Risk factors for neonatal mortality among very low birth weight neonates

The objective of this study is to determine risk factors causing increase in very low birth way (VLBW) neonatal mortality. The medical files of all neonates weighing ≤1500 g, born in Vali-e-Asr hospital (2001-2004) were studied. Two groups of neonates (living and dead) were compared up to the time of hospital discharge or death. A total of 317 neonates were enrolled. A meaningful relationship existed between occurrence of death and low gestational age (P=0.02), low birth weight, lower than 1000 g (P=0.001), Apgar score <6 at 5th minutes (P=0.001), resuscitation at birth (P=0.001), respiratory distress syndrome (P=0.001) need for mechanical ventilation (P=0.001), neurological complications (P=0.001) and intraventricular hemorrhage (P=0.001). Regression analysis indicated that each 250 g weight increase up to 1250 g had protective effect, and reduced mortality rate. The causes of death of those neonates weighting over 1250 g should be sought in factors other than weight. Survival rate was calculated to be 80.4% for neonates weighing more than 1000 g. The most important high risk factors affecting mortality of neonates are: low birth weight, need for resuscitation at birth, need for ventilator use and intraventricular hemorrhage.

Methadone maintenance therapy outcomes in Iran

INTRODUCTION

Because of the increasing number of injecting drug users (IDUs) in Iran and the risk of the spread of HIV infection, harm reduction programs have been considered for conventional law enforcement measures. The aim of this study was to evaluate the efficacy of methadone maintenance therapy (MMT) in IDUs and the associated health and social outcomes.

MATERIAL AND METHODS

This case-control study was conducted at the Persepolis Harm Reduction Center in Tehran during the year 2006. Data were gathered from two groups of randomly chosen patients. The first group consisted of 75 IDU patients who had undergone at least 6 months of methadone treatment (the MMT group), and second group consisted of 75 newly admitted clients (the control group). Participants were assessed on their dangerous injection and sexual behaviors, social well-being, and patterns of drug use. The results were compared between the two groups.

RESULTS

The mean age of participants in the two groups was almost the same (34.28 years in the control group and 35.68 years in the MMT group, p >.05). Prevalence of drug injection in the MMT group was less than that in the control group (16% vs. 100%). There was also a dramatic difference in needle and syringe sharing (40% in the control group vs. 4% in the MMT group) but not in crimes and arrests (p = .4). Those in the MMT group had a better relationship with their families, partners, coworkers, and neighbors compared with controls. There was no considerable difference in dangerous sexual behaviors between the two groups.

CONCLUSIONS

Given the large number of HIV-positive cases among IDUs and considering that injection drug use is the main spreading factor for HIV, MMT would play a major role in controlling the HIV epidemic through reduction of heroin injection and the risk behaviors related to it. High inflation rate, lack of interorganization coordination, budget limitation, and no follow-up were the most important limitations of this study.

Economic burden attributable to functional bowel disorders in Iran: a cross-sectional population-based study

OBJECTIVE

While few population-based studies on the economic burden of functional bowel disorders (FBD) have been published from developing countries like Iran, this study aimed to estimate their direct and indirect costs for five groups of patients: irritable bowel syndrome (IBS), functional constipation (FC), unspecified-FBD (U-FBD), functional abdominal bloating (FAB) and functional diarrhea (FD).

METHODS

Up to 18,180 adults randomly sampled from Tehran, Iran (2006-2007) were interviewed using two questionnaires based on the Rome III criteria to detect FBD patients and to estimate their medical expenses (such as visiting the doctor, drugs, hospitalization and laboratory tests) and productivity loss in the previous 6 months. All costs were converted to dollar purchasing power parity (PPP$) to facilitate cross-country comparisons.

RESULTS

The mean total 6-month costs were approximately: 160, 147, 103, 96 and 42 PPP$ for IBS, FC, U-FBD, FAB and FD, respectively. The highest proportion of drug consumption was found in IBS patients. The highest mean duration of absence from work was seen in IBS patients (2.26 days). Overall, doctor visit costs accounted for approximately 1/3 of the total costs for FBD, followed by hospitalization. A higher indirect cost of illness was found in IBS (54 PPP$), whereas it was zero in FD.

CONCLUSION

The economic burden of FBD seems to be moderately high in Iran and it imposes a relatively heavy financial burden on the Iranian national health system because of its high prevalence and its impact on quality of life, productivity and waste of resources.

Direct and indirect medical costs of functional constipation: a population-based study

BACKGROUND

Constipation causes a large number of medical visits each year and imposes significant financial toll on healthcare systems worldwide. So the present community-based study was conducted in order to estimate attributable direct and indirect costs to functional constipation (FC) and to provide an overview of related physician visits in general population of Iran.

METHODS

From May 2006 to December 2007, a total of 19,200 adult persons (aged 16 and above) were drawn randomly in Tehran province, Iran (response rate 94%). Participants who reported any gastrointestinal symptoms (2,790 persons) were referred to assigned physicians to be questioned about symptoms of functional bowel disorders according to the Rome III criteria. Direct and indirect costs to FC were calculated. Attributable costs were reported as purchasing power parity dollars (PPP$).

RESULTS

Of the total 18,180 consenting participants in this study, 435 (2.4%) had FC according to Rome III criteria. Mean total cost of constipation per person was 146.84 PPP$, of which 128.68 PPP$ was related to direct costs and 18.16 PPP$ to indirect costs. Higher educated persons (189.75 PPP$), those above 64 years of age (373.42 PPP$), subjects with BMI of less than 18.5 kg/m(2) (510.84 PPP$), and widowed persons (258.50 PPP$) had the highest costs.

CONCLUSIONS

This study determined that although the economic burden of FC does not seem to be substantial in comparison to other major health problems, it still exacts a substantial toll on the health system for two reasons: chronicity and ambiguity of symptoms.

Mucins in neoplastic spectrum of colorectal polyps: can they provide predictions?

Background

The significance of expression of different mucins in succession of malignant transformation of colorectal polyps is not determined yet. The aim of the present study was to determine the pattern of expression of MUC1, MUC2, MUC5AC and MUC6 in colorectal polyps and to evaluate the applicability of using mucin expression in predicting the extent of malignant transformation in colorectal polyps.

Methods

A total of 454 polyp specimens comprising 36 hyperplastic polyps, 15 serrated adenomas, 258 tubular adenomas, 114 tubulovillous adenomas, and 31 villous adenomas were included in this study, and were immunostained for MUC1, MUC2, MUC5AC and MUC6 by using mucin specific antibodies.

Results

MUC1 and MUC6 were absent in all hyperplastic polyps and their expression was higher in serrated and traditional adenomas. Only 5 cases including 2 serrated adenomas, 1 tubulovillous adenoma, and 2 villous adenomas stained negative for MUC2. The highest expression of MUC5AC was observed in serrated adenomas followed by tubular adenomas. Binary logistic regression analysis indicated that positive staining for MUC1, and MUC6, and negative staining for MUC2 would increase the risk of invasion to mucosa or the muscularis mucosae in colorectal polyps. Ordinal regression analysis demonstrated a positive association between the level of staining for MUC1 and risk of being of high configuration/grade in colorectal polyps.

Conclusions

MUC1, MUC2, MUC5AC, and MUC6 have the potential to be used as predictors of malignant transformation and invasion to mucosa or the muscularis mucosae in colorectal polyps. The most reliable predictions can be achieved by determining the level of expression of MUC1.

Colorectal cancer in Iran: immunohistochemical profiles of four mismatch repair proteins

PURPOSE

The aim of the present study was to determine the profile of mismatch repair (MMR) defects in Iranian colorectal cancer patients by using immunohistochemical staining for products of four MMR genes: MLH1, MSH2, PMS2, and MSH6.

METHODS

Tissue samples of 343 patients were immunostained for MLH1, MSH2, PMS2, and MSH6. Clinical and family history and survival data were compared between normal and abnormal staining patterns.

RESULTS

Fourteen percent of the patients had abnormal nuclear staining for MMR proteins. MLH1 was absent in four, MLH1/PMS2 in 15, PMS2 in five, MSH2 in 12, and MSH2/MSH6 in 12 patients. These tumors were more proximal, had a nonsignificant better survival, and were more associated with positive family history. Estimation of this study of prevalence of hereditary nonpolyposis colorectal cancer in Iran was 5.5% of the total colorectal cancers.

CONCLUSIONS

Along with the recommendations of the National Institute of Cancer, we recommend immunohistochemistry staining for MLH1, MSH2, PMS2, and MSH6 for determining the eligibility of patients for mutation analysis of MMR genes.

Obesity and functional constipation; a community-based study in Iran

BACKGROUND

Many factors have been linked to the occurrence of constipation, but few studies exist regarding the link between obesity and constipation. The aim of this study was to assess the association between body mass index (BMI) and functional constipation in the Iranian community.

METHODS

From May 2006 to December 2007, a cross sectional study was conducted in the Tehran province and a total of 18,180 adult persons were drawn up randomly. One questionnaire was filled in two stages through interviews. In the first part, personal characteristics and 11 gastrointestinal symptoms were listed. Those who reported at least one of these 11 symptoms were referred for the second interview. The second part of the questionnaire consisted of questions about different gastrointestinal disorders based on the Rome III criteria including functional constipation.

RESULTS

459 adult persons were found to have functional constipation. The mean +/- SD of BMI was 26.5 +/- 4.7 and 60% of the patients had a BMI more than 25. Age and education were significantly associated factors with obesity, showing that older patients and less educated patients were more overweight and obese. Smoking, marital status and sex were not significantly associated with obesity but, up to 60% of low educated women who had functional constipation, had a BMI more than 25.

CONCLUSIONS

Our study showed that about 60% of patients with functional constipation were overweight, which was more than the mean of our community. In addition there may be an association between higher BMI level and the low education level with constipation in Iranian women.

Burden of hospitalization for gastrointestinal tract cancer patients - Results from a cross-sectional study in Tehran

BACKGROUND

Cancer is the third most common cause of death in Iran. The gastrointestinal cancers are the most frequent neoplasms among Iranian males and second to breast cancer among females. The objective of this study was to provide accurate up-to-date epidemiological information of hospitalized patients with GI tract cancer in Iran.

METHODS

This study was designed as a retrospective cross-sectional survey included all consecutive GI cancer patients admitted over a one year period in a randomly selected hospital group located in metropolitan Tehran in 2006. Residence, age, sex, type of cancer and length of hospitalization were analyzed.

RESULTS

A total of 2,674 GI tract cancer patients were included in the study, There were 1,616 men (60.4%) and 1,058 women (39.6%). The majority of cancers were in the colorectum (40.0%), followed by the stomach (34.5%) and the esophagus (17.1%). The mean hospitalized durations were 7.5-/+6.5 days for men and 7.2-/+8.1 days for women. Male patients were significantly older than the women.

CONCLUSION

By considering the hospitalized GI tract cancers and majority cases of colorectal cancer, prevention programs like as CRC screening should be going on in order to reducing morbidity and incidence rates in a high-risk population for GI tract cancers.