ARCHIVES OF IRANIAN MEDICINE
Year:2019 | Volume:22 | Issue:1|Papers Count:10

Background: We aimed to evaluate completeness and accuracy of the Golestan Death Registry (GDR) to identify cancer-related causes of death (CCoD). Methods: The GDR data (2004-2015) were compared with cancer data collected from clinical/pathological sources (the considered gold standard) by the Golestan Population-Based Cancer Registry (GPCR). Using a linkage method, matched cases, including subjects with CCoD and those with ill-defined cause of death (ICoD) (garbage codes), were identified and entered into the final analysis as study subjects. The completeness (percentage of study subjects with CCoD) and accuracy (number of subjects with correct CoD from the total number of study subjects) of the GDR were calculated. Results: In total, 3, 766 matched cases were enrolled. Overall, the completeness and accuracy of the GDR for identifying CCoD were 92. 7% and 53. 2%, respectively. There were variations by cancer site and age group, with completeness and accuracy highest for brain cancer (96. 3%) and leukaemia (79. 8%) while the lowest accuracy was observed for colorectal cancer (29. 9%). The completeness and accuracy of GDR was higher in patients aged under 60 years (95. 7% and 53. 6%, respectively). We also found higher completeness (93. 7%) and accuracy (55. 8%) in residents of rural areas. Conclusion: Linkage of death registry data with cancer registry data can be a significant resource for evaluating quality of the death registry data. Our findings suggested that completeness of the GDR for identifying CCoD is reasonable, but accuracy is relatively low. Access to clinical and pathological data from other sources and enhanced training of death certifiers can improve the present situation.

Background: Current advancements in the field of chimeric antigen receptor (CAR) therapy, particularly U. S. FDA approval of Kymriah and Yescarta, heralds a new era of cancer treatment. This rapid progress in technology has urged more countries and institutions to keep pace with the fast-growing and developing technology of producing CAR T cell-based therapies in the race to develop new cancer-targeting drugs. Hence, for stepping in line with global advances and to pave the way for subsequent preclinical and clinical studies, we have established a development protocol for a cancer-targeting CAR T cell; we have chosen CD19 CAR T cell as a well-defined model to set-up T cell expansion, activation, and viral transduction as the prerequisites for diverse CAR T cell therapies. Methods: T cells from peripheral blood mononuclear cells (PBMCs) were activated and expanded. CD19 CAR lentiviral particles were produced in the Lenti-X™ 293T Cell Line using PolyFect Transfection Reagent. Results: Activation protocol resulted in (65 ± 4%; P = 0. 046) increase in the rate of activated T cells 24 hours after the initiation of the procedure. The expansion methodology resulted in a high purity of the T cell population (96 ± 3%) in the pool of PBMCs within 14 days of the procedure. Finally, 35 ± 6% of T cells were transduced with CD19 lentivirus with MOI of 3. Conclusion: Collectively, the results of this study prove that we have successfully overcome the first hurdle on the road to reach CAR T cell technology which is the prerequisite for developing preclinical and clinical phases of CAR therapy in settings with basic resources.

Background: Food insecurity has a considerable impact on the social, physical, and psychological well-being of people and there is no food security assessment tool specific for Iranians. This study aimed to develop and assess the validity and reliability of an Iranian-specific food security questionnaire. Methods: The food security questionnaire was developed by five food security specialists by evaluating all available questionnaires (not specific to Iranians) in terms of applicability to Iranians. Furthermore, questions were developed from interviews conducted with ten families who were below the poverty threshold to understand how they described their food status. This questionnaire was administered to 200 households from different parts of Isfahan, Iran. Households were selected by multi-stage cluster randomized sampling. Households were categorized into 4 groups based on their score on the questionnaire; food secure (total score 0), mildly (total score 1– 2), moderately (total score 3– 7) and severely food insecure (total score 8– 18). In the second stage of the study, 25 households were selected from each food security status group to evaluate the reliability and validity of the questionnaire by assessing sociodemographic, anthropometric, nutritional and biochemical parameters. Results: The prevalence of food security and mildly, moderately and severely food insecure were 24%, 33%, 27% and 16%, respectively. Content and face validity of the questionnaire was evaluated by experts, and latent class analysis confirmed construct validity. The developed questionnaire had good internal consistency (Cronbach’ s α = 0. 91) and showed significant differences in hypothesized directions in food security status for sociodemographic factors. The prevalence of mothers, but not fathers or children, who had hemoglobin, mean corpuscular volume (MCV) and hematocrit less than the normal ranges increased (P = 0. 04, P = 0. 02, P = 0. 02; respectively) with food insecurity. Conclusion: Our findings indicated that the developed questionnaire was a valid and reliable instrument to measure household food insecurity of Iranian families.

Background: Lipid abnormalities are major risk factors for cardiovascular diseases. In addition to age and sex, other variables can affect serum lipid levels, warranting the determination of population-specific reference values. This study aimed to determine age-and sex-specific reference values for serum total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), and triglycerides (TG) in healthy Tehranian adults. Methods: TC, TG, and HDL-C were measured using the enzymatic colorimetric method and the Friedewald equation (LDL-C = TC − HDL-C − TG/5) was used to calculate LDL-C concentrations in individuals with TG <400 mg/dL. After applying the exclusion criteria, 1147 participants (548 men and 599 women) aged ≥ 20 years were included. For determining reference values, the International Federation of Clinical Chemistry guidelines (non-parametric method) and the robust method were used for sample sizes ≥ 120 and <120, respectively. Results: Reference values for serum TC, LDL-C, HDL-C, and TG were 121. 0– 261. 0, 54. 1– 175. 2, 30. 9– 71. 9, and 46. 9– 301. 2 mg/dL in men and 117. 8– 235. 9, 49. 9– 160. 9, 36. 0– 83. 9, and 38. 1– 184. 2 mg/dL in women, respectively. All parameters except HDL-C were higher in men than women and showed an increasing trend with age. Conclusion: Reference values for serum TC, LDL-C, HDL-C, and TG in healthy Tehranian adults were determined, and these values could provide the basis for better decision making in both prevention and clinical settings.

Background: Transmembrane protein 16A (TMEM16A), also known as ANO1 (anoctamin-1), was reported to be vital in the growth and invasion of several malignancies. However, role of TMEM16A in lung cancer remained unclear. The aim of this study was to evaluate the expression of TMEM16A and its significance in lung cancer. Methods: qRT-PCR and Western blots were performed to evaluate the TMEM16A mRNA and protein expression. Proliferation and invasion of H1299 cancer cells were evaluated by CCK-8 and transwell assays. Tumor volumes in nude mice implanted with H1299 cells were assessed once every week for 5 weeks by measuring 2 perpendicular dimensions. Immunofluorescent staining revealed expression of TMEM16A in nude mice cancer tissues. Results: Our findings provided compelling evidence that TMEM16A production in H1299 cells is 2. 1 times higher than observations in HBE16 cells. We showed that overexpression of TMEM16A contributed to the proliferation of H1299 cells. Moreover, T16Ainh-A01, a specific TMEM16A inhibitor or shRNA targeting TMEM16A somewhat inhibited lung tumor cell growth and invasion as evident from in vitro studies and from in vivo xenograft-tumor growth. Inhibition of TMEM16A strongly suppressed EGFR phosphorylation and growth of lung cancer cells. Furthermore, a reduction of p-RAS and p-ERK1/2 was also observed. Conclusion: TMEM16A promoted growth and invasion in lung cancer cells via an EGFR/ MAPK-dependent signaling pathway. So we infer TMEM16A membrane protein may have potential to serve as a biomarker in lung cancer.

The Guilan cohort study was conducted on 10 520 men and women between 35-70 years of age in Guilan province and Some’ e Sara county, northern Iran, from October 8, 2014 to January 20, 2017 as part of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Eligible participants were contacted over the phone and were invited to refer to the cohort center. Demographic information was inquired during the phone call. Upon arrival of participants at the cohort center, consent forms were filled out and additional data on demographic characteristics, socio-economic status, employment, fuel status and location, lifestyle habits, and sleep and food habits were obtained. Blood pressure and anthropometric indices were measured. Finally, biological samples were collected. There was a participation rate of 83. 2%, and a 15-year active follow-up was planned for all of the participants. The results showed that 53. 5% of the participants were female and 56. 1% of the participants were rural residents. A total of 1738 participants (16. 5%) were illiterate. Of the total cohort participants, 4543 (43. 2%) were hypertensive. Hypertension was defined as a systolic blood pressure ≥ 140 mm Hg or a diastolic blood pressure ≥ 90 mm Hg, or a prior diagnosis of hypertension by a health professional, or taking antihypertensive medications. Approximately one-third of participants (n = 3435 or 32. 7%) were obese, and most were females (n = 2647, 77. 1%). Prevalence of diabetes (defined as fasting blood sugar equal or higher than 126 mg/dL or history of diagnosis with diabetes or taking glucose lowering medication) was 24. 1% (20. 2 % in males and 27. 3% in females). We also obtained laboratory samples for basic and genetic scientific research. According to laboratory evaluations, 3, 585 (34. 1%) of the participants had hematuria, and most of them were women (n = 2151 or 60%). The preliminary results of our study demonstrate a high prevalence of metabolic risk factors for Non-Communicable Diseases and mainly cardiovascular diseases in Guilan province, which merit detailed investigation of their intricate relationships. The population-based design of the study as well as its large sample size were the main strengths of our cohort study that makes these investigations feasible. Researchers interested in using the information are invited to visit the following websites: http: //www. gums. ac. ir/cohort and http: //persiancohort. com/.

Longitudinal studies are very common in medical, behavioral, and interventional sciences. One measure of effect of interest in longitudinal studies is risk ratio, naturally estimated by log-binomial regression which suffers from convergence problems. Odds ratio (OR) does not approximate risk ratio (RR) well when the outcome is common, so alternative methods have been introduced in cohort studies with one follow-up visit. In this paper, we illustrate two simple methods: the COPY method and the modified log-Poisson regression for RR estimation in longitudinal data setting. Our unpublished simulation study on RR estimation in longitudinal data setting suggests that the COPY method performs well in terms of closeness of the RR estimate and true RR (mean square error) and so we suggest this method for RR estimation in longitudinal data setting.

Background: Most pancreatic masses are primary ductal adenocarcinomas; however, with the advent of new imaging studies and increasing survival of cancer patients, there are more cases with the diagnosis of secondary metastatic cancer to the pancreas. There is no study regarding cancer metastases to the pancreas from Iran. In this study, we retrieved all of the cases with the diagnosis of secondary cancer of pancreas in the affiliated hospitals of Shiraz University of Medical Sciences. Methods: In 5 years (2012– 2017), we evaluated all cases with the diagnosis of any pancreatic tumors and extracted all of the demographic and clinicopathologic findings of the cases with the diagnosis of metastatic pancreatic tumors from the clinical charts and pathology reports. Results: For the duration of 5 years in our center, there were 131 cases of pancreatic tumors with different diagnoses, 9 of which were diagnosed as metastatic cancers from other organs. Two cases were diagnosed with gastric adenocarcinoma, 2 cases were colonic adenocarcinoma, one case was lung small cell carcinoma, 2 cases were renal cell carcinoma (RCC) and one case was gastrointestinal stromal tumor (GIST). The mesenchymal metastatic cancer to the pancreas has been a case of pleomorphic sarcoma of retroperitoneum. Conclusion: Pancreas is not a common location for metastases; however, colon, stomach, kidney and lung seem to be the most common primary tumors with metastases to the pancreas. Our report is the first study about pancreatic metastatic tumors from Iran.

Hydralazine is an FDA-approved antihypertensive agent which has been utilized for years either alone or in combination with other medications especially the beta-blockers. Hydralazine works as a direct-acting vasodilator, thereby exerting a decrease in vascular resistance and increase in intravascular volume. When overdosed, hydralazine applies its toxic effects by extending its pharmacological action, which produces hypotension, syncope, tachycardia, and nausea. However, studies and case reports of acute hydralazine toxicity and its effects on electrocardiographic changes are rare, and most of the medical literature have only highlighted its immunological side effects. In this report, we are presenting a case of acute hydralazine overdose in a young woman who ended up in CCU due to remarkably abnormal electrocardiogram and unstable hemodynamics followed by myocardial infarction.

a 65-year-old male patient presented with a chief complaint of swelling over the palate for the past 20 years. The patient gave a history of extraction of teeth 20 years ago. A gradual increase in the size of the lesion was noted post-extraction. The patient was a bidi smoker for 25 years and had quit the habit for the past one month.