Provincial clustering of malaria in Iran between 2005 and 2014

Objective: To reveal the provincial clustering of malaria in Iran between 2005 and 2014 based on the epidemiologic factors and the climatic indicators affecting the disease. Methods: This was a descriptive-analytical study using malaria and meteorological data from the Malaria Elimination Programme of the Ministry of Health and Medical Education and National Meteorological Organization. After standardization, the aggregate data was used to produce 10-year means for each province. The data analysis included grouping the provinces with respect to factors using hierarchical clustering method and Kruskal-Wallis test to examine the difference between clusters using SPSS ver.23. Results: The hierarchical clustering stratified the provinces' in 5 clusters. Kruskal-Wallis H test revealed a significant difference in the incidence rate per 100 000 population (P=0.001), male gender (P=0.001), Iranian nationality (P=0.001), Afghan nationality (P=0.003), Pakistani nationality (P=0.001), urban residence (P=0.006), rural residence (P=0.004), autochthonous cases (P=0.007), average minimum temperature (P=0.001), average maximum temperature (P=0.007), average relative humidity (P=0.011), average pressure level (P=0.038), prevailing wind direction (P=0.023), average wind speed (P=0.031) and average precipitation sum (P=0.002) among the clusters. Conclusions: The results of this study and stratification of the provinces could help health policy makers to better manage malaria by allocating resources accordingly.

Comparison of Limberg Flap and Karydakis Flap Surgery for the Treatment of Patients With Pilonidal Sinus Disease: A Single-Blinded Parallel Randomized Study

PURPOSE: Pilonidal sinus disease is a common condition, which mostly affects young men. While various surgical techniques have been introduced for treating intergluteal pilonidal disease (IPD), controversies still exist regarding the best surgical approach. The purpose of this study was to compare the efficiency and the short-term outcomes of Limberg flap and Karydakis flap surgeries for the treatments of patients with IPD.METHODS: A total of 80 patients with IPD who had underwent either Karydakis flap (KF group: n = 37) or Limberg flap (LF group: n = 27) surgery between January 2015 and January 2016 at Imam Khomeini Hospital of Sari in the North of Iran were recruited for inclusion in this randomized, single-blind study.RESULTS: Compared to the KF group, the LF group showed faster complete wound healing, longer duration of surgery and hospital stay, larger wound size, and shorter period of incapacity for work. The overall patient satisfaction in the LF group was significantly higher than that in the KF group. The visual analogue scale score of pain was lower in the LF group than in the KF group. Also, the overall frequency of postoperative complications was higher in the KF group than in the LF group. Recurrence was reported in one patient from the KF group.CONCLUSION: Given the lower rate of postoperative complications and greater cosmetic satisfaction of patients, the Limberg flap procedure should be selected, instead of the Karydakis flap procedure, as the standard technique for treating patients with IPD.

Single-dose intravenous sodium valproate (Depakine) versus dexamethasone for the treatment of acute migraine headache: a double-blind randomized clinical trial

OBJECTIVE: Migraine headache is a chronic and disabling condition in adults. Some studies have investigated the efficacy of sodium valproate in the treatment of acute migraine, but the effectiveness and tolerability of intravenous valproate as abortive therapy remains unclear. This study aimed to evaluate the effects of sodium valproate and dexamethasone in the treatment of acute migraine. METHODS: We conducted a double-blind randomized clinical trial including 90 patients aged 18 to 65 years with acute migraine headache but no aura. Patients were randomized to receive intravenous dexamethasone (8 mg) or sodium valproate (400 mg) diluted into 4 mL of normal saline. The primary outcome measure was pain relief after 0.5, 1, 3, or 6 hours after administration. The secondary outcome criteria were the associated symptom recovery, rate of headache recurrence after 24 hours, and medication side effects. Pearson’s chi square and the t-test were employed in the data analysis. RESULTS: Of the 90 patients, 80 were investigated. The percentage of headache improvement at 0.5 hours after treatment was 55% and 67.5% in the sodium valproate and dexamethasone groups, respectively. Before-treatment and 0.5 hour after treatment pain severity visual analog scale scores were 9.05±0.90 and 3.8±3.09 in the sodium valproate group and 8.92±0.79 and 3.10±2.73 in the dexamethasone group, respectively. There were no significant intergroup differences. CONCLUSION: This randomized clinical trial showed that the intravenous injection of sodium valproate 400 mg has similar effects to those of dexamethasone for improving acute migraine headache.

Evaluation of vegf immunohistochemical expression and correlation with clinicopathologic features in colorectal cancer

Vascular endothelial growth factor [VEGF] is a signal protein produced by cells that stimulates angiogenesis and increased vascular permeability. The prognostic value of VEGF expression in colorectal cancer is unclear as shown by the discordant results still reported in the literature. This study was designed for the evaluation of VEGF expression and correlation with clinicopathologic features in colorectal cancer. In this study, 60 paraffin - embedded blocks including colorectal cancer specimens and adjacent non-neoplastic tissues were evaluated for VEGF irnmunohistochemical expression and their correlation with clinicopathologic features among the patients who admitted in Sari Imam Khomeini hospital. Among the 60 patients [30 males,30 females] 51.7% [31 cases] showed VEGF overexpression [High staining], while it was 1.7% [1 case] in adjacent normal tissue [p=0.004]. VEGF expression was correlated with stage [p-value<0.001],grade [p-value<0.001], lymph node metastasis [p-value<0.001], recurrence [p-value<0.001] and tumor size [p-value<0.001]. In other clinicopathologic parameters, no relationship with VEGF expression was seen. These findings provide further evidence for the role of VEGF in colorectal carcinogenesis. Some previous studies showed discordant results, consequently more studies with larger sample size to confirm results are recommended

Survival of patients with stomach adenocarcinoma in North of Iran

This study was proposed for estimation of survival time in patients with stomach adenocarcinoma. North of Iran has a high mortality rate of stomach adenocarcinoma. The study was historical cohort. The samples were the patients with stomach adenocarcinoma referred to Tooba Clinic between three years [2007-2010]. Survival estimates were calculated using the Kaplan-Meier method the effects of covariates on survival time were assessed by, using survival parametric regression model with gamma frailty. The survival probability of more than two years of patients was calculated 27.7% by using Kaplan Mayer method. The stage, metastasis, surgery, and age were the variables which affect the survival probability of patients, by using survival parametric regression model with gamma frailty and hazard ratio of patients with three treatment protocol was 0.43 times of others [P<0.01] and increasing of patients ages decrease life time of them significantly as per year increasing patient age, risk of death increased by 4% [P<0.04] and patients with staging disease lower 4 had hazard ratio lower than 0.46 times of stage 4 [P<0.01]. The survival time of our patients is much lower than the developed countries, which are related to latency in diagnosis and therapeutic limitations

The study of epidemiology of Tuberculosis in Bane [Kurdistan] between 2003 and 2010

Tuberculosis is a bacterial infection that is commonly caused by Mycobacterium Tuberculosis. As Kurdistan province is close to Iraq [risky due to political instability in recent years], the Bane city had high interaction with Iraq, so the aim of this study was to evaluate the prevalence of tuberculosis in Bane [Kurdistan] between 2003 and 2010. This descriptive longitudinal study was done from 2003 to 2010. The number of people with TB was 94 cases taken from the registry. The data included age, sex, type of isease, age and place of registration. The data were analyzed using descriptive and inferential statistical methods through SPSS 20 software. Among the 94 cases recorded in this analysis, the women had higher percentage than men [41.49 percent and 58.51 for men and women, respectively] and the incidence rates were found to be 7.93 in men and 11.64 in women 100000 persons; therefore, there were significant differences between men and women [a p-value <0.01] in all patients in this study. Fifty five percent were from the urban and some others the rural areas and 98.9 percent of them were from Iran. The incidence rate of tuberculosis in females is higher than males. In addition, the average delay time of symptoms to diagnosis was 191 days, so this time, it is relatively high because TB is an infectious disease. [Yazdani Charati J. Moradi M. The study of Epidemiology of Tuberculosis in Bane[Kurdistan] between 2003 and 2010. IJHS 2013; 1[1]: 8-12] http:/jhs.mazums.ac.ir

Spatial distribution of tuberculosis in Mazandaran province-Iran: spatiotemporal modeling

Incidence of Tuberculosis [TB] in Golestan province is higher than its national incidence rate in Iran [about 13 in 100, 000]. Considering the proximity of Mazandaran to Golestan this survey was conducted to determine the high risk areas in Mazandaran province. This was an observational, longitudinal, ecological study conducted during the years 1999 to 2008. Our understudy cases were 2, 444 TB patients registered in the TB center of Mazandaran province. Collected data including patients' age, gender, type of disease and residential location were analyzed using descriptive statistical methods and Nested Poisson regression models. Of 2, 444 registered patients, 1, 283 [52.5%] were males and 1, 161[47.5%] were females; among which, 61% were urban and 39% were rural residents. A total of 96.4% of them were Iranian. No significant difference was observed in TB incidence between the two genders, but incidence of TB in the cities of Tonekabon and Behshahr was 30% higher than the mean incidence rate of this province [P<0.05]. Risk of contracting TB infection was 1.46 times greater in urban compared to rural areas [95% confidence interval=1.35-1.59]. No significant difference was detected between our study results and those of similar studies conducted in Gilan and Golestan provinces. Higher incidence of TB in Behshahr and Tonekabon compared to the mean incidence of the province is indicative of the spatial correlation of the disease. Lower incidence of TB in neighboring cities might be due to delayed detection of smear-positive pulmonary TB patients