ARCHIVES OF IRANIAN MEDICINE
Year:2018 | Volume:21 | Issue:2|Papers Count:9

Background: Gastrointestinal (GI) neoplasms are among the most common cancers in Iran. This study aimed to measure annual trends in mortality rates from GI cancers in Iran between 1990 and 2015. Methods: This study was part of an ongoing study termed the ‘ National and Subnational Burden of Diseases’ study in Iran. Data used in this study was obtained from the Iranian Death Registration System (1995 to 2010) and from 2 major cemeteries in Tehran (1995 to 2010) and Isfahan (2007 to 2010). All-cause mortality rates were estimated using the spatio-temporal model and the Gaussian process regression model. Age-standardized mortality rates (ASMR) per 100 000 person-years was calculated using data from Iran and the standard world population for comparison. Results: Among GI cancers, gastric cancer represented the leading cause of mortality followed by cancers of the esophagus, liver, and colorectal cancers with the ASMR of 20. 5, 5. 8, 4. 4, and 4. 0 per 100 000 persons-years, respectively, between 1990 and 2015. While a decreasing trend occurred in mortality of esophageal, gastric, and colorectal cancers, particularly in the recent decade, we recorded an upward pattern and steady rise in mortality rates from liver, pancreatic, and gallbladder cancers during the study period. The ASMR of all studied causes were enhanced by advancing age and were found to be more prominent in adults aged 50 or older. Among all age-groups, higher death rates were detected in males versus females for all studied cancers except for gallbladder and biliary tract cancers. Conclusion: Gastric cancer mortality is still high and death rates from several other GI cancers are increasing in the nation. Interventions for cancer prevention, early detection, and access to high quality cancer treatment services are needed to reduce GI cancer burden and death rates in Iran and in the region.

Background: Beta thalassemia major (BTM) and its treatment by hematopoietic stem cell transplantation (HSCT) may have deleterious effects on the endocrine systems. We assessed endocrine complications of HSCT in pediatric patients for 3 months. Methods: In 20 (6 female) pediatric major thalassemic patients (mean age of 10. 8 ± 3. 9 years old), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), T4, T3, thyroid-stimulating hormone (TSH), IGF-1, testosterone (in males) or estradiol (in females) were measured as a batch at the Endocrinology and Metabolism Research Center (EMRC) of Tehran University of Medical Sciences (TUMS) laboratories before HSCT and 1 and 3 months afterwards. The cosyntropin test for all and the clonidine test for short stature patients was conducted before HSCT. Results: Before HSCT, delayed puberty and hypogonadotropic hypogonadism was found in 10% and 20% of patients, respectively. GH deficiency, low IGF1 and short stature was found in 25%, 55% and 40% of patients, respectively. Hypocortisolism, hypothyroidism and panhypopituitarism was found in 15%, 10% and 15% of patients, respectively. Prevalence of hypogonadotropic hypogonadism, low IGF1, hypothyroidism and panhypopituitarism was found in 20%, 40%, 10% and 10% of patients after 3 months, respectively (delayed puberty and short stature prevalence do not change after 3 months). HSCT caused lower T3 and estradiol and higher TSH. Corticosteroid users (15) had higher GH and lower T3 and testosterone or estradiol. Ferritin had a significant (negative) correlation with (before) prolactin and a significant correlation with T3 and T4 after HSCT. Age and acute graft-versus-host disease (GVHD) had no significant effect. Conclusion: Considering the small sample size and short duration of the study, it is difficult to reach any conclusion however it seems HSCT does not appear to have an overall positive or negative effect on prevalence of pituitary-hypothalamus axis disorders in pediatric thalassemic patients in 3 months.

Background: Adverse pregnancy outcome are frequent in developing countries. Pregnancy outcomes are influenced by numerous factors. It seems that maternal anthropometric indices are among the most important factors in this era. The aim of this study was to determine any association between maternal anthropometric characteristics and adverse pregnancy outcomes in Iranian women and provide a predictive model by using factors affecting birth weight (BW) via the pathway analysis. Methods: This study was performed in Alborz province between September 2014 and December 2016. In this cross-sectional study, 1006 pregnant women who had the study criteria were selected from 1500 pregnant women. The data were collected in 2 phases: at their first prenatal visit and during the postpartum period. Demographic data, history of previous pregnancy, fundal height (FH), gestational weight gain (GWG), and abdominal circumference (AC) were recorded. Pathway (path) analysis was used to assess effective factors on pregnancy outcomes. Results: The mean and standard deviation of participant age at delivery was 25. 97 ± 5. 71 years. Overall, 4. 6% of infants were low BW (LBW) and 5. 8% had macrosomia. The final model, with a good fit accounting for 22% of BW variance, indicated that AC and FH (both P < 0. 001), and pre-pregnancy body mass index (BMI) (P = 0. 01) had positive direct effect on BW, while pre-pregnancy BMI and GWG (both P < 0. 001) affected BW indirectly through their effect on FH and AC. Conclusion: Based on the path analysis model, FH and AC of neonates with the greatest impact on BW, could be predicted by mother’ s BMI before pregnancy and weight gain during pregnancy. Therefore, close observation during prenatal care can reduce the risk of abnormal BW.

Background: Enterobius vermicularis (EV) is the most common helminthic infection in the world. This small parasite is predominant in the pediatric population. The presence of EV in the appendix can cause or mimick appendicitis. The aim of our study was to compare patients with EV infection and those without EV infection, and to identify predictive factors that may help the diagnosis of EV infection in patients presenting with right iliac fossa pain and avoid negative appendectomy. Methods: A retrospective analysis of all the appendices removed between January 2012 and December 2016 was conducted at the department of pediatric surgery, Hedi Chaker Hospital, Sfax, Tunisia. According to the final histopathological diagnosis, patients with EV infection were compared to those without EV infection. Data including age, sex, white blood cell (WBC) count, neutrophil count, eosinophil count, C-reactive protein, and ultrasound results for both groups were analyzed and compared. The study protocol was approved by the local hospital ethics committee. Statistical analysis was performed using IBM SPSS, version 20. Descriptive analysis in the form of mean and standard deviation was performed on demographic information. Differences between groups were assessed using the student t-test for continuous variables and the χ 2 test and Fisher exact test where appropriate for categorical variables. Results: In total, 540 pediatric appendectomies were performed. Overall, 63. 5% of patients were male and 36. 5% were female. Mean age was 9. 28 ± 2. 77 years. 22. 2% of procedures were completed laparoscopically, 76. 5% were open and 1. 3% were converted. The negative appendectomy rate was 11. 1%. EV was present in 9. 8% of cases. Comparison of clinical, biological, and ultrasound findings between two groups of patients with EV (EV+) and those without EV (EV-) shows a statistical significance for pruritus ani (P < 0. 001), WBC count (P < 0. 001), neutrophil count (P < 0. 001), C-reactive protein (CRP) (P = 0. 001), positive ultrasound (P < 0. 001), perforation rate (P = 0. 009), and negative appendectomy rate (P < 0. 001). No significant difference between the two groups was seen when comparing gender (P = 0. 271), vomiting (P = 0. 130), eosinophil count (P = 0. 915), and procedure (P = 0. 536)Conclusion: EV was seen in 9. 8% of pediatric appendectomies in our study. Pruritus ani, normal WBC count, normal neutrophil count, and normal CRP level at presentation could predict EV infection in children who present with right iliac fossa pain.

Background: Glucose transporter 3 (GLUT3) plays an important role in tumor progression and drug resistance in numerous malignancies, including acute myeloid leukemia (AML). However, the effect of GLUT3 silencing on treatment of AML remains poorly understood. The purpose of this study was to investigate role of GLUT3 in proliferation and chemosensitivity of AML and its underlying mechanisms. Methods: The siRNA transfection was conducted using LipofectamineTM 2000. Quantitative real-time RT-PCR (qRT-PCR) and Western blot analyses were employed to measure the expression levels of mRNA and protein for GLUT3, respectively. The cytotoxic effects of siRNA and vincristine were determined using the MTT assay. Flow cytometry was performed to analyze apoptosis. Results: GLUT3 siRNA transfection significantly reduced expression levels of GLUT3 mRNA and protein, leading to a strong growth inhibition and enhanced apoptosis (P = 0. 017) in AML cells. Moreover, treatment with GLUT3 siRNA, synergistically enhanced the cytotoxic and apoptotic effects of vincristine (P = 0. 025). We further investigated the possible mechanism involved in regulation of GLUT3 in AML cell proliferation and apoptosis. We found that GLUT3 negatively regulates EGFR activity, as well as the expression of its downstream proteins. Conclusion: Our results demonstrated that GLUT3 plays a fundamental role in the survival and resistance of AML cells to vincristine. Therefore, GLUT3 can be considered as an attractive target for gene therapy of AML patients and siRNA-mediated silencing of this gene may be a novel strategy in AML treatment.

Acute suppurative thyroiditis (AST) leading to thyroid abscess is a rare clinical entity. The aim of this article is to demonstrate a case of severe bilateral pneumonia which originated from a thyroid abscess. The authors report the case of a 57-year-old woman with severe bilateral pneumonia of thyroid origin. The patient had a painful throat and dysphagia for 2 or 3 days. She also had a history of mild fever and hard breathing with a discreet cough 7 days prior to hospital admission. In the past few months, the patient had frequent pneumonias. The patient was treated with a culture-appropriate antibiotic and total thyroidectomy. Primary recommendations for treatment of complicated infections of thyroid origin consider a multidisciplinary approach. Recurrent pneumonia in patients with thyroid nodules may be the result of thyroid inflammation, and, in such patients, neck ultrasound should be conducted as part of the diagnostic workup.

A 30-year-old white man noticed right supraclavicular enlargement and signs of thrombophlebitis in the ipsilateral upper extremity. He also reported epigastric and lumbar pain, nausea, vomiting and progressive dyspnea. Since his 12 years of age, he has been a tobacco dependent and is categorized as a daily heavy smoker...

Dear Editor, The publication on web-based error reporting surveillance system is very interesting. Askarian et al concluded that “ Using a standardized web-based error reporting system can be beneficial. ” Here, we would like to share ideas and experiences on this issue. Indeed, using a web-based reporting system for incidence reporting is useful in quality management of medical centers. Nevertheless, there are some important concerns. First, the collaboration of medical personnel in reporting is very important...

Author’ s ReplyThe other authors and I have reviewed the correspondence recently sent by Dr. Sora Yasri and we found the comments made to be interesting and important. The world has been radically transformed by digital technology – smart phones, tablets and web-enabled devices have changed our daily lives and the way we communicate. Medicine is an information-rich enterprise...