Archives of Iranian Medicine
Volume:25 Issue: 4, Apr 2022

Mental disorders are the most common health problems that affect different population groups. According to the national survey in 2015 based on General Health Questionnaire-28 (GHQ-28), 23.44% of Iranians older than 15 years were suspected of having a mental disorder. The study aimed to determine the mental health status of the population over 15 years of age in the Islamic Republic of Iran, one year after the outbreak of COVID-19 in 2020.

The population-based study was performed on 24584 individuals over 15 years of age in Iran between December and February, 2020. The GHQ-28 was completed through telephone interviews. Data were analyzed using descriptive statistics, chi-square test, independent t-test, and multiple logistic regression at 95% confidence level.

The results showed that the mean age of participants was 44.18±16.47 years. The prevalence of mental disorders was 29.7%. Mental disorder was associated with female gender (OR=1.195, 95% CI 1.10–1.29), 25–44 years (OR=1.206, 95% CI 1.06–1.36), urban life (OR=1.116, 95% CI 1.04–1.19), illiteracy (OR=1.286, 95% CI 1.11–1.48), being divorced (OR=1.924, 95% CI 1.50– 2.45), and unemployment (OR=1.657, 95% CI 1.40–1.94). Among the participants and their families, 14.7% and 32.3% were infected with the disease, respectively. The COVID-19 mortality rate in their families was 13.2%. The prevalence of mental disorders in infected people (40% vs. 27.3%) and bereaved families (39.6% vs. 35.3%) was more than the non-infected groups.

Our results showed that in Iran, the mental health of the general population had a rising trend compared to 2015, especially in people infected with COVID-19 and bereaved families. The observed difference may be due to the prevalence of the COVID-19 epidemic and rapid demographic, social, and economic changes in Iran. Planning to improve mental health in the mentioned population should be considered for the post COVID-19 era.

Retinopathy of prematurity (RoP) is a cause of newborn blindness. Several predisposing factors have been reported to contribute to the disease process. The current study aimed to compare serum vitamin D levels in infants with and without RoP.

This case-control study was conducted on 154 very low birth weight (VLBW) infants admitted to Ghaem hospital, Mashhad, Iran, during 2016–2019. Retinal examination for RoP was done at the 32nd week of pregnancy and vitamin D level was determined using the infants’ first-day serum samples. A researcher-made questionnaire including maternal, infant, laboratory, and retinal examination information was used as the data collection tool.

Out of 154 infants in the study, 56 (36.4%) were normal while 98 (63.6%) had RoP. Based on the severity of retinopathy, 43 infants (43.9%) were at stage I, 48 (49%) at stage II, and 7 (7.1%) at stage III. Significant differences in neonatal (P<0.001) and maternal (P=0.015) vitamin D levels, first and fifth minute Apgar scores (P=0.034 and P=0.001, respectively), and weight (P=0.014) were found between the infants with and without RoP.

The incidence of RoP was higher in infants with lower gestational age, lower birth weight, low first and fifth minutes Apgar scores, and male sex. Low serum levels of vitamin D in premature infants and their mothers were associated with incidence of RoP. The higher the stage of RoP, the greater was the severity of vitamin D deficiency. Thus, controlling the maternal vitamin D level during pregnancy, consumption of vitamin D supplements, and investigation of serum vitamin D levels in premature infants are recommended. Early correction of vitamin D deficiency may lead to reduction of RoP.

Universities of medical sciences (UMSs) in Iran have geographic catchment areas (normally a province) in which they are responsible for public health services as well as provision of care by public providers. The present study strived to analyze and rank the performance of the medical sciences universities in improving the public health and primary healthcare.

Data on 41 indicators on the output (16 indicators), outcome (16 indicators), and impact (9 indicators) levels were extracted from various data sources. Principal component analysis (PCA) was used to calculate the weight for each of the indicators. The score range for each level of performance is between 0 and 1. A score of 1 indicates the highest and a score of 0 indicates the lowest level of performance. Finally, the UMSs were ranked by their scores.

The national mean performance scores of the UMSs on the output, outcome, impact, and the composite indicator levels were 0.756, 0.641, 0.561, and 0.563, respectively. The results show that the changes in performance scores at different levels of the results chain are remarkable.

The national mean performance of the UMSs of Iran is not satisfactory. However, there is considerable dispersion in their performance. Designing effective interventions in proportion to the conditions of universities on different levels of the results chain, developing a robust information system, conducting continuous monitoring and evaluation of public health are recommended for balanced improvements in public health and primary healthcare indicators in the country.

Detecting the main actors and important topics of Iranian cancer research is essential for Iranian policymakers, clinicians, and researchers. This study was conducted to demonstrate the trends and tops in Iranian cancer research from 1960 to 2018.

A total of 22,370 Iranian cancer articles in Web of Science (WoS), PubMed, and Scopus, from 1960 through 2018, were extracted and preprocessed based on data mining techniques and analyzed using the collaboration network analysis, keywords analysis, and bibliometrics methods.

The results reveal that, Tehran University of Medical Sciences (11.46%) among organizations, Asian Pacific Journal of Cancer Prevention (5%) among journals, Malekzadeh R (1.09%) among authors, and Breast cancer (10.37%) among topics ranked the first. The trend of Iranian cancer research represents three periods: 1) germinating period, from 1970 to 2000, 2) developing period, from 2002 to 2014, and 3) flourishing period, from 2014 to 2018. It is expected that this trend will continue. The results indicate an average 12.8% increase in the logarithm of the count of articles published by Iranian cancer researchers each year. The findings are contextualized with Price’s publications trends principal for determining global and Iranian cancer research publication trends.

The number of research papers published by Iranian researchers on cancer is increasing. In order to maintain the publication growth in this field, greater participation by other Iranian institutions is suggested. Although the quantity and quality of papers are increasing in some topics, certain topics and types of cancers should be still further studied and the Iranian policymakers should be encouraged to invest more in these topics.

Renal involvement in patients with anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) often presents as acute kidney injury (AKI), which is closely related to the prognosis of critically ill patients. Nevertheless, there are few researches on the subgroup of AVV patients with AKI. The study aimed to explore clinical features and prognosis in AAV patients with AKI.

A retrospective analysis of AAV patients was conducted. The enrolled patients were grouped according to whether AKI on admission occurred or not. Demographic, clinical data and follow-up records were gathered from medical histories. Survival rates of AAV patients with AKI and risk factors of all AAV patients were studied.

(1) In the AKI group, the levels of hemoglobin, evaluated glomerular filtration rate (eGFR), serum albumin and complement 3 were significantly lower (P<0.05); the proportions of microscopic polyangiitis (MPA) and levels of serum creatinine (SCr) on admission, red blood cell (RBC) counts in urine, 24-hour urine protein excretion (UPE) and Birmingham Vasculitis Activity Score (BVAS) were significantly higher (P<0.05). There was a significantly lower incidence of otorhinolaryngologic involvement in the AKI group (P<0.05). (2) There were significantly lower survival rates and renal survival rates in the AKI group (P<0.05). (3) Higher creatinine and AKI were risk factors for poor prognosis in AAV patients.

AAV patients with AKI have more severe kidney damage, higher disease activity and worse prognosis. More attention should be paid to AAV patients with AKI for both remission induction and infection prevention.

This study aims to explore the healthcare utilization (HCU) and expenditures from complementary health insurance among Iranian people who survived sulfur mustard (SM) exposure during the Iran-Iraq war.

This study was conducted between March 21, 2018 and March 21, 2019 using secondary data. Data on the HCU and expenditure of war survivors after their exposure to SM were obtained from the Iran Veterans and Martyr Affair Foundation (VMAF) database and the national complementary insurance organization that covers their medical expenses. Multiple linear and zero-inflated poison regression (ZIP) models were used to estimate the costs and HCU. Analyses were performed in R software version 3.6.3.

Among 58880 survivors who were included in study, 36383 (61.7%) used at least one service during a year. The total frequency of HCU was 15.6 services per person per year. The annual mean medical cost of each survivor was US$807.6 (±2901.2). The highest number of utilizations was related to medicine and physician visits. The highest median cost was related to rehabilitation (US$151.7), medical equipment (US$84.5), medicine (US$83.3) and inpatient services (US$ 48.8). With increasing age, disability, weight, severity of injury in lung or eye injuries, the rate of health service utilization rose significantly.

Over 30 years after the Iran-Iraq war, Iranian people who were exposed to SM and survived still suffer from injuries and pose a significant drain on healthcare resources.

Breast cancer represents the most frequent cancer and cause of death in women worldwide and in Tunisia. Cyclin D1 is a gene of cell cycle regulation. It represents a potential oncogene in invasive breast cancer; however; the results are conflicting. We performed a retrospective study aiming to analyze the prognostic impact of cyclin D1 expression in patients with invasive breast carcinoma of no special type and its relation with clinical-pathological features.

One hundred cases of invasive breast carcinoma of no special type diagnosed between 2009 and 2011 were included in this study. Immunohistochemical (IHC) staining was performed for cyclin D1 in all cases. Results were analyzed statistically.

Cyclin D1 positivity was seen in 74 cases (74%), of which 32 cases (32%) showed strong immunoreactivity. Cyclin D1 staining was statistically significantly associated with estrogen receptor (ER) and progesterone receptor (PR) positivity (P<0.0001) and with low grade SBR (P=0.007). None of the clinical data and other pathological features had any association with cyclin D1 expression (P>0.05). Univariate analysis revealed that expression of cyclin D1 was not statistically associated with overall survival (OS) and disease-free survival (DFS) (P=0.459 and P=0.564, respectively).

These results confirm that cyclin D1 overexpression can be employed as a beneficial prognostic marker and suggest that anti-cyclin D1 therapy may be efficient, especially for ER positive tumors.

Helicobacter pylori is a gram-negative, spiral-shaped, and microaerophilic bacterium that inhabits the human gastric mucosa and is considered to be the most important etiologic agent for gastrointestinal disorders. Recently, however, there is ample evidence to suggest an association between H. pylori infection and extragastric complications, particularly atherosclerosis. The aim of this study was to evaluate the rate of H. pylori infection and the risk of atherosclerosis in an Iranian population.

We conducted a comprehensive electronic search on PubMed, Scopus, Google scholar, IranMedex, SID, ISC, and Magiran to find the main published documents related to the relationship between H. pylori and atherosclerosis in Iran. A summary odds ratio with 95% confidence interval was used to investigate the potential association between H. pylori and atherosclerosis. In addition, the heterogeneity between studies was assessed by the I 2 index and the Cochrane Q-test. Publication bias was determined using a funnel plot.

A total of 12 studies met our inclusion criteria and were included in the present study. The results showed that there is a significant positive relationship between infection with this bacterium and the two-fold risk of developing atherosclerosis in the Iranian population (OR: 1.44; 95% CI: 1.07–1.95). However, the heterogeneity was significant and we observed a slight publication bias.

We confirmed a positive relationship between H. pylori infection and atherosclerosis in the Iranian population, which is similar to other reports from Western countries. Most likely, H. pylori infection can increase the risk of developing atherosclerosis.

Statistical methods (SM) are a ubiquitous tool in research. This study aimed to review SM used in original article published in the Archives of Iranian Medicine (AIM) and assess their effect on article acceptance period.

The original articles published in the period 2015–2019 from volumes 18 to 22 and issues 1 to 12 of the AIM were reviewed and six items such as SM, study design, statistical population, sample size, software and acceptance period were extracted. Mean (SD), frequency (percentage) and multiple response analysis (MRA) were used for description. The Kruskal-Wallis test and Spearman correlation coefficient were used for data analysis in SPSS 26 with significance level at 5%.

During the study period, 423 original articles were reviewed. The statistical population in most of them was patients (38.8% and 164 articles), and most studies (51.5% and 218 articles) had a sample size of less than 500 people. The study design in most of the articles was analytical-observational (55.1% and 233 articles), and 79.7% (337 articles) used SPSS for data analysis. The median (IQR) acceptance period was 194 (134.25). MRA results showed that the highest rate of use of SM was related to descriptive statistics (277 articles, 30.3%) and Chi square test (130 articles, 14.2%). In the last two years, the acceptance period had a declining trend. There was no significant relation between mentioned variables and acceptance period (P>0.05).

Contrary to the researchers’ misconceptions, the acceptance period was not affected by SM, study design, statistical population, sample size, or type of software.

The differential diagnosis of acute abdominal pain is a challenging task for medical doctors working in the department of gastroenterology. It is clear that acute abdominal pain may be associated with a number of pathologic conditions. We report an unusual case of an unnoticed swallowed wooden toothpick stuck in the ileocecal area of a young man with right lower abdominal pain who was misdiagnosed as acute appendicitis. However, an abdominal computed tomography scan showed an elongated foreign body stuck in the ileocecal area. The elongated foreign body was identified as a wooden toothpick, which was then grasped with a foreign body forceps and successfully removed through colonoscopy. The patient’s abdominal pain was significantly relieved within 2 days following treatment. On the basis of the case report, we suggest the importance of abdominal computed tomography scans for the differential diagnosis of acute abdominal pain and highlight the need for extra vigilance in excluding the diagnosis of foreign bodies in the gastrointestinal tract of patients with acute abdominal pain.