ARCHIVES OF IRANIAN MEDICINE
Year:2017 | Volume:20 | Issue:12|Papers Count:9

In this issue of the Journal, Salimzadeh and colleagues report on the feasibility, uptake, and positive predictive value of the fecal immunochemical test (FIT) to screen for colorectal cancer (CRC) and adenomas in the general population of Iran. The study is well designed, and the results are intriguing. FIT was offered in primary healthcare settings by primary care staff, and the uptake was quite high (1002 of 1044, 96%); the large majority (99. 4%) of the received stool samples were satisfactory for testing...

Background: Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no mass screening for the disease yet. We aimed to measure the feasibility of a pilot CRC screening program based on fecal immunochemical test (FIT) in Iranian population and the implications for scaling-up at the national level. Methods: A single quantitative FIT was offered by health navigators to individuals aged between 45 and 75 years in primary health centers in rural and urban areas in Tehran. Participants who had a positive FIT were referred for colonoscopy. Results: A total of 1044 asymptomatic average-risk individuals were enrolled. The mean age (SD) was 54. 1 ± 7. 0 years and nearly 63. 0% (n = 657) were female. Only a small fraction of the participants had a prior screening practice (2. 2%) and were aware of colon cancer (13. 7%). In sum, 1002 returned the FIT kit, of whom the stool sample was unsatisfactory for testing in six participants (0. 6%). The FIT uptake was 96. 0%, positivity rate was 9. 1% and the detection rates were 11. 9% for adenomas and 7. 1% for advanced adenomas. No cancer was detected. The positive predictive value (PPV) of the FIT was about 17% for any colonic neoplasms. Conclusion: This is the first study that reports minimal quality metrics within a CRC screening process. FIT modality as a test of choice for colon cancer screening in average-risk people is a safe and highly acceptable method of screening in Iranian people. The results of the current study may not be limited to Iranians, and could have implications to other developing countries with similar trends of CRC epidemic.

Background: To compare metabolic changes in 3 groups of postmenopausal women: those who had undergone bilateral salpingo-oophorectomy + hysterectomy (BSO + H), those with hysterectomy ± unilateral salpingo-oophorectomy (H ± USO), and those who reached natural menopause during follow-up. Methods: This longitudinal study was performed on 543 female participants of the Tehran Lipid and Glucose Study (TLGS) who experienced surgical menopause (BSO + H or H ± USO) or natural menopause over a 12-year period. During the follow-up period, changes in metabolic and biochemical profiles were compared between surgically and naturally menopausal women (NMW). In all groups, data was collected using questionnaires twice, at baseline and again after 3 years. Results: Considering the women with natural menopause as the reference group, the odds ratio of metabolic syndrome was 5. 0 in the surgically menopause due to BSO + H. Mean fasting blood glucose was also significantly higher in the H ± USO group, compared to the naturally menopausal, after adjustment for confounding variables. Conclusion: The incidence of metabolic syndrome in the BSO + H group and that of fasting blood glucose in the H ± USO group were higher than NMW.

Background: Research evidence shows that exercise is associated with positive physical and mental health. Moreover, exercise and wheel running in rats activate overlapping neural systems and reward system. The most commonly used models for the study of rewarding and aversive effects of exercise involve using treadmill and wheel running paradigms in mice or rats. The purpose of our experiment was to study the influence of continuous voluntary exercise on exercise-seeking behavior. Methods: In this experimental study, we used 24 adult male Sprague– Dawley rats weighing 275– 300 g on average. Rats were divided into 3 experimental groups for 4 weeks of voluntary wheel running. Each rat ran in the cage equipped with a wheel during 24 hours. A within-subject repeated measure design was employed to evaluate the trend of running and running rates. Results: We found that time and higher levels of exercise will increase exercise tendency. Our results also show that the interaction of exercise within 4 weeks and different levels of exercise can significantly promote rats’ exercise-seeking behavior (F = 5. 440; df = 2. 08; P < 0. 001). Conclusion: Our data suggest that voluntary wheel running can increase the likelihood of extreme and obsessive exercising which is a form of non-drug addiction.

Background: This study was designed to present initial results on clinical presentation, therapeutic modalities, and outcome information of patients with pituitary tumors registered in Iran Pituitary Tumor Registry (IPTR). Methods: We collected data from a web-based electronic medical records of patients with various pituitary tumors referred to four tertiary care centers in the country. Retrospective analysis was performed on demographic, clinical, and therapeutic information of 298 patients including 51 clinically nonfunctioning adenoma (CNFA), 85 acromegaly, 135 prolactinoma, and 27 Cushing’ s disease (CD). Results: From October 2014 to July 2016, 298 people with the diagnosis of pituitary tumor were registered. Prolactinoma was the most prevalent tumor (45. 3%), followed by Acromegaly (28. 6%), CNFPA (17. 1%), and CD (9%). Female dominance was seen among patients with prolactinoma and CD, while the majority of patients with CNFPA were male and acromegaly was equally distributed between men and women. Hypogonadal symptoms were almost always seen in all types of pituitary groups. Surgery alone was the most common therapeutic modality used in cases of acromegaly, CNFPA, and CD. However, medical therapy alone was frequently applied for cases of prolactinoma. Finally, biochemical cure was achieved in most cases of prolactinoma and CD, but only in 36. 5% of acromegalics. Moreover, 80% of patients suffering from CNFPA showed no residual tumor in their imaging. Conclusion: In conclusion, this comprehensive tumor registry enables early identification, selection of best therapeutic approaches, and evaluation of long-term treatment outcomes. Furthermore, this registry can be used to improve surveillance protocols.

Background: The strong correlation between vascular calcification and cardiovascular risk, which is a major cause of mortality in hemodialysis (HD) patients, has been well established. Fetuin-A is an inhibitor of vascular calcification, and pentraxin 3 (PTX3) is produced at the site of inflammation, which is associated with cardiovascular disease (CVD). The main purpose of this study was evaluating the correlation between fetuin-A and PTX3with some biochemical parameters effective upon vascular calcification in HD patients. Methods: We included 84 HD patients and 84 healthy controls matched for age, gender, and body mass index (BMI) in this study. Blood samples were drawn from all subjects and the serum levels of creatinine, urea, albumin, calcium (Ca), phosphorus (P), low-density lipoprotein cholesterol (LDL-C), parathyroid hormone, fetuin-A, high sensitive C-reactive protein, and PTX3were measured by biochemical methods. Results: We found that the serum levels of PTX3, C-reactive protein (CRP), parathyroid hormone (PTH), Ca, and P in the patient group were significantly higher than the control group but the serum levels of fetuin-A and albumin were significantly lower in the patient group. Also, fetuin-A had a significant correlation with high sensitive CRP (hs-CRP) as well as duration of dialysis. In addition, it was shown that the correlation between PTX3 and PTH was significant only in the patient group. Conclusion: In this study, increased PTX3 and decreased fetuin-A levels were observed in the HD patients. According to our results, these 2 parameters may potentially serve as suitable markers for inflammation and prediction of vascular complications in these patients.

Interrupted aortic arch (IAA) is a rare congenital malformation defined as complete discontinuity between ascending and descending parts of aorta. We present a case of IAA, which was referred to us due to dilatation of proximal and mid parts of his thoracic aorta accompanied by narrowing of aorta proximal to the branching of the left subclavian artery. Further evaluation revealed interruption of aorta at the proximal part of descending thoracic aorta by a transverse septum along with several collateral formations. In general, the standard treatment of IAA is open surgical repair. Endovascular repair of IAA is an alternative approach for IAA, which is applied when two distinct parts of aorta are too close to each other. Here, we present a new approach of endovascular transcatheter repair of IAA with implantation of a self-expandable stent that we believe has fewer complications.

Background: The American Presbyterian Missionary in Iran accomplished medical activities in Urmia. Doctor Joseph Plumb Cochran established the first modern medical college (the Westminster College) in 1879 and built a modern hospital of that time (the Westminster Hospital). The medical college and hospital trained 34 native physicians that practiced in the northwest of Iran and its neighboring regions. Although the main aim of American Presbyterian Missionary was theological and evangelistic, their devoted activities improved health and welfare in the northwestern part of Iran and its neighboring countries.

Dear Editor, With interest, we read the article by Shahrokhi et al about a new-born with a β-oxidation defect due to a mutation in the HADHB gene encoding the β-subunit of the trifunctional protein. 1 We have the following comments and concerns. A main disadvantage of the study is that the pathogenicity of the HADHB mutation was confirmed only by in silico techniques...