Archives of Iranian Medicine
Volume:24 Issue: 12, Dec 2021

Pneumatic balloon dilation (PBD) is a first line treatment for idiopathic achalasia. Here we report the safety and efficacy of graded gradual PBD on short and long-term follow-up.

We evaluated 1370 idiopathic achalasia patients over a period of 24 years (1994-2018), prospectively. 216 patients did not undergo PBD due to comorbid diseases. Ultimately, 1092 achalasia patients were enrolled. All patients underwent graded gradual PBD, with repeat dilation if symptoms relapsed. Response to treatment was evaluated by Vantrappen scoring system.

Of 1092 achalasia patients, 937 patients were treated by PBD and 155 patients were treated by combined therapy (PBD 1 month after Botulinum toxin injection). In short-term follow-up, 728 of 1092 patients underwent one PBD and 77.3% of them had excellent or good response (responders), 163 patients (58.6%) who underwent two PBDs were responders, and 44 (51.2%) patients who underwent three PBDs were responders. Overall, 2193 balloon dilations were performed on 1092 patients (mean 2 PBDs/patient). Of 786 patients with long-term follow-up, 259 patients had excellent or good response with one PBD. The responders with two, three, and four or more dilations were 149, 67, and 67, respectively. The overall response rate was 69%. No any serious complications were noted by using the graded gradual method.

Our results show that graded gradual PBD is a safe and effective method for treatment of achalasia patients, and achieves sufficient short and long-term symptomatic remission with high cumulative success rate.

Gastric cancer has been one of the major causes of death in the past decades. It is the fifth most prevalent cancer and the third leading cause of neoplasm death worldwide. Thus, to know more about this health problem, assessing the burden of this cancer and its association with socioeconomic status of countries is of great importance. In this study, we aimed to evaluate the mean trend of gastric cancer mortality-to-incidence ratio (GCMIR) in different super regions defined by the Institute for Health Metrics and Evaluation (IHME) and investigate the relationship between GCMIR and Human Development Index (HDI) in the period 2000-2016.

We used the data from the Global Burden of Disease (GBD) 2016 study to calculate GCMIR for 185 world countries in the period 2000–2016. We also extracted the HDI data for each year under study from the Updates of the UNDP website. To attain the analytic aims, marginal modeling and generalized estimating equations (GEE) were utilized.

Sub-Saharan Africa was the only super region with a positive slope of GCMIR, and high-income countries had the greatest decreasing slope of GCMIR during the study period. Moreover, there was a negative association between GCMIR and HDI in these years.

Our findings revealed that gastric cancer could be thought not only as a biological disease but also as a social event that will be more controllable with the improvement of economic status and other social determinants of health.

Little is known regarding the impact of quantity and quality of sleep on the incidence of cardiovascular disease. The aim of this study was to investigate the possible independent association of late bedtime and premature coronary artery disease (PCAD).

Between October 2016 and November 2019, we conducted a cross-sectional population-based study on 30 101 participants aged 20–65 years in Khuzestan Comprehensive Health Study (KCHS). Data on major risk factors of cardiovascular disease, habit history, physical activity, and sleep behavior was gathered and participants underwent blood pressure, anthropometric, and serum lipid and glucose profile measurements. PCAD was defined as documented history of developing obstructive coronary artery disease before 45 years in men and before 55 years in women.

Of a total of 30 101 participants (64.1% female, mean age: 41.7 ± 11.7 years) included in this study, 1602 (5.3%, 95% confidence interval: 5.1%–5.6%) had PCAD. Late bedtime was reported in 7613 participants (25.3%, 95% confidence interval: 24.9%–25.8%). Age-sex standardized prevalence for PCAD and late bedtime were 3.62 (3.43-3.82) and 27.8 (27.2–28.4), respectively. There was no significant difference ( P = 0.558) regarding prevalence of PCAD between those with late bedtime (5.5%, 95% CI: 4.9%–6.0%) and those with early bedtime (5.3%, 95% CI: 5.0%–5.6%). However, after adjustment for potential confounders, late bedtime was independently associated with PCAD (OR = 1.136, 95% CI = 1.002–1.288, P = 0.046).

In this study, late bedtime was significantly associated with presence of PCAD. Future prospective studies should elucidate the exact role of late bedtime in developing coronary atherosclerosis prematurely.

Neoadjuvant chemotherapy (NAC) is an integral part of breast cancer treatment. Determination of the factors that can distinguish patients who will have best response to NAC is invaluable. In this study, we aimed to elucidate the factors influencing patient response to NAC.

We retrospectively collected data of female patients with non-metastatic breast cancer that had received NAC followed by surgery, admitted to Imam Khomeini hospital between 2015–2019. We investigated the association between various tumor and patients’ characteristics with pathologic complete response (PCR).

Overall data of 205 female patients were collected. PCR was observed in 27.6% of cases. PCR rate in luminal A, luminal B, HER2 enriched, and TNB tumors was reported in 11.1%, 30.2%, 35.7%, and 36.4% of patients respectively ( P = 0.27). In patients with luminal B tumors, PCR was more prevalent in patients with positive HER2 only (P = 0.006). In our study factors which was significantly associated with PCR were: tumor grade, progesterone receptor (PR) status, and HER2 status. In the multiple regression model, positive PR in the tumor lowered the odds of pathologic response 3.6 times (P = 0.004).

In our study, tumor grade, PR status, and HER2 status was associated with response to NAC. PCR was more prevalent in non-luminal tumors; however, PCR rate in luminal B patients-especially those with HER2 positive status- was slightly less than non-luminals.

Hemophilia A (HA) is an X-linked recessive bleeding disorder with a high rate of genetic heterogeneity. The present study was conducted on a large cohort of Iranian HA patients and data obtained from databases.

A total of 622 Iranian HA patients from 329 unrelated families who had been referred to a medical genetics laboratory in Tehran from 2005 to 2019, were enrolled in this retrospective, observational study. Genetic screening of pathogenic variants of the F8 gene was performed using inverse shifting PCR, direct sequencing, and multiplex ligation-dependent amplification (MLPA). Point mutation frequencies in different exons were analyzed for our samples as well as 6031 HA patients whose data were recorded in a database.

A total of 144 different pathogenic or likely pathogenic variants including 29 novel variants were identified. A strategy to decrease costs of genetic testing of HA was suggested based on this finding.

This study provides comprehensive information on F8 pathogenic/likely pathogenic variants in Iranian HA patients which improves the spectrum of causative mutations and can be helpful to clinicians and medical geneticists in counseling and molecular diagnosis of HA.

Despite advances in the treatment of abdominal injuries in patients with trauma, it remains a major public health problem worldwide. Evaluation of hazard ratio (HR) of 90-day mortality in intensive care unit (ICU) patients with abdominal injuries compare with head injuries in trauma patients and non-trauma surgical ICU patients.

This single-center, prospective cohort study was conducted on 400 patients admitted to the ICU between 2018 and 2019 due to trauma or surgery in Hamadan, Iran. The main outcome was mortality at 90-day after ICU admission. Cox proportional hazards models were used to determine the HR and 95% confidence interval (CI) for 90-day mortality.

The 90-day mortality was 21.9% in abdominal injuries patients. According to multivariate Cox regression, the expected hazard mortality was 2.758 times higher in patients with abdominal injuries compared to non-trauma patients (HR: 2.758, 95% CI: 1.077–7.063, P = 0.034). About more than 50% of all deaths in the abdominal and head trauma groups occurred within 20 days after admission. Mean time to death was 27.85± 20.1, 30.27 ± 18.22 and 31.43± 26.24 days for abdominal-trauma, surgical-ICU, and head-trauma groups, respectively.

Difficulty in accurate diagnosis due to the complex physiological variability of abdominal trauma, less obvious clinical symptoms in blunt abdominal injuries, multi-organ dysfunction in abdominal injuries, failure to provide timely acute care, as well as different treatment methods all account for the high 90-day mortality rate in abdominal-trauma patients. Therefore, these patients need a multidisciplinary team to care for them both in the ICU and afterwards in the general ward.

Systemic therapies commonly used in adult psoriasis are mostly used only off-label in children and little is known about the efficacy and tolerability of these drugs in this population. In this study, we aimed to evaluate the efficacy and safety of systemic treatments in pediatric patients with psoriasis

Data were obtained retrospectively from the Department of Dermatology, Ondokuz Mayis University, School of Medicine between 2010–2019. Our study consisted of 742 pediatric patients (age ≤ 18 years) with psoriasis. Demographic data, adverse events of systemic treatments and healing periods were considered.

A total of 195 patients received systemic treatment. The mean age of onset of disease and the initiation of systemic therapy were 9.68 ± 4.62 and 11.33 ± 4.38 years, respectively. Patients received methotrexate ( n = 52, 26.67%), cyclosporine ( n = 18, 9.24%), acitretin ( n = 106, 54.35%) and others (biologics and/or one of conventional treatments) ( n = 19, 9.74%) as systemic therapy. Adverse events occurred in 12 patients (incidence of 6.15%, and its related 95% confidence interval of 2.75%, 9.56%) and nine of them had to discontinue the medication due to those adverse events. Healing periods calculated in the remaining 186 patients were 13.25± 5.87, 10.85± 5.67, 11.05± 7.00, and 9.41± 4.16 (mean± SD) weeks for acitretin, methotrexate, cyclosporine, and others, respectively. No statistically significant differences were noted between the treatments regarding the healing periods.

All treatments were effective and none of them was superior in terms of the healing period. Systemic treatments used in adults can also be used in pediatric patients with psoriasis with similar efficacy and safety rates as long as routine monitoring is provided.

The purpose of this study was to describe the radiologic and histopathologic features of lacrimal gland in patients presenting with lacrimal gland enlargement.

We retrospectively retrieved the data of patients with lacrimal gland enlargement in Farabi Eye Hospital between 2012 and 2017. These data included demographics, the patients’ facial photographs, orbital CT-scans, and histopathological findings of lacrimal gland biopsies.

Forty-seven patients (15 men and 32 women) were enrolled in this study with a median age of 37.9 years (range, 15–79 years). Histopathologic diagnoses were chronic dacryoadenitis in 26 cases (55.32%), IgG4-related disease in 6 patients (12.77%), two cases of acute dacryoadenitis, two cases of non-necrotizing granulomatous inflammation, two cases of Non-Hodgkin’s B-cell lymphoma, two cases of adenoid cystic carcinoma and two cases of mixed tumor (4.26% each), as well as one case of conjunctival epithelial cyst, and one case of benign lymphoid tissue and fibrofatty tissue (2.13%). In two samples (4.26%), biopsy revealed normal lacrimal glands. Interestingly, in two cases with relapsing lacrimal gland enlargement, different histopathologic diagnoses were found in biopsies taken from each lacrimal gland at different times. The average size of enlarged lacrimal glands was 19.67 mm × 7.06 mm on axial CT scan and 19.44 mm × 6.20 mm on coronal CT scan.

Tissue biopsy is needed for diagnosis of lacrimal gland enlargement because it is difficult to distinguish the type of the lacrimal gland pathology based solely on clinical or radiological presentation.

Primary tracheal tumors are very rare and 10%–20% are benign tumors. Tracheal lipoma is extremely rare and only a few cases have been reported in the literature. A 69-year-old male patient presented to the emergency department with complaints of shortness of breath, respiratory distress, chest pain and cough. Chest CT scan showed a round mass in the topography of the trachea that almost caused airway obstruction. The lesion was resected endoscopically and the pedicle base was cauterized. Tracheal lipoma is a rare condition that should lie in the differential diagnosis of treatment-resistant asthma.