK2 expressions in COVID-19 patients, and larger-scale studies are needed. The principal limitations of this study included the lack of longitudinal analysis and limited sample size.

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: The diagnosis and treatment of cancer is stressful and perceived stress and concerns during the treatment period can add to this stress and affect the recovery of patients with gastrointestinal cancer. The aim of this study was to investigate the relationship between illness perception and coping styles, and perceived stress in patients with gastrointestinal cancer. Materials and methods: The present cross-sectional correlational study was conducted in 110 patients with gastrointestinal cancer in Sari Imam Khomeini Hospital, Iran 2022, selected by convenience sampling. Data were collected using a demographic questionnaire, The Brief Illness Perception Questionnaire (Brief IPQ), Billings and Moos Coping Styles Questionnaire, and Perceived Stress Scale (PSS). Finally, the data were analyzed applying descriptive statistics and Chi-square, independent t-test, Pearson's coefficient correlation, and ANOVA. Results: Most of the participants were females (50.9%), with a medium income level (59.1%), living in the city (91.8%), suffering from colon cancer (40.9%), and undergoing treatment (90.0%). Findings showed that most of the patients had a high level of perceived stress (57.3%), moderate levels of illness perception (71.8%), and moderate coping styles (71.8%). We observed an inverse relationship between perceived stress and illness perception (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.

Background and purpose: Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition that may require reduction or discontinuation of chemotherapy. Identifying effective methods in treatment of established CIPN requires determining the frequency of CIPN. There is a lack of comprehensive studies on this issue, so, this study was conducted to investigate the frequency of peripheral neuropathy caused by chemotherapy in cancer patients in Sari Imam Khomeini Hospital. Materials and methods: This longitudinal study was done in cancer patients receiving thalidomide derivatives, vinca alkaloids, taxanes, proteasome inhibitors, platinums, and microtubule destabilizers in Comprehensive Cancer Center at Sari Imam Khomeini Hospital (2021-2022). Neurotoxicity was assessed by the EORTC QLQ-CIPN20 questionnaire before the start of the chemotherapy cycle and three months later. Data analysis was carried out in SPSS by applying Mann-Whitney U test, t-test, and Chi-square. Results: The study included 103 patients. Fifty-four patients (52.4%) were younger than 55 years old and 49 (47.6%) were older than 55 years of age. Forty-nine patients (47.6%) developed chemotherapy-induced neuropathy in the three-month follow-up. Symptoms were more frequent in women, but were not significant (P=0.11). The average body mass index in patients who experienced neuropathy was higher than that in patients without neuropathy. Conclusion: Almost half of the patients developed CIPN which raises the need for preventive training and interventions.

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.

Abstract COVID-19 currently is the main cause of the severe acute respiratory disease and fatal outcomes in human beings worldwide. Several genes are used as targets for the detection of SARS-CoV-2, including the RDRP, N, and E genes. The present study aimed to determine the RDRP, N, and E genes expressions of SARS-CoV- 2 in clinical samples. For this purpose, 100 SARS-CoV-2 positive samples were collected from diagnostic laboratories of Mazandaran province, Iran. After RNA extraction, the real-time reverse transcription PCR (real-time RT-PCR) assay was performed for differential gene expressions’ analysis of N, E, and RDRP. The threshold cycle (Ct) values for N, RDRP, and E targets of 100 clinical samples for identifying SARS-CoV-2 were then evaluated using quantitative real-time PCR (qRT-PCR). This result suggests N gene as a potential target for the detection of the SARS-CoV‐2, since it was observed to be highly expressed in the nasopharyngeal or oropharynges of COVID-19 patients (P

Abstract In this cross-sectional population-based study, we used the baseline data of the Prospective Epidemiologic Research Studies in IrAN cohort study collected in Iran from 2014 to 2020. The main outcomes were the prevalence of hypertension and proportion of awareness, treatment, and control based on the 2017 ACC/AHA guideline compared to the seventh report of the Joint National Committee (JNC7). Of the total of 163,770 participants, aged 35–70 years, 55.2% were female. The sex-age standardized prevalence of hypertension was 22.3% (95% CI 20.6, 24.1) based on the JNC7 guideline and 36.5% (31.1, 41.8) based on the ACC/AHA guideline. A total of 24,312 participants [14.1% (10.1, 18.1)] were newly diagnosed based on the ACC/AHA guideline. Compared to adults diagnosed with hypertension based on the JNC7 guideline, the newly diagnosed participants were mainly young literate males who had low levels of risk factors and were free from conventional comorbidities of hypertension. About 30.7% (25.9, 35.4) of them (4.3% of the entire population) were eligible for pharmacologic intervention based on the ACC/AHA guideline. Implementation of the new guideline may impose additional burden on health systems. However, early detection and management of elevated blood pressure may reduce the ultimate burden of hypertension in Iran.

Background: Several PI3K/Akt/mTOR pathway inhibitors and TLR agonists induce tumor cell death. However, the mechanisms of these therapeutic approaches in acute myeloid leukemia (AML) cells are still unknown. Objectives: To investigate the effects of BEZ235, as a dual inhibitor of PI3K and mTOR pathways, and TLR7/8 agonist R848 on the expression and regulation of the immune inhibitory molecules in myeloid leukemia cells. Methods: WEHI-3 leukemia cells were incubated with dual PI3K and mTOR inhibitor BEZ235 and TLR7/8 agonist R848 for 48 hrs. Firstly, cell viability was assessed by MTT method. The semi-quantitative relative mRNA expression of Galectin-9 (Gal-9), PD-L1, PVR, and STAT3 was assessed according to HPRT as a housekeeping gene. Finally, the protein expression of phosphorylated STAT3 was evaluated by western blotting analysis. Results: WEHI-3 cells showed growth inhibition following treatment with BEZ235 and R848 whose combination exerted more proliferation arrest. The mRNA expression of Gal-9, PD-L1 and PVR immune checkpoint molecules significantly reduced in treated cells with BEZ235 and R848. Combined treatment indicated more reduction compared with the single treatment. Finally, the expression and phosphorylation of STAT3 were down-regulated after a single or dual treatment with BEZ235 and R848. Conclusion: Our results conclude that treatment with the combination of BEZ235 and R848 interferes with immune evasion mechanisms through STAT3-signaling pathway in WEHI-3 leukemia cells.

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.

Background: Frizzled receptors (FZD) play a pivotal role in the initiation and progression of a wide array of cancers. Dysregulated expression of FZD receptors is correlated with higher metastasis and invasive potential, as well as short survival in many malignancies. In this meta-analysis, we aimed to verify the prognostic value of FZD receptor expression on patients’ survival with different types of gastrointestinal (GI) cancers, including gastric, colorectal, and esophageal cancers. Methods: A systematic search was performed using PubMed, Scopus, and Web of Science from 2000 to November 2020. Fourteen studies, including 2997 patients met our inclusion criteria, in which nine articles were considered FZD7 while the rest were about other FZD members. The fixed-effect model was used to estimate the pooled hazard ratio (HR) and the 5-year overall survival (OS) rate. We used the Newcastle-Ottawa scale of cohort articles to determine the quality of included studies. Results: The results showed that high expression of FZD receptors is associated with the poor survival in patients with GI cancers (HR= 1.83, 95% CI: 1.5–2.17). Moreover, multivariate analysis indicated that FZD receptors could be considered as an independent prognostic factor (HR = 1.76, 95% CI: 1.37–2.16). Conclusion: According to our results, overexpression of FZD receptors predicts a poor prognosis in patients with GI cancers and could be used as a useful therapeutic target.

Mature cystic teratoma of the ovary (MCTO) is the most common ovarian germ cell tumor. Its malignant transformation is a rare complication that occurs in almost 2% of the MCTs. MCTO is benign and usually appears between 30 and 40 years of age, but patients with malignant ovarian MCT are 10–15 years older than those with benign MCT. The most common malignant transformation in MCTO is Squamous Cell Carcinoma (SCC) which is rarely diagnosed with pre-operative imaging.We report the case of a postmenopausal woman, presenting with severe abdominal pain and a large palpable mass in her abdomen. She was diagnosed postoperatively with SCC arising from MCTO which was confirmed histopathologically. The patient received postoperative chemotherapy and was well at 6-month follow-up after chemotherapy.MCTO is benign, but can rarely become malignant in older ages. So MCTO-arising SCC should be considered in elderly women with abdominal pain and mass, and also some other evident features such as large tumor diameter, elevated serum markers, and solid components in Magnetic resonance imaging (MRI).

PurposeRobust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness.MethodsWe conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients.ResultsWe show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression in the lower respiratory tract is associated with the presence of a high viral load. We further demonstrate that the systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 infection. For clinical outcome prediction (e.g., respiratory failure), IFI27 expression displays a high sensitivity (0.95) and specificity (0.83), outperforming other known predictors of COVID-19 outcomes. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients.ConclusionThese data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus.

IntroductionThe occurrence of oral candidiasis (OC) is expected in patients with COVID-19, especially those with moderate to severe forms of infection who are hospitalized and may be on long-term use of broad-spectrum antibiotics or prolonged corticosteroid therapy. We aimed to characterize clinical conditions, the prevalence profile of Candida species, and outcomes of COVID-19 patients with OC.MethodsIn this observational study, oral samples were obtained from COVID-19 patients suspected of OC admitted to Razi teaching hospital. Patients with OC were monitored daily until discharge from the hospital. Species identification was performed by a two-step multiplex assay named YEAST PLEX, which identifies 17 clinically important uncommon to common yeast strains.ResultsAmong the 4133 patients admitted with COVID-19, 120 (2.90%) suffered from OC. The onset of signs and symptoms of OC in patients was, on average (2.92 ± 3.596 days) with a range (of 1-29 days). The most common OC presentation was white or yellow macules on the buccal surface or the tongue. In (39.16%) of patients suffering from OC multiple Candida strains (with two or more Candida spp.) were identified. The most common Candida species were C. albicans (60.57%), followed by C. glabrata (17.14%), C. tropicalis (11.42%), C. kefyr (10.83%) and C. krusei (3.42%). Notably, OC caused by multiple Candida strains was more predominant in patients under corticosteroid therapy (P

Background: This study aims to investigate the situation of sleep profile and its related factors in the Tabari Cohort Tabari (TCS) population. Methods: The information of 10255 of the Tabari cohort population in the enrolment phase was used in this study. The sleep profile data was collected and recorded by trained questioners. The sleep duration in day & night, the time interval between going bed and falling asleep, continuous use of sedatives, involuntary nap, limb hypermobility during sleep and shift working were determined for each person. Data analysis was performed by independent T test and Pearson correlation coefficient. Results: Mean, standard deviation, median, minimum and maximum of sleep duration in this population were 7.6, 1.6, 7.5, 0.5 and 17 h. Frequency of sleeping less than 6 h, 6–10 h and more than 10 h were 1168(11.4%), 8463(82.5%) and 624(6.1%) respectively. Prevalence of sleeping more than 10 h among men and women were 5% and 6.8% respectively (P

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.

The evolving trends in colorectal cancer (CRC) as one of the most common malignancies worldwide, have likely been influenced by the implementation of screening programs and changes in lifestyle habits. Changing lifestyle, including the shift in diet composition with higher fat, sugar, and animal-source foods intake, led to an increasing burden of CRC in countries undergoing rapid socioeconomic improvement. Results for the link between specific fatty acids (FAs) and CRC are generally inconclusive and more limited in developing countries than elsewhere. This study aims to investigate the association between FA intakes and CRC and its anatomical subsites in a large Iranian case-control study. A food frequency questionnaire was used to collect information on dietary intake in 865 cases and 3206 controls. We conducted multivariate logistic regression models to calculate the odds ratio (OR) and 95% confidence interval (CI). We found positive association between CRC and high intake of dietary total fat (OR highest quartile Q4 = 1.77, 95% CI = 1.32–2.38), cholesterol (ORQ4 = 1.58, 95% CI = 1.22–2.05), and palmitoleic acid (ORQ4 = 2.16, 95% CI = 1.19, 3.91), and an inverse association with high intake of dietary heptanoic acid (ORQ4 = 0.33, 95% CI = 0.14, 0.79) and low intake of palmitic acid (OR lowest quartile Q2 = 0.53, 95% CI = 0.31–0.88). None of the fat variables were associated with rectal cancer. Our study suggests that the recommendation of limited consumption of fats may decrease the risk of CRC among the Iranian population.

Background and purpose: Cytomegalovirus (CMV) is one of the most important pathogens in immunocompromised patients, those who need regular blood transfusion, and renal failure patients undergoing hemodialysis. The aim of this investigation was to study the epidemiology of cytomegalovirus in hemodialysis patients in Sari, Iran. Materials and methods: This cross-sectional study was performed in 180 hemodialysis patients attending two referral centers in Sari, 2017-2018. To include the patients we considered sociodemographic characteristics, blood transfusion history and period, and duration and frequency/week of hemodialysis. Blood samples were collected from all patients and after centrifuge, serum samples were examined for CMV-specific immunoglobulin G (IgG) using enzyme-linked immunosorbent assay (ELISA). Statistical tests including Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis, and descriptive analysis including proportion for qualitative data and median (quartile range 25-75) for quantitative data were used. Results: The participants were 180 patients, including 93 (51.7%) females and 87 (48.3%) males (mean age: 61.5±14.4). All patients (100%) were positive for anti-CMV IgG antibody. There were no significant relationships between antibody titer and sex, age, dialysis period, dialysis duration, dialysis frequency per week, transfusion, transplantation, or HBV and HCV status (P >0.05). Conclusion: Our findings showed high frequency of CMV-IgG positive in hemodialysis patients. Due to the possibility of CMV infection progression in immunocompromised patients, especially those who undergo hemodialysis, screening programs should be performed to prevent adverse consequences.

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: The Coronavirus Disease 2019 (COVID-19) was first observed in December 2019 and caused a global pandemic. The aim of this study was to evaluate the clinical features and paraclinical findings in patients who died of COVID-19 in Sari Imam Khomeini Hospital, February 2020- May 2020. Materials and methods: A cross-sectional descriptive and retrospective study was done by reviewing the medical records of 149 patients who died of Covid-19 whose diagnosis was confirmed by chest CT scan or PCR-RT. Independent sample t test was used to compare quantitative variables and Chi-square test was used for analyzing qualitative variables. Results: The mean age of death from Covid-19 was 63.36±15.26 years and 58.1% were male. The most common clinical complaints were cough, fever, and dyspnea. The most common manifestation of chest CT scan was bilateral involvement. Among the dead cases of COVID-19, 13.5% had myocarditis and 4.7% developed respiratory complications (such as pneumothorax). According to findings, 54.1% died of cardiac arrest and 44.6% died due to respiratory arrest. Conclusion: Many ambiguities of SARS-CoV-2 still remain that require extensive studies and research in various aspects. Evaluation of demographic, radiological, clinical complications, and laboratory features can help physicians in finding ways to reduce mortality, perform more effective treatments, and use predictive tools.

Background: The outbreak of the coronavirus disease-2019 (COVID-19) has become a global public health challenge. Assessing the effect of COVID-19 on liver injury is of great importance. A systematic review and meta-analysis were conducted to establish the characteristics of liver function tests in COVID-19 patients. Methods: A systematic search of publications from December 2019 up to April 2020 in Web of Science, Scopus, and Medline (via PubMed) databases was performed. Both cross-sectional and case series studies reporting an association between liver injury and COVID-19 infection were included. The data were analyzed using the STATA software (version 11.0) and the random-effects model for I2>50% was used to pool the results.Results: In this meta-analysis, 42 articles comprising a total of 6,557 COVID-19 patients were studied. The prevalence of increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels was 30% and 21% in non-severe patients and 38% and 48% in severe patients, respectively. Patients with severe COVID-19 infection were 4.22, 4.96, and 4.13 times more likely to have elevated AST, ALT, and lactate dehydrogenase (LDH) levels, respectively.Conclusion: Elevation in liver function tests was higher in patients with severe than non-severe COVID-19 infection. Given the widespread use of drugs that increases the risk of hepatotoxicity, healthcare providers should be aware of changes in liver enzymes in COVID-19 patients. The inclusion of other studies from outside China could confirm the pattern of elevation in liver function tests in COVID-19 patients across the globe.Preprint of this article is available on medRxiv, https://www.medrxiv.org/content/10.1101/2020.05.20.20108357v1

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.

Abstract Aims/Introduction In recent years, mesenchymal cellular therapies have received much attention in the treatment of diabetes. In this meta‐analysis, we aimed to evaluate the efficacy of mesenchymal stem cell therapy in type 2 diabetes mellitus patients. Materials and Methods A comprehensive literature search was carried out using PubMed, Scopus, Web of Science and Central databases. A total of 1,721 articles were identified, from which nine full‐text clinical trials were qualified to enter the current meta‐analysis. The assessment groups included patients with type 2 diabetes, and levels of C‐peptide, glycosylated hemoglobin and insulin dose were analyzed before and after mesenchymal stem cell infusion. Data analysis was carried out in Stata version 11, and the Jadad Score Scale was applied for quality assessment. Results Changes in levels of C‐peptide after mesenchymal stem cell therapy were: standardized mean difference 0.20, 95% confidence interval −0.61 to 1.00, glycosylated hemoglobin levels were: standardized mean difference −1.45, 95% confidence interval −2.10 to −0.79 and insulin dose were: standardized mean difference −1.40, 95% confidence interval −2.88 to 0.09. Conclusions This meta‐analysis of prospective studies showed associations between mesenchymal stem cell therapy and control of glucose level in patients with type 2 diabetes.

Abstract Background The association between oral contraceptives (OCP) and hypertension has been reported in the literature with controversial results. According to the growing use of OCPs among women in Iran, this study aims to investigate the association between the duration of the OCP consumption and risk of hypertension among Iranian women. Methods In the current study, the data collected during the enrolment phase of the Tabari cohort were analyzed. Of 6106 women recruited in the cohort, 133 pregnant women were excluded. Epidemiological variables were collected using pre-designed questionnaires as well as the health insurance evidences. In addition, blood pressure and anthropometric factors were measured based on the standard guidelines. Chi square and partial correlation tests as well as logistic regression models were applied for data analysis. Results Frequency of oral contraceptive use among 35–70 year-old women in Tabari cohort study (TCS) was 42.2% (2520/5973). Hypertension was observed among 25% (1793/5973) of them. The adjusted odds ratio for OCP use was 1.23 (95% confidence interval: 1.08, 1.40, p = 0.002). The corresponding odds ratios for 61–120 months and more than 120 months OCP use were 1.39 (1.12,1.73) and 1.47 (1.16,1.87) respectively. Conclusions Oral contraceptives especially in long term use can be associated with hypertension.

Background and purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major hospital and non-hospital pathogens in children. This meta-analysis and systematic review aimed at exploring the data on prevalence of MRSA in Iranian children. Materials and methods: Primary articles in English and Persian were searched using the following keywords: prevalence, children, methicillin-resistant staphylococcus aureus (MRSA), and Iran. Electronic databases, including Pubmed, Web of Science, Google Scholar and Iranian databases such as Magiran and SID were searched for articles published in 2007-2019. Qualitative assessment of studies was done using STROBE checklist and data analysis was done in STSTA V11. Results: A total of 55 articles were identified and 23 met the study inclusion criteria. The prevalence of MRSA in children with S. aureus infection was 22%. The prevalence of community acquired and nosocomial MRSA was 17% and 38%, respectively. Conclusion: The current meta-analysis showed considerable rates of nosocomial and community acquired MRSA infections among children in Iran. So, pediatricians should consider this issue in empirical treatment.

Background: Asthma is a chronic inflammatory respiratory disorder. Nutritional conditions affect allergic diseases such as asthma. The aim of this study was to review the serum zinc level in children with asthma. Methods: This is a review article found in databases such as Google, PubMed, SID, Irandoc, Scopus and up-to-date. Key words for search included zinc, asthma, children and pediatric. There was no time limitation for the search. These articles on zinc levels in asthmatic children were meta-analyzed. Results: Out of the 40 articles, 19 articles were excluded and 21 articles were included in this analysis. 15 articles evaluated serum zinc levels, 4 articles on hair zinc levels, one article evaluated nail zinc levels and another on zinc level in erythrocyte cells in children with asthma. Only 3 articles evaluated effects of zinc supplement treatment in children with asthma. Meta-analysis of studies showed that there was no significant difference between the standard mean differences of zinc level in asthmatic patients compared to the control group. We cannot analyze the association between zinc levels in hair and nail in children with asthma. All clinical trial studies show that zinc supplement improves clinical manifestations of asthma and patient’s pulmonary function test. Conclusion: We found that the mean serum zinc level difference is not significant in children with asthma than healthy control group and it seems that there is no relation between mean serum zinc level and severity of asthma in children.

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

Background and purpose: This research aimed at investigating the effect of herbal medicine on reduction of pulmonary complications in patients with Coronavirus disease 2019 (COVID-19). Materials and methods: Forty patients with COVID-19 infection older than 18 years of age (60% men) with the average age of over 55 years old enrolled in this study. Written consent was obtained and participants with the following symptoms were divided into experimental group and control group: body temperature higher than 38℃, lymphocyte counts of less than 1200, positive CRP, respiratory symptoms, and pulmonary involvement in lung CT scan. The control group was treated with 400 mg Kaletra® and 200 mg hydroxychloroquine oral every 12 hours, and the experimental group, in addition to this regimen, received 5 ml of a herbal medicine (consisting of Satureja hortensis L., Hypericum perforatum L. and Foeniculum vulgare L.) three times a day. Statistical analysis was done in SPSS applying Chi-square test and t-test. Results: The herbal medicine was found to be significantly effective in decreasing the time of hospitalization and recovery from the disease (8.5 days in control group vs. 5 days in experimental group, (P

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.

Abstract Background Measurement of serum human epidermal growth factor receptor-2 (HER-2/neu) levels might play an essential role as a diagnostic/screening marker for the early selection of therapeutic approaches and predict prognosis in breast cancer patients. We aimed to undertake a systematic review and meta-analysis focusing on the diagnostic/screening value of serum HER-2 levels in comparison to routine methods. Methods We performed a systematic search via PubMed, Scopus, Cochrane-Library, and Web of Science databases for human diagnostic studies reporting the levels of serum HER-2 in breast cancer patients, which was confirmed using the histopathological examination. Meta-analyses were carried out for sensitivity, specificity, accuracy, area under the ROC curve (AUC), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Results Fourteen studies entered into this investigation. The meta-analysis indicated the low sensitivity for serum HER2 levels (Sensitivity: 53.05, 95%CI 40.82–65.28), but reasonable specificity of 79.27 (95%CI 73.02–85.51), accuracy of 72.06 (95%CI 67.04–77.08) and AUC of 0.79 (95%CI 0.66–0.92). We also found a significant differences for PPV (PPV: 56.18, 95%CI 44.16–68.20), NPV (NPV: 76.93, 95%CI 69.56–84.31), PLR (PLR: 2.10, 95%CI 1.69–2.50) and NLR (NLR: 0.58, 95%CI 0.44–0.71). Conclusion Our findings revealed that although serum HER-2 levels showed low se nsitivity for breast cancer diagnosis, its specificity, accuracy and AUC were reasonable. Hence, it seems that the measurement of serum HER-2 levels can play a significant role as a verification test for initial negative screening test results, especially in low-income regions due to its cost-effectiveness and ease of implementation.

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of the joints and other tissues and organs of the body. Previous reports have demonstrated the imbalance of T helper (Th) subsets and Treg activity in the development, progression, and remission of RA. Here, we investigated the mRNA expression of four major transcription factors T-bet (Th1), GATA (Th2), RORc (Th17), and Foxp3 (Treg) in peripheral blood of different groups of RA patients. Materials and methods: In this case-control study, 60 patients with RA, including 20 newly diagnosed, 20 under treatment, and 20 in remission, as well as 20 patients with osteoarthritis, and 20 age- and the sex-matched healthy individual were enrolled. Diagnosis and classification of patients were done according to the American College of Rheumatology criteria. The relative mRNA expression of transcription factors, including T-bet, GATA, RORc, and Foxp3, was measured using qRT-PCR. Results: The relative expression of T-bet in RA patients was significantly increased in healthy controls (P = 0.002), while the relative expression of Foxp3 in RA patients was significantly decreased in healthy controls (P < 0.0001). There was no significant difference in the expression of GATA3 or RORc among RA patients, healthy controls, and osteoarthritis group. Conclusions: The results indicate the importance of Th1 and Treg cells in RA; however, the role of Th17 cells appear to be of little importance in these patients. It seems that Th2 cells do not interfere with RA development.

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: To determine the expression of cancer stem cell marker Leucine-rich repeat-containing G-protein coupled receptor 5 (Lgr5) in colorectal carcinoma samples compared to normal adjacent tissue and any possible association with clinicopathological findings. Methods: This study was performed on forty samples of cancerous colorectal tissues (case group) and their adjacent normal mucosa (control group) in Imam Khomeini Hospital (Sari, Mazandaran, Iran). Expression of Lgr5 in tissue sections was done by immunohistochemistry. Statistical analysis was carried out using SPSS software. Results: Forty colorectal cancer patients including 21 males (57.8±11.6 years) and 19 females (58.4±12.77 years) were enrolled. Lgr5 was overexpressed in tumoral samples than normal adjacent tissues (77.5% vs 27.5%, p

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

Abstract Background and objectives Allergic diseases are among major pediatric issues as they are highly prevalent and chronic. Therefore, identification of factors contributing to allergic disease could play a significant role in prevention of these conditions. This study aimed at investigating the IgE level in newborn’s umbilical cord blood and its relationship with some maternal factors. Methods A cross-sectional study was conducted in 101 mothers and their newborns in Babol, Iran 2016. The samples were selected using non-probability convenience sampling. Information including newborn sex, gravidity, history of allergy before and during pregnancy (asthma, allergic rhinitis, eczema, hives, food allergy, and drug allergy), family history of allergy among mothers, history of exposure to secondhand smoke and pets, and delivery techniques was recorded. The IgE levels in newborn umbilical cord blood and maternal serum were measured using an IgE kit and ELISA technique. Results The newborns included 53 females (52.5%) and 29 mothers had vaginal birth (28.7%). History of exposure to secondhand smoke was found in 15 samples (14.9%), and 18 participants reported exposure to pets (17.8%). The median IgE levels in newborns and their mothers were 0.41 and 98.6, respectively. In general, IgE level in all newborns was within the normal range, but, it was higher than normal in 15 mothers (14.9%). The IgE level was significantly higher in male newborns than that of the female newborns (p = 0.011). There were no significant differences in the IgE levels of mothers and their newborns on the basis of delivery technique and history of exposure to pets (p > 0.05). Conclusion In this study, the IgE level in all newborns was within the normal range, and sex was found to be an effective factor in IgE levels.