Increased trend of breast cancer mortality in Iran

BACKGROUND

Breast cancer is the most commonly diagnosed cancer in women worldwide In Iran, it ranks first among cancers diagnosed in women and is the fifth most common cause of death. The aim of this study was to present the mortality trends from breast cancer for Iranian women during a period of almost a decade, in order to provide update information regarding the likely future.

METHODS

We analyzed National death Statistic reported by the Iranian Ministry of Health and Medical Education from 1995 to 2004 to generate annual mortality rates/100,000, overall, by age group (<15, 15-49 and ≥ 50 years of age) and age standardized rate (ASR).

RESULTS

The age standardized mortality rate of breast cancer increased dramatically during these years from 1.40 to 3.52 per 100,000 and its mortality was increasing 151.4% for Iranian women, although it seemed that the rate leveled off from 2002 to 2004. Moreover the increasing rate was higher for those aged between 15-49 compared to age > 50 years old.

CONCLUSION

There is an increasing trend for breast cancer mortality in Iran. Thus, health education programs to rectify the lack of women awareness about breast cancer signs and effective screening are urgently needed.

Functional bowel disorders in Iranian population using Rome III criteria

BACKGROUND/AIM

To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria.

MATERIALS AND METHODS

This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria.

RESULTS

In all, 1.1% met the Rome III criteria for irritable bowel syndrome (IBS), 2.4% for functional constipation (FC), and 10.9% of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8% had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52%) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD.

CONCLUSION

This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population.

Hepatocellular carcinoma in Asia: Prevention strategy and planning

AIM

To review all of epidemiological and etiological aspects of hepatocellular carcinoma (HCC) and examined the prevention of this disease in Asia.

METHODS

We conducted a systematic review according to the PRISMA guidelines. We were chosen articles that published previously, from PubMed (MEDLINE), the Cochrane database and Scopus. The key words used in this research were as follows: HCC in Asia and the way of prevention of this disease, with no language limitations. We selected those papers published before 2014 that we considered to be most important and appropriate. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.

RESULTS

More than 70% of all new cases of liver cancer were diagnosed in Asia, a region that 75% of all those chronically infected with hepatitis B virus (HBV) in the world. Chronic HBV infection is the main cause of HCC in Asia, where the virus is endemic and vertical transmission is common. Japan, Saudi Arabia, Egypt and Pakistan are exception because of high prevalence of HCV infection in these regions. The prevalence of this cancer is high in Eastern and South-Eastern Asia, But Middle Eastern countries are characterized as moderate prevalence rate of HCC region and Central Asia and some part of Middle Eastern countries are known as low prevalence rate of HCC. In addition of HBV and HCV the other factors such as aflatoxin, alcohol, obesity, diabetes and non-alcoholic fatty liver disease (NAFLD) might be responsible for a low prevalence of HCC in Asian countries. Currently available HCC therapies, chemotherapy, surgical are inefficient, mainly due to usually late diagnosis and high recurrence rates after surgical resection, and usually end with treatment failure. Liver transplantation also remains as a difficult strategy in patients with HCC. Thus prevention of HCC by treating and prevention HBV and HCV infection, the major causative agents of HCC, and the other risk factors such as aflatoxin, alcohol, obesity, diabetes and NAFLD is of a great medical importance.

CONCLUSION

The main challenge which still present in Asia, is the high prevalence of chronic hepatitis. So, prevention of HBV and HCV is the key strategy to reduce the incidence of HCC in Asia.

Effects of Stress on Critical Care Nurses: A National Cross-Sectional Study

BACKGROUND:

Health care is a demanding field, with a high level of responsibility and exposure to emotional and physical danger. High levels of stress may result in depression, anxiety, burnout syndrome, and in extreme cases, post-traumatic stress disorder. The aim of this study was to determine which personal, professional, and organizational variables are associated with greater perceived stress among critical care nurses for purposes of developing integrative solutions to decrease stress in the future.

METHODS:

We conducted a correlation research survey using a cross-sectional design and an in-person survey method. The questionnaire consisted of 2 parts: (1) socioeconomic, professional, and institutional variables and (2) work stressors. Surveys were conducted between January 1, 2011, and December 1, 2015. Multistage cluster random sampling was utilized for data collection. Inclusion criteria were (1) age ≥18 years, (2) registered nurse, (3) works in the intensive care unit (ICU), and (4) willing and able to complete the survey.

RESULTS:

We surveyed 21 767 ICU nurses in Iran and found that male sex, lower levels of peer collaboration, working with a supervisor in the unit, nurse-patient ratios, and working in a surgical ICU were positively associated with greater stress levels. Increasing age and married status were negatively associated with stress. Intensive care unit type (semi-closed vs open), ICU bed number, shift time, working on holidays, education level, and demographic factors including body mass index, and number of children were not significantly associated with stress levels.

CONCLUSION:

As the largest study of its kind, these findings support those found in various European, North, and South American studies. Efforts to decrease workplace stress of ICU nurses by focusing on facilitating peer collaboration, improving resource availability, and staffing ratios are likely to show the greatest impact on stress levels.

Role of interferon therapy in severe COVID-19: the COVIFERON randomized controlled trial

Type 1 Interferons (IFNs) have been associated with positive effects on Coronaviruses. Previous studies point towards the superior potency of IFNβ compared to IFNα against viral infections. We conducted a three-armed, individually-randomized, open-label, controlled trial of IFNβ1a and IFNβ1b, comparing them against each other and a control group. Patients were randomly assigned in a 1:1:1 ratio to IFNβ1a (subcutaneous injections of 12,000 IU on days 1, 3, 6), IFNβ1b (subcutaneous injections of 8,000,000 IU on days 1, 3, 6), or the control group. All three arms orally received Lopinavir/Ritonavir (400 mg/100 mg twice a day for ten days) and a single dose of Hydroxychloroquine 400 mg on the first day. Our utilized primary outcome measure was Time To Clinical Improvement (TTCI) defined as the time from enrollment to discharge or a decline of two steps on the clinical seven-step ordinal scale, whichsoever came first. A total of 60 severely ill patients with positive RT-PCR and Chest CT scans underwent randomization (20 patients to each arm). In the Intention-To-Treat population, IFNβ1a was associated with a significant difference against the control group, in the TTCI; (HR; 2.36, 95% CI 1.10-5.17, P-value = 0.031) while the IFNβ1b indicated no significant difference compared with the control; HR; 1.42, (95% CI 0.63-3.16, P-value = 0.395). The median TTCI for both of the intervention groups was five days vs. seven days for the control group. The mortality was numerically lower in both of the intervention groups (20% in the IFNβ1a group and 30% in the IFNβ1b group vs. 45% in the control group). There were no significant differences between the three arms regarding the adverse events. In patients with laboratory-confirmed SARS-CoV-2 infection, as compared with the base therapeutic regiment, the benefit of a significant reduction in TTCI was observed in the IFNβ1a arm. This finding needs further confirmation in larger studies.Trial Registration Number: ClinicalTrials.gov, NCT04343768. (Submitted: 08/04/2020; First Online: 13/04/2020) (Registration Number: NCT04343768).

Comparison of the severity of psychological distress among four groups of an Iranian population regarding COVID-19 pandemic

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic has caused serious psychological problems, including panic attack, anxiety, stress, and depression. The main objective of this study was to measure the prevalence and compare the severity of this psychological distress among four groups of an Iranian population.

METHOD

In a cross-sectional survey, the mental health status of four groups of an Iranian society including community population, patients with COVID-19, medical staff, and medical students were investigated by the self-report questionnaire of Depression, Anxiety, and Stress Scale (DASS). DASS-21 questionnaire and the demographic data sheet were filled out by the participants. All statistical analyses were done using R version 3.6.1 software. P-values less than 0.05 were considered as statistically significant. ANOVA test was used to compare the severity of stress, anxiety, and depression between the four study groups.

RESULTS

Of the 886 participants in this survey, 554 (62.5%) were men and 332 (37.5%) were women, and the mean ± standard division of age was 40.91 ± 10.7 years. Among these participants, 241 (27.2%) were selected from community population, 221 (24.9%) were patients with COVID-19, 217 (24.5%) were medical staff, and 207 (23.4%) were medical students. The mean score of stress, anxiety, and depression in medical students and patients with COVID-19 was significantly higher than in medical staff and community population (P < 0.05). Overall, the anxiety score in men was higher than that in women (27.4 ± 4.6 vs. 26.48 ± 4.8, P = 0.006), and unmarried participants had a significantly higher depression score compared with the married group (27.5 ± 4.8 vs. 26.7 ± 4.6, P = 0.023). In addition, the score of depression was higher in female medical staff (27.08 ± 4.6 vs. 25.33 ± 4.3, P = 0.011) and community population (26.6 ± 4.3 vs. 25.3 ± 4.3, P = 0.02) than in male.

CONCLUSION

COVID-19 patients and medical students in contact with these patients were at a high risk for mental illness due to lower experience compared with professional medical staff and community population. Continuous surveillance and monitoring of psychological distress for outbreaks should become a routine part of preparedness efforts worldwide.

Diagnosis and prevalence of enteropathogenic bacteria in children less than 5 years of age with acute diarrhea in Tehran children's hospitals

INTRODUCTION

Acute diarrhea disease is the second cause of death among all infectious diseases in children younger than 5 years of age worldwide. The aim of this study was to employ a combination of biochemical, microbiological and molecular diagnostic techniques to investigate the stools of Iranian children with acute diarrhea for bacterial enteropathogens.

METHOD

Diarrheagenic Escherichia coli, Shigella spp., Salmonella spp., Campylobacter spp. and Yersinia spp., were investigated from June 2003 to June 2005, in 1087 children less than 5 years old with acute diarrhea. Stool specimens from children were studied for enteropathogens both by standard culturing and molecular methods. This study was designed on hospital based.

RESULT

The highest incidence values were found in the summer and in children less than 1-year-old (42.7%). The Pathogenic bacteria recovered out from fecal samples of 555 (55.1%) patients had the following profile: Shigella spp. (26.7%) was the most prevalent bacterial pathogen and Shiga-like toxin producing E. coli (STEC) and Enteroaggregative E. coli (EAEC) 105 (18.9%) and 92 (16.6%) had the second and third highest prevalence, respectively. Enteropathogenic E. coli (EPEC), Campylobacter, Salmonella and Enterotoxigenic E. coli (ETEC) were found in 70 (12.6%), 60 (10.8%), 42 (7.6%), and 38 (6.8%) positive samples, respectively. In this study neither Yersinia nor E. coli O157:H7 were found. Of the 30 co-infections detected, Shigella flexneri and Campylobacter jejuni accounted for more than 50%.

CONCLUSION

Information about the prevalence of wide-range Shigella and STEC may facilitate the control and management of infant diarrhea diseases in Iran. The results of this study suggest that comprehensive surveys are needed in different parts of the country in order to identify the incidence of different enteropathogenic diarrhea, especially diarrheagenic E. coli in children in Iran.

Non-alcohol fatty liver disease in Asia: Prevention and planning

AIM

To review all of epidemiological aspects of non-alcoholic fatty liver disease (NAFLD) and also prevent this disease is examined.

METHODS

We conducted a systematic review according to the PRISMA guidelines. All searches for writing this review is based on the papers was found in PubMed (MEDLINE), Cochrane database and Scopus in August and September 2014 for topic of NAFLD in Asia and the way of prevention of this disease, with no language limitations. All relevant articles were accessed in full text and all relevant materials was evaluated and reviewed.

RESULTS

NAFLD is the most common liver disorder in worldwide, with an estimated with 20%-30% prevalence in Western countries and 2%-4% worldwide. The prevalence of NAFLD in Asia, depending on location (urban vs rural), gender, ethnicity, and age is variable between 15%-20%. According to the many studies in the world, the relationship between NAFLD, obesity, diabetes mellitus, and metabolic syndrome (MS) is quiet obvious. Prevalence of NAFLD in Asian countries seems to be lower than the Western countries but, it has increased recently due to the rise of obesity, type 2 diabetes and MS in this region. One of the main reasons for the increase in obesity, diabetes and MS in Asia is a lifestyle change and industrialization. Today, NAFLD is recognized as a major chronic liver disease in Asia. Therefore, prevention of this disease in Asian countries is very important and the best strategy for prevention and control of NAFLD is lifestyle modifications. Lifestyle modification programs are typically designed to change bad eating habits and increase physical activity that is associated with clinically significant improvements in obesity, type 2 diabetes and MS.

CONCLUSION

Prevention of NAFLD is very important in Asian countries particularly in Arab countries because of high prevalence of obesity, diabetes and MS.

Predictors of quality of life in breast cancer patients under chemotherapy

BACKGROUND

Today, the quality of life studies has an important role in health care especially in chronic diseases. Breast cancer has third order among women's malignancies. Now, survival rate for this cancer is long. However breast cancer has several complications that affected the patient's life.

AIMS

The aim of this study was to assess the quality of life in Breast cancer patients under chemotherapy.

SETTING AND DESIGN

A cross-sectional study conducted on 119 breast cancer patients that were admitted and treated in chemotherapy ward of Namazi hospital in Shiraz city, south of Iran, between Jan and Feb 2006.

MATERIALS AND METHODS

The QLQ-C30 questionnaire was used to assess quality of life in these patients.

STATISTICAL ANALYSIS

We used univariate methods. A multiple regression analysis was performed to identify predictors of quality of life.

RESULTS

Mean age of patients was 48.27+/-11.42 with quality of life total score 64.92+/-24.28. All symptoms scales had reverse association with quality of life except appetite loss (P>0.05) and diarrhea (P=0.752). The results of the regression analyses showed that only grade of tumor, occupational status, menopausal status, financial difficulties and dyspnea were statistically significant in predicting patients' quality of life.

CONCLUSION

In conclusion, this study demonstrates the strength of the relationship between clinical and sociodemographical factors and breast cancer patients' quality of life. Psychological and financial support for women experiencing breast cancer diagnosis may improve quality of life.

Genetic diversity analysis of Blastocystis subtypes from both symptomatic and asymptomatic subjects using a barcoding region from the 18S rRNA gene

Blastocystis is the most prevalent protozoa found in human stool samples. This study aimed to evaluate genetic diversity among Blastocystis subtypes isolated from both symptomatic and asymptomatic subjects as well as the potential correlation between subtypes and symptoms. A total of 55 Blastocystis-positive isolates were included in this study. A barcoding region of the small subunit rDNA was amplified and genetically assessed using MEGA6 and DnaSP regarding the presence of symptoms. BLAST analyses revealed the presence of 5 different subtypes (ST1, ST2, ST3, ST6 and ST7) among the samples. ST3 was the most prevalent subtype (25/55, 45%) while only one ST7 isolate was detected. Moreover, alleles 4 and 86 for ST1; alleles 9, 11 and 12 for ST2; alleles 31, 34, 36, 37 and 52 for ST3; allele 122 for ST6 and allele 137 for ST7 were detected. No statistically significant association was found between gender and symptoms with certain subtypes. Analysis of the intra-subtype variability in both symptomatic and asymptomatic subjects revealed highest similarity among ST1 isolates while lowest similarity was seen among ST3 isolates. Neutrality indices, Tajima's D and Fu's Fs, were negative but only statistically significant for ST3. Furthermore, highest values of Hd, π and S were observed among ST1, ST2 and ST3 isolated from symptomatic patients indicating high level of diversity among isolates obtained from these subjects. In addition, inter-subtype analysis showed the highest similarity between ST1 and ST2 isolates and the lowest similarity between ST2 and ST7 isolates. This is the first study revealing the presence of both ST6 and ST7 isolates in human from Iran. Phylogenetic analysis did not suggest any significant correlation between clinical manifestations and certain subtypes although genetic analysis showed highest value of diversity and significant neutrality indices among ST3 isolates obtained from symptomatic patients.

Intratumoral infiltrating lymphocytes correlate with improved survival in colorectal cancer patients: Independent of oncogenetic features

BACKGROUND

The clinical relevance and prognostic value of tumor-infiltrating lymphocytes (TILs) as an interplay between malignant cells and immune function has been known for decades. On contrary, this potential may be different by T lymphocytes subsets endowed with a different function. Colorectal cancer (CRC) is a heterogeneous disease with different suggested prognostic biomarkers. So, this study was conducted to examine the prognostic value of CD8+ TILs on the survival rate of CRC as an independent factor of oncogenetic tumor features.

METHODS

With respect to this, 281 formalin-fixed, paraffin-embedded tissue samples of Iranian CRC patients were evaluated for clinical features including tumor location, tumor stage, differentiation grade, and mucinous characteristics. Then, using the standard immunohistochemical technique, tumor sections were examined, and CD8+ TILs were counted and identified in two regions of the tumor, including intratumoral (ITCIL TILs) and stromal (S TILs). The prognostic value of CD8+ TILs was determined by comparing with parameters, such as diagnostic age, tumor stage, adjuvant therapy, microsatellite instability (MSI) status, KRAS and BRAF mutations, family history, and survival.

RESULTS

The presence of intratumoral tumor cell-infiltrating lymphocytes (ITCIL) CD8+ lymphocytes are significantly associated with differentiation (p = 0.004), tumor, node, and metastases (TNM) stage (p = 0.001), and MSI (p = 0.001). Meanwhile, based on the level of stromal infiltrating lymphocytes (SIL) infiltration, analysis of CRC patients was statistically associated with a location (p = 0.002), TNM stage (p < 0.001), metastasis (p < 0.001), and KRAS mutation (p = 0.031). Also, tumors with severe ITCIL CD8+ lymphocytes have a good prognosis compared with tumors with poor or moderate ITCIL CD8+ lymphocytes.

CONCLUSIONS

These results suggest that intratumor cell-infiltrating CD8- T lymphocytes as an independent prognostic factor that have an antitumor activity as judged by their favorable effect on patients' survival and could potentially be exploited in the treatment of CRC.

Seroepidemiology of hepatitis A and E virus infections in Tehran, Iran: a population based study

Hepatitis A virus (HAV) and hepatitis E virus (HEV) are enteric hepatotropic viruses and their prevalence is related to the sanitary conditions of the region under investigation. There are only a few studies on the seroepidemiology of these two viruses in the general Iranian population. The purpose of this investigation was to measure the prevalence of hepatitis A and E infections in the general population. Between 2006 and 2007, a cross sectional study was performed in Tehran, Iran. Blood specimens were collected and questionnaires were filled in for 551 persons. Patient sera were tested by ELISA for anti-HEV and anti-HAV IgGs. The χ(2) test and independent t-test were used for statistical analysis and p<0.05 was considered significant. The overall seroprevalence rates of anti-HEV IgG and anti-HAV IgG were 9.3% and 90%, respectively. The prevalence of antibodies to HAV and HEV was greater among men than women and increased with age. However, there was no significant relationship between age and gender with the existence of anti- HAV and HEV IgG antibodies. Our results show the seroprevalence of HAV and HEV antibodies are high and both viruses are endemic in this region. These findings are in accordance with results obtained from previous studies. We recommend that foreign travelers to Iran are vaccinated against HAV.

Validity and reliability of artificial intelligence chatbots as public sources of information on endodontics

AIM

This study aimed to evaluate and compare the validity and reliability of responses provided by GPT-3.5, Google Bard, and Bing to frequently asked questions (FAQs) in the field of endodontics.

METHODOLOGY

FAQs were formulated by expert endodontists (n = 10) and collected through GPT-3.5 queries (n = 10), with every question posed to each chatbot three times. Responses (N = 180) were independently evaluated by two board-certified endodontists using a modified Global Quality Score (GQS) on a 5-point Likert scale (5: strongly agree; 4: agree; 3: neutral; 2: disagree; 1: strongly disagree). Disagreements on scoring were resolved through evidence-based discussions. The validity of responses was analysed by categorizing scores into valid or invalid at two thresholds: The low threshold was set at score ≥4 for all three responses whilst the high threshold was set at score 5 for all three responses. Fisher's exact test was conducted to compare the validity of responses between chatbots. Cronbach's alpha was calculated to assess the reliability by assessing the consistency of repeated responses for each chatbot.

RESULTS

All three chatbots provided answers to all questions. Using the low-threshold validity test (GPT-3.5: 95%; Google Bard: 85%; Bing: 75%), there was no significant difference between the platforms (p > .05). When using the high-threshold validity test, the chatbot scores were substantially lower (GPT-3.5: 60%; Google Bard: 15%; Bing: 15%). The validity of GPT-3.5 responses was significantly higher than Google Bard and Bing (p = .008). All three chatbots achieved an acceptable level of reliability (Cronbach's alpha >0.7).

CONCLUSIONS

GPT-3.5 provided more credible information on topics related to endodontics compared to Google Bard and Bing.

Burden of Breast Cancer in Iranian Women is Increasing

BACKGROUND

Breast cancer (BC) is the leading cause of oncological death for women, in both developed and developing countries. In Iran, breast cancer ranks first among cancers diagnosed in women. The aim of this study was to present the burden of this cancer including incidence, mortality and years life lost (YLL) due to breast cancer in Iranian women.

MATERIALS AND METHODS

National incidence data from the Iranian annual National Cancer Registration reports from 2003 to 2009 and national death statistics reported by the Ministry of Health and Medical Education from 1995 to 2010, stratified by age group, were included in this analysis. Also calculated YLLs provided by the Institute for Health Metrics and Evaluation (IHME) for the years 1990, 1995, 2000, 2005 and 2010 were employed to express the years lost due to BC for Iranian women.

RESULTS

The general mortality rate of breast cancer increased during these years from 0.96 to 4.33 per 100,000 and incidence increased from 16.0 to 28.3 per 100,000 for the years under study. YLLs calculated by IHME showed both increasing and decreasing patterns, with a tendency for stabilization.

CONCLUSIONS

The burden of breast cancer for Iranian women is still increasing. Thus, health education programs to inform women regarding the signs and risk factors, and national screening to facilitate early diagnosis are needed for the female community in Iran.

Prevalence of Helicobacter pylori vacA, cagA, cagE, oipA, iceA, babA2 and babB genotypes in Iranian dyspeptic patients

There is diversity in clinical outcome of Helicobacter pylori infection in different regions. Microbial, host and environmental factors seem to be reason of such variation. Considering microbial factors, we studied H. pylori genotypes and their association with clinical feature of the infection. Overall 160 H. pylori-positive patients were enrolled in this study. Clinical information and biopsy were collected from each patient. The presence of the major virulence genes were determined by PCR. Regardless to clinical outcomes, vacA, cagA, cagE, oipA, iceA1, babA2 and babB genes was positive in 100%, 69%, 51%, 55%, 26%,78% and 28% of 160 strains respectively. The s1m2 was more common vacA allels and s1a and m1a were predominant s and m regions. In patient with gastric cancer (GC), the oipA was less frequent while the iceA1 was the most common. The babA2 was common in all patient groups. The babB was significantly observed in strains isolated from patients with GC. There were significant association among cagA status with presence of vacAs1, vacAm2, cagE, oipA, iceA1 and babA2. Presence of the babB and oipA was connected with higher and lower risk for GC respectively. There was no association between the cagA, vacA, cagE or iceA status and clinical outcome in patients in Iran. We showed that presence of the babB and iceA1 were significantly connected with higher risk for gastric cancer development in Iranian dyspeptic patients while H. pylori isolates with positive oipA had little threat for leading patients to cancer.

The emerging epidemic of inflammatory bowel disease in Asia and Iran by 2035: A modeling study

BACKGROUND

The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD).

METHODS

To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches.

RESULTS

In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high-income Asia-Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively.

CONCLUSIONS

Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

Effects of flaxseed and flaxseed oil supplement on serum levels of inflammatory markers, metabolic parameters and severity of disease in patients with ulcerative colitis

OBJECTIVE

The present study aimed to evaluate the possible effect of grounded flaxseed and flaxseed oil on serum levels of inflammatory markers, metabolic parameters, and the severity of disease in patients with UC.

METHODS

In this open-labeled randomized controlled trial, 90 UC patients were randomly assigned to one of the 3 groups for 12 weeks: grounded flaxseed (GF; 30 g/day), flaxseed oil (FO; 10 g/day) and control group. The weight, waist circumference, systolic and diastolic blood pressure, serum inflammatory markers (interleukin-6 (IL-6), interferon gamma (INF-γ), transforming growth factor beta (TGF-β), and Erythrocyte Sedimentation Rate (ESR)), and fecal calprotectin were measured at the baseline and end of the study.

RESULTS

Totally, 75 patients (43 men and 32 women) with a mean age of 31.54 ± 9.84 years participated in the present study. Comparing the change of the variables indicated a significant decrease in fecal calprotectin (P < 0.001), Mayo score (P < 0.001), ESR (P < 0.001), INF-γ (P < 0.001), IL-6 (P < 0.001), waist circumference (P = 0.02), Diastolic Blood Pressure (DBP) (P < 0.001), and Systolic Blood Pressure (SBP) (P < 0.001) and a significant increase in TGF-β (P < 0.001) and Inflammatory Bowel Disease Questionnaire-Short form (IBDQ-9) score (P < 0.001) in the GF and FO groups compared to the control. No difference was obvious between the FO and GF groups except for TGF-β.

CONCLUSION

The present study showed that both flaxseed and flaxseed oil, attenuate inflammatory markers, disease severity, blood pressure, and WC. However, the effect of flaxseed on weight and BMI was not evident.

Low Level of Microsatellite Instability Correlates with Poor Clinical Prognosis in Stage II Colorectal Cancer Patients

The influence of microsatellite instability (MSI) on the prognosis of colorectal cancer (CRC) requires more investigation. We assessed the role of MSI status in survival of individuals diagnosed with primary colorectal cancer. In this retrospective cross-sectional study the MSI status was determined in 158 formalin-fixed paraffin-embedded tumors and their matched normal tissues from patients who underwent curative surgery. Cox proportional hazard modeling was performed to assess the clinical prognostic significance. In this study we found that MSI-H tumors were predominantly located in the colon versus rectum (p = 0.03), associated with poorer differentiation (p = 0.003) and TNM stage II/III of tumors (p = 0.02). In CRC patients with stage II, MSI-L cases showed significantly poorer survival compared with patients who had MSI-H or MSS tumors (p = 0.04). This study indicates that MSI-L tumors correlate with poorer clinical outcome in patients with stage II tumors (p = 0.04) or in tumors located in the colon (p = 0.02). MSI-L characterizes a distinct subgroup of CRC patients who have a poorer outcome. This study suggests that MSI status in CRC, as a clinical prognostic marker, is dependent on other factors, such as tumor stage and location.

Estimation of the cure rate in Iranian breast cancer patients

BACKGROUND

Although the Cox's proportional hazard model is the popular approach for survival analysis to investigate significant risk factors of cancer patient survival, it is not appropriate in the case of log-term disease free survival. Recently, cure rate models have been introduced to distinguish between clinical determinants of cure and variables associated with the time to event of interest. The aim of this study was to use a cure rate model to determine the clinical associated factors for cure rates of patients with breast cancer (BC).

MATERIALS AND METHODS

This prospective cohort study covered 305 patients with BC, admitted at Shahid Faiazbakhsh Hospital, Tehran, during 2006 to 2008 and followed until April 2012. Cases of patient death were confirmed by telephone contact. For data analysis, a non-mixed cure rate model with Poisson distribution and negative binomial distribution were employed. All analyses were carried out using a developed Macro in WinBugs. Deviance information criteria (DIC) were employed to find the best model.

RESULTS

The overall 1-year, 3-year and 5-year relative survival rates were 97%, 89% and 74%. Metastasis and stage of BC were the significant factors, but age was significant only in negative binomial model. The DIC also showed that the negative binomial model had a better fit.

CONCLUSIONS

This study indicated that, metastasis and stage of BC were identified as the clinical criteria for cure rates. There are limited studies on BC survival which employed these cure rate models to identify the clinical factors associated with cure. These models are better than Cox, in the case of long-term survival.

Vitamin D receptor gene ApaI polymorphism is associated with susceptibility to colorectal cancer

OBJECTIVES

The purpose of this study was to investigate vitamin D receptor (VDR) gene ApaI and TaqI polymorphisms in relation to the risk of colorectal cancer (CRC) in the Iranian population.

METHODS

Two single nucleotide polymorphisms in intron 8 (ApaI) and exon 9 (TaqI) of the VDR gene were genotyped in 160 subjects with CRC and 180 controls by use of the PCR-RFLP method.

RESULTS

The VDR ApaI genotype distribution differed significantly between subjects with CRC and controls. The ApaI "aa" genotype compared with "AA" genotype was associated with a 2.3-fold increased risk of CRC (P = 0.014; OR = 2.25, 95% CI = 1.18-4.28) and the difference remained significant after adjustment for age, BMI, sex, and smoking status (P = 0.014; OR = 2.32, 95% CI = 1.19-4.54). Furthermore, the ApaI "a" allele was significantly overrepresented in subjects with CRC than controls (P = 0.014; OR = 1.48, 95% CI = 1.08-2.02).

CONCLUSIONS

These findings suggest that VDR ApaI genotype "aa" is associated with increased risk of CRC in the Iranian population. However, these data remain to be confirmed in larger studies and in other populations.

Survival Rates for Breast Cancer in Iranian Patients: a Meta- Analysis

BACKGROUND

Breast cancer is the most common cancer among Iranian women. Since development of the disease in Iranian women occurs relatively early, the survival rate matters considerably. In different countries, survival of breast cancer patients varies considerably. Therefore, the one-year, three-year, five-year, and ten- year survival rates for breast cancer in Iran were assessed using a meta-analysis.

MATERIALS AND METHODS

This systematic review and meta-analysis was based on valid Iranian sources including SID, MAGIRAN and IRANMEDEX, along with reliable English databases, namely, PUBMED and SCOPUS. In domestic databases, a search was conducted based on key words of breast cancer and survival rate, and in international databases, with "breast cancer" and the equivalent of "neoplasm" of Mesh Word, "survival rate" and "Iran. " Then all reviewed papers and theses which met the inclusion criteria were selected for investigation. To conduct the analysis STATA 11.2 software and random-effects models were used.

RESULTS

In 24 studies, 22,745 participants were included. The one-year, three-year, five-year and ten-year survival rates were 0.956, 0.808, 0.695 and 0.559, respectively. The minimum and maximum survival rates for 5-years were 0.48 and 0.87. The average age of the onset of the disease was 48.3.

CONCLUSIONS

As in Iran, since the onset of the disease is at low age, in spite of the relatively high survival rate as compared to other cancers, prevention and screening programs at early age for early stage diagnosis seems necessary.

Prevalence of celiac disease in low and high risk population in Asia-Pacific region: a systematic review and meta-analysis

This systematic review and meta-analysis study was conducted to estimate the pooled prevalence of CD in low and high risk groups in this region. Following keywords were searched in the Medline, PubMed, Scopus, Web of Science and Cochrane database according to the MeSH terms; celiac disease, prevalence, high risk population and Asian-Pacific region. Prevalence studies published from January 1991 to March 2018 were selected. Prevalence of CD with 95% confidence interval (CI) was calculated using STATA software, version 14. The pooled sero-prevalence of CD among low risk group in Asia-Pacific region was 1.2% (95% CI 0.8-1.7%) in 96,099 individuals based on positive anti-tissue transglutaminase (anti-t-TG Ab) and/or anti-endomysial antibodies (EMA). The pooled prevalence of biopsy proven CD in Asia-Pacific among high and low risk groups was 4.3% (95% CI 3.3-5.5%) and 0.61% (95% CI 0.4-0.8%) in 10,719 and 70,344 subjects, respectively. In addition, the pooled sero-prevalence and prevalence of CD in general population was significantly higher in children compared with adults and it was significantly greater in female vs. male (P < 0.05). Our results suggest high risk individuals of CD are key group that should be specifically targeted for prevention and control measures, and screening may prove to have an optimal cost-benefit ratio.

Recurrence and Five -Year Survival in Colorectal Cancer Patients After Surgery

BACKGROUND

Colorectal cancer (CRC) is a common malignancyworldwide and its outcome is most closely related to the extent of disease at presentation. Early diagnosis of an asymptomatic recurrence increases the likelihood of a complete surgical resection.

OBJECTIVES

The aim of this study was to evaluate the incidence of colorectal cancer recurrence and survival rate within 5 years, after surgery.

PATIENTS AND METHODS

During the 9-year period since 21st Mar, 2004 to 20th Mar, 2013, patients whose primary colorectal cancer were resected in Taleghani hospital, Tehran, Iran were selected in a historical cohort. The necessary data such as demographic, age, gender, family history of CRC, site and size of tumor, stage of tumor, operation details, histological results, treatment method, histopathologic, etc. were collected. Then the recurrence and survival of colorectal cancer within 5 years after operation and their risk factors were evaluated. P value less than 0.05 were considered significant. All analysis was done using SPSS software.

RESULTS

A total of 107 patients underwent resection for colorectal cancer during the study period, with mean age of 53.50 ± 12.68 years (range 24 - 76 years), survival rate of 73.8% (rectum 70.0% and colon 75.9%), and mean survival time of 142.17 ± 21.60 month. The recurrence rate of CRC patients, during five years after surgery was 5.7%. Regional lymph nodes, Distance metastasis and Adjuvant therapy were significant prognosis factors of survival after surgery.

CONCLUSIONS

The rate of recurrence in Iranian patients was low, which could be due to improvement of exactness and expertise of surgeons or better adjuvant therapy. The significant association between survival and adjuvant therapy clarifies this finding. Early diagnosis and primary detection could increase the rate of survival.

Prevalence of gluten-related disorders in Asia-Pacific region: a systematic review

BACKGROUND AND AIMS

The epidemiology of gluten-related disorders (GRDs) is still an open field to be explored. We conducted this systematic review based on the current epidemiology knowledge of GRDs, focusing on the changing prevalence of GRDs reported in the Asia-Pacific region.

METHODS

We searched Medline, PubMed, Scopus, Web of Science and Cochrane database with the following MeSH terms and keywords: celiac disease (CD), wheat allergy (WA), non-celiac gluten sensitivity (NCGS), dermatitis herpetiformis (DH) and gluten ataxia (GA) and the prevalence studies published from January 1991 to January 2018. Each article was cross-referenced with "Asia-Pacific region" and countries in this region such as Australia, New Zealand, India, Pakistan, Turkey, Iran and others.

RESULTS

We included 66 studies, which reported the prevalence of GRDs in the Asia-Pacific region. Prevalence of celiac disease was 0.32%-1.41% in healthy children and 0.05%-1.22% in the adult population, while the prevalence in the high risk population was higher (0.6%-11.8%). Previous studies have shown a very low incidence of dermatitis herpetiformis (DH) (<0.001%) and gluten ataxia (GA) in this area. Few studies on NCGS outbreaks have been found in this area due to the lack of specific diagnostic biomarkers. Wheat allergy (WA), although uncommon in most Asian-Pacific countries, is the most common cause of anaphylaxis in this region.

CONCLUSION

The results of this systematic review suggest the need to plan further proper epidemiological studies in order to understand the natural history of GRDs and to assess its burden on health systems.

Metabolic syndrome prevalence in the Iranian adult's general population and its trend: A systematic review and meta-analysis of observational studies

AIMS

Metabolic syndrome (MetS) is one of the most important predictors of CVD. Determining the trend of MetS, represents the trend of its components and consequently could forecast the incidence of related diseases particularly CVD. The main object of this study is describing the trend of MetS prevalence in both male and female.

MATERIALS AND METHODS

Original research studies from March 21, 2005 to March 20, 2015 that were published in English database and Persian databases were included in the systematic review. The random effect model was used to estimate the pooled prevalence of MetS. Subgroup analyses, to portray the trend of MetS, conducted based on implementation year.

RESULTS

The total sample sizes for males using the criteria of ATP III and IDF were 30012 and 35064, and for female were 14572 and 16292. The pooled estimation of MetS prevalence in total, male, and female population according to ATP III was 28%, 23%, and 33%; for IDF definitions was 28%, 22%, and 33%. Moreover, according to meta-regression for ATP III the most important source of heterogeneity was mean age.

CONCLUSION

The findings revealed the trend of MetS prevalence is declining although steady in the last 10 years.