ahmad reza baghestani

Multiple myeloma (MM) is a kind of blood cancer that is caused by the malfunction of plasma cells and their uncontrolled growth, which leads to a decrease in the level of immunity and the formation of bone lesions, especially in the spine, skull, pelvis, and ribs. Common symptoms in MM patients include severe bone pain, kidney problems, anemia, and frequent infections. This study aims to employ appropriate cure models to estimate the cure fraction and prognostic factors affecting overall survival (OS) in MM patients who have undergone transplantation.

This study has analyzed the medical records of 52 patients with multiple myeloma who were admitted to Taleghani Hospital affiliated with Shahid Beheshti University of Medical Sciences in Tehran from January 2010 to August 2016 and were followed up until February 2022. Four cure models were applied to the data and it determined the cure fraction in the Inverse Gaussian model is higher than in other models, so prognostic factors affecting the survival of patients were examined using this model.

The mean age at diagnosis was 53.07 (SD =6.4). The 5-year survival rate for MM patients was 74%, and the long-term survival rate for patients in this study was 54.7%. Using the Inverse Gaussian model, the cure fraction was estimated at 54.4%

This study applies cure models to find prognostic factors based on pre-transplant CBC test on the survival time of MM patients who have been treated with auto-HSCT, so the number of platelets pre-transplantation and the patient's age are effective predictors for overall survival.

Breast cancer in men is a rare disease that has been increasing in recent decades. Identifying factors influencing the survival rate of these patients is particularly important considering the small sample size. The aim of this study was to present the results of the conventional Cox- LASSO method and compare it with the newer refined generalized log-rank (RGLR) method for analyzing survival data with a small sample size.

Available information related to men with breast cancer referred to 3 treatment centers in the country (Iran) between 2012 and 2020 were reviewed. Cox-LASSO and RGLR models were fitted on the data. The analyzes were done using R.4.1.2 software and the significance level of 0.05 was considered.

About 60% of the conflicts are reported on the left side. About 53% of men have been diagnosed at a low stage. The tumor size of 75% of the patients was between 2 and 4.3. Most patients have received modified radical mastectomy (MRM) treatment and adjuvant radiotherapy. 80% of patients had received chemotherapy and most had received anthracycline-taxane base. According to Akaike's criterion, RGLR model (AIC=289.32) was better than Cox-LASSO (AIC=314.76) model. Results of RGLR model indicated that, age (p-value= 0.038, HR >50 vs <50 = 6.75, 95% CI: 2.70–17.30), left laterality (p-value = 0.019, HR left vs right = 3.45, 95% CI: 1.48–8.02), larger tumor size (p-value=0.033, HR T2 vs T1 = 3.70, 95% CI: 2.92–6.68; HR T3 vs T1 = 4.34, 95% CI: 3.17–5.95), higher tumor grades (p-value<0.001, HR grade 2 or 3 vs grade1 = 8.67, 95% CI: 5.10–14.71), are influential factors decreasing male breast cancer patient’s survival.

Although the results of the two existing models in the field of small sample size survival analysis (Cox-LASSO and RGLR) are close to each other, the RGLR model has performed better than the Cox-LASSO. With smaller AIC and SE of parameter estimation, RGLR model was choose compared to Cox-LASSO model.

Blood cancer is a type of cancer that affects the blood cells derived from the bone marrow. Leukemia, lymphoma, and myeloma are the most common subtypes. Usually, bone marrow transplantation (BMT) is performed alongside curative treatments, such as chemotherapy and radiotherapy to transfuse healthy hematopoietic stem cells into a person after their own unhealthy bone marrow has been treated to kill invasive cells.

The aim of this study was to compare the percentage of remission (cure rate) between different types of blood cancer.

In this retrospective cohort study, 458 patients who received BMT between 2007 and 2014 were analyzed. Patients were followed up until 2017 to determine whether they were still alive or had relapsed. The defective Marshall-Olkin Extended Weibull model was used with death being the event of interest.

The study included 34 cases of acute lymphoblastic leukemia, 155 cases of multiple myeloma, 59 cases of acute myeloid leukemia, 156 cases of Hodgkins lymphoma, and 54 cases of non -Hodgkin 's lymphoma. The cure rate was highest in patients with Hodgkin 's lymphoma and multiple myeloma, while it was lowest in patients with acute lymphoblastic leukemia. in addition, age had an inverse effect on the cure rate for blood cancer (P=0.003), and relapse after BMT had a negative effect on the cure rate (P=0.003). In addition, relapse before transplantation had no effect, and body mass index was found to influence cure rate. A sensitivity analysis showed that the estimated cure rates increased slightly with decreasing cohort length.

Multiple myeloma and Hodgkin 's lymphoma had the highest cure rate, while acute lymphoblastic leukemia is barely curable. Obesity may increase the potential for cure and the experience of recurrence after BMT is associated with a lower cure rate.

According to DSM-5, sensory processing problems are among diagnostic criteria in children with autism spectrum disorder (ASD). Various studies have shown that games, as the main occupation of children, can be helpful in performing sensory interventions. Solving sensory problems isoneof themostcommondemandsof families with children withASD. Children’s families play a key role in the implementation of occupational therapeutic interventions.

This randomized clinical trial investigated the effectiveness of sensory play activities performed by parents at home on the sensory patterns of children with ASD.

Fifty-one children with ASD, aged 3 to 6 years, were divided into the intervention and control groups. All participants attended 16 sessions of in-person individualized sensory integration therapy (SIT) in a clinic for 8 weeks. In the intervention group, children received 8 sessions of a sensory play activity intervention performed by parents at home. Data collection instruments included the Gilliam Autism Rating Scale-2 and the sensory profile 2. Parametric (independent and paired t-test) and non-parametric (Mann-Whitney and Wilcoxon tests) were used for statistical analysis to compare between-group and within-group mean differences.

The resultsshowedthat althoughall four sensory processing patterns improved significantly in both groups (P< 0.05) (i.e., the within-group effect), children in the intervention group showed significant improvements in three sensory patterns, including sensory avoiding, sensory sensitivity, and sensory registration (P< 0.01). There was no significant difference in the mean score of the sensory seeking pattern between the 2 groups (P > 0.05).

Sensory integration therapy improved dysfunctional sensory processing patterns in ASD children, an effect that was enhanced by the simultaneous implementation of sensory play interventions.

Systematic reviews and meta-analyses have been placed at the summit of the evidence pyramid in the evidence-based medicine paradigm. Scientometric investigation can provide useful insight into the field's scholarly communications. Therefore, this study is an attempt to scientometric study of the highly cited systematic reviews and meta-analysis articles of cardiac and cardiovascular systems category based on Web of Science.

The study focused on those highly cited articles that were retrieved from Web of Science between July 20th and July 27th, 2019. After multiple phases of screening the retrieved articles, 150 articles formed the current research population. A number of articles in systematic review and meta-analysis, the publication trend, the status of authors' countries, authors’ affiliation, and the publication sources of the articles were examined.

Meta-analysis articles account for 52% of the research population. The largest share of the highly cited papers were for 2018. The results showed 61.3% of the studies conducted by international cooperation. The largest number of the studies have been conducted by researchers of USA, England, Netherland and Canada. The largest number of the articles published in American College of Cardiology, and European Heart Journal. The majority of the highly cited articles (79.33%) published in Q1 journals.

The publication of the highly cited articles has benefited greatly from international collaboration. Researchers from of the United States, the Netherlands, England and Canada significantly contributed to the articles' production. The highly cited papers have been published in the most prestigious journals.

A cure rate survival model was developed based on the assumption that the number of competing reasons for the event of interest has the Geometric distribution and the time allocated to the event of interest follows the Generalized Birnbaum-Saunders distribution.

The Geometric GB-S distribution was defined and two useful representations were represented for its density function which contributes to the creation of some mathematical properties. Furthermore, the parameters of the model with cure rate were estimated by using the maximum likelihood method.

Several simulations were performed and a real data set was analyzed from the medical area for different sample sizes and censoring percentages.

By considering the advantages of the GGB-S model, the model can be implemented as an appropriate alternative to explain or predict the survival time for long-term individuals.

Colorectal cancer is a major health problem both in developing and developed countries. This cancer is among the top three commonly diagnosed cancers in males and females. In this context, assessing the Incidence, Prevalence and Mortality Rate trend of this cancer is of great importance.

We used the data from the GBD 2017 study to assess the global trend of 3 important indicators of colorectal cancer burden and to examine the relationship between trends of these indicators with Human Development Index (HDI). We used the multivariate mixed effects modeling framework with time and HDI as the covariates.

Trend analysis of colorectal cancer burden indicators showed a rather steady trend for mortality rate, while it revealed increasing slopes for both the incidence and prevalence rates. In addition, our findings showed a direct relationship between prevalence and incidence rates of this cancer and HDI level and indirect association between mortality rate and level of HDI.

There were significant changes in indicators of colorectal cancer during the study period. The inverse relationship between mortality due to this cancer and socio-economic status of the countries indicated an urgent need for screening the patients and promoting the level of care in countries with lower levels of HDI.

Neisseria and ureaplasma are considered to be the most important bacteria causing genital infection and infertility. The present study was conducted with the aim of searching for these two pathogens in the cervical secretions of infertile women, emphasizing molecular methods and determining drug resistance genes related to azithromycin and ciprofloxacin.

In this descriptive study, endocervical samples obtained from cervical secretions of 135 infertile women and 135 healthy women referred to Shohada Tajrish Hospital from October 2018 to September 2019 were examined. Data were analyzed by SPSS statistical software (version 21). Chi-square test was used to investigate the relationship between infection and infertility in individuals. P<0.05 was considered statistically significant.

The prevalence of Neisseria gonorrhoea and Ureaplasma urealyticum was significant in the case group compared to the control group (P≤0.05). According to chi-square test, a significant relationship was observed between infection and infertility (P≤0.05). The prevalence of azithromycin resistance in Ureplasma urealyticum and Neisseria gonorrhoeae was 35 cases (48.6%) and 7 cases (58.3%), respectively. Ciprofloxacin resistance was reported in 3 cases (25%) of Neisseria gonorrhoeae and 64 cases (68.8%) of Ureaplasma urealyticum. The highest prevalence of resistance genes in both bacteria was related to mtrR and gyrA.

Antibiotic resistance in the studied bacteria indicates the indiscriminate use of antibiotics, the spread of antibiotic resistance gene structures, and genetic transmission among populations. In order to definitively treat and prevent the occurrence of resistance in pathogen strains, it is necessary to determine the resistance pattern to follow the resistance trend.

As a malignant proliferative disorder, multiple myeloma (MM) is classified as a cancer of the immune system. Generally, a complete blood count (CBC) is the first test for a patient with symptoms of MM. Through CBC, physicians can monitor abnormalities in the blood. To normalize malignancies in their blood, patients must first go through conventional chemotherapy. Afterward, if eligible, subjects would receive high-dose therapy and hematopoietic stem cell transplantation (HSCT). Primarily, patients would be subjected to autologous hematopoietic stem cell transplantation (auto-HSCT).

This retrospective cohort study consisted of 56 MM patients who were diagnosed between January 2010 and August 2016 and were followed up until February 2022. Thesurvival rate of MM patients was assessed based on CBC test at the time of diagnosis. The clinical conditions, i.e., Thrombocytopenia, Leukopenia, and Anemia, were extracted from the CBC test and were used as the desired prognostic factors in companion with age at diagnosis. Overall survival based on the mentioned factors was analyzed using the defective Marshall-Olkin gompertz cure model, which was programmed in R software version 4.0.3.

The mean age at diagnosis was 52.76 (SD = 7.1). The probability of long-term survival for patients in this study was 46%, with five-year overall survival equaling 73.2%. Patients with thrombocytopenia had about 86% lower odds of long-term survival compared with patients with normal Platelet levels (Plt).

The present study indicates that deficiency in Plt count is a significant factor leading to poor survival of MM patients.

Recurrent event data are common in many longitudinal studies. Often, a terminating event such as death can be correlated with the recurrent event process. A shared frailty model applied to account for the association between recurrent and terminal events. In some situations, a fraction of subjects experience neither recurrent events nor death; these subjects are cured.

In this paper, we discussed the Bayesian approach of a joint frailty model for recurrent and terminal events in the presence of cure fraction. We compared estimates of parameters in the Frequentist and Bayesian approaches via simulation studies in various sample sizes; we applied the joint frailty model in the presence of cure fraction with Frequentist and Bayesian approaches for breast cancer.

In small sample size Bayesian approach compared to Frequentist approach had a smaller standard error and mean square error, and the coverage probabilities close to nominal level of 95%. Also, in Bayesian approach, the sampling means of the estimated standard errors were close to the empirical standard error.

The simulation results suggested that when sample size was small, the use of Bayesian joint frailty model in the presence of cure fraction led to more efficiency in parameter estimation and statistical inference.

Electronic health (E-Health) literacy, especially among health students, is a significant challenge in promoting health in society. The present study aims to investigate healthcare students’ E-Health literacy level and the factors affecting it. 

In this correlational survey, the study population included all students of Shahid Beheshti University of Medical Sciences, Iran in 2019. Sample size was 228 students. Sampling method was convenience sampling and eHEALS questionnaire was used as research tool. The questionnaires were completed from June to July 2019. The level of e-Health literacy was reported using frequency distribution tables and mean, median, and mean percentage indicators. The relationship between demographic variables and e-Health literacy was analyzed using the Pearson correlation coefficient test, one-way ANOVA, and Student's t-test. 

Most respondents (67.5%+13.2%) believed that the Internet is essential and very important in accessing health information. Students' e-Health literacy score was 29.22±5 out of 40 (73%). The highest score (3.82±0.71) is related to the item of “I know how to find helpful health resources on the Internet”. E-Health literacy among age groups, disciplines, and different educational levels were significantly different (p <0.001). With increasing age and educational level, e-Health literacy of students also increased (p-value <0.05). The students of Medical Genetics discipline had a higher average health literacy score than other groups.

the level of e-Health literacy skills of students was at a good level, but it is suggested that educators and programmers, and medical librarians pay attention to formal and informal e-Health literacy training to strengthen students' e-Health literacy and eliminate their weaknesses to reach its ideal level.

Acute lymphoblastic leukemia (ALL) is a malignancy of the white blood cells characterized by its rapid and aggressive progress that needs immediate treatment. ALL could affect both adults and children. Various patient- and disease-related factors may be involved in ALL patients’ prognosis. Therefore, it is critical to identify important risk factors related to the competing outcomes of patients with ALL.

This study aimed to stratify the risk of outcomes of children with precursor B-cell ALL using demographic characteristics, laboratory characteristics, and extramedullary diseases. To achieve this goal, we used the best competing risks model to make an appropriate decision for children's treatment according to this classification.

In this retrospective cohort study, 393 patients with ALL were included. ALL with B cell origins (CD20, CD19, CD10, and CD22 positive markers) was differentiated using flow cytometry. Complete remission was defined by a lymphoblast count of less than 5% in the bone marrow, presence of no blasts in cerebrospinal fluid (CSF), as well as complete disappearance of clinical symptoms. Patients with ALL were treated based on Berlin-Frankfurt-Münster (BFM). Competing outcomes were first-relapse and non-relapse mortality, respectively. Risk factors affecting competing outcomes were assessed based on a fully specified sub-distribution model.

Five-year estimates for overall survival and event free survival were 75% (95% CI: 69 - 79%) and 71% (95% CI: 66 - 75%), respectively. Five-year incidence rates for first-relapse and non-relapse mortality in children were 11.4% (95% CI: 8.32 - 15.16%) and 17.6% (95% CI: 13.98 - 21.67%), respectively. Moreover, according to the results, children with WBC > 50000, hemoglobin 8, and tumor lysis syndrome for the first-relapse outcome, and children with central nervous system (CNS) involvement and tumor lysis syndrome for the non-relapse mortality (NRM) outcome were considered as high-risk groups.

We found that extramedullary diseases could have a crucial role in the risk stratification of children with precursor B-cell ALL. Therefore, for a targeted and effective treatment of high-risk children, in addition to chemotherapy, using appropriate PI3K pathway inhibitors, JAK2 pathway inhibitors, and antibody-based immunotherapy is recommended to reduce minimal residual disease and, consequently, mortality rate.

Hodgkin lymphoma (HL) is one of the best curable malignancies. Randomized controlled studies have validated the benefit of hematopoietic stem cell transplant (HSCT) for patients with relapsed or primary refractory HL. This analysis aimed to identify significant prognostic factors on the recurrence of the disease after HSCT applying a cure rate model.

In this retrospective cohort study, there were 92 patients with HL who underwent HSCT from 2007 to 2014 with 18 months of follow-up in Tehran, Iran. The survival time was set as the time interval between transplantation and the recurrence of HL. In addition, we utilized hyper-Poisson distribution as discrete frailty to account the unobserved heterogeneity and random effects.

In non-cured cases, the mean of survival time was 318 (95% confidence interval, 144-493) days. The 1-, 3-, and 5-year survival rates were 88.9%, 83.4%, and 80.7%, respectively. A significant association was observed between the cured patients and the variables such as age, the experience of pre-transplantation relapse, hemoglobin (Hb), mononuclear cells (MNCs), and body surface area (BSA) at the time of transplantation.

The study concluded that less than 30 years of age, a high level of Hb (g/dl), a low level of MNCs and BSA (m2), and the absence of pre-transplantation experience of relapse were associated with better survival following HSCT. Based on this study, post-transplant consolidation therapies could be considered for the treatment of HL patients after HSCT.

Endometriosis is associated with the increased risk of coronary heart disease and immune alterations, which may be attributed to the altered lipid profile and decreased serum level of 25–hydroxyl vitamin D (25(OH)D). The present study aimed to evaluate the effect of radical laparoscopic surgery of endometriosis on serum lipid profile and 25(OH)D.

This cross-sectional study was performed on 47 women aged 15 to 45, with body mass index <30kg/m2, who were referred to Shohaday-eTajrish Hospital, from May 2018 until Jan 2020, for surgical treatment of endometriosis and did not have a systemic disease and did not use oral contraceptives and/or other hormonal therapies three months before surgery were enrolled into the study. The serum lipid profile and 25(OH)D levels of patients two months after surgery were compared with presurgical levels. The results were analyzed by using paired t-test.

A total of 47 patients completed the study (mean age: 32.8±7.5years). About half had no pregnancies (49.1%). Comparing the serum lipid profile of patients before and two months after surgery showed a significant decrease in triglyceride from 108.4±46.2 to 86.4±51.1 mg/dL (P=0.001), ], total cholesterol from 172.5±26.5 to 160.0±28.3mg/dl (P=0.002), and low-density lipoprotein levels from 97±28.3 to 89.8±26.1 mg/dL (P=.003); however, high-density lipoprotein and 25(OH)D levels did not show a significant difference (P>0.05).

the results of the current study showed that laparoscopic resection of endometriotic lesions resulted in a significant reduction of the unfavorable lipid profile after two months, but not 25(OH)D levels.

Hodgkin lymphoma (HL) is one of the best curable cancers. Many researches have validated the benefit of hematopoietic stem cell transplant (HSCT) for patients with relapsed or primary resistant HL. This analysis aimed to identify an effective change point in patients' age, the cure fraction before and after the change point, and significant prognostic factors on the cure fraction before and after the change point for these patients after HSCT in Iran.

In this retrospective cohort study, there were 156 patients with HL who underwent HSCT from 2007 to 2014 with 18 months of follow up in Tehran, Iran. The survival time was set as the time interval between transplantation and the recurrence of HL. Also, the change point and the cure fraction before and after the change point were estimated using the Bayesian estimation method and log-normal distribution.

The estimated cure fraction was 79.2% for all patients. In susceptible cases, the mean survival time was 999 days (2.7 years). Also, the three and five-year survival rates were 82.1% and 80.0%, respectively. The effective change point in the age at transplantation of patients was 35 years, and the cure fraction before the change point was 84.5 % and after the change point was 60.6%.

The study concluded that the age of 35 years is a significant change point in the age at transplantation. If individuals underwent HSCT with HL before the age of 35, they have a higher survival rate (recurrent of HL) than those underwent HSCT after 35.

Adnexal mass is one of the most common gynecologic diseases among women of all ages.

In this cross-sectional study, we enrolled 126 patients with large adnexal masses (≥ 10 cm) managed by laparoscopic surgery during 2013 - 2020. The rates of intraoperative complications, conversion to open surgery, and incidence of cancer were assessed.

Mean mass size was 15.08 ± 5.03 in all participants without significant difference based on the tumor type (P = 0.624). Mean age and operation time were higher in the malignant type compared to the benign type (P < 0.001). Type of surgery and frequency of intraoperative complications were also different among patients with different tumor types (P < 0.001 and P = 0.816, respectively).

Our study showed that large adnexal tumors can be operated by laparoscopic approach, while the most important factor for increased surgical complications and duration was malignancy.

Since coronary artery disease (CAD) is one of the leading causes of death globally, identifying new risk factors can augment risk assessment. This study aimed to investigate the surface expression of stromal cell-derived factor-1 (SDF-1), CXCR4, and CXCR7 on the platelets of CAD patients and to determine whether there is a correlation between their expressions and left ventricular ejection fraction (LVEF).

Sixty CAD patients and 60 healthy volunteers as normal controls were studied. The mean fluorescence intensity (MFI) of SDF-1 and its receptor expression was evaluated by flow cytometry. Biochemical markers and platelet parameters were investigated with an AutoAnalyzer and a cell counter, respectively.

The platelets of the CAD group expressed SDF-1 and CXCR4 significantly more than those of the control group (MFI=1112±304 vs 943±131; P=0.042 and MFI=23372±6804 vs 20634±3482; P=0.033, respectively). Nevertheless, no significant difference was found in the platelet expression of CXCR7 between the CAD and control groups (MFI=35256±8706 vs 25053±7270; P=0.061). Notably, increased expression levels of SDF-1 and CXCR4 were associated with decreased LVEF (r= −0.388, P=0.003 and r= −0.431, P=0.001).

Our findings demonstrated that the overexpression of SDF-1 and CXCR4 on platelets could be considered a promising candidate indicating that asymptomatic patients with decreased LVEF may be at the risk of CAD. (Iranian Heart Journal 2022; 23(1): 42-53)

Chronic Kidney Disease (CKD) is a disease in which damaged kidneys could not remove waste material from the blood which could result in other health problems. The aim of this analysis was to identify significant laboratory prognostic factors on death hazard due to CKD.

There were 109 patients with end-stage renal disease (ESRD) treated at Helal pharmaceutical and clinical complex. The survival time was set as the time interval from starting dialysis until death due to CKD. Age, gender and factors such as creatinine, cholesterol, uric acid, SGOT, SGPT, bilirubin, hemoglobin, potassium, ALP, HbA1C, ferritin, calcium, phosphorus, PTH and albumin were employed in this study. Weibull Distribution with non-Constant Shape Parameter versus constant Shape Parameter for the analysis were used.

Death due to CKD occurred in 29 (26.6%) of the patients. Sixty-seven (61.5%) had uric acid higher than 6.8 (mg/dl) and 39(35%) had phosphorus higher than 4.7 (mg/dl) which were poor prognoses. The incidence of death was 48.4%. Calcium<8.5 (mg/dl) (p=0.002), Calcium > 9.5 (mg/dl) (p=0.003), Albumin 4-6.3 (g/dl) (p=0.034), Phosphorus (p=0.022), hemoglobin<10 (g/dl) (p=0.043), hemoglobin>12.5 (g/dl) (p=0.006) and iPTH (p<0.001) were significant variables which had an effect on death hazard rates.

The Weibull model with Non-Constant shape parameter was suggested to be more accurate for identifying risk factors, leading to more precise results, compared to constant shape parameter. Investigators mostly emphasize on the importance of Calcium, Albumin, Phosphorus, hemoglobin and iPTH for reducing hazard rates in CKD patients.

Treatment of cervical intraepithelial neoplasia is very important since if it remains untreated, it may progress to cervical cancer. It is usually treated with excisional surgery. This study aimed to find the factors affecting the cure rate of cervical intraepithelial neoplasia recurrence after surgery using defective models. Study design: A retrospective cohort study.

Excisional surgery was performed on 307 patients with high-grade cervical intraepithelial neoplasia, from 2009 to 2017. The patients were followed up until recurrence based on histopathology report. Hematologic factors were measured before surgery. The cure rates were estimated using defective models with a Gamma frailty term and the results were compared.

Neutrophil-to-lymphocyte ratio (NLR) (P<0.001) and excised mass size (P<0.001) had significant impacts on cure rates, and their cut-off values were 1.9 (P<0.001) and 15 mm2 (P<0.001), respectively. Patients with lower neutrophil-to-lymphocyte ratios and larger excised tissues had higher cure rates. Defective 3-parameter Gompertz distribution with gamma frailty term had the best fit to the data, and its estimated cure rates were 98% among patients with an excised mass size of >15 mm2 and NLR of <1.9, 84% among patients with an excised mass size of >15 mm2 and NLR of >1.9, 79% among patients with an excised mass size of <15 mm2 and NLR of <1.9, and 30% among patients with an excised mass size of <15 mm2 and NLR of >1.9.

Cervical intraepithelial neoplasia must be identified and treated before its progress. Excision of more tissues during excisional surgery, especially when the NLR of the patient is high, can help to prevent cervical intraepithelial neoplasia recurrence.

 Acute lymphoblastic leukemia (ALL) is the most frequent form of malignant neoplasia diagnosed in ages 0 to 14 years old. Efforts have not yet converted into a better prospect. Bone marrow relapse is still the leading cause of person-year of life lost in this malignancy.

 This study aimed at identifying the associated risk factors for relapse and mortality for pediatric patients with ALL in standard and high-risk groups.

 This study included a cohort of pediatric (0 - 16 years old) patients with ALL referred to Sheikh Hospital, Mashhad, Iran from 2007 to 2016. The demographic, clinical, and laboratory information were considered. Hazard ration (HR) with 95% highest posterior density region was obtained, using a Bayesian competing risks model.

 Of 424 patients with a mean age of 5.56 ± 3.75 years, 172 (40%) were female. Median follow-up time was 43.29 months, 10.6% had a relapse, and 17.2% had mortality related to ALL. Relapse-free survival rates at 1, 3, and 5 years were 97, 91, and 88%, respectively. Overall survival rates were 86, 83, and 82%, respectively. In the standard-risk group, tumor lysis syndrome (TLS) significantly increased either the relapse risk [HR: 13.47 (2.05 - 67.54)] or mortality risk [HR: 19.57 (2.24 - 32.18)]. In the high-risk group, the higher level of hemoglobin, platelet, and lactic acid dehydrogenase was significantly associated with higher relapse risk. TLS was associated with a higher risk of mortality in high-risk groups.

 It was suggested that TLS was a predictor for the disease relapse as well as mortality in pediatric patients with ALL. However, further evaluation on the larger population of patients is demanded to ascertain the precision of such parameters in leukemic management strategies.
 

Breast cancer is a common disease among women around the world. In Iran, it is the most prevalent cancer diagnosed in women. The objective of this study was to assess the cure rate of patients and the associated risk factors.

A retrospective cohort study was conducted on 446 patients with breast cancer admitted to the Shahid Ramezanzadeh Radiotherapy Center. Using R 3.2.2 software, the Kaplan-Meier curve, log-rank test, and cure joint frailty model were utilized in the analysis.

Of the 446 patients, 17.3% died, 20% experienced relapse, and 62.7% were censored. The 1-5-7-year disease-free survival rates were 95.3%, 73.4%, and 69.3%, respectively. In the cure model, stage, involved lymph node, and surgery were statistically significant. In the recurrence model, stage, involved lymph node, lymphovascular invasion, and hormone therapy were statistically significant. In the death model, stage, lymphovascular invasion, and involved lymph node had a statistically significant effect on the survival time.

The cure joint frailty model is a good model when there is a high fraction of patients who do not experience any recurrence or death. In addition, this model allows for the separate estimation of explanatory variable effect on recurrence, death, and cure. The findings of our study can be conducive to preventing the unfavorable effects of breast cancer and increasing the survival of patients.

Cervical ripening/dilatation is necessary for gynecologic procedures, but pharmacological dilators have several adverse effects. In this regard, evening primrose oil (EPO) has been shown as an effective dilator, though it has few complications. This randomized clinical trial (RCT) aimed to compare the effect of EPO and misoprostol on cervical ripening/dilatation.

In this double–blind RCT study, women of reproductive age without history of normal vaginal delivery (NVD) and menopause women (age range: 20–75 years) were enrolled. The subjects who were candidates of hysteroscopy, dilatation, and curettage were randomly assigned into two groups. In one group, 2 capsules of 500 mg EPO (N=81) and in the other group 2 capsules of 200 µg misoprostol (N=84) were placed in posterior fornix 2 hours before surgery. The time to reach complete dilatation (Hegar 3 to 10 mm), size of the first Hegar used to apply force, bleeding volume, and cervical laceration were compared between the groups using the IBM SPSS Statistics for Windows, Version 21.0 (Armonk, NY: IBM Corp).

The two study groups had similar demographic information, number of pregnancies, cesarean sections, and NVDs (P>.05), but had different frequency of surgical types (P=.018). EPO group had a larger mean size of the Hegar (7.32 vs. 6.58 mm; P=.004) and shorter time to reach complete dilatation (242.35 vs. 331.79 min; P=.002); however, bleeding volume and frequency of cervical laceration were not different between the groups (1.41 vs. 2.00 cc and 8.6% vs. 14.3%, respectively; P>.05).

The superiority of EPO capsules to misoprostol for cervical ripening before gynecologic procedures in women of reproductive age without history of normal NVD and menopause women suggests it as an appropriate alternative to misoprostol.

Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematous (SLE). With no specific clinical or laboratory manifestation to predict response to treatment, this study was aimed to provide a panel of predictive biomarkers of response before initiation of treatment.

Liquid chromatography tandem mass spectrometry (LCMS/MS) analysis was performed on plasma and urine samples of 11 patients with biopsy proven proliferative LN at the time of biopsy. Unsupervised principal component analysis (PCA), orthogonal projection to latent structures discriminant analysis (OPLS-DA), gene ontology annotation and protein mapping were performed on 326 proteins in plasma and 1381 proteins in urine samples.

Samples of eight patients achieved complete remission and three reached partial remission were analyzed. The mean 24- hour protein excretion was 3259 mg/d and the mean eGFR was 87.73 cc/min. OPLS-DA analysis of plasma samples showed a clear discrimination for complete and partial remission patients. Twenty plasma proteins and ten urine proteins with the highest fold changes and AUCs were selected as candidate biomarkers (IGHV1-18, PI16, IGHD, C3, FCER2, EPS8L2, CTTN, BLVRB). This plasma and urine biomarker panel is involved in oxidative stress, acute inflammation, reduction in regulatory T cells, complement pathway consumption, and proximal tubule bicarbonate reclamation.

Our suggested panel of plasma and urine biomarkers can precisely discriminate patients with possibility of complete response to treatment. It seems that the higher indices of inflammation will associate with better chance of achieving complete remission.

Skills-based health education isusefulin the promotion of health behaviors. Preparing for puberty is essential for adolescents. This study aimed to assess the effects of a skills-based education on girls' knowledge, attitudes, and practice about health in puberty.

This was an experimental study on 80 female school students in Tehran, Iran. Two groups of forty participants were randomly designated as the experimental and control in two different high schools in Tehran. A skills-based education program trained the experimental group,and a routine lecture-based education taught the control groupabout health in puberty. Data was collected using a questionnaire that assessed the participants' knowledge, attitudes, and practice about health in puberty; before, immediately after, and two months after the education.

Knowledge and attitude were significantly improved in the skills-based education group comparing to the Lecture-based group, immediately after (P = 0.002 and P = 0.045, respectively) and twomonths after the interventions (P <0.001 and P = 0.034, respectively). Both methods were not effective in improving practice.

Skills-based health education is more effective than the routine lecture-based education on improving knowledge and attitudes about puberty in health.

Several studies have focused on the alterations of hematological parameters for a better understanding of the COVID-19 pathogenesis and also their potential for predicting disease prognosis and severity. Although some evidence has indicated the prognostic values of thrombocytopenia, neutrophilia, and lymphopenia, there are conflicting results concerning the leukocyte and monocyte count.

In this retrospective Double Centre study, we reviewed the results of WBC and monocyte counts of 1320 COVID-19 patients (243 of whom (18.4%) had severe disease) both on admission and within a 7-day follow-up.

We found that both the number of monocytes and the percentage of monocytosis were higher in the severe group; however, it was not statistically significant. On the other hand, we found that not only the mean number of WBCs was significantly higher in the severe cases also leukocytosis was a common finding in this group; indicating that an increased number of WBC may probably predict a poor prognosis. Also, the monocyte count was not affected by age; however, univariate analysis showed that the percentage of leukocytosis was significantly greater in the older group (>50) with an odds ratio of 1.71 (P: 0.003).

Alteration of monocytes either on admission or within hospitalization would not provide valuable data about the prediction of COVID-19 prognosis. Although the rapidly evolving nature of COVID-19 is the major limitation of the present study, further investigations in the field of laboratory biomarkers will pave the way to manage patients with severe disease better.