Prevalence of HIV, Hepatitis B and C Virus Co-infections among Iranian High-Risk Groups: A Systematic Review and Meta- Analysis

@#Co-infection with hepatitis B and C among HIV infected patients are prevalent among high-risk populations. This meta-analysis aimed to estimate the prevalence of HIV, HCV and HBV co-infections among high-risk populations in Iran. We systematically searched the national and international electronic databases until 2016. The primary outcome was the prevalence of HIV, HBV, HCV and HIV co-infections in different high-risk populations in Iran. All English and Persian studies conducted on Iranian high-risk groups were included in the study. The review was reported based on PRISMA guidelines and data were analysed at 95% confidence level using random effect models.Overall, 916 relevant papers were recognised and 14 articles were included in the metaanalysis. The pooled estimates of HBV/HCV, HCV/HIV, HBV/HIV and HBV/HCV/HIV were 1.3% (95%CI: 0.5–2.1), 16.3% (95%CI: 1.1–31.6), 0.5% (95%CI: 0–1.4) and 0.5% (95%CI: 0.2–0.8), respectively. Based on subgroup analysis, there was a higher proportion of all co-infections from the years 2010–2016 as compared to that of the years 2003–2009. Our results highlighted that HCV/HIV co-infection in Iranian high-risk groups including injection drug users (IDUs) and prisoners is common. In addition, the increasing trend of coinfections should be considered alarming for policymakers.

Factors Associated with Cesarean Section in Tehran, Iran using Multilevel Logistic Regression Model

OBJECTIVES: Over the past few decades, the prevalence of cesarean sections (CS) have risen dramatically worldwide, particularly in Iran. The aim of this study was to determine the prevalence of CS in Tehran, and to examine the associated risk factors. METHODS: A cross-sectional study of 4,308 pregnant women with singleton live-births in Tehran, Iran, between July 6–21, 2015 was performed. Multilevel logistic regression analysis was performed using demographic and obstetrical variables at the first level, and hospitals as a variable at the second level. RESULTS: The incidence of CS was 72.0%. Multivariate analysis showed a significant relationship between CS and the mother's age, socioeconomic status, body mass index, parity, type of pregnancy, preeclampsia, infant height, and baby's head circumference. The intra-class correlation using the second level variable, the hospital was 0.292, indicating approximately 29.2% of the total variation in the response variable accounted for by the hospital. CONCLUSION: The incidence of CS was substantially higher than other countries. Therefore, educational and psychological interventions are necessary to reduce CS rates amongst pregnant Iranian women.

Prevalence of premenstrual syndrome in Iran: a systematic review and meta-analysis

Background: premenstrual syndrome [PMS] is a common disorder characterized by physical, mental and behavioral changes in the luteal phase of the menstrual cycle in the reproductive age women

Objective: the present study aimed to determine the overall prevalence of PMS in Iran by a systematic review and meta-analysis study

Materials and Methods: in this systematic review and meta-analysis, we searched international databases included ISI Web of Knowledge, PubMed/Medline, Scopus, Google Scholar, and also local databases including Iranmedex, Scientific Information Database, and Magiran for articles in English and Persian language published up to September 2016. We carried out data analysis with Stata version 11. We examined heterogeneity in the results of studies through I[2] statistics and chi- square based Q test. Also, we investigated the effects of potential heterogeneity factors in the prevalence of PMS by meta-regression

Results: we studied a total of 9147 reproductive-age women from 24 articles which entered to meta-analysis. Based on the result of random effect model, we estimated the overall prevalence of PMS 70.8% [95% CI: 63.8-77.7]. The results of subgroup analysis revealed that prevalence of PMS was 80.4% [95% CI; 66.9-93.9] among high school students, 68.9% [95% CI; 59.2-78.6] among university students, and 54.9% [95% CI; 51.6-58.2] in general population. Univariate meta-regression model showed that prevalence of PMS was decreased by increasing the age of subjects but this was not statistically significant [p=0.155]

Conclusion: our finding showed that PMS was prevalent in Iranian reproductive age women especially among high school students. More epidemiological research for determining factors that affect PMS prevalence seems essential

Determinants of the grade A embryos in infertile women; zero-inflated regression model

Objective: In assisted reproductive technology, it is important to choose high quality embryos for embryo transfer. The aim of the present study was to determine the grade A embryo count and factors related to it in infertile women

Materials and Methods: This historical cohort study included 996 infertile women. The main outcome was the number of grade A embryos. Zero-Inflated Poisson [ZIP] regression and Zero-Inflated Negative Binomial [ZINB] regression were used to model the count data as it contained excessive zeros. Stata software, version 13 [Stata Corp, College Station, TX, USA] was used for all statistical analyses

Results: After adjusting for potential confounders, results from the ZINB model show that for each unit increase in the number 2 pronuclear [2PN] zygotes, we get an increase of 1.45 times as incidence rate ratio [95% confidence interval [CI]: 1.23-1.69, P=0.001] in the expected grade A embryo count number, and for each increase in the cleavage day we get a decrease 0.35 times [95% CI: 0.20-0.61, P=0.001] in expected grade A embryo count

Conclusion: There is a significant association between both the number of 2PN zygotes and cleavage day with the number of grade A embryos in both ZINB and ZIP regression models. The estimated coefficients are more plausible than values found in earlier studies using less relevant models

Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes / 한국역학회지

OBJECTIVES: Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. METHODS: In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients' diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders. RESULTS: After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09). CONCLUSIONS: Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.

Prevalence of infertility problems among Iranian infertile patients referred to Royan institute

Background: Few studies have been conducted on the infertility problems in Iran. This study aimed to investigate the prevalence of infertility problems and related factors in Iranian infertile patients

Materials and Methods: In this cross sectional study, 405 infertile patients referred to Royan Institute, Tehran, Iran, between 2014 and 2015, were selected by simple random sampling. Participants completed the Fertility Problem Inventory [FPI] including 46 questions in five domains [social concern, sexual concern, relationship concern, rejection of parenthood, and need for parenthood]. Mean difference between male and female was verified using independent-samples Student's t test. A generalized linear model [GLM] was also used for testing the effect of variables on the fertility problems. Data was analyzed using Stata software version 13

Results: The mean age [SD] of participants was 31.28 [5.42]. Our results showed that 160 infertile men [95.23%] were classified as very high prevalence of infertility problems. Among infertile women, 83 patients [35.02%] were as very high prevalence of infertility problems, and 154 patients [64.98%] were as high prevalence. Age [P<0.001], sex [P<0.001], a history of abortion [P=0.009], failure of previous treatment [P<0.001], and education [P=0.014] had a significant relationship with FPI scores

Conclusion: Bases on the results of current study, an younger male with lower education level, history of abortion and history of previous treatments failure experienced more infertility problems

effect of ambient temperature and exercise to the level of exhaustion on heat shock protein and C-reactive protein plasma levels on male athletes

The increase in the amount of heat shock protein and C-reactive protein occurring as a result of stress was done with the aims of returning cell homeostasis, successful restoration of cell injury and protection of cell against more injuries. Fifteen climber and 15 non athlete subjects were chosen. A selected aerobic test was done by the subjects using Monark bicycle under two different conditions. Before starting the test, the subjects were exposed to a normal condition with the temperature of 24 +/- 2[degree]C for an hour and a blood sample was taken from all the subjects. Then immediately, the subjects took the selected aerobic test to the level of exhaustion and blood sample was taken again. A week later, these subjects were exposed to a heated environment with the temperature of 38 +/- 2[degree]C, followed by blood sample taking. Finally, the test was done by the subjects to the level of exhaustion and the last blood sample was taken. Then, the amount of heat shock protein [HSP] and C - reactive protein [CRP] in blood samples was measured. A meaningful difference was observed in the changes of heat shock proteins [p=0.012] and C-reactive protein [p=0.02] between athlete and non athlete subjects. There was no meaningful difference in CRP and HSP in normal and hot condition for non athlete subjects before and after the test. But the result of the study demonstrates that There was a meaningful difference for athletes in both conditions before and after the test [p=0.002]. Based on the study, it is claimed that while an athlete is exposed to several stressful conditions [e.g. high temperature and physical exercise], compared to a non athlete, the reaction of his body cells is more significant in order to prevent the injury

[ study of the association between oral temperature and sleepiness among night-shift workers in a glass industry]

Night-shift work has adverse effects on workers' health, productivity, and occupational safety. Night workers have complaints about sleepiness, decreased performance, and sleep disorders, due to disruption of circadian rhythm function. This research aimed to determine the level and process of sleepiness among night workers of a hot industry and evaluate its correlation with oral temperature. This study was performed as a cross-sectional study on 80 night-shift workers who were exposed to heat. The sleepiness level of the subjects was measured by Stanford Sleepiness Scale and their oral temperature were recorded at different hours [from 22 pm to 4 am] for two consecutive nights. Data analysis was performed using independent and paired t-tests, one-way ANOVA, repeated measures ANOVA, and Pearson correlation coefficient. The significance level was considered to be p<0.05. In this study, an increasing linear trend over time was obsereved for sleepiness index [p<0.001]. The mean of oral temperature had an increasing trend from 11 pm to 1 am and a decreasing trend afterward [p<0.001]. Also, the mean sleepiness index in the measurement hours of the second night was higher than that of the first night [p<0.001], but, the mean oral temperature in the second night was onsistent with the results obtained in the first night. The sleepiness index among night-shift workers was significantly decreased with increasing oral temperature [r=0.24, p=0.03]. According to the findings of this study, there was an inverse correlation between sleepiness and oral temperature after a few hours of exposure to heat. In this study, sleepiness symptoms were subjectively recorded based on the workers' self-expression; therefore, it is suggested that paraclinical trials, such as hormonal assessments be considered

[ epidemiology of gastrointestinal cancers [Stomach, esophageal, colorectal] In Markazi province during 2005-2010]

Introduction and Aims: cancer is the third leading cause of death after Coronary Artery Disease and accidents in Iran. This Research has been carried out to Study the epidemiology of gastrointestinal cancers [Stomach, esophageal, colorectal] in Markazi province during 2005-2010

Methods: this is an analytical cross-sectional study that was carried out on cancer registry data collected from Markazi province between 2005-2010 years. Cancer incidence adjusted based on the age structure and agespecific incidence rates were calculated

Results: most statistics on the Morbidity of gastric cancers in the study was 642 patients [51.2] that associated with gastric cancer and after which the CRC 444[35.4%] patients and esophageal numbers of 169 [13.5%] patients. in this study 61.8 % [801 patients] of cases in the age group 80-70 years, male, 387 cases [30.8%] and the highest 77.1% living in urban areas has been observed in terms of location. mean age at estimated time of diagnosis was 69 years. Rates age standardized incidence of digestive cancers in males and female was 141.04 and 73.39 respectively

Conclusion: identification of risk factors and prevention of gastrointestinal cancers in Markazi province is required. Training programs related to the prevention of cancer in people at high risk should be presented

[Epidemiology of prostate cancer in Markazi province in 2005-2010]

Background and Aims: prostate cancer is one of the most common cancers among men, that is increasing in incidence and mortality. Considering the epidemiologic trend of prostate cancer, the aim of this study was to investigate the incidence of prostate cancer in the years 2005-2010 in Markazi Province

Methods: in this analytical study, which data was derived from the Cancer Registry of Markazi Province, crude incidence per 100 thousand persons and age-standardized incidence in the method of direct standardization using the world standard population were calculated. Data Analysis was conducted using the Cochran-Armitage and winpepi software version 2.1

Results: in this study among 182 patients with prostate cancer in 2005-2010, 144 patients [%79] inhabited in city and others in rural. Regarding age, 16 persons [%8.8] were between 50-60 and majority 84[%46] were 70-80 years old. In the 6- year study, 182 cases of prostate cancer were recorded. Age-standardized incidence rate during the years 2005 to 2010 was respectively: 3.24, 3, 3.44, 5.05, 5.75, and 5.61 cases per hundred thousand people which show an increase in the disease. The highest observed incidence in the age group was above 70

Conclusion: the standardized incidence rate of prostate cancer in Markazi province in comparison with the world, particularly developed countries, is much less that can be due to lack of screening programs or the incomplete records

[Social factors contributing to violence against women by their partners in Shahid Fayazbakhsh hospital in 2012]

Introduction and Aims: violence against women is a social problem that negatively affects other health priorities, such as maternal and child health and mental health. This study aimed to assess the prevalence of abuse and social factors affecting women who admitted to Shahid Fayazbakhsh Hospital in 2012

Materials and Methods: in this cross-sectional study that was carried out on 100 women who referred to Shahid Fayazbakhsh Hospital of Tehran in 2012, gathered data with questionnaire and interview, finally was analyzed by SPSS software

Results: the most common forms of abuse were verbal abuse, emotional, physical and social. Violence against women was much in older [P=0.01]. There was not significant relationship between education and violence [P=0.182, r=0.10]. The number of children and levels of violence in the family have not a significant correlation [P=0.524]. A significant relationship between income and violence against women was observed [P=0.003]

Conclusion: the results showed that many of women in this study were influenced by a variety of misconduct. With respect to factors that influence this problem seems increasing awareness and life skills training to women and girls to repel the couple abuse, can take steps to reduce this problem

Epidemiology of cancer of liver and intrahepatic bile ducts based on fars province cancer registry's data, [2001-08]

Liver cancer is the fifth most common cancer in men and seventh most common cancer in women. This study aims at analyzing epidemiologically the liver and bile duct cancer in Fars province during 2001 to 2008. In this epidemiological study, the crude incidence rate [CIR] was measured per 100,000 people and the liver cancer's age-standardized incidence rate [ASR] was measured using direct standardization and world's standard population. Out of 344 registered liver cancer cases, 54.4% were men and 45.6% were women. The ASR of liver cancer in 2008 was estimated 3.4 cases per 100,000 which has a significant ascending trend [p=0.001]. The ASR in this study shows that like other countries in West Asia, Fars Province is categorized as a region with low incidence rate

Dietary and physical activity pattern in Fars province, national plan of chronic disease risk factor surveillance

Changes in lifestyle, especially in different aspects of nutrition and physical activity, have been associated with change in the patterns of diseases, from contagious diseases to non-communicable diseases, and with the prevalence of chronic diseases. Accordingly, this study is carried out within the framework of National Plan to Care for Risk Factors of Non-communicable Diseases with the aim of comparing the dietary patterns and physical activity of people under study in Fars province during 2006-2007. Using the WHO Step-by-step Evaluation Model for Risky Factors, the present study determined fifty 20-person clusters, totally 1,000 people within the age group of 15-64 for each year as the research population. After identifying the applicable people, they were visited at their homes and the questionnaires were filled out for them. The necessary analysis was carried out using Version 6 of EPI-info and Version 10 of STATA software. The findings of the present study indicated that men have more intense physical activity than women [p=0.001]. The results also indicated a significant increase in consumption of fruit [p=0.01], vegetable [p=0.001], and fish [p=0.001] in 2007 as compared with 2006. The average number of the consumed vegetable units in women was higher than that of men [p=0.01]. The findings of this study indicated that the average number of daily consumed units of fruit and vegetable as well as the frequencies of fish consumption per week was lower than the recommended amounts

Survival rate of childhood leukemia in Shiraz, southern Iran

Leukemia is the most prevalent type of cancer in children. The aim of this study Was to estimate the 5-year survival rates of Acute Lymphoblastic Leukemia [ALL] and Acute Myeloblastic Leukemia [AML] as well as factors influencing them. This is a nonrandomized retrospective study conducted on 280 patients with ALL and AML. They were all below 15 years old children admitted to Shahid Faghihi hospital, Shiraz, Iran from 2004 to 2008.The survival rates were estimated by applying the Kaplan-Meier method. In addition, the log rank test was used to estimate the statistical significance of differences in the survival probability. Cox regression model was applied to conduct multivariate analysis for adjusting confounding variable. All analyses were performed in SPSS statistical software [version 16]. P-values less than 0.05 were considered as statistically significant. The mean [ +/- standard deviation] of the observation period was 28.2 +/- 16.1 months. In this period, 50 [24.7%] patients [47 ALL and 15 AML] passed away. The cumulative rate of survival in this study was 53.3 +/- 0.1 percent. This probability was 56.6 +/- 0.1% and 44.2 +/- 0.1% for ALL and AML patients, respectively, which indicates no statistically significant difference between them [P=0.8]. According to Cox model, there was a significant relationship among the variables of platelet count and relapse with the survival rate. Platelet count was identified as a positive prognostic factor of the survival rate in ALL patients. However, on the base of our results and other studies, incidence of relapse and the number of relapses are significant factors of survival rates of leukemia

Incidence of breast cancer in Fars province, southern Iran: a hospital-based study

Breast cancer is still considered as one of the most common female cancers worldwide regardless of the countries' level of development. This study determines the incidence of breast cancer in Fars Province, Southern Iran. This study used patients' records from Shiraz University of Medical Sciences Cancer Registry Centre, which is a Hospital- Based Registry of Nemazee Hospital. Data were recorded based on International Classification of Diseases for Oncology [ICD-O] and compromised all invasive cancers in ICD-10 categories of C- 00 to C-80. The findings were shown as the number of cases by site [ICD-10] and gender, with crude incidence [CRs], agespecific incidence and age-standardized incidence rates [ASRs] per 100,000 persons per year, performed by direct method using the world standard population. The age group of 40-49 years had the highest rate of breast cancer and naturally most cases were post-menopause ones. Most cases were diagnosed in moderate differentiated state with an increasing trend. Early diagnosis of in situ neoplasms has not increased over time in comprised with malignant cases. The number of diagnosed cases has sharply increased after year 2004 especially during post-menopause period. As the number of diagnosed cases has increased during postmenopausal period, screening and health programs seem necessary for menopause women

introduction to common systematic errors in medical research

Considering the continuous increase in number of published articles by Iranian researchers in recent years, the matter of quality in design, implementation, analysis and publication of articles is receiving its relevant attention. Of issues in quality of articles and studies are methodological errors. There are different kinds of errors that a researcher may fall into during various phases of a study. Of these errors systematic ones [or biases] can be counted. In this paper we aim to shortly introduce various sorts of biases that might happen in medical research. These biases are of two categories; selection and information biases.

Graft survival rate in pediatric renal transplantation: a single center experience

Renal transplantation is the best option for treatment of the end-stage renal diseases and has more advantages than dialysis. The objective of this study was to determine the ten-year graft survival rate of renal transplantation and its contributing factors among a group of Iranian patients aged 18 years or younger. In a retrospective cohort we aimed to study the ten-year graft survival rate of renal transplantation and its contributing factors among pediatric patients who have been transplanted from March 1999 to March 2009 in Shiraz Namazi Hospital Transplantation Center, southern Iran. Kaplan-Meier method was used to determine the survival rate, log rank test to compare survival curves, and Cox regression model to determine hazard ratios and to model variables affecting survival. The 1, 3, 5, 7 and 10 year-graft survival rates were 96.8, 88.8, 82.8, 78.1, 78.1 percent, respectively. Cox regression model revealed that the duration of hospitalization was one of the important factors in graft survival rate in renal transplantation. In this study, the 10 year-graft survival rate for pediatric renal transplantation was 78.1%. Graft survival was significantly related to hospital stay after the operation. Donor source, cold ischemia time, immunosuppressive drugs regimen, time to diuresis, and cause of ESRD did not influence the survival rate.

[Satisfaction of outpatients referring to teaching hospitals clinics in Shiraz, 2009]

Objective[s]: To determine satisfaction level of out patients in teaching hospitals clinics in Shiraz city. This was a cross- sectional study that carried out on 1175 outpatients in teaching hospitals in Shiraz in 2009

Methods: The data were collected by using questionnaire by interviewing patients. The questionnaire had 17 questions in 4 scopes including satisfaction of therapeutic services, non therapeutic services, and quality of offered services and length of wait time, facilities and physical environment. Statistical analysis was performed by using SPSS software in 5% probability level

Results: The general amount of satisfaction of services was reported low by 45.4% of patients, medium by 16.9% of patients and good by 37.6% of outpatients. The average of patients' satisfaction in Dastgheib hospital significantly was higher than other hospitals. The olds significantly were more satisfied with services. Women significantly were more satisfied than men

Conclusion: By increasing the level of education the amount of satisfaction decreased significantly. High percent of patients who are dissatisfied with outpatient services can be caused patients' weak cooperation, quitting the process of treatment, wasting of resources and damaging hospital fame. So it is necessary to be emphasized on increasing the level of outpatients' satisfaction by hospital managers

[ trend of lung cancer incidence rate based on Fars Province cancer registry's data, 2001-2008]

Objective[s]: To determine the trend of crude and age standardized incidence rate of lung cancer in Fars province, southern Iran, from 2001 to 2008. In this epidemiological study, using Fars province cancer registry data the incidence rates were calculated per 100,000 people a year and age standardized incidence rate was performed by direct method using the world standard population

Methods: Data were analyzed by SPSS, version 16 and Microsoft Excel version 2007. Out of 743 lung cancer cases, 72 percent were male and 28 percent were female

Results: The results showed that through an eight-year period the age standardized incidence rate has increased 3.9 times from 1.5 in 2001 to 5. 9 in 2008 per 100,000 people a year. Also, the lung cancer incidence rate in Fars province exhibited an increasing trend and proved to be higher in male and elderly age groups

Conclusion: According to the results, Fars province considered as low incidence rate area in terms of age standardized incidence rate of lung cancer