Methylene blue for treatment of hospitalized Covid-19 patients: a randomized, controlled, open-label clinical trial, phase 2

ABSTRACT Background: There is no pharmacological intervention on the treatment of hypoxemia and respiratory distress in COVID-19 patients. Objective: The objective of the study was to study the effect of the reduced form of methylene blue (MB) on the improvement of oxygen saturation (SpO2) and respiratory rate (RR). Methods: In an academic medical center, 80 hospitalized patients with severe COVID-19 were randomly assigned to receive either oral MB along with standard of care (SOC) (MB group, n = 40) or SOC only (SOC group, n=40). The primary outcomes were SpO2 and RR on the 3rd and 5th days. The secondary outcomes were hospital stay and mortality within 28 days. Results: In the MB group, a significant improvement in SpO2 and RR was observed on the 3rd day (for both, p < 0.0001) and also the 5th day (for both, p < 0.0001). In the SOC group, there was no significant improvement in SpO2 (p = 0.24) and RR (p = 0.20) on the 3rd day, although there was a significant improvement of SpO2 (p = 0.002) and RR (p = 0.01) on the 5th day. In the MB group in comparison to the SOC group, the rate ratio of increased SpO2 was 13.5 and 2.1 times on the 3rd and 5th days, respectively. In the MB group compared with the SOC group, the rate ratio of RR improvement was 10.1 and 3.7 times on the 3rd and 5th days, respectively. The hospital stay was significantly shortened in the MB group (p = 0.004), and the mortality was 12.5% and 22.5% in the MB and SOC groups, respectively. Conclusions: The addition of MB to the treatment protocols significantly improved SpO2 and respiratory distress in COVID-19 patients, which resulted in decreased hospital stay and mortality. ClinicalTrials.gov: NCT04370288

Impact of propranolol on preventing renal dysfunction in patients with cirrhosis

Background: One of the earliest diagnostic signs of hepatorenal syndrome in patients suffering from liver cirrhosis is an increase in the renal vascular resistive index [RI]. In this study, the impact of propranolol on decreasing this index and to postpone the probability of hepatorenal syndrome has been investigated

Methods: In the current research, 30 patients with liver cirrhosis with different age and sexes have been enrolled. Demographic data and complete medical history have been collected using a specific questionnaire. At first, renal artery Doppler ultrasonography was performed to determine the RI. The patients were then treated with propranolol, and under supervision, the dose of the drug was increased gradually every 3 to 5 days to reach the target of 25% decrease in resting heart rate. One month after reaching the target dose of the medicine, Doppler ultrasonography was repeated for the patients and the second RI was compared with the pretreatment ones

Results: According to our results after treatment with propranolol, a significant decrease of RI was observed [p < 0.01]. However, there was no significant difference in the glomerular filtration rate [GFR] before and after treatment with propranolol [p = 0.290]. In our study, we found that administering propranolol was associated with significant changes in RI and GFR between the patients with compensated and decompensated cirrhosis [mean change: -0.005 +/- 0.017 vs. -0.058 +/- 0.045; p < 0.01 for RI and -4.226 +/- 17.440 vs. 13.486 +/- 12.047; p < 0.01 for GFR in patients with compensated and decompensated cirrhosis, respectively]

Conclusion: Propranolol reduces renal vascular RI in patients with cirrhosis. The response rates in the patients with decompensating cirrhosis were significantly higher than the patients with compensating cirrhosis

Models predicting success of infertility treatment: a systematic review

Background: Infertile couples are faced with problems that affect their marital life. Infertility treatment is expensive and time consuming and occasionally isn't simply possible. Prediction models for infertility treatment have been proposed and prediction of treatment success is a new field in infertility treatment. Because prediction of treatment success is a new need for infertile couples, this paper reviewed previous studies for catching a general concept in applicability of the models

Methods: This study was conducted as a systematic review at Avicenna Research Institute in 2015. Six data bases were searched based on WHO definitions and MESH key words. Papers about prediction models in infertility were evaluated

Results: Eighty one papers were eligible for the study. Papers covered years after 1986 and studies were designed retrospectively and prospectively. IVF prediction models have more shares in papers. Most common predictors were age, duration of infertility, ovarian and tubal problems

Conclusion: Prediction model can be clinically applied if the model can be statistically evaluated and has a good validation for treatment success. To achieve better results, the physician and the couples' needs estimation for treatment success rate were based on history, the examination and clinical tests. Models must be checked for theoretical approach and appropriate validation. The privileges for applying the prediction models are the decrease in the cost and time, avoiding painful treatment of patients, assessment of treatment approach for physicians and decision making for health managers. The selection of the approach for designing and using these models is inevitable

Modified natural cycle frozen-thawed embryo transfer in patients with repeated implantation failure: an observational study

Background: Natural endometrium in Frozen-thawed Embryo Transfer [FET] may have some benefits upon implantation in patients with Repeated Implantation Failure [RIF]. It might be due to possible differences between natural and stimulated endometrial growth factors and cytokins secretions

Objective: The objective of this study was to compare the pregnancy rate of FET on modified natural cycle versus hormone replacement therapy [HRT] cycle endometrium in patients with RIF

Materials and Methods: In this observational study the pregnancy rate of patients with RIF undergoing day 3 FET in natural cycle endometrium [group 1, n=56], were compared with another group of patients with RIF in whom frozen-thawed day 3 embryos were transferred on HRT cycle [group 2, n=52]

Results: The pregnancy rate in group 1 was 41.07%, compared with the pregnancy rate of group 2; 36.5% [p=0.63]. The abortion rate was not significantly different among the groups

Conclusion: It can be concluded that FET in a modified natural cycle is comparable with HRT cycle in patients with RIF

[ efficacy of nardostachys jatamansi root on pre-operative anxiety in orthopedic surgery]

Introduction and Aims: Anxiety has a negative effect on wound healing and tissue repair. Energy expenditure during mental and physical stress of anxiety can lead to prolonged hospital stay and delayed in discharge. One method of reducing anxiety is the use of medicinal plants, in this study efficacy of Nardostachys jatamansi root extract versus oral diazepam on pre-operative anxiety in orthopedic surgery is used

Materials and Methods: This study was a randomized clinical trial on 60 orthopedics patients in Imam Ali hospital of Bojnurd. Patients were divided to two groups 1- valerian [530mg capsules Sedamine] 2-control group. Anxiety [using addition, Berger Anxiety Inventory] and vital signs of patients were measured in orthopedic ward and operating room at the night before and the morning of surgery

Results: The results showed that before intervention, anxiety scores in the intervention group was 46.3 +/- 11.9 and in the control group was 50.2 +/- 5.0. At this stage there is no significant difference between anxiety scores between the two groups [P=0.30]. After the intervention, the mean anxiety score in the intervention group was 36.2 +/- 8.9 and in the control group was 46.9 +/- 6.1, that there is a significant difference between two groups [P=0.005]

Conclusion: Valerian improves patients' anxiety before surgery, which can be used as a good alternative to anti-anxiety drugs

Analyzing Gensini score as a semi-continuous outcome

Background: Investigators frequently encounter continuous outcomes with plenty of values clumped at zero called semi-continuous outcomes. The Gensini score, one of the most widely used scoring systems for expressing coronary angiographic results, is of this type. The aim of this study was to apply two statistical approaches based on the categorization and original scale of the Gensini score to simultaneously assess the association between covariates and the presence and severity of coronary artery disease [CAD]

Methods: We considered the data on 1594 individuals admitted to Tehran Heart Center with CAD symptoms from July 2004 to February 2008. The participants' baseline demographic and clinical characteristics were collected, and their coronary angiographic results were expressed through the Gensini score. The generalized ordinal threshold and two-part models were applied for the statistical analyses

Results: Totally, 320 [20.1%] individuals had a Gensini score of zero. The results of neither the two-part model nor the generalized ordinal threshold model showed a significant association between Factor V Leiden and the occurrence of CAD. However, based on the two-part model, Factor V Leiden was associated with the severity of CAD, such that the Gensini score increased by moving from a wild genotype to a heterozygote [beta = 0.44; 95% CI: 0.20-0.69 in logarithm scale] or a homozygote mutant [beta = 0.70; 95% CI: 0.28- 1.12 in logarithm scale]. The proportional odds assumption was not met in our data [= 54.26; p value < 0.001]; however, a trend toward severe CAD was also observed at each category of the Gensini score using the generalized ordinal threshold model

Conclusion: We conclude that besides loss of information by sorting a semi-continuous outcome, violation from the proportional odds assumption complicates the final decision, especially for clinicians. Therefore, more straightforward models such as the two-part model should receive more attention while analyzing such outcomes

Life and health satisfaction in the adult population of Iran / 한국역학회지

OBJECTIVES: Increasing interest has emerged in the use of subjective well-being as a development indicator and for the evaluation of public policies. The aim of this study was to assess life and health satisfaction and their determinants in the adult population of Iran. METHODS: We conducted a survey of a sample of 3,150 adults at least 18 years of age in Tehran, the capital of Iran. The subjects were selected using a stratified random sampling method, and they were interviewed face-to-face at their usual residence by trained interviewers. Life satisfaction was used as a measure of subjective well-being. We used ordinary least square regression models to assess the associations of life and health satisfaction with socio-demographic variables. RESULTS: On a 0-10 scale, the mean (standard deviation) scores for life and health satisfaction were 6.93 (2.54) and 7.18 (1.97), respectively. The average score for life satisfaction in females was 0.52 points higher than in males. A U-shaped relationship was found between age and life satisfaction, with respondents 35 to 44 years of age having the lowest average level of life satisfaction. Satisfaction with life and health among divorced respondents was significantly lower than among never-married and married participants. The scores for life satisfaction in respondents who rated their health status as poor were 3.83 points lower than in those who rated their health status as excellent. CONCLUSIONS: The majority of the population of Tehran was satisfied with their life and health. Self-rated health status had the greatest impact on life satisfaction.

The evaluation of Serum Copper Level in Hemodialysis Patients with and without anemia Compared with Healthy Controls.

ntroduction: Anemia is a common complication of ESRD with different etiologies. The most common cause of anemia in such patients is insufficient production of erythropoietin by kidneys. Another possible reason is copper deficiency, thus, this study is aimed to evaluate the serum copper level among hemodialysis patients with and without anemia and to compare them to healthy controls. Material and Methods: A total number of 56 patients who underwent regular hemodialysis due to their ESRD were enrolled and divided into two groups of 28 according to their Hgb results including patients with anemia (Hgb<11 gr/dl) and patients without anemia (Hgb>11 gr/dl). Also, 28 healthy individuals participated as the control group. Venous blood samples were collected from patients prior to hemodialysis. Spectrophotometry employed for copper measurements. Data were analyzed using t-test and Pearson regression analysis. Results: Mean age of patients was 44.36±15.80 years. No significant difference was present among the three groups with regarding to age and gender. Mean and SD of serum copper in patients with anemia, without anemia, and controls were 180.11±54.48, 139.66±35.57 and 155.82±42.06 μg/dl respectively. Serum copper level was significantly higher in hemodialysis patients with anemia compared with those without anemia (p<0.03). Also a significant inverse regression between serum copper and Hgb was present in all hemodialysis patients (p=0.02, r=-0.37). Conclusion: Higher levels of serum copper in anemic patients could be a result of restraining role of high serum copper on iron absorption that has a negative effect on the production of Hgb. However, complementary studies are required.

Permanent hemodialysis catheter complications in patients referred to Kashan Akhavan dialysis center from June 2013 to December 2013

Cuffed central venous catheters [CCVC]. as preferred types of vascular access for hemodialysis have several complications [e.g. infection, thrombosis, embolism, bleeding and fractures]. This study aimed to describe the complications of CCVC. In this cross-sectional study, the incidence of complications associated with CCVC in patients referred to Kashan Akhavan dialysis center was evaluated during a six-month period between June 2013 to December 2013. The census sampling method was used and patients in each dialysis session were evaluated for all catheter-related complications using the checklist. Finally, a nephrologist approved the complications. From a total of 183 patients admitted to the Kashan Akhavan dialysis center during the six months, 43 patients were enrolled with permanent hemodialysis catheters. Catheter-related infection and thrombosis were common complications. The incidence rates of catheter-related infection and thrombosis were 1.87 and 1.5 per 1,000 daily catheter use, respectively. Catheter-related infection and thrombosis are two common complications among hemodialysis patients used a CCVC. Therefore, the necessary measures should be taken to reduce these complications

Spirometric parameters: hemodialysis compared to peritoneal dialysis

Introduction: Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare pulmonary function test [PFT] results in patients undergoing hemodialysis [Hd] and peritoneal dialysis [PD]

Materials and Methods: We conducted a cross-sectional study on 50 patients with hemodialysis [HD] and 50 cases with PD who underwent PFT in Ghaem and Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s [FEV1], FEV1/forced vital capacity [FVC], forced expiratory flow 25-75% [FEF] and peak expiratory flow [PEF] were compared between the two groups of patients

Results: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the a forementioned spirometric parameters[restrictive ,obstructive pattern] [P=0.969]. However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 [r=0.381, P=0.008], FVC [r=-0.298, P=0.04], FEF 25-75% [r=0.43, P=0.003], PEF [r= 0.349, P=0.02] and FEV1/FVC [r=-0.363, P=0.01,] in the HD patients and between the patients' age with FEV1/FVC [r=0.03, P=0.02] in the PD patients

Conclusion: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function

Platelet dysfunction among patients with end stage renal diseases [review article]

Introduction and Aims: Platelet dysfunction is a major determinant of bleeding among patients with end stage renal disease [ESRD], The present article has summarized some of published articles about clinical and laboratory manifestations, pathogenesis and treatment of platelet dysfunction among these patients

Materials and Methods: Collecting current data, many studies have reviewed with key words of platelet dysfunction, bleeding and ESRD in a variety of sources such as PubMed, Scopus, and etc. Manuscripts published in English and Persian languages as full-text articles were included in our study

Results: The causes of platelet impairment among patients with ESRD are multifactorial and include anemia, accumulation of uremic toxins, von willebrand factor dysfunction and increase synthesis of prosthacyclin and nitric oxide which are platelet inhibitor

Although specific therapy is not required in patients without bleeding, however correction of platelet dysfunction is desirable among patients with active bleeding or patients who candidate for kidney or liver biopsy. Treatment options include correction of anemia, dialysis, administration of desmopressin which increase release of VIII factor and von willebrand factor multimers from endothelial cells, cryoprecipitate and conjugated estrogens

Conclusion: Excessive bleeding may occur among uremic patients in response to injury or invasive and noninvasive procedures and therefore appropriate treatment should be performed among these patients

Genetic profile variation in vaccine strains and clinical isolates of bordetella pertussis recovered from Iranian patients

Re-emergence of pertussis has been reported in Iran despite a high rate of vaccination coverage. Low efficacy of the vaccine might be due to the genetic divergence between Clinical versus vaccine strains. In the current study, the genetic profiles of Clinical isolates and vaccine strains of Bordetella pertussis [B. pertussis] were assessed by using Pulsed Field Gel Electrophoresis [PFGE]. Following phenotypic and molecular identification of isolates, XbaIdigested genomic DNA of 5 Clinical isolates, 2 vaccine strains and a Tohama I strain were analyzed by PFGE along with B. parapertussis as a control. Seven distinct PFGE profiles were found among all examined isolates/strains. In 5 Clinical isolates, 4 profiles were identified whereas the vaccine strains displayed 2 distinct profiles. The reference strain, Tohama I had a distinct profile. Vaccine and Clinical profiles had low similarity, with relatedness of approximately 40%. The genetic profiles of B. pertussis were different between circulating isolates and vaccine strains used in the national vaccination programs. Since new genetic profiles of B. pertussis can be disseminated periodically, the profiles of isolates circulating in the population should be monitored over the course of the re-emergence

Fibrinolytic therapy in CCU instead of emergency ward: how it affects door to needle time?

The door-to-needle-time [DNT] is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit [CCU]. A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. The mean time interval between arrival at the hospital and electrocardiogram [ECG] assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 +/- 53.00 min ranged 30-325 min that was significantly more than standard DNT [P<0.01]. Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital [P<0.01]. The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU

Multi-state survival analysis in renal transplantation recipients

Renal transplantation is a therapy for end-stage renal disease. During the study of recipients' survival after renal transplantation, there are some events as intermediate events that not only affect the recipients' survival but also events which are affected by various factors. The aim of this study was to handle these intermediate events in order to identify factors that affect recipients' survival by using multi-state models. This retrospective cohort study included 405 renal transplant patients from Afzalipour Hospital, Kerman, Iran, from 2004 to 2010. The survival time of these recipients was determined after transplantation and the effect of various factors on the death hazard with and without renal allograft failure and hazard of renal allograft failure was studied by using multistate models. During 4.06 years [median] of follow-up; 28 [6.9%] recipients died and allograft failure occurred in 51 [12.6%] recipients. Based on the results of multi-state model, receiving a living kidney transplantation decreased the hazard of renal allograft failure [HR=0.38; 95% CI: 0.17- 0.87], pre-transplant hypertension [HR=2.94; 95% CI: 1.54- 5.63] and serum creatinine levels >1.6 upon discharge from the hospital [HR=7.38; 95% CI: 3.87- 7.08] increased the hazard of renal allograft failure. Receiving living kidney transplantation decreased the hazard of death directly [HR=0.18; 95% CI: 0.04- 0.93]. It was concluded that the effect of donor type, pre-transplant hypertension and having serum creatinine >1.6 upon discharge from the hospital was significant on hazard of renal allograft failure. The only variable that had a direct significant effect on hazard of death was donor type

Renal fractional excretion of sodium in relation to arterial blood gas and spirometric parameters in chronic obstructive pulmonary disease

Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease [COPD] patients. There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium [FeNa] with arterial blood gas and spirometric parameters in COPD

Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals [Emam Reza, Ghaem] in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05

Results: Mean age was 65.97 +/- 10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 [P=0.005, r=0.456]. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen [P>0.05], but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia

Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD

Factors affecting the survival of patients with gastric cancer undergone surgery at Iran cancer institute: univariate and multivariate analyses

Gastric cancer is the most prevalent cancer among men and the third most prevalent cancer among women in Iran. Its most important reason for death is its belated diagnosis at the advanced stages of the disease. Various factors can be effective on the survival of these patients after surgery, which are the major concern in this study. Data from 330 patients with Gastric cancer who had undergone surgery at Iran Cancer Institute from 1995 to 1999 were analyzed. The Survival Time of patients was determined after surgery and the effect of individual and demographic; clinical and diagnostic; and treatment and post-surgical factors on patients' survival was studied. For data analysis, Kaplan- Meier, Log-Rank test and Proportional Hazards Model were used. The median of survival time was 16.33 months. The one-year, three-year, and five-year survival rates were, 0.66, 0.31, and 0.21. Based on univariate analysis results of age[P<0.001], metastases[P=0.012], disease stage[P=0.016], and number of renewed treatments[P<0.001], as well as multivariate analysis which was used to investigate the simultaneous effect of influencing variables on patients' survival showed that age[61-70:HR=1.40,>70:HR=2.08], marital status[HR=0.39], number of renewed treatments[1:HR=0.54,2:HR=0.30,3:HR=0.22], relapse[HR=1.51], type of gastrectomy [Subtotal: HR=1.12, Distal:HR=0.49, Partial:HR=0.94, Proximal:HR=0.52], liver metastases [HR=1.79], distance metastases[HR=1.84], and disease stage[II:HR=1.28,III:HR=2.12,IV:HR=1.90] variables had a significant effect on patients' survival. Patients who call on doctors in early stages of disease will have a higher survival rate due to early diagnosis whereas disease progression will increase the risk and will decrease the survival. Identifying factors affecting patients' survival and improving diagnostic methods can prevent disease progression and increase survival rate

Renal biopsy in glomerulonephritis

Glomerulonephritis [GN] is responsible for 25-30% of end-stage renal disease [ESRD] among all causes. Renal biopsy is important to determine the GN treatment method and its prognosis. In some cases, renal biopsy is required for definitive diagnosis. Biopsies were used as a diagnostic method in different disease from 1930. They were performed blindly and at bedside. Complication rate varies from 2 to 20% in different reports. Percutaneous renal biopsy is a routine diagnostic procedure in nephrology nowadays, and it should be individualized for each patient depending on their age, BMI, coagulation status and the availability of skilled radiologist. In this paper, we review image-guided renal biopsy in glomerulonephritis

[Prevalence of low mineral bone density in renal transplant recipients one year or more after transplantation]

Reduction in mineral bone density is a common complication following kidney transplantation and its adverse outcome could be minimized with well recognition and treatment. In this study we evaluated the prevalence of mineral bone density decrease in kidney recipients at least one year after the transplantation. Kidney recipients from whom transplant surgery at least a year had assed and had a good kidney function were selected. Mineral bone densitometry using X- ray energy absorptiometry was performed. The serum levels of Ca, P, Alkaline Phosphatase and Paratormone were measured and the collected data were statistically analyzed. Overall 182 patients were studied. The total rate of mineral bone density decrease was 87.4%. Osteopenia in the femoral bone was 73.6% and osteoporosis was 13.8%. In the lumbar vertebrae an osteopenia of 66.5% and an osteoporosis of 20.9% were noticed. Variance of analysis showed that there were no statistically significant differences between duration of dialysis before kidney transplantation [P=0.777, P=0.420], duration of kidney transplantation [P=0.927, 0.271], the mean of serum PTH [P=0.908, P=0.146] and calcium [P=0.348, P=0.265] in respect to densitometry of femoral bone and lumbar vertebrae. The frequency of mineral bone density reduction one year after kidney transplant in patients with a good transplanted kidney function was high

familial aggregation of cigarette smoking in Kish, Iran

Based on WHO reports, smoking is an epidemic in developing countries. One of important issues about this behavior is its distribution pattern in family members. The main purpose of this study was to evaluate if cigarette smoking had a tendency to cluster or aggregate in the families and what the determinants were. Using a multi-stage random cluster sampling approach, a household survey was conducted in Kish Island in 2009. We used the Alternating Logistic Regressions algorithm to model to show the familial aggregation. The odds ratio for the aggregation of cigarette smoking between family members was 1.63 [1.29-2.06] which increased to 1.96 [1.50-2.55] after adjustment for demographic factors. There was no significant correlation between siblings' cigarette smoking nor was between spouses but the pairwise odds ratio for parents offspring was significant. In other words, cigarette smoking in at least one of the parents increased the odds of being a smoker in offspring significantly. The study showed that the smoking behavior aggregated in families significantly. The inter-parent offspring aggregation was the main component of the familial aggregation. Higher education and age-gender interaction were determinants of smoking in the families. The programs for prevention and cessation of this behavior in the community might be more successful if they were designed in a family-based rather than an individual- based approach

Analysis of familial aggregation in total, against-the-rule, with-the-rule, and oblique astigmatism by conditional and marginal models in the Tehran eye study

The purpose was to determine the familial aggregation of the total, against-the-rule [ATR], with-the-rule [WTR], and oblique astigmatism by conditional and marginal models in the Tehran Eye Study. Total, ATR, WTR, and oblique astigmatism were studied in 3806 participants older than 5 years from August 2002 to December 2002 in the Tehran Eye Study. Astigmatism was defined as a cylinder worse than or equal to -0.5 D. WTR astigmatism was defined as 0 +/- 19[degree sign], ATR astigmatism was defined as 90 +/- 19[degree sign], and oblique when the axes were 20-70[degree sign] and 110-160[degree sign]. The familial aggregation was investigated with a conditional model [quadratic exponential] and marginal model [alternating logistic regression] after controlling for confounders. Using the conditional model, the conditional familial aggregation odds ratios [OR] [95% confidence interval] for the total, WTR, ATRs, and oblique astigmatism were 1.49 [1.43-1.72], 1.91 [1.65-2.20], 2.00 [1.70-2.30], and 1.86 [1.37-2.54], respectively. In the marginal model, the marginal OR of the parent-offspring and sib-sib in the total astigmatism were 1.35 [1.13-1.63] and 1.54 [1.13-2.11], respectively; WTR 1.53 [1.06-2.20] and 1.94 [1.21-3.13] and; ATR 2.13 [1.01-4.50] and 2.23 [1.52-3.30]. The model was statistically significant in sib-sib relationship only for oblique astigmatism with OR of 3.00 [1.25-7.20]. The results indicate familial aggregation of astigmatism in the population in Tehran adjusted for age, gender, cataract, duration of education, and body mass index, so that the addition of a new family member affected with astigmatism, as well as having a sibling or parents with astigmatism, significantly increases the odds of exposure to the disease for all four phenotypes. This aggregation can be due to genetic and/or environmental factors. Dividing astigmatism into three phenotypes increased the odds ratios