Publications by authors named "Azadeh Safaee"

39 Publications

Evaluation of endoscopic characteristics of upper gastrointestinal polyps in patients with familial adenomatous polyposis.

Asian Pac J Cancer Prev 2014 ;15(16):6945-8

Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail :

Background: Familial adenomatous polyposis (FAP) is a disease inherited in an autosomal dominant fashion. Most FAP patients develop upper gastrointestinal polyps; especially those in the antrum and duodenum are usually neoplastic. The aim of this study was to evaluate the prevalence of gastroduodenal polyps in Iranian FAP patients.

Materials And Methods: 28 patients affected by FAP underwent front-view and side-view endoscopy. Papillary biopsies were performed in all patients. Location of polyps, their number and size, pathology study, patient general information (gender, age, family history of FAP or colorectal cancer and gastroduodenal polyps) were analyzed.

Results: Gastric polyps were seen in 39.3 % of patients. Some 72.7% of the affected individuals had fundic gland polyps and 36.36% had hyperplastic polyps. Duodenal adenoma was observed in 25% of patients. While 57% of patients had tubular adenoma with low grade dysplasia, 42.8% showed tubulovillous adenoma with low grade dysplasia.

Conclusions: Findings of this study indicated that the prevalence of gastroduodenal polyps in FAP patients is high and dysplasia may be evident in duodenal polyps. Therefore, it appears that routine gastroduodenal endoscopy in FAP patients is necessary.
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http://dx.doi.org/10.7314/apjcp.2014.15.16.6945DOI Listing
June 2015

Epidemiological features of hepatitis B and C infection in a high risk population: results of screening programs.

Gastroenterol Hepatol Bed Bench 2013 ;6(3):136-40

Department of Disease Control &Prevention, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: The aim of this study was to report the epidemiological features of HBV & HCV infection in an Iranian high risk population.

Background: Hepatitis B and hepatitis C infections are worldwide serious public health problems. Iran has an intermediate prevalence of infection and a screening program was started in 2010 among high risk individuals.

Patients And Methods: This cross-sectional study was conducted on 4455 new patients during two past years. Demographic information, age, gender, occupational status, medical history, history of vaccination against HBV, high risk exposure and laboratory findings were collected for each patient. Then distribution of demographic and risk factors was evaluated in each type of hepatitis.

Results: The mean age of patients was 45.6±17.3 years. More than two-thirds of the diagnosed cases were infected with HBV. 74% of patients were carriers of hepatitis virus. 60% of patients had no symptoms at diagnosis. Illicit intravenous drug use was most common high risk exposure in patients under study (n=366, 8.2%). High risk behaviors including illicit intravenous drug use and unprotected sex were relatively higher in patients infected with hepatitis C compared to patients with hepatitis B infection.

Conclusion: Findings of this study suggest that illicit intravenous drug use, contact with an infected household member and unprotected sex are the most common high risk exposure in Iranian patients infected with viral hepatitis. Therefore, preventive strategies such as health education, vaccination and screening programs should be directed to these groups. The results also show that a majority of patients have no symptoms at the time of diagnosis, therefore periodic screening tests in high risk groups is required.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017516PMC
May 2014

Direct medical care costs associated with patients diagnosed with chronic HCV.

Hepat Mon 2013 May 28;13(5):e8415. Epub 2013 Apr 28.

Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Science, Tehran, IR Iran.

Background: HCV virus (HCV) is a significant global problem with wide-ranging socio-economic impacts. Because of the high morbidity and mortality associated with end-stage liver disease, cirrhosis, and hepatocellular carcinoma (HCC), the economic burden of HCV infection is substantial.

Objectives: This study aimed to estimate the direct medical care costs of chronic HCV infection.

Patients And Methods: For this cross-sectional study, 365 courses of HCV treatment were extracted from medical records of 284 patients being referred to Tehran HCV clinic, a clinical clinic of Baqiyatallah Research Center for Gastroenterology and Liver diseases, from 2005 to 2010. All the patients had been diagnosed with HCV. Direct medical care costs for each course of HCV treatment have been calculated based on Purchasing Power Parity Dollar (PPP$).

Results: Average direct medical costs for the courses treated with conventional interferon plus ribavirin (INF-RBV) were 4,403 PPP$, and 20,010 PPP$ for peg-interferon plus ribavirin (PEG-RBV) courses. There was an increase of the direct costs in both courses of treatment to achieve Sustain Viral Response (SVR). The costs amounted to 10,072 PPP$ in (INF-RBV) treatment and 34,035 PPP$ in (PEG-RBV). The significant difference between the costs of these two courses of treatment is attributable to high cost of Peg-interferon. This indicates that the medication costs are the dominant costs.

Conclusions: According to the results, total direct medical costs for HCV patients in Iran exceeded 12 billion PPP$ in (INF-RBV) treatment and 55 billion PPP$ in (PEG-RBV).
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http://dx.doi.org/10.5812/hepatmon.8415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736623PMC
May 2013

Quality of life outcomes in patients living with stoma.

Indian J Palliat Care 2012 Sep;18(3):176-80

Department of Surgery, Mahdieh Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran.

Background: Despite efforts to maintain the intestinal tissue and treat gastrointestinal disease, a large number of patients undergo ostomy surgery each year. Using stoma reduces the patient's quality of life (QOL) greatly. Although there are approximately 3000 patients in Iran; there is little information about the impact of stoma on their QOL.

Aims: The study aims to evaluate QOL of stoma patients using a special measurement tool.

Settings And Design: This survey was a cross-sectional study that was conducted on 102 random samples of stoma patients.

Materials And Methods: The City of Hope Quality of Life-Ostomy Questionnaire was used for collecting demographic and clinical information and evaluating QOL.

Statistical Analysis Used: Univariate and multiple regression analyses were performed to identify predictors of QOL.

Results: The mean score for the overall QOL for stoma patients was 7.48 ± 0.9. 70% of patients were dissatisfied with sexual activities. More than half of them reported feelings of depression following stoma surgery. Univariate analysis indicated that factors such as the type of ostomy (temporary/permanent), the underlying disease that had led to the stoma, depression, problem with location of ostomy, and change in clothing style had significant effects on overall QOL and its subscales (P < 0.05). The results of the regression analyses showed that only depression and problem with the location of ostomy were statistically significant in predicting patients' QOL and its subscales (P < 0.05).

Conclusions: The findings demonstrated that living with stoma influences the overall aspect of QOL. Education for the patients and their families is important for improving the stoma patients' QOL. Sexual and psychological consultation may also improve patients' QOL.
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http://dx.doi.org/10.4103/0973-1075.105687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573471PMC
September 2012

Specific count model for investing the related factors of cost of GERD and functional dyspepsia.

Gastroenterol Hepatol Bed Bench 2013 ;6(Suppl 1):S122-8

Department of Control & prevention of diseases, Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: The purpose of this study is to analyze the cost of GERD and functional dyspepsia for investing its related factors.

Background: Gastro-oesophageal reflux disease GERD and dyspepsia are the most common symptoms of gastrointestinal disorders. Recent studies showed high prevalence and variety of clinical presentation of these two symptoms imposed enormous economic burden to the society. Cost data that related to economics burden have specific characteristics. So this kind of data needs to specific models. Poisson regression (PR) and negative binomial regression (NB) are the models that were used for analyzing cost data in this paper.

Patients And Methods: This study designed as a cross-sectional household survey from May 2006 to December 2007 on a random sample of individual in the Tehran province, Iran to find the prevalence of gastrointestinal symptoms and disorders and its related factors. The Cost in each item was counted. PR and NB were carried out to the data respectively. Likelihood ratio test was performed for comparison between models. Also Log likelihood, Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) were used to compare performance of the models.

Results: According to Likelihood ratio test and all three criterions that we used to compare performance of the models, NB was the best model for analyzing this cost data. Sex, age and insurance statues were being significant.

Conclusion: PR and NB models were carried out for this data and according the results improved fit of the NB model over PR, it clearly indicates that over-dispersion is involved due to unobserved heterogeneity and/or clustering. NB model in cost data more appropriate fit than PR.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017531PMC
May 2014

Increased oesophageal cancer mortality rate in Iran.

Arab J Gastroenterol 2012 Jun 11;13(2):82-4. Epub 2012 Jul 11.

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background And Study Aims: The aim of this study is to present the mortality trends of oesophageal cancer (EC) in the Iranian population, to provide updated information regarding time trends for this cancer.

Patients And Methods: We analysed the national death statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004. EC [International Classification of Diseases (ICD-9); C15] were expressed as the annual mortality rates/100000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardised rate (ASR).

Results: The age standardised mortality rate of EC increased dramatically during the study period. EC mortality was higher for males and the mortality rate also increased with age.

Conclusion: This study provides a comprehensive projection for the burden of death due to EC, indicating that the trend of EC mortality dramatically increased in the recent decade.
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http://dx.doi.org/10.1016/j.ajg.2012.06.008DOI Listing
June 2012

Four years incidence rate of colorectal cancer in Iran: a survey of national cancer registry data - implications for screening.

Asian Pac J Cancer Prev 2012 ;13(6):2695-8

Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran.

Introduction: Design and implementation of screening programs in each country must be based on epidemiological data. Despite the relatively high incidence of CRC, there is no nationwide comprehensive program for screening in Iran. This study was designed to investigate national CRC data and help to determine guidelines for screening.

Methods: Incidence data used in this study were obtained from Iranian annual of National Cancer Registration report. Age standardized rates (ASR)were calculated using world standard population and were categorized by age, sex, anatomic subsite and morphology of tumor. Data were analyzed using SPSS.V.13 and Open Source Epidemiologic Statistics for Public Health software (OpenEpi v.2.3.1).

Results: A quarter of cases were less than 50 years of age. The majority of tumors were detected in the colon. The overall ASR in the four years period was 38.0 per 100000 and was higher for men compared women (P<0.05). Incidence rate of colorectal cancer increased with age.

Conclusion: Results of present study indicated that incidence of colorectal cancer is relatively high in Iran. Incidence of CRC in people under 50 years and in rectum were reported higher than other countries that related etiologic factors should be investigate in further studies. According to the increasing of ASR after age 50 years, it seems that onset of screening at age 50 would be appropriate.
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http://dx.doi.org/10.7314/apjcp.2012.13.6.2695DOI Listing
February 2013

Estimation of average diagnosis and treatment costs of hepatitis C.

Gastroenterol Hepatol Bed Bench 2012 ;5(3):139-45

Gastroenterology and Liver Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: The objective of this study was to estimate the average cost of diagnosis and treatment of hepatitis C among patients based on their treatment regime, during the one course of treatment and six-month after stopping that.

Background: Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide and a major public health problem.

Patients And Methods: All data for this cross-sectional study were collected from medical records of 200 patients with hepatitis C, who referred to a private gastroenterology clinic between years 2005 through 2009. Information related to the 200 patients was extracted from their medical records and finally, 77 patients of them, who their treatment was not interfering with any other disease entered in this study. Therefore diagnosis and treatment costs of these patients were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$).

Results: Mean costs of diagnosis and treatment in one course of treatment and six month after that with standard interferon plus ribavirin (INF-RBV) exceeds 3,850 PPP$ and for patients who treated with peg-interferon plus ribavirin (PEG-RIBV) was 16,494 PPP$. Also in both types of treatment, medication cost was found to be a dominant cost component.

Conclusion: Hepatitis C represents a very important and potentially costly disease to managed care organizations. Patients with this disease require expensive drug therapies and consume significant health care resources.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017475PMC
May 2014

Irritable bowel syndrome, gastro-oesophageal reflux disease and dyspepsia: overlap analysis using loglinear models.

Arab J Gastroenterol 2012 Mar 5;13(1):20-3. Epub 2012 Apr 5.

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.

Background And Study Aims: Irritable bowel syndrome (IBS), gastro-oesophageal reflux disease (GERD) and dyspepsia are three most important gastrointestinal disorders which occur frequently together in patients. This study aims to assess the association between IBS, GERD and dyspepsia by using loglinear model analysis.

Patients And Methods: This cross-sectional household survey, the purpose of which was to find the prevalence of gastrointestinal symptoms, disorders and the related factors, has been done from May 2006 to December 2007 in Tehran province, Iran. Subjects were interviewed by trained personnel. GERD was diagnosed as the experience of heartburn and/or acid regurgitation at least once a week for the last 3 months. IBS and dyspepsia were diagnosed according to the Rome III criteria. Loglinear models were applied to investigate the simultaneous association between IBS, GERD and dyspepsia.

Results: 77.9% of IBS patients had dyspepsia symptoms and 74.7% had GERD symptoms as well at the same time. As for the other two symptoms, 66% of GERD patients were also suffering from dyspepsia.

Conclusions: These three symptoms frequently overlap; the overlap is systematic and not by chance or random.
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http://dx.doi.org/10.1016/j.ajg.2012.02.005DOI Listing
March 2012

An overview of colorectal cancer survival rates and prognosis in Asia.

World J Gastrointest Oncol 2012 Apr;4(4):71-5

Bijan Moghimi-Dehkordi, Azadeh Safaee, Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran 1985711151, Iran.

Colorectal cancer is a rapidly rising trend in Asia. The incidence in many Asian countries is on par with the West. Several studies have provided data regarding the survival of patients with colorectal cancer. In Asia, the overall cure rate of colorectal cancer has not improved dramatically in the last decade, 5-year survival remaining at approximately 60%. Colorectal cancer survival time has increased in recent years, but mortality rate remains high. Although studies have determined a number of factors that can predict survival of patients after diagnosis, life expectancy has not been increased dramatically. It seems that among the prognostic factors explored so far, the most important are those that relate to early diagnosis of cancer. Primary detection is feasible since efficient screening modalities are available. Colonoscopic surveillance is needed, especially in subjects at higher risk.
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http://dx.doi.org/10.4251/wjgo.v4.i4.71DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3334382PMC
April 2012

History of upper gastrointestinal cancers in relatives: a community-based estimate.

Gastroenterol Hepatol Bed Bench 2012 ;5(2):100-5

Gastroenterology ward, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: The present study aimed to evaluate the prevalence of positive family history of these cancers in a large population-based sample of Tehran province, capital of Iran.

Background: Upper gastrointestinal (UGI) cancers (gastric and esophagus cancer) constitute a major health problem worldwide. A family history of cancer can increase the risk for developing cancer and recognized as one of the most important risk factors in predicting personal cancer risk.

Patients And Methods: This study designed as a cross-sectional survey in general population (2006-2007) of Tehran province. Totally 7,300 persons (age > = 20 years) sampled by random sampling on the basis of the list of postal, of whom 6,700 persons agreed to participate (response rate 92%). Respondents were asked if any first-degree (FDR) or second-degree (SDR) relatives had gastric or esophageal cancer.

Results: Totally, 6,453 respondents (48% male) entered to the study. The mean age of responders with positive FH was significantly higher than those with negative FH (P < 0.05). In total, 341 respondents (5.3%) reporting a history of UGI cancers in their relatives, 134(2.1%) in FDRs, and 207(3.2%) in SDRs.

Conclusion: Our findings showed that the reported prevalence of FH of UGI cancers was relatively low and varied by specific respondent characteristics such as age and sex. However, the estimates of prevalence presented here are likely to be conservative compared with actual prevalence because of self-reported data gathering.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017460PMC
May 2014

Using statistical models to assess medical cost of hepatitis C virus.

Gastroenterol Hepatol Bed Bench 2012 ;5(Suppl 1):S31-6

Baqiyatallah Research Center for Gastroenterology and Liver Disease, Baqiyatallah University of Medical Sciences, Tehran, Iran.

Aim: This study compared PR and NB in predicting HCV patient costs. The objective of this study was to predict the direct cost of the HCV patient in Iran.

Background: Hepatitis C virus (HCV) is a common and expensive infectious disease in Iran. Cost associated with HCV and its complications has not been well characterized. Analysis of cost data is important in providing consistent information to aid budgeting decisions and certain statistical regression models need for prediction mean costs. Poisson regression (PR) and negative binomial regression (NB) are more common in cost prediction study.

Patients And Methods: This study designed as a cross-sectional clinic base from 2001 to 2010. First treatment period of each patient bring in study. We evaluated the doctor visiting, drugs, and hospitalization and laboratory tests of patients. Cost per person per one treatment period estimated in purchasing power parity dollars (PPP$). The PR is one of the models from general linear models (GLM) for describing count outcomes. The NB is another model from (GLM) as an alternative to the PR model.

Results: According to Likelihood ratio test NB was found to be more appropriate than PR (P < 0.001). Genotype, marriage, medication, and SVR were being significant. Genotype 3 versus 1 decreasing cost while marriage, consuming pegasys and SVR increasing.

Conclusion: Choosing best model in cost data is important because of specific feature of this data. After fitting the best model, analyzing and predicting future cost for patient in different situation is possible.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017486PMC
May 2014

Clinical profile and post-operative lifestyle changes in cancer and non-cancer patients with ostomy.

Gastroenterol Hepatol Bed Bench 2012 ;5(Suppl 1):S26-30

Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Science, Tehran, Iran.

Aim: The aim of this was to investigate some clinical profiles and lifestyle changes in stoma patients.

Background: Stoma patients experienced multiple complications due to their ostomy formation.

Patients And Methods: A cross-sectional study performed on 102 random samples of stoma patients. Any patient with adequate physical and mental capability to participate and having had an ostomy in place for at least 3 months was eligible to enter the study. Participants asked to answer study questions concerning age, sex, type of stoma, having permanent or temporary ostomy, underlying cause of stoma formation, type of cancers cause of stoma. Patient also questioned about some lifestyle changes because of stoma including: changing diet, sexual satisfaction (if sexually active after stoma formation), sense of depression, changing job, change clothing style.

Results: Colostomy was the most common type of stoma followed by ileostomy and urostomy. In 80.4% of patients under study the stoma was permanent. Most patients had a stoma because of cancer (77.5%), with colon cancer (41.2%) being the most common malignant diagnosis. The mean age of cancer patients (56.1±10.9) with stoma was significantly higher than non-cancer patients (44.7±12.9) (p < 0.05). A significant differences were found regarding to sexual satisfaction after stoma formation between the two groups (p < 0.05) and the cancer group was less sexually satisfied post-ostomy.

Conclusion: In conclusion, stoma formation can caused multiple problems for both cancer and non-cancer patients. Counseling of patient is an important component of care that could help stoma patients to adjust with new situations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017481PMC
May 2014

Epidemiological features of gastro-esophageal reflux disease in Iran based on general population.

Gastroenterol Hepatol Bed Bench 2012 ;5(1):54-9

Department of Gastroenterology, Alexander Hospital Redditch, United Kingdom.

Aim: The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence.

Background: Gastro-esophageal reflux disease (GERD) is a common and chronic problem. Recent reports from developing countries indicate increment in the incidence and prevalence of the disease over the past.

Patients And Methods: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms.

Results: Altogether 18180 individuals participated in this cross-sectional study. The mean ± SD age of participant was 38.7±17.1 and 9072 (49.9%) were women. The prevalence of GERD was 8.85 (8.43-9.26). There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome (IBS) and uninvestigated dyspepsia (UD).

Conclusion: According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017448PMC
May 2014

Economic burden attributable to functional bowel disorders in Iran: a cross-sectional population-based study.

J Dig Dis 2011 Oct;12(5):384-92

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran.

Objective: While few population-based studies on the economic burden of functional bowel disorders (FBD) have been published from developing countries like Iran, this study aimed to estimate their direct and indirect costs for five groups of patients: irritable bowel syndrome (IBS), functional constipation (FC), unspecified-FBD (U-FBD), functional abdominal bloating (FAB) and functional diarrhea (FD).

Methods: Up to 18,180 adults randomly sampled from Tehran, Iran (2006-2007) were interviewed using two questionnaires based on the Rome III criteria to detect FBD patients and to estimate their medical expenses (such as visiting the doctor, drugs, hospitalization and laboratory tests) and productivity loss in the previous 6 months. All costs were converted to dollar purchasing power parity (PPP$) to facilitate cross-country comparisons.

Results: The mean total 6-month costs were approximately: 160, 147, 103, 96 and 42 PPP$ for IBS, FC, U-FBD, FAB and FD, respectively. The highest proportion of drug consumption was found in IBS patients. The highest mean duration of absence from work was seen in IBS patients (2.26 days). Overall, doctor visit costs accounted for approximately 1/3 of the total costs for FBD, followed by hospitalization. A higher indirect cost of illness was found in IBS (54 PPP$), whereas it was zero in FD.

Conclusion: The economic burden of FBD seems to be moderately high in Iran and it imposes a relatively heavy financial burden on the Iranian national health system because of its high prevalence and its impact on quality of life, productivity and waste of resources.
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http://dx.doi.org/10.1111/j.1751-2980.2011.00526.xDOI Listing
October 2011

Economic burden of gastro-oesophageal reflux disease and dyspepsia: A community-based study.

Arab J Gastroenterol 2011 Jun 6;12(2):86-9. Epub 2011 May 6.

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Taleghani Hospital, Tabnak Street/Yaman Avenue, Velenjak, Tehran, Iran.

Background And Study Aims: Gastro-oesophageal reflux disease (GERD) and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran.

Patients And Methods: The study was performed on a total of 18,180 adult subjects (age>18 years) taken as a random sample in Tehran province, Iran (2006-2007). A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months.

Results: GERD was found in 518 (41.9% males) patients and dyspepsia in 404 patients (38.9% males). Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively (PPP, purchasing power parity dollars). The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively.

Conclusion: According to our results, hospitalisation and physician visits were the main cost of disease that could be minimised by revision of the insurance business in Iran.
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http://dx.doi.org/10.1016/j.ajg.2011.03.005DOI Listing
June 2011

Familial prevalence of cancer in Iran: a general population estimate.

Asian Pac J Cancer Prev 2011 ;12(1):289-95

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Iran.

Background: Having a family history (FH) of cancer is recognized as one of the most important factors in predicting personal cancer risk. Since reports on cancer FH from developing countries are limited, the present study was conducted to provide a first report on the prevalence of familial cancers in Iran.

Methods: Cross-sectional analysis performed on self-reported FH of cancers based on data from a large population based study in Tehran, the capital of Iran. Each participant was shown a list of site-specific cancers and asked if a relative had been diagnosed with any cancer on the list, completing the question by specifying the age of diagnosis.

Results: Stomach cancer (4.6%) was the most common condition noted for family members, followed by the cancers of the breast (4.2%), lung (3.5%), liver (3.1%), leukemia (3.0) and colorectum (2.8%). The most frequent cancer reported by the responders was breast (1.8%) in first degree relatives (FDR) and stomach (1.8%) and stomach (2.8%) in second degree relatives (SDR). A FH of cancer was more commonly reported by younger persons and females. Of all respondents with a positive FH, 28.2% had at least one affected person diagnosed at age under 50 years in their FDRs.

Conclusion: A substantial proportion of individuals in the Iran report having a family member affected by cancer, and thus may be recommended for early cancer screening services.
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May 2012

Decreased trend of pancreatic cancer mortality in iran.

Asian Pac J Cancer Prev 2011 ;12(1):153-5

Research Center for Gastroenterology and Liver diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Pancreatic cancer is a fatal cancer with a 5-year survival of only about 4% for all tumors. There are only published data on mortality from pancreas cancer and its epidemiology in Iran. The aim of this study was to present the mortality trends from pancreatic cancer for the Iranian population, using national death statistics in order to provide update information for its burden.

Methods: National Death Statistics reported by the Ministry of Health from 1999 to 2004 stratified by age group, sex, and cause of death were included in the analysis to generate pancreas cancer (ICD-10; 25) annual mortality rates/100,000, overall, by sex and by age group (< 15, 15-49 and ≥ 50 years of age) and age-standardized rates (ASRs).

Results: The age standardized mortality rate of pancreatic cancer decreased slightly during the years under study. Values were higher for males and increased with age.

Conclusion: This study provides a projection of burden of death due to pancreatic cancer for Iran, indicating that the trend of its mortality is decreasing and may be leveling off in recent years.
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May 2012

Bloating in irritable bowel syndrome.

Gastroenterol Hepatol Bed Bench 2011 ;4(2):86-90

Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: The purpose of this study was to describe the occurrence of self report bloating and related factors in patients with irritable bowel syndrome (IBS).

Background: Bloating symptoms are common in patients with IBS and have significant impact on normal daily function.

Patients And Methods: This study was a community-based cross-sectional survey that conducted using a valid questionnaire base on Rome III criteria. Univariate analysis was used for investigation about distribution of self reported bloating according to demographic and psychological factors in irritable bowel syndrome patients.

Results: Out of 18180 subjects under study, 198 cases met criteria for the diagnosis of the irritable bowel syndrome according to criteria ROME III and 61.6% reported bloating symptoms. Bloating symptoms were more prevalent among patients with intermittent symptoms and diarrhea than in patients with constipation. Catastrophic events and depression were independent risk factors for bloating.

Conclusion: Findings of this study support the clinical impression regarding the high prevalence of bloating symptoms in patients with irritable bowel syndrome. Further studies are needed to understand the role of physiological and psychological factors and their interaction in development of bloating in irritable bowel syndrome patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017413PMC
May 2014

Characteristics of colorectal mucinous adenocarcinoma in Iran.

Asian Pac J Cancer Prev 2010 ;11(5):1373-5

Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University, Tehran, Iran.

Aims And Background: Mucinous adenocarcinoma (MA) colorectal cancer accounts for 10 to 15% of colorectal carcinoma. It is generally thought that patients with MA present at a more advanced stage of disease and have a poorer prognosis than those with other types of carcinoma. The purpose of the present study was to clarify the clinicopathological characteristics of mucinous colorectal carcinoma in the Iranian population.

Methods: Between January 2002 and March 2008, Of the 1283 colorectal cancer patients, 110 patients were considered to have mucinous tumors according to pathology report. Patients evaluated on the basis of sex, age, location of tumor, stage, differentiation of tumor and family history of cancer. Kaplan-Meier curves and log-rank tests were used for survival analysis.

Results: The median age of these patients at diagnosis was 50.07 years. More than 50% of patients were younger than aged 50 years. 34.5% of patients had a family history of colorectal cancer in their first-degree relatives. Most tumors were presented in right colon. 54.3% of MA patients had advanced stage lesions. The Kaplan-Meier method indicated that, the 1, 3 and 5 year survival rates are 92.6, 80.1 and 41.3 percent, respectively. Survival of the patients was related to disease stage (P = 0.023).

Conclusion: Our suggests that genetic factors may be play an important role in the development of this disease in our country and screening programs, especially genetic screening programs, should be considered as a main measure for prevention and control of colorectal cancer in Iran.
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October 2011

Assessment the relationship between reflux and body mass index with comparing different regression models.

Gastroenterol Hepatol Bed Bench 2011 ;4(1):23-8

Research Institute for Gastroenterology and Liver Disease, Shahid Beheshti University, M.C., Tehran, Iran.

Aim: The aim of this study was to determine whether there is relation between body mass index and symptoms of gastro-esophageal reflux disease in our community using Logit, Probit and Complementary log-log models.

Background: The most frequent statistical tool to address the relationship among a dichotomous response and other covariates is logistic regression. However logistic regression is familiar for researchers, some other models with similar results are favorable to assess such relationship like as Probit and Complementary log-log.

Patients And Methods: We carried out a population-based study to estimate the strength of the association between body mass and reflux symptoms. During interview, participants completed a valid Gastro-esophageal Reflux Questionnaire. The coefficients calculated by logistic, Probit and Complementary log-log regression with multivariate adjustments for covariates.

Results: Reflux symptoms at least once a week over the last three months were reported by 522 (9.1%) of the 5733 interviewees. There were no evidence in all models to address the significant relation between Reflux and BMI and all models derived in same efficacy.

Conclusion: Our results showed that the choice of the link function in this analysis is not the most important issue but still a user could also look forward to some other link functions like Probit and Complementary log-log.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017398PMC
May 2014

Impact of age on prognosis in Iranian patients with gastric carcinoma: review of 742 cases.

Asian Pac J Cancer Prev 2010 ;11(2):335-8

Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University(MC), Tehran, Iran. b_ moghimi_ [email protected] yahoo.com

Background: Gastric carcinoma is one of the most common gastrointestinal malignancies worldwide. Some studies have suggested that it has a worse prognosis in non-elderly than in elderly patients. The aim of the present study was to clarify whether the patient's age is an independent prognostic factor.

Methods: A total of 742 patients with gastric carcinoma, who had registered in our cancer registry center between years 2001- 2006 were reviewed to investigate the prognostic significance of age. They were divided into the following two groups: non-elderly (under 70 years) and elderly (70 years or older). The clinicopathological features were reviewed retrospectively and a multivariate analysis was carried out.

Results: Lymph node metastasis and differentiated type were more frequently observed in non-elderly than in elderly patients (P<0.0001) and older patients diagnosed with more advanced stages compared with those younger than 70 years old (P=0.015). 5-year survival rates were 27.2 and 15.2% in non-elderly and elderly patients, respectively, the difference being statistically significant (P<0.001). Multivariate analysis showed that age and wall penetration were independent prognostic factors

Conclusions: Age clinically serves as an important predictor of survival in patients with gastric carcinoma and elderly patients with gastric carcinoma have a worse prognosis than nonelderly patients.
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March 2011

Functional bowel disorders in Iranian population using Rome III criteria.

Saudi J Gastroenterol 2010 Jul-Sep;16(3):154-60

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University (M.C), Tehran, Iran.

Background/aim: To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria.

Materials And Methods: This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria.

Results: In all, 1.1% met the Rome III criteria for irritable bowel syndrome (IBS), 2.4% for functional constipation (FC), and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8% had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52%) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD.

Conclusion: This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population.
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http://dx.doi.org/10.4103/1319-3767.65183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003223PMC
November 2010

Using data reduction methods to predict quality of life in breast cancer patients.

East Afr J Public Health 2009 Apr;6 Suppl(1):39-40

Research Center of Gastroenterology and Liver diseases, Shahid Beheshti University, (M.C), Tehran, Iran.

Background: Quality of life study has an important role in health care especially in chronic diseases, in clinical judgment and in medical resources supplying. Statistical tools like linear regression are widely used to assess the predictors of quality of life. But usually existed a lot of factor cause difficulty for fitting the models and predicting. In statistical method there are different methods of data reduction that recommended.

Methods: A cross-sectional study conducted on 119 breast cancer patients that admitted and treated in chemotherapy ward of Namazi hospital in Shiraz. QLQ-C30 questionnaire was used to assessment quality of life in these patients. Principal component analyzing and factor analyzing are tow statistical method of data reduction was used for reducing the number of predictors.

Results: The mean score for the global health status for breast cancer patients was 64.92 +/- 11.42. univariate Linear regression showed that only role function, social function and diarrhea were not significant. Principal component analyzing and factor analyzing, consider all of 14 factors to 7 component and 7 factors. According to adjusted R square model fitting with reducing predictors were better than model fitting with initial predictors.

Conclusion: when there are a lot of factors existed in a model, use different method of data reduction causing better and easier model fitting and predicting.
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http://dx.doi.org/10.4314/eajph.v6i3.45772DOI Listing
April 2009

Irritable bowel syndrome: a population based study.

J Gastrointestin Liver Dis 2009 Dec;18(4):413-8

Department of Health System Research, Research Center for Gastroenterology and Liver Disease, Shahid Beheshti University (M.C), Tehran, Iran.

Background: The prevalence of irritable bowel syndrome (IBS) is relatively high, but up to now, no population based study in Iran has used the ROME III criteria. The aim of the present study was to determine the prevalence of IBS by using the ROME III criteria in the adult population of Iran.

Methods: A face to face survey was conducted in a large area of the Tehran province. IBS was diagnosed by using a validated questionnaire based on the ROME III criteria.

Results: The study population comprised 18,180 participants, with a female to male ratio of 1. 15.3% of participants complained of gastrointestinal (GI) symptoms, while the prevalence of IBS was estimated to be 1.1% (139 women, 59 men, p=0.000). IBS patients were more likely to be married, and older. The most common presenting symptoms of IBS were abdominal pain that was relieved by defecation (94%), change in fecal consistency (78%), and change in bowel frequency (70%). Constipation was predominant in 52% of IBS cases, diarrhea was predominant in 18%, and 8% experienced intermittent diarrhea and constipation.

Conclusion: The prevalence of IBS is relatively low in the Iranian adult population according to the ROME III criteria. The most probable reasons are the specificity of ROME III criteria and the characteristic low prevalence of GI symptoms in the study population.
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December 2009

Comparison of colorectal and gastric cancer: survival and prognostic factors.

Saudi J Gastroenterol 2009 Jan;15(1):18-23

Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Taleghani Hospital, Tehran, Iran.

Background/aims: Gastric and colorectal cancers are the most common gastrointestinal malignancies in Iran. We aim to compare the survival rates and prognostic factors between these two cancers.

Methods: We studied 1873 patients with either gastric or colorectal cancer who were registered in one referral cancer registry center in Tehran, Iran. All patients were followed from their time of diagnosis until December 2006 (as failure time). Survival curves were calculated according to the Kaplan-Meier Method and compared by the Log-rank test. Multivariate analysis of prognostic factors was carried out using the Cox proportional hazard model.

Results: Of 1873 patients, there were 746 with gastric cancer and 1138 with colorectal cancer. According to the Kaplan-Meier method 1, 3, 5, and 7-year survival rates were 71.2, 37.8, 25.3, and 19.5%, respectively, in gastric cancer patients and 91.1, 73.1, 61, and 54.9%, respectively, in patients with colorectal cancer. Also, univariate analysis showed that age at diagnosis, sex, grade of tumor, and distant metastasis were of prognostic significance in both cancers (P < 0.0001). However, in multivariate analysis, only distant metastasis in colorectal cancer and age at diagnosis, grade of tumor, and distant metastasis in colorectal cancer were identified as independent prognostic factors influencing survival.

Conclusions: According to our findings, survival is significantly related to histological differentiation of tumor and distant metastasis in colorectal cancer patients and only to distant metastasis in gastric cancer patients.
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http://dx.doi.org/10.4103/1319-3767.43284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2702946PMC
January 2009

Obesity and functional constipation; a community-based study in Iran.

J Gastrointestin Liver Dis 2009 Jun;18(2):151-5

Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University (MC), Tehran, Iran.

Background: Many factors have been linked to the occurrence of constipation, but few studies exist regarding the link between obesity and constipation. The aim of this study was to assess the association between body mass index (BMI) and functional constipation in the Iranian community.

Methods: From May 2006 to December 2007, a cross sectional study was conducted in the Tehran province and a total of 18,180 adult persons were drawn up randomly. One questionnaire was filled in two stages through interviews. In the first part, personal characteristics and 11 gastrointestinal symptoms were listed. Those who reported at least one of these 11 symptoms were referred for the second interview. The second part of the questionnaire consisted of questions about different gastrointestinal disorders based on the Rome III criteria including functional constipation.

Results: 459 adult persons were found to have functional constipation. The mean +/- SD of BMI was 26.5 +/- 4.7 and 60% of the patients had a BMI more than 25. Age and education were significantly associated factors with obesity, showing that older patients and less educated patients were more overweight and obese. Smoking, marital status and sex were not significantly associated with obesity but, up to 60% of low educated women who had functional constipation, had a BMI more than 25.

Conclusions: Our study showed that about 60% of patients with functional constipation were overweight, which was more than the mean of our community. In addition there may be an association between higher BMI level and the low education level with constipation in Iranian women.
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June 2009

Prognostic factors in gastric cancer using log-normal censored regression model.

Indian J Med Res 2009 Mar;129(3):262-7

Research Center for Gastroenterology & Liver Disease, Shahid Behashti University, M.C., Iran.

Background & Objective: Gastric cancer is one of the most common cancers in the world. It is rarely detected early, and the prognosis remains poor. Cox proportional hazard model is used to examine the relationship between survival and covariates. Parametric survival models such as log normal regression model can also be used for this analysis. We used log normal regression model in this study to evaluate prognostic factors in gastric cancer and compared with Cox model.

Methods: We retrospectively studied the 746 patients diagnosed with gastric cancer admitted in a referral hospital in Tehran, Iran, from February 2003 through January 2007. Age at diagnosis, sex, extent of wall penetration, histology type, tumour grade, tumour size, pathologic stage, lymph node metastasis and presence of metastasis were entered into a log normal model. Hazard rate (HR) was employed to interpret the risk of death and the results were compared with Cox regression. The AIC (Akaike Information Criterion) was employed to compare the efficiency of models.

Results: Univariate analysis indicated that with increasing age the risk of death increased significantly in both log normal and Cox models. Patients with greater tumour size were also in higher risk of death followed by those with poorly differentiated and moderately differentiated in tumour grade and advanced pathologic stage. The presence of metastasis was significant prognostic factor only in log normal analysis. In final multivariate model, age was still a significant prognostic factor in Cox regression but it was not significant in log normal model. Presence of metastasis followed by histology type were other prognostic features found significant in log normal results. Based on AIC, log normal model performed better than Cox.

Interpretation & Conclusion: Our results suggest that early detection of patients in younger age and in primary stages and grade of tumour could be important to decrease the risk of death in patients with gastric cancer. Comparison between Cox and log normal models indicated that log normal regression model can be a useful statistical model to find prognostic factors instead of Cox.
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March 2009

Burden of hospitalization for gastrointestinal tract cancer patients - Results from a cross-sectional study in Tehran.

Asian Pac J Cancer Prev 2009 Jan-Mar;10(1):107-10

Research Center of Gastroenterology and Liver Diseases, Shahid Beheshti University M.C, Tehran, Iran.

Background: Cancer is the third most common cause of death in Iran. The gastrointestinal cancers are the most frequent neoplasms among Iranian males and second to breast cancer among females. The objective of this study was to provide accurate up-to-date epidemiological information of hospitalized patients with GI tract cancer in Iran.

Methods: This study was designed as a retrospective cross-sectional survey included all consecutive GI cancer patients admitted over a one year period in a randomly selected hospital group located in metropolitan Tehran in 2006. Residence, age, sex, type of cancer and length of hospitalization were analyzed.

Results: A total of 2,674 GI tract cancer patients were included in the study, There were 1,616 men (60.4%) and 1,058 women (39.6%). The majority of cancers were in the colorectum (40.0%), followed by the stomach (34.5%) and the esophagus (17.1%). The mean hospitalized durations were 7.5-/+6.5 days for men and 7.2-/+8.1 days for women. Male patients were significantly older than the women.

Conclusion: By considering the hospitalized GI tract cancers and majority cases of colorectal cancer, prevention programs like as CRC screening should be going on in order to reducing morbidity and incidence rates in a high-risk population for GI tract cancers.
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August 2009

Uninvestigated dyspepsia and its related factors in an Iranian community.

Saudi Med J 2009 Mar;30(3):397-402

Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University, MC, Tehran, Iran.

Objective: To determine the prevalence and determinants of uninvestigated dyspepsia in the Iranian population.

Methods: A cross-sectional study conducted in Tehran province from May 2006 to December 2007, included 18,180 adult persons selected randomly. The study took place at Shahid Beheshti University, MC, Tehran, Iran. A questionnaire was completed in 2 steps. In the first part, personal characteristics and 11 gastrointestinal symptoms were inserted. Those who reported at least one of these 11 symptoms were referred for the second interview, which consisted of questions on different gastrointestinal disorders based on Rome III criteria, including uninvestigated dyspepsia.

Results: The prevalence rate of uninvestigated dyspepsia was 8.5% (10.9% in women and 6.4% in men). Among the subjects diagnosed with dyspepsia, bothersome postprandial fullness was the most common symptom (41.5%). Uninvestigated dyspepsia was more common in low educated and widowed participants. Approximately 41.4% of patients had a history of depression, and 66.1% had self report of stress. The prevalence of functional irritable bowel syndrome in patients with uninvestigated dyspepsia was 8.3% and gastroesophageal reflux disease was 64.9%.

Conclusion: Uninvestigated dyspepsia has a less common prevalence in the general Iranian population than developed countries. Women, older, obese, widowed, and low education subjects are more likely to suffer from dyspepsia.
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March 2009