فهرست مطالب

Archives of Iranian Medicine
Volume:17 Issue: 12, Dec 2014

  • تاریخ انتشار: 1393/10/03
  • تعداد عناوین: 13
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  • Shohreh Naderimagham, Sadaf Alipour, Shirin Djalalinia, Amir Kasaeian, Atefeh Noori, Shadi Rahimzadeh, Mitra Modirian, Ardeshir Khosravi, Kourosh Etemad, Hamid Reza Jamshidi, Fashad Farzadfar Page 794
    Background
    Estimating the burden of diseases، injuries and major risk factors is necessary for adopting appropriate health policies in every country، and this paper aims to explain the study protocol of national and sub-national burden of breast cancer in Iran from 1990 to 2013.
    Methods
    We will perform a systematic review of the confirmed databases and literature to gather data on breast cancer epidemiology in Iran. The definitions، data sources، organizing the team، methods of data gathering and data generating will be explained in this paper. The methodology of estimating the trend of prevalence، years of life lost due to premature death (YLLs)، years of life lost due to disability (YLDs) and disability-adjusted life years lost (DALYs) of breast cancer by age groups، provinces and probable inequalities will be explained. We will tackle possible data problems due to the lack of data points on provinces and years and also geographical misalignment by using two advanced statistical methods، namely Bayesian autoregressive multilevel and Spatio-temporal models. Trend estimation will be reported using these two models together with uncertainty intervals.
    Conclusion
    This study provides a comprehensive assessment of breast cancer and its specific pattern in Iran. The results will help policy makers to know the trend of prevalence، the distribution، and the inequalities of breast cancer in Iran to allocate resources in a better way.
    Keywords: Burden of diseases, Breast cancer, Bayesian autoregressive multilevel model, Spatio, temporal model, Iran
  • Tahereh Hassannia, Farshad Farzadfar, Atefeh Noori, Mazyar Moradi, Lakeh, Farnaz Delavari, Hamid Reza Jamshidi, Shirin Djalalinia, *Shohreh Naderimagham Page 800
    Background
    End Stage Renal Diseases (ESRD) imposes a huge economic burden on the health system; however, there is a serious lack of data related to ESRD, especially at Sub-national level, in Iran. Calculating the burden of ESRD at National and Sub-national level provides an opportunity to apply cost-effective interventions for the purpose of prevention and treatment. The current study protocol aims to explain the general structure and methods that will be used in the burden of ESRD study in Iran from 1990 to 2013.
    Methods
    The prevalence, incidence, mortality and geographical and socioeconomic inequality trend of ESRD will be calculated through a comprehensive systematic review of published and unpublished data. Years of Life Lost due to premature mortality, and Years Lived with Disability and Disability-Adjusted Life Years (DALYs) will be quantified for ESRD by gender, age group, and province with their uncertainly intervals. “Spatio-Temporal” and “Bayesian multilevel autoregressive” will be applied to deal with data scarcity and misalignment problem which exist in the data sources.
    Discussion
    The findings of the burden of ESRD study will be useful to organize preventive, treatment also research priorities at national and sub-national levels in Iran. Better understanding of the magnitude of ESRD burden is essential to prevent the progression of chronic kidney diseases to the end stage phase which is considered as a devastating illness.
    Keywords: Burden, chronic kidney disease, end stage renal disease, Iran, study profile
  • Mehdi Varmaghani, Arash Rashidian, Abbas Kebriaeezadeh, Maziar Moradi, Lakeh, Mostafa Moin, Anoosheh Ghasemian, Ehsan Rezaei, Darzi, Sadaf Ghajarieh Sepanlou, Niloofar Peykari, Nazila Rezaei, Mahboubeh Parsaeian, *Farshad Farzadfar Page 804
    Background
    Asthma is a chronic inflammatory airway disease caused or worsened by environmental factors in genetically vulnerable people. The study of national and sub-national burden of asthma aims to provide a quantitative method and valid estimates for the prevalence, incidence, and economic burden of asthma disease in Iran from 1990 to 2013 and this papers explains measures, data sources, methods, and challenges that we will use in the study.
    Methods
    In order to conduct this study, we will use all available unpublished data sources, including claim databases and data collected by the food and drug organization (FDO). Moreover, we will devise and run a systematic review of all studies and literature published about asthma epidemiology in Iran, which includes all cross-sectional, cohort and case-control studies with asthma epidemiology focus that are population based. In this study, we will use two statistical models, including spatio-temporal and multilevel autoregressive models to estimate mean and uncertainty intervals for the parameters under study by gender, age, year, and province. All programs will be written in R statistical packages (version 3.0.1).
    Conclusion
    This study helps to obtain information concerning the variation among regions and provinces, and in general among sub-national divisions. Our study can be contribute to better allocation of resources, since it helps policymakers to recognize inequalities between regions and provinces and consequently help them to allocate resources more efficiently.
    Keywords: Burden of disease, prevalence, asthma, Iran
  • Elham Ashrafi, *Seyed, Farzad Mohammadi, Akbar Fotouhi, Alireza Lashay, Mohsen Asadi, Lari, Alireza Mahdavi, Mahmoud Jabbarvand, Sahar Sobhani, *Farshad Farzadfar Page 810
    Background
    Although Visual impairment (VI) and its prevention is a public health issue, sub-optimal information about its magnitude in national level and its distribution is one of the impediments for visual health advocacy. In this article, we are detailing the approaches which will be taken to estimate the magnitude (prevalence, incidence, and burden), distribution, and trend (1990 to 2013) of low vision and blindness in Iran. Besides that, an attempt will be made to describe inequalities and their determinants.
    Methods
    After finalizing the list of diseases, a systematic search will be started using confirmed search terms and all published and unpublished data will be extracted. Other data sources, including data from hospital records, schoolchildren amblyopia and refractive error screening data, registries such as Iran Eye Bank keratoplasty will be added to the data extraction sheet. Using distinct statistical models including spatio-temporal model and multilevel autoregressive model, we will estimate rate of burden measures of eye disease and their uncertainty interval by sex, age, year, and province as well as social determinants of visual impairment inequality.
    Conclusion
    The results of the current study will address gaps in different regions and have implication for evidence-based policy making in Iran.
    Keywords: Blindness, burden, DALY, eye diseases, visual impairment, social determinants of health
  • Farshad Sharifi, Baharak Najafi, Hossein Fakhrzadeh, Maryam Noroozian, Shohreh Naderimagham, Ian Philp, Seyed Masood Arzaghi, Mahtab Alizadeh, Shervan Shoaee, Tahereh Hassannia, Ali Sheidaei, Maziar Moradi, Lakeh, *Farshad Farzadfar, Bagher Larijani Page 816
    Background
    Dementia is a disabling syndrome, which generally affects aged population more than any other age group. This syndrome has a growing prevalence and incidence worldwide. The prevalence and burden of this group of diseases in Iran have not been estimated in a community-based study yet. This paper aims to explain the systematic approach, data sources, research methodology, and statistical analysis that will be used to quantify the prevalence and burden of dementia at national and sub-national levels.
    Methods
    This is the protocol of a secondary data study that explains the design and method of conducting the study. We will use several sources of data that will include a systematic review of articles and gray literature which have reported the prevalence or incidence of dementia and its uncertainty at national and sub-national levels in Iran, in addition to data about dementia-specific drug sales per each year at provincial levels, as well as data extracted from 23 million health insurance prescriptions over 8 years and some data from medical documents of Iranian Alzheimer’s Association members. The technical groups of National and Sub-national Burden of Disease will collect some covariate data, such as age and sex structure of population, urbanization status, mean years of schooling, plasma cholesterol, fasting plasma glucose, and systolic and diastolic blood pressure at provincial levels which will be used in our models. Two statistical models, namely spatio-temporal and hierarchical autoregressive models, will be used for interpolation and extrapolation of missing data.
    Conclusion
    It seems that the study of national and sub-national burden of dementia could provide more accurate estimation of prevalence and burden of dementia in Iran with an acceptable level of uncertainty than the previous studies.
    Keywords: Dementia, Burden of disease, Prevalence, Iran
  • Mansour Shamsipour, Farshad Farzadfar, Kimiya Gohari, Mahboubeh Parsaeian, Hassan Amini, Katayoun Rabiei, Mohammad Sadegh Hassanvand, Iman Navidi, Akbar Fotouhi, Kazem Naddafi, Nizal Sarrafzadegan, Anita Mansouri, Alireza Mesdaghinia, Bagher Larijani, *Masud Yunesian Page 821
    Background
    Management and cleaning of large environmental monitored data sets is a specific challenge. In this article, the authors present a novel framework for exploring and cleaning large datasets. As a case study, we applied the method on air quality data of Tehran, Iran from 1996 to 2013.
    Methods
    The framework consists of data acquisition [here, data of particulate matter with aerodynamic diameter ≤10 µm (PM10)], development of databases, initial descriptive analyses, removing inconsistent data with plausibility range, and detection of missing pattern. Additionally, we developed a novel tool entitled spatiotemporal screening tool (SST), which considers both spatial and temporal nature of data in process of outlier detection. We also evaluated the effect of dust storm in outlier detection phase.
    Results
    The raw mean concentration of PM10 before implementation of algorithms was 88.96 µg/m3 for 1996–2013 in Tehran. After implementing the algorithms, in total, 5.7% of data points were recognized as unacceptable outliers, from which 69% data points were detected by SST and 1% data points were detected via dust storm algorithm. In addition, 29% of unacceptable outlier values were not in the PR. The mean concentration of PM10 after implementation of algorithms was 88.41 µg/m3. However, the standard deviation was significantly decreased from 90.86 µg/m3 to 61.64 µg/m3 after implementation of the algorithms. There was no distinguishable significant pattern according to hour, day, month, and year in missing data.
    Conclusion
    We developed a novel framework for cleaning of large environmental monitored data, which can identify hidden patterns. We also presented a complete picture of PM10 from 1996 to 2013 in Tehran. Finally, we propose implementation of our framework on large spatiotemporal databases, especially in developing countries.
    Keywords: Air pollution, air quality data management, EBD, NASBOD, Iran, outlier detection, Tehran
  • Shirin Djalalinia, Roya Kelishadi, Mostafa Qorbani, Niloofar Peykari, Amir Kasaeian, Sahar Saeedi Moghaddam, Kimiya Gohari, Bagher Larijani, *Farshad Farzadfar Page 830
    Background
    The importance of data quality whether in collection, analysis or presenting stage is a tangible and undeniable scientific fact and the main objects of researches implementation.
    Objective
    This paper aims at explaining the main problems of the Iranian scientific papers for providing better data in the field of national and sub-national prevalence, incidence estimates and trends of obesity and overweight.
    Methods
    To assess and evaluate papers, we systematically followed an approved standard protocol. Retrieval of studies was performed through Thomson Reuters Web of Science, PubMed, and Scopus, as well as Iranian databases including Irandoc, Scientific Information Database (SID), and IranMedex. Using GBD (Global Burden of Diseases) validated quality assessment forms to assess the quality and availability of data in papers, we considered the following four main domains: a) Quality of studies, b) Quality report of the results, c) Responsiveness of corresponding authors, and d) Diversity in study settings.
    Results
    We retrieved 3,253 records; of these 1,875 were from international and 1378 from national databases. After refining steps, 129 (3.97%) papers remained related to our study domain. More than 51% of relevant papers were excluded because of poor quality of studies. The number of reported total population and points of data were 22,972 and 29 for boys, and 38,985 and 47 for girls, respectively. For all measures, missing values and diversities in studies’ setting limited our ability to compare and analyze the results. Moreover, we had some serious problems in contacting the corresponding authors for complementary information necessary (Receptiveness: 17.9%).
    Conclusion
    As the present paper focused on the main problems of Iranian scientific papers and proposed suggestions, the results will have implications for better policy making.
    Keywords: data presentation, data quality, obesity, overweight, pediatric
  • Ehsan Rezaei, Darzi, *Farshad Farzadfar, Amir Hashemi, Meshkini, Iman Navidi, Mahmoud Mahmoudi, Mehdi Varmaghani, Parinaz Mehdipour, Mahsa Soudi Alamdari, Batool Tayefi, Shohreh Naderimagham, Fatemeh Soleymani, Alireza Mesdaghinia, Alireza Delavari, *Kazem Mohammad Page 837
    Background
    This study aimed to evaluate and compare the prediction accuracy of two data mining techniques, including decision tree and neural network models in labeling diagnosis to gastrointestinal prescriptions in Iran.
    Methods
    This study was conducted in three phases: data preparation, training phase, and testing phase. A sample from a database consisting of 23 million pharmacy insurance claim records, from 2004 to 2011 was used, in which a total of 330 prescriptions were assessed and used to train and test the models simultaneously. In the training phase, the selected prescriptions were assessed by both a physician and a pharmacist separately and assigned a diagnosis. To test the performance of each model, a k-fold stratified cross validation was conducted in addition to measuring their sensitivity and specificity.
    Result
    Generally, two methods had very similar accuracies. Considering the weighted average of true positive rate (sensitivity) and true negative rate (specificity), the decision tree had slightly higher accuracy in its ability for correct classification (83.3% and 96% versus 80.3% and 95.1%, respectively). However, when the weighted average of ROC area (AUC between each class and all other classes) was measured, the ANN displayed higher accuracies in predicting the diagnosis (93.8% compared with 90.6%).
    Conclusion
    According to the result of this study, artificial neural network and decision tree model represent similar accuracy in labeling diagnosis to GI prescription.
    Keywords: Artificial neural networks, decision tree, insurance prescriptions
  • Mohammad Ali Amirzargar, Ali Akbar Ilati, Amir Drakhshanfar, *Jalal Poorolajal, Adel Eslami Page 844
    In this report، we explain a case of true aneurysm of the internal iliac artery in a previously transplanted kidney، which was reconstructed successfully by interposing saphenous vein graft، using double balloon shunt to prevent renal ischemia as a new approach. The case was a 26 year old female with a 4 × 4 cm aneurysm at the anastomotic site of the transplanted renal artery detected by ultrasonographic evaluation and confirmed by magnetic resonance imaging technique. This rare complication was managed successfully through an open surgical arterial reconstruction using reversed saphenous vein graft. According to our findings، double balloon shunt seems feasible and safe in open surgical repair of transplanted renal artery and internal iliac artery aneurysms and can prevent renal ischemia during reconstruction.
    Keywords: Aneurysm, internal iliac artery, renal ischemia transplanted renal artery, transplanted kidney
  • Binny Khandakar*, Soumit Dey, Prabir Chandra Paul, Sriparna Medda, Aparna Bhattacharya, Saikat Datta Page 847
    Ancient schwannoma is a rare variant of benign peripheral nerve sheath tumor, often morphologically mimicking malignancy. Retroperitoneum is an uncommon location. We describe one case of giant retroperitoneal ancient schwannoma. Literature concerning this variant is also reviewed. A 65 year old male presented with altered bowel habits. Imaging findings revealed a large heterogeneous mass in the retroperitoneum. The patient was treated with complete excision. Grossly, the tumor was predominantly solid with focal cystic degeneration. Histological examination showed an encapsulated spindle cell tumor with nuclear palisading, very focal nuclear atypia and widespread foam cell infiltration - findings consistent with ancient schwannoma. A diagnosis of ancient schwannoma can be considered for a solid-cystic encapsulated mass in the retroperitoneum. Malignant transformation is very rare. Local recurrence is uncommon following complete excision. The authors have nothing to disclose.
    Keywords: Ancient, giant, schwannoma, S100
  • Sheng, Huei Wang, Chun, Jung Juan, *Te, Yu Lin Page 850
    Septic arthritis of the shoulder is very rarely caused by Aeromonas hydrophila. We present the case of a 45-year-old woman who presented with symptoms of painful shoulder for 2 weeks and dropped head for 1 week prior to admission. A. hydrophila was isolated from a culture of purulent synovial fluid. Magnetic resonance imaging revealed profuse abscess collection between the right infraspinatus muscle and trapezius muscle and swelling of the right and left paraspinatus muscles, which suggested myositis-related dropped head syndrome. After surgery with arthrotomy, function of the shoulder and neck extensors was significantly improved.
    Keywords: Aeromonas hydrophila, arthritis, septic
  • Ahmadreza Afshar*, Behrouz Ilkhanizadeh Page 853
  • Golnaz Rezaeizadeh, *Fatemeh Nayeri, Mamak Shariat Page 855