A Cure Rate Model with Discrete Frailty on Hodgkin Lymphoma Patients after Diagnosis

Introduction: Hodgkin lymphoma (HL) is an uncommon cancer of lymphocytes, characterized by cancerous Reed-Sternberg cells in an inflammatory background. HL is an exceptionally curable disease with combination chemotherapy, radiotherapy, or combined modality treatment. This analysis aimed to identify significant prognostic factors on the cure rate. Materials and Methods: The medical records of 110 patients hospitalized from 2007 up to 2014 with 18 months follow-up was retrospectively reviewed in Taleghani hospital of Tehran, Iran. The survival time was set as the time interval between diagnosis and a patient's death from HL. Also, if the cure rate was present in survival, data encompasses zero frailty. Thus, using hyper-Poisson (hP) distribution as discrete frailty, the unobserved heterogeneity and random effects were accounted for. Results: The estimated cure fraction was 81.2%, which was obtained after 2717 days (7.4 years). In noncured cases, the mean survival time was 1535 days (4.2 years). Also, the five and ten-year survival rates were 0.91 and 0.80, respectively. After diagnosis, results revealed that patients with age  45, hemoglobin  12, WBC  15000, and BMI  30 were associated with poor outcome by using simple analysis. More importantly, there is no significant difference between males and females in the cure of HL patients. Conclusion: As expected, the study indicated that a high proportion of HL patients got cured. A cure rate model with discrete frailty utilization provided a suitable way to account for heterogeneity among HL patients. &nbsp

Joint frailty model for recurrent events and a terminal event in the presence of cure fraction

The observations of repeated or recurrent events occur in many longitudinal studies. Furthermore, sometimes there may exist a terminal event such as death, which is strongly correlated with recurrent events. In many situations, a fraction of subjects who will never experience the event of interest during a long follow-up period is considered to be cured. In this article, we proposed a joint frailty model in the presence of cure fraction. The dependency is modeled by shared frailty that is contained in both the recurrent andterminal events hazard functions. It allows to estimate two separate sets of parameters on the recurrent, death, and cure model. We applied the maximum likelihood method under a piecewise constant hazard function for model fitting. The proposed model is evaluated by simulation studies and an application to a breast cancer data is provided

Survival Analysis of Iranian Patients with Breast Cancer Using Joint Frailty Model with a Cure Rate

Background: Breast cancer is a common disease among women around the world. In Iran, it is the most prevalent cancer diagnosed in women. The objective of this study was to assess the cure rate of patients and the associated risk factors. Method: A retrospective cohort study was conducted on 446 patients with breast cancer admitted to the Shahid Ramezanzadeh Radiotherapy Center. Using R 3.2.2 software, the Kaplan-Meier curve, log-rank test, and cure joint frailty model were utilized in the analysis. Results: Of the 446 patients, 17.3% died, 20% experienced relapse, and 62.7% were censored. The 1-5-7-year disease-free survival rates were 95.3%, 73.4%, and 69.3%, respectively. In the cure model, stage, involved lymph node, and surgery were statistically significant. In the recurrence model, stage, involved lymph node, lymphovascular invasion, and hormone therapy were statistically significant. In the death model, stage, lymphovascular invasion, and involved lymph node had a statistically significant effect on the survival time. Conclusion: The cure joint frailty model is a good model when there is a high fraction of patients who do not experience any recurrence or death. In addition, this model allows for the separate estimation of explanatory variable effect on recurrence, death, and cure. The findings of our study can be conducive to preventing the unfavorable effects of breast cancer and increasing the survival of patients

میزان همخوانی یافته های سی تی اسکن شکم با یافته های آزمایش ادرار در کودکان دچار هماچوری در اثر ضربه غیرنافذ شکمی

Introduction: The present study compares the diagnostic accuracy of urinalysis with computed tomography (CT) scan in pediatrics with blunt abdominal trauma. The aim of this study was comparing the diagnostic value of urinalysis and abdominal CT scan with contrast, as the gold standard, for predicting probable abdominal organ injury in these patients. Methods: The present diagnostic accuracy study was done on children with blunt abdominal trauma aged less than 16 years who were presented to emergency department and both urinalysis and abdominal CT scan had been done for them. Demographic data, trauma mechanism, and results of urinalysis, ultrasonography and abdominal CT scan regarding abdominal organs were recorded. To evaluate the diagnostic power of urinalysis, statistical indices such as sensitivity, specificity, positive and negative predictive value were used. Results: In this study, 70 children under 16 years old who visited ED were evaluated. Mean age of the studied population was 7.1 ± 4.86 years and 48 of the patients (68.6%) were male. The correlation between hematuria and positive CT scan findings was confirmed. Sensitivity, specificity and positive and negative predictive values of hematuria were calculated to be 26.67%, 92.73%, 50% and 82.26%, respectively. Conclusion: Based on the results of the present study, although presence of hematuria has acceptable specificity, its sensitivity is very low compared to CT scan for prediction of abdominal organ injuries in pediatrics with blunt abdominal trauma. In other words, absence of hematuria is not a good reference to dismiss abdominal organ injury, yet its presence can be an indicator of serious injury. مقدمه: مطالعه حاضر به بررسی دقت تشخیصی نتیجه آزمایش ادرار در مورد کودکان دچار آسیب غیرنافذ شکم، در مقایسه با سی تی اسکن می پردازد. هدف از این مطالعه بررسی مقایسه ای میان ارزش تشخیصی آزمایش ادرار و سی تی اسکن شکم با کنتراست به عنوان روش استاندارد طلایی تشخیص در پیشگویی آسیب احتمالی احشای شکمی در این بیماران است. روش کار: مطالعه حاضر از نوع ارزیابی دقت تشخیصی بر روی کودکان دچار ترومای بلانت شکم کوچکتر از 16 سال که به بخش اورژانس مراجعه کرده بودند و برای آنها آزمایش ادرار و سی تی اسکن شکم درخواست شده بود، انجام گرفت. اطلاعات دموگرافیک، مکانیسم تروما، نتایج آزمایش ادرار، سونوگرافی و سی تی اسکن شکم در خصوص آسیب احشای شکمی ثبت گردید. برای سنجش قدرت تشخیصی بیماران توسط آزمایش ادرار از شاخصهای آماری حساسیت، ویژگی، ارزش اخباری مثبت و منفی استفاده شد. يافته ها: در این مطالعه تعداد70 کودک بین 0 تا 16 سال مراجعه کننده به بخش اورژانس وارد مطالعه شدند. 48 نفر (6/68 درصد) از بیماران پسر بودند. میانگین سنی ایشان 6/4±1/7 سال بود. در این مطالعه ارتباط بین وجود خون در ادرار و یافته های مثبت سی تی اسکن تایید شد. میزان حساسیت،ویژگی،ارزش اخباری مثبت و منفی به ترتیب 67/26 % و 73/92 % و 50 % و 26/82 % بدست آمد. نتيجه گيری: طبق نتایج مطالعه حاضر وجود هماچوری با وجود ویژگی قابل قبول، از حساسیت بسیار پایینی در مقایسه با سی تی اسکن در پیشگویی آسیب احشای شکمی در کودکان دچار ترومای بلانت شکم دارد. به بیانی دیگر عدم وجود هماچوری معیار مناسبی برای رد آسیب احشای شکمی نیست ولی وجود آن می تواند مطرح کننده آسیب جدی باشد

Effective factors on the recurrence of Bipolar mood disorder i in an Iranian population sample using the frailty model with bayesian approach

Objective: Bipolar I disorder is one of the most frequent mental disorders characterized by manic or mixed +/- depressive episodes. Drug treatment has been proved to diminish next episodes, but many other factors are important for exacerbating the conditions. This study aimed to investigate the effective factors on the time and number of episodes in these patients by applying the shared frailty model. Method: In this retrospective longitudinal study, the information of 606 patients with bipolar I disorder, admitted for the first time in Ibn-e-Sina psychiatric hospital in Mashhad from the beginning of 2007 until the end of 2009 were used. These patients were followed up until the end of 2018 for readmission. The Cox model with gamma frailty and Bayesian approach were used to determine the effective factors of frequent recurrences. Results: History of head trauma, substance abuse, and legal conflict had a positive impact on recurrences, while age had a negative effect on recurrences and the risk of recurrence was higher in younger people (P < 0.05). The variance estimation of frailty effect was 0.97 that indicates a correlation between the recurrence intervals of bipolar I patients, owing to a heterogeneity among patients. Conclusion: Based on the results, a higher risk of recurrence of bipolar I disorder was found in younger patients and those with a history of head trauma, substance abuse, and legal conflicts. Further investigations are required to account for the genetic factor and psychosocial exposure during critical periods applying this model

Psychological Distress Among Iranian Patients With Epilepsy During COVID-19 Pandemic

Background: During Coronavirus disease-2019 (COVID-19) pandemic, patients with epilepsy (PWE) have faced with delayed outpatient visits, cancellation of their para-clinic tests, and problems in accessing to emergencies. Regarding to the previous studies, PWE are at increased risk of psychological disorders than healthy persons. Objectives: This study aimed to compare psychological distress between PWE and a healthy control group. Materials & Methods: This study was performed in the sixth wave of COVID-19 in Mashhad, Iran. We evaluated 132 PWE who consecutively referred to the Neurology Clinics of 22 Bahman Hospital. Also, 132 age and sex matched-healthy persons were included as the control group. Demographic and epilepsy related-data were collected through a questionnaire. The 6-item Kessler questionnaire was used to assess psychological distress. Results: The included PWE and the control groups were similar among all demographic variables, unless monthly income. We found that PWE had significantly higher psychological distress level (P=0.03) and spent significantly more time following the COVID-19-related news (P=0.000). By using ANCOVA test we found that PWE have significant higher levels of concerns about COVID-19 (P=0.03) and spend more time following COVID-19-related news (P=0.04). Logistic regression revealed that PWE 1.124 times more concern about COVID-19 outbreak and 0.294 time pay less attention to COVID-19 related news. Conclusion: During public health emergencies, health care professionals should focus not only on seizure control but also on the mental health status of PWE, particularly those with higher number of seizures

The Value of Urinalysis in Detection of Abdominal Organ Injuries in Children with Hematuria Following Blunt Abdominal Trauma; A Diagnostic Study

Background Currently, almost all patients with probable abdominal injury undergo urinalysis in emergency department (ED). The present survey was conducted with the aim of assessing the diagnostic values of urinalysis compare with abdominal computed tomography (CT) scan with contrast for predicting possible intra-abdominal injuries in children affected by blunt trauma. Materials and Methods: The present diagnostic accuracy study was accomplished on patients' < 16-year-old with blunt abdominal trauma who were admitted to emergency department (ED) and underwent both urinalysis and abdominal CT scan. Demographic and baseline characteristics data, and the results of urinalysis and abdominal CT scan were recorded. Thereafter, screening performance characteristics were calculated. Results Seventy eligible patients with the mean age of 7.1 ± 4.86 years were enrolled (68.6% male). Screening performance characteristics including sensitivity, specificity and positive and negative predictive values of hematuria were 26.7%, 92.7%, 50.0% and 82.3%, respectively. Positive and negative likelihood ratios were calculated as 3.67 and 0.79, respectively. Conclusion It is likely that, presence of hematuria has acceptable specificity, but very low sensitivity in comparison with CT scan for prediction of abdominal organ injuries in children with blunt abdominal trauma. Therefore, urinalysis is not useful for screening the presence of organ injuries in this population

Anti-inflammatory and tissue repair effect of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblasts and macrophages

Abstract Background Recurrent aphthous stomatitis has a complex and inflammatory origin. Among the great variety of medications it is increasingly common to use herbal medicines due to the adverse side effects of chemical medications. Considering the anti-inflammatory properties of cinnamaldehyde and the lack of studies related to the effectiveness of its nano form; This study investigates the effect of cinnamaldehyde and nano cinnamaldehyde on the healing rate of recurrent aphthous stomatitis lesions. Methods In a laboratory experiment, cinnamaldehyde was converted into niosomal nanoparticles. The niosome vesicles diameter and polydispersity index were measured at 25°C using a dynamic light scattering (DLS) Mastersizer 2000 (Malvern Panalytical technologies: UK) and Zetasizer Nano ZS system (Malvern Instruments Worcestershire: UK). After characterizing these particles, the (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) [XTT] assay was used to assess the toxicity of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblast (HGF) and macrophage (THP-1) cells. By determining the release of TNF-α, IL-6, and TGF-β cytokines using ELISA kits, the level of tissue repair and anti-inflammatory capabilities of these two substances were evaluated. Results The size and loading rate of the cinnamaldehyde nanoparticles were established after its creation. The optimized nanovesicle exhibited the following characteristics: particle size of 228.75 ± 2.38 nm, PDI of 0.244 ± 0.01, the zeta potential of -10.87 ± 1.09 mV and the drug encapsulation percentage of 66.72 ± 3.93%. PDIs range was between 0.242–0.274. The zeta potential values at 25°C were from -2.67 to -12.9 mV. The results of the XTT test demonstrated that nano cinnamaldehyde exhibited dose-dependent toxicity effects. Moreover, nano cinnamaldehyde released more TGF-β and had better reparative effects when taken at lower concentrations than cinnamaldehyde. Conclusion Nano cinnamaldehyde and cinnamaldehyde are effective in repairing tissue when used in non-toxic amounts. After confirmation in animal models, it is envisaged that these substances can be utilized to treat recurrent aphthous stomatitis