Archives of Iranian Medicine
Volume:24 Issue: 3, Mar 2021

The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladder, lung, and colon and rectum. In this paper, we describe the rationale, design, and some initial results of the IROPICAN Study.

The IROPICAN is a multi-center case-control study conducted in 10 provinces of Iran. The cases were all histologically confirmed and the controls were selected from hospital visitors who were free of cancer, were not family members or friends of the cancer patients, and were visiting the hospital for reasons other than their own ailment. The questionnaires included detailed questions on opium use (including age at initiation, duration, frequency, typical amount, and route), and potential confounders, such as tobacco use (e.g., cigarettes, nass and water-pipe), and dietary factors. Biological samples, including blood and saliva, were also collected.

The validation and pilot phases showed reasonably good validity, with sensitivities of 70% and 69% for the cases and controls, respectively, in reporting opium use. The results also showed excellent reliability, with intra-class correlation coefficients of 0.96 for ever opium use and 0.88 (95% CI: 0.80, 0.92) for regular opium use. In the main phase, we recruited 3299 cancer cases (99% response rate) and 3477 hospital visitor controls (89% response rate). The proportion of ever-use of opium was 40% among cases and 18% among controls.

The IROPICAN study will serve as a major resource in studies addressing the effect of opium on risk of cancers of the head and neck, bladder, lung, and colon and rectum.

Non-alcoholic fatty liver disease (NAFLD) is common in people with type 2 diabetes mellitus (T2DM). We aimed to explore predictive factors of NAFLD in T2DM and identify high risk subgroups.

This was a cross-sectional study including 100 individuals with T2DM and 100 without diabetes matched for age, sex, and body mass index (BMI). Hepatic steatosis grades (calculated by controlled attenuation parameters-CAP score-3), and liver fibrosis stages (F0-F4) were determined using transient elastography.

The frequency of NAFLD was comparable between the two study groups. However, CAP scores were significantly higher in individuals with diabetes (294.90 ± 53.12 vs. 269.78 ± 45.05 dB/m; P < 0.001). Fifty percent of individuals with diabetes had severe steatosis (S3), while this figure was 31.6% in those without diabetes (P < 0.05). Significant fibrosis (F2-F4) was more frequent in individuals with T2DM (13% vs. 4.1%, P = 0.02). Individuals with T2DM and advanced fibrosis had significantly higher BMI, waist circumference (WC), waist-hip ratio (WHR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and CAP score compared to those without fibrosis (P < 0.05). In the regression analysis, a model including BMI, WHR, AST and female gender explained 50% of the variation in CAP score in patients with diabetes (all P < 0.05, adjusted R2 : 0.508). CAP scores were also the major determinant of liver fibrosis in this group (OR: 1.04; CI: 1.017–1.063; P = 0.001).

Individuals with diabetes are more likely to have severe fibrosis. Obesity (especially central obesity), the female gender, elevated liver enzymes, and higher degree of insulin resistance are associated with more advanced liver disease in individuals with T2DM.

Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI).

This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups.

Among 1180 patients, Escherichia coli was the commonest pathogen (68.1%) followed by Enterococcus spp. (8.8%) and Klebsiella pneumonia (8.0 %). Non-E. coli pathogens were more frequent among males (41.8% versus 24.8% in females, P<0.01) and in those aged under 20 years (61.0% versus 22.2% in older than 20 years, P<0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9%), meropenem (92.2%), and amikacin (91.9%); moderate sensitivity to gentamicin (64.4%), cefepime (52.6%) and ceftazidime (47.2%); and low susceptibility to ceftriaxone (41.8%), cefotaxime (40.0%), ciprofloxacin (38.6%) and trimethoprim-sulfamethoxazol (31.3%). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years.

We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area.

Rheumatoid arthritis (RA) presents with inflammation in the joints and bony tissues around them. The trabecular bone score (TBS) is a relatively new indicator that predicts fracture risk better than bone mineral density (BMD). The aim of the current study was to measure TBSs and BMD of patients with RA referring to Resalat Hospital, Tehran.

In this descriptive cross-sectional study, 129 men and women with RA entered the study through convenient sampling during 2016. TBS and BMD were measured in L1-L4. The relationships between age, sex, body mass index (BMI), duration of disease, and daily corticosteroids dose with TBS and BMD were determined by chi-square test, independent samples t test, Pearson correlation, and linear and logistic regression.

The TBS of 34.9%, 31.8%, and 33.3% of study subjects were higher than 1.35, 1.25–1.35, and lower than 1.25, respectively. The prevalence of TBS lower than 1.25 was 48.7% in women aged age more than 50 years. Age was the only predictor of low TBS in patients with RA. TBS and BMD were positively correlated in vertebral and hip bones. In women older than 50 years, BMI (-1.292) and age (-1.330) were predictors of low TBS.

One-third of patients with RA were at risk of fracture. Gender and BMI were two factors which affected the TBS. This index can show the effect of disease on bones, which is related to age.

Influenza is one of the most important viral diseases with high mortality and morbidity that can have a great impact on public health and economy.

To investigate the clinical and epidemiological features of influenza virus A/H1N1, A/H3N2, and B infection in Fars province, southern Iran, in 2015-2019.

In this retrospective cross-sectional study, we assessed the archived data of Syndromic Surveillance System of Iran’s Health Ministry, allowed access by Communicable Diseases’ Unit of Health chancellor of Shiraz University of Medical Sciences, from December 22, 2015 to September 22, 2019. The participants included all patients whose data were recorded as influenza-like illness (ILI) and severe acute respiratory infections/illness (SARI). Influenza viral infection was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR).

Totally, 1269 patients suspected of influenza were sampled. The mean ± SD of age was 29.40 ± 26.91 years. Fever was the most common symptom (68.6%). The highest incidence was in winter (55.9%). Of 928/1269 laboratory’s results which were recorded in the registry, 204 (16.08%) samples were positive and 724 (57.05%) were negative. Among 204 positive results, 191 (15.05%) were influenza type A, and 8 (0.63%) influenza type B. Among patients with definite influenza type A, 34 (2.68%) had H1N1/p subtype, 58 (4.57%) H3N2, and one (0.08%) had other subtypes; however, subtypes were not identified in 7.72% of patients. Six (3.0%) patients with confirmed influenza expired.

The incidence of influenza, especially type A, in Fars province, southern Iran is considerable and requires more attention for prevention in health policy programs.

The study aimed at evaluating steroid biomarker genes (ERα, PGR, ERβ) and determining the expression level of estrogen-regulated genes (SCUB2 and BCL2) and growth factors receptors (HER2 and IGFR1) in cancer tissue samples obtained from Iranian patients with breast cancer. Moreover, relationships with clinicopathologic aspects of tumor and response to treatment were studied.

The current study was conducted on 246 breast tissue samples. The expression levels of these genes and their relationships with clinicopathologic aspects and treatment response were evaluated.

Based on immunohistochemistry (IHC) results, 12% of the ER negative patients expressed ERα. Comparing the effects of ERα and coexpression of BCL2 and SCUBE2 on the survival of the patients demonstrated remarkably poorer survival in ERα positive, SCUBE2, and BCL2 negative groups in comparison with other patients, which was statistically significant in the logrank analysis (P = 0.01). Evaluation of the effects of coexpression of HER2 and IGFR1 on patients’ survival demonstrated a worse survival rate in patients with positive expression of both receptors, which was insignificant.

Many studies suggest that PGR alone is not enough for the functional evaluation of ERα. Evaluation of the progesterone receptor expression as well as other genes such as BLC2, SCUBE2, and IGFR1, seems necessary to evaluate functionality.

Capsule endoscopy (CE) and double-balloon enteroscopy (DBE) have provided great help in the diagnosis and treatment of small bowel diseases (SBD). The aim of this study was to explore the positive rate and diagnostic value of CE and DBE for patients who were suspected of having SBD, and to make a comparison between the two methods.

A retrospective study was conducted to analyze the cases at Renmin Hospital of Wuhan University. We divided the patients into CE and DBE group, and recorded the basic characteristics of the patients, checking the results of CE and DBE, positive rate, sensitivity and specificity for statistical analysis.

A total of 244 patients were included in our research, including 122 in the CE group and 122 in the DBE group. The positive rate of CE for intestinal diseases was 84.4%, higher than that of DBE (78.7%), but DBE (75.2% and 92.3%) had higher sensitivity and specificity than CE (70.5% and 88.2%), though the differences were not statistically significant. The three most common positive findings in patients were inflammation, erosion, or ulcers (28.7%), vascular malformations (14.3%), and eminence lesions (9.0%). CE had a higher rate detection of inflammation, erosion, or ulcers than DBE (36.1% vs 21.3%), but they both had high positive rates for vascular malformations (13.9% and 14.8%). In addition, both methods had higher positive rates in patients with gastrointestinal bleeding compared to other symptoms.

CE and DBE are both important methods for intestinal examination. Patients can choose appropriate tests according to their condition.

The aim of present study is to determine the spatial-temporal epidemiology of acute lymphoblastic leukemia (ALL) in Iranian children.

This ecological study was performed using an exploratory mixed design. The study population consists of 3769 children with ALL who were reported in the National Cancer Registry Program of Iran from 2006 to 2014. Data analysis was conducted using Mann-Whitney U, joinpoint regression analysis, Global Moran’s I and Anselin Local Moran’s I.

The average annual incidence rate of ALL was 2.25 per 100000 children under 15 years of age during the study period, which was 1.37 times higher in males. The average annual percentage change (AAPC) of the disease was 7.1%, which is higher than that of developed countries. The incidence of ALL was higher in spring and summer and its peak incidence was at the age of 2–5. Spatial autocorrelation of the ALL was 0.358 and significant (P value <0.001). The high-risk cluster of ALL was identified in Fars and Kohgiluyeh and Boyer-Ahmad provinces and the low-risk cluster in Kermanshah, Zanjan and Kurdistan provinces.

The incidence of ALL is on rise in Iranian children and appropriate healthcare services are required to prevent new cases of this disease in high-risk areas.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the most common form of dementia in the old age population, making it a worldwide concern. Unfortunately, few drugs have been presented for treatment of mild and moderate AD. To meet this need, more effective anti-AD agents are emerging. Accumulating evidence supports the beneficial roles of natural-based products in brain function, neurotransmission, neurogenesis, synaptogenesis, and the prevention of amyloid fibrillation and neuronal injury. Several in vitro, preclinical, and clinical studies suggest that saffron (its bioactive compounds) is a potential nutraceutical with antioxidant, radical scavenging, anti-inflammatory, hypolipidemic, hypotensive, neuroendocrine, and neuroprotective effects. It has also been proposed that saffron may delay the onset of AD, prevent its progression or help to attenuate the symptoms of the disease. Therefore, we performed a comprehensive search on this plant and its derivatives for AD treatment. Saffron and its active constituents interfere with AD by improving learning behavior, spatial memory, and cognitive function; protecting against neuronal loss; inhibiting beta-amyloid aggregation and neurotoxicity; preventing senile plaques and neurofibrillary tangle (NFT) formation; suppressing the acetylcholinesterase (AChE) activity; and reducing neuroinflammation. Given conclusive scientific findings, saffron and its derivatives might counter neurodegenerative diseases through multiple pathways. Further clinical trials are expected to confirm the neuroprotective properties of this herb and also to translate such findings to improve patients’ outcomes.

Neurotrauma (NT) is one of the common causes of mortality and morbidity. Investigating the role of people who had an impact on the development of knowledge of NT is reasonable. Our aim is to investigate the role of Bizhan Aarabi, professor of Neurosurgery, on the knowledge development in NT. Accordingly, we searched the Scopus database for Bizhan Aarabi on August 8, 2020 and selected papers with at least 10 citations, investigating his impact on NT and details of his publications. He has published 168 papers including original articles, reviews, conference papers, letters, and editorials according to the Scopus databases. There are 112 papers with 10 or more citations. Thirty-eight out of 112 papers (33.9%) were in the first and the highest rank journal: 29 in Neurosurgery and 9 in the Journal of Neurotrauma. Twenty-four papers have the level of evidence (LOE) of “1”. Bizhan Arabi developed knowledge in NT especially in the cervical spine/spinal cord trauma and brain injury and his publications are references for spine/neurosurgeons

Since December 2019, the world has been facing one of the most critical health threats of the last decades. In March 2021, the official number of deaths passed 2.6 million worldwide. Most countries have developed policies to control the disease. Nevertheless, countries have experienced different outcomes related to their various adapted policies. Complementing our first report, in this article, we report our findings of comparing the policies adopted to combat coronavirus disease 2019 (COVID-19) in Iran, with those from nine selected countries, including China, Japan, South Korea, Singapore, Germany, the United States, the United Kingdom, Spain, and Italy, to draw evidence-informed policy lessons.

This is a qualitative study conducted based on document analysis related to COVID-19 policies in Iran and nine selected countries. Using a deductive approach, data were extracted and analyzed based on the components of the WHO Building Blocks Framework. Finally, we compared the Iranian policies with the nine selected countries.

Documents analysis revealed a spectrum of policies, which have led to a variety of outcomes. Based on our findings, three main strategies (widespread testing, comprehensive contact tracing, and timely measures) were the most effective directions to combat COVID-19.

The experience of the first and second waves of COVID-19 showed that the risk of coronavirus is serious and will continue until a vaccine or decisive treatment is achieved. Therefore, countries are required to adopt appropriate and tailored policies to deal with this crisis effectively. Applying the experiences from the previous waves is essential for more efficient performance in the likely upcoming waves.