Publications by authors named "Saeed Dastgiri"

80 Publications

Association between nitrate concentration in drinking water and rate of colorectal cancer: a case study in northwestern Iran.

Int J Environ Health Res 2021 Apr 13:1-10. Epub 2021 Apr 13.

Department of Community and Family Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

Nitrate, as a major pollutant of drinking water, is associated with colorectal cancer (CRC) and serves as an environmental health concern, especially in the districts with unregulated agriculture. In this case study in northwestern Iran, we used two databases of nitrate concentration (1999-2013) and age-standardized incidence rate (ASR) for CRC (2002-2012) from 19 counties of East Azerbaijan province. The trend and correlation between nitrate and ASR was investigated. Inverse distance weighted technique was used to spatially interpolate the maps. Expectedly, drinking water nitrate has increased throughout the province (8-20.5 mg/L) as well as the ASR for CRC of men (from 2.07 to 18.05 mg/L) and women (from 1.57 to 10.94 mg/L). While ASR for CRC of men was positively correlated to nitrate (Pearson's = 0.624, -value = 0.040), no statistically significant correlation was found between nitrate and ASR for women's CRC (Pearson's = 0.289, -value = 0.351). According to our findings, the incidence of CRC was not higher for those residing in the regions with higher nitrate, suggesting that risk factors such as genetic predisposition and diet that were not taken into account could be determinants of this pattern. However, even a small increase in CRC rate due to water nitrate could translate into a large public health concern. The incremental pattern observed in nitrate levels of different counties over the years gives the health policymakers a better perspective of the problem and how the control of water nitrate level as a CRC risk factor might contribute to the prevention of CRC.
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http://dx.doi.org/10.1080/09603123.2021.1914322DOI Listing
April 2021

Survival of infants born with esophageal atresia among 24 international birth defects surveillance programs.

Birth Defects Res 2021 Mar 18. Epub 2021 Mar 18.

Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia.

Background: Esophageal atresia (EA) affects around 2.3-2.6 per 10,000 births world-wide. Infants born with this condition require surgical correction soon after birth. Most survival studies of infants with EA are locally or regionally based. We aimed to describe survival across multiple world regions.

Methods: We included infants diagnosed with EA between 1980 and 2015 from 24 birth defects surveillance programs that are members of the International Clearinghouse for Birth Defects Surveillance and Research. We calculated survival as the proportion of liveborn infants alive at 1 month, 1- and 5-years, among all infants with EA, those with isolated EA, those with EA and additional anomalies or EA and a chromosomal anomaly or genetic syndrome. We also investigated trends in survival over the decades, 1980s-2010s.

Results: We included 6,466 liveborn infants with EA. Survival was 89.4% (95% CI 88.1-90.5) at 1-month, 84.5% (95% CI 83.0-85.9) at 1-year and 82.7% (95% CI 81.2-84.2) at 5-years. One-month survival for infants with isolated EA (97.1%) was higher than for infants with additional anomalies (89.7%) or infants with chromosomal or genetic syndrome diagnoses (57.3%) with little change at 1- and 5-years. Survival at 1 month improved from the 1980s to the 2010s, by 6.5% for infants with isolated EA and by 21.5% for infants with EA and additional anomalies.

Conclusions: Almost all infants with isolated EA survived to 5 years. Mortality was higher for infants with EA and an additional anomaly, including chromosomal or genetic syndromes. Survival improved from the 1980s, particularly for those with additional anomalies.
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http://dx.doi.org/10.1002/bdr2.1891DOI Listing
March 2021

Corrigendum to "Breast Cancer Survival and Incidence: 10 Years Cancer Registry Data in the Northwest, Iran".

Int J Breast Cancer 2021 20;2021:2604819. Epub 2021 Feb 20.

Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

[This corrects the article DOI: 10.1155/2020/1963814.].
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http://dx.doi.org/10.1155/2021/2604819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920743PMC
February 2021

Impact of mutations on clinical and prognostic outcomes in metastatic colorectal cancer.

Bioimpacts 2021 20;11(1):5-14. Epub 2019 Dec 20.

Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Early-activated mutation status is a key molecular finding in colorectal cancer (CRC), while these mutations have been proposed as predictive and prognostic biomarkers. The present study has been designed as a longitudinal study to evaluate and summarize the different genotypes of metastatic CRC (mCRC), and assessing any association with the disease prognosis and clinicopathological characteristics. This study was performed in two main referral hospitals of Tabriz University of Medical Sciences, over three years (2016-2018). Mutations were detected by Idylla tests of among a total of 173 mCRCs, using surgically-resected specimens or biopsied samples. To evaluate the factors associated with overall survival (OS) and prognosis, the Cox proportional hazards model was used in two steps to estimate the outcome measures (hazard ratio, or HR) with a 95% confidence interval (CI). The nominal 1 to 5-year OS rates were 78%, 65%, 55%, 46%, and 42%, respectively. KRAS mutations in codon 12 was an independent significant prognostic factor, as the patients with codon 12 mutations had a significantly lower OS (P Log-rank=0.049) and a higher hazard of mortality (HR=2.30; 95% CI: 0.95-5.58; =0.066). Also, the mCRC patients with liver metastasis (HR=2.49; 95% CI: 1.49-12.52; =0.002) and tumors of the distal colon (HR=3.36; 95% CI: 1.07-10.49; =0.037) had a significantly worse prognosis. mutation in codon 12 was an independent significant poor prognostic factor, and patients with liver metastasis had a significantly worse prognosis. Routinely performing specific oncogenic tests may help improve the patients' prognosis and life expectancy.
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http://dx.doi.org/10.34172/bi.2021.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803924PMC
December 2019

Prevalence and mortality in children with congenital diaphragmatic hernia: a multicountry study.

Ann Epidemiol 2021 Apr 27;56:61-69.e3. Epub 2020 Nov 27.

Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR. Electronic address:

Purpose: This study determined the prevalence, mortality, and time trends of children with congenital diaphragmatic hernia (CDH).

Methods: Twenty-five hospital- and population-based surveillance programs in 19 International Clearinghouse for Birth Defects Surveillance and Research member countries provided birth defects mortality data between 1974 and 2015. CDH cases included live births, stillbirths, or elective termination of pregnancy for fetal anomalies. Prevalence, cumulative mortality rates, and 95% confidence intervals (CIs) were calculated using Poisson regression and a Kaplan-Meier product-limit method. Joinpoint regression analyses were conducted to assess time trends.

Results: The prevalence of CDH was 2.6 per 10,000 total births (95% CI: 2.5-2.7), slightly increasing between 2001 and 2012 (average annual percent change = 0.5%; 95% CI:-0.6 to 1.6). The total percent mortality of CDH was 37.7%, with hospital-based registries having more deaths among live births than population-based registries (45.1% vs. 33.8%). Mortality rates decreased over time (average annual percent change = -2.4%; 95% CI: -3.8 to 1.1). Most deaths due to CDH occurred among 2- to 6-day-old infants for both registry types (36.3%, hospital-based; 12.1%, population-based).

Conclusions: The mortality of CDH has decreased over time. Mortality remains high during the first week and varied by registry type.
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http://dx.doi.org/10.1016/j.annepidem.2020.11.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009766PMC
April 2021

A multi-country study of prevalence and early childhood mortality among children with omphalocele.

Birth Defects Res 2020 12 17;112(20):1787-1801. Epub 2020 Oct 17.

International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy.

Background: Omphalocele is the second most common abdominal birth defect and often occurs with other structural and genetic defects. The objective of this study was to determine omphalocele prevalence, time trends, and mortality during early childhood, by geographical region, and the presence of associated anomalies.

Methods: We conducted a retrospective study with 23 birth defect surveillance systems in 18 countries who are members of the International Clearinghouse for Birth Defects Surveillance and Research that submitted data on cases ascertained from 2000 through 2012, approximately 16 million pregnancies were surveyed that resulted in live births, stillbirths, or elective terminations of pregnancy for fetal anomalies (ETOPFA) and cases with omphalocele were included. Overall prevalence and mortality rates for specific ages were calculated (day of birth, neonatal, infant, and early childhood). We used Kaplan-Meier estimates with 95% confidence intervals (CI) to calculate cumulative mortality and joinpoint regression for time trend analyses.

Results: The prevalence of omphalocele was 2.6 per 10,000 births (95% CI: 2.5, 2.7) and showed no temporal change from 2000-2012 (average annual percent change = -0.19%, p = .52). The overall mortality rate was 32.1% (95% CI: 30.2, 34.0). Most deaths occurred during the neonatal period and among children with multiple anomalies or syndromic omphalocele. Prevalence and mortality varied by registry type (e.g., hospital- vs. population-based) and inclusion or exclusion of ETOPFA.

Conclusions: The prevalence of omphalocele showed no temporal change from 2000-2012. Approximately one-third of children with omphalocele did not survive early childhood with most deaths occurring in the neonatal period.
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http://dx.doi.org/10.1002/bdr2.1822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722785PMC
December 2020

Staple Food Fortification with Folic Acid and Iron and Gastrointestinal Cancers: Critical Appraisal of Long-Term National Fortification.

Nutr Cancer 2020 Aug 10:1-5. Epub 2020 Aug 10.

Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

The co-occurrence of wheat flour fortification with folic acid and iron and gastrointestinal cancer incidences were critically assessed in the East Azerbaijan province in Northwest of Iran. In an ecological design, overall gastrointestinal cancer rate ratios and their 95% confidence intervals (95% CI) were calculated as primary outcome before (2004-2006) and after (2007-2015) the introduction of fortification. No consistent changes were observed in esophageal and gastric cancer, but the rate ratios of colorectal cancer increased significantly after fortification in the 35-54 years age group (women: 2.07, 95% CI: 1.79-2.49; men: 1.59, 95% CI: 1.33-1.89) and the 55-74 years age group (women 1.50, 95% CI: 1.27-1.76; men: 2.51, 95% CI: 2.13-2.95). The increased incidence of colorectal cancer was contemporary with long-term fortification; further investigation is required to establish the associations.
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http://dx.doi.org/10.1080/01635581.2020.1801778DOI Listing
August 2020

Breast Cancer Survival and Incidence: 10 Years Cancer Registry Data in the Northwest, Iran.

Int J Breast Cancer 2020 1;2020:1963814. Epub 2020 May 1.

Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Methods: Data were obtained from East Azerbaijan cancer registry database for the 10-year period between 2007 and 2016. Survival analysis was performed to calculate the breast cancer-specific survival proportions and mortality rates. Joinpoint trend analysis was performed to estimate the incidence trend of the cancer.

Results: A total number of 4989 patients were recorded with primary diagnosis of breast cancer. Of them, we collected follow-up data for 1335 (1309 female and 26 male). The 10-year crude mortality rate was 3.34 (per 100,000). The one-, two-, three-, five-, and ten-year breast cancer-specific survival proportions were 0.92 (95% CI 0.91-0.93), 0.88 (95% CI 0.86-0.90), 0.84 (95% CI 0.83-0.86), 0.77 (95% CI 0.74-0.80), and 0.65 (95% CI 0.60-0.70), respectively. Over the study period, the age-standardized incidence rates increased from 21.68 to 36.99 (per 100,000) with an annual percentage change of 5.5 percent. Older individuals and males patients had significantly worse survival, and patients with high-grade tumors had significantly higher risk of mortality.

Conclusion: A relatively better survival for breast cancer in East Azerbaijan, Iran, was observed compared to the overall breast cancer-specific survival proportions and mortality rates in the country. However, it is still poor compared to the developed countries indicating that inappropriate treatment modalities might have played a role on this.
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http://dx.doi.org/10.1155/2020/1963814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211235PMC
May 2020

Folic Acid Supplement Intake and Risk of Colorectal Cancer in Women; A Case Control Study.

Ann Glob Health 2020 02 27;86(1):23. Epub 2020 Feb 27.

Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, NL.

Background: An ongoing controversy exists on the role of folic acid supplementation in colorectal cancer risk among epidemiological studies.

Objective: To assess the association between maternal folic acid supplementation and colorectal cancer risk.

Methods: A paired matched case control study of 405 subjects was performed, including women residing in 135 villages of East Azerbaijan, Iran. Per area, subjects were followed regularly in local healthcare centers, where health- and social-related information have been collected prospectively in face to face interviews by well-trained health workers. We extracted folic acid supplement intake, baseline characteristics, and confounders from healthcare records. The data for study participants were linked to national cancer registry repositories, from which we retrieved the data of 135 women diagnosed with colorectal cancer between 2005 to 2015. Two hundred seventy controls were individually matched with cases in terms of residing village, age, and gender. We applied multivariate conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Findings: There was no significant association between folic acid supplementation and colorectal cancer risk in those with history of folic acid intake compared to those with no history of intake (OR 0.95; 95% CI 0.59 to 1.53), in those with less than five years of folic acid (0.79; 0.45 to 1.39) or in those with ≥5 years intake (1.09; 0.52 to 2.26). This risk did not change after adjustment for covariates or further stratification.

Conclusions: Maternal folic acid supplementation did not affect colorectal cancer risk in a population where supplemental folic acid is prescribed with regular intervals for women of child-bearing age.
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http://dx.doi.org/10.5334/aogh.2664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7047757PMC
February 2020

Sociodemographic Pattern of Physical Activity in the Northwest of Iran: Results of the Pilot Phase of the Azar Cohort Study.

Int J Prev Med 2019 25;10:154. Epub 2019 Sep 25.

Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Sedentary lifestyle plays a key role in the emergence of many noncommunicable diseases. Given the importance of physical activity (PA) in population-based studies, the present study was conducted to investigate the pattern of PA and its correlates in the pilot phase of Azar cohort study.

Methods: In the pilot phase of Azar cohort study, 1236 individuals aged 35-70 years in Khameneh, a city in East Azarbaijan, Iran, were invited to participate in the study. A total of 952 individuals completed the overall and the PA questionnaire, a response rate of 82%. The PA level was evaluated using the classified PA questionnaire based on the equivalent metabolic activities. The general linear model was used to determine the factors affecting PA.

Results: The overall mean score of PA was 36.54 (standard deviation = 5.3). In multivariate analysis, after adjustment for sociodemographic variables, total PA score was associated with gender (adjusted β = 0.014, confidence interval [CI] 95% = [0.01-0.82]), occupation (adjusted βs ranged over 0.015-0.059, (CI 95% = 0.01-0.079), level of education (adjusted βs ranged over 0.010-0.018, CI 95% = 0.001-0.026). In other word, sex (mean ranged over 35.49-36.81), educational level (mean ranged over 35.01-36.73) and occupation status (mean ranged over 34.62-39.62) were predictors of PA (all < 0.05). This variable could also predict 20% of the variance of the PA.

Conclusions: The current study identifies that gender, occupation and level of education could be factors that influence on PA level in the study population.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_472_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826577PMC
September 2019

Blood transfusions for treating acute chest syndrome in people with sickle cell disease.

Cochrane Database Syst Rev 2020 01 16;1:CD007843. Epub 2020 Jan 16.

Tabriz University of Medical Sciences, Tabriz Health Services Management Research Center, Tabriz, Iran, 5166615739.

Background: Sickle cell disease is an inherited autosomal recessive blood condition and is one of the most prevalent genetic blood diseases worldwide. Acute chest syndrome is a frequent complication of sickle cell disease, as well as a major cause of morbidity and the greatest single cause of mortality in children with sickle cell disease. Standard treatment may include intravenous hydration, oxygen as treatment for hypoxia, antibiotics to treat the infectious cause and blood transfusions may be given. This is an update of a Cochrane Review first published in 2010 and updated in 2016.

Objectives: To assess the effectiveness of blood transfusions, simple and exchange, for treating acute chest syndrome by comparing improvement in symptoms and clinical outcomes against standard care.

Search Methods: We searched The Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. Date of the most recent search: 30 May 2019.

Selection Criteria: Randomised controlled trials and quasi-randomised controlled trials comparing either simple or exchange transfusion versus standard care (no transfusion) in people with sickle cell disease suffering from acute chest syndrome.

Data Collection And Analysis: Both authors independently selected trials and assessed the risk of bias, no data could be extracted.

Main Results: One trial was eligible for inclusion in the review. While in the multicentre trial 237 people were enrolled (169 SCC, 42 SC, 15 Sβ⁰-thalassaemia, 11Sβ-thalassaemia); the majority were recruited to an observational arm and only ten participants met the inclusion criteria for randomisation. Of these, four were randomised to the transfusion arm and received a single transfusion of 7 to 13 mL/kg packed red blood cells, and six were randomised to standard care. None of the four participants who received packed red blood cells developed acute chest syndrome, while 33% (two participants) developed acute chest syndrome in standard care arm. No data for any pre-defined outcomes were available.

Authors' Conclusions: We found only one very small randomised controlled trial; this is not enough to make any reliable conclusion to support the use of blood transfusion. Whilst there appears to be some indication that chronic blood transfusion may play a roll in reducing the incidence of acute chest syndrome in people with sickle cell disease and albeit offering transfusions may be a widely accepted clinical practice, there is currently no reliable evidence to support or refute the perceived benefits of these as treatment options; very limited information about any of the potential harms associated with these interventions or indeed guidance that can be used to aid clinical decision making. Clinicians should therefore base any treatment decisions on a combination of; their clinical experience, individual circumstances and the unique characteristics and preferences of adequately informed people with sickle cell disease who are suffering with acute chest syndrome. This review highlights the need of further high quality research to provide reliable evidence for the effectiveness of these interventions for the relief of the symptoms of acute chest syndrome in people with sickle cell disease.
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http://dx.doi.org/10.1002/14651858.CD007843.pub4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984655PMC
January 2020

Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012.

Paediatr Perinat Epidemiol 2019 11 21;33(6):436-448. Epub 2019 Oct 21.

International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy.

Background: Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains.

Objectives: To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries.

Methods: We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution.

Results: Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America.

Conclusions: Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.
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http://dx.doi.org/10.1111/ppe.12589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899817PMC
November 2019

Trisomy 13 and 18-Prevalence and mortality-A multi-registry population based analysis.

Am J Med Genet A 2019 12 30;179(12):2382-2392. Epub 2019 Sep 30.

CARIS (Congenital Anomaly Register & Information Services), Public Health Wales, Singleton Hospital, Swansea, UK.

The aim of the study is to determine the prevalence, outcomes, and survival (among live births [LB]), in pregnancies diagnosed with trisomy 13 (T13) and 18 (T18), by congenital anomaly register and region. Twenty-four population- and hospital-based birth defects surveillance registers from 18 countries, contributed data on T13 and T18 between 1974 and 2014 using a common data-reporting protocol. The mean total birth prevalence (i.e., LB, stillbirths, and elective termination of pregnancy for fetal anomalies [ETOPFA]) in the registers with ETOPFA (n = 15) for T13 was 1.68 (95% CI 1.3-2.06), and for T18 was 4.08 (95% CI 3.01-5.15), per 10,000 births. The prevalence varied among the various registers. The mean prevalence among LB in all registers for T13 was 0.55 (95%CI 0.38-0.72), and for T18 was 1.07 (95% CI 0.77-1.38), per 10,000 births. The median mortality in the first week of life was 48% for T13 and 42% for T18, across all registers, half of which occurred on the first day of life. Across 16 registers with complete 1-year follow-up, mortality in first year of life was 87% for T13 and 88% for T18. This study provides an international perspective on prevalence and mortality of T13 and T18. Overall outcomes and survival among LB were poor with about half of live born infants not surviving first week of life; nevertheless about 10% survived the first year of life. Prevalence and outcomes varied by country and termination policies. The study highlights the variation in screening, data collection, and reporting practices for these conditions.
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http://dx.doi.org/10.1002/ajmg.a.61365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848757PMC
December 2019

Estimation of the preventable proportion of congenital anomalies by selected risk factors in mothers: A case study in Iran.

Med J Islam Repub Iran 2019 15;33:68. Epub 2019 Jul 15.

School of Medicine, Tabriz University of Medical Sciences, Iran.

Worldwide, 1-6 percent of infants have at least one congenital anomaly that can lead to long-term consequences. This may have significant impacts on individuals, families, health-care systems, and societies. The aim of this study was to estimate the Population Attributable Fraction (PAF) of some congenital anomalies by three selected risk factors (obesity, diabetes and smoking) in the northwest of Iran and to estimate the number of preventable defects at birth in the population if we could reduce 50 percent of the exposure rate to these three risk factors at population level. The regional data on smoking, obesity, and diabetes were entered in Population Estimate of Attributable Fraction of Congenital Conditions Everywhere (PEACE) software developed by International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). It calculates the PAF for congenital anomalies attributed to exposure to those three risk factors. This study showed that main anomalies attributed to "obesity" include Spina Bifida 40.1% (95% CI: 31.7-47.7), Hydrocephaly 26.8 (95% CI: 9.3-42.3) and Anencephaly 17.4 (95% CI: 1.6-31.9). The highest attributable defect to "smoking" was Cleft lip w/out Palate 5.8% (95% CI: 4.3-7.4), whereas for "diabetes" it was Tetralogy of Fallot 33.3 (95% CI: 17.2-49.5). A similar pattern was found when assumed in the model, the impact of 50 percent reduction in the exposure to each of the risk factors on preventable cases of birth defects in the population. Obesity, diabetes, and smoking in women of childbearing age increased the risk of occurrence of congenital anomalies. However, obesity and diabetes had a remarkably greater impact compared to smoking. More studies are needed to investigate the role of passive smoking as a risk factor for the occurrence of birth defects.
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http://dx.doi.org/10.34171/mjiri.33.68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708091PMC
July 2019

Hypospadias Prevalence and Trends in International Birth Defect Surveillance Systems, 1980-2010.

Eur Urol 2019 10 9;76(4):482-490. Epub 2019 Jul 9.

School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA. Electronic address:

Background: Hypospadias is a common male birth defect that has shown widespread variation in reported prevalence estimates. Many countries have reported increasing trends over recent decades.

Objective: To analyze the prevalence and trends of hypospadias for 27 international programs over a 31-yr period.

Design, Setting, And Participants: The study population included live births, stillbirths, and elective terminations of pregnancy diagnosed with hypospadias during 1980-2010 from 27 surveillance programs around the world.

Outcome Measurements And Statistical Analysis: We used joinpoint regression to analyze changes over time in international total prevalence of hypospadias across programs, prevalence for each specific program, and prevalence across different degrees of severity of hypospadias.

Results And Limitations: The international total prevalence of hypospadias for all years was 20.9 (95% confidence interval: 19.2-22.6) per 10000 births. The prevalence for each program ranged from 2.1 to 39.1 per 10000 births. The international total prevalence increased 1.6 times during the study period, by 0.25 cases per 10000 births per year (p<0.05). When analyzed separately, there were increasing trends for first-, second-, and third-degree hypospadias during the early 1990s to mid-2000s. The majority of programs (61.9%) had a significantly increasing trend during many of the years evaluated. Limitations include known differences in data collection methods across programs.

Conclusions: Although there have been changes in clinical practice and registry ascertainment over time in some countries, the consistency in the observed increasing trends across many programs and by degrees of severity suggests that the total prevalence of hypospadias may be increasing in many countries. This observation is contrary to some previous reports that suggested that the total prevalence of hypospadias was no longer increasing in recent decades.

Patient Summary: We report on the prevalence and trends of hypospadias among 27 birth defect surveillance systems, which indicate that the prevalence of hypospadias continues to increase internationally.
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http://dx.doi.org/10.1016/j.eururo.2019.06.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265200PMC
October 2019

Defining a Core Data Set for Registry of Esophageal Atresia in the Northwest of Iran.

J Registry Manag 2018 ;45(3):132-135

Defining the core data set is the main step for establishing a registry system. The aim of this study was to define the core data set for the registry of esophageal atresia in the northwest of Iran.

Methods: First, the preliminary list of data elements was extracted from the related registries of other countries, as well as from the literature. Then, a group of multidisciplinary experts was asked to score the tabulated list of data elements in terms of their importance using a 5-point Likert scale through a dual-round Delphi technique. Availability of data was assessed through a medical record review of 410 patients with esophageal atresia who had been hospitalized between March 2006 and March 2016 in Tabriz Children's Hospital.

Results: The main classes of data were defined, including maternal information, patient demographics, clinical information, complications, and follow-up data. Thirty-two of 51 data elements (the core data elements) had 100% availability. Demographic data were completely available for 60% of the data elements. For clinical data, the availability rate was above 75%, while for complications and follow-up, it was 100% (except for the weight and height). In the category of maternal data, no data was available on the genetic screening and amniocentesis.

Conclusion: This study presents the core data set required for establishing an esophageal atresia registry in the northwest of Iran. A considerable number of identified cases and high availability of patient data indicated the feasibility of establishing the first esophageal atresia registry in the area.
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May 2019

Main Risk Factors Association with Proto-Oncogene Mutations in Colorectal Cancer

Asian Pac J Cancer Prev 2018 Aug 24;19(8):2183-2190. Epub 2018 Aug 24.

Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Email:

Objective: Although several factors have been shown to have etiological roles in colorectal cancer, few investigations have addressed how and to what extent these factors affect the genetics and pathology of the disease. Precise relationships with specific genetic mutations that could alter signaling pathways involved in colorectal cancer remain unknown. We therefore aimed to investigate possible links between lifestyle, dietary habits, and socioeconomic factors and specific mutations that are common in colorectal cancers. Methods: Data were retrieved from a baseline survey of lifestyle factors, dietary behavior, and SES, as well as anthropometric evaluations during a physical examination, for 100 confirmed primary sporadic colorectal cancer patients from Northwest Iran. Results: High socioeconomic status was significantly associated with higher likelihood of a KRAS gene mutation (P < 0.05) (odds ratio: 3.01; 95% CI: 0.69–13.02). Consuming carbohydrates and alcohol, working less, and having a sedentary lifestyle also increased the odds of having a KRAS mutation. Conclusion: Although research has not yet described the exact relationships among genetic mutations with different known risk factors in colorectal cancer, examples of the latter may have an impact on KRAS gene mutations.
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http://dx.doi.org/10.22034/APJCP.2018.19.8.2183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171391PMC
August 2018

Folic acid intake and folate status and colorectal cancer risk: A systematic review and meta-analysis.

Clin Nutr 2018 12 28;37(6 Pt A):1926-1934. Epub 2017 Oct 28.

School of Medicine, Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz 51666114731, Iran. Electronic address:

Background & Aims: To evaluate the controversies among the studies assessing the association between folic acid intake or folate status and colorectal cancer risk.

Methods: PubMed, Cochrane library and references of related articles were searched from January 2000 to September 2016. Studies on folic acid intake or folate status and colorectal cancer or adenoma risk were included. Full text review was conducted for potentially eligible studies. Quality assessment was performed. Random-effects meta-analysis was used to estimate risk ratio and 95% Confidence Intervals. Analysis was conducted by Comprehensive Meta-Analysis software.

Results: Folic acid supplement intake showed no significant effect on colorectal cancer risk in meta-analysis of randomized controlled trials, RR: 1.07 (95% CI: 0.86-1.43). The effect on risk was not significant in cohort studies either; RR = 0.96 (95% CI: 0.76-1.21). However, there was significant reduced colorectal cancer risk in total folate intake in cohort studies; 0.71 (95% CI: 0.59-0.86). Odds Ratio was also significantly reduced in case control studies; 0.77 (95% CI: 0.62-0.95). Nevertheless once folate status was measured as Red Blood Cell folate content, no significant effect on colorectal cancer risk was observed; 1.05 (95% CI: 0.85-1.30).

Conclusion: The differences in bioavailability and metabolism of synthetic folic acid and natural dietary folate as well as variation in the baseline characteristics of subjects and various methods of folate status assessment might be the main reasons for these controversies. Findings of present study highlight the importance of individualized folic acid supplement intake given the fact that the beneficiary effects of long term folic acid supplementation is not confirmed.
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http://dx.doi.org/10.1016/j.clnu.2017.10.010DOI Listing
December 2018

Uses, Limitations, and Validity of a Registry of Congenital Anomalies in Iran: A Critical Review.

J Environ Public Health 2017 11;2017:6972617. Epub 2017 Jul 11.

Pediatric Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.

Background And Aims: Preventive strategies of congenital anomalies are basically relying on the systematic ongoing collection and analysis of data and timely dissemination of information. The aim of this paper is to briefly report a critical review of a surveillance system of congenital anomalies in a developing country, by describing the challenges and experience of the registry since it began.

Methods: Tabriz Registry of Congenital Anomalies (TRoCA) was mainly set up based on the guidelines provided by the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) for data collection, coding, process, analysis, use, and evaluation of the system.

Findings: TRoCA has successfully achieved its main objective as a pilot model for setting up a nationwide registry of congenital anomalies in the country. The programme has too succeeded in relation to its regional objectives: epidemiological rates and data have been produced consistently for etiological investigations, methodological studies, service provision, and preventive measures for selected anomalies.

Conclusions: Our successful experience, as a small registry in a developing country, might be of interest and useful to practitioners, policymakers of birth defects control programmes, and mainly those willing to set up a monitoring system of congenital anomalies in similar areas.
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http://dx.doi.org/10.1155/2017/6972617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525091PMC
November 2017

Induced Abortion: a Systematic Review and Meta-analysis.

Mater Sociomed 2017 Mar;29(1):58-67

School of Management and Medical Informatics, Tabriz University of Medical Sciences.

Background: Induced abortion accounts for 1 in 8 of approximately 600000 maternal deaths that occur annually worldwide. Induced abortion rate can be considered as one of the indicators for assessing availability of the appropriate reproductive health plans for women and identifying needs for appropriate related health policies and programs.

Material And Methods: Researchers searched Pubmed, Google Scholar, CINAHL, Embase, PsycINFO, Cochrane, Iranian Scientific Information Database (SID), Iranian biomedical journals (Iranmedex), and Iranian Research Institute of Information and Documentation (Irandoc) between January 2000 and June 2013, which reported induced abortion. Search terms from two categories including abortion and termination of pregnancy were compiled. The search terms were "induced abortion", "illegal abortion", "illegal abortion", "unsafe abortion", and "criminal abortion". The search was also conducted with "induced termination of pregnancy", "illegal termination of pregnancy", "illegal termination of pregnancy", "unsafe termination of pregnancy" and "criminal termination of pregnancy". Meta-analysis was carried out by using OpenMeta software. Induced abortion rates were calculated based on the random effect model.

Results: Overall induced abortion rate was obtained 58.1 per 1000 women (95%CI: 55.16-61.04). In continental level, rate of induced abortion was 14 per 1000 women (95%CI: 11-16). Nation-wide and local rates were obtained 67.27 per 1000 women (95% CI: 60.02-74.23) and 148.92 (95% CI: 140.06-157.79) respectively.

Discussion And Conclusion: Induced abortion is a major public health problem that occurs worldwide whether under the legal restriction or freedom, and it remains as reproductive health concern globally. To eliminate the need for induced abortion is at the core of any effort for preventing this issue. Option with the highest priority is to prevent unwanted pregnancies through promoting reproductive health plans for women of reproductive age. In case the prevention strategies fail, universal provision of safe abortion services should be put in place.
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http://dx.doi.org/10.5455/msm.2017.29.58-67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402385PMC
March 2017

The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis.

Complement Ther Clin Pract 2017 May 30;27:11-18. Epub 2016 Nov 30.

Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Low back pain (LBP) is one of the most common health problems in adults. The impact of LBP on the individual can cause loss of health status and function related to pain in the back. To reduce the impact of LBP on adults, drug therapy is the most frequently recommended intervention. But over the last decade, a substantial number of randomized clinical trials of non-pharmacological intervention for LBP have been published.

Objective: To determine the effectiveness of acupuncture, acupressure and chiropractic (non-pharmacological) interventions on the treatment of chronic nonspecific low back pain in Iran.

Study Design: Systematic review and meta-analysis.

Methods: A systematic literature search was completed without date restrictions up to May 2013 in five major databases (Medline, CINAHL, Science Direct, CAJ Full-text Database, and Cochrane databases). Only randomized controlled trials published in Persian (Farsi) or English languages were included. Two independent reviewers extracted the data. The quality of the papers was assessed using the Cochrane Back Review Risk of Bias criteria.

Results: Initial searches revealed 415 papers, 382 of which were excluded on the basis of abstract alone. After excluding 23 papers due to duplication, the remaining 10 trial papers were subjected to a more detailed analysis of the full text, which resulted in three being excluded. The seven remaining trials had a lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different comparators with regards to the primary outcomes, the number of treatments, the duration of treatment and the duration of follow-up.

Conclusion: This systematic review demonstrates that acupuncture, acupressure and chiropractic may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.
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http://dx.doi.org/10.1016/j.ctcp.2016.11.012DOI Listing
May 2017

The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis.

Complement Ther Clin Pract 2017 May 30;27:11-18. Epub 2016 Nov 30.

Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Low back pain (LBP) is one of the most common health problems in adults. The impact of LBP on the individual can cause loss of health status and function related to pain in the back. To reduce the impact of LBP on adults, drug therapy is the most frequently recommended intervention. But over the last decade, a substantial number of randomized clinical trials of non-pharmacological intervention for LBP have been published.

Objective: To determine the effectiveness of acupuncture, acupressure and chiropractic (non-pharmacological) interventions on the treatment of chronic nonspecific low back pain in Iran.

Study Design: Systematic review and meta-analysis.

Methods: A systematic literature search was completed without date restrictions up to May 2013 in five major databases (Medline, CINAHL, Science Direct, CAJ Full-text Database, and Cochrane databases). Only randomized controlled trials published in Persian (Farsi) or English languages were included. Two independent reviewers extracted the data. The quality of the papers was assessed using the Cochrane Back Review Risk of Bias criteria.

Results: Initial searches revealed 415 papers, 382 of which were excluded on the basis of abstract alone. After excluding 23 papers due to duplication, the remaining 10 trial papers were subjected to a more detailed analysis of the full text, which resulted in three being excluded. The seven remaining trials had a lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different comparators with regards to the primary outcomes, the number of treatments, the duration of treatment and the duration of follow-up.

Conclusion: This systematic review demonstrates that acupuncture, acupressure and chiropractic may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.
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http://dx.doi.org/10.1016/j.ctcp.2016.11.012DOI Listing
May 2017

A novel gene mutation report in sporadic colorectal cancer, from Northwest of Iran.

Clin Case Rep 2017 03 9;5(3):338-341. Epub 2017 Feb 9.

Hematology and Oncology Research Center Tabriz University of Medical Sciences Tabriz Iran; Tabriz Health Services Research Center Tabriz University of Medical Sciences Tabriz Iran.

While the role of gene mutations has been widely accepted for predicting responses to anti-EGFR therapy in patients with colorectal cancer, although this study was based on observation of a single case it gives hope that some gene mutation may have favorable prognosis. More studies are required on patients with similar mutation to validate this finding.
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http://dx.doi.org/10.1002/ccr3.779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331244PMC
March 2017

Erratum to: The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study.

Int J Behav Med 2017 06;24(3):480

Department of Health Sciences, Unit for Public Health Science, Mid Sweden University, Sundsvall, Sweden.

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http://dx.doi.org/10.1007/s12529-017-9631-xDOI Listing
June 2017

Association between proto-oncogene mutations and clinicopathologic characteristics and overall survival in colorectal cancer in East Azerbaijan, Iran.

Onco Targets Ther 2016 7;9:7385-7395. Epub 2016 Dec 7.

Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Tabriz Health Services Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Colorectal cancer (CRC) is the third-most common cancer in Iran. The increasing incidence of CRC in the past three decades has made it a major public health burden in the country. This study aimed to determine any relationship of specific mutations in CRCs with clinicopathologic aspects and outcome of patients.

Materials And Methods: This study was conducted on 100 CRC patients by the case-only method. Polymerase chain-reaction products were analyzed by Sanger sequencing, and sequence results were compared with the significant and gene mutations in the My Cancer Genome database. Logistic regression models were used to detect associations of clinicopathologic characteristics with each of the mutations. Kaplan-Meier and Cox regression models were constructed to estimate overall survival in patients.

Results: A total of 26 subjects (26%) had heterozygote-mutant , and mutations were not detected in the amplified exon of in both tumor and normal tissues of the 100 CRCs. Rectal tumors had 1.53-fold higher likelihood of mutations than colon tumors, and men had 1.37-fold higher odds than women. The presence of metastasis increased the likelihood of mutations 2.36-fold over those with nonmetastatic CRCs. Compared to patients with wild-type cancers, those with mutations had significantly higher mortality (hazard ratio 3.74, 95% confidence interval 1.44-9.68; log-rank =0.003).

Conclusion: Better understanding of the causality of CRC can be established by combining epidemiology and research on molecular mechanisms of the disease.
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http://dx.doi.org/10.2147/OTT.S116373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153263PMC
December 2016

An Epidemiological Study of Road Traffic Accidents in Guilan Province, Northern Iran in 2012.

Bull Emerg Trauma 2016 Oct;4(4):230-235

Department of Epidemiology, Tabriz University Medical Science, Tabriz, Iran.

Objective: To determine the epidemiological characteristics of the road traffic injuries (RTIs) in Guilan province, northern Iran.

Methods: This study was a cross-sectional study which included all of RTIs admitted to medical centers of Guilan province (northern Iran) during 2012. ICD-10 was used as diagnostic criteria. Demographic variables also injury circumstance and in hospital variables such as length of stay, time of admission, type of surgery, ICU admission, final outcome and mechanism of injury, anatomical part of injury according to Abbreviated Injury Scale (AIS) classification were derives from records by trained research team. Descriptive data is reported. The predictors of mortality were also determined.

Results: The prevalence of road traffic injuries in Guilan province was 31 in 10,000 populations. Of total 7671 accidents, 5976 (77.9%) were men and 1695 (22.1%) were women. Mean age of these victims was 33.3 ± 17.289 years (32.64±16.939 for men, 35.62±18.312 for women). Most of them (32.5%) were 20-29 years old. Motorcycle-car accidents had the highest frequency followed by car-car crashes and car accidents involving pedestrians. Most of the patients (85.9%) were hospitalized and 280 injured died (3.7%). Upper extremities were the most sites of injuries. Male sex, length of hospital stay, multiple injuries and increased age were associated with road traffic accident associated mortality.

Conclusion: RTIs cause enormous death and disability in this area and more road traffic preventive programs should be enforcement in these areas to reduce incidences RTI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118576PMC
October 2016

Psychometric evaluation of a self-reported physical activity questionnarie used in the pilot phase of the AZAR Cohort Study.

Health Promot Perspect 2016 10;6(3):152-8. Epub 2016 Aug 10.

Tabriz Health Services Management Research Centre,Tabriz University of Medical Sciences, Tabriz, Iran.

Background: The purpose of this study was to assess the psychometric properties of a self-reported physical activity (PA) questionnaire based on data from the pilot phase of the AZAR Cohort Study.

Methods: In this cross-sectional study, all 35-70 years old people living in Khameneh, a city in East Azarbaijan, Iran were invited to take part in the pilot phase of the AZAR Cohort Study. A total of 952 people completed the self-reported PA questionnaire and the International Physical Activity Questionnaire (IPAQ). Construct validity was evaluated by exploratory and confirmatory factor analyses (EFA and CFA). Spearman's correlation coefficient between the scores of the two instruments was used to examine the concurrent validity. Reliability was measured using intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient.

Results: In EFA applying principal component analysis with varimax rotation, four factors were identified including recreational leisure time (variance = 52.73%), sedentary leisure time (variance = 38.68%), household/gardening work (variance = 38.66%), and occupation work (variance = 12.67%). The extracted factors were also supported by the CFA (CFI = 0.98, GFI =0.936, RMSEA=0.057). The results indicated moderate concurrent validity (ρ = 0.62, P < 0.001). ICC and Cronbach's alpha were 0.59 and 0.7, respectively.

Conclusion: These results showed acceptable and moderate psychometric properties for the self-reported PA questionnaire to assess PA in this population-based study.
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http://dx.doi.org/10.15171/hpp.2016.24DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002882PMC
August 2016

Blood transfusions for treating acute chest syndrome in people with sickle cell disease.

Cochrane Database Syst Rev 2016 Aug 30(8):CD007843. Epub 2016 Aug 30.

Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, 5166615739.

Background: Sickle cell disease is an inherited autosomal recessive blood condition and is one of the most prevalent genetic blood diseases worldwide. Acute chest syndrome is a frequent complication of sickle cell disease, as well as a major cause of morbidity and the greatest single cause of mortality in children with sickle cell disease. Standard treatment may include intravenous hydration, oxygen as treatment for hypoxia, antibiotics to treat the infectious cause and blood transfusions may be given. This is an update of a Cochrane review first published in 2010.

Objectives: To assess the effectiveness of blood transfusions, simple and exchange, for treating acute chest syndrome by comparing improvement in symptoms and clinical outcomes against standard care.

Search Methods: We searched The Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings.Date of the most recent search: 25 April 2016.

Selection Criteria: Randomised controlled trials and quasi-randomised controlled trials comparing either simple or exchange transfusion versus standard care (no transfusion) in people with sickle cell disease suffering from acute chest syndrome.

Data Collection And Analysis: Both authors independently selected trials and assessed the risk of bias, no data could be extracted.

Main Results: One trial was eligible for inclusion in the review. While in the multicentre trial 237 people were enrolled (169 SCC, 42 SC, 15 Sβ⁰-thalassemia, 11Sβ(+)-thalassemia); the majority were recruited to an observational arm and only ten participants met the inclusion criteria for randomisation. Of these, four were randomised to the transfusion arm and received a single transfusion of 7 to 13 ml/kg packed red blood cells, and six were randomised to standard care. None of the four participants who received packed red blood cells developed acute chest syndrome, while 33% (two participants) developed acute chest syndrome in standard care arm. No data for any pre-defined outcomes were available.

Authors' Conclusions: We found only one very small randomised controlled trial; this is not enough to make any reliable conclusion to support the use of blood transfusion. Whilst there appears to be some indication that chronic blood transfusion may play a roll in reducing the incidence of acute chest syndrome in people with sickle cell disease and albeit offering transfusions may be a widely accepted clinical practice, there is currently no reliable evidence to support or refute the perceived benefits of these as treatment options; very limited information about any of the potential harms associated with these interventions or indeed guidance that can be used to aid clinical decision making. Clinicians should therefore base any treatment decisions on a combination of; their clinical experience, individual circumstances and the unique characteristics and preferences of adequately informed people with sickle cell disease who are suffering with acute chest syndrome. This review highlights the need of further high quality research to provide reliable evidence for the effectiveness of these interventions for the relief of the symptoms of acute chest syndrome in people with sickle cell disease.
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http://dx.doi.org/10.1002/14651858.CD007843.pub3DOI Listing
August 2016

Psychiatric Disorders in Iranian Children and Adolescents.

Iran J Psychiatry 2016 Apr;11(2):87-98

Deputy of Research, Iran University of Medical Sciences, Tehran, Iran.

Objective: The aim of the present study was to investigate the epidemiology of psychiatric disorders in children and adolescents in five provinces of Iran: Tehran, Shiraz, Isfahan, Tabriz and Mashhad.

Method: In the present study, we selected 9,636 children and adolescents aged 6-18 years through multistage cluster random sampling method from Tehran, Shiraz, Isfahan, Tabriz and Mashhad. We instructed the clinical psychologists to complete the Strengths and Difficulties Questionnaire (SDQ) for the participants, andthose who received a high score on SDQ, completed the Persian version of Kiddie-SADS-Present and Lifetime Version (K-SADS-PL). We used descriptive analysis and 95% confidence interval to investigate the relationship between scores of the K-SADS questionnaire and demographic factors. We used one-way ANOVA to test the significant differences among the disorders according to sex, age and province of residence.

Results: Based on the results, oppositional defiant disorder (ODD) (4.45%) had the highest prevalence of psychiatric disorders in the five provinces and substance abuse and alcohol abuse (0%) had the lowest prevalence. In addition, attention deficit hyperactivity disorder (ADHD) had the most prevalence in boys (5.03%) and ODD had the most prevalence in girls (4.05%). Among the three age groups, 6 to 9 year olds had the highest rates of ADHD (5.69%); 10 to 14 and 15 to 18 year olds had the highest rates of ODD (4.32% and 4.37% respectively). Among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia.

Conclusion: The current study revealed that the overall frequency of psychiatric disorders based on Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) was higher than a similar study. Moreover, in this study, among the five provinces, Tehran and Mashhad allocated the highest rates of ODD; Isfahan and Shiraz had the highest rates of ADHD; and Tabriz had the highest rates of social phobia. Therefore, these percentage of psychiatric disorders in Iran lead us toward a greater use of consultation and mental health services.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947225PMC
April 2016