Twenty years of breast cancer in Iran: downstaging without a formal screening program.

BACKGROUND: breast cancer (BC) is the most common malignancy among Iranian women. Although the relative incidence of BC is low, the cause-specific mortality is much higher than developed countries. The present study surveyed the overall trend of BC in Tehran. PATIENTS AND METHODS: all breast pathologic records were studied in five major hospitals in Tehran during three phases (1: 1985-1995; 2: 1996-2000; and 3: 2001-2005). Malignant cases were classified according to the tumor-node-metastasis classification. Data were compared across the study. RESULTS: Of 9050 medical records from male and female patients with 'breast disease', 2946 females with BC were included. A significant increase in the diagnosis of palpable early BCs (stage II increased, stage III decreased) was observed between phases 1 and 2. A relative increases in stages 0 and I were noted between phases 3 and 2. Nevertheless, 76.8% of cases were T2 or higher and 65.3% had positive lymph nodes in the last phase. The proportion of patients with stage IIIb was increased in phase 3, despite the reduction in phase 2. CONCLUSIONS: despite the relative improvement in the status of BC patients, the vast majority are diagnosed in advanced stages. Specific screening measures should be implemented in Iran.

Injury epidemiology in Kermanshah: the National Trauma Project in Islamic Republic of Iran.

In a cross-sectional study, all trauma patients hospitalized for 24 hours or more over a 4-month period in Taleghani hospital, the only referral teaching centre in Kermanshah city, were studied (n = 779). Mean age was 34.7 (standard deviation 19.9) years. Male, unemployed and illiterate patients predominated. Road traffic accidents, falls and interpersonal violence were the most common mechanisms of injury. Among road traffic accident victims, pedestrians were the most vulnerable group. A total of 7.8% of patients died, mostly due to head injuries (78.7%). Our findings also showed the importance of head trauma as the main anatomical site of injury.

Injury epidemiology in Kermanshah: the National Trauma Project in Islamic Republic of Iran

In a cross-sectional study, all trauma patients hospitalized for 24 hours or more over a 4-month period in Taleghani hospital, the only referral teaching centre in Kermanshah city, were studied [n = 779]. Mean age was 34.7 [standard deviation 19.9] years. Male, unemployed and illiterate patients predominated. Road traffic accidents, falls and interpersonal violence were the most common mechanisms of injury. Among road traffic accident victims, pedestrians were the most vulnerable group. A total of 7.8% of patients died, mostly due to head injuries [78.7%]. Our findings also showed the importance of head trauma as the main anatomical site of injury

Occupational exposure to body fluids among healthcare workers: a report from Iran.

INTRODUCTION: Healthcare workers (HCWs) are at substantial risk of acquiring blood-borne infections through contact with body fluids of patients. The main objectives of this study were to determine the epidemiological characteristics and risk factors of the occupational exposures to body fluids. METHODS: This cross-sectional study was conducted from December 2004 to June 2005 among HCWs from three University hospitals in Tehran, Iran, who had the potential for high risk exposures during the year preceding the study. RESULTS: Of 900 HCWs studied, 391 (43.4 percent) had at least one occupational exposure to blood and other infected fluids. Overall, 476 exposures had occurred (0.53 exposures per person-year). The highest exposure rate (per person-year) was observed among housekeeping staff nurses (0.78) and nurses (0.63), and occurred most commonly in the medical wards (23.0 percent). HCWs with a working experience of more than ten years had an odds of exposure of 0.5 times compared to those with less than five years' job experience. Percutaneous injury was reported in 280 participants. The history of hepatitis B (HBV) vaccination was positive in 85.9 percent of the exposed HCWs. Hand-washing and consultation with an infectious disease specialist was reported in 91.0 and 29.0 percent of the cases, respectively. There were 72 exposures to human immunodefiency virus, HBV and hepatitis C, with exposure to HBV being the most common. In 237 of the exposure occasions, the viral status of the source was unknown. CONCLUSION: Type of job, years of experience and specific hospital wards were the risk factors for exposure.

Pattern of motorcycle-related injuries in Tehran, 1999 to 2000: a study in 6 hospitals.

We studied motorcycle-related injuries in Tehran from 23 August 1999 to 21 September 2000 in 6 hospitals. Data were obtained from the trauma registry and questionnaires completed by trained physicians. Of a total of 8500 patients with trauma injuries, 1332 were motorcyclists, with a male to female ratio of 15:1. Of these, 1226 patients were driving the motorcycle at the time of the accident and 75 were pillion passengers. Crashes involving another vehicle were the commonest kind of accident (72.5%). Helmet use was noted in only 8.6% of cases. There were 28 fatalities and head injuries were the prominent cause of death. Of those who died, none had been wearing a helmet at time of the crash. Only 2.7% of helmeted riders sustained a head injury, compared with 11.2% of riders without a helmet. The commonest musculoskeletal injury was fracture: tibial fracture with 509 cases (49.8%) comprised the largest proportion.

Pattern of motorcycle-related injuries in Tehran, 1999 to 2000: a study in 6 hospitals

We studied motorcycle-related injuries in Tehran from 23 August 1999 to 21 September 2000 in 6 hospitals. Data were obtained from the trauma registry and questionnaires completed by trained physicians. Of a total of 8500 patients with trauma injuries, 1332 were motorcyclists, with a male to female ratio of 15:1. Of these, 1226 patients were driving the motorcycle at the time of the accident and 75 were pillion passengers. Crashes involving another vehicle were the commonest kind of accident [72.5%]. Helmet use was noted in only 8.6% of cases. There were 28 fatalities and head injuries were the prominent cause of death. Of those who died, none had been wearing a helmet at time of the crash. Only 2.7% of helmeted riders sustained a head injury, compared with 11.2% of riders without a helmet. The commonest musculoskeletal injury was fracture: tibial fracture with 509 cases [49.8%] comprised the largest proportion

Patient delay in women presenting with advanced breast cancer: an Iranian study.

INTRODUCTION: Due to the lack of systematic screening programmes for early detection of breast cancer in Iran and the predominance of advanced cases, we aimed to study the extent and determinants of patient delay in women with advanced breast cancer. MATERIALS AND METHODS: In this 1-year cross-sectional study, all consecutive women with advanced breast cancer (stages IIb, III or IV) who initially presented to a university hospital were studied. RESULTS: Sixty-eight percent (136/200) of cases had delayed their first visit by >1 month and 42.5% by >3 months. The median patient delay was 12 weeks. Delay was associated with: older age, being married, lower income, less education, place of residence (small cities), negative family history of breast cancer, belief in the fatality of breast cancer, lack of access to health care services, lack of knowledge of breast cancer symptoms, and denying the importance of breast self-examination. The main reasons given for the delay were: lack of knowledge regarding the necessity of such a visit, fear, negligence, lack of access to physicians, and poverty. DISCUSSION: In contrast to some other studies, this study found that married women and those with a negative family history of breast cancer waited longer than others before seeking care. Public education initiatives focused on encouraging women (especially high-risk groups such as older women, married women, and those living in small cities or villages) to see a doctor promptly for evaluation of breast symptoms can decrease delay and improve patient outcome.

Injuries caused by falls from trees in Tehran, Islamic Republic of Iran.

Although falls from trees are rare, the consequences can be severe. Over 13 months in 6 hospitals in Tehran 49 (0.57%) of 8500 registered trauma patients had fallen from trees. The mean age was 31 years (range 6 to 74 years) and 21 (42.9%) were aged < 20 years. Home and recreational/sports grounds were the most common sites of trauma. Most falls occurred during leisure time; only 3 (6.1%) were occupation-related. Eleven patients (22.4%) sustained a fracture of the spinal column; 2 of them became permanently paraplegic and 2 others who had severe thoracic vertebral fractures and paraplegia on first observation were transferred to other hospitals for treatment. Due to the severity of this type of injury, especially among the young, effective preventive efforts may be necessary.

Injuries caused by falls from trees in Tehran, Islamic Republic of Iran

Although falls from trees are rare, the consequences can be severe. Over 13 months in 6 hospitals in Tehran 49 [0.57%] of 8500 registered trauma patients had fallen from trees. The mean age was 31 years [range 6 to 74 years] and 21 [42.9%] were aged < 20 years. Home and recreational/sports grounds were the most common sites of trauma. Most falls occurred during leisure time; only 3 [6.1%] were occupation-related. Eleven patients [22.4%] sustained a fracture of the spinal column; 2 of them became permanently paraplegic and 2 others who had severe thoracic vertebral fractures and paraplegia on first observation were transferred to other hospitals for treatment. Due to the severity of this type of injury, especially among the young, effective preventive efforts may be necessary