Objective
Febrile seizure (FS) as the most common form of seizures in childhood, affects 2-5% of all children across the world. The present study reviews available reports on FS recurrence frequency and evaluates its associated risk factors in Iran.Methods
We searched the Persian database such as: SID, MagIran, Medlip, Irandoc, Iranmedex as well as English databases PubMed, ISI, and Scopus. Random effects models were used to calculate 95% confidence intervals. Meta regression was introduced to explore the heterogeneity between studies.Findings
The overall FS recurrence rate was 20.9% [95% confidence interval (CI): 12.3-29.5%]. The frequency of FS simple and complex types was 69.3% (95% CI: 59.5-79.0) and 25.3% (95% CI: 19.6-31.0), respectively. A positive familial history of 28.8% (95% CI: 19.3-38.4%) was observed for childhood FS including 36.2% (95% CI: 27.3-39.6%) for the simple and 29.4% (95% CI: 23.1-33.5%) for the complex type. The heterogeneity of recurrent FS was significantly affected by sample size (P=0.026).Conclusion
Almost one-third of FS children had a positive familial history. The increased risk of recurrence in patients with symptomatic seizures needs to be fully considered by parents, physicians, nurses and health policy makers. 相似文献Background
The aim of this study is to evaluate the prognostic factors of overall survival (OS) after haematopoietic stem cell transplant (HSCT) in acute lymphoblastic leukaemia (ALL) patients using accelerated failure time (AFT), Cox proportional hazard (PH), and Cox time-varying coefficient models.Methods
206 patients were enrolled after HSCH in Shariati Hospital between 1993 and 2007. There was evidence of marked departures from the proportional hazards assumption with two prognostic factors, relapse and chronic graft-versus-host disease (cGVHD) (P < .001). Performance among AFT and Cox''s models was assessed using explained variation and goodness of fit methods. Discrimination among the exponential, Weibull, generalized gamma (GG), log-logistic, and lognormal distributions was done using maximum likelihood and Akaike information criteria.Results
The 5-year OS was 52% (95%CI: 47.3–56.7). Peak mortality hazard occurred at months 6–7 after HSCT followed by a decreasing trend. In univariate analysis, the data was better fitted by GG distribution than by other distributions. Univariate analysis using GG distribution showed a positive association between OS with acute graft-versus-host disease (aGVHD) (P = .021), no relapse (P < .001), cGVHD (P < .001), neutrophil recovery (P < .001) and platelet recovery (P < .001). Based on Cox PH models; however cGVHD and relapse were the predictive factors of OS (P < .001). Multivariate analysis indicated that, OS is related to relapse (P < .001) and platelet recovery (P = .037), where predictive power of Weibull AFT models was superior to Cox PH model and Cox with time-varying coefficient (R2 = 0.46 for AFT, R2 = .21 for Cox PH and R2 = .34 for Cox time-varying coefficient). Cox-Snell residual shows Weibull AFT fitted to data better than other distributions in multivariate analysis.Conclusion
We concluded that AFT distributions can be a useful tool for recognizing prognostic factors of OS in acute lymphoblastic leukemia patients. 相似文献Introduction
Preeclampsia is a major cause of maternal and prenatal mortality and morbidity worldwide. There are some risk factors that are of great value for prediction of preeclampsia by which the practitioners can counsel women regarding this disease. The aim of this study was to analyze the role of such risk factors as the predictors associated with preeclampsia among Iranian women using logistic regression.Material and methods
The role of some risk factors such as demographic, anthropometric, medical and obstetrics variables in preeclampsia among 610 women attending the obstetric ward of Mustafa hospital in Ilam in the west of Iran was analyzed from May to September 2010. All the pregnant women referred to this hospital participated in the study except those cases that had abortion. Unvaried and Multiple logistic regression analyses were used to find the predictive factors behind preeclampsia. Standard errors of area compute using nonparametric methods. A p-value of 0.05 was considered statistically significant.Results
Prevalence of preeclampsia was 9.5% (95% CI 7.4–11.6%). Predictive model build using history of preeclampsia, history of hypertension, and history of infertility. Area Under the Receiver Operation Character (AUROC) was estimated 0.67 (95% CI 0.59–0.67, p < 0.01) that showed that using the model is much better than having a guess.Conclusions
The odd of preeclampsia increased in women with a history of preeclampsia, hypertension and infertility. Recognition of these predictor factors would improve the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions. 相似文献Methods: This was a systematic review and meta-analysis study. All studies conducted in Iran were extracted between 2000 and 2016 during a search in internal and external databases of Medlib, Medline, Pubmed, Web of Science, Google Scholar, Scopus, Magiran, SID, Cochrane, Irandoc, and all articles published. Then, the required data were entered into the Spss16 software (SPSS Inc., Chicago, IL); and the model of fixed and random effects was analyzed in meta-analysis, Cochran, meta-regression using statistical tests.
Results: A total of 30 studies with a sample size of 928,311 patients were enrolled. Baby’s gender (1–1.55: CI95%) OR: 1.25, preterm delivery (1.71–3.69: CI 95%) OR: 2.51, low birth weight (1.13–2.67: CI95%) OR: 1.74, age older than 35 for the pregnant mother (1.41–6.3: CI 95%) OR: 2.98, multiple births (1.14–3.46: CI 95%) OR: 1.99, mother suffering from chronic diseases (1.68–3.31: CI 95%) OR: 2.36 are significantly related with the risk of congenital malformations.
Conclusion: Based on the results the baby’s gender, premature birth, low birth weight, mother’s age, consanguineous marriages, multiple births, family history of congenital malformations, and the risk of chronic diseases in the mother during pregnancy increase the birth of children with congenital malformations. As a result, control or modification of the above factors implementing a health and education intervention program can reduce the birth of children with congenital malformations. 相似文献
Objective:
Unrecognized congenital hypothyroidism (CH) leads to mental retardation. Newborn screening and thyroid therapy started within 2 weeks of age can normalize cognitive development. In this systematic review, the local results of the national CH screening program in different provinces in Iran are reviewed and evaluated.Methods:
Literature on the CH screening, the national databases including SID, Medlib, Iran Medex, Magiran as well as international databases including PubMed/Medline, ISI Web of Knowledge and web of science, EMBASE, SCOPUS and Google Scholar. Appraisal was guided by a checklist assessing clarity of aims and research questions. The 95% confidence intervals were calculated by I-square models. Meta regression was introduced to explore the heterogeneity between studies.Findings:
We identified 25 samples including 1425124 neonates in our country. Data were Meta analyzed using random-effects models, and we found a TSH levels of 19633 babies in the first sampling were greater than the cut-off level (TSH ≥5mIU/L). The pooled recall rate was 0.014 (95 % CI: 0.013 – 0.015). According to Meta analysis the overall incidence of CH was 2/1000 (95% CI: .002 – .002). The incidence of CH did not appear to be increasing over time (P=0.08).Conclusion:
Considering TSH ≥5mIU/L as a cut-off point for recalling neonates and low positive predictive value (14%) of this point shows that more investigation and research is needed for establishing accurate level of TSH as a criterion for recalling patients. 相似文献Graft-versus-host disease (GVHD) is an exaggerated and dysregulated response of the normal immune system to tissue damage that is intrinsic to transplantation. The aim of this study was to assess the effects of acute GVHD (aGVHD) and chronic GVHD (cGVHD) according to relapse status on the survival rate in patients with acute lymphocytic leukemia (ALL).
Methods
Patients with ALL (n = 425) between 1991 and 2011, who underwent bone marrow transplantation and stem cell transplantation in Tehran (Iran), were recruited into a longitudinal study. All patient records were screened for the occurrence of adverse events including GVHD and relapse. Data were assessed using SPSS software with log-rank, univariate, and multivariate Cox regression analyses.
Results
Five-year survival rate based on a Kaplan–Meier curve was 60.2% overall (95% confidence interval (CI): 54.32–66.08) and 66.6% (95% CI: 59.35–73.86) for individuals in their first complete remission (CR1) disease stage. A significantly higher survival rate was observed for patients who developed cGVHD in comparison with those who did not develop it, with a 2.7 fold increased risk of mortality for the latter group (P < 0.001). A significant Cox proportional hazard ratio of 2.3 was observed for mortality following adjustments for age and gender. The presence of cGVHD, reduced the risk of mortality for all individuals, which was observed to be significant for those patients without relapse (P = 0.004).
Conclusion
This study is one of the largest studies (regarding the number of participants) done to date in the Middle East with quite a long duration (20 years). Findings suggest that cGVHD has a positive influence on the survival rates for ALL patients, which subsequently may assist physicians to make optimal treatment decisions. Additional research is now needed to determine the mechanisms around this increased survival and its influence on patients’ survival. 相似文献
Background Improving the survival of patients diagnosed with metastatic colorectal cancer requires the use of chemotherapy to be managed with minimum adverse effects. Randomized control trials (RCTs) have shown promising results with a combination of bevacizumab and erlotinib to block two important tumor growth pathways, namely vascular endothelial growth factor and epidermal growth factor receptor. Aim of the Review We aimed to examine the efficacy and safety of the combination of bevacizumab and erlotinib with bevacizumab alone in the maintenance treatment of metastatic colorectal cancer, by examining PFS, OS, overall response rate (ORR), and toxicity. This study performed a systematic review meta-analysis using existing randomized clinical trial. Methods Randomized controlled trials were systematically reviewed from PubMed, Cochrane library, SCOPUS, CRD, and Google scholar databases. After evaluating the quality of studies through the Cochrane checklist, data of the relevant studies were extracted. This meta-analysis included outcomes of overall survival, progression-free survival of the disease through the hazard ratio, and the upper and lower confidence intervals for the third and fourth degree side effects of relative risk. To perform the meta-analysis for both types of survival, two fixed and random effect models were used. Results A total of three trials, providing data of 682 patients who received maintenance treatment, were included in this meta-analysis. Conclusion The combination of bevacizumab and erlotinib significantly increased the overall survival compared to using bevacizumab alone [HR?=?0.78, 95% CI 0.66–0.93]. This combination, effectively increased progression-free survival [HR?=?0.81, 95% CI 0.7–0.93] too. The side effects of diarrhea and grade III rash were more frequent in the group administered bevacizumab plus erlotinib. The combination of bevacizumab and erlotinib, in the maintenance treatment of metastatic colorectal cancer, significantly improved the overall survival and progression-free survival of patients, and the resulting side effects were easily treatable.
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