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Introduction: Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specially in Iran. An accurate assessment of the incidence of coronary heart disease (CHD) is very important for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years follow-up. Methods: The population of MASHAD cohort study were followed up for 6 years, every 3 years initially by phone and those who reported symptoms of cardiovascular disease (CVD) were asked to attend for a cardiac examination. An estimate of the incidence of CHD was determined with 95% confidence interval (95% CI) and multiple logistic regression analysis was performed to assess the association of several baseline characteristics with the incidence of a CHD event. Evaluation of goodness-of-fit was undertaken using ROC analysis. CHD cases were divided into four different categories: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results: In the six years of follow-up of the Mashhad study participants, the incidence density of CHD events in men and women in 1000 person-year with 95% confidence intervals were 19.20 (8.10-30.30) and 11.60 (7.30-15.90), respectively. The areas under ROC curve (AUC), based on multiple logistic regression model of CHD outcome, was determined to be 0.783. Conclusion: Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age, and our final model was able to predict approximately 78% of CHD events in this Iranian population.

Introduction: People with diabetes often develop diverse microvascular, macrovascular, and neuropathic complications. Diabetes named high disease because of its high prevalence, high incidence, chronicity and high costs. Accurate projections of diabetes burden are essential for health planning so the aim of this study was to calculate the burden of diabetes in Razavikhorasan population, in Iran. Methodology: We used Disability Adjusted Life Years (DALYs) index using computer model (DisMod) for assessment of burden of diabetes and complications in Razavikhorasan province in Iran in year 2010-2011. Results: Burden of diabetes in Razavikhorasan population was 64,733 DALY in year 2010-2011. The total Years Life Lost (YLL) from diabetes mellitus was 62,883 (34,216 in men and 28,667 in women) due to premature death and the total Years Life Disability (YLD) was 1850. Conclusion: Diabetes mellitus and lesser forms of glucose intolerance can now be found in almost every population and epidemiological evidences suggest that, without effective prevention and control programs, diabetes will continue to increase and therefore advances in all levels of prevention may help reduce the number of people with diabetes.

Background: Cancer is one of the most important leading causes of morbidity and mortality worldwide. Objectives: This study aimed to calculate the burden of 9 common cancers in the population covered by Mashhad University of Medical Sciences in Iran in 2010-2011. Patients and Methods: We calculated disability adjusted life years (DALYs ) for each of nine cancers according to the sex and age groups of (0-4, 5-14, 15-29, 30-44, 45-59, 60-69, 70-79, and ≥ 80 years) using disease modeling (DisMod) version II software. The population-based data used in this study is mostly from cancer registries. The final estimates for the survival time were derived by combining several information sources. We applied r = 0.03 discounting and β = 0.04 age weighting. In our study, the standard life expectancy considered 80 years for men and 82.5 for women. Results: This study shows that the most years life lost (YLL) related to gastric, leukemia and lung cancers are 10116, 9564 and 7061 respectively. Cancers with the most years lost due to disability (YLD) were breast, brain and esophageal cancers (594, 506 and 460). The most DALY related to gastric, leukemia and lung cancers (10516, 9803 and 722). The maximum DALY was for breast cancer (1550) seen in women aged 30-44 years old. Conclusions: It can be concluded that the YLL (93%) has a major role in the burden of diseases in developing countries. Better strategies for improving the prevention and screening program are really needed in developing countries.

Physicians often do not use the International Classification of Headache Disorders (ICHD-II) for diagnosis of migraine in their routine clinical practice. The diagnosis of headache subtypes in 453 patients was made by headache experts according to the ICHD-II and the likelihood ratios (LR) of clinical characteristics of migraine were calculated in Part I of the study. Asian headache specialists designed the Asian Migraine Criteria (AMC) based on these LR and their experience. In Part II of the study, another group of 500 patients with headache were evaluated by a family physician, based on the AMC. Thereafter the headache experts, who were blinded to the diagnosis of these patients based on the AMC, re-evaluated them according to the ICHD-II. The AMC consists of seven items: (i) unilateral location; (ii) throbbing quality; (iii) nausea and/or vomiting; (iv) photophobia and/or sonophobia; (v) osmophobia; (vi) family history of migraine; and (vii) aura. In the AMC the presence of at least three items in adults and at least two items in children is necessary for the detection of definite migraine. The AMC had a sensitivity 99.3%, specificity 84.5%, positive predictive value (PPV) 96.9%, negative predictive value (NPV) 96.1% and validity of 96.8% for diagnosis of adult migraine compared to the ICHD-II as the gold standard. The AMC had a sensitivity 93.5%, specificity 46.8%, PPV 69.9%, NPV 86.6% and a validity of 73.4% for detection of childhood migraine against the ICHD-II. The AMC was shown to be a highly valid and reliable tool for screening of adult migraine by non-neurologists. AMC was shown to be moderately valid for detection of pediatric migraine.

Abstract INTRODUCTION: Ischemic stroke is rarely seen in childhood. The pediatric causes of stroke are very different from adult causes. methods: This population-based study was conducted to determine the incidence, clinical manifestations and etiology of pediatric ischemic stroke in Southern Khorasan, Iran, during 2002-2007. In this province, every child with possible diagnosis of stroke is referred to a stroke neurologist and routinely admitted to the Pediatric Division of Vali-e-Asr tertiary care hospital. The diagnosis of ischemic stroke was made based on the clinical presentation and brain imagery. All of the patients underwent a standard battery of diagnostic investigations. results: Seventeen children with ischemic stroke (7 girls, 10 boys) were evaluated. The incidence of pediatric ischemic stroke in Khorasan province is 1.8 cases per 100,000 children population per year. Meningoencephalitis-induced vasculopathy constituted 23.5% of the etiology followed by Fallot tetralogy, head trauma, dehydration, migraine, and hypercoagulable state. 23.5% of our patients had uncertain causes of stroke. In-hospital mortality of our pediatric ischemic stroke patients was 11.7%. CONCLUSIONS: The incidence and clinical characteristics of pediatric brain infarction in Iran are the same as in other studies. Meningoencephalitis-induced vasculopathy is the most common determined etiology of pediatric ischemic stroke in Southern Khorasan. Keywords: Child, stroke, incidence, etiology.

The hospital-based stroke registry is useful for understanding diverse clinical characteristics of stroke related to geographical, racial, or environmental differences.The Khorasan Stroke Registry was established for evaluation of incidence, clinical manifestations, risk factors, topography, and etiology of ischemic stroke in Southern Khorasan, Iran, during 2001 - 2005. Consecutive stroke patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Topography and etiology of brain infarction was determined based on the Practical Iranian Criteria classification.The incidence of ischemic stroke in Khorasan population is 43.17 cases per 100,000 people per year. During a 5-year period 1,392 ischemic stroke patients (738 females, 654 males) were evaluated in the Khorasan Stroke Registry. Atherosclerosis constituted 53.6% of etiologies followed by uncertain causes (19.9%), cardioembolism (11.8%), and miscellaneous etiologies (2.9%). Eleven point seven percent of our patients had both atherosclerosis and cardioembolic mechanisms. Rheumatic valvular disease was present in 44.8% of cardioembolic strokes and caused 4.31 preventable stroke cases per 100,000 Iranian population per year. Hypertension and history of ischemic cerebrovascular events were the most frequent risk factors, 53.1% and 22.3% respectively. In-hospital mortality of our ischemic stroke patients was 7.3%.High frequency of atherosclerotic etiology in the Khorasan Stroke Registry is because of its classification criteria, which does not separate small vessel territory infarcts as a different etiologic subtype. Rheumatic valvular disease is an important cause of stroke in Khorasan population.

Stroke in young adults causes morbidity in this socioeconomically-active age group. Etiologic frequency of ischemic stroke in young adults is different around the world. This study was conducted to determine the causes of stroke in Iranian young adults.The study population consisted of 314,000 young adult residents in the Southern Khorasan Province, East of Iran. All the patients with stroke, admitted to Vali-e-Asr Tertiary Care Hospital, entered this study. Demographic data, clinical presentation, and investigations of consecutive patients aged 15 - 45 years, presented with ischemic stroke, were registered in Southern Khorasan Stroke Database between 2000 and 2005. All the patients underwent a standard battery of diagnostic investigations by a stroke neurologist. Etiologic classification of stroke in the patients was made based on the Practical Iranian Criteria.One hundred and twenty-four patients (60 females and 64 males) were prospectively investigated during a 5-year period. The incidence of ischemic stroke in young adults was 8/100,000 per year. Cardioembolic mechanism constituted 54% of all stroke etiologies in young adults. Rheumatic valvular heart disease was present in 32% of the patients and caused 2.5 preventable stroke cases per 100,000 young adults per year.Rheumatic valvular heart disease is the most common cause and a preventable etiology of stroke in Iranian young adults.