Do the tuberculin skin test and the QuantiFERON-TB Gold in-tube test agree in detecting latent tuberculosis among high-risk contacts? A systematic review and meta-analysis

Erfan Ayubi,Amin Doosti-Irani,Ehsan Mostafavi 한국역학회 2015 Epidemiology and Health Vol.37 No.-

OBJECTIVES: The QuantiFERON-TB Gold in-tube test (QFT-GIT) and the tuberculin skin test (TST) are used to diagnose latent tuberculosis infection (LTBI). However, conclusive evidence regarding the agreement of these two tests among high risk contacts is lacking. This systematic review and meta-analysis aimed to estimate the agreement between the TST and the QFT-GIT using kappa statistics. METHODS: According to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, scientific databases including PubMed, Scopus, and Ovid were searched using a targeted search strategy to identify relevant studies published as of June 2015. Two researchers reviewed the eligibility of studies and extracted data from them. The pooled kappa estimate was determined using a random effect model. Subgroup analysis, Egger’s test and sensitivity analysis were also performed. RESULTS: A total of 6,744 articles were retrieved in the initial search, of which 24 studies had data suitable for meta-analysis. The pooled kappa coefficient and prevalence-adjusted bias-adjusted kappa were 0.40 (95% confidence interval [CI], 0.34 to 0.45) and 0.45 (95% CI, 0.38 to 0.49), respectively. The results of the subgroup analysis found that age group, quality of the study, location, and the TST cutoff point affected heterogeneity for the kappa estimate. No publication bias was found (Begg’s test, p=0.53; Egger’s test, p=0.32). CONCLUSIONS: The agreement between the QFT-GIT and the TST in diagnosing LTBI among high-risk contacts was found to range from fair to moderate.

Effect of maternal smoking during pregnancy on Tourette syndrome and chronic tic disorders among offspring: a systematic review and meta-analysis

( Erfan Ayubi ),( Kamyar Mansori ),( Amin Doosti-Irani ) 대한산부인과학회 2021 Obstetrics & Gynecology Science Vol.64 No.1

Current studies have controversial reports about the effect of maternal smoking during pregnancy (MSDP) on the risk of psychiatric disorders among offspring. The purpose of this systematic review and meta-analysis was to assess the effect of MSDP on the risk of Tourette syndrome (TS) and chronic tic disorders (CTD) among offspring. A systematic search using PubMed, Scopus, and Web of Science was conducted up to July 2019 to retrieve potential studies in English. Fixed and random-effects meta-analyses was performed to estimate pooled relative risk (RR) with 95% confidence interval (CI) according to heterogeneity. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Heterogeneity among studies was explored using the I² statistic. Of the 641 studies from the initial search, 7 were included in the quantitative synthesis (3 cohort and 4 case control studies). Overall, MSDP increased the risk of TS and CTD among the offspring by 35% (pooled RR, 1.35; 95% CI, 1.17-1.56; I²=45.8%; P-value=0.08). The results of this meta-analysis revealed that there is a significant association between MSDP and the risk of TS and CTD in offspring, and MSDP may be considered a potential risk factor for TS and CTD.

Spatial modeling of cutaneous leishmaniasis in Iranian army units during 2014-2017 using a hierarchical Bayesian method and the spatial scan statistic

Erfan Ayubi,Mohammad Barati,Arasb Dabbagh Moghaddam,Ali Reza Khoshdel 한국역학회 2018 Epidemiology and Health Vol.40 No.-

OBJECTIVES: This study aimed to map the incidence of cutaneous leishmaniasis (CL) in Iranian army units (IAUs) and to identify possible spatial clusters. METHODS: This ecological study investigated incident cases of CL between 2014 and 2017. CL data were extracted from the CL registry maintained by the deputy of health of AJA University of Medical Sciences. The standardized incidence ratio (SIR) of CL was computed with a Besag, York, and Mollié model. The purely spatial scan statistic was employed to detect the most likely high- and low-rate clusters and to obtain the observed-to-expected (O/E) ratio for each detected cluster. The statistical significance of the clusters was assessed using the log likelihood ratio (LLR) test and Monte Carlo hypothesis testing. RESULTS: A total of 1,144 new CL cases occurred in IAUs from 2014 to 2017, with an incidence rate of 260 per 100,000. Isfahan and Khuzestan Provinces were found to have more CL cases than expected in all studied years (SIR>1), while Kermanshah, Kerman, and Fars Provinces were observed to have been high-risk areas in only some years of the study period. The most significant CL cluster was in Kermanshah Province (O/E, 67.88; LLR, 1,200.62; p<0.001), followed by clusters in Isfahan Province (O/E, 6.02; LLR, 513.24; p<0.001) and Khuzestan Province (O/E, 2.35; LLR, 73.71; p<0.001), while low-rate clusters were located in the northeast areas, including Razavi Khorasan, North Khorasan, Semnan, and Golestan Provinces (O/E, 0.03; LLR, 95.11; p<0.001). CONCLUSIONS: This study identified high-risk areas for CL. These findings have public health implications and should be considered when planning control interventions among IAUs.

Association between maternal smoking during pregnancy and risk of bone fractures in offspring: a systematic review and meta-analysis

Ayubi, Erfan,Safiri, Saeid,Mansori, Kamyar The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.3

This study aimed to investigate the effect of maternal smoking during pregnancy (MSDP) on the risk of bone fractures in the offspring through a systematic review and meta-analysis. The PubMed, Web of Science, and Scopus databases were systematically searched for relevant articles published through July 2019. According to heterogeneity, the pooled risk ratio (RR) and odds ratio (OR) and their corresponding 95% confidence interval (CI) were obtained using fixed or random effects models. The heterogeneity and quality of the included studies were assessed by the I-squared (I²) statistic and the Newcastle-Ottawa scale, respectively. Sensitivity analyses were performed to test the effect of MSDP misclassification on the results. The review of 842 search records yielded 5 studies including 8,746 mother-child pairs that were included in the meta-analysis. Pooling adjusted effect measures showed that MSDP was not associated with a later risk of bone fractures in the offspring (pooled RR, 1.15; 95% CI, 0.84-1.58; I²=66.8%; P=0.049). After the adjustment for misclassification, MSDP may be associated with a 27% increased risk of bone fracture (pooled OR, 1.27; 95% CI, 1.00-1.62; I²=0%; P=0.537). After the adjustment for misclassification, MSDP is associated with an increased risk of bone fractures among children whose mothers smoked during pregnancy.

Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic

Erfan Ayubi,Mohammad Ali Mansournia1,Ali Ghanbari Motlagh,Alireza Mosavi-Jarrahi,Ali Hosseini,Kamran Yazdani 한국역학회 2017 Epidemiology and Health Vol.39 No.-

OBJECTIVES: The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran. METHODS: The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters. RESULTS: There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p〈0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p〈0.001). CONCLUSIONS: Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.

Factors associated with in-hospital death in patients with nosocomial infections: a registry-based study using community data in western Iran

Salman Khazaei,Erfan Ayubi,Ensiyeh Jenabi,Saeid Bashirian,Masud Shojaeian,Leili Tapak 한국역학회 2020 Epidemiology and Health Vol.42 No.-

OBJECTIVES: Determining the predictors of in-hospital death related to nosocomial infections is an essential part of efforts made in the overall health system to improve the delivery of health care to patients. Therefore, this study investigated the predictors of in-hospital death related to nosocomial infections. METHODS: This registry-based, longitudinal study analyzed data on 8,895 hospital-acquired infections (HAIs) in Hamadan Province, Iran from March 2017 to December 2019. The medical records of all patients who had been admitted to the hospitals were extracted from the Iranian Nosocomial Infections Surveillance Software. The effects of the type and site of infection, as well as age group, on in-hospital death were estimated using univariate and multivariable Cox regression models. RESULTS: In total, 4,232 (47.8%) patients with HAIs were males, and their mean age was 48.25±26.22 years. In both sexes, most nosocomial infections involved Gram-negative bacteria and the most common site of infection was the urinary tract. Older patients had a higher risk of in-hospital death (adjusted hazard ratio [aHR], 2.26; 95% confidence interval [CI], 1.38 to 3.69 for males; aHR, 2.44; 95% CI, 1.29 to 4.62 for females). In both sexes, compared with urinary tract infections, an increased risk of in-hospital death was found for ventilator-associated events (VAEs) (by 95% for males and 93% for females) and bloodstream infections (BSIs) (by 67% for males and 82% for females). CONCLUSIONS: We found that VAEs, BSIs, and fungal infections were independently and strongly associated with increased mortality.

Association between previous abortion history and risk of autism spectrum disorders among offspring: a meta-analysis

Jenabi Ensiyeh,Ayubi Erfan,Bashirian Saeid,Seyedi Mahdieh,Rezaei Mohammad 대한소아청소년과학회 2023 Clinical and Experimental Pediatrics (CEP) Vol.66 No.2

Background: Previous studies have been showed an association between previous abortion history and risk of Autism spectrum disorders (ASD). However, there is still controversy about true effect estimate of the association.Purpose: This meta-analysis aimed to evaluate the association between previous abortion history and the risk of ASD.Methods: A systematic search was performed using PubMed, Scopus, and Web of Sciences databases to identify potential studies published until December 2021. The presence of statistical heterogeneity was determined using the <i>I²</i> value. In the case of substantial heterogeneity, the random-effects model meta-analysis was used to estimate the pooled relative risks. The publication bias was assessed using the Egger and Begg tests.Results: Thirteen studies with a total of 331,779 children remained in the present meta-analysis. The estimated odds ratio of the risk of ASD associated with previous abortion history was 1.64 (95% confidence interval [CI], 1.28–2.0; <i>I²</i>=61.7%) in adjusted studies and 1.10 (95% CI, 1.01–1.20; <i>I²</i>=0.0%) in crude studies, based on the random effect model. There was moderate heterogeneity in adjusted studies. The p values for Egger and Begg regression among children with ASD were 0.393 and 0.056, respectively.Conclusion: This meta-analysis suggests that children born from mothers with a history of previous abortion have an increased risk of development of ASD compared to children of mothers without a history of previous abortion.

Determination of maternal risk factors of preterm delivery: adjusted for sparse data bias; results from a population-based case-control study in Iran

( Mehrdad Valipour ),( Erfan Ayubi ),( Narges Shiravand ),( Yousef Moradi ),( Abolfazl Abbaszadeh ),( Firooz Amrai ),( Shahin Mokhtari ),( Kaveh Bahmanpour ),( Kamyar Mansori ) 대한산부인과학회 2020 Obstetrics & Gynecology Science Vol.63 No.2

Objective To determine the maternal risk factors associated with preterm delivery in Iran. Methods A population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models. Results Multivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60-127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01-0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78-1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20-85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03-0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80-0.92). Conclusion Our study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Is meconium exposure associated with autism spectrum disorders in children?

Jenabi, Ensiyeh,Ayubi, Erfan,Khazaei, Salman,Bashirian, Saeid,Khazaei, Mojtaba The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.7

Background: The results differ among published studies regarding exposure to meconium and the risk of developing autism spectrum disorders (ASDs). Purpose: The present study pooled all of the epidemiologic studies retrieved from broader databases on the association between meconium exposure and risk of developing ASD in children. Methods: The Web of Science, PubMed, Scopus, and Google Scholar databases were searched without language restrictions for articles published between their inception to February 20, 2020, using relevant keywords. The pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated as random-effect estimates of the associations among studies. A subgroup analysis was conducted to explore any potential sources of heterogeneity among studies. Results: The pooled estimate of OR reported a weakly significant association between meconium exposure and ASD development in children (OR, 1.13; 95% CI, 1.03-1.24). There was low heterogeneity among the articles reporting risk for ASD among children (I²=19.3%; P=0.259). The results of subgroup analysis based on meconium exposure showed a significant association between a meconium-stained neonate and ASD development (OR, 1.18; 95% CI, 1.11-1.24). Couclusion: Meconium exposure was weakly associated with an increased risk of ASD. However, more evidence based on large prospective cohort studies is required to provide conclusive evidence about whether meconium exposure is associated with an increased risk of ASD development.

Neonatal risk factors associated with attention-deficit/hyperactivity disorder: an umbrella review

Sajjad Farashi,Ensiyeh Jenabi,Erfan Ayubi,Saeid Bashirian,Fereshteh Mehri 대한소아청소년과학회 2023 Clinical and Experimental Pediatrics (CEP) Vol.66 No.10