scholarly journals Identification of drugs associated with reduced severity of COVID-19: A case-control study in a large population

eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Ariel Israel ◽  
Alejandro A Schäffer ◽  
Assi Cicurel ◽  
Ilan Feldhamer ◽  
Ameer Tal ◽  
...  
Keyword(s):  
Protective Effect ◽  
Multiple Testing ◽  
Severe Disease ◽  
Large Population ◽  
Positive Control ◽  
Case Control ◽  
National Institutes Of Health ◽  
P Value ◽  
Exact Test ◽  
Control Study

Background: Until COVID-19 drugs specifically developed to treat COVID-19 become more widely accessible, it is crucial to identify whether existing medications have a protective effect against severe disease. Towards this objective, we conducted a large population study in Clalit Health Services (CHS), the largest healthcare provider in Israel, insuring over 4.7 million members. Methods: Two case-control matched cohorts were assembled to assess which medications, acquired in the last month, decreased the risk of COVID‑19 hospitalization. Case patients were adults aged 18-95 hospitalized for COVID-19. In the first cohort, five control patients, from the general population, were matched to each case (n=6202); in the second cohort, two non-hospitalized SARS-CoV-2 positive control patients were matched to each case (n=6919). The outcome measures for a medication were: odds ratio (OR) for hospitalization, 95% confidence interval (CI), and the p‑value, using Fisher's exact test. False discovery rate was used to adjust for multiple testing. Results: Medications associated with most significantly reduced odds for COVID-19 hospitalization include: ubiquinone (OR=0.185, 95% CI (0.058 to 0.458), p<0.001), ezetimibe (OR=0.488, 95% CI ((0.377 to 0.622)), p<0.001), rosuvastatin (OR=0.673, 95% CI (0.596 to 0.758), p<0.001), flecainide (OR=0.301, 95% CI (0.118 to 0.641), p<0.001), and vitamin D (OR=0.869, 95% CI (0.792 to 0.954), p<0.003). Remarkably, acquisition of artificial tears, eye care wipes, and several ophthalmological products were also associated with decreased risk for hospitalization. Conclusions: Ubiquinone, ezetimibe and rosuvastatin, all related to the cholesterol synthesis pathway were associated with reduced hospitalization risk. These findings point to a promising protective effect which should be further investigated in controlled, prospective studies. Funding: This research was supported in part by the Intramural Research Program of the National Institutes of Health, NCI.

scholarly journals Large population study identifies drugs associated with reduced COVID-19 severity

2020 ◽  
Author(s):  
Ariel Israel ◽  
Alejandro A. Schäffer ◽  
Assi Cicurel ◽  
Ilan Feldhamer ◽  
Ameer Tal ◽  
...  
Keyword(s):  
Protective Effect ◽  
Population Study ◽  
Multiple Testing ◽  
Anatomical Therapeutic Chemical ◽  
Severe Disease ◽  
Large Population ◽  
P Value ◽  
Exact Test ◽  
Latex Gloves ◽  
Surgical Masks

AbstractBACKGROUNDIt may take months to years until drugs specifically designed to treat COVID-19 are available. Until then, it is crucial to identify whether existing medications could have a protective effect against severe disease. This is the objective of this large population study performed in Clalit Health Services (CHS), the largest healthcare provider in Israel.METHODSCHS centrally manages electronic health records (EHRs) including medication purchases for over 4.5 million members. Two case-control matched cohorts were assembled to assess systematically which drugs affected the risk of COVID-19 hospitalization: in both cohorts, case patients were hospitalized for COVID-19; matched control patients were taken from the general population in the first cohort, and non-hospitalized SARS-CoV-2 positive patients in the second cohort. For each medication anatomical-therapeutic-chemical (ATC) class acquired during the last month before the index-date, we computed the odds ratio (OR) for hospitalization, 95% confidence interval (CI), and the p-value, using Fisher’s exact test. False discovery rate was used to adjust for multiple testing.RESULTSSeveral drugs and pharmacy sold items were associated with significantly reduced odds for SARS-CoV-2 hospitalization, notably ubiquinone (OR=0.185, 95% CI [0.058,0.458], p<0.001), ezetimibe (OR=0.513, 95% CI [0.375,0.688], P<0.001), rosuvastatin (OR=0.746, 95% CI [0.645,0.858], p<0.001) and flecainide (OR=0.303, 95% CI [0.080,0.813], p<0.01). Additionally, acquisition of surgical masks, latex gloves and several ophthalmological products were associated with decreased risk for hospitalization.CONCLUSIONUbiquinone, ezetimibe and rosuvastatin, all related to the cholesterol synthesis pathway were associated with reduced hospitalization risk. These findings suggest a promising protective effect which should be further investigated.

scholarly journals Role of monoamine-oxidase-A-gene variation in the development of glioblastoma in males: a case control study

2019 ◽  
Vol 145 (2) ◽  
pp. 287-294
Author(s):  
Rickard L. Sjöberg ◽  
◽  
Wendy Yi-Ying Wu ◽  
Anna M. Dahlin ◽  
Spiridon Tsavachidis ◽  
...  
Keyword(s):  
Multiple Testing ◽  
Case Control Study ◽  
Amine Oxidase ◽  
Population Based ◽  
Case Control ◽  
Monoamine Oxidase A ◽  
P Value ◽  
Nucleotide Polymorphisms ◽  
Mao A ◽  
Control Study

Abstract Background The Mono-amine oxidase-A (MAO-A) enzyme is involved in the degradation and regulation of catecholamines such as serotonin, dopamine, epinephrine and nor-epinephrine. Preclinical studies suggest that this enzyme may contribute to an environment favorable for growth of malignant glioma. The MAO-A gene is located on the X-chromosome and has at least one functional genetic polymorphism. The aim of the present study was to explore possible effects of MAO-A genotype on development of glioblastoma in males. Methods Genotypes for 437 glioma cases and 876 population-based controls from the Swedish Glioma International Case–Control study (GICC) were compared. We analyzed the germline DNA using the Illumina Oncoarray. We selected seven single nucleotide polymorphisms (SNPs) located in the MAO-A gene, and imputed genotypes based on data from the 1000 genomes project. We used 1579 male glioblastoma cases and 1875 controls comprising the whole GICC cohort for subsequent validation of findings. Results The rs144551722 SNP was a significant predictor of development of glioblastoma in males (p-value = 0.0056) but not in females even after correction for multiple testing. We conducted haplotype analysis to confirm an association between MAO-A gene and risk of glioblastoma (p-value = 0.016). We found similar results in the validation sample. Conclusions These results suggest the possibility of a role for the MAO-A enzyme and the MAO-A gene in the development of glioblastoma in males.

scholarly journals Maternal Lipid Profile in Preeclampsia: Case-Control Study

2021 ◽  
pp. 159-166
Author(s):  
J. O. Agbara ◽  
K. A. Rabiu ◽  
A. Gbadegesin ◽  
N. W. Okoh
Keyword(s):  
Pregnant Women ◽  
Lipid Profile ◽  
Case Control Study ◽  
Severe Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Case Control ◽  
P Value ◽  
Low Density ◽  
Control Study

Background: Preeclampsia has continued to be a challenge especially in the areas of understanding the pathogenesis and prevention or treatment of the disease. Previous reports on the relationship between maternal lipids and preeclampsia have varied as its role in the aetiopathogenesis of pre-eclampsia is not clearly defined. This study aimed at comparing the lipid profile in preeclampsia with that in normotensive pregnancy. It also examined for any relationship between an abnormal profile and severe disease. Methods: This was a prospective case-control study. It was conducted among pregnant women who presented for routine antenatal care and those seen in the emergency room of the obstetrics unit of a tertiary institution in Lagos, Nigeria.  The duration of the study was 6 months as it took place between May 2015 to October 2015. Pregnant women in their second half of pregnancy, diagnosed to have pre-eclampsia and, who gave consent were consecutively recruited as cases and pregnant women with similar age and gestational age, who had normal blood pressure were also selected as controls within the study period. The Maternal lipid profile was assayed using an enzyme-based assay kit and analysed according to the manufacturer’s instructions. All participants were followed up till delivery. Results: One hundred and seventy pregnant women in the third trimester of pregnancy participated in this study. They were within 18 – 45 years of age. More of the participants were nulliparous. Eighty-five of them had pre-eclampsia and constituted the study group while 85 were normotensive in the control group. The mean age was similar in both groups (control=29.59 ± 4.50 years versus pre-eclampsia=29.73 ± 5.10 years). The gestational ages at blood sampling of the patients in this study ranged between 27 – 40 weeks.  The analysis of data revealed that the level of total cholesterol, triglycerides, low-density lipoprotein and very-low-density lipoprotein was higher in the cases compared with the control. This difference was statistically significant because the calculated P-value was <0.05. The level of high-density lipoprotein was lower in those with pre-eclampsia. Serum cholesterol and low-density lipoprotein were significantly higher (P-value= 0.04) in those with severe disease. A significant positive relationship was observed between mean arterial blood pressure and abnormal levels of lipids. Conclusion: An abnormal pattern of lipid profile was observed in women with preeclampsia and this was more marked in those with severe disease. A larger multi-centre study will be required to substantiate this finding.

SERUM PROLACTINE LEVEL IN PATIENTS OF PSORIASIS VULGARIS AND ITS CORRELATION WITH DISEASE SEVERITY: A CASE-CONTROL STUDY

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pawan Kumar Saini ◽  
Devendra Yadav ◽  
Rozy Badyal ◽  
Suresh Jain ◽  
Arti Singh ◽  
...  
Keyword(s):  
Disease Severity ◽  
Prolactin Level ◽  
Case Control Study ◽  
Statistical Significance ◽  
Case Control ◽  
Serum Prolactin ◽  
P Value ◽  
Serum Prolactin Level ◽  
R Value ◽  
Control Study

Background: Psoriasis is an autoimmune chronic inflammatory disorder affecting the skin mediated by T-lymphocytes resulting in production of cytokines which cause hyperproliferation of keratinocytes.  Several factors and hormones like Prolactin have an action similar to these cytokines in promoting the multiplication of keratinocytes and other cells like lymphocytes and epithelial cells may have a role on the etiopathogenesis of psoriasis. Aim:-The aim of study is to compare the serum Prolactin levels in patients of psoriasis with a control group. Setting and study design: This is a case-control study conducted in the department of Dermatology, Venereology and Leprosy GMC, Kota over a period of 1year from July 2017 to June 2018 Material and method: The study included 100 cases of psoriasis (60 males and 40 females) and 100 controls similar for age and sex. Serum Prolactin levels were measured by ECLIA and results were obtained. Statistical analysis: Mean and standard deviation were calculated for each variable. Statistical significance of the results was analyzed using correlation analysis (Pearson correlation coefficient) and independent samples t-test. Statistical significance was assumed at p value<0.05. Result: Serum Prolactin level was significantly higher in cases of psoriasis compared to controls (p-value <0.001). PASI score and serum Prolactin levels were found to have a positive correlation (r value = 0.337; p-value: 0.001). No significant  correlation was found between serum levels of Prolactin and duration of disease r value= -0.034, P value =0.733). Serum Prolactin level was higher in male patients compared to females patients. Conclusion:- High serum Prolactin may be a biological marker of disease severity in psoriasis and may have a role in the pathogenesis of psoriasis. Further studies with large sample size are required to confirm this hypothesis.

ANALISIS FAKTOR RISIKO YANG BERHUBUNGAN DENGAN KEJADIAN PNEUMONIA BALITA DI WILAYAH KERJA UPTD PUSKESMAS BANDA RAYA KOTA BANDA ACEH TAHUN 2019

2020 ◽  
Vol 6 (1) ◽  
pp. 20-28
Author(s):  
Miftahul Jannah ◽  
Asnawi Abdullah ◽  
Melania Hidayat ◽  
Qatratul Asrar
Keyword(s):  
Retrospective Study ◽  
Case Control Study ◽  
Case Control ◽  
P Value ◽  
Chi Square ◽  
Control Study ◽  
Banda Aceh

Latar Belakang: Pneumonia merupakan pembunuh utama balita di seluruh dunia. Berdasarkan Laporan Dinas Kesehatan Banda Aceh tahun 2018, jumlah balita penderita Pneumonia meningkat setiap tahunnya. Kasus Pneumonia balita yang paling banyak terdapat di UPTD Puskesmas Banda Raya. Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian Pneumonia pada Balita di wilayah kerja UPTD Puskesmas Banda Raya Kota Banda Aceh tahun 2019. Metode: Penelitian ini menggunakan desain Case Control Study atau Retrospective Study. Penelitian ini menggunakan total populasi dengan jumlah sampel adalah 142 anak balita berusia 12–59 bulan. Data dianalisis secara Univariat dan Bivariat. Analisis Bivariat menggunakan Uji Chi-Square dengan derajat kepercayaan 95% (p value0.05). Hasil: Hasil penelitian menunjukkan bahwa faktor risiko yang berhubungan dengan kejadian pneumonia adalah luas ventilasi rumah (OR=15.81; CI 95%=4.70-53.12; p value=0.0001); sedangkan umur balita (OR=1.15; CI 95%=0.54-2.43; p value=0.705); jenis kelamin (OR=1.11; CI 95%=0.57-2.16; p value=0.737); pengetahuan ibu (OR=0.38; CI 95%=0.12-1.24; p value=0.112); dan kepadatan hunian (OR=1.80; CI 95%=0.78-4.13; p value=0.163), tidak terbukti secara signifikan sebagai faktor risiko pneumonia balita di UPTD Puskesmas Banda Raya Kota Banda Aceh. Kesimpulan: Faktor risiko yang berhubungan dengan kejadian Pneumonia balita adalah luas ventilasi rumah. Oleh karena itu diperlukannya sanitasi lingkungan yang sehat sebagai upaya preventif terhadap kejadian Pneumonia, serta memperbaiki pola perilaku hidup bersih dan sehat.

Antioxidant potential of diet: Association between dietary antioxidant index and odds of coronary heart disease: A case-control study

2021 ◽  
pp. 1-13
Author(s):  
Farhad Vahid ◽  
Zahra Nasiri ◽  
Amir Abbasnezhad ◽  
Ezatollah Fazeli Moghadam
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Antioxidant Capacity ◽  
Case Control Study ◽  
Case Control ◽  
P Value ◽  
Dietary Antioxidants ◽  
Dietary Antioxidant ◽  
The Relationship ◽  
Control Study

BACKGROUND: Oxidative stress and chronic inflammation are among the leading causes of coronary heart disease (CHD). Studies investigated the relationship between dietary antioxidants and the risk/odds of CHD, and contradictory results have been reported. Dietary antioxidant index (DAI) is a novel and reliable nutritional tool that examines the diet’s overall antioxidant capacity. Its validity was examined using serum total antioxidant capacity and malondialdehyde. OBJECTIVE: This study aimed to investigate the relationship between DAI score and odds of CHD. METHODS: In this incidence case-control study, 320 individuals with a definitive diagnosis of CHD and 320 participants without CHD or related risk factors attending the same hospitals/polyclinics were selected as the case and control groups. We estimated the DAI by summing up six standardized intakes of major dietary antioxidants, including manganese, vitamin E, A, C, selenium, and zinc. RESULTS: Modeling DAI categorized according to the median (–0.38), in multi-adjusted model showed a significant protective association with the odd of CHD (OR = 0.72; 95%CI:0.51–0.99, p-value = 0.05). Also, modeling DAI as a continuous variable in multi-adjusted models (OR = 0.94;95%CI:0.90–0.95; p-value = 0.01) showed significant results. CONCLUSION: Using the DAI to investigate the relationship between dietary antioxidants and CHD can show more realistic results than a single study of antioxidants.

Risk Factors Associated With Dengue Fever Outbreak in Taiz Governorate, Yemen, 2018: Case-control Study

2021 ◽  
Author(s):  
Abdulkareem Ali Hussein Nassar ◽  
Amr Abdulaziz Torbosh ◽  
Yassin Abdulmalik Mahyoub ◽  
Mohammed Abdullah Al Amad
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Case Control Study ◽  
Significant Risk ◽  
Case Fatality ◽  
Case Control ◽  
Case Definition ◽  
P Value ◽  
Factors Associated ◽  
Control Study

Abstract Background: Dengue Fever (DF) is a significant health problem in Yemen especially in the coastal areas. On November 6, 2018, Taiz governorates surveillance officer notified the Ministry of Public Health and Population on an increase in the number of suspected DF in Al Qahirah and Al Mudhaffar districts, Taiz governorate. On November 7, 2018, Field Epidemiology Training Program sent a team to perform an investigation. The aims were to confirm and describe the outbreak by person, place and time in Taiz governorate, and identify its risk factors.Methodology: Descriptive and case-control study (1:2 ratio) were conducted. WHO case definition was used to identify cases in Al Qahirah or Al Mudhaffar districts during August-November 2018. Control was selected from the same districts who did not suffer from DF. Predesigned questionnaire was used to collect data related to sociodemographic, behavioral and environmental characteristics. Bivariate and multivariate backward stepwise analyses were used. The adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated. A P value < 0.05 was considered as the cut point for statistically significant. Epi info version 7.2 was used.Results: A total of 50 DF cases were found. Almost 52% were males and 76% were <30 years of age. The overall attack rate was 1/10,000 of the population. Case fatality rate was 4%. In multivariate analysis, not working (aOR = 26.6, 95% CI: 6.8–104.7), not using mosquito repellent (aOR = 13.9, 95% CI:1.4–136.8), wearing short sleeves/pants (aOR = 27.3, 95% CI: 4.8–156.8), poor sanitation (aOR = 5.4, 95% CI: 1.4–20.3), presence of outdoor trees (aOR = 13.2, 95% CI: 2.8–63.0) and houses without window nets (aOR = 15.7, 95% CI: 3.9–63.4) were statistically significant risk factors associated with DF outbreak. Eleven 11 (58%) of blood samples were positive for DF IgM.Conclusions: DF outbreak in Al Qahirah and Al Mudhaffar districts, Taiz governorate was confirmed. This study provides evidence-based information regarding the identified risk factors that contributed to the occurrence of this outbreak. Raising community awareness on the importance of personal protection measures and improving the sanitation services are strongly recommended.

scholarly journals Dietary patterns and risk of oral cancer: a case-control study in São Paulo, Brazil

2007 ◽  
Vol 41 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Dirce Maria Lobo Marchioni ◽  
Regina Mara Fisberg ◽  
José Francisco de Góis Filho ◽  
Luiz Paulo Kowalski ◽  
Marcos Brasilino de Carvalho ◽  
...  
Keyword(s):  
Oral Cancer ◽  
Dietary Patterns ◽  
Case Control Study ◽  
Case Control ◽  
Sao Paulo ◽  
Southeastern Brazil ◽  
P Value ◽  
São Paulo ◽  
Factor Scores ◽  
Control Study

OBJECTIVE: To analyze the association between dietary patterns and oral cancer. METHODS: The study, part of a Latin American multicenter hospital-based case-control study, was conducted in São Paulo, Southeastern Brazil, between November 1998 and March 2002 and included 366 incident cases of oral cancer and 469 controls, frequency-matched with cases by sex and age. Dietary data were collected using a food frequency questionnaire. The risk associated with the intake of food groups defined a posteriori, through factor analysis (called factors), was assessed. The first factor, labeled "prudent," was characterized by the intake of vegetables, fruit, cheese, and poultry. The second factor, "traditional," consisted of the intake of rice, pasta, pulses, and meat. The third factor, "snacks," was characterized as the intake of bread, butter, salami, cheese, cakes, and desserts. The fourth, "monotonous," was inversely associated with the intake of fruit, vegetables and most other food items. Factor scores for each component retained were calculated for cases and controls. After categorization of factor scores into tertiles according to the distribution of controls, odds ratios and 95% confidence intervals were calculated using unconditional multiple logistic regression. RESULTS: "Traditional" factor showed an inverse association with cancer (OR=0.51; 95% CI: 0.32; 0.81, p-value for trend 0.14), whereas "monotonous" was positively associated with the outcome (OR=1.78; 95% CI: 1.78; 2.85, p-value for trend <0.001). CONCLUSIONS: The study data suggest that the traditional Brazilian diet, consisting of rice and beans plus moderate amounts of meat, may confer protection against oral cancer, independently of any other risk factors such as alcohol intake and smoking.

scholarly journals Helicobacter pylori Infection as a Risk Factor for Hepatocellular Carcinoma: A Case-Control Study in Ethiopia

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Hailemichael Desalegn Mekonnen ◽  
Henok Fisseha ◽  
Tewodros Getinet ◽  
Fisseha Tekle ◽  
Peter R. Galle
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Case Control Study ◽  
Clinical History ◽  
Case Control ◽  
Chronic Liver ◽  
P Value ◽  
H Pylori ◽  
Control Study

Background and Aims.Hepatocellular carcinoma is a major cause of cancer death worldwide, accounting for over half a million deaths per year. Its incidence varies with geographic locations and the type of etiologic factors. In Ethiopia, unidentified causes of liver disease are of sizeable proportion. Recent studies have shown an association of H. pylori infection with different spectrums of chronic liver disease. This study was conducted at St. Paul’s Hospital Millennium Medical College in Ethiopia and assesses liver cancer and the association with H. pylori infection.Method.A prospective case-control study conducted on patients with chronic liver disease presenting with a suspicious liver lesion and diagnosed to have HCC in the Gastrointestinal (GI) Clinic of St. Paul’s Hospital MMC from Dec 30, 2016, to Nov 1, 2017 G.C. Descriptive surveys on clinical history and physical examination and laboratory profiles were obtained, and the clinical course of the patients including the type of treatment was followed prospectively. Control cases were taken from adult patients without evidence of liver disease in the internal medicine clinic coming for routine evaluation. After collection data were analyzed using SPSS version 23 and associations were assessed using chi-square test. Binary logistic regression was used to assess the association of HCC with different variables and H. pylori infection. All variables with p-value <0.05 were considered as statistically significant.Results.One hundred twenty patients were analyzed with equal representation of cases and controls. The majority of patients with HCC were male with a mean age of 36 years. Older age adjusted Odds Ratio (AOR) (95%CI, p-value) 1.07(1.03-1.09, <0.001), viral hepatitis B (AOR) (95%CI, p-value) 6.19 (1.92-19.93, 0.002), and H. pylori infection (AOR) (95%CI, p-value) 5.22 (2.04–13.31, <0.001) were statistically significantly associated with HCC.Conclusion.H. pylori infection is associated with HCC in this case-control study. This study supports the emerging evidence of H. pylori association with other extra-gastric manifestations.

scholarly journals A Case-Control Study for Assessing Risk Factors for Congenital Anomalies among Children in Sulaimani City

2018 ◽  
pp. 90-95 ◽  
Author(s):  
Niaz Mustafa Kamal ◽  
Nasih Othman
Keyword(s):  
Risk Factors ◽  
Congenital Anomalies ◽  
Maternal Obesity ◽  
Case Control Study ◽  
Significant Risk ◽  
Case Control ◽  
P Value ◽  
Maternal Risk ◽  
Wide Range ◽  
Control Study

Congenital anomalies comprise a wide range of abnormalities in body structure or function that are present at birth and are of prenatal origin. These are defined as structural changes that have significant medical, social or cosmetic consequences for the affected individual, and typically require medical intervention. According to our Knowledge, research is scarce on these conditions in Sulaimaniyah city. Therefore, the current study was conducted to investigate potential risk factors for congenital anomalies. A case-control study was carried out from March to August 2017 involving 400 children (200 cases and 200 controls) aged 0-5 years. Required data were obtained on the risk factors through face to face interviews with mothers of cases and controls. The data were using descriptive statistical methods, Chi-square and Logistic Regression using STATA 11, calculating odds ratios and condensing P value less than 0.05 as statistically significant. The mean age of the children was 1.9 years and age of their mothers at the time of pregnancy was 28 years. Congenital heart anomalies were the commonest type accounting for 27.5%. Significant risk factors for congenital anomalies were family history (OR=2.24, P= 0.007), maternal obesity (OR= 2.26, P= 0.001), mothers age over 30 (OR=2.78, P= 0.002) and mothers not using folic acid during pregnancy (OR=2.12, P= 0.0007). In general, in order to control and prevent the cases of CM, it is important to provide health education and policies to reduce environmental and maternal risk factors. Further, studies with larger sample size are needed to investigate incidence and risk factors of congenital anomalies.

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