Reza Malekzadeh

BACKGROUND Chronic constipation is one of the most common gastrointestinal disorders. It has negative effects on the patients' quality of life, and their productivity, and results in a high economic burden on the healthcare services. The aim of the present study was to estimate the prevalence of chronic constipation and its associated factors in pars cohort study (PCS). METHODS A cross-sectional study was conducted on the baseline data of the PCS. Data gathering was done by structured questionnaire and physical examination. A total of 9264 subjects aged between 40 and 75 years were enrolled in the PCS. Diagnosis of chronic constipation was done using Rome IV criteria. Multivariable binary logistic regression was applied for data analysis. RESULTS A total of 752 (8.1%) participants were diagnosed as having chronic constipation (9.3% of female and 6.7% of male participants). Older age (OR: 1.55, 95% CI: 1.31-1.83), physical activity (OR: 0.56, 95% CI: 0.46-0.68), opium consumption...

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs amo...

Objective(s) Due to increasing emergence of drug-resistance in Helicobacter pylori isolates, traditional plants are potentially valuable sources of novel anti-H. pylori agents. In this research, anti-H. pylori activity of the organic extracts of twenty native Iranian plants was determined against ten clinical isolates of H. pylori. Materials and Methods Disc diffusion was used to determine the biological activity of 20 plant extracts as well as 8 antibiotics commonly used to treat H. pylori infections. Minimum inhibitory concentrations were also measured by tube and agar dilution methods for the biologically active plant extracts. Results Of the twenty plant extracts analyzed, sixteen exhibited good anti-H. pylori activity, using disc diffusion. The ten most active extracts were Carum bulbocastanum, Carum carvi, Mentha longifolia, Saliva limbata, Saliva sclarea, Ziziphora clinopodioides, Thymus caramanicus, Glycyrrhiza glabra, Xanthium brasilicum and Trachyspermum copticum. Minimum ...

Smoking has been associated with acquisition and increased persistence of Helicobacter pylori infection, as well as with lower effectiveness of its eradication. A greater prevalence of infection among smokers could contribute to the increased risk for gastric cancer. We aimed to estimate the association between smoking and seropositivity to H. pylori through an individual participant data pooled analysis using controls from 14 case-control studies participating in the Stomach Cancer Pooling Project. Summary odds ratios and prevalence ratios (PRs), adjusted for age, sex and social class, and the corresponding 95% confidence intervals (CIs) were estimated through random-effects meta-analysis. Heterogeneity was quantified using the I statistic and publication bias with Egger's test. There was no significant association between smoking (ever vs. never) and H. pylori seropositivity (adjusted odds ratio=1.08; 95% CI: 0.89-1.32; adjusted PR=1.01; 95% CI: 0.98-1.05). The strength of the...

Tobacco smoking is one of the main risk factors for gastric cancer, but the magnitude of the association estimated by conventional systematic reviews and meta-analyses might be inaccurate, due to heterogeneous reporting of data and publication bias. We aimed to quantify the combined impact of publication-related biases, and heterogeneity in data analysis or presentation, in the summary estimates obtained from conventional meta-analyses. We compared results from individual participant data pooled-analyses, including the studies in the Stomach Cancer Pooling (StoP) Project, with conventional meta-analyses carried out using only data available in previously published reports from the same studies. From the 23 studies in the StoP Project, 20 had published reports with information on smoking and gastric cancer, but only six had specific data for gastric cardia cancer and seven had data on the daily number of cigarettes smoked. Compared to the results obtained with the StoP database, conv...

Cardiovascular mortality in Western Asia is high and still rising. However, most data documented on risk prediction has been derived from Western countries and few population-based cohort studies have been conducted in this region. The current study aimed to present the process of pooling data and cardiovascular disease (CVD) mortality incidences for four Iranian cohorts. From the Iran Cohort Consortium, the Golestan Cohort Study (GCS), Tehran Lipid and Glucose Study, Isfahan Cohort Study (ICS) and the Shahroud Eye Cohort Study (ShECS) were eligible for the current study since they had appropriate data and follow-up visits. Age-standardised CVD mortality rates were estimated for ages 40-80 and 40-65 years. Cox regression was used to compare mortalities among cohorts. Adjusted marginal rates were calculated using Poisson regression. Overall, 61 291 participants (34 880 women) aged 40-80 years, free of CVD at baseline, were included. During 504 606 person-years of follow-up, 1981 CVD ...

BACKGROUND Epidemiology of diseases changes over time with changes in socio-economic status, culture and health care systems. Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are among the diseases whose epidemiology has changed over the past few decades in the west. Studies addressing the trend of GERD and PUD occurrence in Iran are lacking. We aimed to look at the time trends of GERD and PUD in a referral endoscopy clinic in Tehran, Iran. METHODS All patients with dyspeptic symptoms who underwent upper GI endoscopy from 1993 to 2005 (inclusive) in a tertiary outpatient GI referral center in Tehran were enrolled. Erosive esophagitis (EE, used as a proxy for GERD as a whole), PUD, rapid urease test (RUT) status and demographic characteristics were recorded from the endoscopy reports according to the year the endoscopy was performed. RESULTS Over a period of 13 years, 8,029 endoscopic examinations were performed. The most common endoscopic diagnosis was EE that o...

The incidence of esophageal squamous cell carcinoma (ESCC) is very high in northeastern Iran. However, the genetic predisposing factors to ESCC in this region have not been clearly defined. The P21(waf1/cip1) gene is involved in the arrest of cellular growth, as induced by the p53 tumor suppressor gene. Two polymorphisms of p21 gene in codon 31 (p21 C98A, dbSNP rs1801270) and the 3'UTR (p21 C70T, dbSNP rs1059234) may affect protein expression and play a role in cancer susceptibility. The present study aimed to investigate the association of p21 polymorphisms in codon 31 and the 3'UTR, and cigarette smoking on the risk of ESCC in northeastern Iran. A case-control study was carried out to detect the p21 polymorphism in the 3'UTR and codon 31 of samples from 126 ESCC cases and 100 controls from 2006 to 2007. There were no significant differences of age and sex between cases and controls. Genotyping of p21 polymorphisms were determined with the PCR-RFLP method. Conditional l...

The occurrence of strains resistant to metronidazole is causing failure of the 4-drug regimen for eradication of Helicobacter pylori in the Islamic Republic of Iran. This study compared the in vitro efficacy of furazolidone with metronidazole, clarithromycin, amoxicillin and tetracycline in 70 H. pylori isolates from dyspeptic patients. Of the isolates, 33% were resistant to metronidazole but all were susceptible to furazolidone. Furazolidone could be considered as an appropriate substitute for metronidazole for H. pylori infections.

For almost 30 years no population-based cancer statistics have been available with which to estimate the cancer burden in Iran. In 2002 and 2003 two separate reports of population based cancer registries were published from Iran and the cancer incidence rates from these sources have permitted informed estimates of cancer incidence and mortality to be prepared. They suggest that more than 51,000 cases of cancer are diagnosed and 35,000 deaths due to cancer occur each year. The 5 most common cancers in males (by ASR) are stomach (26.1 per 10(5)), esophagus (17.6 ), colon-rectum (8.3), bladder (8.0) and leukemia (4.8), and in females are breast (17.1), esophagus (14.4), stomach (11.1), colon-rectum (6.5) and cervix uteri (4.5). The incidence rates of esophageal and stomach cancer in Iran are high, well above the world average, while the incidence of lung cancer is very low. Breast cancer, although the most common cancer of females in Iran, has rates that are low by world standards, esp...

Background: Gastroesophageal reflux disease (GERD) is prevalent in the West. Mayo-GERQ is one of the most widely used questionnaires for screening GERD. We validated GERQ in an Iranian population. Methods: The Mayo-GERQ was translated into Persian (P-GERQ) and reviewed and commented by two gastroenterologists. Eleven lay-people filled it in and commented on it. Reliability was assessed by test-retest within 2-6 wks in 53 hospital staff. Concurrent-validity was checked in another 53, comparing the results of the self- ...

To examine the causes of premature mortality (<70 years) and associated risk factors in the Golestan Cohort Study. Prospective. The Golestan Cohort Study in northeastern Iran. 50 045 people aged 40 or more participated in this population-based study from baseline (2004-2008) to August 2017, with over 99% success follow-up rate. The top causes of premature death, HR and their 95% CI and population attributable fraction (PAF) for risk factors. After 444 168 person-years of follow-up (median of 10 years), 6347 deaths were reported, of which 4018 (63.3%) occurred prematurely. Ischaemic heart disease (IHD) accounted for 33.9% of premature death, followed by stroke (14.0%), road injuries (4.7%), stomach cancer (4.6%) and oesophageal cancer (4.6%). Significant risk/protective factors were: wealth score (HR for highest vs lowest quintile: 0.57, PAF for lowest four quintiles vs top quintile: 28%), physical activity (highest vs lowest tertile: 0.67, lowest two tertiles vs top tertile: 22%)...

Various duration of standard regimen (Amoxicillin, Metronidazole, Colloidal Bismuth Sub-citrate for 2 weeks and with additional Ranitidine for 1 or 2 weeks) on eradication of Helicobacter Pylori in peptic ulcer Iranian patients. A randomized controlled trial.

Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Progression of gastric cancer follows several steps from gastritis to atrophy, intestinal metaplasia, dysplasia, and finally cancer. The aim of this study was to determine the prevalence of gastric precancerous lesions and related common risk factors in a group of chronic dyspeptic patients. A total of 688 chronic dyspeptic patients older than 40 years of age were consecutively enrolled. The exclusion criteria were pregnancy, and a history of gastric cancer and gastric surgery. A questionnaire including demographic and clinical data, smoking habits, alcohol use, NSAIDs, and regular aspirin use was completed for all patients. Upper endoscopy and gastric biopsy were performed for all of the participants according to the standard protocols. Upper endoscopy was performed for all of the participants and biopsies were taken according to the biopsy protocol. The specimens were examined in a blinded manner by tw...

The northeastern region of Iran has some of the highest rates of esophageal squamous cell carcinoma (ESCC) in the world. To investigate the role of polycyclic aromatic hydrocarbons (PAHs) in the etiology of ESCC in northeastern Iran, we measured urine 1-hydroxypyrene glucuronide (1-OHPG), a stable PAH metabolite, in 99 inhabitants of this area. The median urine 1-OHPG in participants of this study was 4.2 pmol/ml. Forty-two subjects (42%) had levels ranging from 1 to 5 pmol/ml, indicative of moderate PAH exposure, and 41 (41%) had levels above 5 pmol/ml, indicative of very high exposure. Further analysis showed that 1-OHPG levels were high in all subgroups of our study subjects, including both sexes, rural and urban dwellers, and smokers and non-smokers. Only 15% of the variance in 1-OHPG was explained by age, sex, residence, smoking, nass, or opium consumption. This pattern of PAH exposure parallels the ESCC incidence pattern seen in this area. We conclude that people in northeaste...

The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) constitutes an unprecedented collaboration of 488 scientists from 303 institutions in 50 countries, focusing on describing the state of health around the world using a uniform method. Results for the world and 21 regions for 1990 and 2010 have been reported for 291 diseases and injuries, 1160 sequelae of these causes, and 67 risk factors or clusters of risk factors. The burden of each disease, injury, or risk factor has been quantifi ed in terms of deaths, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). Although only global and regional results have been reported so far, the underlying unit of analysis for GBD 2010 was 187 countries. Age-specifi c mortality was analysed for each country for each year from 1970 to 2010. Causes of death were estimated for each country from 1990 to 2010 with country-specifi c data and models. Disease and injury sequelae were estimated in most cases with a Bayesian meta-regression method (DisMod-MR) that includes estimation of systematic diff erences in incidence, prevalence, or excess mortality between countries within regions. Systematic analysis of risk factor exposure, excess health risks associated with each risk–outcome pair, and counterfactual minimum risk levels of exposure were used to compute attributable burden. On the basis of these analyses, GBD 2010 provides a complete assessment of the burden of diseases, injuries, and risk factors for 187 countries including quantifi cation of uncertainty in the estimates for 1990 and 2010, albeit with important limitations because of the scarcity of data for some outcomes in some countries and the need to use a range of statistical models to generate estimates. The availability of standardised estimates for each of the 187 countries over time provides an unprecedented opportunity to undertake comparative assessments, to benchmark country performance in control of critical diseases, injuries, and risks, and to stimulate evidencebased action. Most of the scientists in the GBD 2010 collaboration volunteered their own time or raised their own funds to participate. A key motivation for them was the opportunity to publish more detailed analyses of data, methods, and results for specifi c diseases, injuries, and risk factors. Many reports are in submission or in preparation and provide more detail for specifi c diseases, injuries, risk factors, and countries. Although we expect that these reports will be important contributions to the scientifi c literature, we recognise that country results from the GBD are a global public good that could be a useful or even critical input into a more informed national, regional, and global dialogue about health challenges. Already, governments of several developed and developing countries have approached us seeking access to more detailed results. Because we believe that the dissemination and rapid availability of the detailed results is a moral imperative, we are providing global access to these details on March 5, 2013, through a series of online visualisations. To allow suffi cient time for members of the GBD 2010 collaboration to report their own research fi ndings, we will defer dissemination of public-use datasets of the underlying results presented in the visualisations until Sept 1, 2013. In this way, we believe that we can provide global access to these important results while at the same time respecting the intellectual investment of the collaboration’s members. Nonetheless, anticipating that some governments might wish to have immediate access to more detailed information as an input to national policy dialogue, we have provided and will continue to provide detailed national disease burden results on request. We also encourage use of the visualisations or snapshots of their images for teaching, communication, and other educational purposes. Alongside the reporting of global and regional results in The Lancet, fi ve data visualisations were made available in December, 2012. For visualisation of country-level data, the Institute for Health Metrics and Evaluation (IHME) has developed new visualisations with expanded scope and functionality, which are being launched on March 5. Data visualisations can make complex information accessible and interpretable without advanced statistical or epidemiological training. The primary purpose of these visualisations is to allow health specialists, policy makers, the media, donors, and the general public to explore the patterns of health in diff erent age and sex groups, countries, and time periods. Providing information on patterns of health to this broad audience could enhance the scope and quality of national, regional, and global dialogue about the main For data visualisations see http://www.ihmeuw.org/ GBDregionalviz

Background: Prolonged antiacid and antibiotic usage in gasterointestinal diseases may predispose candidial colonization in GI tract. In order to isolate and diagnose of candida infections in patients with gastritis, duodenitis, gastric ulcer and duodenal ulcer, this study have been planned. Methods: We studied 300 biopsy specimens of patients referred to hospital, 51.7% of the patients were male and the others were female. The isolated fungi were identified by direct examination and culture of specimens. Results: Frothy four cases ...

BACKGROUND Opium is one of the most common substances used worldwide with variable epidemiologic features in different regions. This study was performed in southern Iran, to find the epidemiology of opium use and its association with different factors and diseases. METHODS This cross-sectional study was performed on baseline data extracted from Pars Cohort Study performed in Valashahr, a rural area in southern Iran. For any subject, information was collected about demographic factors, some common diseases including heart disease, stroke and hypertension and the state of using opium, other substances and cigarettes. RESULTS There were 4276 males and 4988 females, with a mean age of 52.6 ± 9.7 years of whom 8.4% reported opium use (17.3% of males and 0.7% of females). In men, the history of stroke and heart disease were significantly more common in opium users (12.6% vs. 8.8%, P = 0.001 and 2.8% vs. 1.5%, P = 0.01, respectively) while the history of hypertension was significantly more...

... Malekzadeh, Akram Pourshams, Mina Gharravi, Afshin Aslani, Alireza Nateghi, Mansoor Rastegarpanah, Masoud Khoshnia, G Neil Thomas, Bagher Larijani ... 9 Dec 2011); Deborah Cohen: Censorship and transparency in science (8 Dec 2011); Seye Abimbola: David Cameron ...

This study was designed to determine the correlation of hepatitis B virus surface Ag (HBsAg) variations with the clinical/serological pictures among chronic HBsAg positive patients. The surface gene (S-gene) was amplified and directly sequenced in twenty-five patients. Eight samples (group I) contained at least one mutation at the amino acid level. Five showed alanine aminotransferase (ALT) levels above the normal range of which only one sample was anti-HBe positive. Group II (17 samples) did not contain any mutation, 4 were anti-HBe positive and 9 had increased ALT levels. In both groups, from a total of 18 mutations, 5 (27.5%) and 13 (72.5%) occurred in anti-HBe and HBeAg positive groups respectively. The small number of amino acid mutations might belong to either the initial phase of chronicity in our patients; or that even in anti-HBe positive phase in Iranian genotype D-infected patients, a somehow tolerant pattern due to the host genetic factors may be responsible.

To investigate the impact of gender on multimorbidity in northern Iran. A cross-sectional analysis of the Golestan cohort data. Golestan Province, Iran. 49 946 residents (age 40-75 years) of Golestan Province, Iran. Researchers collected data related to multimorbidity, defined as co-existence of two or more chronic diseases in an individual, at the beginning of a representative cohort study which recruited its participants from 2004 to 2008. The researchers utilised simple and multiple Poisson regression models with robust variances to examine the simultaneous effects of multiple factors. Women had a 25.0% prevalence of multimorbidity, whereas men had a 13.4% prevalence (p<0.001). Women of all age-groups had a higher prevalence of multimorbidity. Of note, multimorbidity began at a lower age (40-49 years) in women (17.3%) compared with men (8.6%) of the same age (p<0.001). This study identified significant interactions between gender as well as socioeconomic status, ethnicity, ...