Archives of Iranian Medicine
Volume:23 Issue: 3, Mar 2020

There is currently little known about the epidemiology of lymphomas in Iran. The aim of this paper is to describe the geographic and time variations in incidence rates of lymphomas in the Golestan province between 2004 and 2013.

The Golestan Population-based Cancer Registry (GPCR) routinely registers primary cancer patients from all sources (e.g. pathology centers, hospitals, etc.) throughout the Golestan province. We obtained data on newly-diagnosed lymphomas in Golestan during 2004-2013 from the GPCR dataset. Crude rates and age standardized incidence (ASR) rates (per 100000) of lymphomas were estimated, joinpoint regression was used to quantify incidence trends and average annual percent changes (AAPCs) were calculated.

In total, 898 new cases of lymphoma were registered in the GPCR during 2004-2013. The ASR of Hodgkin lymphoma (HL) was 1.5 and 1.1 in males and females, respectively, while corresponding non-Hodgkin lymphoma (NHL) rates were greater, at 6.5 and 3.4 in males and females, respectively. Our results indicated a significant difference in the trends of HL between males (AAPC = -3.2) and females (AAPC = 3.6, P value = 0.001). The incidence rates of lymphoma were considerably higher in the urban population (ASR = 7.3) compared to those residing in rural areas (ASR = 5.3, P value = 0.054). We also found higher incidence rates for both HL and NHL in the western parts of the Golestan province.

The incidence rates of lymphoma in the Golestan province are relatively high and vary geographically, with a higher incidence observed in the western area. Such differences may reflect unknown lifestyle and environmental determinants linked to ethnic susceptibility differing between the two areas.

Breast cancer (BC) is a highly complex, heterogeneous and multifactorial disease and is the most commonly diagnosed cancer and the leading cause of cancer–related mortality in women worldwide. Family history and genetic mutations are important risk factors for BC. While studies in twins have estimated that about 10%–30% of BC are due to hereditary factors, only 4%–5% of them are due to mutations in BRCA1 or BRCA2 genes. Our aim was to investigate the role of other BC genes in familial BC among the Iranian population.

We selected 61 BC patients who were wild-type for BRCA1 and BRCA2 mutations but who met the criteria for hereditary BC based on the American College of Medical Genetics and Genomics (ACMG) and the National Comprehensive Cancer Network (NCCN) guidelines. We performed targeted sequencing covering the exons of 130 known cancer susceptibility genes based on the Cancer Gene Census list.

We found seven mutations in seven known BC susceptibility genes (RAD50, PTEN, TP53, POLH, DKC1, WRN and CHEK2) in seven patients including two pathogenic frameshift variants in RAD50 and WRN genes, four pathogenic missense variants in TP53, PTEN, POLH, and DKC1 genes and a pathogenic splice donor variant in the CHEK2 gene. The presence of all these variants was confirmed by Sanger sequencing and Gap reverse transcription-polymerase chain reaction (RT–PCR) for the splice variant. In silico analysis of all of these variants predicted them to be pathogenic.

Panel testing of BC patients who met the established criteria for hereditary BC but who were negative for BRCA1/2 mutations provided additional relevant clinical information for approximately 11.5% of the families. Our findings indicate that next generation sequencing (NGS) is a powerful tool to investigative putative mutagenic variants among patients who meet the criteria for hereditary BC, but with negative results on BRCA1/2 testing.

Considering the importance of the increasing incidence of non-tuberculous mycobacteria, especially Mycobacterium abscessus worldwide, we conducted a study to evaluate the incidence of these diseases in our area. The aim of this study was to evaluate the prevalence of M. abscessus in patients with non-tuberculous mycobacteria.

This descriptive study was performed on 18,083 samples isolated from patients with non-tuberculous mycobacteria during 2011-2017 at the Mycobacteriology Research Center (MRC), Tehran, Iran. To identify the Mycobacterium species, a 439 bp fragment of the IS6110 gene was first amplified using primers TB1 and TB2. Samples with a negative polymerase chain reaction (PCR) result were analyzed to investigate non-tuberculosis mycobacteria (NTM), especially M. abscessus using the RFLP method.

Of the 18,083 samples, 5513 (30.49%, 95% CI, 12.95) strains of Complex Tuberculosis and 236 (1.31%, 95% CI, 1.84) strains of NTM were identified. The mean age of the patients with NTM was 18 years, and most of them were male. The most commonly identified species in this study were M. abscessus type Ι 32 (13.56%, 95% CI, 18.36) and M. abscessus type II 13 (5.51%, 95%CI, 20.04).

In this study, we observed a high prevalence of Mycobacterium abscessus type 1 in patients. As the treatment protocol for non-TB mycobacteria is different from M. abscessus complex, the diagnosis of these species as soon as possible will be significant for physicians.

Papillary thyroid carcinoma (PTC) is a common subtype of thyroid carcinoma with a rising incidence rate. The purpose of this study was to provide a better understanding of age and PTC using the Surveillance, Epidemiology, and End Results (SEER) Program.

The study derived patients’ information from the SEER Program (2010–2015). Chi-square or Fisher exact tests, and Kaplan–Meier method were used to analyze survival. Prognostic factors associated with survival were analyzed by Cox multivariate regression.

A total of 1738 records were included from SEER, with 1079 PTC in the age group <55 years, and 659 PTC in the age group ≥55 years. The 5-year survival rate was 94% and the overall survival (OS) curve in different age groups indicated that patients younger than 55yr have a longer survival time (P<0.05). In multivariate Cox regression, age, M stage and surgery treatment were independent risk factors (P<0.05). Regarding PTC-specific survival, age and surgery treatment were the two main independent prognostic factors in multivariate regression. However, AJCC and M stage were not in the disease specific survival.

Age is a prognostic factor in OS and PCT specific survival. AJCC I stage and surgery treatment are also significant in predicting prognosis

Biological and psychological factors contribute to cardiovascular disease (CVD). This study aimed to test the moderating effect of social loneliness in the relationship between worry and anger rumination, and CVD severity.

A total of 327 patients with CVD (138 women, 189 men) participated in this study. The Penn State Worry Questionnaire (PSWQ), Anger Rumination Scale (ARS), Social Loneliness Scale (SLS), and Gensini score as an indicator of CVD severity were used to collect data. Data were analyzed using Pearson correlation and stepwise regression.

The results of this study showed a significant positive correlation between worry (54.44 ± 12.31, r = 0.59, P<0.01), anger rumination (46.54±12.47; r = 0.36; P<0.01), and social loneliness (28.22 ± 9.13, r = 0.65, P<0.01) with CVD severity (15.07 ± 5.13). In other words, higher levels of worry, anger rumination, and social loneliness are associated with exacerbation of CVD. Social loneliness was a moderator in the relationship between worry and CVD severity (ΔR2 = 0.007, F= 4.2870, P<0.05), suggesting the importance of worry in CVD severity, especially in lonely people. The main effects of worry and social loneliness on CVD severity were β = 0.32, SE = 0.04, 95% CI = 0.2289, 0.4222, P<0.001 and β = 0.46, SE = 0.04, 95% CI = 0.3649, 0.5572, P<0.001, respectively. The moderating effect of social loneliness on the relationship between worry and CVD severity was β = 0.07; SE = 0.03; 95% CI = 0.0074, 0.1522; P<0.001. Social loneliness was not a moderator in the relationship between anger rumination and CVD severity (ΔR2 = 0.006, F= 3.10, P>0.05).

Based on the findings of this research, it can be concluded that along with biological factors, attention to the role of psychological factors of worry, anger rumination, and loneliness in preventive and therapeutic interventions related to CVD is a special necessity

With the growing rate of tumors, cancer has become one of the most important health concerns in Iran. The urgency with which Iranian researchers and health professionals address this challenge leads to a load of scientific materials.

To reveal gaps in produced knowledge and suggest future research directions, applying well-validated scientometric tools, we assessed the trends of Iranian published scientific articles and citations in the field of oncology. The inclusion criteria consisted of all oncology-related articles that were data-based, and peer-reviewed; with at least an abstract published in English; and authored by at least one researcher affiliated with Iranian institutions.

Amongst 5063525 oncology research records indexed in at least one of PubMed, Scopus, or Web of Science Core Collection (WoS) from the start to February 2019, Iranian researches accounted for about 24867 (0.49%). Published articles on all cancers by Iranian researchers had a sharp continuously ascending trend, with the same pattern for citations received. Some important topics such as complementary and alternative medicine (CAM) therapies have been missing and some such as diagnostic and pharmaceutical innovations have been less investigated. The most collaborative country was the United States, while no close collaboration was observed with China that was introduced as the most productive country in the field of oncology over the past decades.

Despite the progressive trend in most oncology fields, some significant practical topics are still missing. Systematic reviews of produced theoretical innovations and translating them to functional knowledge can be of importance to fulfill the mentioned gaps.

Hepatitis B infection is the major risk factor for liver cancer in Iran. There is no comprehensive population-based study on the prevalence of hepatitis B by regional distribution. Moreover, systematic reviews of hepatitis B prevalence lack knowledge of some regions. We aimed to estimate the prevalence of hepatitis B and its temporal trends over 17 years by sex, age and geographical distribution.

We used the Iranian Blood Donors data in addition to systematic reviews on population-based studies at national and provincial levels and statistical methods (A two-stage spatio-temporal model and crosswalk approach) to address the missing points of hepatitis B prevalence among the general population. The direct age-standardized approach was applied using Iran’s national population in 2016.

At national level, age-standardized hepatitis B prevalence in Iran decreased from 3.02% (95% uncertainty interval; 2.26 to 3.96) in 2000 to 1.09% (95% uncertainty interval; 0.85 to 1.37) in 2016, with a total -64.84% change. Hepatitis B prevalence was more than 1.3 times greater in males than females in 2016. Overall, the prevalence of hepatitis B increased with increasing age. At provincial level, in 2016, the province with the highest prevalence had a nearly 11-time greater rate compared to the lowest prevalence. The declining annual percent change (APC) of the prevalence trend varied between -11.53% to -0.5% at provincial level from 2000 to 2016. Only one province did not witness a downward trend in which the APC was 0.5% (95% UI:0.47-0.54).

The downward trend in prevalence of hepatitis B infection indicates the effectiveness of strategies and preventive measures adapted in Iran. Nevertheless, we need to eradicate this infection. In this regard, re-evaluating preventive measures, especially in high-risk age groups of the population, is recommended

Depression and anxiety are the most common mental disorders and currently, they constitute one of the main causes of disability and death. The high prevalence of psychiatric disorders and their increasing burden are noteworthy. The aim of this study is to investigate the effectiveness of community-based preventive interventions for depression and anxiety in women.

We systematically searched for articles published up to the beginning of 2018, which addressed community-based preventive interventions for depression and anxiety in women. The studies were searched in PubMed, Scopus, Cochrane Library, Web of Science, PsycInfo, IranMedex, SID and EMBASE electronic databases. Articles that complied with our inclusion criteria (preventive interventions involving healthy adult women aged 18 to 65 years) were reviewed. Quality assessment of the articles was performed using standard tools. We extracted the required data and reported the results in a narrative form.

Twenty-three articles were identified and entered into the final review. Depression and anxiety symptoms were decreased in more than 70% of interventions. Cognitive behavioral therapy (CBT) and exercise were the most effective interventions. In addition, computer and internet-based programs had positive outcomes in both categories of depression and anxiety.

Community-based preventive programs for depression and anxiety in women had promising and positive results. CBT and exercise were the most effortless, yet the most effective interventions to apply. Computer and internet-based programs had the benefit of covering many people simultaneously. These interventions are cost-effective and feasible among Iranian women.

Hereditary spherocytosis (HS), a familial defect involving red blood cell (RBC) membrane proteins, is associated with reduced deformability, increased fragility, and progressive destruction of spherical cells. The present study focuses on three subjects of a family showing a history of repeated episodes of lethargy and pallor of unknown etiology. All patients displayed reticulocytosis and spherocytosis and one of them had anemia and splenomegaly. The patients underwent screening tests to rule in/out possible underlying disorders, and deficiency/dysfunction of RBC membrane proteins was suspected. Definitive diagnosis can be made on the basis of membrane protein analysis by quantitative sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Interestingly, all patients showed marked decrease in the protein 4.2 expression and therefore, HS was confirmed. This case report highlights the simultaneous occurrence of protein 4.2-dependent “typical” and “atypical” HS in a family and serves as a reminder to clinicians to consider RBC membrane disorders in patients presenting with suspicious and unexplained clinical signs.

Iran is a great country with a long history of civilization and medicine. Following the increase in the prevalence of multiple sclerosis (MS), Iranian scientists and physicians started considering this disease and its outcomes in Iran. The first MS paper published by Iranian scientists dates back to 1963, when a case of hereditary spastic ataxia mimicking MS was reported. With the cooperation of his colleagues, Prof. Jamshid Lotfi conducted the first MS-related paper. The Iranian MS Society was established in 1998 in Iran, and is currently a member of the MS International Federation (MSIF). Progressively, after the scientific development of Iranian universities and recognizing the importance of the disease, the first specialized MS ward was established in Sina hospital by Prof. Mohammad Ali Sahraian and was followed by the establishment of the first MS research center. MS Society is presently quite active and the Iranian MS congress is annually held in one of the Iranian universities to review the most recent achievements in the field of the disease. The present study aims to illustrate the history of the efforts made on the way, and attempts to introduce the people who took significant steps in this regard.