Vaginal bleeding in pregnancy and adverse clinical outcomes: a systematic review and meta-analysis.

Background: Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis.Methods: Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS).Results: A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4).Conclusions: Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.

Vaginal bleeding in the first trimester of pregnancy increases the relative risk of preterm birth, low birth weight, premature rupture of membranes, abortion, stillbirth, placental abruption and placenta previa.

Dietary fats and their sources in association with the risk of bladder cancer: A pooled analysis of 11 prospective cohort studies.

The effects of fat intake from different dietary sources on bladder cancer (BC) risk remains unidentified. Therefore, the present study aimed to investigate the association between fat intakes and BC risk by merging world data on this topic. Data from 11 cohort studies in the BLadder cancer Epidemiology and Nutritional Determinants (BLEND) study, provided sufficient information on fat intake for a total of 2731 BC cases and 544 452 noncases, which yielded 5 400 168 person-years of follow-up. Hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox-regression models stratified on cohort. Analyses were adjusted for total energy intake in kilocalories, gender, smoking status (model-1) and additionally for sugar and sugar products, beers, wine, dressing and plant-based and fruits intakes (model-2). Among women, an inverse association was observed between mono-unsaturated fatty acids (MUFAs) and BC risk (HR comparing the highest with the lowest tertile: 0.73, 95% CI: 0.58-0.93, P-trend = .01). Overall, this preventative effect of MUFAs on BC risk was only observed for the nonmuscle invasive bladder cancer (NMIBC) subtype (HR: 0.69, 95% CI: 0.53-0.91, P-trend = .004). Among men, a higher intake of total cholesterol was associated with an increased BC risk (HR: 1.37, 95% CI: 1.16-1.61, P-trend = .01). No other significant associations were observed. This large prospective study adds new insights into the role of fat and oils in BC carcinogenesis, showing an inverse association between consumption of MUFAs and the development of BC among women and a direct association between higher intakes of dietary cholesterol and BC risk among men.

Late diagnosis of HIV infection and its associated factors in Shiraz, Southern Iran: a retrospective study.

Late diagnosis (LD) of HIV infection can give rise to suboptimal responses to antiretroviral treatment. The current study aimed to determine the prevalence and associated factors of HIV LD in Shiraz, Southern Iran. This retrospective cohort study was conducted from August 1997 to May 2018. Medical records were examined to extract required data. Individuals with time period less than three months from HIV diagnosis to an advanced phase of AIDS on CD4 < 350 were considered as LD. Multivariable logistic regression used to investigate the associated factors of late HIV diagnosis and adjusted odds ratios were reported. Of 1385 individuals, 1043 (75.3%) were considered as LD. The following factors were identified as the associated factors of LD: age at diagnosis (OR = 1.72, 95% CI: 1.22, 2.41), HCV co-infection (OR = 1.65, 95% CI: 1.23, 2.21), not living in Shiraz (OR = 1.36, 95% CI: 1.02, 1.82), increased likelihood of LD and being housewife (OR = 0.67, 95% CI: 0.47, 0.95) which decreased the likelihood of LD. Our results showed delayed diagnosis of a large proportion of individuals with HIV. It is critical to improve the HIV testing guidelines in Iran to identify individuals with HIV without delays in order to provide them with timely HIV medical care and treatment.

Dietary patterns and risk of bladder cancer: a systematic review and meta-analysis.

BACKGROUND: Several studies have investigated the relationship between dietary patterns and the risk of bladder cancer (BC) in different regions including Europe, the United States, and Asia, with no conclusive evidence. A meta-analysis was undertaken to integrate the most recent information on the relationship between a data-driven Western diet (WD), the Mediterranean diet (MD), and dietary-inflammatory-index (DII) and the risk of BC. METHOD: We looked for published research into the relationship between dietary patterns and the incidence of BC in the PubMed/Medline, Cochrane Library, Web of Science, and Scopus databases up until February 2021. Using a multivariate random-effects model, we compared the highest and lowest categories of WD, MD and DII patterns and provided the relative risk (RR) or odds ratios (OR) and 95 percent confidence intervals (CIs) for the relevant relationships. RESULTS: The analysis comprised 12 papers that were found to be suitable after scanning the databases. Both case-control (OR 0.73, 95% CI: 0.52, 0.94; I2 = 49.9%, n = 2) and cohort studies (RR 0.93, 95% CI: 0.88, 0.97; I2 = 63%, n = 4) found a substantial inverse association between MD and BC. In addition, although cohort studies (RR 1.53, 95% CI 1.37, 1.70; I2 = 0%, n = 2) showed a direct association between WD and BC, case-control studies (OR 1.33, 95% CI 0.81, 1.88; I2 = 68.5%, n = 2) did not. In cohort studies, we found no significant association between DII and BC (RR 1.02, 95% CI 0.93, 1.12; I2 = 38.5%, n = 2). In case-control studies, however, a strong direct association between DII and BC was discovered (RR 2.04, 95% CI 1.23, 2.85; I2 = 0%, n = 2). CONCLUSION: The current meta-analysis showed that MD and WD have protective and detrimental effects on BC risk, respectively. No significant association between DII and the risk of BC was observed. More research is still needed to confirm the findings. Additional study is warranted to better understand the etiological mechanisms underlying how different dietary patterns affect BC. TRIAL REGISTRATION: Protocol registration number: CRD42020155353. Database for protocol registration: The international prospective register of systematic reviews database (PROSPERO). Data of registration: August 2020.

The association between meat and fish consumption and bladder cancer risk: a pooled analysis of 11 cohort studies.

Evidence on the effects of meat consumption from different sources on the risk of bladder cancer (BC) is limited and controversial. Therefore, this study aimed to evaluate the associations between meat consumption and BC risk using a pooled data approach. Individual data from 11 prospective cohorts comprising 2848 BC cases and 515,697 non-cases with a total of 5,498,025 person-years of follow-up was pooled and analysed to investigate the potential associations between total red meat and products, red meat, processed meat, poultry and total fish and BC risk. Hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox regression models stratified on cohort. Overall, an increased BC risk was found for high intake of organ meat (HR comparing highest with lowest tertile: 1.18, 95% CI: 1.03, 1.36, p-trend = 0.03). On the contrary, a marginally inverse association was observed for total fish intake and BC risk among men (HR comparing highest with lowest tertile: 0.79, 95% CI 0.65, 0.97, p-trend = 0.04). No associations were observed for other meat sources. Results of this prospective study suggest that organ meat consumption may be associated with BC development. Replication in large-scale prospective studies and investigation of possible causal mechanisms is needed.

COVID-19, body mass index and cholesterol: an ecological study using global data.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is now globally considered a serious economic, social and health threat. A wide range of health related factors including Body Mass Index (BMI) is reported to be associated with the disease. In the present study, we analyzed global databases to assess the correlation of BMI and cholesterol with the risk of COVID-19. METHODS: In this ecological study, we used age-standardized BMI and cholesterol levels as well as the incidence and mortality ratio of COVID-19 at the national-levels obtained from the publicly available databases such as the World Health Organization (WHO) and NCD Risk Factor Collaboration (NCD-RisC). Bivariate correlation analysis was applied to assess the correlations between the study variables. Mean differences (standard deviation: SD) of BMI and cholesterol levels of different groups were tested using independent sample t-test or Mann-Whitney rank test as appropriate. Multivariable linear regression analysis was performed to identify variables affecting the incidence and mortality ratio of COVID-19. RESULTS: Incidence and mortality ratio of COVID-19 were significantly higher in developed (29,639.85 ± 20,210.79 for cases and 503.24 ± 414.65 for deaths) rather than developing (8153.76 ± 11,626.36 for cases and 169.95 ± 265.78 for deaths) countries (P < 0.01). Results indicated that the correlations of BMI and cholesterol level with COVID-19 are stronger in countries with younger population. In general, the BMI and cholesterol level were positively correlated with COVID-19 incidence ratio (ß = 2396.81 and ß = 30,932.80, p < 0.01,| respectively) and mortality ratio (ß = 38.18 and ß = 417.52, p < 0.05,| respectively) after adjusting for socioeconomic and demographic factors. CONCLUSION: Countries with higher BMI or cholesterol at aggregate levels had a higher ratios of COVID-19 incidence and mortality. The aggregated level of cholesterol and BMI are important risk factors for COVID-19 major outcomes, especially in developing countries with younger populations. We recommend monitoring and promotion of health indicices to better prevent morbidity and mortality of COVID-19.

Adherence to a Western dietary pattern and risk of bladder cancer: A pooled analysis of 13 cohort studies of the Bladder Cancer Epidemiology and Nutritional Determinants international study.

Little is known about the association of diet with risk of bladder cancer. This might be due to the fact that the majority of studies have focused on single food items, rather than dietary patterns, which may better capture any influence of diet on bladder cancer risk. We aimed to investigate the association between a measure of Western dietary pattern and bladder cancer risk. Associations between adherence to a Western dietary pattern and risk of developing bladder cancer were assessed by pooling data from 13 prospective cohort studies in the "BLadder cancer Epidemiology and Nutritional Determinants" (BLEND) study and applying Cox regression analysis. Dietary data from 580 768 study participants, including 3401 incident cases, and 577 367 noncases were analyzed. A direct and significant association was observed between higher adherence to a Western dietary pattern and risk of bladder cancer (hazard ratio (HR) comparing highest with lowest tertile scores: 1.54, 95% confidence interval (CI): 1.37, 1.72; P-trend = .001). This association was observed for men (HR comparing highest with lowest tertile scores: 1.72; 95% CI: 1.51, 1.96; P-trend = .001), but not women (P-het = .001). Results were consistent with HR above 1.00 after stratification on cancer subtypes (nonmuscle-invasive and muscle-invasive bladder cancer). We found evidence that adherence to a Western dietary pattern is associated with an increased risk of bladder cancer for men but not women.

Growth retardation among children in southern Iran: a 7-year population based cohort study.

BACKGROUND: Growth retardation is a common health problem, which requires early prevention and detection. This study was conducted to define the approximate age at which stunting starts among the Iranian boys and girls. METHOD: The second phase of a population-based retrospective cohort nested case-control study on 400 children who were followed from birth to 7 years of age. This study was performed to define the pattern of growth among stunted and normal children and to reveal the age at which stunting starts in each gender. RESULTS: Of the selected participants, 53% were girls. Also, about 18% of the children registered by the selected health centers were defined as stunted (under the 3rd percentile of the corresponding sex-age NCHS/WHO growth reference). For boys, the height was relatively similar between the two groups until the age of 6 months at which the difference in height between normal and stunted children starts to become significantly large (difference = 0.70 cm, P = 0.04). For girls, height in the two groups is relatively similar until the age of 9 months at which the difference starts to become significantly large (difference = 0.97 cm, P = 0.01). No significant difference in the weight of the girls was observed between the normal and stunted groups during the study period (difference = 283.21 g, P > 0.05). However, boys from the stunted group were lighter since almost the same time that they started to become significantly shorter (difference = 1265.19 g, P = 0.001). CONCLUSIONS: Soon after birth (at about the 6 months of age), the growth pattern of some (stunted) children starts to stumble and divert from normal. The sixth month of age is the age at which mothers start weaning with withdrawing breast milk and start supplementary foods and adult diet. A specially designed study is needed to understand the actual reason for observing such a phenomenon among Iranian children.

Exercise and Type 2 Diabetes.

The epidemic of diabetes mellitus has already become a serious global health threat. In the past three decades, the number of people with diabetes mellitus has quadrupled globally, and diabetes mellitus is known as the ninth major cause of death in the world nowadays. The increasing prevalence of type 2 diabetes mellitus is in coincidence with the augmentation of obesity in most developed countries as well as in developing countries. A sedentary lifestyle is well-known as one of the major reasons for the rising epidemic of type 2 diabetes mellitus besides the other reasons such as adopting energy-dense diets relative to the actual need for energy and population aging. Exercise as a regular physical activity at a medium to vigorous intensity is found to be an efficient influencer that would switch back most of the known type 2 diabetes mellitus factors toward healthier positions. Exercise is proven to have clinical benefits, such as improved insulin sensitivity, reductions in glycosylated hemoglobin (A1C) and increased peak oxygen consumption (VO2peak) which are definitely preventive toward diabetes. Exercise training can favorably affect glycemic parameters, the lipid profile, blood pressure, and high-sensitivity C-reactive protein. Exercise improves blood glucose control in type 2 diabetes, reduces cardiovascular risk factors, and regulates body weight by reducing body fat percentage and enhancing lean mass. In this chapter, the effect of regular exercise on the prevention of diabetes and short-term glucose and energy metabolism will be discussed. In addition, the effect of exercise on most common complications of type 2 diabetes including cardiovascular diseases, dyslipidemia, nephropathy, neuropathy, and retinopathy will be reviewed.

Effects of Exercise on the Immune Function, Quality of Life, and Mental Health in HIV/AIDS Individuals.

Physical exercise is a common type of planned physical activity in order to enhance or maintain a person's physical fitness. Physical exercise may act as an effective strategy to take control of certain conditions associated with HIV-1 infection. HIV infection and its related treatments not only affect the immune system but also cause several musculoskeletal disorders including pre-sarcopenia or sarcopenia, myalgia, and low bone mineral density. Moderate- to high-intensity aerobic exercise, progressive resistance exercise, or a combination of both is considered as a complementary part of medical care and treatment of HIV-infected individuals. In the present chapter, the results of recent investigations regarding the effects of physical activity on muscle strength and function, mental health, and immune system of HIV infected individuals will be discussed.

The effect of behavioral parent training on sleep problems of school-age children with ADHD: A parallel randomized controlled trial.

OBJECTIVE: The aim of this study was to examine the effect of behavioral parental training (BPT) on sleep problems in children diagnosed with ADHD. METHODS: This parallel randomized controlled trial was conducted in a psychiatric clinic in an urban area of Iran. Participants of this study were 58 school-age children who were diagnosed with ADHD, were receiving methylphenidate and had at least one problem in sleeping. They were randomly assigned into BPT or control groups. Participants' parents in the BPT group underwent a 5-week behavioral intervention program. Data were collected at baseline, immediately after the intervention, and two months after the intervention. Data were analyzed using Chi-square, Fisher's exact test, independent sample t-test, and repeated measure ANOVA test via the SPSS software. RESULTS: Children in the intervention group experienced a significant improvement in total sleep scores two months after the intervention compared to the control group (p = 0.03). Also, the findings showed a significant decline in total sleep problems in the intervention group compared to the control group over time (p = 0.01). CONCLUSION: The results suggest that BPT could be an effective method in improving sleep problems of school-age children diagnosed with ADHD undergoing methylphenidate treatment.

Heterogeneity in risk factors for ductal and lobular breast carcinomas: A case-control study.

Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast are the most common histological subtypes of breast cancer. However, the associations and heterogeneity between histological subtypes and their risk factors are not well established. This study aimed to investigate risk factors for IDC and ILC. This case-control study included 1,009 incident breast cancer cases and 1,009 hospital controls, frequency-matched by age. Data were obtained from the patients' medical files and an interview administered via a questionnaire. Multinomial logistic regression was used and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The heterogeneity of the associations was assessed using the Wald test. Family history of breast cancer was associated with IDC (OR 2.64, 95% CI: 1.97-3.55) but not ILC (OR 0.81, 95% CI: 0.42-1.57; p for heterogeneity <0.001). Conversely, a history of miscarriage was associated with ILC (OR 1.71, 95% CI: 1.17-2.51) but not IDC (OR 1.18, 95% CI: 0.95-1.46; p for heterogeneity = 0.04). Similarly, type 2 diabetes was associated with ILC but not IDC (p for heterogeneity = 0.02). Age at first delivery and breastfeeding were significantly associated with IDC but not ILC, though p values for heterogeneity did not reach the significance level. Deliberate weight loss and age at menarche were significantly associated with ILC but not IDC (p for heterogeneity ≥0.27). Smoking, history of benign breast disease and BMI were associated with both subtypes. The present study supports the hypothesis that IDC and ILC are etiologically distinct tumours.

Western Dietary Pattern, But not Mediterranean Dietary Pattern, Increases the Risk of Prostate Cancer.

BACKGROUND AND AIM: Prostate cancer is the most common cancer among men. Several studies have investigated the effects of dietary patterns on prostate cancer risk, but this topic is still a matter of debate. This study aimed to examine the association between dietary patterns and prostate cancer risk. METHODS: In a case-control study, 60 newly diagnosed prostate cancer cases and 60 hospital-based controls were selected from two main hospitals of Shiraz, Iran. Data on dietary intakes, anthropometric features, and demographic characteristics were collected. To determine the dietary patterns factor analysis, and to estimate the odds ratios (ORs), multivariable logistic regression was performed. RESULTS: Two major dietary patterns were identified: Western dietary (WD) pattern and Mediterranean dietary (MD) pattern. After adjusting for potential confounders, men who had higher scores for WD pattern (above the median) were more likely to have prostate cancer (OR = 5.15; 95% CI (1.44-18.47); P = 0.01) compared with men who had lower scores. A nonsignificant inverse association was found for MD pattern (OR = 0.62; 95% CI (0.22-1.77); P = 0.37). CONCLUSIONS: Our findings suggest that WD pattern may increase the risk of prostate cancer and the beneficial effects of MD pattern on prostate cancer risk need further research.

Stunting and its associated factors among 6-7-year-old children in southern Iran: a nested case-control study.

OBJECTIVE: Height-for-age shorter than 3th percentile or 2 sd below the median of the National Center for Health Statistics/WHO growth reference is known as stunting. The present study aimed to measure the association of several factors with stunting in a cohort born from 2009 to 2010 in Shiraz, Iran.Design/Setting/SubjectsNested case-control study conducted on pre-school children in 2016. Participants were 200 children suffering from stunting (case group) and 200 children with normal height (control group). RESULTS: Results of multivariable logistic regression analysis suggested a significant relationship (adjusted OR; 95 % CI) between stunting and mother's occupation (employed v. housewife: 3·58; 1·73, 7·39) and chronic diseases (yes v. no: 2·93; 1·25, 6·88). In addition, significant associations were found between family income (30 million Rials: 5·63; 2·46, 12·87), diary consumption (very little v. high: 5·93; 1·74, 20·18) and animal protein in diet (low v. very high: 2·42; 1·13, 5·19) and stunting among children. Also, chance of stunting was inversely associated with birth interval (<2 years v. first child: 3·13; 1·45, 6·76) and duration of exclusive breast-feeding (18-24 months v. formula only or breast-feeding for <18 months: 0·53; 0·30, 0·92). CONCLUSIONS: Mothers being housewife, possibly due to having more time to take care of their children, childhood diseases and consumption of dairy foods are strong and modifiable factors which can positively affect Iranian children's stature. Higher family income is another important factor in stunting but under less parental control.

The effect of a 12-week combinational exercise program on CD4 count and mental health among HIV infected women: A randomized control trial.

BACKGROUND/OBJECTIVE: There are conflicting results regarding the effects of exercise on immune function of HIV positive patients. Exercise can also be beneficial to psychological functioning of the patients. The purpose of this study was to determine the impact of a 12-week aerobic and resistance exercise training program on mental health and CD4 counts among female HIV+ patients. METHODS: This clinical trial was conducted between September and December 2013. Forty participants (women age range 20-40) were carefully selected from 240 HIV-positive women referred to Voluntary Counseling and Treatment Center (VCT) and randomly assigned to either exercise (80 min of aerobic and strength training while receiving the VCT's routine services) group (n = 20) or control (received the VCT's routine services only) group (n = 20). To assess their mental health status, all participants completed GHQ28 questionnaire. Blood samples were collected to measure CD4 and T-cell counts at baseline and at the end of the 12-week intervention. RESULTS: From a sample of 40 women with HIV infection, the data of 30 participants [experimental group (14) and control group (16)] were analyzed (participation rate 75%). The results indicated that after the intervention program, a significant difference in CD4 cell counts was found between the two groups (P = 0.01). With regard to mental health, after performing intervention, significant improvement in all subscales including anxiety disorder, social function, depression and mental health's total score was observed in the exercise compared to the control groups (P < 0.001). CONCLUSION: Exercise training can be included in health care services in order to improve the mental health status of women with HIV infection. No effect on CD4 count was detected.

Factors predicting survival in patients with early stage laryngeal cancer: A cohort study between 2000 to 2015.

PURPOSE: In recent years, trends of treatment and survival of laryngeal cancer have received heightened attention. Despite the fact that most laryngeal cancers are diagnosed at early stage, a concern of worsening survival in patients with localized cancer has been raised but not consistently observed. This study aimed to determine factors affecting laryngeal cancer survival. METHODS: This was a cohort study from 2000 to 2015 in which clinical and demographic characteristics of patients at early stage of laryngeal cancer were collected. Medical records and telephone interviews were used to define patient's demographic and clinical status during the study period. Multivariate Cox model was used as the main method for analyzing data. RESULTS: Age at diagnosis, type of treatment, stage, and tumor grade were statistically associated with patient survival. Older patients were more prone to worse prognosis (HR=1.69, 95% CI: 1.03-2.75, p=0.03). The results also suggested that people who had surgery compared with those who received only radiation therapy (RT) survived longer (HR=0.44, 95% CI: 0.20-0.94, p=0.03). Furthermore, for those whose tumor was grade 3 at diagnosis, the risk of death was 2.45-fold higher than those with grade 1 (HR =2.45, 95% CI: 1.19-5.40, p=0.01). Stage II patients experienced worse prognosis than stage I patients (HR=1.77, 95% CI: 1.06-2.93, p=0.02). CONCLUSION: This study revealed several factors that can influence patient survival rate, among them different therapeutic approaches.

Association between anogenital distance as a noninvasive index in the diagnosis and prognosis of reproductive disorder: A systematic review.

Background: There are 2 measures of anogenital distance (AGD) in men and women. AGD has been used as an indicator of fetal androgen dysfunction and an adverse outcome in adulthood. Some studies have shown the association of AGD as a predictor in the diagnosis and prognosis of diseases and disorders. Objective: To systematically summarize the latest evidence for presenting AGD as a new approach for prognosis and early diagnosis of diseases. Materials and Methods: A systematic review of the available literature was performed using Medline via PubMed, Scopus, and ISI Web of Knowledge up to July 2021, using search terms "anogenital distance" OR "anogenital index" OR "ano genital distance" OR "ano genital index". Language restrictions were not imposed. Results: After reviewing the retrieved articles, 47 unique studies were included in this systematic review. Different outcomes, including endometriosis, prostate cancer, polycystic ovary syndrome, pelvic organ prolapse, hypospadias, cryptorchidism, fertility and semen parameters, maternal and birth development, and ovarian and gynecological-related disorders, have been studied in the included evidence. A negative association was observed between AGD and endometriosis and hypospadias and a positive association between AGD and prostate cancer, polycystic ovary syndrome, male fetal gender, and fertility parameters. Conclusion: Using quantitative indicators such as AGD may be a useful clinical tool for the diagnosis of diseases. Although many studies have shown an association between AGD and diseases, some factors, including different measurement methods, different measurement tools, age, and different definitions of AGD, can be involved in the variation of AGD.

Global and regional geographical prevalence of depression in gastric cancer: a systematic review and meta-analysis.

BACKGROUND: Substantial uncertainty exists about the prevalence of depression in patients with gastric cancer. We aimed to summarise the global and regional pooled prevalence of depression among patients with gastric cancer. METHOD: Up to February 2020, we searched PubMed/MEDLINE, Embase, Scopus, Web of science (ISI) and PsychINFO to identify published studies on the prevalence of depression among patients with gastric cancer. The study selection procedure was in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We estimated the prevalence of depression in gastric cancer patients using a random-effect pooled estimate analysis approach with subgroup analysis based on WHO regions, and methods of depression measurement. RESULTS: Totally, we retrieved 3781 studies from the previously mentioned databases, of which 18 (12 cross-sectional and 6 cohort studies in design) met the eligibility criteria, which were published from 2001 to 2017 in different regions. The total sample size of the included studied contained 4709 patients with gastric cancer, of which 1885 cases were diagnosed with depression. The pooled prevalence of depression among gastric cancer patients was 37%(95% CI: 26% to 48%). Subgroup analysis showed that the highest prevalence of depression was in Eastern Mediterranean (pooled prevalence=42%; 95% CI: 18% to 65%) followed by the Western Pacific region (pooled prevalence=40%;95% CI: 26% to 54%). The results indicated a significant heterogeneity (I 2=98.8%,P<0.05). CONCLUSION: Our findings indicated that depression is high among gastric cancer patients. The findings suggest health authorities to provide specially designed social and psychological supportive care services, including screening for depression, among such patients. PROSPERO REGISTRATION NUMBER: CRD42020139836.

Signs, Symptoms, and Side-Effects Presented by Different Types of COVID-19 Vaccines: A Prospective Cohort Study.

The concern about post-COVID-19 vaccine complications still remains. In addition, the evidence on Sinopharm, Sputnik V, Covaxin, and, in particular, COVIran Barekat, as well as comparisons between them by dosage after post-vaccination, is scarce. This study aimed to investigate and compare the prevalence of self-reported post-vaccination signs and symptoms following the first and second doses of different types of COVID-19 vaccines. Research design and methods: This prospective cohort study was conducted on more than 1500 health professionals who had received at least one dose of any type of Sputnik V, Sinopharm, Oxford AstraZeneca, Covaxin, and COVIran Barekat vaccines in Iran. The survey questionnaire was sent to participants online, 28 days after receiving each dose of the vaccine. Results: About 73% of health professionals reported at least one post-vaccination sign or symptom, developing mostly within the first 12 h (69.9%) and lasting up to 12 h (59.0%). Pain and tenderness at the injection site, fever, and muscle pain were the most common post-vaccination signs and symptoms in all vaccines, which were significantly higher in the Oxford AstraZeneca vaccine (p < 0.001) for both the first and second doses. The incidence rate of all post-vaccination signs and symptoms was significantly higher in the first dose than in the second dose (p < 0.05). Conclusion: The Oxford AstraZeneca vaccine showed the highest incidence rate, onset, and lasting time of signs and symptoms in both doses; however, they were not life-threatening. The onset time of signs and symptoms was significantly higher for the COVIran Barekat and Oxford AstraZeneca vaccines in both the first and second doses.

Adherence to a western dietary pattern and risk of invasive ductal and lobular breast carcinomas: a case-control study.

Little is known about the role of diet in the risk of invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) of the breast, the most common histological subtypes of breast cancer (BC). This is because, the majority of studies on the association of diet and the risk of BC are focused on single food items, and studies considering the overall diet in terms of dietary patterns are limited. Also, the potential heterogeneity in the impact of Western diet (WD) on histological subtypes of BC is not established. This, the age-frequency-matched case-control study included 1009 incident BC cases and 1009 healthy controls. The required data was obtained from the patients' medical files and interviews using a previously validated researcher-designed questionnaire for collecting data on socio-economic and anthropometric statuses and a valid food frequency questionnaire (FFQ) to measure the participants' dietary intake. We used multinomial logistic regression, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. A positive and significant association was observed between higher adherence to a WD and risk of IDC (OR comparing highest with the lowest tertile: 2.45, 95% CI 1.88, 3.17; p-trend < 0.001), whereas no significant association was observed between adherence to the WD and the risk of ILC (OR comparing highest with the lowest tertile: 1.63, 95% CI 0.63, 3.25) (p for heterogeneity = 0.03). The results of an analysis stratified by menopausal status suggested a similar pattern. We provided evidence that adherence to a WD raises the risk of IDC, but not ILC, suggesting different etiological mechanisms for IDC and ILC.