Aim: The aim of this study was to assess the association between survival of patients with colorectal cancer and prognostic factors in a competing risk parametric model using Weibull distribution. Background: The prognosis of colorectal... more
Aim: The aim of this study was to assess the association between survival of patients with colorectal cancer and prognostic factors in a competing risk parametric model using Weibull distribution. Background: The prognosis of colorectal cancer is relatively good in terms of survival time. In many prognostic studies, patients may be exposed to several types of competing events. These different causes of death are called competing risks. Methods: Data was recorded from 372 patients with colorectal cancer who registered in the Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences (Tehran, Iran) from 2004 to 2015 in a retrospective study. Analysis was performed using competing risks model and Weibull distribution. Software used for data analysis was R, and significance level was regarded as 0.05. Results: The result indicated that, at the end of follow-up, 111 (29.8%) deaths were from colorectal cancer and 14 (3.8%) deaths were due to other diseases. The average body mass index (BMI) was 24.61(SD 3.98). The mean survival time for a patient in 372 was 62.05(SD 48.78) month with median equals to 48 months. According to competing-risks method, only stageIII (HR, 1.69; 95% CI, 1.246-2.315 ), stageIV( HR, 4.51; 95% CI,2.91-6.99 ) and BMI( HR, 0.96; 95% CI, 0.96-0.975) have a significant effect on patient's survival time. Conclusion: This study indicated pathologic stage (III,IV) and BMI as the prognosis, using a Weibull model with competing risks analysis, while other models without the competing events lead to significant predictors which may be due to over-estimation.
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Aim: The aim of this study is to estimate oral cavity cancer mortality for Iranian population, using Bayesian approach in order to revise this misclassification. Background: Mortality is a familiar projection to address the burden of... more
Aim: The aim of this study is to estimate oral cavity cancer mortality for Iranian population, using Bayesian approach in order to revise this misclassification. Background: Mortality is a familiar projection to address the burden of cancers, but according to Iranian death registry, about 20% death statistics were still recorded in misclassified categories. Patients and methods: We analyzed national death statistic reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004 stratified by age group, sex, and cause of death are included in this analysis. Oral cavity cancer [ICD-10; C00-08] were expressed as the annual mortality rates/100,000, overall, by sex and by age group (<50 and ≥50 years of age) and age standardized rate (ASR). The Bayesian approach to correct and account for misclassification effects in Poisson count regression with a beta prior employed to estimate the mortality rate of EC in age and sex group. Results: According to the Bayesian re-estimate there were between 20 to 30 percent underreported mortality records in death due to oral cavity cancer. The age standardized mortality rate of oral cavity cancer increased dramatically during these years, Age specific rate for oral cavity cancer indicated higher mortality rate for older age. Conclusion: Our findings suggested a substantial undercount of oral cavity cancer mortality in Iranian population. So policy makers who determine research and treatment priorities on death rates should notice to this underreported data.
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Background: The Cox Proportional Hazard model is the most popular technique to analysis the effects of covariates on survival time but under certain circumstances parametric models may offer advantages over Cox's model. In this study we... more
Background: The Cox Proportional Hazard model is the most popular technique to analysis the effects of covariates on survival time but under certain circumstances parametric models may offer advantages over Cox's model. In this study we use Cox regression and alternative parametric models such as: Weibull, Exponential and Lognormal models to evaluate prognostic factors affecting survival of patients with stomach cancer. Comparisons were made to find the best model. Methods: To determine independent prognostic factors reducing survival time for stomach cancer, we compared parametric and semi-parametric methods applied to patients who registered in one cancer registry center located in southern Iran using the Akaike Information Criterion. Results: Of a total of 442 patients, 266 (60.2%) died. The results of data analysis using Cox and parametric models were approximately similar. Patients with ages 60-75 and >75 years at diagnosis had an increased risk for death followed by those with poor differentiated grade and presence of distant metastasis (P<0.05). Conclusion: Although the Hazard Ratios in the Cox model and parametric ones are approximately similar, according to Akaike Information Criterion, the Weibull and Exponential models are the most favorable for survival analysis.
Research Interests: Medicine, Iran, Humans, Female, Pubmed, and 15 moreMale, Regression Analysis, Confidence intervals, Registries, Aged, Middle Aged, Neoplasm Invasiveness, Adult, Proportional hazards model, Prognosis, Akaike Information Criterion, Parametric Statistics, Cohort Studies, Neoplasm staging, and Accelerated Failure Time Model
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Introduction: Dysmenorrhea is one of the most common gynecological problems in women which can be treated with chemical drugs, herbal medicines, acupuncture, acupressure, and massage therapy. With regard to the possible positive effect of... more
Introduction: Dysmenorrhea is one of the most common gynecological problems in women which can be treated with chemical drugs, herbal medicines, acupuncture, acupressure, and massage therapy. With regard to the possible positive effect of Achillea-Millefolium (AM) on dysmenorrhea and lack of adequate studies in the area, this study was performed with aim to investigate the effect of extract capsule of AM on duration and severity of primary dysmenorrheal pain. Methods: This triple-blind randomized controlled clinical trial was performed on 50 women referring to Valiears health center affiliated to Tehran University of Medical Sciences in 2015-2016. The subjects were divided into intervention and control group. During three first day of menstruation, the intervention group was treated with 150mg AM capsule for every eight hours and 250mg Mefenamic-acid capsules for every six hours, and control group was treated with AM placebo capsules and Mefenamic-acid capsules during two consecutive months. The study tools were demographic questionnaire and visual analogue scale (VAS). The severity of pain was measured by visual analogue scale (VAS) and duration of pain was measured by the day (one cycle before the study and two cycle during the intervention). Data was analyzed by SPSS software (version 22) and t-independent statistical tests, Mann-Whitney, Fisher and Friedman tests. PResults: Before the intervention, two groups were similar in terms of pain severity and duration of pain. During two cycles of intervention, pain severity and duration of pain significantly decreased (P 0.05). Conclusion: Decreased dysmenorrheal pain was higher in the group of AM and Mefenamic-acid capsules compared to the group of Mefenamic-acid capsules that may be is due to the effect of AM on dysmenorrheal pain.
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Research Interests: Dysphagia, Medicine, Diarrhea, Constipation, Heartburn, and 3 moreNausea, Abdominal Pain, and Vomiting
Aim: We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy. Background: Biofeedback therapy is an... more
Aim: We designed this study to evaluate the effectiveness of the combination of topical rectal therapy with biofeedback in treatment of solitary rectal ulcer compared to single biofeedback therapy. Background: Biofeedback therapy is an appropriate treatment for patients with solitary rectal ulcer syndrome (SRUS) but it seems that it is not effective alone. Topical medical therapies are supposed to have an additive role to biofeedback. Methods: This randomized, controlled trial was conducted on 63 patients with SRUS. Patients were randomly enrolled into two groups of combination and single therapy. The patients in combination group (n=31) received biofeedback plus a topical therapy (an enema contained dexamethasone, sulfasalazine and bismuth) and the patients in single therapy group (n=32) were treated with biofeedback alone. Results: Endoscopic responses to treatment in the combination and single groups were 80% and 50%, respectively (P<0.05). Clinical improvement in symptoms such as difficulty to evacuate, digitation to evacuate, feeling of incomplete evacuation, time to need to evacuation and life style alternation were significantly better in treated group by combination therapy than single therapy. Regarding to the mean total score based on all subjective parameters, the results were also significantly better in the treated group by combination therapy. Conclusion: Topical anti-inflammatory therapies in combination with biofeedback is an efficient treatment for patients with SRUS.
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Aim: The aim of this study was to investigate relation between H-ras T81C polymorphism and some of the important risk factors in gastric adenocarcinoma (GA). Background: GA is one of the leading causes of cancer death in most countries.... more
Aim: The aim of this study was to investigate relation between H-ras T81C polymorphism and some of the important risk factors in gastric adenocarcinoma (GA). Background: GA is one of the leading causes of cancer death in most countries. RAS gene is an important member in the PI3K-AKT signaling and the single nucleotide polymorphism at H-rasc DNA position 81 has been demonstrated has an important role in tumor genesis. Patients and methods: In this study, we carried out single-nucleotide polymorphism analysis in an Iranian population. A total of 100 patients with gastric adenocarcinoma and 100 controls were examined for the presence of T81C H-ras polymorphism using PCR- RFLP assay. Results: Statistical analysis revealed no relationship significant between TT, TC, CC and risk of GA, but, there was a poorly relation between male patient with C-carrier genotype and increasing risk of GA (P=0.07). Also, we investigate effect of four important risk factors for GA. There was a statistically significant difference between increasing of age and susceptibility for GA (OR=1.106, 95%CI=1.073-1.139, P < 0.001). We observed a statistically significant between smoking and T81C polymorphism C-carrier genotypes (OR=3.98, 95%CI=1.831-8.68, P < 0.001) as this individual had three-time risk for GA. We did not show a significant association between three main genotypes and H. pylori infection for risk of GA. Conclusion: These results suggested that there is no relationship between T81C-HRAS polymorphism and gastric cancer risk in Iranian patients. But, gender (male in our study) and the other risk factor described above have an important role in developing of GA.
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Aim: The present study aimed to evaluate the association between serum levels of interleukin IL-1, IL-6, IL-8 genes as well as interferon (IFN)-γ and the risk of celiac disease (CD). Background: The role of serum cytokine levels in the... more
Aim: The present study aimed to evaluate the association between serum levels of interleukin IL-1, IL-6, IL-8 genes as well as interferon (IFN)-γ and the risk of celiac disease (CD). Background: The role of serum cytokine levels in the pathophysiology of CD is still an open field to be explored. Methods: This case-control study was performed on 110 patients with CD and 46 healthy controls referring to Taleghani Hospital, Tehran, Iran. Expression levels of IL-1, IL-6, IL-8, and IFN-γ were assessed by enzyme-linked immunosorbent assay (ELISA) kits. Results: The Bayesian intervention odds ratio (OR) and Highest Posterior Density (HPD) interval were 1.133 (95% credible interval 1.018- 1.269), 0.947 (95% credible interval 0.898 - 0.996) and 1.004 (95% credible interval 1.001- 1.009) for IL-1, IL-6, and IL-8 respectively. Conclusion: The serum level of IFN-γ has no effect on the risk of CD, but given the OR and the HPD interval obtained for serum levels of IL-1, IL-6 and IL-8, with one unit increase in IL-1 serum, the risk of CD grows by 1.13 times while one unit increase in IL-6 serum reduces the risk of CD by 15%. Finally, regarding IL-8, the risk of CD increases by 0.004 times with a unit increase in IL-8 serum.
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Background: Oral cavity cancer is the eighth most frequent cancer among men in the world. Its incidence varies widely geographically and two-thirds of the incident cases are diagnosed in developing countries. The aim of this study was to... more
Background: Oral cavity cancer is the eighth most frequent cancer among men in the world. Its incidence varies widely geographically and two-thirds of the incident cases are diagnosed in developing countries. The aim of this study was to present the mortality trends from this cancer for Iranian population during a period of almost a decade, in order to provide update information regarding time trends for this cancer. Methods: We analyzed National death Statistics reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004, stratified by age group, sex, and cause of death. Oral cavity cancer [ICD-10; C00-08] was assessed for annual mortality rates/100,000, overall, by sex and by age group (<15, 15-49 and ≥ 50 years of age) and age standardized rates (ASR) were calculated. Results: The age standardized mortality rate of oral cavity cancer increased dramatically during these years from 0.09 per 100,000 in 1995 to 0.59 per 100,000 in 2002. However, a sharp decrease was observed from 2002 to 2004. Moreover the mortality of oral cavity cancer was higher for males except from 2000-2002 during which the rate of female's death was close to male's. Age specific rates for oral cavity cancer indicated higher mortality rate for older age. Conclusion: In conclusion, this study provides comprehensive projection for burden of death due to oral cavity cancer, indicating that the trend of its mortality was increased in recent decade and then would be leveled off. While the burden of oral cavity cancer in Iran is lower than other Asian countries, further studies are required to establish risk factors or modifiers for this cancer in Iranian population in order to decrease its incidence and mortality.
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In time to event analysis, the situation of competing risks arises when the individual (or subject) may experience p mutually exclusive causes of death (failure), where cause-specific hazard functi...
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Cancer registration is an important source for measuring the burden of cancer in a population. In practice, however, quite frequently incorrect patients are registered or data items can be inaccurately recorded or not recorded at all.... more
Cancer registration is an important source for measuring the burden of cancer in a population. In practice, however, quite frequently incorrect patients are registered or data items can be inaccurately recorded or not recorded at all. Also the process or quality of these registrations varies among countries. In this paper, we briefly discussed some statistical techniques including; Mortality and Incidence Analysis Model (MIAMOD), Prevalence and Incidence Analysis Model (PIAMOD), Bayesian Inference and Capture-recapture methods, which provide tools to re-correct the incomplete or misclassified cancer statistics with regards to gastrointestinal cancers.
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... 2005; 6: 359 –63. 24. Somi MH, Farhang S, Mirinezhad SK, Naghashi S, Sief-Farshad M, Golzari M. Cancer in East Azerbaijan, Page 6. ... 27. Movahedi M, Afsharfard A, Moradi A, Naser Moadeli A, Khoshnevis J, Fattahi F, Akbari ME.... more
... 2005; 6: 359 –63. 24. Somi MH, Farhang S, Mirinezhad SK, Naghashi S, Sief-Farshad M, Golzari M. Cancer in East Azerbaijan, Page 6. ... 27. Movahedi M, Afsharfard A, Moradi A, Naser Moadeli A, Khoshnevis J, Fattahi F, Akbari ME. Survival rate of gastric cancer in Iran. JRMS. ...
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The aim of this study is to investigate relation between demographic factors and hospitalization in gastrointestinal disorders. Quantile regression was used to analyze the predictors of duration of staying in hospital for patients with GI... more
The aim of this study is to investigate relation between demographic factors and hospitalization in gastrointestinal disorders. Quantile regression was used to analyze the predictors of duration of staying in hospital for patients with GI disease. This study was designed as a retrospective cross-sectional survey included all consecutive gastrointestinal (GI) patients admitted over one year period in a random selected hospital group located in Tehran metropolitan in 2006. Residence, age, sex and type of GI disorders were analyzed respectively using quantile regression. A total of 6405 patients with GI disorders were included in the study, There were 3633 men (56.7%) and 2772 women (43.3%). Type of diseases was a significance predictor for length of staying at hospital in quantile regression analysis. Age was significant only in second quartile and sex was not assessed as a predictor at all. The results have demonstrated that duration of hospitalization for inpatients with GI cancers was longer than other groups and quantile analysis drawn a good picture of predictors for length of hospitalization.
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Aim: The aim of this study is to determine the factors influencing predicted survival time for patients with colorectal cancer (CRC) using parametric models and select the best model by predicting error's technique. Background: Survival... more
Aim: The aim of this study is to determine the factors influencing predicted survival time for patients with colorectal cancer (CRC) using parametric models and select the best model by predicting error's technique. Background: Survival models are statistical techniques to estimate or predict the overall time up to specific events. Prediction is important in medical science and the accuracy of prediction is determined by a measurement, generally based on loss functions, called prediction error. Patients and methods: A total of 600 colorectal cancer patients who admitted to the Cancer Registry Center of Gastroenterology and Liver Disease Research Center, Taleghani Hospital, Tehran, were followed at least for 5 years and have completed selected information for this study. Body Mass Index (BMI), Sex, family history of CRC, tumor site, stage of disease and histology of tumor included in the analysis. The survival time was compared by the Log-rank test and multivariate analysis was carried out using parametric models including Log normal, Weibull and Log logistic regression. For selecting the best model, the prediction error by apparent loss was used. Results: Log rank test showed a better survival for females, BMI more than 25, patients with early stage at diagnosis and patients with colon tumor site. Prediction error by apparent loss was estimated and indicated that Weibull model was the best one for multivariate analysis. BMI and Stage were independent prognostic factors, according to Weibull model. Conclusion: In this study, according to prediction error Weibull regression showed a better fit. Prediction error would be a criterion to select the best model with the ability to make predictions of prognostic factors in survival analysis.
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Aim: The aim of this study was to assess the incidence of irritable bowel syndrome in women undergoing hysterectomy and tubular ligation. Background: The results of previous studies have shown an increased incidence of irritable bowel... more
Aim: The aim of this study was to assess the incidence of irritable bowel syndrome in women undergoing hysterectomy and tubular ligation. Background: The results of previous studies have shown an increased incidence of irritable bowel syndrome after gynecological surgeries. Patients and methods: Participants were patients of Alzahra and Taleghani University hospitals in Tabriz. One hundred and seventy two women without gastrointestinal symptoms or a diagnosis of the irritable bowel syndrome underwent tubular ligation and 164 women underwent hysterectomy. Patients were assessed every 3 month after hysterectomy and tubular ligation for 12 months. Irritable bowel syndrome was diagnosed by a questionnaire based on Rome II criteria. Results: During 12 months after surgeries, 19 (11%) patients in tubular ligation group and 19 (11%) in hysterectomy group had abdominal pain with at least two symptoms of irritable bowel syndrome. Irritable bowel syndrome was diagnosed in 9 (5%) patients in the tubular ligation and 13 (8%) patients in hysterectomy groups (P>0.05). In both studied groups, the most prevalent symptoms along with abdominal pain were chronic constipation and abnormal bowel movement and the least prevalent were diarrhea and passage of mucus. Conclusion: These results suggest that gynecological surgeries (tubular ligation and hysterectomy) may predispose to the development of the irritable bowel syndrome.
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Introduction: Metabolic syndrome (MetS) may affect prognosis of the patients diagnosed with colorectal cancer (CRC). Objectives: This study was aimed to design a model and to examine the prognostic effect of MetS on survival time in the... more
Introduction: Metabolic syndrome (MetS) may affect prognosis of the patients diagnosed with colorectal cancer (CRC). Objectives: This study was aimed to design a model and to examine the prognostic effect of MetS on survival time in the patients with CRC. Patients and methods: Data were collected from 1127 cases of CRC from Cancer Registry Center of the Research Institute of Gastroenterology and Liver Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In this cohort study, patients were divided into two groups based on the presence of MetS. We tested the prognostic value of MetS in the patients by Cox proportional hazard modeling. Results: Mean ± standard deviation of the patients' age at diagnosis in MetS group and non-MetS group was 56 ± 13 years old and 53 ± 15 years old respectively. Tumor stage as an independent variable affected CRC survival. The mean survival time of the MetS and non-MetS groups was 23 and 27 months respectively. Independent variables like tumor stage (hazard ratio [HR], 1.76; 95% CI, 0.29-0.90) and educational level (HR, 0.50; 95% CI, 0.23-0.97) had significant effect on CRC survival and MetS (HR, 0.95; 95% CI, 0.52-1.5), tumor size (HR, 1.390; 95% CI, 1.237-1.560), family history, age, gender, and smoking had non-significant effect on CRC survival. Conclusion: MetS could be a prognostic factor for survival in the patients with CRC. The results suggested that effect of MetS was not significant.
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Aim: The aim of this study was to estimate the economic burden of celiac disease (CD) in Iran. Background: The assessment of burden of CD has become an important primary or secondary outcome measure in clinical and epidemiologic studies.... more
Aim: The aim of this study was to estimate the economic burden of celiac disease (CD) in Iran. Background: The assessment of burden of CD has become an important primary or secondary outcome measure in clinical and epidemiologic studies. Methods: Information regarding medical costs and gluten free diet (GFD) costs were gathered using questionnaire and checklists offered to the selected patients with CD. The data included the direct medical cost (including Doctor Visit, hospitalization, clinical test examinations, endoscopies, etc.), GFD cost and loss productivity cost (as the indirect cost) for CD patient were estimated. The factors used for cost estimation included frequency of health resource utilization and gluten free diet basket. Purchasing Power Parity Dollar (PPP$) was used in order to make inter-country comparisons. Results: Total of 213 celiac patients entered to this study. The mean (standard deviation) of total cost per patient per year was 3377 (1853) PPP$. This total cost including direct medical cost, GFD costs and loss productivity cost per patients per year. Also the mean and standard deviation of medical cost and GFD cost were 195 (128) PPP$ and 932 (734) PPP$ respectively. The total costs of CD were significantly higher for male. Also GFD cost and total cost were higher for unmarried patients. Conclusion: In conclusion, our estimation of CD economic burden is indicating that CD patients face substantial expense that might not be affordable for a good number of these patients. The estimated economic burden may put these patients at high risk for dietary neglect resulting in increasing the risk of long term complications.
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Background: Pancreatic cancer is a fatal cancer with a 5-year survival of only about 4% for all tumors. Mortality is a familiar projection to address the burden of cancers, but according to the Iranian death registry, about 20% of death... more
Background: Pancreatic cancer is a fatal cancer with a 5-year survival of only about 4% for all tumors. Mortality is a familiar projection to address the burden of cancers, but according to the Iranian death registry, about 20% of death statistics are still recorded in misclassified categories. The aim of this study was to estimate pancreatic cancer mortality for Iranian population, using a bayesian approach in order to revise this misclassification. Methods: National Death Statistics reported by the Ministry of Health from 1999 to 2004, stratified by age group, sex and cause of death, were the basis for this analysis. Pancreas cancer [ICD-10; 25] were expressed as the annual mortality rates/100,000, overall, by sex and by age group (<50 and ≥50 years of age) and age standardized rate (ASR). The bayesian approach to correct and account for misclassification effects in Poisson count regression was employed with a beta prior to estimate the mortality rate by age and sex group. Results: According to the bayesian analysis, there were between 20 to 30 percent underreported mortality records in deaths due to pancreatic cancer and the rate decreased slightly during the years of the study. Conclusion: Our findings suggest a substantial undercount of pancreatic cancer mortality in the Iranian population. Therefore policy makers who determine research and treatment priorities should note these underreported data for death rates.
Research Interests: Demography, Cancer, Medicine, Pancreatic Cancer, Bayesian Analysis, and 15 moreIran, Population, Humans, Female, Pubmed, Male, Poisson regression, Registries, Middle Aged, International Classification of Diseases, Bayes Theorem, Cancer Registry, Mortality rate, Cause of death, and Pancreatic neoplasms
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Background: Hereditary non polyposis colorectal cancer (HNPCC) appears to have a better prognosis than sporadic cancer. In the present study we evaluated the clinical outcome of HNPCC patients with respect to that of patients with... more
Background: Hereditary non polyposis colorectal cancer (HNPCC) appears to have a better prognosis than sporadic cancer. In the present study we evaluated the clinical outcome of HNPCC patients with respect to that of patients with colorectal cancer recorded in a population-based cancer registry. Aim of our study was to examine survival rates in Iranian HNPCC patients with colorectal cancer and compare them with survival rates of sporadic cases arising from the general population. Patients and methods: The population studied consists of 121 individuals including 61 patients with sporadic colorectal cancer and 60 patients with HNPCC who were followed-up between 2003 and 2008 in Taleghani hospital Tehran. The subjects with HNPCC were screened according to Amsterdam criteria II and Bethesda Guidelines. All those with sporadic cancer had no familial history of colorectal cancer. Observed survival was estimated using the Kaplan-Meier method and compared with log rank test. Multivariate analysis was performed using the Cox regression analysis. Results: In the HNPCC group, 85.0% showed tumors in colon, vs. 68.9% in the sporadic cancer group. The 5-year survival was 82.5% in the HNPCC study group compared with only 56.4% in the general population group (P= 0.044). The age distribution at diagnosis of sporadic patients was significantly higher than HNPCC patients (mean 50.1 years vs 44.3 years P= 0.008). The hazard ratio for sporadic for tumor location was 3.233 (95% CI 1.123-9.307) compared with the HNPCC group (P= 0.030). Conclusion: Our findings corroborate the results of previous study which showed overall survival of colorectal cancer in patients with HNPCC is better than sporadic CRC patients.
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Research Interests: Biology, Medicine, Colorectal cancer, Humans, Internal Medicine, and 15 moreFemale, Male, Genetic Association Studies, Aged, Middle Aged, Genotype, Adult, Allele, Biochemistry and cell biology, Case Control Studies, Colorectal Neoplasms, confounding, alleles, Gene frequency, and Genetic predisposition to disease
Background: Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide. Iran is located in a low risk area but, while the true prevalence of HCC in Iran is unknown, it is not an uncommon malignancy. The aim of this study... more
Background: Hepatocellular carcinoma (HCC) is the sixth most prevalent cancer worldwide. Iran is located in a low risk area but, while the true prevalence of HCC in Iran is unknown, it is not an uncommon malignancy. The aim of this study was to provide quantitative estimations of the burden of death due to HCC cancer in Iran and its trend during over recent decades for the Iranian population. Methods: National death statistics reported by the Ministry of Health and Medical Education (MOH and ME) from 1999 to 2004, stratified by age group, sex, and cause of death (ICD-9) were used to generate HCC mortality (ICD-9; 20) expressed as the mortality rate per 100,000 people. The Bayesian approach to correct for misclassification was employed and a time series model was applied to predict mortality. The burden of HCC, including years of life lost (YLL), was calculated using Iranian life expectancy. Results: The rate of HCC mortality and YLL moderately increased from 1999 to 2004 but according to our prediction it seems that these rates are going to level off. Also HCC mortality and YLL was higher for older age, and was considerably greater in men than in women. Conclusion: Burden of HCC is low in Iran because most of cases are due to HBV and this infection is less common in Iran than Southeast Asia and Africa and there is nomajor increase projected for the future. However, up to 40% of its death statistics are underreported. Screening can be advised for early HCC detection in chronic HCV and HBV carriers.
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Background: Cancer is the third most common cause of death in Iran. The gastrointestinal cancers are the most frequent neoplasms among Iranian males and second to breast cancer among females. The objective of this study was to provide... more
Background: Cancer is the third most common cause of death in Iran. The gastrointestinal cancers are the most frequent neoplasms among Iranian males and second to breast cancer among females. The objective of this study was to provide accurate up-to-date epidemiological information of hospitalized patients with GI tract cancer in Iran. Methods: This study was designed as a retrospective cross-sectional survey included all consecutive GI cancer patients admitted over a one year period in a randomly selected hospital group located in metropolitan Tehran in 2006. Residence, age, sex, type of cancer and length of hospitalization were analyzed. Results: A total of 2,674 GI tract cancer patients were included in the study, There were 1,616 men (60.4%) and 1,058 women (39.6%). The majority of cancers were in the colorectum (40.0%), followed by the stomach (34.5%) and the esophagus (17.1%). The mean hospitalized durations were 7.5-/+6.5 days for men and 7.2-/+8.1 days for women. Male patients were significantly older than the women. Conclusion: By considering the hospitalized GI tract cancers and majority cases of colorectal cancer, prevention programs like as CRC screening should be going on in order to reducing morbidity and incidence rates in a high-risk population for GI tract cancers.
Research Interests: Epidemiology, Incidence Geometry, Cancer, Breast Cancer, Medicine, and 14 moreColorectal cancer, Iran, Humans, Internal Medicine, Hospitalization, Female, Pubmed, Male, Length of Stay, Middle Aged, Public health systems and services research, Gastrointestinal Cancer, Cross sectional Study, and Cross Sectional Studies
Background: Colorectal cancer is the third most common cause of cancer-related deaths in the world. Addressing the burden of related mortality is therefore important but according to the Iranian mortality registry, about 20% of death... more
Background: Colorectal cancer is the third most common cause of cancer-related deaths in the world. Addressing the burden of related mortality is therefore important but according to the Iranian mortality registry, about 20% of death statistics were still recorded in misclassified categories. The aim of this study is to re-estimate the CRC mortality rate for Iranian population, using a Bayesian approach in order to revise this misclassification. Methods: National Death Statistics Reported by the Ministry of Health and Medical Education (MOH and ME) from 1995 to 2003 were included in this analysis. The Bayesian approach to correct and account for misclassification effects in Poisson count regression was employed to estimate the mortality rates by age and sex group. Results: According to the Bayesian re-estimate there were between 30 to 40 percent underreported mortality records in death due to colorectal cancer and the rate for related mortality had moderately increased through recent years. Conclusion: Our findings suggest a substantial undercount of colorectal cancer mortality in the Iranian population. Therefore healthcare policy makers who determine research and treatment priorities from death rates as indicators of public health problems should pay notice to this underreporting.
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Background: Many factors have been linked to the occurrence of constipation, but few studies exist regarding the link between obesity and constipation. The aim of this study was to assess the association between body mass index (BMI) and... more
Background: Many factors have been linked to the occurrence of constipation, but few studies exist regarding the link between obesity and constipation. The aim of this study was to assess the association between body mass index (BMI) and functional constipation in the Iranian community. Methods: From May 2006 to December 2007, a cross sectional study was conducted in the Tehran province and a total of 18,180 adult persons were drawn up randomly. One questionnaire was filled in two stages through interviews. In the first part, personal characteristics and 11 gastrointestinal symptoms were listed. Those who reported at least one of these 11 symptoms were referred for the second interview. The second part of the questionnaire consisted of questions about different gastrointestinal disorders based on the Rome III criteria including functional constipation. Results: 459 adult persons were found to have functional constipation. The mean +/- SD of BMI was 26.5 +/- 4.7 and 60% of the patients had a BMI more than 25. Age and education were significantly associated factors with obesity, showing that older patients and less educated patients were more overweight and obese. Smoking, marital status and sex were not significantly associated with obesity but, up to 60% of low educated women who had functional constipation, had a BMI more than 25. Conclusions: Our study showed that about 60% of patients with functional constipation were overweight, which was more than the mean of our community. In addition there may be an association between higher BMI level and the low education level with constipation in Iranian women.
Research Interests: Obesity, Medicine, Iran, Overweight, Humans, and 15 moreConstipation, Female, Pubmed, Male, Body Mass Index, Questionnaires, Adult, Age Factors, Educational Status, Asian Continental Ancestry Group, Risk Factors, Cross sectional Study, Cross Sectional Studies, Marital Status, and Functional constipation
Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases, which may be related. To assess the association between gastro-oesophageal reflux disease and irritable bowel syndrome in a country with high prevalence... more
Gastro-oesophageal reflux disease and irritable bowel syndrome are common diseases, which may be related. To assess the association between gastro-oesophageal reflux disease and irritable bowel syndrome in a country with high prevalence of Helicobacter pylori. This study was designed as cross-sectional and population-based in Tehran province, Iran. The participants were interviewed by using a valid and reliable questionnaire. Gastro-oesophageal reflux disease was defined by weekly or more frequent heartburn and/or acid regurgitation. Irritable bowel syndrome was diagnosed according to the Rome III. The association between these two disorders was calculated using a statistical model that allows the odds ratio (OR) to be measured. A total of 6526 individuals were selected randomly, the response rate was 87.8%. Among the respondents, 178 (3.1%) participants reported both the diseases. The OR of having gastro-oesophageal reflux disease and irritable bowel syndrome together was estimated to be 16.55 (95% confidence interval: 12.85-21.33) indicating significant association between the two diseases. Thirty-four percent of patients with gastro-oesophageal reflux disease and 61.5% with irritable bowel syndrome suffered from both diseases. Sex did not have a significant effect on the OR of coexistence. Older participants were statistically more prone to the coexistence of two diseases. The association between gastro-oesophageal reflux disease and irritable bowel syndrome was significantly higher in our community compared with others. Their association occurs predominantly in older participants. Further studies for understanding of the pathophysiological mechanisms behind these two diseases are required.
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Background: Researchers in medical sciences often tend to prefer Cox semi-parametric instead of parametric models for survival analysis because of fewer assumptions but under certain circumstances, parametric models give more precise... more
Background: Researchers in medical sciences often tend to prefer Cox semi-parametric instead of parametric models for survival analysis because of fewer assumptions but under certain circumstances, parametric models give more precise estimates. The objective of this study was to compare two survival regression methods - Cox regression and parametric models - in patients with gastric adenocarcinomas who registered at Taleghani hospital, Tehran. Methods: We retrospectively studied 746 cases from February 2003 through January 2007. Gender, age at diagnosis, family history of cancer, tumor size and pathologic distant of metastasis were selected as potential prognostic factors and entered into the parametric and semi parametric models. Weibull, exponential and lognormal regression were performed as parametric models with the Akaike Information Criterion (AIC) and standardized of parameter estimates to compare the efficiency of models. Results: The survival results from both Cox and Parametric models showed that patients who were older than 45 years at diagnosis had an increased risk for death, followed by greater tumor size and presence of pathologic distant metastasis. Conclusion: In multivariate analysis Cox and Exponential are similar. Although it seems that there may not be a single model that is substantially better than others, in univariate analysis the data strongly supported the log normal regression among parametric models and it can be lead to more precise results as an alternative to Cox.
Research Interests: Statistics, Survival Analysis, Medicine, Multivariate Analysis, Humans, and 15 moreFemale, Pubmed, Male, Regression Analysis, Middle Aged, Analysis of Variance, Proportional hazards model, Akaike Information Criterion, Statistical models, Weibull distribution, Parametric Statistics, Proportional Hazards Models, Univariate Analysis, Parametric Model, and Stomach neoplasms
Objectives: Atypical presentation is the most prevalent form of coeliac disease (CD) and mostly clinically indistinguishable from other gastrointestinal (GI) disorders. The first objective of this study was to determine the prevalence of... more
Objectives: Atypical presentation is the most prevalent form of coeliac disease (CD) and mostly clinically indistinguishable from other gastrointestinal (GI) disorders. The first objective of this study was to determine the prevalence of CD in patients with GI symptoms and the second objective was to characterize the typical manifestations of the atypical forms of CD. Methods: This was a cross sectional study comprising 5,176 individuals by random sampling of self-referred people from the Tehran province, during the years 2006-2007 in a primary care setting. From 5,176 individuals, 670 with GI symptoms were selected for coeliac serology including total immunoglobulin A (IgA) and anti-tissue transglutaminase (tTG) antibodies. Those with IgA deficiency were tested with IgG tTG. Results: This study shows that 13% (670/5176) of self-referred patients to a general practice suffer from GI symptoms. Dyspepsia was the most common symptom in 25 seropositive cases similar to the rest of the study group. A positive anti-tTG test was found in 22 from 670 investigated subjects (17 women, 5 men) (95% CI: 1.70-4.30) and 8/670 were IgA deficient. A positive IgG tTG was detected in 3/8 IgA deficient individuals. The prevalence of CD antibodies in serologically screened samples excluding IgA-deficient was 3.3% and 3.7% when including those IgA-deficient with positive tTG-IgG. Conclusions: Non-specific GI symptoms seem to be the typical presentation of atypical CD. This study indicated that there is a high prevalence of CD antibodies among patients with GI symptoms (3.7%). More awareness regarding the atypical presentation of CD could be the key step in identifying asymptomatic patients.
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The cancers in the digestive system including gastric cancer, colorectal cancer, liver cancer, esophageal cancer and pancreatic cancer are one of the most common cancers in Asia. The burden of GI cancer is increasing in Asia because of... more
The cancers in the digestive system including gastric cancer, colorectal cancer, liver cancer, esophageal cancer and pancreatic cancer are one of the most common cancers in Asia. The burden of GI cancer is increasing in Asia because of aging, growth of the population and the risk factors including smoking, obesity, changing lifestyle and high prevalence of H pylori, HBV and HCV. In most Asian countries, cancer control programs or early detection and treatment services are limited despite this increase. There are many people in the developing countries inside Asia who have no health insurance and many of them are too poor to go for screening tests, early detection or medical treatments. Therefore, it is important for the health organizations and governments in each country to recognize these groups and reduce the incidence and mortality of gastrointestinal cancers, using simple and economic screening test, vaccination and changing risk factors such as smoking, diet and lifestyle by education programs.
Research Interests: Obesity, Cancer, Medicine, Colorectal cancer, Pubmed, and 3 moreAsia, Burden, and Gastrointestinal Cancers
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A Confounder is a variable whose presence affects the variables being studied so that the results do not reflect the actual relationship. There are various ways to exclude or control confounding variables including Randomization,... more
A Confounder is a variable whose presence affects the variables being studied so that the results do not reflect the actual relationship. There are various ways to exclude or control confounding variables including Randomization, Restriction and Matching. But all these methods are applicable at the time of study design. When experimental designs are premature, impractical, or impossible, researchers must rely on statistical methods to adjust for potentially confounding effects. These Statistical models (especially regression models) are flexible to eliminate the effects of confounders.
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Background and aim of the work: European COVID-19 statistics showed differentiation between mortality and new cases. Some studies suggested several factors including migration, cancer incidence, life expectancy and health system capacity... more
Background and aim of the work: European COVID-19 statistics showed differentiation between mortality and new cases. Some studies suggested several factors including migration, cancer incidence, life expectancy and health system capacity maybe associated with differentiations. Up to now, impact of those factors in different European societies is not discussed and compared. Aim of the present study was to perform the cluster analysis in European countries in attention to clinical and epidemiological factors due to covid-19. Methods: We collected some appropriate extreme data of COVID-19 to access the situations by ANOVA post-hoc test in 3 scenarios, as well as to estimate regression coefficients in simple linear regression, and a cluster analysis using average linkage. The present study was designed to assess the situation in the European region in the face of COVID-19 from the beginning of the conflict to April 24, 2020. Results: Among 39 European countries, several countries reported highest rate of confirmed cases included of Italy (current statues=2270.52) and Spain (current status=2616.24). The highest rate of mortality was seen in France (current status=242.16), Italy (current status=305.52). Life expectancy (female) (P=0.01, 95%Cl=1521.27,15264.58), migration (P<0.001, 95%Cl=41.42,96.72) had significant association with confirmed cases and death. Overall cancer death (P<0.001, 95%Cl=0.36,0.68; P<0.001, 95%Cl=0.01,0.07) and lung cancer death (P<0.001, 95%Cl=1.97,3.56; P<0.001, 95%Cl=0.09,0.37) associated with confirmed cases and mortality, too. We were also determined 5 clusters which more than 30 countries were categorized in the first cluster. Conclusions: Demographic factors, including population, life expectancy and migration, underlying disorders, such as several types of cancers, especially lung cancers lead to various distribution of COVID-19 in terms of prevalence and mortality, across European counties. (www.actabiomedica.it)
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Background: Gastrointestinal diseases are maladies that produce multiple symptoms. Suffering from these symptoms attributes people to an illness and self-treat or seek medical care. The objective of this study is to determine the relation... more
Background: Gastrointestinal diseases are maladies that produce multiple symptoms. Suffering from these symptoms attributes people to an illness and self-treat or seek medical care. The objective of this study is to determine the relation between gastrointestinal symptoms and demographic factors using population pyramid. Methods: This study was a cross-sectional survey conducted from May 2006 to December 2007 Tehran province, Iran. The questionnaire included personal and family characteristics such as age, gender, and educational level. In addition to this, interviewers asked about 10 GI symptoms. Comparison prevalence of GI symptoms among age groups was made via population pyramid. All analysis carried out using SPSS version 16. Results: A total of 30,334 subjects were included in the study. The prevalence of GI symptoms increased with increasing age. Moreover, women had higher prevalence of symptoms and the GI symptoms were more prevalent in married individuals than single one. Conclusion: Age is dynamic in the sense that individuals continually age. It is the timing and sequencing of such changes that could be incorporated into analyses of health. So age pyramid is a flexible way to evaluate the effect of this factor on health in population.