Early Detection of Gestational Trophoblastic Neoplasia Based on Serial Measurement of Human Chorionic Gonadotrophin Hormone in Women with Molar Pregnancy.

BACKGROUND: The majority of studies which investigate the predicted power of Human chorionic gonadotropin (hCG) levels to the occurrence of Gestational trophoblastic neoplasia (GTN) considered the effect of a single measurement of hCG or used classical statistical methods without considering the endogenous marker. The aim of this study is to investigate the association between weekly measurements of ß-hCG with time to GTN occurring, using a robust Bayesian joint modeling. METHODS: Data of 201 women with a molar pregnancy were considered for this retrospective cohort study. After the first measurement of ß-hCG in 48 hours post evacuation of mole, the other titration was performed on a weekly basis until three consecutive normal titers. The association between serial measurements of ß-hCG and risk of GTN occurring were assessed by the classic and Bayesian joint modeling and in separate analysis the mixed linear effect and Cox-PH model were used. RESULTS: The mean age (SD) of participants was 26.6 (6.55) year. The GTN was occurred among 14.9% of patients. The association parameter using Bayesian approach was estimated as 1.30 (95% CI: 0.44 to 2.20) which showed one unit increase in the log ß-hCG corresponds to the 2.80-times increase in the hazard for the occurrence of GTN (Hazard Ratio: 2.80, 95% CI: 1.55 to 8.98). CONCLUSIONS: Findings of this study revealed that weekly measurements of ß-hCG are an important and reliable biomarker to early detection of developing of molar pregnancy to persistent GTN.

Profile of drug users in the residential treatment centers of Tehran, Iran.

Background: The current study aimed at determining the pattern of drug dependence and its related factors in mid-term residential treatment centers (MTRCs). Methods: The current cross-sectional study was conducted on all drug dependent people residing in MTRCs of Tehran, Iran, who were voluntarily seeking treatment from April to August, 2018. Required data were collected through face-to-face interviews. Drug dependence was categorized into four groups: soft opioids, hard opioids, methamphetamine, and combination of hard opioids and methamphetamine. The association of potential risk factors with drug dependence was measured using chi-square test and multinomial logistic regression. Results: Out of 1868 participants in the current study, 97% were male. Mean age (SD) of the participants was 38.1 (9.9). The different types of drug dependence were hard opioids (43.0%),soft opioids (29.5%), methamphetamine (15.4%), and a combination of hard opioids and methamphetamine (12.1%). The prevalence of injecting drug use was 2.7%. In comparison with the reference group (soft opioids), being un-married and unemployment, significantly increased the risk of using the three groups of drugs (odds ratios [ORs]: 1.5-3.34, P values: <0.001-0.033).Age ≥30 years at the initiation of drug use, and using current drug for more than 10 years, significantly increased the risk of using hard opioids and a combination of hard opioids and methamphetamine (ORs: 1.65-2.31, P values: <0.001-0.030). Age ≥50 years significantly decreased the risk of using the three groups of drugs (ORs: 0.21-0.43, P≤0.001). Conclusion: Different pattern of drug dependence found in MTRCs, they were mostly hard opioid users, lower injecting drug use and higher mean of age.

Interleukin-10 and Transforming Growth Factor Beta1 Gene Polymorphisms in Chronic Heart Failure.

BACKGROUND: As cytokines, including interleukin-10 (IL-10) and transforming growth factor beta 1(TGF-ß1) seem to contribute towards the pathogenesis of chronic heart failure (CHF), this study was performed to assess the associations of certain single nucleotide polymorphisms (SNPs) of these genes in a case control study. METHODS: This investigation was carried out to determine the frequency of alleles, genotypes and haplotypes of TGF-ß1 and IL-10 single-nucleotide polymorphisms (SNPs) in 57 Iranian patients with CHF compared with 140 healthy subjects using polymerase chain reaction with sequence-specific primers method. RESULTS: Results of the analyzed data divulged a negative association for both TGF-ß1 GC genotype at codon 25 (P=0.047) and CT genotype at codon 10 (P=0.018) and CHF proneness. Although, TGF-ß1 CC genotype at codon 10 was found to be positively associated with CHF (P=0.011). Moreover, the frequency of IL-10 (-1082, -819, -592) ATA haplotype and TGF-ß1 (codon 10, codon 25) TG haplotype were significantly lower in the patients group (P=0.004 and P=0.040, respectively), while TGF-ß1 (codon 10, codon 25) CG haplotype was overrepresented in patients with CHF (P=0.007). CONCLUSIONS: Cytokine gene polymorphisms might affect vulnerability to CHF. Particular genotypes and haplotypes in IL-10 and TGF-ß1 genes could render individuals more susceptible to CHF.

Interleukin-2 and Interferon-Gamma Single Nucleotide Polymorphisms in Iranian Patients with Chronic Heart Failure.

BACKGROUND: Inflammatory cytokines have been known to be associated with Chronic Heart Failure (CHF). Given the importance of cytokines in the context of the failing heart, the prevalence of Interleukin-2 (IL-2) and Interferon-gamma (IFN-γ) polymorphisms was studied in patients with CHF due to ischemic heart disease in a case-control study. METHODS: Fifty-six Iranian patients with CHF were enrolled in this study as the case group and compared with 139 healthy subjects, using polymerase chain reaction with sequence-specific primers method, so as to determine the frequency of alleles, genotypes and haplotypes of IFN-γ (+874 A/T) and IL-2 (-330 G/T, +166 G/T) SNPs. RESULTS: The GG genotype at IL-2 -330 in patients with CHF was significantly over-represented in comparison with the control group (p=0.013). Such a positive genotypic association was also observed for IL-2 +166/TT (p=0.022). Meanwhile, the GT genotype frequency at IL-2 -330/GT in the patient group was significantly lower than the one in healthy controls (p=0.049). No significant association was detected between the IFN-γ gene polymorphisms and individuals' susceptibility to CHF. CONCLUSION: Certain genotypes in IL-2 gene were overrepresented in patients with CHF, which could render individuals more vulnerable to this disease.

Tumor Necrosis Factor-Alpha and Interleukin-6 Gene Polymorphisms in Iranian Patients with Ischemic Heart Failure.

BACKGROUND: Proinflammatory cytokines have been known to be elevated in patients with Chronic Heart Failure (CHF). Given the importance of proinflammatory cytokines in the context of the failing heart, the prevalence of Tumor Necrosis Factor-α (TNF-α), Interleukin (IL)-6 polymorphisms in patients with CHF was studied due to ischemic heart disease. METHODS: Forty three patients with ischemic heart failure were enrolled in this study and compared with 140 healthy individuals. The allele and genotype frequency of four Single Nucleotide Polymorphisms (SNPs) within the IL-6 (-174, nt565) and TNF-α (-308, -238) genes were determined, using Polymerase Chain Reaction with Sequence-Specific Primers (PCR-SSP) assay. RESULTS: The frequency of the TNF-α (-238) A/A genotype was significantly higher in patients comparing to controls (p=0.043), while TNF-α G/A genotype at the same position decreased significantly, in comparison with controls (p=0.018). The most frequent haplotype for TNF-α was A/A in the patient group in comparison with controls (p=0.003). There was no significant difference in allele and genotype frequencies of IL-6 at positions -174 and nt565, and TNF-α at position -308. CONCLUSION: Certain alleles, genotypes, and haplotypes in TNF-α, but not IL-6, gene were overrepresented in patients with ischemic heart failure, which may, in turn, predispose individuals to this disease.

An ad hoc method for dual adjusting for measurement errors and nonresponse bias for estimating prevalence in survey data: Application to Iranian mental health survey on any illicit drug use.

Purpose The prevalence estimates of binary variables in sample surveys are often subject to two systematic errors: measurement error and nonresponse bias. A multiple-bias analysis is essential to adjust for both biases. Methods In this paper, we linked the latent class log-linear and proxy pattern-mixture models to adjust jointly for measurement errors and nonresponse bias with missing not at random mechanism. These methods were employed to estimate the prevalence of any illicit drug use based on Iranian Mental Health Survey data. Results After jointly adjusting for measurement errors and nonresponse bias in this data, the prevalence (95% confidence interval) estimate of any illicit drug use changed from 3.41 (3.00, 3.81)% to 27.03 (9.02, 38.76)%, 27.42 (9.04, 38.91)%, and 27.18 (9.03, 38.82)% under "missing at random," "missing not at random," and an intermediate mode, respectively. Conclusions Under certain assumptions, a combination of the latent class log-linear and binary-outcome proxy pattern-mixture models can be used to jointly adjust for both measurement errors and nonresponse bias in the prevalence estimation of binary variables in surveys.

Sperm Retrieval in Patients with Klinefelter Syndrome: A Skewed Regression Model Analysis.

BACKGROUND: The most common chromosomal abnormality due to non-obstructive azoospermia (NOA) is Klinefelter syndrome (KS) which occurs in 1-1.72 out of 500-1000 male infants. The probability of retrieving sperm as the outcome could be asymmetrically different between patients with and without KS, therefore logistic regression analysis is not a well-qualified test for this type of data. This study has been designed to evaluate skewed regression model analysis for data collected from microsurgical testicular sperm extraction (micro-TESE) among azoospermic patients with and without non-mosaic KS syndrome. MATERIALS AND METHODS: This cohort study compared the micro-TESE outcome between 134 men with classic KS and 537 men with NOA and normal karyotype who were referred to Royan Institute between 2009 and 2011. In addition to our main outcome, which was sperm retrieval, we also used logistic and skewed regression analyses to compare the following demographic and hormonal factors: age, level of follicle stimulating hormone (FSH), luteinizing hormone (LH), and testosterone between the two groups. RESULTS: A comparison of the micro-TESE between the KS and control groups showed a success rate of 28.4% (38/134) for the KS group and 22.2% (119/537) for the control group. In the KS group, a significantly difference (P<0.001) existed between testosterone levels for the successful sperm retrieval group (3.4 ± 0.48 mg/mL) compared to the unsuccessful sperm retrieval group (2.33 ± 0.23 mg/mL). The index for quasi Akaike information criterion (QAIC) had a goodness of fit of 74 for the skewed model which was lower than logistic regression (QAIC=85). CONCLUSION: According to the results, skewed regression is more efficient in estimating sperm retrieval success when the data from patients with KS are analyzed. This finding should be investigated by conducting additional studies with different data structures.

MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data.

PURPOSE: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. METHODS: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. RESULTS: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. CONCLUSION: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.

PADI4 Polymorphisms in Iranian Patients with Rheumatoid Arthritis.

AIM: Rheumatoid arthritis (RA) is a chronic autoimmune disease which affects many tissues and organs, but majorly attacks synovial joints. Beyond the major histocompatibility complex (MHC) genes, Peptidyl arginine deiminase type IV (PADI4) has been suggested to be associated with RA susceptibility. Evidence regarding the association of PADI4 single nucleotide polymorphisms (SNP) and RA is controversial, thus we conducted this large-scale case-control study to assess the association of rs874881 and rs11203367 PADI4 SNPs with susceptibility to RA. MATERIALS AND METHODS: Study population (including 665 RA patients and 392 sex-, age-, and ethnicity-matched healthy controls) were enrolled from Rheumatology Research Center of Tehran University of Medical Sciences, Shariati hospital. RESULTS: Allele or genotype frequencies of the investigated PADI4 SNPs were not different between RA patients and healthy subjects; genotypes (expressed as odds ratios) of rs11203367 [TT 0.98 (0.68-1.4), CT 0.93 (0.71-1.24), P value > 0.05] and rs874881 [CC 1.02 (0.71-1.46), CG (0.70-1.39), p value > 0.05] did not affect RA risk. Disease severity score DAS28, RF and anti-CCP antibodies of RA patients were not different between various genotypes of PADI4 SNPs. CONCLUSIONS: These findings were similar for haplotypes and diplotypes of rs11203367 and rs874881 PADI4 SNPs. In conclusion, in this case-control study with sufficient sample size to detect associations, we observed that PADI4 SNPS rs11203367 and rs874881 do not significantly determine RA susceptibility; which is in line with studies of some European populations. It seems RA pathogenesis might be different among various ethnicities, which encourage us to consider these differences in developing therapeutic interventions for management of patients.

Assessing measurement error in surveys using latent class analysis: application to self-reported illicit drug use in data from the Iranian Mental Health Survey.

Latent class analysis (LCA) is a method of assessing and correcting measurement error in surveys. The local independence assumption in LCA assumes that indicators are independent from each other condition on the latent variable. Violation of this assumption leads to unreliable results. We explored this issue by using LCA to estimate the prevalence of illicit drug use in the Iranian Mental Health Survey. The following three indicators were included in the LCA models: five or more instances of using any illicit drug in the past 12 months (indicator A), any use of any illicit drug in the past 12 months (indicator B), and the self-perceived need of treatment services or having received treatment for a substance use disorder in the past 12 months (indicator C). Gender was also used in all LCA models as a grouping variable. One LCA model using indicators A and B, as well as 10 different LCA models using indicators A, B, and C, were fitted to the data. The three models that had the best fit to the data included the following correlations between indicators: (AC and AB), (AC), and (AC, BC, and AB). The estimated prevalence of illicit drug use based on these three models was 28.9%, 6.2% and 42.2%, respectively. None of these models completely controlled for violation of the local independence assumption. In order to perform unbiased estimations using the LCA approach, the factors violating the local independence assumption (behaviorally correlated error, bivocality, and latent heterogeneity) should be completely taken into account in all models using well-known methods.

Work-related exacerbation of asthma among adults treated by pulmonary specialists.

The most common chronic occupational lung disease is occupational asthma. This study aimed to assess the prevalence of work-related respiratory symptoms (WRS) in asthmatic adults at pulmonary clinics. A cross-sectional study was performed. Current employed subjects were subdivided into 2 groups by WRS status according to questionnaire mainly based on one developed by the National Institute for Occupational Safety and Health (NIOSH). Subjects' occupation and workplace exposures were evaluated by asthma-specific job exposure matrix (JEM). Thirty-nine of 179 current employed asthmatics had WRS. Subjects with WRS were more likely to have self-reported allergy and exposure to low-molecular-weight antigens (prevalence ratio [PR]: 2.7). The 2 most frequent occupational classes for asthmatics with WRS were trades, transport and equipment operators, and processing and manufacturing. Self-reported allergy, high-risk exposures, and occupations unique to processing, manufacturing, and utilities were estimated to be risk factors of WRS.

Psychological Well-Being (PWB) of School Adolescents Aged 12-18 yr, its Correlation with General Levels of Physical Activity (PA) and Socio-Demographic Factors In Gilgit, Pakistan.

BACKGROUND: Adolescence is a critical developmental stage marked by complex transitions. The purpose of study was to assess school adolescents' PWB, examine the relationship of PA and socio-demographic factors with PWB. METHODS: A cross sectional study conducted in five randomly selected schools with 345 adolescents (aged 12-18) from grade 6(th)-10(th). A self-administered Well-Being index was adapted to measure PWB and questionnaire for adolescents PA (PAQ-A). Socio-demographic variables determined: age, gender, household income and parental education. Bivariate and multivariate regression analyses performed to examine the association between PWB, PA and covariates. RESULTS: Findings indicated the mean age 14.64 (SD=1.275), 55.4% were female. Without gender difference the majority (43.4%) of adolescents showed moderate, while (23.2%) revealed low level of PWB. Participants with low level likely to have depression but scores were significantly not different between low, moderate and high PWB with PA. Socio-demographic trends of adolescents' were observed significant (P <0.005) for PWB. In multivariable analysis the mean wellbeing in females adjusted for other covariates was significant (P =0.004) than males. PWB importantly (P <0.001) decreased by 3.36 units as its covariates increased and PA score in boys found 0.05 unit more than girls. CONCLUSION: The study results are invaluable in addressing low, moderate and high levels of PWB. Inadequate PA and PWB decreasing with some socio-demographic covariates is crucial health issue among female adolescents in Pakistan. Further studies need to find barrier, social indicators of PWB and implication of health among adolescents.

Mitochondrial haplogroups and control region polymorphisms in Kaposi's sarcoma patients.

Inflammation and reactive oxygen species (ROS) production have recently considered as key mechanisms in the pathogenesis of Kaposi's sarcoma (KS). Since mitochondria are the major source of ROS production, this organelle may play a main role in KS development. However, there are no studies on mtDNA variations and haplogroups in this area. The focus of this study was to investigate the mtDNA variants and haplogroups in KS patients and their relationship to tumor development. To address this, we have genotyped mtDNA in 45 Iranian KS patients and 48 age and sex-matched Iranian controls. A strong positive correlation was observed between UK cluster and decreased risk of KS. Our results suggest that the UK cluster might be a protective haplogroup for KS development. It is probably superhaplogroup UK, with lower ATP and ROS production, may prevent KSHV reactivation from latent to lytic phase that is essential for KS development.

Meta-analysis of type-specific human papillomavirus prevalence in Iranian women with normal cytology, precancerous cervical lesions and invasive cervical cancer: Implications for screening and vaccination.

To predict the impact of current vaccines on cervical cancer and for the improvement of screening programs, regional data on distribution of human papillomavirus (HPV) types in women with or without cervical cancer is crucial. The present meta-analysis intend to comprehensively evaluate the HPV burden in women with invasive cervical cancer, high-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 2 and 3), low-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 1), atypical squamous cells of undetermined significance and normal cytology, as these data will help decision making in regards with screening programs and HPV vaccination in Iran. To determine the HPV prevalence and type distribution in Iranian women with or without cervical cancer, 20 published studies were included in this meta-analysis. In total, 713, 124, 104, 60, and 2577 women invasive cervical cancer, high-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 2 and 3), low-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 1), atypical squamous cells of undetermined significance and normal were reviewed, respectively. Overall HPV prevalence in women with invasive cervical cancer, high-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 2 and 3), low-grade squamous intraepithelial lesion (cervical intraepithelial neoplasia 1), atypical squamous cells of undetermined significance and normal cytology were 77.4%, 71.8%, 65.3%, 61.7%, and 8.4%, respectively. The six most common types were HPV 16, 18, 6/11, 31, and 33; among them HPV 16 was the most frequent type in all five different groups. According to this study, it was estimated that HPV vaccines could have a great impact on prevention of cervical cancer in Iran. In conclusion, this meta-analysis highlights the necessity of introducing vaccination program in Iran.

Effects of probiotic yogurt on fat distribution and gene expression of proinflammatory factors in peripheral blood mononuclear cells in overweight and obese people with or without weight-loss diet.

OBJECTIVES: The purpose of this study was to investigate whether probiotics had an effect on proinflammatory markers and cytokines in overweight and obese individuals and whether they could have synergistic effects with weight-loss diets. METHODS: A total of 75 healthy overweight and obese individuals completed this randomized doubled-blind controlled clinical trial. Participants were randomly assigned to groups consuming regular yogurt with a low-calorie diet (LCD, RLCD; n = 25) or receiving probiotic yogurt with LCD (PLCD; n = 25) or consuming probiotic yogurt without LCD (PWLCD; n = 25) for 8 weeks. The pribiotic regimen contained 200 g/day yogurt, enriched by Lactobacillus acidophilus La5, Bifidobacterium BB12, and Lactobacillus casei DN001 10(8) colony-forming units/g. Body fat percentage, high-sensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), leptin, and mRNA levels of inflammation-related genes (TNF-α and RAR-related orphan receptor gamma [ROR-γt]) in peripheral blood mononuclear cells (PBMCs) were measured. RESULTS: A reduction in body mass index (BMI), fat percentage, and leptin level was observed that was more obvious in groups who received the weight-loss diet with probiotic yogurt. Reduction in the gene expression of ROR-γt was significant in the PLCD group (p < 0.001). The expression of TNF-α did not change among all groups after intervention. The mean concentration of leptin was significantly decreased in all groups after the dietary intervention, but the mean changes in leptin level in the PLCD group was more prominent compared to the other two groups (-2.38, p < 0.001 [PLCD] vs -1.75, p = 0.002 [RLCD] and -0.55 ng/mL, p = 0.12 [PWLCD]). The reduction in serum levels of hs-CRP was more evident in the PWLCD group compared to the PLCD and RLCD groups after the 8-week intervention (-3.4, p = 0.03 vs -1.76, p < 0.001 and -2.98 pg/mL, p < 0.001, respectively). CONCLUSION: Our results suggested that the weight-loss diet and probiotic yogurt had synergistic effects on T-cells subset specific gene expression in PBMCs, fat percentage, and body weight among overweight and obese individuals.

Determination of IL-23 receptor gene polymorphism in Iranian patients with ankylosing spondylitis.

INTRODUCTION: The result of recent genome-wide association studies revealed that, in addition to HLA-B27, a few non-HLA genes are associated with susceptibility to ankylosing spondylitis (AS) in Caucasian populations. According to these studies, IL-23R is one of the genes that is associated with AS. In this study, we evaluated five important single nucleotide polymorphisms (SNPs) of the IL-23R gene which confers susceptibility to AS, and its effects on the severity of the disease in HLA-B27 positive and negative patients and several subtypes of HLA-B27. MATERIALS AND METHODS: The study population consisted of 294 AS patients and 352 age-, sex-, and ethnicity-matched healthy controls. All patients were examined by rheumatologists, and met modified, New York criteria for the disease. Five SNPs (rs1004819, rs11209032, rs1495965, rs11465804, and rs1004819) of the IL-23R gene were genotyped using the Real-Time PCR TaqMan genotyping method. RESULTS: We found that only rs1004819 has a significant association with AS, and that the remaining four SNP alleles are not associated with AS. Also, there was no association between these five polymorphisms and BASDAI, BASFI, and BASMI indices. Two haplotypes, ACGAT and ACGAG, were found to be associated with the heritability of AS. In addition, two significant, protective diplotypes (D8, GCGAG/GTGGG ; and D9, ACGAG/GCGAG) were discovered. CONCLUSION: This study supported our previous findings regarding the differences between the genetic patterns of AS in Iranian patients compared with those in other parts of the world.

Attenuation of Hemodynamic Responses to Laryngoscopy and Tracheal Intubation: Propacetamol versus Lidocaine-A Randomized Clinical Trial.

The purpose of this study is to assess the effects of propacetamol on attenuating hemodynamic responses subsequent laryngoscopy and tracheal intubation compared to lidocaine. In this randomized clinical trial, 62 patients with the American Anesthesiologists Society (ASA) class I/II who required laryngoscopy and tracheal intubation for elective surgery were assigned to receive propacetamol 2 g/I.V./infusion (group P) or lidocaine 1.5 mg/kg (group L) prior to laryngoscopy. Systolic and diastolic blood pressures (SBP, DBP), mean arterial pressure (MAP), and heart rate (HR) were recorded at baseline, before laryngoscopy and within nine minutes after intubation. In both groups P and L, MAP increased after laryngoscopy and the changes were statistically significant (P < 0.001). There were significant changes of HR in both groups after intubation (P < 0.02), but the trend of changes was different between two groups (P < 0.001). In group L, HR increased after intubation and its change was statistically significant within 9 minutes after intubation (P < 0.001), while in group P, HR remained stable after intubation (P = 0.8). Propacetamol 2 gr one hour prior intubation attenuates heart rate responses after laryngoscopy but is not effective to prevent acute alterations in blood pressure after intubation.

The influence of mothers' lifestyle and health behavior on their children: an exploration for oral health.

BACKGROUND: Parents and teachers involvement reinforce health promotion programs for children's health. OBJECTIVES: The purpose of this study was to evaluate mothers' lifestyle behavior and its association with children's oral health. MATERIALS AND METHODS: The study was a cross sectional study on 383 children and their mothers who were selected from 6 primary schools in Tehran, Iran. Mothers and children who participated in this study were asked to complete a questionnaire containing demographic questions, knowledge of oral health, attitude towards the oral health behavior, and oral health behaviors. Furthermore, the Simplified Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI) were assessed by two calibrated dentists. Data were analyzed with multilevel mixed model analyses. RESULTS: The average age of the children and their mothers were 11.6 and 38.4 years, respectively. Mothers' higher knowledge, higher educational status, positive attitude, higher frequent oral health behaviors, lower DMFT and lower CPI were all associated significantly with children's higher oral health status. CONCLUSIONS: The results suggest that to improve children's oral health, educational interventions should focus on both children and mothers to obtain a more promising outcome.

Application of Gaussian Process Regression (GPR) in estimating under-five mortality levels and trends in Iran 1990 - 2013, study protocol.

BACKGROUND: Searching for the latest methods of estimating mortality rates is a major concern for researchers who are working in burden of diseases. Child mortality is an important indicator for assessing population health care services in a country. The National and Sub-national Burden of Diseases, Injuries, and Risk Factors (NASBOD) is conducted in Iran with comparative methods and definitions of Global Burden of Disease (GBD) 2010 to estimate major population health measures including child mortality rate. The need to have accurate and valid estimation of under-5 mortality rate led to apply more powerful and reliable methods. METHOD: The available datasets consist of under-five mortality rates from different sources including death registration systems and summary birth history (SBH) questions from censuses and Demographic Health Survey. These datasets are gathered at national and sub-national levels. We have five time series of under-five mortality rates from SBH method that each one contains 25-year time period. We also calculated Child mortality rates from death registration for 5 years. The main challenge is how to combine and integrate these different time series and how to produce unified estimates of child mortality rates during the course of study. By synthesizing the result of other models, Gaussian Process Regression (GPR) is used as the final stage for generating yearly child mortality rates in this study. GPR is a Bayesian technique that uses data information and defines several hierarchical prior parameters for model. In corporation of GPR and MCMC methods, predicted rates are updated using data and defined parameters in model. This method, also captures both sampling and non-sampling errors and provides uncertainty intervals. The existence of uncertainty for predicting mortality rate is one of the considerable advantages of GPR that distinguish it from other alternative methods. DISCUSSION: Estimating accurate and reliable child mortality rates at national and sub-national levels is one of the important parts of NASBOD project in Iran. Gaussian Process Regression with its special features improves achievement of this goal. GPR is a serious competitor for other supervised mortality predictive methods. This article aims to explain the application and preferences of GPR method in estimating child mortality rate.

Model for End stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores: Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions.

BACKGROUND: There are many patients awaiting liver transplantation with only few donors providing the organ. The Child-Turcotte-Pugh score (CTP) and the Model for End stage Liver Disease (MELD) are the most common scores for prioritizing patients on waiting lists. In this study, we compared the ability of these scores to predict mortality or removal from the waiting list due to poor medical conditions. METHODS: A total of 257 patients were included in our study and we observed their status in the waiting list over a 9-month period. MELD and CTP of the patients at the time of listing were calculated. We used both ROC-curve and Area Under the Curve (AUC) to calculate the predictive ability of these scores. RESULTS: During follow up, 22 patients died and 9 patients were removed from the waiting list due to poor medical conditions. Comparing the predictive ability of CTP and MELD, the AUC for CTP was larger than that of MELD (0.75 versus 0.69; P-value = 0.065). The best cutoff point for discriminating mortality or removal from the waiting list due to severe deterioration is 8 for CTP and 13.67 for MELD. The sensitivity and specificity was 0.74 and 0.67, respectively for CTP and 0.74 and 0.58, respectively for MELD. CONCLUSION: The CTP score can predict mortality or removal from the liver transplantation waiting list better than the MELD over a 9-month period. However, better improved models need to be developed for prioritization of patients in the waiting list.