Publications by authors named "Kamran B Lankarani"

145 Publications

A Comprehensive Systematic Review and Meta-analysis on the Risk Factors of Stroke in Iranian Population.

Arch Iran Med 2021 01 1;24(1):64-77. Epub 2021 Jan 1.

Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: There are limited data on vascular risk factors (VRFs) in low- and middle-income countries (LMICs). This meta-analysis was completed to summarize the existing evidence on stroke risk factors (SRFs) in the Iranian population.

Methods: An electronic literature search of the databases including PubMed, Embase, Web of Science, Scopus, Scientific Information Database (SID), Magiran, and IranMedex was performed to identify the related articles published up to March 2018. For categorical or continuous variables, the data were also pooled using the fixed- or the random-effect models, respectively, expressed as odds ratio (OR) or weighted mean difference (WMD).

Results: A total of 15 articles were recruited. The risk of stroke was associated with mean age, but not gender. Among traditional VRFs, hypertension (HTN), systolic and diastolic blood pressure (DBP), diabetes mellitus (DM), and fasting blood glucose (FBG) were associated with increased risk of stroke. Apart from the high circulating levels of triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), total cholesterol (TC), and low high-density lipoprotein-cholesterol (HDL-C), other potential risk factors namely cigarette smoking (CS), opioid addiction (OD), and waist circumference (WC) were identified to be independent stroke determinants.

Conclusion: The present systematic review and meta-analysis provided a summary of the most important SRFs, which are potentially modifiable and preventable. Overall, Iran, similar to many other LMICs, is experiencing an ever-increasing rate of stroke-prone elderly people. The LMICs are thus suggested to develop national approaches to recognize and address VRFs, to monitor and control CS and OD rates, and to encourage a healthy lifestyle.
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http://dx.doi.org/10.34172/aim.2021.10DOI Listing
January 2021

Reliability and Validity of Simple Stroke Food Frequency Questionnaire (SS-FFQ) for Nutrition Monitoring in Patients with Acute Ischemic Stroke.

J Neurosci Rural Pract 2021 Jan 4;12(1):51-59. Epub 2020 Dec 4.

Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

 Standard dietary questionnaires may have some limitations in cases with stroke, particularly in those suffering from language and communication difficulties. The present study aimed to develop a dietary questionnaire appropriate for patients with acute ischemic stroke (AIS).  Major food groups ( = 19) were first identified using the dietary questionnaire of the INTERHEART study. Using the Food Frequency Questionnaire (FFQ), an expert dietitian and a vascular neurologist then selected a total number of 68 corresponding food items from 168 available FFQ items. In the next phase, a panel of expert dietitians ( = 10) assessed the face validity and the content validity of these 68 items and approved a total number of 62 items for the final questionnaire, namely, the Simple Stroke FFQ (SS-FFQ). Employing test-retest method, the intraclass correlation (ICC) of the SS-FFQ was subsequently calculated in 30 randomly selected cases affected with AIS. Ultimately, principal component analysis (PCA) was utilized for 153 cases with AIS to assess the construct validity of the questionnaire concerned. The SPSS Statistics software (version 18: SPSS Inc., Chicago, Illinois, United States) as well as descriptive tests including mean and percentage were additionally used to account for the baseline characteristics of the study participants.  The results revealed that the reliability of the newly developed form of the SS-FFQ was perfect (ICC = 0.86). Dietary conditions were further assessed administering the SS-FFQ on 153 cases of AIS with the mean age of 63.76 ± 15.93 years. The PCA results also showed that 15 extracted items of the given questionnaire could explain 73.10% of total item variance.  It was concluded that the SS-FFQ was a valid and reliable questionnaire to assess nutrient intakes among patients with AIS.
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http://dx.doi.org/10.1055/s-0040-1718843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846314PMC
January 2021

Investigating the contributing factors to HIV/AIDS infection from the perspective of HIV-infected patients.

BMC Psychol 2021 Jan 25;9(1):13. Epub 2021 Jan 25.

Department of Biostatistics, School of Medicine, Arak University of Medical Sciences, Faculties Building, Payambar A'zam, University Campus, Baseej Square, Sardasht, Islamic Republic of Iran.

Background: People with HIV have always faced stigma and discrimination. Given the numerous papers that have addressed the psychological and social risk factors in spreading HIV, a pressing question is whether individuals' mere careless and behavioural flaws can still account for the spread of HIV. Barriers and opposing politic made a hard position for HIV and sex education in Iran.

Methods: The present study investigated the causes of contracting HIV/AIDS from the perspective of HIV-infected patients. To accomplish this, 150 patients referring to the voluntary counseling and testing Center, Shiraz were convenient selected based on the convenient sampling method and responded to a researcher-made questionnaire From June to August 2019. The data were analyzed through descriptive statistics (mean, SD, frequency tables) and inferential statistics (chi-square).

Results: Results revealed that the main cause of HIV infection amongst males was the injection of narcotics, and in the females it was sexual intercourse with an infected individual. Meanwhile, 57% of the females and 66% of the males blamed themselves for contracting and transmitting the disease. The patients stated that if they could return to pre-infection period, they would use one of the following ways to prevent the disease: (a) they would pay attention to hygienic/sanitary principles; (b) they would not get married; and (c) they would prevent drug addiction. Also only 44% of the individuals had successful siblings (those who were neither addicts nor HIV/AIDS-infected individuals), which was an observation that emphasizes on the epidemic of high-risk behaviors in the patients' families.

Conclusions: According to participants' statements collected in our study, weakness in governmental public health education, along with family-related and individual factors, are important causes of HIV spread.
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http://dx.doi.org/10.1186/s40359-021-00513-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836197PMC
January 2021

Is driver education contributing towards road safety? a systematic review of systematic reviews.

J Inj Violence Res 2021 Jan 18;13(1). Epub 2021 Jan 18.

Department of Social Sciences, University of Nicosia, Cyprus.

Background: There is a vast amount of literature on the effects of driver education. However, the evidence has become somewhat fragmented, making it challenging to understand driver education's effectiveness for improving road safety. The current study aimed to provide the efficacy of pre-LDE and post-LDE interventions aimed at improving the safety of drivers (includes crashes, injuries, or secondary outcomes).

Methods: The following online databases were searched up to the 21st of February 2020: Web of Science (WOS), Scopus, PubMed, Cochrane library, and other relevant databases. Systematic reviews (SR) and meta-analyses were selected to investigate the efficacy of driving education in reducing crashes, injuries, or secondary outcomes. Two investigators independently conducted the data extraction and used the assessment of multiple systematic reviews (AMSTAR) tool to conduct a quality assessment of each SR identified.

Results: Out of the 229 potential articles, seven SRs were eligible for the current overview of systematic reviews and meta-analyses. This overview showed that pre-and post-license education by people of all ages led to improvements in secondary outcomes, such as performance, self-perceived driving abilities, behind-the-wheel driving performance, and even a small decrease in traffic offenses. However, education was not effective in reducing crashes or injuries, either at the individual or community level.

Conclusions: There was no evidence that driver education is an effective approach to reducing crashes or injuries. This negative result might be due to ineffective teaching methods. To improve road safety, it appears necessary to change the method or content of driving education since the current approaches to driving education do not reduce traffic crashes or injuries.
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http://dx.doi.org/10.5249/jivr.v13i1.1592DOI Listing
January 2021

Why is COVID-19 more deadly among physicians than other healthcare workers in the Islamic Republic of Iran?

East Mediterr Health J 2020 Dec 9;26(12):1440-1441. Epub 2020 Dec 9.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Islamic Republic of Iran.

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http://dx.doi.org/10.26719/emhj.20.134DOI Listing
December 2020

Knowledge and Attitude regarding COVID-19 among Pregnant Women in Southwestern Iran in the Early Period of its Outbreak: A Cross-Sectional Study.

Am J Trop Med Hyg 2020 12 27;103(6):2368-2375. Epub 2020 Oct 27.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Both knowledge and attitude can play key roles in the prevention of novel COVID-19. This cross-sectional study was conducted on a statistical sample of pregnant women in southwestern Iran between March and April 2020 to evaluate their knowledge and attitude toward this condition. So, pregnant mothers registered in antenatal clinics affiliated to Shiraz University of Medical Sciences were called and asked to fill in a three-part online questionnaire including sociodemographic characteristics, obstetric/medical history, and knowledge/attitude toward COVID-19. -values < 0.05 were considered statistically significant. The mean score of knowledge among 540 respondents was 34 (±4.1) out of 43. Also, 44.3% answered more than 80% of the items correctly. Higher knowledge scores were accordingly associated with marriage duration, area of residence, health insurance coverage, socioeconomic status (SES), and self-rated health status. However, a strong relationship was found between knowledge, SES, and health insurance coverage with reference to multivariate analysis results. Moreover, majority of the pregnant women and their households expressed their concern about using preventive measures against COVID-19. Although most respondents were moderately worried about becoming infected with COVID-19, 264 (48.9%) cases reported that they were very much anxious about their newborns being infected with COVID-19 and 388 (71.9%) individuals asserted that they were worried about their mortality due to this infection. Besides, most mothers maintained that they had some degrees of rumination, which could interfere with their routine daily chores. Hence, health policy-makers should pay much focus on educating pregnant mothers to help them prevent mental exhaustion.
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http://dx.doi.org/10.4269/ajtmh.20-0608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695057PMC
December 2020

The Effect of Octreotide in Acute Nonvariceal Upper Gastrointestinal Bleeding: A Randomized, Double-Blind, Placebo-Controlled Trial.

J Res Pharm Pract 2020 Apr-Jun;9(2):94-100. Epub 2020 Jun 26.

Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: Nonvariceal upper gastrointestinal bleeding (NUGIB) is a common cause of hospitalization and is associated with considerable mortality and morbidity. Octreotide has been shown to be an effective treatment in the control of variceal UGIB. Theoretically, octreotide could be effective in the treatment of other types of bleeding ulcers.

Methods: This randomized, double-blind, placebo-controlled trial was carried out on patients with NVUGIB who had been admitted to two referral centers in Shiraz, Iran. Patients were randomized to two groups: Group A ( = 58) received octreotide and Group B ( = 58) received a placebo. Patients in both groups received pantoprazole 40 mg as an initial dose, then 40 mg every 12 h intravenously. In addition to the pantoprazole, patients in Group A received 100 μg octreotide subcutaneously every 8 h for 72 h or until they were discharged. Patients in Group B received pantoprazole and a placebo at the same dose schedule.

Findings: There were no statistically significant differences between Groups A and B in terms of mortality (0 vs. 5.17%; = 0.21,) rebleeding rate (5.17% vs. 1.72%; = 0.5), blood transfusion requirement (1.65 ± 0.47 units vs. 1.70 ± 0.45 units; = 0.45), length of hospital stay (1.96 ± 1.00 days vs. 1.65 ± 0.84 days; = 0.44), and need for surgery (1.72% vs. 1.72%; = 0.7).

Conclusion: The results showed that use of subcutaneous octreotide as an adjuvant treatment did not have a beneficial effect on the treatment of NVUGIB.
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http://dx.doi.org/10.4103/jrpp.JRPP_19_57DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547747PMC
June 2020

A Population-Based Study on Patients Complaining Regarding Community Pharmacies Services.

J Res Pharm Pract 2020 Apr-Jun;9(2):88-93. Epub 2020 Jun 26.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: Patients' complain regarding pharmaceutical services at community pharmacies is a fundamental issue as it can directly affect people's service utilization. For the first time in Iran, this survey aimed to investigate the experience of people regarding declare a complaint against the pharmacy sectors as a community-based study.

Methods: In this cross-sectional study, over 100 samples based on postal codes were randomly selected from the city of Shiraz in 2017-2018. The data collection instrument was designed in two parts (demographic and social profile which record the complaint experiences against pharmacists, pharmacy services, etc.). The data were analyzed by SPSS.

Findings: All 1035 eligible participants had a mean age of 45.54 ± 15.82 years (ranged from 14 to 91). Nearly 70% of the participants were female. Around 81.8% had a family physician coverage, whereas 7.4% of them had no medical insurance coverage. The frequency of complaints from the pharmacies was 35.6%. Nearly 55% of the complaints were related to governmental pharmacies. Homemakers were 1.36 times more likely to have experienced complaints in comparison with their employed female counterparts. Health status had an inverse association with complaints. Those participants who had received prescription medication were about two times more likely to have filed a complaint in comparison with those who received medication without a prescription. In addition, females aged 40-59 and above 60 and unemployed participants were more satisfied with respect to complaint follow-up process.

Conclusion: Low level of satisfaction with respect to the complaint process is a concerning issue; hence, strategies are warranted to improve the quality of services provided in the pharmacies.
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http://dx.doi.org/10.4103/jrpp.JRPP_19_82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547744PMC
June 2020

Evaluating Pharmacist's Patient Care Process in Shiraz, using a newly-validated questionnaire: The First Report from Iran.

Acta Biomed 2020 09 7;91(3):e2020059. Epub 2020 Sep 7.

Health Policy Research Center, Institute of Heath, Shiraz University of Medical Sciences, Shiraz, Iran..

Background: The Pharmacists' Patient Care Process (PPCP) as one of many inter-related foundations for the delivery of evidence-based and outcomes-focused patient care has a positive trend in academic literatures in the world. Unfortunately, PPCP has not been establish well in community pharmacies in Iran, yet. This study was performed to explore the current status of the provision and perception toward patient care services and finally evaluate professional competency of pharmacists about PPCP implementation, in both patients and pharmacist's perspectives.

Methods: A cross-sectional study was conducted using two self-administrated Likert-based questionnaires_ one for pharmacists and another one for patients. In total, 121 pharmacists and 479 patients participated to the study. Questionnaires were distributed and collected in the Shiraz during the Oct 2017 till Jun 2018. Obtained data were analyzed through the statistical package for social sciences (SPSS) version 25. In addition, the competency to PPCP implementation was classified to three groups _good, moderate, and weak _ based on achieving ≥75%, 50%-75%, and <50% of the dimensions' total score, respectively.

Results: The pharmacist's age range was 23-76 years (mean age: 40.61±12.85 years). Their Competency to PPCP implementation was good (43.8%), moderate (52%), and just 4% weak. Patient's response to PPCP was 11.2% good, 50.7% moderate and 35.6% weak.

Conclusion: Besides promotion of public awareness about PPCP, improvement of pharmacists' motivation toward these services seems necessary. In addition, the introduced instrument may be useful for practice of pharmacists, but it should be used cautiously until it is tested among clients of pharmacies known to provide all levels of pharmacy care within pharmacy stores.
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http://dx.doi.org/10.23750/abm.v91i3.8027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7717002PMC
September 2020

Hookah Smoking: A Potentially Risk Factor for First-Ever Ischemic Stroke.

J Stroke Cerebrovasc Dis 2020 Oct 18;29(10):105138. Epub 2020 Jul 18.

Department of Neurology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Sciences & department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.

Objective: Hookah consumption, as a common non-cigarette tobacco product, is wrongly considered as less harmful. Moreover, little is known about hookah consumption and risk of ischemic stroke. The current study aimed to assess the association between hookah consumption and first-ever ischemic stroke (FEIS).

Methods: This case-control study was performed on individuals admitted at a tertiary referral center in Shiraz, Southern Iran between October 1, 2018 and September 20, 2019. We compared FEIS patients with randomly selected stroke-free individuals as a control group. Using a multiple logistic regression analysis, we assessed the association between hookah consumption and FEIS.

Results: A total of 208 FEIS patients (mean age 65.2 ± 15.9 years) and 212 age and sex-matched controls (mean age 63.2 ± 14.4) were recruited. The prevalence of vascular risk factors and comorbidities including ischemic heart disease, hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, cigarette smoking, and sleep apnea was higher in patients with FEIS than their control counterparts. After adjusting for a wide range of confounders, including socioeconomic factors, hookah consumption was still an independent risk factor for FEIS (odds ratio: 3.2, 95% CI: 1.7-6.1).

Conclusion: Hookah consumption is associated strongly with FEIS. Public awareness about risk of hookah consumption should be raised.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105138DOI Listing
October 2020

Letter: genetic associations of non-alcoholic fatty liver, malignancies and heart disease.

Aliment Pharmacol Ther 2020 08;52(4):757

Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.

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http://dx.doi.org/10.1111/apt.15918DOI Listing
August 2020

Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis.

Eur J Med Res 2020 Aug 3;25(1):30. Epub 2020 Aug 3.

Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Background: More severe cases of COVID- 19 are more likely to be hospitalized and around one-fifth, needing ICU admission. Understanding the common laboratory features of COVID-19 in more severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. This systematic review and meta-analysis aimed to compare the laboratory test findings in severe vs. non-severe confirmed infected cases of COVID-19.

Methods: Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of Science, and Google Scholar from the beginning of 2019 to 3rd of March 2020. Heterogeneity across included studies was determined using Cochrane's Q test and the I statistic. We used the fixed or random-effect models to pool the weighted mean differences (WMDs) or standardized mean differences and 95% confidence intervals (CIs).

Findings: Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapore) with 3396 ranging from 12 to1099 patients were included. Our meta-analyses showed a significant decrease in lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the neutrophil, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. No significant changes in white blood cells (WBC), Creatine Kinase (CK), troponin I, myoglobin, IL-6 and K between the two groups were observed.

Interpretation: This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of ICU admission. Future well-methodologically designed studies from other populations are strongly recommended.
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http://dx.doi.org/10.1186/s40001-020-00432-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396942PMC
August 2020

The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis.

Life Sci 2020 Oct 29;258:118167. Epub 2020 Jul 29.

Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran. Electronic address:

Aims: This study aimed to make a comparison between the clinical laboratory-related factors, complete blood count (CBC) indices, cytokines, and lymphocyte subsets in order to distinguish severe coronavirus disease 2019 (COVID-19) cases from the non-severe ones.

Materials And Methods: Relevant studies were searched in PubMed, Embase, Scopus, and Web of Science databases until March 31, 2020. Cochrane's Q test and the I statistic were used to determine heterogeneity. We used the random-effect models to pool the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Key Findings: Out of a total of 8557 initial records, 44 articles (50 studies) with 7865 patients (ranging from 13 to 1582), were included. Our meta-analyses with random-effect models showed a significant decrease in lymphocytes, monocyte, CD4+ T cells, CD8+ T cells, CD3 cells, CD19 cells, and natural killer (NK) cells and an increase in the white blood cell (WBC), neutrophils, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP)/hs-CRP, erythrocyte sedimentation rate (ESR), ferritin, procalcitonin (PCT), and serum amyloid A (SAA), interleukin-2 (IL-2), IL-2R, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (INF-γ) in the severe group compared to the non-severe group. However, no significant differences were found in IL-1β, IL-17, and CD4/CD8 T cell ratio between the two groups.

Significance: Decrease in total lymphocytes and lymphocyte subsets as well as the elevation of CRP, ESR, SAA, PCT, ferritin, and cytokines, but not IL-1β and IL-17, were closely associated with COVID-19 severity, implying reliable indicators of severe COVID-19.
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http://dx.doi.org/10.1016/j.lfs.2020.118167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387997PMC
October 2020

Knowledge, attitudes, risk perceptions, and practices of adults toward COVID-19: a population and field-based study from Iran.

Int J Public Health 2020 Jul 24;65(6):731-739. Epub 2020 Jun 24.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: To determine peoples' knowledge, attitudes, risk perceptions, and practices to provide policymakers pieces of field-based evidence and help them in the management of the COVID-19 epidemic.

Methods: This population-based survey was conducted using multi-stage stratified and cluster sampling in Shiraz, Iran. A total of 1331 persons were interviewed. The questionnaires were completed by face-to-face interviews. Univariable and multivariable (linear regression) data analyses were done using SPSS.

Results: The participants answered 63% of questions regarding knowledge, and 78% of questions regarding practice correctly. Only, 4.8% knew about common symptoms of COVID-19 and 7.3% about warning signs that require referral to hospitals. Males, lower educated people, and elders had a lower level of knowledge and poorer practices. Knowledge was also lower in the marginalized (socially deprived) people. Knowledge and practices' correlation was 37%. Overall, 43.6% considered themselves at high risk of COVID-19, and 50% considered it as a severe disease. This disease had negative effects on most participants' routine activities (69.1%). The participants preferred to follow the news from the national TV/Radio, social networks, and foreign satellite channels, respectively.

Conclusions: Encouragement of people to observe preventive measures and decreasing social stress, especially among males, lower educated people, elders, and marginalized groups, are highly recommended.
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http://dx.doi.org/10.1007/s00038-020-01406-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311321PMC
July 2020

Endoscopic mucosal resection of a glomus tumour of the duodenum.

Prz Gastroenterol 2020 8;15(2):173-174. Epub 2020 Jun 8.

Health Policy Research Centre, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.5114/pg.2020.95559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294970PMC
June 2020

Dangerous interactions of gastrointestinal drugs with experimental treatments for COVID-19.

Eur J Gastroenterol Hepatol 2020 11;32(11):1481

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.1097/MEG.0000000000001778DOI Listing
November 2020

Survival analysis of patients with hip fracture, Shiraz, Iran.

Arch Osteoporos 2020 03 2;15(1):33. Epub 2020 Mar 2.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

This study aimed to determine factors affecting the survival of patients with hip fracture in Shiraz, Iran. Alzheimer's disease, hypertension, and cardiovascular diseases were risk factors, while female gender and living with family members or in nursing homes were protective factors against mortality following hip fracture.

Purpose: Hip fractures are the most common orthopedic fractures in elderly. This study aimed to determine the factors affecting the survival of patients with hip fracture in Shiraz.

Methods: This historical cohort study was conducted in Shiraz, Iran. All patients with hip fracture who were admitted to any of the hospitals providing orthopedic services in Shiraz, from September 1, 2011, to August 30, 2012, were included in the study. The log rank test, Kaplan-Meier methods, and the univariate and multivariate Cox regression model were used for data analysis.

Results: A total of 631 patients were enrolled, of these, 264 (41.8%) were male. The mean age of patients was 74.9 ± 11.5. The patients' survival rate after the 1st, 2nd, 3rd, 4th, and 5th year were 81.1%, 73.7%, 69.4%, 64.8%, and 60.2%, respectively. After adjusting data for age, Alzheimer's disease (HR = 4.9, 95% CI 1.4-7.3, P = 0.023), hypertension (HR = 2.27, 95% CI 1.3-3.8, P = 0.003), and cardiovascular diseases (HR = 2.02, 95% CI 1.04-3.09, P = 0.039) remained as risk factors for mortality in patients with hip fracture. However, female patients (HR = 0.46, 95% CI 0.27-0.8, P = 0.006) and those who lived with family members or in nursing homes (HR = 0.43, 95% CI 0.19-0.92, P = 0.03) were protective factors.

Conclusion: This study showed that women are more likely to have hip fractures, but mortality among men is more observable. Alzheimer's disease, hypertension, and cardiovascular diseases were considered as risk factors, while patients who were female and those who lived with the family member or in nursing homes had better survival.
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http://dx.doi.org/10.1007/s11657-020-00714-7DOI Listing
March 2020

The effects of resveratrol on lipid profiles and liver enzymes in patients with metabolic syndrome and related disorders: a systematic review and meta-analysis of randomized controlled trials.

Lipids Health Dis 2020 Feb 17;19(1):25. Epub 2020 Feb 17.

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, IR, Iran.

Background: There are current trials investigating the effect of resveratrol supplementation on lipid profiles and liver enzymes among patients with metabolic syndrome (MetS) and related disorders; however, their findings are controversial. This systematic review and meta-analysis were aimed to determine the effects of resveratrol supplementation on lipid profiles and liver enzymes among patients with MetS and related disorders.

Methods: We performed a comprehensive search of the following online databases up to November 2018: Cochrane Library, PubMed, Embase, and Web of Science. The relevant articles were assessed for quality of studies using the Cochrane risk of bias tool.

Results: Out of 2459 citations, 31 articles were appropriate for including to the current meta-analysis. The pooled results indicated that resveratrol use significantly decreased total cholesterol [weighted mean difference (WMD) = - 7.65 mg/dL; 95% CI, - 12.93, - 2.37; P < 0.01; I: 83.4%] and increased gamma-glutamyl transferase (GGT) concentrations (WMD = 1.76 U/l; 95% CI, 0.58, 2.94; P < 0.01; I: 20.1%). We found no significant effect of resveratrol supplementation on triglycerides (WMD = - 5.84 mg/dL; 95% CI, - 12.68, 1.00; P = 0.09; I: 66.8%), LDL- (WMD = -2.90 mg/dL; 95% CI, - 10.88, 5.09; P = 0.47; I: 96.0%), HDL-cholesterol (WMD = 0.49 mg/dL; 95% CI, - 0.80, 1.78; P = 0.45; I: 74.0%), alanine aminotransferase (ALT) (WMD = -0.14 U/l; 95% CI, - 3.69, 3.41; P = 0.93; I: 79.6%), and aspartate aminotransferase (AST) (WMD = -0.34 U/l; 95% CI, - 2.94, 2.27; P = 0.80; I: 88.0%) concentrations.

Conclusions: This meta-analysis demonstrated that resveratrol supplementation among patients with MetS and related disorders significantly reduced total cholesterol and increased GGT concentrations, but did not affect triglycerides, LDL-, HDL-cholesterol, ALT, and AST concentrations. This data suggests that resveratrol may have a potential cardio-protective effect in patients with MetS and related disorders.
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http://dx.doi.org/10.1186/s12944-020-1198-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026982PMC
February 2020

The Status of Liver Transplantation in the Middle East.

Clin Liver Dis (Hoboken) 2019 Dec 29;14(6):215-218. Epub 2020 Jan 29.

Shiraz Transplant Research Center Shiraz University of Medical Sciences Shiraz Iran.

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http://dx.doi.org/10.1002/cld.889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988425PMC
December 2019

Letter to the editor: What we can learn from health transformation plan.

Med J Islam Repub Iran 2019 28;33:102. Epub 2019 Sep 28.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.34171/mjiri.33.102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946926PMC
September 2019

The effects of alpha-lipoic acid supplementation on fasting glucose and lipid profiles among patients with stroke: a systematic review and meta-analysis of randomized controlled trials.

J Diabetes Metab Disord 2019 Dec 29;18(2):585-595. Epub 2019 Jul 29.

9Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. Iran.

Background And Objective: Stroke is a devastating condition with long-term comorbidities including metabolic abnormalities. Alpha lipoic acid (ALA), with its antioxidant properties, might improve metabolic status of patients, though current evidence is still inclusive. This systematic review of randomized controlled trials (RCTs) was conducted to summarize the existing evidence regarding the effects of ALA supplementation on fasting glucose and lipid profiles among patients with stroke.

Methods: We searched Cochrane Library, EMBASE, MEDLINE, and Web of Science from 1990 until April 5th, 2018. The relevant randomized-controlled articles, based on defined key words, were included in the analyses. Two independent researchers investigated study eligibility, extracted data, and assessed the risk of bias for included studies. Heterogeneity among included studies was tested using Q-test and I statistics. Random-effects models were applied to pool the data and standardized mean differences (WMD) were considered as summary effect size.

Results: A total of five studies (140 patients in each intervention group) were included in our meta-analysis. The findings showed that ALA supplementation significantly decreased fasting glucose levels (WMD -36.93 mg/dL; 95% CI, -65.58, -8.28;  = 0.01; I = 85.0%) in patients with stroke. We found no significant effect of ALA supplementation on triglycerides (WMD -7.45 mg/dL; 95% CI, -51.35, 36.45;  = 0.739; I = 83.9%), total cholesterol (WMD -23.23 mg/dL; 95% CI, -48.07, 1.62;  = 0.067; I = 80.5%), LDL-cholesterol (WMD -10.46 mg/dL; 95% CI, -21.01, 0.09;  = 0.052; I = 47.4%) and HDL-cholesterol levels (WMD -3.02 mg/dL; 95% CI, -20.18, 14.14;  = 0.730; I = 85.8%).

Conclusions: This meta-analysis suggested the beneficial impacts of ALA supplementation in improving fasting glucose of patients diagnosed with stroke.
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http://dx.doi.org/10.1007/s40200-019-00423-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915248PMC
December 2019

Long-term Results of Endoscopic Balloon Dilatation for Gastric Outlet Obstruction Caused by Peptic Ulcer Disease.

Middle East J Dig Dis 2019 Oct 5;11(4):218-224. Epub 2019 Nov 5.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.

BACKGROUND Gastric outlet obstructions (GOO) is a disabling complication of peptic ulcer disease (PUD). The introduction of endoscopic through the scope balloon dilatation (EBD) has eased the management but there are few reports on the long term results of this modality of treatment on patients' symptoms. METHODS Over a period of 4 years from January 2012 to December 2015 in two major referral hospitals affiliated to Shiraz university, medical endoscopy reports were reviewed retrospectively to identify those who received EBD for the treatment of GOO due to PUD .All of these patients were recalled and their current status were evaluated. RESULTS 22 consecutive patients with symptomatic GOO secondary to benign stricture underwent endoscopic balloon dilatation by a single operator. Of them, 14 had balloon dilatation twice and 6 had ballooning three times. The interval between the first referral and the last follow-up was 25.2 ± 10.3 (min: 4.8 max:43.4) months. The averages of maximum balloon size were 14.4 ± 5 mm in the first session, 14.3 ± 3.1mm in the second session, and 16 ± 2.4 mm in the third session. 73% of the patients had a significant improvement in clinical symptom with two sessions of EBD and did not require repeat dilatation. CONCLUSION EBD is a safe and efficient method in the management of GOO with good long term results.
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http://dx.doi.org/10.15171/mejdd.2019.152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895853PMC
October 2019

Correction: The effects of melatonin supplementation on blood pressure in patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials.

J Hum Hypertens 2020 May;34(5):413

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41371-019-0278-8DOI Listing
May 2020

RAGE is a Potential Cause of Onset and Progression of Nonalcoholic Fatty Liver Disease.

Int J Endocrinol 2019 18;2019:2151302. Epub 2019 Sep 18.

Endocrinology and Internal Medicine, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.

Objective: Fatty liver is a rising global health concern, significantly increasing the burden of health care cost. Nonalcoholic fatty liver disease (NAFLD) has a correlation with metabolic syndrome and its complications.

Method: We reviewed the literature regarding the mechanisms of developing NAFLD through AGE-RAGE signaling.

Results: NAFLD, metabolic syndrome, and production of advanced glycation end-products (AGEs) share many common risk factors and appear to be connected. AGE induces production of the receptor for AGE (RAGE). AGE-RAGE interaction contributes to fat accumulation in the liver leading to inflammation, fibrosis, insulin resistance, and other complications of the fatty liver disease. The immune system, especially macrophages, has an important defense mechanism against RAGE pathway activities.

Conclusion: Soluble form of RAGE (sRAGE) has the capability to reduce inflammation by blocking the interaction of AGE with RAGE. However, sRAGE has some limitations, and the best method of usage is probably autotransplantation of transfected stem cells or monocytes, as a precursor of macrophages and Kupffer cells, with a virus that carries sRAGE to alleviate the harmful effects of AGE-RAGE signaling in the settings of fatty liver disease.
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http://dx.doi.org/10.1155/2019/2151302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766674PMC
September 2019

Low-risk planned caesarean versus planned vaginal delivery at term: early and late infantile outcomes.

East Mediterr Health J 2019 Oct 4;25(7):503-513. Epub 2019 Oct 4.

Health policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran.

Background: Understanding the impact of delivery mode on neonatal morbidity becomes essential in the context of rising Caesarian delivery rates.

Aims: We aimed to compare the selected outcomes in neonates born by low-risk planned Caesarian delivery versus planned normal vaginal delivery (NVD).

Methods: This prospective cohort study examined early, and late neonatal complications among 1071 neonates born through low-risk planned Caesarian delivery and 1367 neonates born through planned NVD, in Fars, Islamic Republic of Iran, during 2012-2014.

Results: Gestational age of neonates born through Caesarian delivery was significantly lower than their counterparts in NVD group. Accordingly, babies' birth weights were 3166 (±442.4) grams in Caesarian delivery group and 3213 (±454.8) grams in NVD group. Normal skin colour at birth was more prevalent in the Caesarian delivery group compared to the NVD group (85% vs. 81.3%, P = 0.04). No significant differences were detected between the two groups regarding birth trauma, birth height and head circumference, and developing infection, icterus and convulsion during neonatal period. Also, height and weight at two years of age did not significantly differ in both groups.

Conclusion: The results of this study show that neonates born by Caesarian delivery and NVD had the same early and late outcomes.
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http://dx.doi.org/10.26719/emhj.18.066DOI Listing
October 2019

The effects of vitamin D supplementation on muscle function among postmenopausal women: a systematic review and meta-analysis of randomized controlled trials.

EXCLI J 2019 6;18:591-603. Epub 2019 Aug 6.

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.

The loss of muscle mass and its strength is one of the most critical changes in aging which is associated with an increased risk of falls, osteoporotic fractures and mobility disability. Vitamin D, with its extra-skeletal benefits, might improve muscle function in elderly. The current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize available relevant data and determine the effect of vitamin D supplementation on muscle function among postmenopausal women. We reached databases including; Cochrane library, Embase, PubMed, and Web of Science database until the end of May 2018 to identify relevant published RCTs. Heterogeneity among included studies was assessed using Q-test and I statistics. Random-effect model was applied to pool data and weighted mean difference (WMD) was calculated representing summary effect size. Outcomes of interest included the effects of vitamin D supplementation on hand grip strength (HGS), back muscle strength (BMS), and Timed Up and Go (TUG). Twelve RCTs out of 1739 potential reports were included in our meta-analysis. The pooled findings showed that vitamin D supplementation had no significant effect on HGS (WMD -0.03 kilogram (Kg); 95 % CI, -0.26, 0.20; P=0.78), BMS (WMD 7.21 newton (N); 95 % CI, -5.98, 20.40; P=0.28), and TUG (WMD 0.01 second (S); 95 % CI, -0.17, 0.18; P=0.93) in postmenopausal women. Overall, the current meta-analysis showed that taking vitamin D supplementation by postmenopausal women did not affect markers of muscle function. Further studies are required to confirm the effect of vitamin D supplementation on markers of muscle function.
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http://dx.doi.org/10.17179/excli2019-1386DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785780PMC
August 2019

Incidence Rate of Gastric Cancer Adenocarcinoma in Patients With Gastric Dysplasia: A Systematic Review and Meta-Analysis.

J Clin Gastroenterol 2019 Nov/Dec;53(10):703-710

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, I.R. Iran.

Several studies have reported the risk of progression to gastric adenocarcinoma (GAC) in patients with gastric dysplasia (GD); however, the findings are controversial. We performed a systematic review and meta-analysis to study the incidence rate of GAC among patients with GD. Using a comprehensive search strategy, we systematically searched online databases including PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science databases for identifying all relevant original articles through inception until July 2018. Cochran Q and I tests were used to assess heterogeneities between included studies. The incidence rates of GAC and their corresponding 95% confidence intervals (CIs) were pooled using random-effect or fixed-effect models. Of the 1980 retrieved records, 30 eligible articles (61 studies) were included. The overall pooled incidence rate of GAC was 40.36 (95% CI, 27.08-55.71; I, 96.0%) cases per 1000 person-years in patients with GD. Subgroup analysis according to the type of GD indicated the highest incidence rate of GAC was 186.40 (95% CI, 106.63-285.60; I, 94.6%) per 1000 person-years among patients with high-grade dysplasia (HGD) lesions. Although the incidence rates of GAC in low-grade dysplasia (LGD) lesions and in nonclassified lesions were 11.25 (95% CI, 3.91-21.22; I, 89.3%), and 1.40 (95% CI, 0.00-9.71; I, 78.8%), respectively. Compared with patients with LGD lesions, progression rate from GD to GAC was roughly 16 times greater in patients with HGD lesions. As the majority of patients with GAC are diagnosed in an advanced stage our study suggests strict management of HGD lesions to prevent GAC.
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http://dx.doi.org/10.1097/MCG.0000000000001257DOI Listing
September 2020

Vitamin D Status in Women with Pelvic Floor Disorders: A Meta-Analysis of Observational Studies.

J Midlife Health 2019 Apr-Jun;10(2):57-62

Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.

The current evidence regarding the association between vitamin D status and pelvic floor disorder (PFD) are inconclusive. This meta-analysis was aimed to summarize existing data demonstrating the association between Vitamin D status and PFD using published observational studies. All national and international databases including Web of Science, PubMed, Google Scholar, and Scopus were searched up until January 30, 2018, and related published studies retrieved for meta-analysis. The effect sizes of Vitamin D status were presented as standardized mean difference (SMD) with 95% confidence interval (CI), using random-effect models and inverse variance method. The Cochran Q statistic and tests were used to evaluate the heterogeneity across included studies. Seven studies with 3219 women were included our meta-analysis. There was heterogeneity existing among included studies ( = 96.4%, < 0.001), so a random-effect model was used. The findings of this meta-analysis revealed that the mean serum Vitamin D levels in women with PFD were significantly lower than healthy women (SMD -0.60; 95% CI, -1.06, -0.13; = 0.01). This meta-analysis demonstrates lower levels of serum Vitamin D in women with PFD rather than healthy women. Additional prospective studies regarding the association between Vitamin D status and PFD are required to confirm our findings.
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http://dx.doi.org/10.4103/jmh.JMH_9_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6643706PMC
August 2019

Relationships Between Various Components of Metabolic Syndrome and Chronic Kidney Disease in Shiraz, Iran.

Int J Endocrinol Metab 2019 Apr 27;17(2):e81822. Epub 2019 Feb 27.

Shiraz Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Chronic kidney disease (CKD) can potentially be associated with metabolic syndrome (MetS).

Objectives: We aimed to determine the association of MetS and the number of metabolic syndrome components with the risk of CKD in the Iranian population in southern Iran.

Methods: A total of 819 subjects aged 18 - 88 years were enrolled using weight-based random cluster sampling. We constructed a logistic regression model to determine the adjusted odds ratios (ORs) and 95% confidence intervals (CI) of the association of MetS individual components and the number of these components with CKD.

Results: The prevalence rate of MetS was 25.9% (30.9% in women and 18.8% in men). CKD was present in 16.6% of the participants (men: 14% and women: 19.4%). The most prevalent component was abdominal obesity (63.6%), followed by low HDL cholesterol (36.7%), high triglyceride level (31.7%), hypertension (25.6%) and high fasting blood sugar (21.9%). Central obesity and low HDL level were observed to be more prevalent among women (P < 0.001). The presence of MetS was associated with CKD with an increased OR for CKD (OR: 3.07, 95% CI 2.09 - 4.50; P < 0.001). The adjusted ORs (95% CI) were 1.189 (0.554 - 2.555), 2.025 (0.990 - 4.141) and 4.769 (2.413 - 9.424) as the number of risk factors increased from 1 to ≥ 3. Individuals with hypertension and abdominal obesity had a higher OR of increased susceptibility to CKD in multivariate analysis.

Conclusions: Our study indicated a strong association between CKD and MetS in the Iranian population. It is also suggested that individuals with metabolic risk factors should be detected earlier; they should also undergo multidisciplinary interventions to hinder worsening of the individual components of MetS and development of CKD.
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http://dx.doi.org/10.5812/ijem.81822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628220PMC
April 2019

Gastric cancer in patients with gastric atrophy and intestinal metaplasia: A systematic review and meta-analysis.

PLoS One 2019 26;14(7):e0219865. Epub 2019 Jul 26.

Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.

Aim: Intestinal metaplasia (IM) and gastric atrophy (GA) are precancerous lesions in the stomach. There is a large debate on natural course of these lesions and surveillance strategy in these patients. This meta-analysis was aimed to find the most appropriate follow up and the rate of progression from IM and GA to GC.

Methods: This meta-analysis is followed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including EMBASE, PubMed, Web of Science databases, Scopus, and the Cochrane Library were searched until July 2018. Cochran's Q test and I-square (I2) test were used to examine heterogeneity across included studies. We pooled data using random-effect or fixed effect models indicated as incidence rate or proportion with 95% confidence intervals (CI). The variables of study included demographic data, endoscopy interval, follow up interval and time, GA and IM type and GC stage. Moreover, incidence rate of GC and progress rate, regress and persistence proportion in both GA and IM patients were assessed.

Results: Overall, 68 original articles out of 32981 citations were included in our meta-analysis. The pooled GC incidence rate in patients with GA was 1.24 (95% CI, 0.80, 1.76; I2: 83.6%) cases per 1,000 person-years. The rates of later diagnosis of IM and gastric dysplasia in patients with GA were estimated as 41.42 (95% CI, 3.11, 64.45; I2: 95.6%) and 6.23 (95% CI, 2.34, 11.46; I2: 83.0%) cases per 1,000 person-years, respectively. The pooled regressed proportion was 32.23 (95% CI, 18.07-48.02; I2: 94.0%) and the persistence proportion was 38.83 (95% CI, 20.20-59.13; I2: 97.0%) per 100 observations in GA patients. In IM studies, the pooled incidence rate of GC was 3.38 (95% CI, 2.13, 4.85; I2: 93.4%) cases per 1,000 person-years. The progressed rate to dysplasia in IM patient was estimated to be 12.51 (95% CI, 5.45, 22.03; I2: 95.1%) cases per 1,000 person-years. The pooled regressed proportion was 31.83 (95% CI, 25.48-38.51; I2: 91.0%) and the persistence proportion was 43.46 (95% CI, 32.52-54.71; I2: 96.0%) per 100 observations in IM patients.

Conclusion: Overall, the incidence of GC in patients with IM and GA are low but there is heterogeneity in data with the highest rate in Asian, males with those with incomplete IM. There is probability of regression or persistence without progression in patients with IM and GA who receive appropriate management.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0219865PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660080PMC
February 2020