Mortality determinants in colorectal cancer patients at different grades: a prospective, cohort study in Iran.

BACKGROUND Colorectal cancer (CRC) is an important cause of mortality and morbidity in many communities worldwide. This population based study was conducted to assess determinants of colorectal mortality in Iranian patients. MATERIALS AND METHODS A cohort of 1,127 cases of confirmed colorectal cancer registered in a population based registry covering 10 referral hospital in Tehran, Iran, were followed for five years. Information about tumor characteristics, smoking status and family history were collected at base line and survival status were followed every six months by contacting patient or next of kin (if patients died during the follow-up). The cause of death for each case was validated by verbal autopsy and referring to patient medical records at the time of death. The data were analyzed by Stata software using univariate and multivariate analysis (Cox regression). In building the model a p value of less than 5% was considered as significant. RESULTS The age at diagnosis was 53.5±14 years. Sixty one percent were male. Colorectal mortality among the patients was 96.9 person-years among men and 83 person-years among women. Seventy five percent of patients lived for 2.72 years, 50% for 5.83, and 25% for 13 years after the diagnosis of colorectal cancer. The age at diagnosis was significantly different between men and women (p<0.03). Higher tumor grade predicted higher death rate; the adjusted hazard ratios were 1.79 (95%CI, 0.88-3.61), 2.16 (95%CI, 1.07-4.37), and 3.1 (95%CI, 1.51-6.34) for grades II, III, and IV respectively when they were compared with grade I as reference. Ethnicity, marital status, family history of cancer, and smoking were related to survival with different degrees of magnitude. CONCLUSIONS Among many factors related to survival among the colorectal patients, tumor grade and smoking showed the highest magnitudes of association

Incidence rate of thyroid cancer in Iranian population, trend analysis from 2003 to 2009

Background and aims: Thyroid cancer is the most common endocrine malignant and papillary cancer and three times more prevalent in women than men. The aim of this study was to evaluate the incidence rate and trend of thyroid cancer in Iranian population. Methods: National incidence was rated by Iran National Cancer Registry data derived from Iran’s annual national cancer registration reported from 2003 to 2009. The crude rate and age standardized rate were used to express the incidence of thyroid cancer. Results: The results indicated that, the incidence of thyroid cancer increased from 2003 to 2009. The age standardized rate for women and men increased from 2.02 and 0.82 to 4.2 and 1.36 per 100,000, respectively. Conclusion: This study indicated remarkable increasing trends in thyroid cancer incidence. So, attention to high risk groups and public programs is necessary to reduce the incidence of this cancer in future

Effect of metabolic syndrome and its components on survival in colorectal cancer: a prospective study.

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

Factors Affecting the Decline in Childbearing in Iran: A Systematic Review

AbstractIntroduction: The decline in fertility and childbearing tendency in Iran is due tovarious demographic, economic, social, and cultural variables. The present research wasconducted to review studies carried out on factors affecting the decline in childbearing.Methods: This systematic review searched for articles published from 2011 to 2017in all the available Iranian and foreign databases, including SID, Magiran, Irandoc,Medlib, Pubmed, Google Scholar, Science Direct, and Proquest using the followingkeywords, “childbearing”, “fertility”, “fertility decline” and “population decline”. Thesearch ultimately led to the inclusion of 53 studies.Results: The main factors affecting the decline in childbearing discussed in the 53reviewed articles were divided to three general categories: 1. Personal and familyfactors, including aging, older age at marriage, current number of children, theduration of marriage, the mean birth spacing, gender preferences, hopefulness, maritalsatisfaction, and quality of life, 2. Socioeconomic factors, including social support,education, occupation and social participation, especially of females, place of residenceand the effect of social networks, 3. Cultural factors, including modernity, urbanizationand industrialization, attitude change towards the value of children, changes in familyvalues and religion.Conclusions: To intervene in the decline in childbearing and to increase the successrate of the designed plans and strategies, policy-makers and planners should providestrategies to deal with all the three noted groups of factors affecting childbearing

Global incidence and mortality rate of covid-19; Special focus on Iran, Italy and China

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a new coronavirus, was diagnosed in China in December 2019. Around the globe, a total of 71 429 were infected up to February 17, 2020, with 98.9 of cases in China. On March 11, 2020, the World Health Organization (WHO) characterized the COVID-19 as 'pandemic'. Rapid positive worldwide incidence was the motivation behind this study to investigate the incidence and mortality globally. Methods: We used the data published by the WHO until March 9, 2020. Non-parametric tests and change point analysis were used for inferences. Results: Change point analysis for Iran and China and the world excluding China for the first 20 days revealed around 78, 195 and 2 further new cases per day, respectively. Italy had a big jump in incidence on the 36th day. Similarly, a sharp rise of positive cases was reported for the world on the 35th day. China successfully controlled the ascending reports of incidence on the 23rd day. Mortality in China and the world were almost similar for the first 20 days. There was an ascending incidence trend with two change points in Italy (30th and 36th days) and one change point in Iran on the 17th day. Mortality in the world jumped remarkably after day 42 with an estimation of almost more than 25 deaths per day. Conclusion: The incidence of COVID-19 varied by regions; however, after March 11, it became 'pandemic'. It was observed that after about 6 days with an emergence of sharp increase in incidences, there would be a mutation in mortality rate. On the other hand, the importance of 'on-time' quarantine programs in controlling this virus was confirmed. © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons. org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The Prognostic Value of Echocardiographic Findings in Prediction of In-Hospital Mortality of COVID-19 Patients

Introduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate.&nbsp;Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality.&nbsp;Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI).&nbsp;Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the two independent prognostic factors of in-hospital mortality.&nbsp;Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19

COVID-19 related hospitalization costs; assessment of influencing factors

Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients.&nbsp;Methods: Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020&nbsp;until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The&nbsp;corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear&nbsp;model.&nbsp;Results: The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran,&nbsp;for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged&nbsp;alive from the hospital, the costs increased with patients’ pregnancy (P&lt;0.001), loss of consciousness during&nbsp;hospitalization (P&lt;0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P&lt;0.001), end&nbsp;stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly&nbsp;(P=0.033) and occurrence of myocardial infarction during hospitalization (P&lt;0.001). In deceased patients, low&nbsp;age P&lt;0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization&nbsp;(P=0.044) were related to increase in therapeutic costs.&nbsp;Conclusion: Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching&nbsp;hospital in Iran were 271.1 USD. Hoteling and medications made upmost of the costs. History of cardiovascular&nbsp;disease and new onset episodes of such complications during hospitalization were the most important factors&nbsp;contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases&nbsp;are of other independent factors affecting hospitalization costs in COVID-19 patients

Effect of the rehabilitation program on the fatigue of patients with coronary artery diseases

Background: This study aimed to evaluate the changes in fatigue of patients with coronary artery diseases after the rehabilitation intervention based on demographic and clinical variables. Methods: This study was a single-arm clinical trial with a pre and post-intervention design. The statistical population of the study included patients with coronary artery diseases who underwent coronary artery bypass surgery or percutaneous coronary interventions, 4-6 weeks after discharge, referred to Khorramabad Cardiac Rehabilitation Center. They were selected by a purposeful sampling method. The data were collected through demographic and clinical information questionnaires and Piper Fatigue Measurement Questionnaire. Education on risk factors at home (weeks 4 and 8) was presented in the area of rehabilitation, the data were analyzed with descriptive and analytical statistics in SPSS software. Results: Most of the patients were male (54.4%), married (87%), and in the age group of 47-58 years (50%). Their mean age was 54.63 ± 8.87 years, and the mean duration of heart disease in the subjects (by months) was 33.24 ± 50.84. Comparing the mean changes in fatigue after the intervention based on some influencing demographic variables of the patients, including age, gender, type of treatment, and the duration of the disease showed no significant difference (p&gt;0.05). Conclusion: The implementation of a home cardiac rehabilitation program by nurses, as a low-cost, accessible, and feasible intervention, can be considered an effective step in reducing the fatigue of patients with coronary artery disease and should be considered by managers