Incidence In Iran Research Articles

Projection of the prevalence of tracheal, bronchus, and lung cancer incidence using cigarette smoking prevalence in Iran from 1990 to 2018: a comparison of latent period-based models with standard forecasting models

BackgroundSmoking is the major risk factor for tracheal, bronchus, and lung (TBL) cancers. We investigated the feasibility of projecting TBL cancer incidence using smoking incidence rates by incorporating a range of latent periods from the main risk factor exposure to TBL cancer diagnosis.MethodsIn this ecological study, we extracted data on TBL cancer incidence rates in Iran from 1990 to 2018 from the Global Burden of Disease (GBD) database. We also collected data on Iranian cigarette smoking patterns over the past 40 years through a literature review. The weighted average smoking incidence was calculated using a fixed-effects model with Comprehensive Meta-Analysis (CMA) software. Using these data, the five-year TBL cancer incidence in Iran was projected through time series modeling with IT Service Management (ITSM) 2000 software. A second model was developed based on cigarette smoking incidence using linear regression with SPSS (version 22), incorporating different latent periods. The results of these two models were compared to determine the best latent periods.ResultsAn increasing trend in TBL cancer incidence was observed from 2019 to 2023 (first model: 10.30 [95% CI: 9.62, 10.99] to 11.42 [95% CI: 10.85, 11.99] per 100,000 people). In the second model, the most accurate prediction was obtained with latent periods of 17 to 20 years, with the best prediction using a 17-year latent period (10.13 to 11.40 per 100,000 people) and the smallest mean difference of 0.08 (0.84%) per 100,000 people using the standard forecasting model (the ARIMA model).ConclusionProjecting an increase in TBL cancer incidence rates in the future, an optimal latent period of 17 to 20 years between exposure to cigarette smoke and TBL cancer incidence has implications for macrolevel preventive health policymaking to help reduce the burden of TBL cancer in upcoming years.

Latest Developments in Early Detection and Effective Treatment of Cancer: A Meeting Report.

Despite a lower estimated rate of cancer incidence in Iran compared to the global average, the trend is unfortunately increasing. This necessitates the implementation of early detection of cancer and targeted therapies to effectively treat various types of cancer. Therefore, the 5th "International Royan Cancer Conference: From Bench to Bedside" was held to focus on critical cancer-related aspects such as gene- and cell therapy, immunotherapy, oligonucleotides in cancer treatment, biosensors for detection, and drug delivery. The 2-day conference took place in February 2024 at the Royan Institute, Tehran. This collaborative effort brought together experts from both basic and clinical research fields. The primary objective of the conference was to address clinical challenges and harness the potential of basic sciences for early cancer diagnosis and treatment, with a robust emphasis on ethical considerations. The conference aimed to ensure optimal patient care while advancing scientific understanding in the field and facilitating effective research collaborations among researchers and enthusiasts dedicated to combating cancer.

Comparing Spatial Ecological Regression Models in Breast Cancer Incidence in Iran

Comparing Spatial Ecological Regression Models in Breast Cancer Incidence in Iran

Bayesian estimation of the time-varying reproduction number for pulmonary tuberculosis in Iran: A registry-based study from 2018 to 2022 using new smear-positive cases

IntroductionTuberculosis (TB) is one of the most prevalent infectious diseases in the world, causing major public health problems in developing countries. The rate of TB incidence in Iran was estimated to be 13 per 100,000 in 2021. This study aimed to estimate the reproduction number and serial interval for pulmonary tuberculosis in Iran. Material and methodsThe present national historical cohort study was conducted from March 2018 to March 2022 based on data from the National Tuberculosis and Leprosy Registration Center of Iran's Ministry of Health and Medical Education (MOHME). The study included 30,762 tuberculosis cases and 16,165 new smear-positive pulmonary tuberculosis patients in Iran. We estimated the reproduction number of pulmonary tuberculosis in a Bayesian framework, which can incorporate uncertainty in estimating it. Statistical analyses were accomplished in R software. ResultsThe mean age at diagnosis of patients was 52.3 ± 21.2 years, and most patients were in the 35–63 age group (37.1%). Among the data, 9121 (56.4%) cases were males, and 7044 (43.6%) were females. Among patients, 7459 (46.1%) had a delayed diagnosis between 1 and 3 months. Additionally, 3039 (18.8%) cases were non-Iranians, and 2978 (98%) were Afghans. The time-varying reproduction number for pulmonary tuberculosis disease was calculated at an average of 1.06 ± 0.05 (95% Crl 0.96–1.15). ConclusionsIn this study, the incidence and the time-varying reproduction number of pulmonary tuberculosis showed the same pattern. The mean of the time-varying reproduction number indicated that each infected person is causing at least one new infection over time, and the chain of transmission is not being disrupted.

Colorectal Cancer Incidence in Iran Based on Sex, Age, and Geographical Regions: A Study of 2014-2017 and Projected Rates to 2025.

While there has been extensive research on colorectal cancer (CRC) incidence and its associated factors in Iran, a significant gap exists in studies predicting its future trends. Our study aimed to thoroughly report CRC incidence across Iran from 2014 to 2017, by sex, age, and geographical regions, and provide a projection for 2025. This retrospective study utilized data from the Iranian National Population-based Cancer Registry (INPCR). Patients with the International Classification of Diseases for Oncology, 3rd Edition (ICD-O-3) codes C18 to C21 were included. The age-standardized incidence rate (ASR), was calculated per 100000 individuals annually, and crude incidence rates were retrieved for various demographic groups and years. Between 2014 and 2017, a total of 43580 new CRC cases (55.96% males) were registered. Men exhibited an ASR of 134.45, while women's ASR was 94.85. The highest ASRs were observed in Tehran, Qom, and Ilam (18.99, 18.26, and 18.06, respectively). Incidence rates surpassed 20 after age 50 for both genders, reaching their peak within the 80-84 age group. Adenocarcinoma was the most frequent histological type of CRC in nearly all provinces. Case numbers and ASRs are projected to continuously rise until 2025, with a predominance of male cases. The anticipated increase in CRC incidence in Iran emphasizes the need for additional studies to better identify risk factors. Furthermore, implementing screening programs is recommended for individuals at a higher risk of CRC, including men, the elderly population, and those residing in regions with a notable prevalence of CRC.

Application of Rodenticides for the Control of Zoonotic Cutaneous Leishmaniasis in Iran: A Systematic Review of the Literature

Introduction: Rodent control programs have a long history of controlling zoonotic cutaneous leishmaniasis (ZCL) in Iran. The present systematic review reports the effect of rodenticides in reducing ZCL in Iran. Materials and Methods: Various electronic databases were explored for reliable research using appropriate keywords between January 1970 and September 2023. Relevant studies were included based on the inclusion criteria. All articles identified from the systematic search were added into Endnote X9 (Clarivate Analytics) and duplicate articles were removed. This study followed standard procedures for systematic reviews and reported results according to systematic reviews guidelines. Results: Overall, 637 documents were identified after screening based on the PRISMA checklist, and finally, 13 papers were included in this systematic review. The findings indicated that most of studies used zinc phosphide (2.5%) and Klerat® mixed with wheat grains in rodents control programs in Iran. The results showed that rodent control programs were implemented in five provinces of Iran, including Esfahan, Yazd, Semana, Golestan, Kermanshah, and Fars, with the highest number of studies in Esfahan province. According to results, the incidence rate of ZCL significantly reduced after rodenticide implementation. Conclusion: This review study provides a better understanding of rodent control programs trends as a promising and practical approach to reducing ZCL incidence in Iran over the past 50 years and can serve as a reference for planning future control and research programs.

Cancer patterns in Iran: a gender-specific spatial modelling of cancer incidence during 2014–2017

BackgroundCancer is a significant public health concern and the second leading cause of death. This study aims to visualize spatial patterns of top common cancer types and identify high-risk and low-risk counties for these cancers in Iran from 2014 to 2017.MethodsIn this study, we analyzed 482,229 newly diagnosed cancer cases recorded by the Iranian National Population-Based Cancer Registry from 2014 to 2017. We employed a purely spatial scanning model and local Moran I analysis to explore spatial patterns across Iran.ResultsApproximately 53% of all cases were male. The average age of cancer diagnosis was 62.58 ± 17.42 years for males and 56.11 ± 17.33years for females. Stomach cancer was the most common cancer in men. The northern and northwestern regions of Iran were identified as high-risk areas for stomach cancer in both genders, with a relative risk (RR) ranging from 1.26 to 2.64 in males and 1.19 to 3.32 in females. These areas recognized as high-risk areas for trachea, bronchus, and lung (TBL) cancer specifically in males (RR:1.15–2.02). Central regions of Iran were identified as high-risk areas for non-melanoma skin cancers in both genders, ranking as the second most common cancer (RR:1.18–5.93 in males and 1.24–5.38 in females). Furthermore, bladder cancer in males (RR:1.32–2.77) and thyroid cancer in females (RR:1.88–3.10) showed concentration in the central part of Iran. Breast cancer, being the most common cancer among women (RR:1.23–5.54), exhibited concentration in the northern regions of the country. Also, northern regions of Iran were identified as high-risk clusters for colon cancer (RR:1.31–3.31 in males and 1.33–4.13 in females), and prostate cancer in males (RR:1.22–2.31). Brain, nervous system cancer, ranked sixth among women (RR:1.26–5.25) in central areas.ConclusionsThe study's revelations on the spatial patterns of common cancer incidence in Iran provide crucial insights into the distribution and trends of these diseases. The identification of high-risk areas equips policymakers with valuable information to tailor targeted screening programs, facilitating early diagnosis and effective disease control strategies.

Terrorist attacks in Iran: A counter-terrorism medicine analysis.

Terrorism is a combined phenomenon, the concept of which is strongly affected by the spatial and temporal situation. Terrorist attacks can affect the demand for and delivery of healthcare services and often put a unique burden on the first responders, hospitals, and health systems. This study provides an epidemiological description of all -terrorist-related attacks in Iran from 1979 to 2020. Data were collected using a retrospective search through Global Terrorism Database (GTD). GTD was searched using internal database search functions for all incidents that occurred in Iran from January 1, 1979, to December 31, 2020. The target type, attack type, primary weapon type, perpetrator group, country where the incident occurred, and the number of fatalities and injuries were collected, and the results were analyzed. In total, 543 terrorist attacks were identified in the study period, which resulted in the fatality of 1,150 people and the injury of 3,792 people. It indicates 2.12 fatalities and 7,009 injuries per incident. Explosives were used in 301 attacks (55.63 percent), followed by incendiary weapons in 177 attacks (32.71 percent). The most significant types of attacks are bombings in 290 attacks (52.3 percent), followed by assassination in 99 attacks (17.9 percent), and armed assaults in 81 attacks (14.6 percent). Due to a decreasing trend of terrorist incidents in Iran, we can state that national security and stability have improved in Iran. However, the development of security promotion policies and passive defense approaches can help prevent the occurrence of such incidents.

Distribution incidence, mortality of tuberculosis and human development index in Iran: estimates from the global burden of disease study 2019

BackgroundTuberculosis is one of the most serious challenges facing the global healthcare system. This study aims to investigate the incidence and mortality of tuberculosis in Iran from 2010 to 2019 as well as its relationship with the human development index (HDI).MethodsThe present study is an ecological study aiming at investigating the incidence and mortality of tuberculosis in Iran during the years 2010 to 2019. The related data were extracted from the Global Burden of Disease (GBD) website. The spatial pattern attributed to tuberculosis in the provinces of Iran was analyzed using ArcGIS software. In this study, the two-variable correlation method was used to analyze the data extracted to study the correlation between Tuberculosis and HDI.ResultBased on the results recorded in GBD, the incidence of tuberculosis in 2010, that is, 14.61 (12.72, 16.74), declined compared to 2019, namely 12.29 (10.71, 14.09). The age-standardized mortality rate which was 1.63 (1.52, 1.73) in 2010, has decreased compared to 2019: 1.17 (1.07, 1.32). The incidence and mortality rates of tuberculosis in Iran in all age groups have decreased in 2019 compared to 2010. The highest incidence and mortality among tuberculosis patients were recorded in Sistan and Baluchistan and Golestan provinces. The results indicated that there was a negative and significant correlation between the mortality rate of tuberculosis and the human development index in 2010 (r = -0.509, P-value = 0.003) and 2019 (r = -0.36, P-value = 0.001); however, this correlation between incidence and human development index was not significant (p > 0.05).ConclusionSince mortality is mostly observed in areas with low HDI, health system policymakers must pay more attention to these areas in order to improve care and perform screenings to diagnose and treat patients thus reducing the mortality rate of tuberculosis and preventing an increase in its incidence in Iran.

Socioeconomic and environmental determinants of foot and mouth disease incidence: an ecological, cross-sectional study across Iran using spatial modeling

Foot-and-mouth disease (FMD) is a highly contagious animal disease caused by a ribonucleic acid (RNA) virus, with significant economic costs and uneven distribution across Asia, Africa, and South America. While spatial analysis and modeling of FMD are still in their early stages, this research aimed to identify socio-environmental determinants of FMD incidence in Iran at the provincial level by studying 135 outbreaks reported between March 21, 2017, and March 21, 2018. We obtained 46 potential socio-environmental determinants and selected four variables, including percentage of population, precipitation in January, percentage of sheep, and percentage of goats, to be used in spatial regression models to estimate variation in spatial heterogeneity. In our analysis, we employed global models, namely ordinary least squares (OLS), spatial error model (SEM), and spatial lag model (SLM), as well as local models, including geographically weighted regression (GWR) and multiscale geographically weighted regression (MGWR). The MGWR model yielded the highest adjusted {R}^{2} of 90%, outperforming the other local and global models. Using local models to map the effects of environmental determinants (such as the percentage of sheep and precipitation) on the spatial variability of FMD incidence provides decision-makers with helpful information for targeted interventions. Our findings advocate for multiscale and multidisciplinary policies to reduce FMD incidence.

National and Subnational Incidence Trend of Bladder Cancer in Iran: Report of a 12-Year Period

Background: Bladder cancer is one of the most common cancers worldwide and also in Iran. Understanding of bladder cancer epidemiology is of great value for policymakers and assists in the prevention and early detection of the disease. Objectives: The aim of the present study was to report national and subnational incidence trends of bladder cancer in Iran between 2003 and 2015. Methods: This study investigated the age-standardized incidence rates (ASIRs) per annum of bladder cancer from 2003 to 2015 in Iran using the data from the cancer registration system of the Ministry of Health and Medical Education of Iran. The crude incidence rates were calculated by dividing incident cases by the country and province population, which were provided by the Statistic Center of Iran. Age standardization was performed using the WHO standard population, and ASIRs were compared by age, sex, and province. Results: The ASIR of bladder cancer increased from 8.35 in 2003 to 13.57 in 2015 in men. The ASIR of bladder cancer also showed a mild increase in females, 2.12 in 2003 versus 2.86 in 2015. The province of Yazd had the highest rate of bladder cancer in men, and West Azerbaijan had the highest rate for women (15.13 and 7.79 per 100,000), while Sistan va Baluchestan and Ilam had the lowest ASIRs for men and women (3.01 and 0.96 per 100,000, respectively). Conclusions: The increasing trend of bladder cancer incidence in Iran, despite the clear decreasing global trend accompanying to ongoing aging of the population highlights the diseases as a potential health problem in the upcoming years in Iran. Therefore, it is necessary for health organizations to implement effective research and control programs in the country to prevent further increases in disease burden.

Population genetics and phylogeography of alfalfa mosaic virus in China and a comparison with other regional epidemics based on the cp gene.

Alfalfa mosaic virus (AMV) is the most pervasive epidemic virus affecting alfalfa production. However, detailed investigations on the molecular population genetics and evolutionary dynamics of AMV are scarce. This study aimed to report on a large-scale long-term survey of genetic variability in AMV populations from China and perform a comparative analysis of AMV population genetics in the three most thoroughly studied countries to date: China, Iran, and Spain. The study was based on the analysis of the coat protein gene (cp) using two analytical approaches: an analysis of molecular variance (AMOVA) and a Bayesian Markov Chain Monte Carlo approach that investigates the association between geographical origin and phylogeny. Both analytical approaches found significant genetic differentiation within localities, but not among localities nor among provinces. This observation might result from inappropriate agronomical practices involving extensive exchange of plant materials followed by rapid viral diversification within localities. In the Chinese population, both methods found that genetic diversification in AMV was strongly associated with different bioclimatic zones. Rates of molecular evolution were similar in the three countries. The estimated epidemic exponential population size and growth rate suggest that the epidemics grew faster and with higher incidence in Iran, followed by Spain and China. Estimates of the time to the most recent common ancestors suggest that AMV was first seen in Spain by the beginning of the twentieth century and later on in eastern and central Eurasia. After ruling out the existence of recombination breakpoints within the cp gene, a codon-based selection analysis per population was performed and identified many codons under significant negative selection and a few under significant positive selection; the latter varied among countries, suggesting regional differences in selective pressures.

Iranian stroke model-how to involve health policymakers

Iranian stroke model-how to involve health policymakers

Spatial modeling of visceral leishmaniasis in Iran from 2010 to 2018

Kala-Azar is the most lethal type of leishmaniasis, sporadic in most parts of Iran and prevalent in some provinces. Using the Geographical Information System (GIS) and satellite data analysis, we intended to assess the disease's incidence in Iran. Methods: Using GIS, data received from the Ministry of Health and Medical Education in Tehran, Iran, and other associated institutions between 2010 and 2018 were evaluated. The disease's geographical distribution maps were then constructed, and the disease's hotspots in Iran were identified using spatial analysis using ArcGIS10.5 software. Geographically weighted regression (GWR) analysis in ArcGIS10.5 was used to link disease-influencing variables such as temperature, relative humidity, normalized difference vegetation index (NDVI), and incidence of visceral leishmaniasis. Linear regression analysis, SPSS 21 software descriptive statistics, and chi-square test were used to analyze the data. Results: This study revealed that the provinces of Ardabil, East Azarbaijan, North Khorasan, and Fars were the hot spots of VL. The provinces of Ardabil, East Azarbaijan, North Khorasan, Fars, Bushehr, Semnan, Sistan, Baluchistan, Esfahan, Chaharmahal Bakhtiari, Qom, Golestan, and Kerman had the highest correlation between temperature, vegetation density, and the incidence of Kala Azar, as determined by geographical weighted regression analysis.

Pancreatic Cancer in Iran - Result of the Iranian National Cancer Registry Program.

In this article, we aimed to report the incidence rate of PC at the national and regional levels of Iran from 2014 to 2017 for the first time based on the IARC protocols. The data was recruited from the Iranian national program of cancer registry, a national cancer registry program reformed in 2014 after including cancer diagnosis based on clinical judgment and death certificates. This registry includes data from the pathology laboratories and clinical sectors included with death certificates from 60 medical universities in 31 provinces of Iran. Age-standardized incidence rates were calculated at the national and regional levels. From 2014 to 2017, 8851 new cases (males=60.46%) were diagnosed, with a mean age of 66.2 ± 19.6. Forty-one percent of the patients were diagnosed by microscopic verification, and 51% were diagnosed based on clinical judgment without microscopic verification and death certificates. The age-standardized incidence rate was measured as 3.45 per 100,000 in 2017, with the highest rates in individuals older than 85 (30.91 per 100,000), and the provinces of Qom, Tehran, and Isfahan recorded the highest incidence rates with 3.87, 3.85, and 3.66 per 100,000 respectively. PC incidence in Iran is still lower than in western countries. However, the incidence from 2014 to 2017 is higher than previous national and regional reports and should not be overlooked. Improvement in the national cancer registry program and documentation may be reasons for this difference.

The Effectiveness of Music Therapy on Anxiety, Self-esteem, and Social Adjustment of Children With Cancer in Kerman

Background: Cancer is the second largest cause of child mortality after accidents worldwide. Childhood cancers have an average incidence in Iran, with 176 cases in one million people. The objective of this study was to examine the efficacy of music therapy on anxiety, self-esteem, and social adjustment of children with cancer in Kerman in 2019. Methods: A quasi-experimental method with a pre-test and post-test design with a control group was used in this study. The statistical population of research included all children with cancer admitted to Afzalipour hospital in Kerman (Iran) in 2019, and thirty children were selected by the convenience sampling method and then randomly divided into experimental (n=15) and control (n=15) groups. Data were collected using the children’s Multidimensional Anxiety Scale, the Coopersmith Self-esteem Inventory, and California Social Adjustment Scale. Finally, the data were analyzed using SPSS22 through the multivariate analysis of covariance. Results: The results indicated that music therapy was effective in reducing anxiety (P<0.001, F=179.29) while increasing self-esteem (P=0.001, F=120.60) and social adjustment (P=0.001, F=48.56) in children with cancer. Conclusion: It can be argued that music therapy in children with cancer has been successful for anxiety, self-esteem, and social adjustment and can be applied to alleviate psychological issues in children with cancer

Dramatic changes in multiple sclerosis incidence in Iran may be related to the “Will Rogers phenomenon”

In recent years, studies have shown that multiple sclerosis (MS) incidence has greatly increased in different geographical areas of Iran (Pakdel et al., 2020; Hosseinzadeh et al., 2021). The increases in MS incidence in Iran are usually attributed to obesity and overweight childhood, cigarette and waterpipe smoking, vitamin D deficiency, urbanization, industrialization, and air pollution (Amiri, 2021; Hosseinzadeh et al., 2019; Asmarian et al., 2021). However, one of the most important factors that may be related to the increase of MS incidence in Iran and has been neglected is the “Will Rogers phenomenon

Trend of Breast Cancer Incidence in Iran During A Fifteen-Year Interval According To National Cancer Registry Reports

Trend of Breast Cancer Incidence in Iran During A Fifteen-Year Interval According To National Cancer Registry Reports

Ecology of sand flies (Diptera: Psychodidae, Phlebotominae) in Jajarm County, an area with high risk of cutaneous leishmaniasis, in North Khorasan, Iran

The present study was conducted to investigate the ecological aspects of sand flies in southwestern North Khorasan, in which cutaneous leishmaniasis caused by Leishmania major has been reported with the highest annual incidence in Iran. Sampling was carried out in four localities including: Khorasha (natural), Ghamiteh (natural), Jorbat (semi urban) and Brick kilns (urban), twice a month using 105 sticky paper traps from indoors and outdoors dwellings during May-December 2017. Specimens were removed from sticky papers, washed in acetone, preserved in 80% ethanol, mounted on microscopic slides by Puri’s medium, and identified using valid morphological keys. Simpson (D), richness (S), Menhinick (DMg), Margalef (DMn), Shannon-Weiner (H′), evenness (J’) were calculated for species diversity. The synanthropic index was determined for the first time in the area. Totally 517 specimens were collected, 47% in outdoors and 30.4% in human indoor dwellings and 22.6% in animal. Eight species of sand flies including 5 species of the genus Phlebotomus and 3 species of the genus Sergentomyia were identified. Phlebotomus papatasi and Sergentomyia sintoni were the most common and Eudominant species, active in all months, collected in the maximum number and percentage in September and August, respectively, and showed the highest abundance in outdoors. The synanthropic index ranged from 6.25 to 38.9 in the study area. The Shannon-Wiener index was estimated to be up to 1.4 and 1.37 in Khorasha and November, respectively, which showed the highest diversity due to maximal richness and evenness compared to other areas. High abundance of Ph. papatasi, as the main vector of cutaneous leishmaniasis, can enhance the potential risk of emerging CL in new areas, the data can be equally important when vector control measures are considered.

Geographic Distribution and Estimating the Childhood Cancer Incidence in Iran: Three-Source Capture-Recapture Analysis on National Registries Data.

Background:Cancers seldom happen in childhood age and awareness of accurate cancer incidence is essential in order to preventive programs. This study aimed to estimate the childhood cancer incidence in Iran using the three-source capture -recapture method.Methods:Total new cases of childhood cancer reported by three national data sources of MAHAK charity database, pathology reports and clinical records in Iran were enrolled in this study. The common cases among three sources were determined using data linkage method. The childhood incidence rate per 1 million populations was estimated based on three-source capture-recapture method. We used BIC, G2 and AIC statistics to select the best-fit model. Arch GIS was used to determine geographic distribution.Results:Overall, 2567 childhood cancer was included by three sources of registries. The total estimated number of childhood cancer was 5388 (95% CI: 4742.15–6228,14). The higher estimated incidence rate was Leukemia, Lymphoma by 94.91 and 24.80 per 1 million populations and the lower incidence was liver and retinoblastoma with 2.35 and 7.01 per 1 million populations. Provinces of Ardabil and Kohgiluyeh with an incidence rate of 420.01 and 404.61 per 1 million populations had a higher incidence rate and Mazandaran and Ilam with an incidence rate of 60.87 and 66.88 per 1 million populations had the lowest incidence. The overall completeness of the childhood cancer registry based on three-source was 48%.Conclusion:The low-quality childhood cancer registration system highlights the needs for urgent screening programs for early detection in the high prevalent area in Iran.