Archives of Iranian Medicine
Volume:23 Issue: 6, Jun 2020

We aimed to present the temporal and geographical trends in the incidence of stomach cancer in the Golestan province, a high-risk area in Northern Iran.

This study was conducted on stomach cancer cases registered in the Golestan Population-based Cancer Registry (GPCR) during 2004-2016. Age-standardized incidence rates (ASRs) per 100000 person-years were calculated. The Joinpoint regression analysis was used to calculate the average annual percent changes (AAPC). We also calculated the contribution of population aging, population size and risk to the overall changes in incidence rates.

Overall, 2964 stomach cancer patients were registered. The ASR of stomach cancer was significantly higher in men (26.9) than women (12.2) (P<0.01). There was a significant decreasing trend in incidence of stomach cancer in men (AAPC=-1.80, 95% CI: -3.30 to-0.28; P=0.02). We found a higher ASR of stomach cancer in the rural (21.4) than urban (18.1) (P=0.04) population, as well as a significant decreasing trend in its rates (AAPC=-2.14, 95% CI: -3.10to-1.17; P<0.01). The number of new cases of stomach cancer increased by 22.33% (from 215 in 2004 to 263 in 2016), of which 18.1%, 25.1% and -20.9% were due to population size, population aging and risk, respectively. Our findings suggest a higher rate for stomach cancer in eastern areas.

We found high incidence rates as well as temporal and geographical diversities in ASR of stomach cancer in Golestan, Iran. Our results showed an increase in the number of new cases, mainly due to population size and aging. Further studies are warranted to determine the risk factors of this cancer in this high-risk population.

Tobacco smoking is one of the most important avoidable causes of mortality from non-communicable diseases (NCDs). This study aimed to report the crude and standardized prevalence of current, ever, and secondhand smoking at national and provincial levels.

This study was performed through an analysis of the results of the STEPs survey 2016, which was conducted as a cross-sectional national study. The samples were selected via multistage cluster sampling and they were representative of general population aged ≥18 years in all provinces of Iran. All the data were analyzed via survey analysis while considering population weights. Age-standardized prevalence was also calculated for the Iranian national population in 2016 and the World Health Organization (WHO) Population 2000-2025.

A total of 29963 subjects aged ≥18 years from all provinces of Iran, except for Qom, participated in this study. The age standardized prevalence of current tobacco smoking among adult males and females were 24.4% (95% CI: 23.6%–25.1%) and 3.8% (95% CI: 3.5%–4.1%), respectively. Among the participants, the majority of the current smokers were among those aged 45-54 years (14.5%; 95% CI: 13.6%–15.5%). With increase in age, the prevalence of secondhand smoking decreased to 34.8% (95% CI: 33.3%–36.7%) among people aged 18–24 years and to 22·6% (95% CI: 21.0%–24.3%) among subjects over 70 years.

The result of the study can be used to inform policy makers about the status of smoking and help them to design policies for setting rules on and limiting the import of cigarettes and their components to the country.

A rise in the global prevalence of severe obesity (body mass index; BMI of ≥35 kg/m2 ) has been reported. In this study, we investigated the trends in the prevalence of severe obesity among Tehranian adults over the past two decades.

A representative sample of 10,045 Tehranians aged ≥19 years were followed from 1999 to 2017. The trends in the prevalence of severe obesity were investigated over six cross-sectional phases with 3.6-year intervals using generalized estimating equations.

In this cohort, the overall prevalence of severe obesity increased from 4.6% (1.8% in males and 6.7% in females) in 1999 to 10.1% (4.7% in males and 14.3% in females) in 2017. The persisted rising in prevalence in the youngest age-group in both genders, with the most rapid increase among females aged 19–29 years, plateaued in the older ages and remained unchanged among males aged over 50 years. After age-sex standardized analysis by using Tehranian urban population data, the prevalence rates of severe obesity in Tehranian men and women were estimated to be 1.9% and 5.7% in 1996, and 4.5% and 10.9% in 2016, respectively.

There was a significant and continuous increase in the prevalence of severe obesity in Tehranian adults over the past two decades. Preventive interventions should be focused on the younger and middle-aged population, to mitigate the subsequent burden of severe obesity on Tehranian population and the healthcare system.

Patients with subclinical thyroid disease have few or no clinical symptoms of thyroid dysfunction and thus, laboratory diagnosis is needed. In this context, the objective of the current study was to analyze the prevalence rate and pattern of thyroid function in children with Down syndrome in the Polish population.

A total of 30 children, aged 6–12 years, with cytogenetically confirmed Down syndrome were studied. The control group included 27 children.

Of the 30 patients with Down syndrome, 14 (46.7%) had abnormal thyroid profiles. Mean thyroid-stimulating hormone (TSH) and fT4 concentrations in children with Down syndrome were found to be significantly increased compared with the controls (4.30 ± 1.9 µIU/mL, 95% CI: 3.55–5.04 µIU/mL vs. 3.10 ± 1.47 µIU/mL, 95% CI: 2.52–3.68 µIU/mL, P = 0.013, 95% CI: 0.26–2.14, and 1.33 ± 0.23 ng/dL, 95% CI: 1.25–1.42 vs. 1.19 ± 0.14 ng/dL, 95% CI: 1.13–1.25, P = 0.008, 95% CI: 0.04–0.24, respectively). In Down syndrome, subclinical hypothyroidism was recognized in 10 children (33.3%) (high TSH and normal fT4 and fT3 levels). Two children (6.67%) had evident hypothyroidism (high TSH and low fT4). In the control group, subclinical hypothyroidism was diagnosed in four (14.8%) children.

Children with Down syndrome may have increased secretion of TSH, even when thyroid hormone and autoantibodies are normal, suggesting that an isolated increase in TSH does not predispose the patient to the development of thyroid disease. We also recommend that all patients with Down syndrome should be screened for thyroid dysgenesis, since they have thyroid dysfunction more frequently as compared to the general healthy population.

Recent studies have revealed the increasing importance of sagittal spinopelvic alignment. Knowing the values of sagittal spinopelvic parameters, which are affected by ethnicity, is essential in the normal asymptomatic population. In the current study, these parameters were measured in a sample of asymptomatic Iranian population.

Seventy asymptomatic participants without complaint of musculoskeletal problems were enrolled. They had no complaint about musculoskeletal problems. Lateral full-length spinal and pelvic x–rays were taken. The following parameters were measured on x-rays and presented as mean ± standard deviation: pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), thoracic kyphosis (TK), lumbar tilt (LT) and thoracic tilt (TT).

The population consisted of 37 males and 33 females aged 26.6 ± 4.27 years. The mean values of PI, SS, PT, LL, TK, LT, and TT were 44.5 ± 10.1, 35.4 ± 6.7, 9.1 ± 7.9, 41.9 ± 14.7, 28.8 ± 8.3, 11.9 ± 7.4 and –7.5 ± 5.7 (median: –10; 5th percentile: –14; 95th percentile: 4.4) degrees, respectively. The variables were similar between males and females except for LL which was significantly higher in females (37.8 ± 16.5 versus 46.5 ± 11; P = 0.013). In addition, the linear regression model revealed age to be independently related with PI (beta = 0.344; P = 0.004) and PT (beta = 0.366; P = 0.002). PI (r = 0.344, P = 0.004) and PT (r = 0.359, P = 0.002) were positively correlated with age. Additionally, PI was positively correlated to SS, PT and LL and negatively to TT.

These findings may be used as referential values for sagittal spinopelvic parameters in the Iranian population. The positive correlation of PI with age questions the constancy of PI throughout life. However, larger studies are required.

The proposed mechanism of vancomycin-induced nephrotoxicity (VIN) is indirect production of reactive oxygen species in the kidney tissue. This study aimed to investigate the effectiveness of N-acetylcysteine (NAC), an anti-oxidant agent, in the prevention of VIN.

Patients who received vancomycin for any indication were randomly divided to drug (NAC) and control groups. The patients in the drug group received oral NAC 600 mg every 12 hours for 10 days, starting concurrently with vancomycin. Serum creatinine (SCr) levels and blood urea nitrogen (BUN) as well as creatinine clearance (CrCl) and 12-hour urine volume were recorded at baseline, every other day during the study, and 12 hours after the last dose of vancomycin on the 10th day. Furthermore, the cases of acute kidney injury (AKI; ≥ 0.5 mg/dL or at least 50% increase in serum creatinine from baseline) were recorded in the two groups.

Over the study period, 84 and 95 patients completed the study in drug and control groups, respectively. SCr and CrCl were significantly lower and higher, respectively, at all-time points (except for baseline) in the NAC compared to the control group. Furthermore, although not statistically significant, 12 cases of vancomycin-induced AKI were observed in the control group (12.63%), while 4 cases (4.76%) were reported from drug group (P = 0.066; relative risk [RR] = 0.377, 95% CI: 0.126–1.124).

NAC has the potential for reduction of VIN. However, more studies are necessary to confirm this effect.

Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac.

Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy.

A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum.

Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy

Collagenofibrotic glomerulopathy is a rare clinical entity with fewer than 40 cases reported worldwide. We describe a case of adult onset nephrotic syndrome with partial villous atrophy of the intestine who was diagnosed with this rare entity. Collagenofibrotic glomerulopathy is characterized by subendothelial and mesangial collagen type III deposition and increased procollagen III peptide levels. Extra renal involvement has been described in the form of hypertension, anemia and microangiopathic hemolytic anemia but villous atrophy has not been associated with this condition so far, possibly reflecting the paucity of literature. We describe this case and review the condition in this report.

One of the historical periods of Iran that can be studied for contagious diseases and how they spread, is the late Qajar period. The city of Mashhad, after Tehran and Tabriz, had a special place among Russian and English governments in the Qajar period as one of the significant religious, political and economic centers in Iran due to Imam Reza’s holy shrine, a large population and great geographical scale. The central governments’ incompetence in preventing the outbreak of contagious diseases and lack of essential amenities, caused many lives to be lost all over Iran and especially Mashhad during the Qajar period. Hence, the neighbor governments such as Russia, ordered for quarantines to be set up at the borders and dispatched doctors to stop diseases’ from reaching Russian lands. However, these attempts did not prevent the deaths of people in the border areas, especially in Mashhad, from diseases such as cholera, plague, smallpox, typhus, flu and other diseases. In this study, we investigate and explain the subjects: disease outbreaks, the problem of commerce, quarantine and its outcomes at the end of Qajar period, between the years 1892 and 1921 AD in Mashhad, with the help of historical and documentary sources using an analytical and medical historiography method.

We have recently established an intestinal rehabilitation unit (IRU) in Abu Ali Sina transplantation center affiliated to Shiraz University of Medical Sciences, Iran. Our intestinal failure rehabilitation and transplant program aims to provide state-of-the-art care for adult patients with different degrees of intestinal insufficiency and failure. In the IRU, we aimed to design an algorithmic approach to patients with small bowel ischemia and short bowel syndrome (SBS) based on our institutional experience in our country and based on other pioneering studies from other regions of the world.