Publications by authors named "Naeimehossadat Asmarian"

18 Publications

  • Page 1 of 1

Comparing the effect of administering gelatin- low dose albumin versus albumin on renal function in liver transplantation: A randomized clinical trial.

Clin Transplant 2022 Aug 11:e14791. Epub 2022 Aug 11.

Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Science, Shiraz, Iran.

Background: Acute kidney injury is a common complication after liver transplantation that is independently associated with an increased risk of morbidity and mortality. This study aimed to evaluate the effects of administering gelatin-low dose albumin versus albumin on renal function and other early outcomes in liver transplantation.

Methods: This randomized controlled clinical trial was conducted on 140 patients undergoing liver transplantation from brain death donors. Patients were randomly assigned to two groups: albumin or modified gelatin with albumin. Blood samples were collected before (T0) and on the first (T1), second (T2), third (T3), fifth (T4), and last day of hospitalization (T5) after liver transplantation for the detection of laboratory parameters, including renal and liver function tests.

Results: The incidence of acute kidney injury on the basis of RIFLE criteria was 31.42 % in the gelatin group (R: 59.10 %, I: 36.40 %, and F: 4.50 %) and 25.71 % in the albumin group (R: 66.70 %, I: 27.80 %, and F: 5.50 %) (P = 0.845). Two patients in the gelatin and one in the albumin groups required renal replacement therapy. There was no significant difference between groups when the trends of changes in renal and liver function parameters were assessed during the study period (T0-T5). Furthermore, the incidence of complications was similar across groups.

Conclusion: This study showed that modified gelatin could be used without inappropriate outcomes on renal function in patients with normal preoperative kidney function tests undergoing liver transplantation. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/ctr.14791DOI Listing
August 2022

Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study Based on Machine-learning Approach from Iran.

Indian J Crit Care Med 2022 Jun;26(6):688-695

Shiraz University of Medical Sciences, Student Research Committee, Shiraz, Iran.

Background: Prioritizing the patients requiring intensive care may decrease the fatality of coronavirus disease-2019 (COVID-19).

Aims And Objectives: To develop, validate, and compare two models based on machine-learning methods for predicting patients with COVID-19 requiring intensive care.

Materials And Methods: In 2021, 506 suspected COVID-19 patients, with clinical presentations along with radiographic findings, were laboratory confirmed and included in the study. The primary end-point was patients with COVID-19 requiring intensive care, defined as actual admission to the intensive care unit (ICU). The data were randomly partitioned into training and testing sets (70% and 30%, respectively) without overlapping. A decision-tree algorithm and multivariate logistic regression were performed to develop the models for predicting the cases based on their first 24 hours data. The predictive performance of the models was compared based on the area under the receiver operating characteristic curve (AUC), sensitivity, and accuracy of the models.

Results: A 10-fold cross-validation decision-tree model predicted cases requiring intensive care with the AUC, accuracy, and sensitivity of 97%, 98%, and 94.74%, respectively. The same values in the machine-learning logistic regression model were 75%, 85.62%, and 55.26%, respectively. Creatinine, smoking, neutrophil/lymphocyte ratio, temperature, respiratory rate, partial thromboplastin time, white blood cell, Glasgow Coma Scale (GCS), dizziness, international normalized ratio, O saturation, C-reactive protein, diastolic blood pressure (DBP), and dry cough were the most important predictors.

Conclusion: In an Iranian population, our decision-based machine-learning method offered an advantage over logistic regression for predicting patients requiring intensive care. This method can support clinicians in decision-making, using patients' early data, particularly in low- and middle-income countries where their resources are as limited as Iran.

How To Cite This Article: Sabetian G, Azimi A, Kazemi A, Hoseini B, Asmarian N, Khaloo V, Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study based on Machine-learning Approach from Iran. Indian J Crit Care Med 2022;26(6):688-695.

Ethics Approval: This study was approved by the Ethical Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.018).
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http://dx.doi.org/10.5005/jp-journals-10071-24226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9237161PMC
June 2022

Effectiveness of pentoxifylline in severe early-onset fetal growth restriction: A randomized double-blinded clinical trial.

Taiwan J Obstet Gynecol 2022 Jul;61(4):612-619

Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Objective: Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR.

Materials And Methods: This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups.

Results: Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group.

Conclusion: Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade.
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http://dx.doi.org/10.1016/j.tjog.2021.12.003DOI Listing
July 2022

Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial.

Ann Emerg Med 2022 Jun 22. Epub 2022 Jun 22.

Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.

Study Objective: To determine the effectiveness of intranasal topical application of tranexamic acid in reducing the need for anterior nasal packing and determine the number of episodes of rebleeding in adult patients presenting with spontaneous atraumatic anterior epistaxis.

Methods: This study was a double-blind randomized trial conducted from September to November 2021 in the ears, nose, and throat (ENT) emergency department (ED), Khalili Hospital, Shiraz, Iran. Cotton pledgets soaked in either phenylephrine and lidocaine (control group) or tranexamic acid with phenylephrine and lidocaine (intervention group) were inserted into the patients' nostrils for 15 minutes. The primary outcome was the need for anterior nasal packing. The secondary outcomes were staying in the ED for more than 2 hours, needing electrical cauterization, and rebleeding within 24 hours and 1 to 7 days of the first referral to the ED. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20210403050815N1).

Results: A total of 240 patients (120 in each group) were enrolled in this study. Tranexamic acid was associated with a lower rate of need for anterior nasal packing (50.0% versus 64.2%; odds ratio [OR], 0.56; 95% confidence interval [CI], 0.33 to 0.94). There were no significant differences between the 2 groups in terms of the need for electrical cauterization and the rate of rebleeding within 1 to 7 days. Tranexamic acid was associated with a lower rate of stay in the ED for more than 2 hours (9.2% versus 20.8%; OR, 0.38; 95% CI, 0.18 to 0.82) and rebleeding in 24 hours (15.0% versus 30%; OR, 0.41; 95% CI, 0.22 to 0.78) compared with the rates in the control group.

Conclusion: Intranasal topical application of tranexamic acid is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED; it may be considered a part of the treatment for atraumatic anterior epistaxis.
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http://dx.doi.org/10.1016/j.annemergmed.2022.04.010DOI Listing
June 2022

Risk factors of the post-reperfusion syndrome during orthotopic liver transplantation: a clinical observational study.

BMC Anesthesiol 2022 04 2;22(1):89. Epub 2022 Apr 2.

Shiraz Transplant Center, Abu-Alisina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Post reperfusion syndrome (PRS) is a relatively common and life-threatening complication during orthotopic liver transplantation (OLT). It is associated with poor patient and transplanted liver outcomes.

Objective: This study aimed to compare the risk factors of PRS during OLT.

Design: Clinical-epidemiological observational retrospective study.

Setting: We gathered the records of patients who underwent OLT in 3 years, from May 22, 2016, to May 22, 2019, in Namazi and Bu-Ali Sina organ transplantation hospitals.

Patients: In this study, we assessed 1182 patients who underwent OLT. Patients were divided into two groups based on the presence or absence of PRS.

Main Outcome Measures: Diagnosing the predictors of PRS was the primary outcome of this study.

Results: Results showed that age > 60 years, Child-Pugh scores C, higher Model End Stage liver disease score, and preoperative sodium < 130 mmol/l (parameters of the liver recipient), increase in cold ischemic time (the donors' parameters), and the classical technique (the surgical parameters) were the strong predictors of PRS.

Conclusions: The results indicated that underlying liver disease was not the predictor of PRS in the presence of other risk factors; therefore, clinicians have to consider these risk factors in patients undergoing OLT.
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http://dx.doi.org/10.1186/s12871-022-01635-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8976299PMC
April 2022

Importance of TP53 codon 72 and intron 3 duplication 16 bp polymorphisms and their haplotypes in susceptibility to sarcopenia in Iranian older adults.

BMC Geriatr 2022 02 5;22(1):103. Epub 2022 Feb 5.

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Sarcopenia is described as age-related progressive skeletal muscle failure that results in marked reduction in the patient's independence and life quality. In this study, we explored the association of TP53 exon 4 Arg72pro (rs1042522) and Intron 3 16-bp Del/Ins (rs17878362) polymorphisms and their haplotypes with sarcopenia, anthropometric, body composition and biochemical parameters.

Methods: A total of 254 older individuals (65 sarcopenic and 189 healthy) were recruited in this research and genotyped by PCR-RFLP. Linear regression was applied to find the correlation between TP53 polymorphism, and biochemical and anthropometric parameters. The correlation between TP53 polymorphism and haplotypes and the risk of sarcopenia was investigated by logistic regression.

Results: Arg/Pro genotype carriers was at a lower (OR = 0.175, 95% CI = 0.068 - 0.447; P < 0.001) risk of sarcopenia compared to the Arg/Arg group. In haplotypes analysis, Arg-Ins (OR: 0.484, 95% CI = 0.231 - 1.011, P = 0.043) and Pro-Ins (OR: 0.473, 95% CI = 0.210 - 1.068, P = 0.022) haplotypes showed decreased risk of developing sarcopenia. Moreover, in the case of codon 72 polymorphism, skeletal muscle mass, appendicular lean mass (ALM), skeletal muscle mass index (SMI), hand grip strength and Triglycerides, for Intron 3 16-bp Del/Ins polymorphism, albumin, calcium, cholesterol, and LDL were different, and for the haplotypes, skeletal muscle mass, SMI, ALM, HDL and triglycerides were significantly different between groups.

Conclusions: We suggested that the Arg/Pro genotype of the codon 72 polymorphism in exon 4 of TP53, and Arginine-Insertion and Proline-Insertion haplotypes might decrease the risk of sarcopenia in Iranian older adults.
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http://dx.doi.org/10.1186/s12877-022-02765-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8818191PMC
February 2022

Comparison of the Effect of Ketamine, Ketamine-Midazolam and Ketamine-Propofol on Post-Tonsillectomy Agitation in Children.

Malays J Med Sci 2021 Oct 26;28(5):72-81. Epub 2021 Oct 26.

Anaesthesiology and Critical Care Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Emergence agitation (EA) in children is one of the most common complications following anaesthesia. We aimed to compare the effect of ketamine, ketamine-midazolam and ketamine-propofol on EA after tonsillectomy.

Methods: This study was a randomised, double-blind clinical trial conducted on 162 children undergoing adenotonsillectomy surgery. The participants were randomly divided into three groups of receiving ketamine (0.5 mg/kg) ( = 54), ketamine (0.5 mg/kg) + propofol (1 mg/kg) ( = 54) and ketamine (0.5 mg/kg) + midazolam (0.01 mg/kg) ( = 54) 10 min before the end of the operation. At the time of the patients' entry into the post-anaesthesia care unit (PACU) and at intervals of 5 min, 10 min and 20 min after that, consciousness, mobility, breathing, circulation and SpO were recorded. Modified Aldrete recovery score (MARS), the objective pain score (OPS) and Richmond agitation-sedation scale (RASS) were also evaluated.

Results: At the time of entrance to the PACU and 5 min later, the ketamine-midazolam and ketamine-propofol groups had lower RASS scores than the ketamine group ( < 0.001); after 10 min and 20 min, the ketamine-propofol group showed the lowest RASS score ( < 0.001). Ketamine-propofol group had a significantly lower MARS score at all-time points ( < 0.001). Recovery time was the longest for the ketamine-propofol group ( = 0.008).

Conclusion: The ketamine-midazolam group had lower RASS, greater haemodynamic stability and MARS values without delayed awakening.
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http://dx.doi.org/10.21315/mjms2021.28.5.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8793969PMC
October 2021

Comparison of the effects of remifentanil and dexmedetomidine on surgeon satisfaction with surgical field visualization and intraoperative bleeding during rhinoplasty.

BMC Anesthesiol 2022 01 14;22(1):24. Epub 2022 Jan 14.

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, 71937-11351, Iran.

Objective: We aimed to compare the effect of dexmedetomidine with remifentanil on hemodynamic stability, surgical field quality, and surgeon satisfaction during rhinoplasty.

Methods And Materials: In this double-blind randomized controlled-trial, 60 participants scheduled for rhinoplasty at the Mother and Child Hospital, Shiraz, Iran, was randomely divided into the dexmedetomidine group (IV infusion of 1 μg/kg dexmedetomidine over 20 min before induction of anesthesia then 0.6 μg/kg/hr. dexmedetomidine from the time of induction until the end of the operation) or in the the remifentanil group (an infusion rate of 0.25 μg/kg/min from the time of anesthesia induction until the end of the operation). Bleeding volume, surgeon satisfaction, postoperative pain (visual analog scale (VAS)), Level of sedation (Richmond Agitation Sedation Scale (RASS)), Patient satisfaction, Vital signs & recovery, and the Aldrete Score (used to discharge the patients from recovery) were measured for all participants.

Results: The patients in the dexmedetomidine group had less bleeding (p = 0.047) and shorter time to return of respiration, extubation, and the postoperative recovery time (p < 0.001). The surgeon satisfaction was higher in the dexmedetomidine group (p < 0.001). Patient satisfaction was significantly different between the two groups (p < 0.001). VAS scores, intaking paracetamol, and RASS score were significantly lower in the remifentanil group (p < 0.001). SBP, DBP, MAP, and heart rate were lower in dexmedetomidine group.

Conclusion: Dexmedetomidine was associated with relatively stable hemodynamics, leading to decreased intraoperative bleeding, recovery time, and greater surgeon satisfaction and the level of consciousness in the recovery ward. However, painlessness and patient satisfaction were greater with the use of remifentanil.

Trial Registration: IRCT20141009019470N112 .
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http://dx.doi.org/10.1186/s12871-021-01546-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759207PMC
January 2022

Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial.

Braz J Anesthesiol 2021 Dec 29. Epub 2021 Dec 29.

Shiraz University of Medical Sciences, Laparoscopy Research Center, Shiraz, Iran.

Background: Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated.

Objectives: The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries.

Methods: In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test.

Results: Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications.

Conclusion: Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.
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http://dx.doi.org/10.1016/j.bjane.2021.12.007DOI Listing
December 2021

The effect of posterior tibial and sural nerve blocks on postoperative pain of patients following open reduction and internal fixation of calcaneal fractures.

Foot Ankle Surg 2021 Nov 24. Epub 2021 Nov 24.

Orthopedic Foot and Ankle Surgeon, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Introduction: Postoperative pain control and achieving opioid-free anesthesia are major issues for surgically treated patients with calcaneal fractures. We evaluated the potential role of posterior tibial and sural nerve blocks as a part of multimodal pain control techniques in patients underwent open reduction and internal fixation (ORIF) of calcaneal fractures via extensile lateral approach.

Methods: Forty-eight patients randomly allocated to receive either posterior tibial and sural nerve blocks with bupivacaine (peripheral nerve block (PNB) group) or normal saline, after induction of general anesthesia. Patients were assessed for pain intensity, Interval from entrance to the recovery room to the first request for analgesic, recovery room and ward morphine consumption, global satisfaction and morphine side effects.

Results: PNB group had less pain score compared to sham block (SB) group at each time point measurement during recovery room stay. There was also significant difference between the 2 groups regarding the pain scores after 2, 4 and 6 h of the operation in the ward. Time to the first request for analgesic was significantly prolonged in the PNB group (P < 0.001). The recovery room and ward morphine consumption was significantly lower in the PNB group (P < 0.001). Global satisfaction in PNB group was significantly more than that of SB group. No complication related to the nerve block was detected at the first postoperative visit in the outpatient clinic.

Conclusion: Peripheral nerve block could result in less postoperative pain especially in the early hours after ORIF of calcaneal fractures and reduce opioid administration within the first 24 h following the surgery.
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http://dx.doi.org/10.1016/j.fas.2021.11.009DOI Listing
November 2021

Parkinson's Disease Rating Scale Using Synchronization Analysis of Gait Dynamics.

Biomed Res Int 2021 25;2021:5651519. Epub 2021 Aug 25.

Faculty of Engineering, Ardakan University, Ardakan, Iran.

Analysis of gait dynamics is a noninvasive and totally painless test, and it can be an ideal method for the diagnosis of neurodegenerative diseases. In this study, based on the strength of synchronization between dynamics of strides, we have suggested a rating scale method for Parkinson's disease (PD). . The sample included 15 persons with PD (age: 66.8 ± 10.9 years) and 16 healthy persons (age: 39.3 ± 18.5 years) which were recruited from the Neurology Outpatient Clinic at Massachusetts General Hospital and were instructed to walk a 77 m long, straight hallway. The time interval of strides and subphases of strides were measured. Using the Hilbert transformation method, we obtained the data phase and used mean absolute error (MAE) to calculate the synchronization strength of the data phase. . In order to check the accuracy of our method, we measured the correlation between our numerical results (MAE) and values of the Hoehn-Yahr scale. Spearman's rank correlation coefficients () and the values were calculated. MAE of left and right stride intervals (LRSI) significantly correlates with the Hoehn-Yahr scale for the subjects with PD (with = 0.60 and = 0.025 < 0.05). . We have revealed that the synchronization weakness of LRSI shows the severity of PD. This method seems to be well suited as a rating scale for people with PD.
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http://dx.doi.org/10.1155/2021/5651519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8413035PMC
October 2021

Multiple sclerosis incidence rate in southern Iran: a Bayesian epidemiological study.

BMC Neurol 2021 Aug 10;21(1):309. Epub 2021 Aug 10.

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

Background: Multiple Sclerosis (MS) remains to be a public health challenge, due to its unknown biological mechanisms and clinical impacts on young people. The prevalence of this disease in Iran is reported to be 5.30 to 74.28 per 100,000-person. Because of high prevalence of this disease in Fars province, the purpose of this study was to assess the spatial pattern of MS incidence rate by modeling both the associations s of spatial dependence between neighboring regions and risk factors in a Bayesian Poisson model, which can lead to the improvement of health resource allocation decisions.

Method: Data from 5468 patients diagnosed with MS were collected, according to the McDonald's criteria. New cases of MS were reported by the MS Society of Fars province from 1991 until 2016. The association between the percentage of people with low vitamin D intake, smoking, abnormal BMI and alcohol consumption in addition to spatial structure in a Bayesian spatio-temporal hierarchical model were used to determine the relative risk and trend of MS incidence rate in 29 counties of Fars province.

Results: County-level crude incidence rates ranged from 0.22 to 11.31 cases per 100,000-person population. The highest relative risk was estimated at 1.80 in the county of Shiraz, the capital of Fars province, while the lowest relative risk was estimated at 0.11 in Zarindasht county in southern of Fars. The percentages of vitamin D supplementation intake and smoking were significantly associated with the incidence rate of MS. The results showed that 1% increase in vitamin D supplementation intake is associated with 2% decrease in the risk of MS and 1% increase in smoking is associated with 16% increase in the risk of MS.

Conclusion: Bayesian spatio-temporal analysis of MS incidence rate revealed that the trend in the south and south east of Fars province is less steep than the mean trend of this disease. The lower incidence rate was associated with a higher percentage of vitamin D supplementation intake and a lower percentage of smoking. Previous studies have also shown that smoking and low vitamin D, among all covariates or risk factors, might be associated with high incidence of MS.
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http://dx.doi.org/10.1186/s12883-021-02342-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8353854PMC
August 2021

COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran.

Virol J 2021 03 17;18(1):58. Epub 2021 Mar 17.

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: With the novel coronavirus pandemic, the impact on the healthcare system and workers cannot be overlooked. However, studies on the infection status of medical personnel are still lacking. It is imperative to ensure the safety of health-care workers (HCWs) not only to safeguard continuous patient care but also to ensure they do not transmit the virus, therefore evaluation of infection rates in these groups are indicated.

Methods: Demographic and clinical data regarding infected cases among HCWs of Fars, Iran with positive SARS-CoV-2 PCR tests were obtained from 10th March to 17th May 2020.

Results: Our data demonstrated a rate of 5.62% (273 out of 4854 cases) infection among HCW, with a mean age of 35 years and a dominance of female cases (146 cases: 53.5%). The majority of infected cases were among nurses (51.3%), while the most case infection rate (CIR) was among physicians (27 positive cases out of 842 performed test (3.2%)). Also, the highest rate of infection was in the emergency rooms (30.6%). Also, 35.5% of the patients were asymptomatic and the most frequent clinical features among symptomatic patients were myalgia (46%) and cough (45.5%). Although 5.5% were admitted to hospitals, there were no reports of ICU admission. Furthermore, 10.3% of the cases reported transmitting the infection to family and friends. Regarding safety precautions, 1.6% didn't wear masks and 18.7% didn't use gloves in work environments.

Conclusion: HCWs are among the highest groups at risk of infection during the COVID-19 pandemic; therefore, evaluating infection rates and associated features is necessary to improve and adjust protective measures of these vulnerable, yet highly essential group.
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http://dx.doi.org/10.1186/s12985-021-01532-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968574PMC
March 2021

Bayesian spatial modeling of transfusion-dependent β-thalassemia incidence rate in Fars Province, Southern Iran.

Spat Spatiotemporal Epidemiol 2021 02 7;36:100389. Epub 2020 Nov 7.

Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Using maps and spatial analysis are technologies to evaluate the magnitude and spatial distribution of disease in epidemiology investigations. We aimed to conduct a Bayesian spatial analysis on epidemiologic data of transfusion-dependent β-thalassemia (TDT) patients.

Methods: In this cross-sectional study, data of all TDT patients diagnosed during 1955-2018 in all counties of Fars Province were obtained from data registry of the Organization of Special Diseases of Shiraz University of Medical Sciences in Shiraz, Fars Province, Iran. Besag, York, and Mollie's (BYM) model was used for mapping.

Results: The estimated relative risk ranged from 0.23 to 1.66 for TDT patients. The highest and lowest relative risks of TDT were observed in Larestan located in Southern and Abadeh in Northern Fars Province respectively.

Conclusions: Determining the accurate geographical distribution of a chronic disease such as β-thalassemia can be an essential prerequisite in allocation of regional health system resources.
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http://dx.doi.org/10.1016/j.sste.2020.100389DOI Listing
February 2021

Bayesian Spatial Joint Model for Disease Mapping of Zero-Inflated Data with R-INLA: A Simulation Study and an Application to Male Breast Cancer in Iran.

Int J Environ Res Public Health 2019 11 13;16(22). Epub 2019 Nov 13.

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz 7134845794, Iran.

Hierarchical Bayesian log-linear models for Poisson-distributed response data, especially Besag, York and Mollié (BYM) model, are widely used for disease mapping. In some cases, due to the high proportion of zero, Bayesian zero-inflated Poisson models are applied for disease mapping. This study proposes a Bayesian spatial joint model of Bernoulli distribution and Poisson distribution to map disease count data with excessive zeros. Here, the spatial random effect is simultaneously considered into both logistic and log-linear models in a Bayesian hierarchical framework. In addition, we focus on the BYM2 model, a re-parameterization of the common BYM model, with penalized complexity priors for the latent level modeling in the joint model and zero-inflated Poisson models with different type of zeros. To avoid model fitting and convergence issues, Bayesian inferences are implemented using the integrated nested Laplace approximation (INLA) method. The models are compared according to the deviance information criterion and the logarithmic scoring. A simulation study with different proportions of zero exhibits INLA ability in running the models and also shows slight differences between the popular BYM and BYM2 models in terms of model choice criteria. In an application, we apply the fitting models on male breast cancer data in Iran at county level in 2014.
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http://dx.doi.org/10.3390/ijerph16224460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6888013PMC
November 2019

Area-to-Area Poisson Kriging and Spatial Bayesian Analysis in Mapping of Gastric Cancer Incidence in Iran

Asian Pac J Cancer Prev 2016 10 1;17(10):4587-4590. Epub 2016 Oct 1.

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Email:

Background: In many countries gastric cancer has the highest incidence among the gastrointestinal cancers and is the second most common cancer in Iran. The aim of this study was to identify and map high risk gastric cancer regions at the county-level in Iran. Methods: In this study we analyzed gastric cancer data for Iran in the years 2003-2010. Areato- area Poisson kriging and Besag, York and Mollie (BYM) spatial models were applied to smoothing the standardized incidence ratios of gastric cancer for the 373 counties surveyed in this study. The two methods were compared in term of accuracy and precision in identifying high risk regions. Result: The highest smoothed standardized incidence rate (SIR) according to area-to-area Poisson kriging was in Meshkinshahr county in Ardabil province in north-western Iran (2.4,SD=0.05), while the highest smoothed standardized incidence rate (SIR) according to the BYM model was in Ardabil, the capital of that province (2.9,SD=0.09). Conclusion: Both methods of mapping, ATA Poisson kriging and BYM, showed the gastric cancer incidence rate to be highest in north and north-west Iran. However, area-to-area Poisson kriging was more precise than the BYM model and required less smoothing. According to the results obtained, preventive measures and treatment programs should be focused on particular counties of Iran.
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http://dx.doi.org/10.22034/apjcp.2016.17.10.4587DOI Listing
October 2016

Bayesian spatial analysis of the surgical incidence rate of human cystic echinococcosis in north-eastern Iran.

Acta Trop 2016 Nov 2;163:80-6. Epub 2016 Aug 2.

Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Cystic echinococcosis (CE) is a zoonotic disease that presents a public health challenge and a socioeconomic burden on developing areas in the Middle East. This study used spatial methods to assess the distribution of surgically managed CE cases in an endemic region of north-eastern Iran.

Methods: For the years 2001-2007, a case series of all 446 patients that were surgically treated for CE in a referral hospital in north-eastern Iran was evaluated. Patients seen at the referral hospital represent 35 counties in three provinces (Razavi Khorasan, North Khorasan, and South Khorasan). A Besag, York and Mollie (BYM) spatial model was used to produce smoothed standardized incidence ratios (SIRs) for surgically managed cases of CE for the 35 counties represented in this study.

Results: Out of 446 surgically managed patients, 54% were male. County-level crude incidence rates ranged from 0 to 3.27 cases per 100,000 population. The highest smoothed SIR (3.46) was for Sarakhs County in the province of Razavi Khorasan, while the lowest smoothed SIR (0.05) was for Birjand County, located in the province of South Khorasan.

Conclusion: SIRs for CE were highest for the province of Razavi Khorasan, which has large ranching and agricultural industries. Additional studies are needed to better evaluate the role of climate, land cover, and livestock rearing on local Echinococcus granulosus transmission in Iran.
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http://dx.doi.org/10.1016/j.actatropica.2016.08.003DOI Listing
November 2016
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