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فهرست مطالب نویسنده:

reza malekzadeh

  • Saiedeh Sadeghi, Nastaran Saeidi, Ali Salehi, Kamal Attari, Mohammadali Irani, Seyed Sasan Aryanezhad, Reza Malekzadeh*, Reza Mahmoudi Anzabi
    Purpose

    The utilization of Ionizing Radiation (IR) in diagnostic dental techniques poses inherent risks, especially when patients are exposed to it repeatedly. Therefore, it is crucial to continuously evaluate and improve the measures taken to protect individuals from the potentially harmful effects of ionizing radiation in dental radiology. This study desires to assess the advancements made in recent years regarding ionizing radiation protection measures in the field of dental radiology.

    Materials and Methods

    A thorough review was conducted using prominent databases such as PubMed, Science Direct, and Dentistry and Oral Sciences Source (via EBSCOhost). The primary conclusions and relevant units of measurement are also included. According to the predefined inclusion and exclusion criteria, a total of 26 articles were systematically reviewed for this study.

    Results

    Recent data reveals the urgent need to update radiation protection guidelines to accommodate newer technologies like Cone Beam Computed Tomography (CBCT) and digital imaging. Digital intraoral X-ray technology has shown promising results in significantly reducing radiation exposure. To ensure standardized practices, Diagnostic Reference Levels (DRLs) have been defined for CBCT and must be established for different clinical indications. Moreover, advancements in nanotechnology provide potential opportunities for the production of radiation shielding supplies that are lighter and customizable. These innovative materials can prove invaluable for everyday use, offering enhanced protection during extended periods of physical activity. The review findings suggest that samples with nanostructures are more efficient at reducing X-ray energy. The research findings indicate that the implementation of a nanocomposite shield leads to a notable reduction in radiation dose, with a range of 15 to 35%. Given the increasing frequency of dental CBCT imaging and the unmatched dose levels compared to conventional dental radiography, it is imperative to set DRLs in this domain.

    Conclusion

    This literature review focuses on the most common types of radiation protection in dental radiology, aiming to demonstrate improved techniques for individual protection.

    Keywords: Dental Radiography, Radiation Safety, X-Ray Shielding, Cone Beam Computed Tomography, Diagnosticreference Levels
  • Abbas Ali Nazeri, Reza Malekzadeh, Parinaz Mehnati, Soheila Refahi
    Purpose

    Nowadays, the use of polymer composites with several metals to design and build new radiation composite shields with practical features in radiology is expanding.

    Materials and Methods

    Three metal oxides, including Bismuth oxide (Bi2O3), Tungsten oxide (WO3), and Tin oxide (SnO2) were used as mono-metal and bimetallic compound silicon matrixes for clarification of their practical use. Monte Carlo simulation methods were used to enter the specifications of each metal in combination with silicon. The mass attenuation coefficients of the mono- and bimetallic composites were calculated in the energy ranges of 40 to 150 KeV by classification to low/ medium/high groups.

    Results

    The results showed the beam reduction ability for both the mono- and the bimetallic composites. The mass attenuation coefficients of Bi2O3, WO3, and SnO2 at 80 KeV were 0.38, 0.33, and 0.57 cm2/gr, respectively. Moreover, the Bismuth-Tin bimetallic combination at low energies and the Bismuth-Tungsten at high energies had better attenuation than the other samples. To select bimetallic compounds with a high attenuation coefficient, it is better to match the energy used in the imaging method specifically. For example, in the 70-90 KeV energy range, the Sn-W combination had the highest beam attenuation coefficient.

    Conclusion

    The advantage of mono- and bimetallic shields in terms of energy attenuation amount depends on beam energy and shielding metal “K-absorption” edge. In comparing the attenuation of recorded beams in low, medium, and high ranges of energy, mono-metallic Bismuth shows higher attenuation coefficients than mono-metallic Tungsten and bi-metallic Bismuth–Tungsten. Dose reduction of the bi-metallic state of Bismuth - Tin was greater than that of mono-metallic Bismuth and Tin in low energies. Also, the attenuation of the Bi-Sn composite shield in low energy was the highest amount among all silicon composite shields.

    Keywords: Bismuth, Tin, Tungsten, Nanocomposites, Computed Tomography Shields, Patient Radiation
  • Amin Nakhostin-Ansari, Iman Menbari Oskouie, Reyhaneh Aghajani, Mohammadmehdi Khadembashiri, Mohammad Ahmadi, Abdollah Gandomkar, Fatemeh Malekzadeh, Hossein Poustchi, Mohammadreza Fattahi, Amir Anushiravani, Reza Malekzadeh*
    Background

     Studies on the prevalence of nonalcoholic steatohepatitis (NASH) and the factors associated with its high prevalence among Iranian people are limited. This study evaluated the prevalence of NASH and its associated factors among Iranian adults using Pars Cohort Study (PCS) data.

    Methods

     This cross-sectional study was conducted based on PCS, which includes 40-75-year-old adults from the Valashahr area. NASH was defined as alanine aminotransferase (ALT) higher than 40 U/L without evidence of hepatitis B or C infections. The prevalence of NASH and its associations with basic and demographic characteristics, socioeconomic characteristics, medical history, gastrointestinal symptoms, and laboratory tests were evaluated.

    Results

     Overall, 8734 patients, including 3917 men (44.8%), were enrolled in this study. The mean age of participants was 52.62 years (SD=9.68), and 605 individuals had NASH (6.9%). In the regression analysis, in contrast to female gender (OR=0.31, 95% CI=0.249‒0.386, P<0.001) and age (OR=0.951, 95% CI=0.941‒0.962, P<0.001), history of heart disease (OR=1.499, 95% CI=1.146‒1.962, P=0.003), history of diabetes (OR=1.523, 95% CI=1.162‒1.995, P=0.002), hypertension (OR=1.241, 95% CI=1.023‒1.506, P=0.029), being overweight or obese (OR=2.192, 95% CI=1.755‒2.737, P<0.001), being in the richest or second richest wealth index quantiles (OR=1.315, 95% CI=1.107‒1.156, P=0.002), and increased waist circumference (OR=1.409, 95% CI=1.107‒1.793, P<0.005) were independently associated with a higher risk of having NASH.

    Conclusion

     In this study, we determined the prevalence of NASH and found male gender, younger age, history of heart disease, history of diabetes, hypertension, socioeconomic status, and obesity as possible factors associated with a higher risk of NASH among Iranians.

    Keywords: Epidemiology, Iran, Nonalcoholic Steatohepatitis, Prevalence
  • Elham Jafari, Hossein Poustchi, Abbas Mohagheghi, Maryam Sharafkhah, Masoud Khoshnia, Alireza Nateghi, Shahin Merat, Reza Malekzadeh*
    Background

     While cardiovascular disease (CVD) polypills have demonstrated significant benefits in preventing CVD events by managing CVD risk factors and improving patient adherence, their effects on blood glucose levels, an important risk factor for CVD, remain unknown.

    Methods

     We analyzed data from the PolyIran-Liver trial, which involved 1,508 participants aged 50 and above. Of these, 787 were randomly assigned to receive a polypill (consisting of aspirin, atorvastatin, hydrochlorothiazide, and valsartan), while 721 received usual care as the control group over a five-year period. The aim was to determine whether there were any significant differences in fasting blood sugar (FBS) levels between the two groups at baseline, middle, and end of the study. The data analysis focused on three subgroups: participants with diabetes, those with metabolic syndrome (MetS) but without diabetes, and participants without diabetes or MetS.

    Results

     Of the total studied population, with a mean age of 59±6.7 years, 328(22%) were identified with diabetes, 371 (25%) with MetS but without diabetes, and 809 (54%) without diabetes or MetS. We observed a trend of rising FBS levels until month 30, followed by a subsequent decline at month 60. Participants in the polypill group exhibited lower FBS levels than the control group at both time points, with statistically significant differences in all three subgroups at month 30 and in the MetS-without diabetes at month 60 (mean difference: -9.3 mg/dl, 95% CI: 13.9 to -4.6).

    Conclusion

     The polypill used in this study may have the potential to delay the onset of diabetes in patients with MetS more effectively than in the general population. However, its beneficial effects on the blood sugar levels of diabetic individuals require further investigation.

    Keywords: Cardiovascular Disease, Diabetes Mellites, Fixed Dose Combination, Metabolic Syndrome, Polypill, Primary Prevention
  • Seyed Reza Abdipour Mehrian, Zahra Ghahramani, Mohammad Reza Akbari, Elham Hashemi, Ehsan Shojaeefard, Reza Malekzadeh, Bita Mesgarpour, Abdullah Gandomkar, Mohammad Reza Panjehshahin, Jafar Hasanzadeh, Fatemeh Malekzadeh, Hossein Molavi Vardanjani*
    Background

     Drug data has been used to estimate the prevalence of chronic diseases. Disease registries and annual surveys are lacking, especially in less-developed regions. At the same time, insurance drug data and self-reports of medications are easily accessible and inexpensive. We aim to investigate the similarity of prevalence estimation between self-report data of some chronic diseases and drug data in a less developed setting in southwestern Iran.

    Methods

     Baseline data from the Pars Cohort Study (PCS) was re-analyzed. The use of disease-related drugs were compared against self-report of each disease (hypertension [HTN], diabetes mellitus [DM], heart disease, stroke, chronic obstructive pulmonary disease [COPD], sleep disorder, anxiety, depression, gastroesophageal reflux disease [GERD], irritable bowel syndrome [IBS], and functional constipation [FC]). We used sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the Jaccard similarity index.

    Results

     The top five similarities were observed in DM (54%), HTN (53%), heart disease (32%), COPD (30%), and GERD (15%). The similarity between drug use and self-report was found to be low in IBS (2%), stroke (5%), depression (9%), sleep disorders (10%), and anxiety disorders (11%).

    Conclusion

     Self-reports of diseases and the drug data show a different picture of most diseases’ prevalence in our setting. It seems that drug data alone cannot estimate the prevalence of diseases in settings similar to ours. We recommend using drug data in combination with self-report data for epidemiological investigation in the less-developed setting.

    Keywords: Data Source, Drug Data, Prevalence, Self-Report, Validity
  • Zahra Momayez Sanat, Homayoon Vahedi, Reza Malekzadeh, Amir Kasaeian, Negar Mohammadi Ganjaroudi, Alireza Sima, Fariborz Mansour Ghanaei, Mohammadreza Ghadir, Hafez Tirgar Fakheri, Siavosh Nasseri Moghaddam, Sudabeh Alatab*, Anahita Sadeghi, Amir Anushiravani, Iradj Maleki, Abbas Yazdanbod, Hassan Vossoughinia, Mohammadreza Seyyedmajidi, Sayed Jalaleddin Naghshbandi, Nadieh Baniasadi, Baran Parhizkar
    Background

     Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) marked by rectal and colon inflammation, leading to relapsing symptoms. Its prevalence is increasing, particularly in developed nations, impacting patients’ health. While its exact cause remains unclear, genetic and environmental factors are implicated, elevating the risk of colorectal cancer (CRC). Colectomy, though declining, is still performed in select UC cases, necessitating further study.

    Methods

     We analyzed data from the Iranian Registry of Crohn’s and Colitis (IRCC) to examine UC patients undergoing colectomy. We collected demographic and clinical data from 91 patients, focusing on dysplasia. Statistical analyses assessed dysplasia risk factors.

    Results

     Patients with dysplasia were older at diagnosis and surgery compared to those without dysplasia. Age emerged as a significant risk factor for dysplasia in UC patients undergoing colectomy. No significant associations were found between dysplasia and other factors.

    Conclusion

     Age plays a crucial role in dysplasia risk among UC patients undergoing colectomy. Older age at diagnosis and surgery may indicate a higher risk of dysplasia and CRC. Clinicians should consider age when managing UC patients and implementing screening protocols. Further research with larger samples is needed to confirm these findings.

    Keywords: Colectomy, Dysplasia, Ulcerative Colitis
  • Elham Jafari, Shahin Merat, Amir Anoushiravani, Amir Reza Radmard, Gholamreza Roshandel, Maryam Sharafkhah, Masoud Khoshnia, Alireza Nateghi, Abolfazl Shiravi Khuzani, Hossein Poustchi *, Reza Malekzadeh
    Background

    Metabolic dysfunction-associated fatty liver disease (MAFLD) is a rising global public health concern. It has been demonstrated that its prevalence and characteristics vary by region and racial/ethnicity. We aimed to investigate the prevalence of MAFLD and its characteristics among Turkmen and non-Turkmen ethnic groups in a multiethnic population region of Iran.

    Methods

    In this cross-sectional study, we analyzed baseline data for 1614 participants, aged above 50 years, from the PolyIran-Liver trial who were randomly selected from Gonabad city and determined the prevalence of MAFLD and its demographic and metabolic disorders for both the Turkmen and non-Turkmen ethnic groups. Multivariate binary logistic regressions were applied to identify MAFLD-associated factors for men and women separately for the Turkmen and non-Turkmen populations.

    Results

    The mean (SD) age of the participants was 59.1(6.7) years. Of the participants, 51.5% (n = 831) were men, and 52.9% (n = 854) were Turkmen. The prevalence of MAFLD among the overall study population was 39.8% (n = 614). It was more common among women (45.8% vs. 34.1% in men, P < 0.001), non-Turkmens (43.9% vs. 36.1% in Turkmens, P < 0.001), and at age 50-64 (41.5% vs.36.1% in age ≥ 65 P = 0.004). The fully adjusted multivariate analysis in sex strata exhibited an independent negative association between Turkmen ethnicity only among men but not among women. The increased waist circumference (WC) was the most common metabolic disorder, observed in more than 95.5% of patients with MAFLD (P < 0.001). Multivariate analysis in sex/ethnic strata with adjustment for potential confounders revealed an independent association of MAFLD with increased WC, insulin resistance, impaired fasting glucose/diabetes type 2, and high alanine aminotransferase (ALT) among women in both ethnic groups while with elevated triglyceride (TG) only among Turkmen and high body mass index (BMI) only among non-Turkmen women. Increased WC had the strongest independent association with MAFLD among women and the highest odds ratio (OR) with MAFLD in Turkmen women (OR: 6.10; 95% CI 1.56-23.86 vs. 4.80 in non-Turkmen women). Among men, MAFLD was independently associated with insulin resistance, high BMI, and high ALT in both ethnic groups and elevated TG only in non-Turkmen men (all P < 0.001). Insulin resistance had the strongest independent OR with MAFLD among men with similar size in both ethnic groups (4.68 [95% CI 2.56-8.55]) in non-Turkmen men and 4.37 (95% CI 2.27-8.42 in Turkmen men).

    Conclusion

    This study revealed the high prevalence of MAFLD with a sex and ethnic disparity in the middle-aged population of Gonabad city. Further research is needed to understand the factors contributing to the higher prevalence of MAFLD in this region, particularly in women. Furthermore, considering the diverse ethnic population of Iran, it is suggested that future investigations on the sex and ethnic aspects of MAFLD in the Iranian population be conducted to provide targeted prevention strategies better suited for the Iranian population.

    Keywords: MAFLD, NAFLD, Ethnicity, Genetic, Insulin Resistance, Iran
  • Maryam Abolhasani, Ata Ollah Mohseni, Ramin Shakeri, Ali Khavanin, Mehrdad Khajehei, Abbasali Omidi, Bita Geramizadeh, Ensieh Shafigh, Farshad Naghshvar, Payam Fathizadeh, Leyla Taghizadehgan, Atoosa Gharib, Margaret L. Gulley, Sanford M. Dawsey, Reza Malekzadeh, Charles S. Rabkin *, Mohammad Vasei
    Background

     Gastric cancer is the fourth leading cause of cancer-related deaths in the world. The identification of gastric cancer subtypes related to recognizable microbial agents may play a pivotal role in the targeted prevention and treatment of this cancer. The current study is conducted to define the frequency of Epstein-Barr virus (EBV) infection in gastric cancers of four major provinces, with different incidence rates of gastric cancers, in Iran.

    Methods

     Paraffin blocks of 682 cases of various types of gastric cancer from Tehran, South and North areas of Iran were collected. Twelve tissue microarray (TMA) blocks were constructed from these blocks. Localization of EBV in tumors was assessed by in situ hybridization (ISH) for EBV-encoded RNA (EBER). Chi-squared test was used to evaluate the statistical significance between EBV-associated gastric cancer (EBVaGC) and clinicopathologic tumor characteristics.

    Results

     Fourteen out of 682 cases (2.1%) of gastric adenocarcinoma were EBER-positive. EBER was positive in 8 out of 22 (36.4%) of medullary carcinomas and 6 out of 660 (0.9%) of non-medullary type, which was a statistically significant difference (P<0.001). The EBVaGCs were more frequent in younger age (P=0.009) and also showed a trend toward the lower stage of the tumor (P=0.075).

    Conclusion

     EBV-associated gastric adenocarcinoma has a low prevalence in Iran. This finding can be due to epidemiologic differences in risk factors and exposures, and the low number of gastric medullary carcinomas in the population. It may also be related to gastric tumor heterogeneity not detected with the TMA technique.

    Keywords: Gastric Cancer, Epstein-Barr Virus, Iran, Tissue Microarray
  • Mohammad Sadra Gholami Chahkand, Fatemeh Esmaeilpour Moallem, Fatemeh Ghasemi-Kebria, Reza Malekzadeh, Gholamreza Roshandel, Mohammad Taher *
    Background

    We aim to present incidence rates and geographical distribution of most common early-onset gastrointestinal cancers (EOGICs), including early-onset esophageal cancer (EOEC), gastric cancer (EOGC) and colorectal cancer (EOCRC) in Iran, 2014- 2018.

    Methods

    Data on new cases of EOEC, EOGC and EOCRC were obtained from publicly available annual reports of the Iranian National Population-based Cancer Registry (INPCR). Incidence rates were calculated using the population data available from the Statistical center of Iran. We considered the World standard population for calculation of age-standardized incidence rates (ASR). We also calculated 95% confidence intervals (CIs) for ASR. All rates are presented per 100 000 person-years.

    Results

    Overall, 19,679 new cases of EOGIC were registered by the INPCR between 2014 and 2018. The ASRs (95% CI) of EOEC, EOGC and EOCRC were 0.49 (95% CI: 0.47–0.51), 1.67 (1.63–1.71), and 3.07 (3.01–3.13) per 100,000 person-years, respectively. Our findings indicate decreasing and constant trends in the ASR of EOEC and EOGC during the study period, 2014-2018. There was an increasing trend in the ASR of EOCRC. We also found geographical disparities in the incidence rates of EOGICs across provinces of Iran, suggesting the highest ASRs of EOEC in Golestan (1.3), EOGC in Ilam (2.99) and EOCRC in Ilam (4.49).

    Conclusion

    Our findings suggested that the incidence rate of EOCRC is consistently increasing. We also found variations in the incidence of EOGICs among different provinces. Further investigations are recommended to clarify the time trends and risk factors of EOGICs in Iran.

    Keywords: Early-onset, Esophageal cancer, Gastric cancer, Colorectal cancer, Iran
  • Maryam Hashemian, Hossein Poustchi, Maryam Sharafkhah, Akram Pourshams, Fatemeh Mohammadi-Nasrabadi, Azita Hekmatdoost, Reza Malekzadeh*
    Background

     An association has already been hypothesized between iron, copper, and magnesium status assessed through food frequency questionnaires (FFQs) and the risk of esophageal squamous cell carcinoma (ESCC). However, self-reported dietary assessment methods are prone to measurement errors. We studied the association between iron, copper, and magnesium status and ESCC risk, using hair samples as a long exposure biomarker.

    Methods

     We designed a nested case-control study within the Golestan Cohort Study, that recruited about 50000 participants in 2004-2008, and collected biospecimens at baseline. We identified 96 incident cases of ESCC with available hair samples. They were age-matched with cancer-free controls from the cohort. We used inductively coupled plasma mass spectrometry (ICP-MS) to measure iron, copper, and magnesium concentrations in hair samples. We used multiple logistic regression models to determine odds ratios and 95% confidence intervals.

    Results

     Median concentrations of iron, copper, and magnesium were 35.4, 19.3, and 41.7 ppm in cases and 25.8, 18.3, and 50.0 ppm in controls, respectively. Iron was significantly associated with the risk of ESCC in continuous analysis (OR=1.41, 95% CI=1.03-1.92), but not in the tertiles analyses (ORT3 vs. T1=1.81, 95% CI=0.77-4.28). No associations were observed between copper and magnesium and ESCC risk, in either the tertiles models or the continuous estimate (copper: ORT3 vs. T1=2.56, 95% CI=1.00-6.54; magnesium: ORT3 vs. T1=0.75, 95% CI=0.32-1.78).

    Conclusion

     Higher iron status may be related to a higher risk of ESCC in this population.

    Keywords: Cancer, Copper, Esophageal squamous cell carcinoma, Iron, Magnesium, Minerals
  • علی علی عسگری، آناهیتا صادقی *، مجید سروری، ناصر ابراهیمی دریانی، رضا ملک زاده
    Ali Ali Asgari, Anahita Sadeghi*, Majid Soruri, Naser Ebrahimi Daryani, Reza Malekzadeh

    Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP.

    Keywords: Iatrogenic colonic perforation, Colonoscopy, Peritonitis, Surgery
  • Reza Malekzadeh, Ali Tarighatnia, Parinaz Mehnati, Nader Nader
    Purpose

    This study aimed to design an improved form of a composite shield with different materials and shapes and simultaneously reduce the radiation dose to both the patient and operator.

    Materials and Methods

    A female phantom study was performed with and without bismuth belt-shaped composite shields on the breast region at different beam projections used in coronary angiography. Dose measurements were conducted using GR-200 thermo-luminescence dosimeters, dose area product (DAP), and air kerma (AK) over regular and large breast locations, with and without using bismuth shields. An electronic personal dosimeter was used for operator dose assessment. Patients received doses between 2.27 mSv and 3.38 mSv, depending on the size and strength of beam projections.

    Results

    The use of the developed shields caused a dose reduction of 18%–25% of sensitive breast tissue due to breast size and shield type. During coronary angiography, the mean values of DAP and AK were 2.02 (1.24-2.80) mGy.m2 and 314.1 (202.8-500) mGy, respectively. The highest recorded dose was at the LAO/CRA and LAO/CAU beam projections for both the patient and operator. After applying a belt shield, the operator's radiation dose was decreased by approximately 32%. We found a statistically significant correlation between the radiation dose received by the operator and the patient's breast radiation exposure dose (p<0.001, r2=0.93).

    Conclusion

    The designed belt shield can be a potentially promising protective device for decreasing the radiation risk to the patient's breast and the operator during coronary angiography. However, further studies will be considered before the application of this shield in standard clinical practice.

    Keywords: Bismuth Composite Shield, Breast Shield, Coronary Angiography, Radiation Protection, OperatorDose
  • Reza Malekzadeh, Masoud Seidi, Nikan Asadpour, Hadi Sabri
    Purpose

    The correlation of different samples can be described by analytical models such as random matrix theory. In this study, we tried to describe the correlation of different types of ultraviolet values in different months, weeks, and hours to get a significant relationship of special times, which one needs to get enough intensity of the sun or avoid getting sunburn.

    Materials and Methods

    To this aim, we focused on the hourly and daily mean amounts of ultraviolet A, B, and C intensities of solar radiation in Tabriz urban area were measured during a full year of 2017-2018. We used such ultraviolet values which are measured at the same hour of the day to satisfy the same symmetry criteria which are necessary in random matrix theory. These data are unfolded and classified in different sequences to analyze in the nearest neighbor spacing distribution framework via the maximum likelihood estimation technique.

    Results

    Strong correlation is yielded for daily values of UVA in comparison with the other types of ultraviolet radiations. Also, we considered the dependence of correlation degrees of these three types of ultraviolet to average temperature and humidity at different months.

    Conclusion

    The results propose more correlation of UVA indices in August while such correlation of UVC radiations are yielded in December.

    Keywords: Random Matrix Theory, Modeling, Environmental Radiation, Ultra Violet
  • Majid Namaki, Maryam Hashemian, Abbas Arj, Hossein Poustchi, Gholamreza Roshandel, Amir Hossein Loghman, Sadaf G. Sepanlou, Akram Pourshams, Masoud Khoshnia, Abdolsamad Gharavi, Nafiseh Abdolahi, Sima Besharat, Azita Hekmatdoost, Paul Brennan, Sanford M. Dawsey, Farin Kamangar, Paolo Boffetta, Christian C. Abnet, Reza Malekzadeh*, Mahdi Sheikh
    Background

    Recent evidence suggests overall diet quality, as assessed by dietary scores, may play a role in the development of upper gastrointestinal (UGI) cancers. However, the existing dietary scores are derived from high-income countries with different dietary habits than regions with the highest burden of UGI cancers, where limited data is available. This study aimed to investigate the association between overall diet quality and risk of esophageal and stomach cancers in a high-risk region for UGI cancers.

    Methods

    We recruited 50 045 individuals aged 40-75 between 2004-2008 from northeastern Iran and followed them annually through July 2020. Data on demographics, diet, and various exposures were collected using validated questionnaires. Diet quality was assessed by calculating the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Alternative Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and World Cancer Research Fund–American Institute for Cancer Research (WCRF-AICR) scores.

    Results

    During an average 12 years of follow-up, 359 participants developed esophageal cancer and 358 developed stomach cancer. After adjustments, each standard deviation increase in baseline dietary scores was associated with up to 12% reduction in esophageal cancer risk and up to 17% reduction in stomach cancer risk. Esophageal cancer showed stronger inverse associations with adherence to AMED (HRQ4-vs-Q1 = 0.69 (0.49–0.98), P-trend = 0.038). Stomach cancer showed stronger inverse correlation with WCRF-AICR (HRQ4-vs-Q1 = 0.58 (0.41–0.83), P-trend = 0.004), and DASH (HRC4-vs-C1 = 0.72 (0.54–0.96), P-trend = 0.041). These associations were comparable across different population subgroups. We did not observe significant associations between HEI and AHEI scores and UGI cancers in this population.

    Conclusion

    Despite the differences in consuming individual food groups, adherence to the available dietary recommendations (derived from high-income countries) was associated with lower risk for subsequent esophageal and gastric cancers in this high-risk population. Educating the public to have a healthy eating pattern might be an effective strategy towards prevention of UGI cancers in high-risk regions.

    Keywords: Diet, Digestive, Epidemiology, Malignancies, Nutrition
  • Fateme Alipour, Hassan Hashemi, Alireza Lashay*, Fatemeh Jafari, Nazgol Motamed-Gorji, Mahmoud Jabbarvand Behrouz, Mohammad Mirzaei, Yousef Alizade, Mohammad Reza Soleymani, Mohammad Reza Shoja, Kourosh Shahraki, Gholam Reza Khataminia, Hossein Poustchi, Reza Malekzadeh
    Background

    To report the study protocol, methodology and latest enrollment data of a large epidemiological multi-central eye cohort named PERSIAN Eye Cohort Study (PECS), originating from the ongoing PERSIAN Cohort Study, to investigate the distribution of ophthalmic disorders in different regions and ethnicities of Iran, and determine their associations with various exposures of ophthalmic and non-ophthalmic nature.

    Methods

    A central committee designed the study and equipped six chosen centers (Khameneh, Some’e Sara, Hoveizeh, Yazd, Rafsanjan and Zahedan). A focal point in each center conducted the study under close supervision of the central committee.

    Results

    This ongoing study was launched in 2014. Out of 65,580 eligible participants of the PERSIAN Cohort, 48,618 individuals aged 35-70 have been enrolled in the PECS (response rate: 74.13%) until June 2021. Slit lamp and fundus photography were performed for 28,702 (59.03%) and 27,437 (56.43%) individuals, respectively.

    Conclusion

    This large epidemiological multi-central eye cohort can improve our epidemiological knowledge of the prevalent ophthalmic disorders in different regions and ethnicities of Iran, and determine their associations with various exposures of ophthalmic and non-ophthalmic nature. This will be very useful for future planned nationwide and global interventions.

    Keywords: Cohort study, Epidemiology, Iran, Ophthalmology
  • Hamideh Salimzadeh*, Catherine Sauvaget, Alireza Delavari, Anahita Sadeghi, Mohammad Amani, Sepideh Salimzadeh, Azita Karimi, Ali Ghanbari Motlagh, Eric Lucas, Partha Basu, Reza Malekzadeh
    Background

     Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults.

    Methods

     In this feasibility study, 7039 individuals aged 50–75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs).

    Results

     Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1–1.8) [males: 0.7 (0.01–3.6), females: 0.6 (0.07–2.0)] and 4.2 (2.5–6.4) [males: 5.9 (2.6–11.0), females: 3.4 (1.7–6.0)], respectively. PPVs were 2.0% (0.4–5.7) for CRC and 13.3% (8.3–19.8) for AAs. There was no association between gender and the studied outcomes.

    Conclusion

     Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.

    Keywords: Colorectal cancer, Feasibility studies, Screening
  • Amir Anushiravani, Hossein Jafari Khamirani, Ashraf Mohamadkhani, Arya Mani, Mehdi Dianatpour*, Reza Malekzadeh*
    Background

     The LIPA gene on chromosome 10q23.31 contains 10 exons and encodes lipase A, the lysosomal acid lipase (LAL) containing 399 amino acids. Pathogenic variants in the LIPA result in autosomal recessive Wolman disease and cholesteryl ester storage disease (CESD). Here, we report a novel missense variant (NM_001127605.3:c.928T>A, p.Trp310Arg) of LIPA in an Iranian family with fatty liver disease identified by whole-exome sequencing and confirmed by Sanger sequencing.

    Methods

     A 28-year-old woman referred with lean NASH cirrhosis and extremely high cholesterol levels. Fatty liver disease was found in six of her family members using vibration-controlled transient elastography (VCTE). Baseline routine laboratory tests were performed and whole-exome sequencing and confirmation by Sanger sequencing were done.

    Results

     The index case had severe dyslipidemia and cirrhosis despite a body mass index of 21.09 kg/m2 . Six other family members had dyslipidemia and fatty liver or cirrhosis. A homozygous missense variant (NM_001127605.3:c.928T>A, p.Trp310Arg) of LIPA which caused LAL-D was found to be associated with fatty liver disease and/or cirrhosis.

    Conclusion

     A homozygous missense variant (NM_001127605.3:c.928T>A, p.Trp310Arg) of the LIPA gene which caused LAL-D was found to be associated with dyslipidemia, fatty liver disease and/or cirrhosis in six members of an Iranian family. These results should be confirmed by functional studies and extending the study to at least three families.

    Keywords: Genetic association studies, LIPA protein, Liver cirrhosis, Lysosomal acid lipase deficiency, Non-alcoholic fatty liver disease, Whole exome sequencing
  • Hamed Zandian, Telma Zahirian Moghadam *, Farhad Pourfarzi, Reza Malekzadeh, Satar Rezaei, Sevda Ghorbani
    Background

    Helicobacter pylori infection is a major risk factor for gastric cancer in Iran, but the impact of socioeconomic factors on its prevalence is poorly understood. This study aimed to assess the socioeconomic inequalities and risk factors associated with H. pylori infection in Iran.

    Methods

    This cross-sectional study was conducted based on the PERSIAN cohort study. A total of 20 460 individuals aged 35 to 70 years in Ardabil, Iran were included in the study. H. pylori infection was determined based on stool tests and clinical records. Multilevel logistic regression models with random intercepts at household and community levels were used to identify risk factors associated with H. pylori prevalence. The concentration index (CIn) and concentration curve (CC) were employed to assess socioeconomic-related inequality.

    Results

    In this study, 70.4% (CI 69.6–71.0) of the participants were infected with H. pylori, with a higher prevalence in women (71.2%) than men (69.6%). Age (OR: 1.37, CI: 1.17-1.61), sex (OR: 1.20, CI: 1.12-1.28), level of education (OR: 1.33, CI: 1.17-1.49), cardiac disease (OR: 1.32, CI:1.18-1.46), and BMI groups (OR: 2.49, CI: 1.11-5.58) were significantly associated with H. pylori infection based on the multivariable logistic regression. The results of the CIn and CC indicated that H. pylori were more prevalent among economically disadvantaged groups (CIn: -0.1065; [-0.1374 to -0.0755]).

    Conclusion

    The prevalence of H. pylori in Iran is higher than in other developing countries, and significant socioeconomic inequality exists between the poor and the rich. To reduce the rate of gastric cancer, socio-economic and demographic factors, especially the poor and people with low levels of education, should be considered.

    Keywords: Disease prevalence, Helicobacter infections, Socioeconomic factors, Stomach neoplasms
  • Fatemeh Bardestani, Seyed Alireza Marandi, Reza Malekzadeh, Abolhassan Nadim, Hossein Malekafzali, Kamran Bagheri Lankarani, Mohsen Bavandi, Alireza Mesdaghinia, MohammadMehdi Gouya, Roya Sadrizadeh, Ehsan Mostafavi*

    In line with the commemoration of the scientists who played a significant role in advancing knowledge and providing services to the country, it is imperative to publish their biographies so that their lives and achievements are recorded in the history of the country and serve as an example for future generations. Dr. Bijan Sadrizadeh, a physician and a public health specialist, undertook many valuable activities, particularly in the field of public health in Iran and the world during more than 60 years of great services, including the promotion of public health in the Islamic Republic of Iran, the development of I.R. Iran’s international collaborations in the field of public health, and the development of research programs in the field of neglected tropical diseases and the eradication of polio in the world. He served the country in many high-level executive capacities, including three periods as deputy Minister of Health. In addition to several years of full-time employment in the World Health Organization (WHO), Dr. Sadrizadeh also served on the WHO Executive Board and was a member of numerous scientific and advisory committees. In reviewing his life, great determination, devotion, believing in primary health care and universal health coverage and a deep sense of responsibility are visible and can be an inspiration and a model for all.

    Keywords: History of medicine, Polio, Public health
  • Somayeh Bazdar, MohammadHossein Sharifi, Hossein Puostchi, Abdullah Gandomkar, Reza Malekzadeh, Fatemeh Malekzadeh, Hossein Molavi Vardanjani*
    Background

    Despite the evidence for validity of body image pictogram (BIP) to discriminate overweight, obese, and normal individuals, there is little evidence on the probable effect of socio-demographic variables on its validity. To investigate the effects of socioeconomic status (SES), age, ethnicity, and educational level on the validity of BIP to discriminate normal weight, overweight, and obese people.

    Methods

    We used the Pars Cohort Study (PCS) data. Stunkard’s BIP score was used as test measure. Participants were classified as normal (body mass index [BMI]<25), overweight (BMI=25 to 29.9), and obese (BMI≥29.9) based on their BMI (kg/m2 ). Area under curve (AUC) and its 95% CI were estimated and compared. Optimal cutoff points and their sensitivity, specificity, and likelihood ratio were reported.

    Results

    A total of 9232 participants with a female/male ratio of 1.03 were included. The prevalence of overweight and obesity was 37.4% and 18.2%, respectively. Regardless of socio-demographic levels, the optimal cut-points to discriminate normal BMI from overweight, and overweight from obese participants were BIP score of four and five, respectively. Estimated AUC correlated with ethnicity (P<0.001) for both genders, and with SES for females (P<0.05).

    Conclusion

    Although BIP may be a valid measure to categorize the general adult population into normal, overweight and obese, its validity depends on SES and ethnicity. BIP may be available as a proxy measure for BMI categories in socio-demographically homogeneous populations but not in heterogeneous populations.

    Keywords: Body image pictogram, Ethnicity, Obesity, Pars Cohort Study, Socio-economic status, Validity
  • Sadaf G. Sepanlou, Hossein Rezaei Aliabadi, Reza Malekzadeh*, Mohsen Naghavi*
    Background

     During the past three decades, neonate, infant, and child mortality declined in North Africa and Middle East. However, there is substantial heterogeneity in mortality rates across countries.

    Methods

     This study is part of the Global Burden of Diseases study (GBD) 2019. We report the number as well as mortality rates for neonates, infants, and children by cause across 21 countries in the region since 1990.

    Results

     Between 1990 and 2019, the neonate mortality rate in the region declined from 31.9 (29.8, 34.0) to 12.2 (11.1, 13.3) per 1000 live births. Respective figures for under 5 mortality rates (U5MRs) were 79.1 (75.7, 82.7) in 1990 and 24.4 (22.3, 26.7) per 1000 live births in 2019. The majority of deaths among children under 5 years were due to under 1 year deaths: 75.9% in 1990 and 81.8% in 2019. Mortality rates in males were higher than females. The mortality rate among neonates ranged from 2.4 (2.1, 2.6) per 1000 live births in Bahrain to 25.0 (21.6, 28.4) in Afghanistan in 2019. Similarly, in 2019, the U5MR ranged from 5.0 (4.2–6.0) per 1000 live births in United Arab Emirates to 55.3 (47.9–63.5) in Afghanistan. Neonatal disorders, congenital birth defects, and lower respiratory infections were the three main causes of neonate, infant, and child mortality in almost all countries in the region.

    Conclusion

     In 2019, most countries in this region have achieved the SDG targets for neonate and child mortality. However, there is still substantial heterogeneity across countries.

    Keywords: Child mortality, Inequality, Infant mortality, Middle East, North Africa
  • رضا ملک زاده، احسان مصطفوی، ابراهیم قادری، قباد مرادی، حمید شریفی، علیرضا بیگلری، مصطفی قانعی، فرید نجفی، محمدمهدی گویا، علی اکبر حق دوست*

    به رغم گذشت بیش از سه سال از شروع همه گیری کووید-19، هنوز این همه گیری در سطح جهان و ایران ادامه داشته و کماکان یک دغدغه بزرگ سلامت محسوب می شود. تلقی پایان همه گیری اشتباه بوده است و وضعیت فعلی به معنی برگشت به شرایط قبل از همه گیری نیست؛ بنابراین باید تدابیری در سطوح مختلف بهداشتی، درمانی و سیاست گذاری برای مدیریت درست این بحران اتخاذ شود. در این مقاله ابتدا به تحلیل مدیریت همه گیری در ایران پرداخته شده است و عملکرد کشور در حوزه هایی نظیر نظام گزارش دهی و مراقبت، آزمایش های تشخیصی، عوارض بلندمدت عفونت کووید-19، واکسن و واکسیناسیون، درمان، و پایش واریانت ها مورد بررسی و نقد قرار گرفته است و مواردی برای تصمیم گیران حوزه سلامت و کرونا پیشنهاد شده است.

    کلید واژگان: شیوع همه گیری، کووید-19، مدیریت بیماری
    Reza Malekzadeh, Ehsan Mostafavi, Ebrahim Ghaderi, Ghobad Moradi, Hamid Sharifi, Alireza Biglari, Mostafa Ghanei, Farid Najafi, MohammadMehdi Gouya, Aliakbar Haghdoost*

    Despite the fact that over three years have passed since the onset of the Covid-19 pandemic, it still remains a significant public health concern in Iran and around the world. It is important to acknowledge that the current situation does not signify an end to the epidemic, and measures must be taken across various levels of prevention, treatment, and policy to effectively manage this crisis. This paper analyzes Iran's response to the epidemic, evaluating the country's performance in areas such as surveillance and healthcare systems, diagnostic testing, long-term Covid-19 complications, vaccinations, treatment, and monitoring of variants. Recommendations are also provided for decision-makers in the field of health and Covid-19.

    Keywords: Covid-19, Disease Management, Pandemics
  • Niloofar Khoshnam-Rad, Homayoon Vahedi, Anahita Sadeghi, Mansoor Rastegarpanah, Soha Namazi, Amir Anushiravani, Ali Reza Sima, Shabnam Shahrokh, Sudabeh Alatab *, Reza Malekzadeh
    Background

    Pharmacotherapy with biologics and small molecules, as the more effective therapies for moderate to severe ulcerative colitis (UC) and Crohn’s disease (CD), is complex. Choosing the best methods for their utilization in order to induce and maintain remission are critical for practicing gastroenterologists. We aimed to develop an Iranian consensus on the management of inflammatory bowel disease (IBD) patients with biologics and small molecules.

    Methods

    A Delphi consensus was undertaken by experts who performed a literature summary and voting process. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development, and Evaluation; and an additional risk of bias-protocol.

    Results

    Following an extensive search of the literature, 219 studies were used to determine the quality of the evidence. After three rounds of voting, consensus (defined as ≥ 80% agreement) was reached for 87 statements.

    Conclusion

    We considered different aspects of pharmacotherapy in this consensus. This guideline, along with clinical judgment, can be used to optimize management of IBD patients.

    Keywords: Consensus guideline, Biologic drugs, Small therapeutic molecules, Pharmacotherapy
  • Anahita Sadeghi*, Desmond Leddin, Reza Malekzadeh

    Global warming and climate change are important worldwide issues which are a major human health threat. Climate change can affect the gastrointestinal (GI) system in many ways. Increased rainfall events and flooding may be associated with increased GI infections and hepatitis. Climate change could cause changes in gut microbiota, which may impact the pattern of GI diseases. The stress of access to essential needs such as clean water and food, the effects of forced migration, and natural disasters could increase brain-gut axis disorders. The association between air pollution and GI disorders is another challenging issue. There is a lot to do personally and professionally as gastroenterologists regarding climate change.

    Keywords: Climate change, Health, Gastroenterology
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  • رضا ملک زاده
    رضا ملک زاده
    (1401) دکتری تربیت بدنی گرایش مدیریت راهبردی در سازمانهای ورزشی، دانشگاه آزاد اسلامی واحد اسلامشهر
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