Archives of Iranian Medicine
Volume:26 Issue: 6, Jun 2023

 Breast cancer accounted for 28.1% of all female cancers in 2020 in Iran. This study was conducted to evaluate the time trend of breast cancer incidence and to identify the changes of breast cancer incidence in age, period, and birth cohorts in Iran, in the 2009–2017 timeframe.

 Annual cancer statistics for female breast cancer were obtained from the Iranian National Population-based Cancer Registry (INPCR) database from 2009 to 2017. The age-period-cohort (APC) analysis was used to evaluate the time trend of breast cancer incidence in age, period and birth cohorts between 2009 and 2017. R package (Epi) was used to analyze data. Results were considered statistically significant at P<0.05.

 The age effect showed an increased incidence of breast cancer until the age of 45, and after this age the speed of increase was slower until 65 years. There was an increased diagnosis in 2015–2017 (period effect) for many age groups, especially in the 70- and over 80-year-old group.

 Our findings indicated that breast cancer incidence peaks in the age of 45 in Iranian women, which is a decade earlier compared to the Western world. The period effect in 2015–2017 can be explained by the fact that in 2014, the former Iranian pathology-based cancer registry was upgraded to a population-based cancer registry, which resulted in improved coverage of cancer registry and case finding.

 The aim of this study was to compare moderate- versus high-intensity statin therapy in patients with type 2 diabetes and low-density lipoprotein (LDL) cholesterol less than 130 mg/dL.

 This was a randomized, open-label, parallel design trial comprised of 79 patients randomly allocated into two groups receiving high-intensity [atorvastatin 40 mg (A40) or rosuvastatin 20 mg (R20) daily] or moderate-intensity [atorvastatin 20 mg (A20) or rosuvastatin 10 (R10) mg daily] statins for eight weeks. The variables investigated were lipid profile, high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6).

 The percentage of decrease in LDL levels (±SD) for the high-intensity group (-35.5±25.5) was significantly greater than the moderate-intensity group (-24.6±23.5) (P=0.04). While 38.1% (n:8) of patients receiving A20 and 55% (n:11) of those being on R10 achieved the targets of≥30% reduction in the LDL level, these figures were 63.2% (n=12) and 73.8% (n=14) for A40 and R20 subgroups, respectively. Subsequently, the likelihood of achieving LDL reduction≥30%, was significantly greater with high-intensity statin therapy (OR: 3.1, 95% CI: 1.09, 8.90, P=0.03). Logistic regression analysis also showed that for every 1 mg/dL increase in the baseline LDL level, the odds of achieving the LDL reduction≥30% increased by 1.04 times [95% CI: (1.01, 1.07), P=0.003].

 Despite the general conception, moderate-intensity statins are not adequate for the majority of patients with T2DM and mild hyperlipidemia and greater numbers of patients could reach the LDL cholesterol target with high-intensity statin therapy.

 Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors.

 This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters.

 Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality.Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas.

 Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.

 Anemia is a serious public health problem which may be associated with cardiovascular diseases (CVDs) and brain damage. This survey aims to determine the prevalence of anemia and its association with demographic and biochemical factors and metabolic syndrome in a human sample derived from the MASHAD cohort study.

 This survey was conducted on a sub-sample of 9847 individuals aged 35 to 65 as part of the MASHAD cohort study. Demographic characteristics and biochemical and anthropometrics indices were recorded. Data were analyzed using SPSS version 20.

 Anemia was seen in 11.5% of the population. Anemia was significantly more prevalent in younger subject (P<0.001), females (P<0.001) and those with elevated body mass index (BMI) (P<0.001). Mean high-density lipoprotein (HDL) was higher in anemic participant (P=0.032). The incidence of anemia was significantly lower in smokers (P<0.001) and also participant with hypertension (HTN) (P<0.001), diabetes mellitus (DM) (P<0.001) and metabolic syndrome (MetS) (P<0.001). Mean FBG (P<0.001), TG (P<0.001), total cholesterol (P<0.001), LDL (P<0.001) and uric acid (P<0.001) were significantly lower in anemic subjects. Cholesterol, MetS, low-density lipoprotein (LDL), BMI, uric acid, diabetes mellitus and also TG remained significantly different after multivariate analysis between anemic and healthy participants.

 The studied population had a lower prevalence of anemia compared to the previous WHO report for Iranians. Iron deficiency is recognized as the most important cause of anemia in Iran; however, further investigations will be need to confirm this pattern. We demonstrated that anemia is adversely associated with MetS and DM.

 Cardiovascular diseases (CVDs) are known as an important group of risk factor for progression of the Coronavirus-19 disease (COVID-19). The present study compared epidemiological features and outcomes in COVID-19 patients with CVDs versus those without CVDs.

 This is a retrospective study performed on 1497 patients with CVDs and 26926 patients without CVDs, all of whom were confirmed to have COVID-19. All clinical signs and comorbidities were investigated in the subjects. Mann-Whitney U test and Pearson’s Chi-square test were applied to compare mortality between the groups. Logistic regression was used to identify the predictors of mortality among patients.

 The mean age of COVID-19 patients with underlying CVD was 60 years. Totally, about 5.3% of the individuals under study had CVD. Also, 21.6% of all deaths occurred in COVID-19 patients with CVD. Cough, fever, shortness of breath, muscle pain, and underlying diseases such as diabetes, hypertension, chronic liver and kidney disease, chronic lung disease, and immunodeficiency were significantly higher in patients with CVD than those without CVDs. The odds of death in COVID-19 patients were 1.9 times higher with underlying CVD, 2.1 times with diabetes, 3.4 times with hypertension, 1.9 times with immunodeficiency, and 2.3 times with chronic liver and kidney disease.

 CVDs are a serious threat to COVID-19 patients because they increase mortality among these patients. As a result, preventive and therapeutic strategies must be developed for these vulnerable groups, who will be prone to higher mortality.

 Aggression and suicide attempt are behaviors that affect public health. To better understand the nature of these behaviors, the present study was conducted to investigate the concurrence of suicide attempt and aggression in young people. This study sought to identify those factors which contribute to the co-occurrence of suicide attempt and aggression in young people.

 The present study was part of the recruitment phase of Ravansar youth cohort study (a branch of the PERSIAN Cohort) with a sample of 2991 people from Ravansar in western Iran. Registration and data collection were done between October 2014 and January 2017. Data were collected using structured interviews and standard questionnaires, and analyzed using multi-nominal logistic regression analysis.

 The results showed that the variables of age and education were significant correlates of concurrence of suicide attempt and aggression. Also, among the mental disorders, only major depressive disorder (MDD) (OR=8.34, P=0.001) predicted the concurrence of suicide attempt and aggression in the past 12 month. In contrast, the variables of generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), dysthymia, and substance use disorder were not significant in predicting the concurrence of attempted suicide and aggression.

 The occurrence of aggression and suicide in young people is a complex phenomenon, and more research should be done to better understand this phenomenon.

 The similarity in the mechanism of action between paracetamol and ibuprofen can cause similar side effects. However, in preterm neonates with feeding intolerance, intravenous (IV) paracetamol has replaced oral ibuprofen. Therefore, a comparison of the effectiveness and side effects is essential.

 In this retrospective cohort study, the data of 118 preterm infants with a definite diagnosis of patent ductus arteriosus (PDA), including 59 patients who received oral ibuprofen and 59 patients who received IV paracetamol were analyzed. Laboratory evaluations of serum total and direct bilirubin, hemoglobin, and creatinine levels before and seven days after treatment were made. Using analysis of covariance (ANCOVA) and multiple multinomial logistic regression models, the effect of two treatment groups on the post-treatment variables as well as their efficacy comparison were evaluated.

 In both pre- and post-treatment periods, there was no significant association between echocardiography variables with treatment groups. The results from the ANCOVA model showed that the paracetamol and ibuprofen were followed by a significant decrease in the mean total bilirubin and Hct variables after treatment by 1.38 and 1.65 units, respectively. In addition, results from the Mann-Whitney U test revealed that the median Hb and K differences after and before treatment had a significant difference between the two treatment groups. Furthermore, based on the multiple multinomial logistic model results, the odds of complete arterial duct closure with IV paracetamol was 1.27 times higher than with oral ibuprofen, while in the oral ibuprofen group, the odds of closing was 1.44 times higher than the IV paracetamol group, but there was no statistically significant difference between the two groups.

 Intravenous paracetamol has equal efficacy compared to oral ibuprofen in the treatment of PDA. Also, it seems to be associated with a lower risk of hyperbilirubinemia following the treatment.

 Based on the critical role of MT4-MMP and MT6-MMP in carcinogenesis, we focused on MT4-MMP and MT6-MMP circulating levels in patients with thyroid nodules.

 Plasma samples were collected from three groups, including papillary thyroid cancer (PTC; n=30), multinodular goiter (MNG; n=30), and healthy subjects (n=22). Enzyme-linked immunosorbent assay (ELISA) was used to obtain the concentration of MT4-MMP and MT6-MMP in the three groups.

 Analysis of data demonstrated increased levels of MT4-MMP (PTC: 4.90±1.35, MNG: 4.89±1.37, and healthy: 3.13±1.42) and MT6-MMP (PTC: 8.29±2.50, MNG: 7.34±2.09, and healthy:5.01±2.13) in thyroid nodules by comparison with healthy subjects (P<0.05). There were no significant differences in the levels of the two MT-MMPs between PTC and MNG (P>0.05). Increased plasma levels of MT4-MMP (odds ratio=2.48; 95% CI: 1.46–4.19; P=0.001) or MT6-MMP (odds ratio=1.81; 95% CI: 1.29–2.53; P=0.001) were associated with increased risk of PTC tumorigenesis. Interestingly, a strong positive association was observed between MT4-MMP and MT6-MMP in the three groups (PTC: r=0.766**, P=0.000; MNG: r=0.856**, P=0.000; healthy r=0.947**, P=0.000). Areas under the ROC curve for MT4-MMP and MT6-MMP were 0.82 and 0.96, respectively. At the cutoff value>4.7 (ng/mL), MT4-MMP and MT6-MMP showed a sensitivity of 63.3% and 90.0%, respectively, with 100% specificity.

 Our work has led us to imply that the higher levels of MT4-MMP and MT6-MMP are closely linked with both PTC and MNG tumorigenesis. They may probably promote the development of thyroid lesions; however, more research is needed to further clarify the current findings.

 Inactivating mutations of the protein kinase A regulatory subunit 1 alpha (PRKAR1A) gene have been reported in familial cardiac myxoma. However, the role of PRKAR1A mutation in sporadic cardiac myxoma remains unknown.

 Targeted next-generation sequencing (NGS) was performed to identify mutations with the PRKAR1A gene in seven cases of sporadic cardiac myxomas. Sanger sequencing of DNA from cardiac myxoma specimens and matched peripheral blood samples was performed to verify the identified mutations.

 Targeted NGS of myxoma DNA revealed 232 single nucleotide variants in 141 genes and 38 insertion-deletion mutations in 13 genes. Six PRKAR1A mutations were identified in four of the seven cardiac myxoma cases, and thus, the PRKAR1A inactivating mutation rate was 57.2% (4/7, 95% CI=0.44-0.58, P<0.05). The PRKAR1A variants identified by Sanger sequencing analysis were consistent with those from the NGS analysis for the four myxoma specimens. All of the pathogenic PRKAR1A mutations led to premature termination of PRKAR1A, except for one synonymous mutation. Moreover, none of the nonsense and missense mutations found in the myxoma specimens were found in the matched peripheral blood samples.

 Pathogenic mutations of the PRKAR1A gene were identified in tumor specimens from four cases of sporadic cardiac myxoma, and the absence of these mutations in peripheral blood samples demonstrated that they were somatic mutations.

An inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract, which can cause obstruction or intussusception when it reaches a large diameter. We present a case of a 46-year-old female admitted to our clinic with recurrent ileus attacks. We performed segmental resection of the small bowel due to a 3-cm pedunculated polypoid lesion located in the terminal ileum that caused ileo-ileal intussusception and whose pathology was reported as an inflammatory fibroid polyp. In adults presenting with ileus, the possibility of intussusception should be kept in mind.