Measurement and Decomposition of Socioeconomic Inequality in Metabolic Syndrome: A Cross-sectional Analysis of the RaNCD Cohort Study in the West of Iran / 예방의학회지

Objectives@#Socioeconomic inequality in metabolic syndrome (MetS) remains poorly understood in Iran. The present study examined the extent of the socioeconomic inequalities in MetS and quantified the contribution of its determinants to explain the observed inequality, with a focus on middle-aged adults in Iran. @*Methods@#This cross-sectional study used data from the Ravansar Non-Communicable Disease cohort study. A sample of 9975 middle-aged adults aged 35-65 years was analyzed. MetS was assessed based on the International Diabetes Federation definition. Principal component analysis was used to construct socioeconomic status (SES). The Wagstaff normalized concentration index (CIn) was employed to measure the magnitude of socioeconomic inequalities in MetS. Decomposition analysis was performed to identify and calculate the contribution of the MetS inequality determinants. @*Results@#The proportion of MetS in the sample was 41.1%. The CIn of having MetS was 0.043 (95% confidence interval, 0.020 to 0.066), indicating that MetS was more concentrated among individuals with high SES. The main contributors to the observed inequality in MetS were SES (72.0%), residence (rural or urban, 46.9%), and physical activity (31.5%). @*Conclusions@#Our findings indicated a pro-poor inequality in MetS among Iranian middle-aged adults. These results highlight the importance of persuading middle-aged adults to be physically active, particularly those in an urban setting. In addition to targeting physically inactive individuals and those with low levels of education, policy interventions aimed at mitigating socioeconomic inequality in MetS should increase the focus on high-SES individuals and the urban population.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES@#Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.@*METHODS@#All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.@*RESULTS@#The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.@*CONCLUSIONS@#Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran. METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata. RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk. CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Dietary patterns, nutrition, and risk of breast cancer: a case-control study in the west of Iran / 한국역학회지

OBJECTIVES: Unhealthy dietary patterns are the most important changeable risk factors for breast cancer. The aim of this study was to assess the relationship between dietary patterns and the risk of breast cancer among under-50 year women in the west of Iran.METHODS: All women under 50 years old with pathologically confirmed breast cancer between 2013 and 2015 who were referred to oncology clinics in the west of Iran, and 408 under-50 women referred to other outpatient clinics who were without breast or other cancers at the time of the study and 2 years later were selected as the control group. The data were collected using the middle-aged periodical care form of the Iranian Ministry of Health and analyzed using univariate and multivariate logistic regression in Stata.RESULTS: The most powerful risk factor for breast cancer was fried foods; the odds ratio of consuming fried foods more than once a month for breast cancer was 4.5 (95% confidence interval, 2.1 to 9.4). A dose-response model indicated that increasing vegetable and fruit consumption up to 90 servings per month decreased the odds of breast cancer, but consuming more than 90 servings per month increased the risk.CONCLUSIONS: Inadequate consumption of vegetables and consumption of soft drinks, industrially produced juices, fried foods, and sweets were identified as risk factors for breast cancer. In response to these findings, it is necessary to raise awareness and to provide education about healthy diets and the need to change unhealthy dietary patterns.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran / 예방의학회지

OBJECTIVES@#Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort.@*METHODS@#The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard.@*RESULTS@#Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency.@*CONCLUSIONS@#The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Associations between Muscle Strength with Different Measures of Obesity and Lipid Profiles in Men and Women: Results from RaNCD Cohort Study

We aimed to examine associations between muscle strength and obesity and serum lipid profile in Ravansar Non-Communicable Disease (RaNCD) cohort study. This study was conducted on 6,455 subjects aged 35–65 years old from baseline data of RaNCD in Iran. The associations between grip strength and adiposity measurements were explored using linear regression with adjustment for age, height, smoking status, alcohol intake, social class, and prevalent disease. The mean of body mass index (BMI) and muscle strength was 27.2 ± 4.6 kg/m² and 33.3 ± 11.5, respectively. Muscular strength increased with increasing BMI and waist circumference (WC) in both sexes. Multivariate regression analysis revealed a 3.24 (95% confidence interval [CI], 2.29, 4.19) kg difference between BMI in top and bottom in men, and 1.71 (95% CI, 0.98, 2.34) kg/m² in women. After multivariable adjustment, a difference of 2.04 (95% CI, 1.12, 2.97) kg was observed between the top and bottom WC quartiles in men and 1.25 (95% CI, 0.51, 1.98) kg in women. In men, with increase of low-density lipoprotein and cholesterol, the mean muscle strength was significantly increased. Muscle strength may be associated with body composition and lipid profiles. Muscle strength can be an appropriate indicator for predicting some of the problems caused by body composition disorders, which requires further longitudinal studies.

Validity of Self-reported Hypertension and Factors Related to Discordance Between Self-reported and Objectively Measured Hypertension: Evidence From a Cohort Study in Iran / 예방의학회지

OBJECTIVES: Self-reporting can be used to determine the incidence and prevalence of hypertension (HTN). The present study was conducted to determine the validity of self-reported HTN and to identify factors affecting discordance between self-reported and objectively measured HTN in participants in the Ravansar Non-Communicable Diseases (RaNCD) cohort. METHODS: The RaNCD cohort included permanent residents of Ravansar, Iran aged 35-65 years. Self-reported data were collected before clinical examinations were conducted by well-trained staff members. The gold standard for HTN was anti-hypertensive medication use and blood pressure measurements. The sensitivity, specificity, positive and negative predictive values, and overall accuracy of self-reporting were calculated. Univariate and multivariate logistic regression were used to examine the discordance between self-reported HTN and the gold standard. RESULTS: Of the 10 065 participants in the RaNCD, 4755 (47.4%) were male. The prevalence of HTN was 16.8% based on self-reporting and 15.7% based on medical history and HTN measurements. Of the participants with HTN, 297 (18.8%) had no knowledge of their disease, and 313 (19.9%) had not properly controlled their HTN despite receiving treatment. The sensitivity, specificity, and kappa for self-reported HTN were 75.5%, 96.4%, and 73.4%, respectively. False positives became more likely with age, body mass index (BMI), low socioeconomic status, and female sex, whereas false negatives became more likely with age, BMI, high socioeconomic status, smoking, and urban residency. CONCLUSIONS: The sensitivity and specificity of self-reported HTN were acceptable, suggesting that this method can be used for public health initiatives in the absence of countrywide HTN control and detection programs.

Comparison of 3 Nutritional Questionnaires to Determine Energy Intake Accuracy in Iranian Adults

A precision instrument is required to assess the nutritional status. This study was conducted on comparison of 3 nutritional questionnaires to determine energy intake (EI) accuracy in adults in Ravansar Non-Communicable Chronic Disease (RaNCD) cohort study. This cross-sectional study was conducted on 118 of participant's RaNCD. EI was evaluated with 3 questionnaires including food frequency questionnaire (FFQ), 24-hours recall (24HR), and food habits questionnaire (FHQ). Resting metabolic rate (RMR) was measured using indirect calorimetry. We used EI/RMR cut off to evaluate EI reporting status. The mean ± standard deviation of age in men and women were 44.1 ± 6.5 and 43.7 ± 5.25 respectively and 50.8% of participants were men. Among 3 EI estimating questionnaires, FFQ was more accurate than 2 other questionnaires (67.8%). We observed that implausible reporters of 24HR were likely overweight (p < 0.005) but we did not observe a significant difference between EI reporting of FFQ and FHQ with participants' body composition. Our finding showed that EI underreporting of 24HR and FHQ were high. Under reporters were seemed to be overweight. Therefore, these results suggested that among 3 nutritional questionnaires the FFQ was an appropriate approach to determine EI in this population due to plausible EI reporting was higher than 2 other nutritional questionnaires (24HR and FHQ).

Measuring and Decomposing Socioeconomic Inequalities in Adult Obesity in Western Iran / 예방의학회지

OBJECTIVES: Obesity is a considerable and growing public health concern worldwide. The present study aimed to quantify socioeconomic inequalities in adult obesity in western Iran. METHODS: A total of 10 086 participants, aged 35-65 years, from the Ravansar Non-communicable Disease Cohort Study (2014-2016) were included in the study to examine socioeconomic inequalities in obesity. We defined obesity as a body mass index ≥30 kg/m2. The concentration index and concentration curve were used to illustrate and measure wealth-related inequality in obesity. Additionally, we decomposed the concentration index to identify factors that explained wealth-related inequality in obesity. RESULTS: Overall, the prevalence of obesity in the total sample was 26.7%. The concentration index of obesity was 0.04; indicating that obesity was more concentrated among the rich (p < 0.001). Decomposition analysis indicated that wealth, place of residence, and marital status were the main contributors to the observed inequality in obesity. CONCLUSIONS: Socioeconomic-related inequalities in obesity among adults warrant more attention. Policies should be designed to reduce both the prevalence of obesity and inequalities in obesity by focusing on those with higher socioeconomic status, urban residents, and married individuals.

Estimation of the rate and number of underreported deliberate self-poisoning attempts in western Iran in 2015 / 한국역학회지

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran. METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level. RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population. CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.

Estimation of the rate and number of underreported deliberate self-poisoning attempts in western Iran in 2015 / 한국역학회지

OBJECTIVES: Rates of attempted deliberate self-poisoning (DSP) are subject to undercounting, underreporting, and denial of the suicide attempt. In this study, we estimated the rate of underreported DSP, which is the most common method of attempted suicide in Iran.METHODS: We estimated the rate and number of unaccounted individuals who attempted DSP in western Iran in 2015 using a truncated count model. In this method, the number of people who attempted DSP but were not referred to any health care centers, n0, was calculated through integrating hospital and forensic data. The crude and age-adjusted rates of attempted DSP were estimated directly using the average population size of the city of Kermanshah and the World Health Organization (WHO) world standard population with and without accounting for underreporting. The Monte Carlo method was used to determine the confidence level.RESULTS: The recorded number of people who attempted DSP was estimated by different methods to be in the range of 46.6 to 53.2% of the actual number of individuals who attempted DSP. The rate of underreported cases was higher among women than men and decreased as age increased. The rate of underreported cases decreased as the potency and intensity of toxic factors increased. The highest underreporting rates of 69.9, 51.2, and 21.5% were observed when oil and detergents (International Classification of Diseases, 10th revision [ICD-10] code: X66), medications (ICD-10 code: X60-X64), and agricultural toxins (ICD-10 codes: X68, X69) were used for poisoning, respectively. Crude rates, with and without accounting for underreporting, were estimated by the mixture method as 167.5 per 100,000 persons and 331.7 per 100,000 persons, respectively, which decreased to 129.8 per 100,000 persons and 253.1 per 100,000 persons after adjusting for age on the basis of the WHO world standard population.CONCLUSIONS: Nearly half of individuals who attempted DSP were not referred to a hospital for treatment or denied the suicide attempt for political or sociocultural reasons. Individuals with no access to counseling services are at a higher risk for repeated suicide attempts and fatal suicides.

Epidemiologic characteristics of patients with inflammatory bowel disease in Kermanshah, Iran

Background: This study was done to define some epidemiological aspects of inflammatory bowel disease [IBD], and to describe its characteristics in west of Iran

Methods: In this descriptive study all patient with the diagnosis of IBD who were visited in university-affiliated medical centers, between 2014 and 2015 were recruited. Their demographic characteristics, disease-related manifestations, complications, disease course and their chief complaints were analyzed

Results: Of 156 referred individuals, 153 patients had ulcerative colitis [UC] and 3 patients had Crohn's diseases [CD]. The mean age of the patients at diagnosis was 35.69+/-12.35 [range: 17-80] years with the most common age group of 25-35 years and slight female predominance [51.9%]. More urban patients were registered [90.4%] and 57% had high school or upper education. Positive family history of the disease was in 25.6% and 66.6% had four or more family members. Furthermore, 51.9% had left sided colitis and 40.4% had pancolitis with bloody diarrhea [79.5%] and abdominal pain [68.6%] as the most common manifestations. 36.5% had other autoimmune diseases. Multiple flare was seen in 47.4%, most commonly due to drug discontinuation [26.28%]. Hospital admission was reported in 34.6%. History of contraceptive pill use was in 38.8% of the female patients

Conclusion: The demographic and clinical manifestations of IBD are usually the same as other developing countries; however, the rarity of CD is eminent. Although the accurate epidemiological characteristic of IBD in Iran is still obscure, it is not a rare disease as previously thought and it seems that gradual reception of a western lifestyle may be linked to the ongoing rise in IBD

Epidemiology of traffic crash mortality in west of Iran in a 9 year period / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>In Iran, the most common cause of injuries and the second leading cause of deaths are traffic accidents, and those problems impose a substantial financial burden on the society. This study aims to determine traffic accident mortality trends and their epidemiologic characteristics in the Kermanshah province, west of Iran.</p><p><b>METHODS</b>In a cross sectional study, road traffic fatality data from 2004 to 2013 were analyzed to determine the epidemiological pattern of traffic accident mortality. Trend assessment was performed to ascertain the decreasing or increasing status. Chi-square and one-way analysis of variance (ANOVA) tests, as well as Poisson regression were used to determine the significance of the data in time. Data were analyzed using Excel and statistical package of SPSS version 19.</p><p><b>RESULTS</b>Out of 5110 people that died in traffic accidents, 4024 (78.7%) were males. The state of accidents indicated that 404 (43.8%) female pedestrians died as a result of car crashes, and 1330 (41.4%) males died because of car collisions. 1554 (31.9%) deaths happened to pedestrians and 1556 (32.1%) to vehicle drivers, and the rest belonged to vehicle passengers. Head trauma was the cause of death for as much as 3400 (69.9%) cases. Fatal crashes in which pedestrians were involved mostly occurred between the hours 13:00 to 15:00, while the time for vehicle drivers was between 16:00 to 18:00. 2882 people (59.1%) died before reaching to health care facilities. Traffic crash mortality trend for pedestrians follows a linear pattern with a gentle downward slope, but the trend shows various swings when it comes to vehicle drivers.</p><p><b>CONCLUSION</b>The number of traffic crash deaths from 2004 to 2013 indicates a decreasing trend in two groups of road users: vehicle drivers and car occupants. This can be due to some interventions such as modification of traffic rules and enhancement of police control which has been implemented in recent years. Moreover, more attention should be paid to promote the optimal health care services to save the lives of the injured from traffic accidents.</p>

Determinant of road traffic crash fatalities in Iran: a longitudinal econometric analysis

Background: Injuries and deaths from road traffic crashes are one of the main public health problems throughout the world. This study aimed to identify determinants of fatality traffic accident in Iran for the twenty-span year from 1991 to 2011

Methods: A time series analysis [1991-2011] was used to examine the effects of some of the key explanatory factors [GDP per capita, number of doctors per 10,000 populations, degree of urbanization, unemployment rate and motorization rate] on deaths from road traffic in Iran. In order to examine long- and short-run effects of variables, we employed autoregressive distributed lag [ARDL] approach and error correction method [ECM]. The data for the study was obtained from the Central Bank of Iran [CBI], Iranian Statistical Center [ISC] and Legal medical organizations [LMO]

Results: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate had a significant impact on fatality from road traffic in Iran. We did not observe any short- and long-term effects of the unemployment rate on fatality from road traffic

Conclusion: GDP per capita, doctor per 10,000 populations, degree of urbanization and motorization rate were identified as main determinant of fatality from road traffic accidents in Iran. We hope the results of the current study enable health policy-makers to understand better the factors affecting deaths from road traffic accidents in the country

[Comparative study of echocardiographic right ventricular systolic function before and after angioplasty on right coronary artery]

Background: In patients who undergoing PCI, association between right ventricular function and outcome of the procedure remained unclear

The present study aimed to determine association between echocardiography findings of systolic right ventricular function and functional status of patients following PCI

Methods: In a cross-sectional study conducted at Imam Ali hospital and heart center in Kermanshah, Iran in 2013, 40 patients with history of inferior wall myocardial infarction [Inf MI] according to previous electrocardiography [ECG] in past hospitalization for MI who were candidate for percutaneous coronary intervention [PCI] on right coronary artery [RCA] and had left ventricle ejection fraction [LVEF] less than 40% were included

The subjects underwent echocardiography on admission to assess echocardiography indices of systolic right ventricular function including tricuspid annular plane systolic excursion [TAPSE], tricuspid annular systolic velocity [TASV], Tei-index [Myocardial performance index), and RV fractional area [RVFA] change that was repeated one month later. Baseline functional status was assessed based on the New York Heart Association functional classification score [NYHA score] that divided to 4 grades

Results: NYHA score improved following PCI procedure [from 2.20+/-0.46 to 1.10+/-0.30, P<0.001]. The mean score of TAPSE significantly increased from 18.68+/-2.12 to 20.40+/-2.11 [P<0.001]

The mean of TASV also increased from 13.28 +/- 1.52 to 14.85+/-1.90 [P<0.001]

Also, Tei-index was improved from 0.52+/-0.05 to 0.47+/-0.03 [P<0.001]

Moreover, RVFA was significantly increased after PCI [from 35.02+/-2.40 to 38.25+/-2.57, P<0.001]

There was no significant relationship between the changes in NYHA score and each of right ventricular systolic function indices

Conclusion: Although right ventricular systolic function considerably improved following PCI procedure, but the changes in this improvement is not associated with the improvement of function class after the procedure

Trends of mortality of road traffic accidents in Fars province, Southern Iran, 2004 - 2010

The aim of this study was to investigate the trends in mortality from road traffic accidents [RTA] in Fars Province, southern Iran. The Age and sex-standardized mortality rate attributed to RTA from 2004 to 2010 in Fars Province was calculated using world standard population. We also used linear regression and chi-squared tests. Over the period of study [7 years], 12954 people died in RTA. The age- and sex-standardized mortality rate was 27 per 100,000. While the rate of death due to RTA had an incremental rate in age group 18-30 years and among women, it had a decreasing trend in age groups 35-45, under18 and among men. An increase in mortality rate of RTA among people aged 18-30 yr and women need to be addressed by health policy makers and other involved sections

Association of air pollution and hospital admission for cardiovascular disease: a case study in Kermanshah, Iran

The objective of the present study was to estimate the contribution of environmental pollutants to hospital admissions for cardiovascular disease [CVD] on subjects living in Kermanshah. This study is an ecological analysis. Data of CVD was collected from the largest CVD hospital of Kermanshah during 1 March 2010 until 30 February 2011. The air pollution data were obtained from environmental center. Magnitude of association was estimated by Poisson regression model. Among air pollutants PM[10] and CO was significantly associated with hospital admission for CVD. This study suggests that short-term exposure of people with some air pollutants such as PM[10] and CO could increase CVD hospital admission

comparative study of Tacrolimus versus Cyclosporine as immunosuppression for kidney transplant recipients

Kidney transplantation is the most common transplantation in the world. Annually, a large number of patients that have chronic renal failure are undergoing renal transplantation and the major subject about these patients is the rejection of graft that should be controlled by immunosuppressive agents. The aim of this study is investigation of the effect of Cyclosporin against Tacrolimus in patients with kidney transplantation. This study was performing between 2010 and 2012 on all patients who had kidney transplantation and refer to Imam Reza hospital from Kermanshah University of Medical Sciences. 100 patients, aged 18-60 years, with end-stage renal disease were administered either Tacrolimus [n=49] or Cyclosporine [n=51]. In both groups, Cellept could be discontinued from day 92 onwards. Corticosteroid treatment comprised methylprednisolone boluses followed by a rapid prednisone taper from 20 mg [day 2] to 5 mg [day 43 and thereafter]. Patients followed up 12 months. In the Tacrolimus treatment group, 7 grafts [14%] were lost and 8 [16%] grafts were lost in the Cyclosporine treatment group between months 0 and 12 and there is no significant different between these groups [P= 0.845]. No cases were diagnosed with biopsy-proven chronic rejection at months 0 and 12. Mean serum creatinine concentrations were 1.8 +/- 1.5 mg/dl in the Tacrolimus group and 2.3 +/-2.9 in the Cyclosporine group by month 12 [P= 0.348]. these data are consistent with previously published observations and confirm that Tacrolim us is a highly efficacious baseline immunosuppressant for patients undergoing kidney transplantation. Tacrolimus-based immunosuppression may promote long-term benefits with regard to graft functio n and graft survival

Profile of acute carbon monoxide poisoning in the west province of Iran

To document the epidemiology and risk factors of acute carbon monoxide [CO] poisoning in the west of Iran and specify potentially presentable characteristics. Observational study. Imam Khomeini Hospital of Kermanshah, Iran, from July 2006 to March 2008. This study was conducted using the records of 143 cases of CO poisoning referred to the only centre for the reference of poisoning cases. Intent, age groups, source of poisoning and clinical presentation were noted and described as frequency. One-hundred forty two cases [99.3%], were accidental and only one case [0.7%] was suicidal. Mortality was [21.7%, n=31]. The highest mortality was found in the age groups of 20-30 years and below 10 years. The greatest frequency happened in autumn and winter. The clinical symptoms and manifestations of CO poisoning included headache [35.3%], nausea [25.4%], vomiting [21%], dyspnea [10.3%], and decrease in level of consciousness [8%]. Gas water heaters [35%], room heaters [32%], stoves [24%] and other items [9%] were the principal sources of the individuals' exposure to CO. CO poisoning is a serious public health problem in west of Iran [Kermanshah]. The number of CO poisoning cases was highest in the colder seasons of the year, whereas the majority of the poisoning cases could be prevented

Prophylaxis for deep venous thrombosis: knowledge and practice of surgeons

Despite high incidence [10%-80%]] for venous thromboembolism [VTE] after surgery, many report show suboptimal risk assessment and inadequate prophylactic measure for this condition. The aim of this study was to determine knowledge, attitude and practice of surgeons about deep venous thromboembolism [DVT] prophylaxis. The knowledge and attitude of faculty member surgeons working in Kermanshah University of Medical Sciences were evaluated using a questionnaire. In addition, their practice was assessed by reviewing the hospital chart of 4105 patients who had elective or emergency surgery. Patients were categorized based on claget criteria into high, moderate and low risk for DVT. Mean knowledge score was 9.05 +/- 1.07 [82.3% of best predicted] and for attitude was 21.9 +/- 2.78 [73.1% of best predicted]. There were no statistical significant differences between surgical clinical groups. Nearly all of surgeons believed that use of low dose heparin was dangerous. Type of prophylactic measure was only low dose heparin. Only 9 [3.2%] patients from high risk group and 9 [1.08%] patients from moderate risk group received prophylactic treatment and no one from low risk group for DVT received prophylaxis. Degree of under use of prophylactic measure for DVT is higher in this study as to compare with other investigations. Increased awareness about optimal prevention and outcomes is needed. It is highly recommended that all patients undergoing surgery must be routinely assess for preoperative risk for DVT and consider aggressive prophylactic measure against this condition