Publications by authors named "Farhad Pishgar"

30 Publications

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Human resources for health density and its associations with child and maternal mortality in the Islamic Republic of Iran.

East Mediterr Health J 2021 Jan 23;27(1):16-22. Epub 2021 Jan 23.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran.

Background: The Family Physician and Social Protection Scheme for Iranian rural inhabitants was launched in June 2005 to improve physician density. To our knowledge, a comprehensive study of the impact of the Scheme on mortality-related health indicators has not been conducted.

Aims: To investigate the effects of health workforce density on maternal, neonatal, infant and under-5 mortality rates in rural areas of the Islamic Republic of Iran between 2005 and 2011.

Methods: We built mixed-effects Poisson regression models including mortality measures as response variables and physician and behvarz (community-based health worker) densities as independent variables, using data from the Iranian Vital Horoscope tool, annual Households Income and Expenditure Survey, and DTARH software. We also included population sizes, age of inhabitants, rate of urbanization, years of schooling, and wealth index in each district, as well as effect of time, as covariates.

Results: Physician density was significantly associated with child mortality rates (1.5%, 1.1% and 63.5% decrease in neonatal, under-5 and maternal mortality with a 1-unit increase in physician density per 1000 individuals). In the model built for infant mortality rate, physician density and behvarz densities were not significantly associated with this measure.

Conclusions: Improving the distribution of family physicians was associated with lower child and maternal mortality. Improvements in behvarz densities were not associated with decrements in these rates, which probably calls for improvement in access to more professional health services and facilities.
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http://dx.doi.org/10.26719/2021.27.1.16DOI Listing
January 2021

Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data.

Knee 2020 Dec 25;27(6):1971-1979. Epub 2020 Nov 25.

Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.

Background: Increase in lateral patellar tilt-(LPT) can cause increased pressure on the lateral facet of the knee and can lead to patellar or femoral cartilage damage and further osseous changes. This study aims to test the hypothesis whether there is an association between increased LPT and MRI-based patellofemoral osteoarthritis-(OA) features at baseline and their worsening over a 2-year follow-up in participants of the Osteoarthritis Initiative-(OAI).

Methods: Recorded clinical and imaging data of 600 participants in the FNIH-OA biomarkers consortium was extracted from its database. The LPT-(as the angle betweenthe longest patella diameter and posterior aspect of condyles) was measured using theaxial knee MRI. Associations of LPT (every 5° increase) with MRI OA Knee Scoring-(MOAKS) for OA-related features, including cartilage and bone marrow lesions (BMLs) in addition to knee cartilage volume at baseline and their worsening after 2-year follow-up were assessed using regression models adjusted for several possible confounders.

Results: The mean LPT angle in this sample was 8.84° ± 5.19. In baseline, higher LPT was associated with lower cartilage volumes and higher cartilage lesions and BMLs MOAKS scores in the lateral trochlear and patellar subregions. Over the follow-ups, subjects with higher LPT measures in the baseline showed higher odds of experiencing BML score worsening in the lateral trochlear subregion-(OR:1.25[1.01-1.56]) over the 2-year follow-ups.

Conclusions: Increase in LPT measures may be associated with OA-related features in the trochlear subregion. Therefore, aside from its use as an indicator of patellofemoral instability syndrome, LPT may be associated with longitudinal progression of patellofemoral OA.
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http://dx.doi.org/10.1016/j.knee.2020.11.002DOI Listing
December 2020

Conventional MRI-based subchondral trabecular biomarkers as predictors of knee osteoarthritis progression: data from the Osteoarthritis Initiative.

Eur Radiol 2020 Nov 25. Epub 2020 Nov 25.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC, Baltimore, MD, 21287, USA.

Objectives: To evaluate the reliability and validity of measuring subchondral trabecular biomarkers in "conventional" intermediate-weighted (IW) MRI sequences and to assess the predictive value of biomarker changes for predicting near-term symptomatic and structural progressions in knee osteoarthritis (OA).

Methods: For this study, a framework for measuring trabecular biomarkers in the proximal medial tibia in the "conventional" IW MRI sequence was developed. The reliability of measuring these biomarkers (trabecular thickness [cTbTh], spacing [cTbSp], connectivity density [cConnD], and bone-to-total volume ratio [cBV/TV]) was evaluated in the Bone Ancillary Study (within the Osteoarthritis Initiative [OAI]). The validity of these measurements was assessed by comparing to "apparent" biomarkers (from high-resolution steady-state MRI sequence) and peri-articular bone marrow density (BMD, from dual-energy X-ray absorptiometry). The association of these biomarker changes from baseline to 24 months (using the Reliable Change Index) with knee OA progression was studied in the FNIH OA Biomarkers Consortium (within the OAI). Pain and radiographic progression were evaluated by comparing baseline WOMAC pain score and radiographic joint space width with the 24-to-48-month scores/measurements. Associations between biomarker changes and these outcomes were studied using logistic regression adjusted for the relevant covariates.

Results: With acceptable reliability, the cTbTh and cBV/TV, but not cTbSp or cConnD, were modestly associated with the "apparent" biomarkers and peri-articular BMD (β: 1.10 [95% CI: 0.45-1.75], p value: 0.001 and β: 3.69 [95% CI: 2.56-4.83], p value: < 0.001, respectively). Knees with increased cTbTh had higher (OR: 1.44 [95% CI: 1.03-2.02], p value: 0.035) and knees with decreased cTbTh (OR: 0.69 [95% CI: 0.49-0.95], p value: 0.026) or decreased cBV/TV (OR: 0.67 [95% CI: 0.48-0.93], p value: 0.018) had lower odds of experiencing OA pain progression over the follow-ups.

Conclusions: Measurement of certain "conventional" MRI-based subchondral trabecular biomarkers has high reliability and modest validity. Though modest, there are significant associations between these biomarker changes and knee OA pain progression up to 48-month follow-up.

Key Points: • Despite the lower spatial resolution than what is required to accurately study the subchondral trabecular microstructures, the "conventional" IW MRI sequences may retain adequate information that allows quantification of trabecular microstructure biomarkers. • Subchondral trabecular biomarkers obtained from "conventional" IW MRI sequences (i.e., cTbTh, cTbSp, and cBV/TV) are reliable and valid measures of trabecular microstructure changes compared to those from "apparent" trabecular biomarkers (from the FISP MRI sequence) and peri-articular BMD (from DXA). • Increased trabecular thickness and bone-to-total ratio (cTbTh and cBV/TV, obtained from "conventional" IW MRI sequences) from baseline to 24-month visits may be associated with higher odds of knee OA pain progression over 48 months of follow-up.
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http://dx.doi.org/10.1007/s00330-020-07512-2DOI Listing
November 2020

Association Between MRI-Based Tibial Slope Measurements and Mucoid Degeneration of the Anterior Cruciate Ligament: A Propensity Score-Matched Case-Control Study.

Orthop J Sports Med 2020 Nov 6;8(11):2325967120962804. Epub 2020 Nov 6.

Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.

Background: The cause of mucoid degeneration (MD) of the anterior cruciate ligament (ACL), which is commonly observed on magnetic resonance imaging (MRI) of patients with knee pain, has yet to be elucidated. Despite the limited evidence on the relationship between ACL lesions (injury and MD) and tibial morphologic features (ie, posterior tibial slope), the potential association between the presence of ACL MD and medial and lateral tibial slope (MTS and LTS) has not been well-established.

Purpose: To investigate whether MTS and LTS measurements are associated with the presence of ACL MD.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Consecutive knee MRI examinations of patients referred by an orthopaedic surgeon for potential internal joint derangements were identified within a 4-year period. The presence of ACL MD and the MTS/LTS values were assessed by independent expert observers in consensus in a blinded fashion. From 413 consecutive knee MRI scans, a sample of 80 knees, including 32 knees with ACL MD (cases) and 48 knees with normal ACL (controls), were selected using propensity score matching method for age, sex, body mass index, and presence of severe medial tibiofemoral compartment cartilage damage. The association between ACL MD and MTS/LTS was evaluated using conditional regression models.

Results: Knees with ACL MD had higher values of LTS (mean ± SD, 7.18° ± 3.58°) in comparison with control knees (5.32° ± 3.35°). Conditional regression analysis revealed a significant association between LTS measurements (not MTS) and ACL MD; every 1° increase in LTS was associated with a 17% (95% CI, 1%-35%) higher probability of having ACL MD.

Conclusion: Excessive LTS was associated with the presence of ACL MD, independent of participants' age, sex, BMI, and cartilage damage severity.
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http://dx.doi.org/10.1177/2325967120962804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7658517PMC
November 2020

Association between Race and Radiographic, Symptomatic, and Clinical Hand Osteoarthritis: A Propensity Score-Matched Study Using Osteoarthritis Initiative Data.

Arthritis Rheumatol 2020 Feb 23. Epub 2020 Feb 23.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Objectives: To determine the associations between race (black versus nonblack) and the presence of radiographic, symptomatic, and clinical hand osteoarthritis (OA).

Methods: Using the Osteoarthritis Initiative cohort with available hand radiographs (n=4,699, black subjects n=849[18.1%], nonblack subjects n=3,850[81.9%]), propensity score-matching method was used to select black and nonblack subjects matched for known potential hand OA risk factors (age, gender, BMI, smoking status, cardiovascular disease, osteoporosis, excessive hand use, and knee OA). Posteroanterior radiographs of subjects' dominant hands were read by a musculoskeletal radiologist for this study in a blinded fashion. The modified KL grades (mKL, 0-4 scale) and the presence of erosive OA in the hand joints were recorded. Associations between race and hand OA severity criteria (mKL sum score), presence of radiographic OA (mKL≥2), erosive OA, symptomatic OA (radiographic OA with hand pain), and clinical OA (presence of Heberden's nodes) were studied using regression models. Odds ratios (ORs) and their 95% confidence interval (CI) are reported.

Results: Black subjects had less severe hand OA (β:-1.93[95%CI:-2.53--1.34]), lower odds of radiographic (OR:0.79[95%CI:0.66-0.94]), erosive (OR:0.23[95%CI:0.11-0.47]), symptomatic (OR:0.63[95%CI:0.49-0.82]), and clinical (OR:0.49[95%CI:0.41-0.60]) hand OA.

Conclusions: In contrast to the well-established association between black race and knee or hip OA, odds of hand OA are lower in black versus nonblack subjects, which is not mediated by known hand OA risk factors. Future mechanistic works are warranted to determine the mediating protective factors for hand OA among the black subjects.
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http://dx.doi.org/10.1002/art.41231DOI Listing
February 2020

Trends of National and Subnational Incidence of Childhood Cancer Groups in Iran: 1990-2016.

Front Oncol 2019 14;9:1428. Epub 2020 Jan 14.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Childhood cancer is a double-edged sword, considering its high rate of response to treatment despite a high vulnerability to develop future malignancies in survivors. Thus, multidisciplinary preventive, curative, and supportive strategies must be incorporated in childhood cancer care that require understanding the distribution and trend of cancer in the target population. In this article, we aimed to report the national and subnational trends of childhood cancer incidence in Iran from 1990 to 2016, and mortality/incidence ratio (MIR), which, to our knowledge, have not been reported in previous literature. Data on the incidence and mortality rates were collected from the National and Subnational Burden of Diseases project. We employed a two-stage spatiotemporal model to estimate cancer incidences by sex, age, province, and year based on the primary dataset of national death registration system. National and subnational age and gender-specific trends as well as MIR were calculated. The age-standardized incidence rate had a steady increasing trend for cancers in both female [annual percent change (APC), 1.6%] and male (APC, 2.1%) patients. Not only there was an increasing trend in most provinces but also there was a 40% divergence in age-standardized incidence rate at subnational levels. Leukemia, lymphoma, neoplasms of the central nervous system (CNS), digestive tract, endocrine gland, and urinary tract were the leading causes of cancer comprising more than half of all cancers. There was a remarkable general decrease in MIR by 75% as a proxy of care quality. Regarding the increased trend of childhood cancer incidence, there is an essential need to address the etiologic factors and establish preventive plans for childhood cancers. Despite the favorable outcomes observed in cancer care, commensurate health resource allocation must be applied to diminish the subnational disparities.
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http://dx.doi.org/10.3389/fonc.2019.01428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970968PMC
January 2020

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017: A Systematic Analysis for the Global Burden of Disease Study.

Authors:
Christina Fitzmaurice Degu Abate Naghmeh Abbasi Hedayat Abbastabar Foad Abd-Allah Omar Abdel-Rahman Ahmed Abdelalim Amir Abdoli Ibrahim Abdollahpour Abdishakur S M Abdulle Nebiyu Dereje Abebe Haftom Niguse Abraha Laith Jamal Abu-Raddad Ahmed Abualhasan Isaac Akinkunmi Adedeji Shailesh M Advani Mohsen Afarideh Mahdi Afshari Mohammad Aghaali Dominic Agius Sutapa Agrawal Ayat Ahmadi Elham Ahmadian Ehsan Ahmadpour Muktar Beshir Ahmed Mohammad Esmaeil Akbari Tomi Akinyemiju Ziyad Al-Aly Assim M AlAbdulKader Fares Alahdab Tahiya Alam Genet Melak Alamene Birhan Tamene T Alemnew Kefyalew Addis Alene Cyrus Alinia Vahid Alipour Syed Mohamed Aljunid Fatemeh Allah Bakeshei Majid Abdulrahman Hamad Almadi Amir Almasi-Hashiani Ubai Alsharif Shirina Alsowaidi Nelson Alvis-Guzman Erfan Amini Saeed Amini Yaw Ampem Amoako Zohreh Anbari Nahla Hamed Anber Catalina Liliana Andrei Mina Anjomshoa Fereshteh Ansari Ansariadi Ansariadi Seth Christopher Yaw Appiah Morteza Arab-Zozani Jalal Arabloo Zohreh Arefi Olatunde Aremu Habtamu Abera Areri Al Artaman Hamid Asayesh Ephrem Tsegay Asfaw Alebachew Fasil Ashagre Reza Assadi Bahar Ataeinia Hagos Tasew Atalay Zerihun Ataro Suleman Atique Marcel Ausloos Leticia Avila-Burgos Euripide F G A Avokpaho Ashish Awasthi Nefsu Awoke Beatriz Paulina Ayala Quintanilla Martin Amogre Ayanore Henok Tadesse Ayele Ebrahim Babaee Umar Bacha Alaa Badawi Mojtaba Bagherzadeh Eleni Bagli Senthilkumar Balakrishnan Abbas Balouchi Till Winfried Bärnighausen Robert J Battista Masoud Behzadifar Meysam Behzadifar Bayu Begashaw Bekele Yared Belete Belay Yaschilal Muche Belayneh Kathleen Kim Sachiko Berfield Adugnaw Berhane Eduardo Bernabe Mircea Beuran Nickhill Bhakta Krittika Bhattacharyya Belete Biadgo Ali Bijani Muhammad Shahdaat Bin Sayeed Charles Birungi Catherine Bisignano Helen Bitew Tone Bjørge Archie Bleyer Kassawmar Angaw Bogale Hunduma Amensisa Bojia Antonio M Borzì Cristina Bosetti Ibrahim R Bou-Orm Hermann Brenner Jerry D Brewer Andrey Nikolaevich Briko Nikolay Ivanovich Briko Maria Teresa Bustamante-Teixeira Zahid A Butt Giulia Carreras Juan J Carrero Félix Carvalho Clara Castro Franz Castro Ferrán Catalá-López Ester Cerin Yazan Chaiah Wagaye Fentahun Chanie Vijay Kumar Chattu Pankaj Chaturvedi Neelima Singh Chauhan Mohammad Chehrazi Peggy Pei-Chia Chiang Tesfaye Yitna Chichiabellu Onyema Greg Chido-Amajuoyi Odgerel Chimed-Ochir Jee-Young J Choi Devasahayam J Christopher Dinh-Toi Chu Maria-Magdalena Constantin Vera M Costa Emanuele Crocetti Christopher Stephen Crowe Maria Paula Curado Saad M A Dahlawi Giovanni Damiani Amira Hamed Darwish Ahmad Daryani José das Neves Feleke Mekonnen Demeke Asmamaw Bizuneh Demis Birhanu Wondimeneh Demissie Gebre Teklemariam Demoz Edgar Denova-Gutiérrez Afshin Derakhshani Kalkidan Solomon Deribe Rupak Desai Beruk Berhanu Desalegn Melaku Desta Subhojit Dey Samath Dhamminda Dharmaratne Meghnath Dhimal Daniel Diaz Mesfin Tadese Tadese Dinberu Shirin Djalalinia David Teye Doku Thomas M Drake Manisha Dubey Eleonora Dubljanin Eyasu Ejeta Duken Hedyeh Ebrahimi Andem Effiong Aziz Eftekhari Iman El Sayed Maysaa El Sayed Zaki Shaimaa I El-Jaafary Ziad El-Khatib Demelash Abewa Elemineh Hajer Elkout Richard G Ellenbogen Aisha Elsharkawy Mohammad Hassan Emamian Daniel Adane Endalew Aman Yesuf Endries Babak Eshrati Ibtihal Fadhil Vahid Fallah Omrani Mahbobeh Faramarzi Mahdieh Abbasalizad Farhangi Andrea Farioli Farshad Farzadfar Netsanet Fentahun Eduarda Fernandes Garumma Tolu Feyissa Irina Filip Florian Fischer James L Fisher Lisa M Force Masoud Foroutan Marisa Freitas Takeshi Fukumoto Neal D Futran Silvano Gallus Fortune Gbetoho Gankpe Reta Tsegaye Gayesa Tsegaye Tewelde Gebrehiwot Gebreamlak Gebremedhn Gebremeskel Getnet Azeze Gedefaw Belayneh K Gelaw Birhanu Geta Sefonias Getachew Kebede Embaye Gezae Mansour Ghafourifard Alireza Ghajar Ahmad Ghashghaee Asadollah Gholamian Paramjit Singh Gill Themba T G Ginindza Alem Girmay Muluken Gizaw Ricardo Santiago Gomez Sameer Vali Gopalani Giuseppe Gorini Bárbara Niegia Garcia Goulart Ayman Grada Maximiliano Ribeiro Guerra Andre Luiz Sena Guimaraes Prakash C Gupta Rahul Gupta Kishor Hadkhale Arvin Haj-Mirzaian Arya Haj-Mirzaian Randah R Hamadeh Samer Hamidi Lolemo Kelbiso Hanfore Josep Maria Haro Milad Hasankhani Amir Hasanzadeh Hamid Yimam Hassen Roderick J Hay Simon I Hay Andualem Henok Nathaniel J Henry Claudiu Herteliu Hagos D Hidru Chi Linh Hoang Michael K Hole Praveen Hoogar Nobuyuki Horita H Dean Hosgood Mostafa Hosseini Mehdi Hosseinzadeh Mihaela Hostiuc Sorin Hostiuc Mowafa Househ Mohammedaman Mama Hussen Bogdan Ileanu Milena D Ilic Kaire Innos Seyed Sina Naghibi Irvani Kufre Robert Iseh Sheikh Mohammed Shariful Islam Farhad Islami Nader Jafari Balalami Morteza Jafarinia Leila Jahangiry Mohammad Ali Jahani Nader Jahanmehr Mihajlo Jakovljevic Spencer L James Mehdi Javanbakht Sudha Jayaraman Sun Ha Jee Ensiyeh Jenabi Ravi Prakash Jha Jost B Jonas Jitendra Jonnagaddala Tamas Joo Suresh Banayya Jungari Mikk Jürisson Ali Kabir Farin Kamangar André Karch Narges Karimi Ansar Karimian Amir Kasaeian Gebremicheal Gebreslassie Kasahun Belete Kassa Tesfaye Dessale Kassa Mesfin Wudu Kassaw Anil Kaul Peter Njenga Keiyoro Abraham Getachew Kelbore Amene Abebe Kerbo Yousef Saleh Khader Maryam Khalilarjmandi Ejaz Ahmad Khan Gulfaraz Khan Young-Ho Khang Khaled Khatab Amir Khater Maryam Khayamzadeh Maryam Khazaee-Pool Salman Khazaei Abdullah T Khoja Mohammad Hossein Khosravi Jagdish Khubchandani Neda Kianipour Daniel Kim Yun Jin Kim Adnan Kisa Sezer Kisa Katarzyna Kissimova-Skarbek Hamidreza Komaki Ai Koyanagi Kristopher J Krohn Burcu Kucuk Bicer Nuworza Kugbey Vivek Kumar Desmond Kuupiel Carlo La Vecchia Deepesh P Lad Eyasu Alem Lake Ayenew Molla Lakew Dharmesh Kumar Lal Faris Hasan Lami Qing Lan Savita Lasrado Paolo Lauriola Jeffrey V Lazarus James Leigh Cheru Tesema Leshargie Yu Liao Miteku Andualem Limenih Stefan Listl Alan D Lopez Platon D Lopukhov Raimundas Lunevicius Mohammed Madadin Sameh Magdeldin Hassan Magdy Abd El Razek Azeem Majeed Afshin Maleki Reza Malekzadeh Ali Manafi Navid Manafi Wondimu Ayele Manamo Morteza Mansourian Mohammad Ali Mansournia Lorenzo Giovanni Mantovani Saman Maroufizadeh Santi Martini S Martini Tivani Phosa Mashamba-Thompson Benjamin Ballard Massenburg Motswadi Titus Maswabi Manu Raj Mathur Colm McAlinden Martin McKee Hailemariam Abiy Alemu Meheretu Ravi Mehrotra Varshil Mehta Toni Meier Yohannes A Melaku Gebrekiros Gebremichael Meles Hagazi Gebre Meles Addisu Melese Mulugeta Melku Peter T N Memiah Walter Mendoza Ritesh G Menezes Shahin Merat Tuomo J Meretoja Tomislav Mestrovic Bartosz Miazgowski Tomasz Miazgowski Kebadnew Mulatu M Mihretie Ted R Miller Edward J Mills Seyed Mostafa Mir Hamed Mirzaei Hamid Reza Mirzaei Rashmi Mishra Babak Moazen Dara K Mohammad Karzan Abdulmuhsin Mohammad Yousef Mohammad Aso Mohammad Darwesh Abolfazl Mohammadbeigi Hiwa Mohammadi Moslem Mohammadi Mahdi Mohammadian Abdollah Mohammadian-Hafshejani Milad Mohammadoo-Khorasani Reza Mohammadpourhodki Ammas Siraj Mohammed Jemal Abdu Mohammed Shafiu Mohammed Farnam Mohebi Ali H Mokdad Lorenzo Monasta Yoshan Moodley Mahmood Moosazadeh Maryam Moossavi Ghobad Moradi Mohammad Moradi-Joo Maziar Moradi-Lakeh Farhad Moradpour Lidia Morawska Joana Morgado-da-Costa Naho Morisaki Shane Douglas Morrison Abbas Mosapour Seyyed Meysam Mousavi Achenef Asmamaw Muche Oumer Sada S Muhammed Jonah Musa Ashraf F Nabhan Mehdi Naderi Ahamarshan Jayaraman Nagarajan Gabriele Nagel Azin Nahvijou Gurudatta Naik Farid Najafi Luigi Naldi Hae Sung Nam Naser Nasiri Javad Nazari Ionut Negoi Subas Neupane Polly A Newcomb Haruna Asura Nggada Josephine W Ngunjiri Cuong Tat Nguyen Leila Nikniaz Dina Nur Anggraini Ningrum Yirga Legesse Nirayo Molly R Nixon Chukwudi A Nnaji Marzieh Nojomi Shirin Nosratnejad Malihe Nourollahpour Shiadeh Mohammed Suleiman Obsa Richard Ofori-Asenso Felix Akpojene Ogbo In-Hwan Oh Andrew T Olagunju Tinuke O Olagunju Mojisola Morenike Oluwasanu Abidemi E Omonisi Obinna E Onwujekwe Anu Mary Oommen Eyal Oren Doris D V Ortega-Altamirano Erika Ota Stanislav S Otstavnov Mayowa Ojo Owolabi Mahesh P A Jagadish Rao Padubidri Smita Pakhale Amir H Pakpour Adrian Pana Eun-Kee Park Hadi Parsian Tahereh Pashaei Shanti Patel Snehal T Patil Alyssa Pennini David M Pereira Cristiano Piccinelli Julian David Pillay Majid Pirestani Farhad Pishgar Maarten J Postma Hadi Pourjafar Farshad Pourmalek Akram Pourshams Swayam Prakash Narayan Prasad Mostafa Qorbani Mohammad Rabiee Navid Rabiee Amir Radfar Alireza Rafiei Fakher Rahim Mahdi Rahimi Muhammad Aziz Rahman Fatemeh Rajati Saleem M Rana Samira Raoofi Goura Kishor Rath David Laith Rawaf Salman Rawaf Robert C Reiner Andre M N Renzaho Nima Rezaei Aziz Rezapour Ana Isabel Ribeiro Daniela Ribeiro Luca Ronfani Elias Merdassa Roro Gholamreza Roshandel Ali Rostami Ragy Safwat Saad Parisa Sabbagh Siamak Sabour Basema Saddik Saeid Safiri Amirhossein Sahebkar Mohammad Reza Salahshoor Farkhonde Salehi Hosni Salem Marwa Rashad Salem Hamideh Salimzadeh Joshua A Salomon Abdallah M Samy Juan Sanabria Milena M Santric Milicevic Benn Sartorius Arash Sarveazad Brijesh Sathian Maheswar Satpathy Miloje Savic Monika Sawhney Mehdi Sayyah Ione J C Schneider Ben Schöttker Mario Sekerija Sadaf G Sepanlou Masood Sepehrimanesh Seyedmojtaba Seyedmousavi Faramarz Shaahmadi Hosein Shabaninejad Mohammad Shahbaz Masood Ali Shaikh Amir Shamshirian Morteza Shamsizadeh Heidar Sharafi Zeinab Sharafi Mehdi Sharif Ali Sharifi Hamid Sharifi Rajesh Sharma Aziz Sheikh Reza Shirkoohi Sharvari Rahul Shukla Si Si Soraya Siabani Diego Augusto Santos Silva Dayane Gabriele Alves Silveira Ambrish Singh Jasvinder A Singh Solomon Sisay Freddy Sitas Eugène Sobngwi Moslem Soofi Joan B Soriano Vasiliki Stathopoulou Mu'awiyyah Babale Sufiyan Rafael Tabarés-Seisdedos Takahiro Tabuchi Ken Takahashi Omid Reza Tamtaji Mohammed Rasoul Tarawneh Segen Gebremeskel Tassew Parvaneh Taymoori Arash Tehrani-Banihashemi Mohamad-Hani Temsah Omar Temsah Berhe Etsay Tesfay Fisaha Haile Tesfay Manaye Yihune Teshale Gizachew Assefa Tessema Subash Thapa Kenean Getaneh Tlaye Roman Topor-Madry Marcos Roberto Tovani-Palone Eugenio Traini Bach Xuan Tran Khanh Bao Tran Afewerki Gebremeskel Tsadik Irfan Ullah Olalekan A Uthman Marco Vacante Maryam Vaezi Patricia Varona Pérez Yousef Veisani Simone Vidale Francesco S Violante Vasily Vlassov Stein Emil Vollset Theo Vos Kia Vosoughi Giang Thu Vu Isidora S Vujcic Henry Wabinga Tesfahun Mulatu Wachamo Fasil Shiferaw Wagnew Yasir Waheed Fitsum Weldegebreal Girmay Teklay Weldesamuel Tissa Wijeratne Dawit Zewdu Wondafrash Tewodros Eshete Wonde Adam Belay Wondmieneh Hailemariam Mekonnen Workie Rajaram Yadav Abbas Yadegar Ali Yadollahpour Mehdi Yaseri Vahid Yazdi-Feyzabadi Alex Yeshaneh Mohammed Ahmed Yimam Ebrahim M Yimer Engida Yisma Naohiro Yonemoto Mustafa Z Younis Bahman Yousefi Mahmoud Yousefifard Chuanhua Yu Erfan Zabeh Vesna Zadnik Telma Zahirian Moghadam Zoubida Zaidi Mohammad Zamani Hamed Zandian Alireza Zangeneh Leila Zaki Kazem Zendehdel Zerihun Menlkalew Zenebe Taye Abuhay Zewale Arash Ziapour Sanjay Zodpey Christopher J L Murray

JAMA Oncol 2019 12;5(12):1749-1768

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.

Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning.

Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence.

Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs).

Conclusions And Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.
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http://dx.doi.org/10.1001/jamaoncol.2019.2996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777271PMC
December 2019

Insulin pen use and diabetes treatment goals: A study from Iran STEPS 2016 survey.

PLoS One 2019 28;14(8):e0221462. Epub 2019 Aug 28.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Frequency of insulin pen use, despite its higher costs, is increasing to substitute the traditional use of insulin vials. This study aims to report insulin pen use frequency and its associated factors among participants of the STEPS survey 2016 in Iran, which was conducted based on the World Health Organization (WHO) STEPS methodology.

Methods: In this cross-sectional study, 19,503 (mean age of 46.03±0.13) out of 30,541 participants of the Iran STEPS survey were included (Inclusion criteria: aged >25 years old and availability of their demographic, clinical, and laboratory results for serum glucose, HbA1c, and lipid profile). Clinical and demographic characteristics, a frequency of use of each diabetes mellitus treatment type, and the association of insulin pen use with health outcomes are reported using descriptive analysis and propensity score modeling.

Results: There were 1,999(10.85%) individuals diagnosed with diabetes in the population, while 1,160(56.87%) cases were taking antihyperglycemic treatments. In this subset, 240(21.14%) individuals administered insulin with or without using oral agents at the same time. 52.28% of participants who were under insulin therapy used insulin pens. None of the socioeconomic determinants, including gender (p-value = 0.11), type of residential areas (p-value = 0.52), years of schooling (p-value = 0.27), wealth index (p-value = 0.19), marital status (p-value = 0.37), and insurance types (p-value = 0.72) were significantly different among groups using insulin pens and insulin vials. Moreover, in the propensity score modeling, pen usage was not associated with a lower heart attack and ischemic stroke histories, systolic blood pressure, serum lipid profile, blood glucose, or HbA1c levels.

Conclusion: Results showed that the use of the higher-costing insulin pens compared to traditional vials and syringes is not associated with improved glycemic control and better lipid profile in our sample. Future studies are needed to confirm these findings and to compare other aspects of insulin pen use, including adherence to treatment and cost-effectiveness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221462PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713357PMC
March 2020

National and Sub-National Pediatric Cancer Mortality in Iran, 2000-2015.

Arch Iran Med 2019 06 1;22(6):293-300. Epub 2019 Jun 1.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Cancer, a common disease in adulthood, is a rare albeit slowly increasing condition among children. Currently, limited data are available on the incidence, prevalence, and mortality of these diseases in many regions, including developing countries. Herein, we are reporting national and sub-national estimates on deaths due to childhood cancers between 2000 and 2015 in Iran.

Methods: Cancer mortality rates were estimated using the national death registration system's data after addressing its incompleteness and misclassification, using demographic (complete birth history and summary birth history) and statistical analysis (spatiotemporal, Gaussian process regression, and generalized linear mixed models). We included data from cemeteries of two cities (Tehran and Isfahan) that were not included in the death registration system. We used census data and household expenditure and income surveys for data on population and other covariates used in the modeling.

Results: The overall age-standardized death rate (ASDR) of childhood cancers have decreased by 69.52% (80.67-49.71) in Iran (equal to an annual percent change of -3.63 [-4.53- -2.24]), declining from 12.24 (95% UI: 10.52-14.49) in 2000 to 3.73 (2.8-5.29) deaths per 100000 in 2015. This decrement was equal to an annual percent change of 4.35% over these years. Leukemia, brain, and nervous system malignancies accounted for about 66% of all cancer-related mortalities among children and adolescents in 2015, which had a 10% increase compared to 2000. Moreover, trends at the sub-national level showed that the highest and lowest ASDR of childhood cancers ranged from 2.12 to 4.99 across provinces of Iran in 2015.

Conclusion: Although the overall mortalities have decreased, there is still inequality in the distribution of the recorded deaths. This inequality should be addressed with the improvement of the quality of care and better access to pediatric hospitals and oncologists in these areas.
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June 2019

Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative.

Eur Radiol 2020 Jan 11;30(1):128-140. Epub 2019 Jul 11.

Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 4240, Baltimore, MD, 21287, USA.

Objectives: Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI).

Methods: Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT-TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall-Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd-4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini-Hochberg procedure.

Results: Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT-TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04-1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04-1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05-1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03-1.16), corrected p value = 0.02).

Conclusions: Higher TT-TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression.

Key Points: • Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. • Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. • Using longitudinal MRI data, each millimeter increase of TT-TG distance is associated with a 9% (95% confidence interval, 3-16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.
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http://dx.doi.org/10.1007/s00330-019-06324-3DOI Listing
January 2020

Financial Burden of Prostate Cancer Screening: Changing Trends After Health Sector Reform in a Developing Country.

Urol J 2020 05 16;17(3):325. Epub 2020 May 16.

Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.22037/uj.v0i0.4738DOI Listing
May 2020

Iran in transition.

Lancet 2019 05 28;393(10184):1984-2005. Epub 2019 Apr 28.

Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Disease Research Center, Shiraz University of Medical Science, Shiraz, Iran.

Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.
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http://dx.doi.org/10.1016/S0140-6736(18)33197-0DOI Listing
May 2019

Global, regional and national burden of testicular cancer, 1990-2016: results from the Global Burden of Disease Study 2016.

BJU Int 2019 09 3;124(3):386-394. Epub 2019 May 3.

Uro-Oncology Research Centre, Tehran University of Medical Sciences, Tehran, Iran.

Objective: To provide estimates of the global incidence, mortality and disability-adjusted life-years (DALYs) associated with testicular cancer (TCa) between 1990 and 2016, using findings from the Global Burden of Disease (GBD) 2016 study.

Materials And Methods: For the GBD 2016 study, cancer registry data and a vital registration system were used to estimate TCa mortality. Mortality to incidence ratios were used to transform mortality estimates to incidence, and to estimate survival, which was then used to estimate 10-year prevalence. Prevalence was weighted using disability weights to estimate years lived with disability (YLDs). Age-specific mortality and a reference life expectancy were used to estimate years of life lost (YLLs). DALYs are the sum of YLDs and YLLs.

Results: Global incidence of TCa showed a 1.80-fold increase from 37 231 (95% uncertainty interval [ UI] 36 116-38 515) in 1990 to 66 833 (95% UI 64 487-69 736) new cases in 2016. The age-standardized incidence rate also increased from 1.5 (95% UI 1.45-1.55) to 1.75 (95% UI 1.69-1.83) cases per 100 000. Deaths from TCa remained stable between 1990 and 2016 [1990: 8394 (95% UI 7980-8904), 2016: 8651 (95% UI 8292-9027)]. The TCa age-standardized death rate decreased between 1990 and 2016, from 0.39 (95% UI 0.37-0.41) to 0.25 (95% UI 0.24-0.26) per 100 000; however, the decreasing trend was not similar in all regions. Global TCa DALYs decreased by 2% and reached 391 816 (95% UI 372 360-412 031) DALYs in 2016. The age-standardized DALY rate also decreased globally between 1990 and 2016 (10.31 [95% UI 9.82-10.84]) per 100 000 in 2016).

Conclusion: Although the mortality rate for TCa has decreased over recent decades, large disparities still exist in TCa mortality, probably as a result of lack of access to healthcare and oncological treatment. Timely diagnosis of this cancer, by improving general awareness, should be prioritized. In addition, improving access to effective therapies and trained healthcare workforces in developing and under-developed areas could be the next milestones.
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http://dx.doi.org/10.1111/bju.14771DOI Listing
September 2019

Effects of Opium Dependency on Testicular Tissue in a Rat Model: An Experimental Study.

Urol J 2019 08 18;16(4):375-379. Epub 2019 Aug 18.

Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: This study is aimed to evaluate the effects of opium dependency on testicular tissue in a rat model.

Methods: Thirty-two Wistar male rats (aged 30 days and weighing 200-250 grams) were randomized into two groups. Group A, consisting of 16 rats, received dissolved oral opium tablets in drinking water for 45 days, whereas group B (control group) consisted of 16 rats that received opium-free water. After 45 days vertical and horizontal diameters of testis, number of seminiferous tubules, mean seminiferous tubule diameter, number of germ cells, height of germinal epithelium, percentage of degenerating Leydig and germ cells and glutathione density of testicular tissue (µmol/g of tissue) were compared between study groups.

Results: Morphological evaluation of testicular tissue revealed a significantly higher percentage of degenerating Leydig and germ cells in the treated group compared to control group. (10.08 ± 0.351 vs. 1.83 ± 0.88, 4.50 ± 0.769 vs. 0.607 ± 0.118, respectively) (P-value<0.001 for each) Interestingly, vertical and horizontal diameter of testis, the average number of germ cells, height of germinal epithelium and number of seminiferous tubules, were significantly higher in the treated group compared to control group. Seminiferous tubule diameter and glutathione density of testicular tissue were not statistically significantly different between the groups.

Conclusions: Applying a rat model, we noted that opium has a substantial effect on testicular structure and function. A significantly higher proportion of Leydig and germ cells were degenerated in treated rats despite an increase in the average number of seminiferous tubules and germ cells. These findings support the hypothesis that opium consumption adversely affects male fertility.
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http://dx.doi.org/10.22037/uj.v0i0.4066DOI Listing
August 2019

Global, Regional and National Burden of Bladder Cancer, 1990 to 2016: Results from the GBD Study 2016.

J Urol 2019 05;201(5):893-901

Norris Comprehensive Cancer Center, University of Southern California Institute of Urology , Los Angeles , California.

Purpose: Bladder cancer is among the leading causes of cancer death worldwide. Data on the bladder cancer burden are valuable for policy-making. We aimed to estimate the burden of bladder cancer by country, age group, gender and sociodemographic status between 1990 and 2016.

Materials And Methods: Data from vital registration systems and cancer registries were the input to estimate the bladder cancer burden. Mortality was estimated in an ensemble model approach, incidence was estimated by dividing mortality by the mortality-to-incidence ratio and prevalence was estimated using the mortality-to-incidence ratio as a surrogate for survival. We modeled the years lived with disability using disability weights of bladder cancer sequelae. Years of life lost were calculated by multiplying the number of deaths by age by the standard life expectancy at that age. Disability adjusted life-years were calculated by summing the years lived with disability and the years of life lost. Moreover, we also estimated the burden attributable to bladder cancer risk factors, smoking and high fasting plasma glucose using the comparative risk assessment framework of the Global Burden of Disease study.

Results: In 2016 there were 437,442 incident cases (95% UI 426,709-447,912) of bladder cancer with an age standardized incidence rate of 6.69/100,000 (95% UI 6.52-6.85). Bladder cancer led to 186,199 deaths (95% UI 180,453-191,686) in 2016 with an age standardized rate of 2.94/100,000 (95% UI 2.85-3.03). Bladder cancer was responsible for 3,315,186 disability adjusted life-years (95% UI 3,193,248-3,425,530) in 2016 with an age standardized rate of 49.45/100,000 (95% UI 47.68-51.11). Of bladder cancer deaths 26.84% (95% UI 19.78-33.91) and 7.29% (95% UI 1.49-16.19) were due to smoking and high fasting glucose, respectively, in 2016.

Conclusions: Although the number of bladder cancer incident cases is growing globally, the age standardized incidence and number of deaths are decreasing, as mirrored by a decreasing smoking contribution.
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http://dx.doi.org/10.1097/JU.0000000000000025DOI Listing
May 2019

Value of urinary carbohydrate antigen 19-9 to predict failure of conservative management in children with ureteropelvic junction obstruction.

J Pediatr Surg 2019 Aug 2;54(8):1650-1653. Epub 2018 Oct 2.

Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: To assess the role of urinary carbohydrate antigen 19-9 (CA19-9) measurement in determining optimal management of ureteropelvic junction obstruction (UPJO) and predicting failure of conservative management.

Patients And Methods: Children with UPJO diagnosed between December 2012 and April 2015 were included. Depending on clinical and para-clinical findings, patients were divided into three groups: Group 1 consisted of patients who were considered for non-operative management with improvement of the condition during the course of follow-up. Group 2 were suitable for observation; however due to deterioration of condition pyeloplasty was indicated after a period of observation. Group 3 patients required immediate pyeloplasty. Urinary CA19-9 was measured in all patients at baseline and compared between the study groups.

Results: A total of 112 children (115 affected kidneys) with UPJO and mean age of 18.6 ± 3.3 months were assessed. Group 1, 2, and 3 consisted of 54(48.2%), 24(21.4%), and 34(30.4%) patients, respectively. Mean baseline urinary CA19-9 was 37.83 ± 5.20, 145.45 ± 18.38 and 244.62 ± 41.42 in groups 1, 2 and 3, respectively. Multivariate analysis showed that both CA19-9 and APD are independent predictors of need for surgery in patients on observation. ROC curve analysis revealed that urinary CA19-9 level at cut off value of 52.6 U/mL had sensitivity of 92.0% and specificity of 70.9% in predicting failure of non-operative management.

Conclusion: Higher urinary CA19-9 level is associated with failure of non-operative management in patients with UPJO. Such patients may require close follow-up and assessments to prevent irreversible damage to the kidney.

Type Of Study: Study of Diagnostic Test.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.09.007DOI Listing
August 2019

National and subnational mortality of urological cancers in Iran, 1990-2015.

Asia Pac J Clin Oncol 2019 Apr 1;15(2):e43-e48. Epub 2018 Oct 1.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To study trends of urological cancers mortalities in Iran between 1990 and 2015 as a part of a larger project named national and subnational burden of diseases, injuries, and risk factors.

Methods: The primary dataset of this project comprises data of national death registration system. Cause-specific mortality fraction for each age, sex, province, and year group was calculated using a two-stage mixed effects and spatiotemporal models, and then these fractions were applied to all-cause mortality rates, obtained from a parallel study to estimate mortality rates attributable to each cause.

Results: In 2015, urological cancers constituted 8% of cancer-related deaths in Iran, and number of deaths due to prostate, bladder, testicular, and kidney and other urinary organs cancers were estimated as 2,128 (1,565-2,891), 297 (230-385), 301 (144-639), and 195 (143-267), respectively. Our estimates show that age-standardized death rates (ASDRs) of these cancers reached 6.8 (5-9.23), 0.47 (0.37-0.61), 0.96 (0.46-2.04), and 0.24 (0.18-0.33) deaths per 100,000 individuals in 2015, a reduction in the three latter cancers, from 4.09 (2.92-5.76), 13.04 (10.04-16.95), 1.23 (0.46-3.34), and 1.76 (1.28-2.42) deaths per 100,000 individuals in 1990, respectively.

Conclusions: In conclusion, despite disparities among different provinces, overall mortality rate of urological cancers decreased significantly since 1990s in Iran.
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http://dx.doi.org/10.1111/ajco.13074DOI Listing
April 2019

HLA-DRB1 polymorphism and susceptibility to multiple sclerosis in the Middle East North Africa region: A systematic review and meta-analysis.

J Neuroimmunol 2018 08 6;321:117-124. Epub 2018 Jun 6.

MS Research Centre, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

This meta-analysis explores association of HLA-DRB1 alleles with MS risk in the Middle-east North Africa (MENA) countries. Divided into two groups of alleles (10 studies, 899 cases/1457 controls) and phenotypes (8 studies, 1,040 cases/1,256 controls), Odds ratios (ORs) of DRB1 distribution in MS subjects were assessed using Cochrane RevMan software. DRB1*15 demonstrated significant association with MS in both groups (OR=1.6 and OR=2.51, respectively). In phenotypes, DRB1*03 and DRB1*04 had predisposing role (OR=1.8 and OR=1.9), while DRB1*07 and DRB1*11 were protective (OR=0.56 and OR=0.67). Similar but non-significant trends were seen among alleles, which in sum coincides with a Caucasian-like pattern.
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http://dx.doi.org/10.1016/j.jneuroim.2018.06.005DOI Listing
August 2018

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study.

Authors:
Christina Fitzmaurice Tomi F Akinyemiju Faris Hasan Al Lami Tahiya Alam Reza Alizadeh-Navaei Christine Allen Ubai Alsharif Nelson Alvis-Guzman Erfan Amini Benjamin O Anderson Olatunde Aremu Al Artaman Solomon Weldegebreal Asgedom Reza Assadi Tesfay Mehari Atey Leticia Avila-Burgos Ashish Awasthi Huda Omer Ba Saleem Aleksandra Barac James R Bennett Isabela M Bensenor Nickhill Bhakta Hermann Brenner Lucero Cahuana-Hurtado Carlos A Castañeda-Orjuela Ferrán Catalá-López Jee-Young Jasmine Choi Devasahayam Jesudas Christopher Sheng-Chia Chung Maria Paula Curado Lalit Dandona Rakhi Dandona José das Neves Subhojit Dey Samath D Dharmaratne David Teye Doku Tim R Driscoll Manisha Dubey Hedyeh Ebrahimi Dumessa Edessa Ziad El-Khatib Aman Yesuf Endries Florian Fischer Lisa M Force Kyle J Foreman Solomon Weldemariam Gebrehiwot Sameer Vali Gopalani Giuseppe Grosso Rahul Gupta Bishal Gyawali Randah Ribhi Hamadeh Samer Hamidi James Harvey Hamid Yimam Hassen Roderick J Hay Simon I Hay Behzad Heibati Molla Kahssay Hiluf Nobuyuki Horita H Dean Hosgood Olayinka S Ilesanmi Kaire Innos Farhad Islami Mihajlo B Jakovljevic Sarah Charlotte Johnson Jost B Jonas Amir Kasaeian Tesfaye Dessale Kassa Yousef Saleh Khader Ejaz Ahmad Khan Gulfaraz Khan Young-Ho Khang Mohammad Hossein Khosravi Jagdish Khubchandani Jacek A Kopec G Anil Kumar Michael Kutz Deepesh Pravinkumar Lad Alessandra Lafranconi Qing Lan Yirga Legesse James Leigh Shai Linn Raimundas Lunevicius Azeem Majeed Reza Malekzadeh Deborah Carvalho Malta Lorenzo G Mantovani Brian J McMahon Toni Meier Yohannes Adama Melaku Mulugeta Melku Peter Memiah Walter Mendoza Tuomo J Meretoja Haftay Berhane Mezgebe Ted R Miller Shafiu Mohammed Ali H Mokdad Mahmood Moosazadeh Paula Moraga Seyyed Meysam Mousavi Vinay Nangia Cuong Tat Nguyen Vuong Minh Nong Felix Akpojene Ogbo Andrew Toyin Olagunju Mahesh Pa Eun-Kee Park Tejas Patel David M Pereira Farhad Pishgar Maarten J Postma Farshad Pourmalek Mostafa Qorbani Anwar Rafay Salman Rawaf David Laith Rawaf Gholamreza Roshandel Saeid Safiri Hamideh Salimzadeh Juan Ramon Sanabria Milena M Santric Milicevic Benn Sartorius Maheswar Satpathy Sadaf G Sepanlou Katya Anne Shackelford Masood Ali Shaikh Mahdi Sharif-Alhoseini Jun She Min-Jeong Shin Ivy Shiue Mark G Shrime Abiy Hiruye Sinke Mekonnen Sisay Amber Sligar Muawiyyah Babale Sufiyan Bryan L Sykes Rafael Tabarés-Seisdedos Gizachew Assefa Tessema Roman Topor-Madry Tung Thanh Tran Bach Xuan Tran Kingsley Nnanna Ukwaja Vasiliy Victorovich Vlassov Stein Emil Vollset Elisabete Weiderpass Hywel C Williams Nigus Bililign Yimer Naohiro Yonemoto Mustafa Z Younis Christopher J L Murray Mohsen Naghavi

JAMA Oncol 2018 11;4(11):1553-1568

Institute for Health Metrics and Evaluation, University of Washington, Seattle.

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.

Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.

Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.

Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories.

Conclusions And Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.
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http://dx.doi.org/10.1001/jamaoncol.2018.2706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248091PMC
November 2018

Global, Regional and National Burden of Prostate Cancer, 1990 to 2015: Results from the Global Burden of Disease Study 2015.

J Urol 2018 05 9;199(5):1224-1232. Epub 2017 Nov 9.

Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: Data on the incidence, mortality and burden of prostate cancer as well as changing trends are necessary to provide policy makers with the evidence needed to allocate resources appropriately. This study presents estimates of prostate cancer incidence, mortality and burden from 1990 to 2015 by patient age, country and developmental status using the results of the Global Burden of Disease 2015 study.

Materials And Methods: Data from vital registration systems and cancer registries were used to generate mortality estimates. Cause specific mortality served as the basis for estimating incidence, prevalence and disability adjusted life years. The global number of incident cases, deaths and disability adjusted life years attributable to prostate cancer are reported as well as age standardized rates.

Results: Incident cases of prostate cancer increased 3.7-fold from 1990 to 2015. The age standardized incidence rate also increased 1.7-fold during the study period and in 2015 it reached 56.71/100,000 person-years (95% uncertainty interval 45.86-78.45). Global estimates of the age standardized death rate decreased slightly to 14.24 deaths (95% uncertainty interval 11.8-17.95) per 100,000 person-years in 2015. The decline in the age standardized death rate was more prominent in high income countries. Disability adjusted life years attributable to prostate cancer increased by 90% during the study period.

Conclusions: The prostate cancer mortality rate is decreasing in high income countries. However, the incidence and burden of disease are steadily increasing globally, resulting in further challenges in the allocation of limited health care resources. The current study provides comprehensive knowledge of the local burden of disease and help with appropriate allocation of resources for prostate cancer prevention, screening and treatment.
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http://dx.doi.org/10.1016/j.juro.2017.10.044DOI Listing
May 2018

Disability-Adjusted Life-Years (DALYs) for 315 Diseases and Injuries and Healthy Life Expectancy (HALE) in Iran and its Neighboring Countries, 1990-2015: Findings from Global Burden of Disease Study 2015.

Arch Iran Med 2017 07;20(7):403-418

Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Summary measures of health are essential in making estimates of health status that are comparable across time and place. They can be used for assessing the performance of health systems, informing effective policy making, and monitoring the progress of nations toward achievement of sustainable development goals. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) provides disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) as main summary measures of health. We assessed the trends of health status in Iran and 15 neighboring countries using these summary measures.

Methods: We used the results of GBD 2015 to present the levels and trends of DALYs, life expectancy (LE), and HALE in Iran and its 15 neighboring countries from 1990 to 2015. For each country, we assessed the ratio of observed levels of DALYs and HALE to those expected based on socio-demographic index (SDI), an indicator composed of measures of total fertility rate, income per capita, and average years of schooling.

Results: All-age numbers of DALYs reached over 19 million years in Iran in 2015. The all-age number of DALYs has remained stable during the past two decades in Iran, despite the decreasing trends in all-age and age-standardized rates. The all-cause DALY rates decreased from 47,200 in 1990 to 28,400 per 100,000 in 2015. The share of non-communicable diseases in DALYs increased in Iran (from 42% to 74%) and all of its neighbors between 1990 and 2015; the pattern of change is similar in almost all 16 countries. The DALY rates for NCDs and injuries in Iran were higher than global rates and the average rate in High Middle SDI countries, while those for communicable, maternal, neonatal, and nutritional disorders were much lower in Iran. Among men, cardiovascular diseases ranked first in all countries of the region except for Bahrain. Among women, they ranked first in 13 countries. Life expectancy and HALE show a consistent increase in all countries. Still, there are dissimilarities indicating a generally low LE and HALE in Afghanistan and Pakistan and high expectancy in Qatar, Kuwait, and Saudi Arabia. Iran ranked 11th in terms of LE at birth and 12th in terms of HALE at birth in 1990 which improved to 9th for both metrics in 2015. Turkey and Iran had the highest increase in LE and HALE from 1990 to 2015 while the lowest increase was observed in Armenia, Pakistan, Kuwait, Kazakhstan, Russia, and Iraq.

Conclusions: The levels and trends in causes of DALYs, life expectancy, and HALE generally show similarities between the 16 countries, although differences exist. The differences observed between countries can be attributed to a myriad of determinants, including social, cultural, ethnic, religious, political, economic, and environmental factors as well as the performance of the health system. Investigating the differences between countries can inform more effective health policy and resource allocation. Concerted efforts at national and regional levels are required to tackle the emerging burden of non-communicable diseases and injuries in Iran and its neighbors.
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July 2017

Impact of rural family physician program on child mortality rates in Iran: a time-series study.

Popul Health Metr 2017 06 2;15(1):21. Epub 2017 Jun 2.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: The rural family physician program and social protection scheme were started in Iran about 10 years ago, and no comprehensive study has been carried out to investigate the effects of this program on mortality-related health indicators yet. The present study aims to examine the impacts of implementation of the family physician program and rural insurance program, which was launched in June 2005, on neonatal (NMR), infant (IMR), and under-5-year (U5MR) mortality rates in rural areas of Iran between 1995 and 2011, using a time-series analysis.

Methods: Three segmented regression models were built to evaluate the effects of the program on NMR, IMR, and U5MR, and several independent variables were entered into the models, including annual incremental effect of the program (variable of interest), time effect, behvarz density, effect of the family physician and rural insurance programs, as well as socioeconomic variables including years of schooling, wealth index, sex ratio, and logarithmic scales of rural population size in each area. Data were gathered from secondary sources and other studies. Data pertaining to the year 2007 were excluded from the final analysis due to their inaccuracy.

Results: Our results show that the incremental effect of implementing the rural family physician program is associated with significant reductions in NMR (β = - 0.341. p - value = 0.003) and IMR (β = - 0.016. p - value = 0.009). Although the association between this effect and reductions in U5MR were evident, they were not statistically significant (β = - 0.003. p - value = 0.542). Moreover, wealth status of inhabitants was associated with reductions in NMR (β = - 0.889. p - value = 0.001), IMR (β = - 0.052. p - value < 0.001), and U5MR (β = - 0.055. p - value < 0.001) in the time period of the study.

Conclusions: In this nationally representative study, we showed that implementation of the second health system reform in Iran, known as the family physician program and social protection scheme for rural inhabitants, is associated with significant reductions in NMR and IMR. However, reported reductions in U5MR were not found to be statistically associated with the launch of the program. The advantage of this study was the ability to depict a more precise picture of the outcomes of a national-level intervention.
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http://dx.doi.org/10.1186/s12963-017-0138-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455106PMC
June 2017

Socioeconomic inequalities in neonatal and postneonatal mortality: Evidence from rural Iran, 1998-2013.

Int J Equity Health 2017 05 18;16(1):83. Epub 2017 May 18.

Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Over the past three decades, interventions have been implemented to reduce childhood mortality in Iran. Despite declines in overall mortality rates, inequalities in mortality across socioeconomic groups have remained unchanged. In this study, we assessed inequalities in infant mortality in rural regions of Iran.

Methods: We obtained data from the Iranian vital registration system, which includes data on 5,626,158 live births, 79,457 neonatal deaths, and 36,397 postneonatal deaths in rural areas of Iran over the course of a 16-year period, which was then divided into 4 four-year intervals. In addition to building multivariate regression models to identify factors associated with mortality, we calculated a concentration index for each province to measure inequalities in neonatal and postneonatal mortality, using wealth index as the socioeconomic variable of interest. We further assessed these inequalities as a component of their contributors by using the decomposition method.

Results: Although both neonatal (17.62 to 10.92) and postneonatal (8.11 to 5.14) mortality rates exhibited decreasing trends from 1998-2001 to 2010-2013, the inequalities observed in these indices remained nearly unchanged (concentration indices of -0.062 to -0.047 and -0.098 to -0.083, respectively). Furthermore, fraction of births occurred in hospitals and literate women contributed positively to the inequalities observed in both neonatal and postneonatal mortality rates, whereas the proportion of infants classified as low birth weight contributed negatively over all study periods. We also identified decreasing trends in inequalities of the proportion of infants classified as having low birth weight, being born in hospitals, being covered by health insurance, mothers' age, and literacy of women within the time intervals under study.

Conclusions: Although infant mortality rates in Iran decreased over the studied time period, we observed notable inequalities in these measures. Several steps are needed to overcome these inequalities, including improving access to professional health services for lower income households, fairly distributing facilities and human resources, and improving insurance coverage to protect families from financial hardships. Moreover, social factors, such as literacy of women, were found to be important in decreasing inequalities in infant mortality. These steps require improving societal awareness of infant mortality and implementing improved and problem-oriented health policies.
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http://dx.doi.org/10.1186/s12939-017-0570-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5437686PMC
May 2017

Birth seasonality in rural areas of Iran, analysis of 5,536,262 births from 1992 to 2007.

Ann Epidemiol 2016 12 4;26(12):846-852.e3. Epub 2016 Oct 4.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: We conducted this study to investigate birth seasonality in rural parts of Iran.

Methods: In this study, patterns of 5,536,262 live births in rural parts of Iran between 1992 and 2007 were studied. Information about birth numbers, environmental factors, and sociocultural status of participants was obtained from previous works. Visually inspecting the seasonal variation of birth, studying its trend using autocorrelation analysis, examining the trend of birth seasonality using the seasonality coefficient, a newly introduced index, studying correlations between birth seasonality and possible associated factors, and analyzing associations between these variables and birth seasonality using multiple regression model were performed in this study.

Results: In this study, we showed birth seasonality in rural parts of Iran, with the highest births in the first two seasons, winter and spring, mostly before the year of 2002. Latitude and mean temperature of districts, wealth status of families, education of women, and mothers' ages were associated with birth seasonality. However, latitude, temperature, and mothers' ages lost their associations after adjusting for sociocultural factors in the regression model.

Conclusions: Birth numbers in rural areas of Iran follow a rhythmic seasonal pattern; however, the ordering of seasons changes in the last years of the study period.
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http://dx.doi.org/10.1016/j.annepidem.2016.09.009DOI Listing
December 2016

The role of serum and urinary carbohydrate antigen 19-9 in predicting renal injury associated with ureteral stone.

Ren Fail 2016 Nov 18;38(10):1626-1632. Epub 2016 Oct 18.

b Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences , Tehran , Iran.

This study was designed to evaluate the role of urinary and serum carbohydrate antigen 19-9 (CA19-9) as a biomarker in the assessment of patients with ureteral stone. A total of 38 patients with ureteral stone and hydronephrosis who underwent transurethral lithotripsy (TUL) (Group A) and 24 age-matched healthy controls (Group B) were evaluated in this study. Urinary and serum CA19-9 concentrations were measured in group A patients before TUL as well as 4 and 8 weeks following the operation. Urinary and serum CA19-9 concentrations were also measured in group B participants. Median concentration of urinary and serum CA19-9 was 34.0 and 15.0 kU/L in group A patients and 16.1 and 5.3 kU/L in group B, respectively (p < 0.001). Medians of CA19-9 concentration in urine and serum reduced to 12.5 and 4.5 kU/L 8 weeks after TUL (p < 0.001). Following successful TUL and hydronephrosis resolution, a significant decline was detected in serum and urinary CA19-9. We also noted that duration of ureteral obstruction was associated with serum and urinary CA19-9 concentrations, suggesting the potential role of this marker in predicting renal damage associated with urinary tract obstruction and determining the appropriate timing of interventions.
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http://dx.doi.org/10.1080/0886022X.2016.1202732DOI Listing
November 2016

Unique Imaging Features of Renal Arteriopelvic Fistula on Contrast-enhanced Multidetector Computed Tomography.

Urology 2016 Aug 25;94:e11. Epub 2016 May 25.

Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

The development of renal arteriopelvic fistula after percutaneous renal interventions is an extremely rare complication. We report a case of iatrogenic left renal arteriopelvic fistula in a 78-year-old man with unique imaging features on contrast-enhanced multidetector computed tomography.
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http://dx.doi.org/10.1016/j.urology.2016.05.037DOI Listing
August 2016

Parity, duration of lactation and prevalence of maternal metabolic syndrome: a cross-sectional study.

Eur J Obstet Gynecol Reprod Biol 2016 Jun 31;201:70-4. Epub 2016 Mar 31.

Endocrine Research Center (Firouzgar), Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.

Objective: Pregnancy is associated with insulin resistance in tissues. Although this condition is resolved after termination of pregnancy, subtle metabolic changes can remain and prompt incidence of metabolic syndrome. However, lactation causes increased metabolic load and energy needs and it may confer with unfavorable effects of pregnancy in metabolic status. We conduct this study to evaluate impacts of lactation on development of metabolic syndrome (MetS) among women.

Study Design: In this cross-sectional study, we enrolled 978 women aged between 40 and 70 years who had at least one previous live birth, referred to population research center of Amol, Iran in 2011. We surveyed medical registries of participants of Amol health cohort and filled the checklist we had designed for our study. The checklist included main variables like age, number of pregnancies, life-time lactation duration, waist size, systolic and diastolic blood pressures, blood triglyceride level, and blood glucose level.

Results: We included 978 women among which, the mean age of participants was 53.24±7.8 years. Calculated odds ratio (OR) for relationship of number of parities and metabolic syndrome (OR=1.14 [95% CI=1.02-1.28] p-value=0.017) was found to be statistically significant. However, calculated odds ratio for relationship of lactation duration and MetS (OR=0.99 [95% CI=0.99-1.00], p-value=0.322) was not statistically meaningful. Moreover, we calculated OR and Pearson correlation coefficient in different strata of number of parities, none of which were statistically significant and hence did not support protective roles of lactation in development of metabolic syndrome.

Conclusions: Our data did not support protective roles of lactation in development of metabolic syndrome, since in our study longer lactation durations as well as higher number of parities were seen among participants with metabolic syndrome.
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http://dx.doi.org/10.1016/j.ejogrb.2016.03.038DOI Listing
June 2016

Re: Kryvenko et al.: Prostate-specific Antigen Mass Density - A Measure Predicting Prostate Cancer Volume and Accounting for Overweight and Obesity-related Prostate-specific Antigen Hemodilution (Urology, 2016;90:141-147).

Authors:
Farhad Pishgar

Urology 2016 Apr 22;90:228-9. Epub 2016 Jan 22.

Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1016/j.urology.2016.01.013DOI Listing
April 2016

Transition Zone Prostate-specific Antigen Density Could Better Guide the Rebiopsy Strategy in Men With Prostate Inflammation at Initial Biopsy.

Urology 2015 Nov 15;86(5):985-90. Epub 2015 Aug 15.

Department of Urology, Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objective: To assess the role of transition zone prostate-specific antigen density (TZPSAD) in determining rebiopsy strategy in men with prostate inflammation at initial biopsy.

Materials And Methods: Analysis was performed on data derived from transrectal ultrasound-guided prostate biopsy registry containing 2461 men who underwent biopsy between March 2005 and January 2015. Eligible patients were divided into 2 groups based on the presence of chronic inflammation in prostate. Group 1 consisted of 920 patients with histopathologic evidence of chronic inflammation and group 2 consisted of 1287 patients with no evidence of inflammation. Receiver operating characteristic curve analysis was performed to evaluate the accuracy of PSA, PSA density (PSAD), and TZPSAD for detecting prostate cancer (PCa) in each group. Patients who underwent rebiopsy during the study period were further assessed to determine factors that may predict the presence of PCa on subsequent biopsies.

Results: In group 1 patients, at 90% sensitivity for detecting PCa, PSAD and TZPSAD showed 19.7% and 37.8% specificity at cutoff values of 0.10 and 0.27 ng/mL/mL respectively, whereas in group 2 patients, PSAD and TZPSAD revealed 29.8% and 31.4% specificity, respectively. Chronic inflammation at initial biopsy was associated with a significant decrease in the likelihood of cancer detection during rebiopsy (odds ratio, 0.42; 95% confidence interval, 0.18-0.99). TZPSAD was found to be capable of sparing 39.8% of unnecessary rebiopsies in group 1 patients, whereas it spared 20.5% of unnecessary rebiopsies in group 2 patients.

Conclusion: Applying TZPSAD is advantageous in determining rebiopsy strategy in patients with proven inflammation of prostate at initial biopsy.
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http://dx.doi.org/10.1016/j.urology.2015.08.005DOI Listing
November 2015

Prevalence of gestational diabetes mellitus in Rafsanjan: a comparison of different criteria.

Med J Islam Repub Iran 2015 5;29:209. Epub 2015 May 5.

Medical student of Tehran University of Medical Sciences, Faculty of Medicine, Tehran, Iran.

Background: Gestational diabetes mellitus (GDM) is common during pregnancy. This survey was designed based on the frequency of GDM among an urban population according to the American Diabetes Association (ADA) and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria.

Methods: We included all pregnant women who were admitted to a gynecology clinic from September 2012 until May 2013. The fasting blood sugar (FBS) was measured. Those having FBS≥ 126 mg/dl were excluded from the study. All women underwent a standard OGTT (oral glucose tolerance test) by ingesting 75g of glucose in the 24th to 32nd week of their pregnancy.

Results: Two hundred ninety pregnant women with a mean±SD age of 27.72±5.091 years were included in the study. The mean±SD FBS, blood glucose one hour and two hours after ingesting 75g of glucose were 82.48±9.41, 146.86±34.22 and 114.21±27.79 mg/ dl, respectively. Based on the criteria of the ADA, 9.3% (n= 27) of the admitted patients suffered from GDM. For the IADPSG and the WHO, those numbers were 31% (n= 90) and 15.2% (n= 44), respectively.

Conclusion: The prevalence of GDM was 1.5-times and 3 times higher when the IADPSG based data were compared to those of the WHO or the ADA.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476219PMC
July 2015